In the past five years — the first half of the second decade of the 21st century — global health has faced unprecedented challenges. Heatwaves ravage India, polio persists in Pakistan and Afghanistan, the shadow of the coronavirus disease 2019 (COVID-19) still looms large, while nutritional gaps undermine resilience. From climate-driven deaths to stalled disease eradication, these crises expose a global system unprepared to protect the vulnerable, highlighting the need for stronger health systems, especially in vulnerable regions.
In fact, the world is under siege from health emergencies, and the response falters.
Crises Surge, Solutions Stall: Health Woe
Globally, heatwaves strain health systems, with the WHO noting rising deaths from Europe to South Asia. A pressing health emergency is the surge of heatwaves across India, a crisis fueled by climate change with global implications. North-Western, Central, and South-Central India have emerged as heatwave hotspots over the past half-century. These heatwaves, marked by prolonged high temperatures and humidity, are increasingly frequent and intense, particularly in areas with low diurnal temperature range, where nights offer little relief.
The health toll is severe, with heat stress and heatstroke driving mortality, especially in states like Odisha and Andhra Pradesh. “Most parts of India are reeling under heat stress with serious health implications,” an expert warns, highlighting risks to the elderly, children, and outdoor workers.
India’s response includes heat action plans—early warning systems and cooling centres in cities like Ahmedabad. These measures have saved lives in urban areas, but their urban-centric focus leaves rural communities, where infrastructure is scarce, dangerously exposed. This urban-rural divide highlights a critical policy failure: localised plans are a start, but scaling them nationally, with investments in rural cooling and healthcare, is urgent. For policymakers, this suggests a need for climate-resilient health systems, integrating environmental and health policies to protect the most vulnerable. The WHO’s 2024 annual report reinforces this, noting that India’s health system must be “adaptable and resilient,” a sentiment that applies globally.
Heat, Virus, Hunger: Health’s Global Gap
Globally, the World Health Organization (WHO) has noted rising heat-related mortality, linking it to climate change’s relentless advance – a trend mirrored in regions from Europe to South Asia.
Heat action plans, WHO reforms, and dietary awareness signal progress, but the scale of suffering demands more. The global health landscape in the first half of the second decade of the 21st century — from 2020 to 2025 — has been a tapestry of crisis and innovation, marked by both profound challenges and incremental advancements. Heatwaves, polio, and nutritional health offer a glimpse into the broader dynamics at play.
This is the story of a world racing against time—and falling behind. The period, spanning the height of the COVID-19 pandemic to the present day (April 27, 2025), reveals a world grappling with interconnected health crises, where advancements often fall short of addressing the scale of suffering, particularly for rural and conflict-affected populations.
As we critically examine these dynamics, offering a fact-based, empathetic perspective on where health systems stand and where they must go, we find that any call for “equitable adaptation strategies” remains largely unheeded, with funding and logistical barriers stalling progress.
Infectious diseases present another formidable challenge. Take, for example, polio’s persistence in Pakistan and Afghanistan. India’s eradication of polio in 2014, achieved through rigorous vaccination campaigns, stands in stark contrast to the struggles in Pakistan and Afghanistan, where insecurity, mistrust, and logistical barriers impede progress.
Vaccination efforts have slashed global polio cases by 99.9% since the 1980s, but the last mile remains elusive, requiring not just vaccines but also political stability and secure delivery systems. A focus on persistent cases critiques the global health community’s inability to close this gap, a failure rooted in systemic unpreparedness. Despite Africa’s polio-free milestone in 2020, the disease endures in these conflict zones.
For policymakers, this underscores the need for binding international commitments to ensure vaccine access in conflict zones, moving beyond voluntary pledges that falter under political and logistical pressures. The establishment’s narrative of “near-eradication” often glosses over these ground realities, demanding a shift toward integrated approaches that combine health interventions with peacebuilding and governance reforms.
It is important to situate this within the context of the WHO’s International Health Regulations (IHR) review, prompted by the COVID-19 pandemic’s chaos. WHO asserted that “the review will help countries respond to pandemics like COVID-19 and health challenges like polio,” signalling a commitment to stronger global coordination.
The COVID-19 pandemic is a central theme in the 2020 IHR report. Declared a public health emergency by the WHO in January 2020, it overwhelmed health systems worldwide, with millions of deaths by 2021. In India, as implied through Global Bihari’s Bihar-centric lens, urban hospitals were stretched beyond capacity, while rural areas faced acute shortages of care.
The IHR review aimed to strengthen disease surveillance, funding mechanisms, and vaccine deployment, with global campaigns delivering over 13 billion doses by April 2025, per WHO data. However, inequities persist, with developing nations facing delays as wealthier countries stockpile supplies, and a gap in reform remains unaddressed. For policymakers, this underscores the need for equitable distribution frameworks, enforcing binding agreements on resource sharing to prevent future pandemics from deepening global divides. The establishment’s claim of “global solidarity” during COVID-19 rings hollow when access to life-saving tools was skewed. India’s role as a vaccine producer highlights its potential to lead regionally, but this requires sustained investment in manufacturing and distribution networks.
Besides, last month, WHO experts also called for urgent policy shifts to counter vaccine scepticism before it results in major outbreaks. Against the backdrop of the current political and societal developments that it claimed jeopardised global health, including vaccination programmes worldwide, the Strategic Advisory Group of Experts on Immunisation (SAGE), convened by WHO, held its biannual meeting from March 10–13, 2025, in Geneva.
A balanced diet is key to good health, as malnutrition remains a silent but pervasive emergency globally. In India, where over 60% of children under five suffer from anaemia, and globally, where 149 million children are stunted, malnutrition amplifies vulnerability to heatwaves, infections, and pandemics.
India’s POSHAN Abhiyaan targets malnutrition through multi-sectoral interventions, but there are governance challenges, with ministries often working in silos. Globally, WHO’s nutrition programmes aim to reduce stunting, but rising food costs, exacerbated by climate impacts, hinder access. Policymakers must integrate agriculture and health policies, subsidising nutrient-rich foods and supporting local farming to break the cycle of malnutrition. A focus on a nutritious vegetable such as parwal reflects a grassroots approach, but systemic food insecurity persists, underscoring the need for broader reforms.
The maternal mortality ratio (MMR) dropped from 130 (2014–16) to 97 (2018–20) per 100,000 live births, a trend that indirectly supports nutritional improvements in India.
Digital health and sanitation initiatives offer additional dimensions of progress. WHO’s pandemic response report of 2020 indirectly referenced India’s CoWIN platform, expanded under the Ayushman Bharat Digital Mission to streamline vaccination and healthcare access. By 2025, this mission had digitised health records for over 50 million people, improving coordination, as per Ayushman Bharat Digital Mission.
However, rural connectivity gaps and data privacy concerns limit reach. The Swachh Bharat Mission doubled rural sanitation coverage in 2021, reducing waterborne diseases and aligning with WHO’s clean water goals. Yet, uneven rollout leaves urban slums and remote areas underserved.
The link between sanitation and health emergencies—diarrhoea weakening malnourished children, compounding risks from heatwaves and pandemics—demands integrated policies. Policymakers must ensure last-mile connectivity for digital health tools and complete sanitation coverage, addressing the digital divide and infrastructure gaps to build resilient systems. The 2024 WHO report notes that only 37% of Indians have health insurance, highlighting the need for universal coverage ([WHO India Health Profile].
Rural India lacks cooling infrastructure, Pakistan’s polio hotspots lack access, global vaccine equity remains uneven, and malnutrition persists amid economic strain.
Emergencies Rise, Fixes Falter: Health Cry
There have been other recent emergencies, such as mpox (declared a WHO emergency in 2022), Ebola, and Marburg, besides Malaria and Measles. They highlight a broader issue of an adequate framework for addressing emerging diseases, with stronger surveillance and rapid response systems. However, on World Malaria Day on April 25, 2025, the WHO lamented that funding cuts and rising challenges now threaten decades of gains.
The current situation is worrisome, as the world is experiencing a troubling increase in outbreaks of diseases that vaccines can effectively prevent, such as measles, meningitis, and yellow fever. Furthermore, diseases like diphtheria, which had been kept in check or nearly eliminated in various parts of the world, are now facing the threat of re-emergence.
These crises—heatwaves, polio, COVID-19, malnutrition—are interconnected, with each amplifying the others’ impact. Heatwaves exacerbate food insecurity, worsening malnutrition, which heightens disease vulnerability. Advancements, while promising, reveal a pattern of half-measures: heat action plans falter rurally, IHR reforms lag, vaccines miss conflict zones, digital health excludes the disconnected, and sanitation skips the marginalised.
Systemic issues—underfunding (India’s health spending at 2.1% of GDP versus WHO’s 5% recommendation), governance silos, and lack of global coordination—hinder progress. The establishment’s optimistic narratives often mask these gaps and demand a critical lens. On April 10, 2025, Dr. Tedros Adhanom Ghebreyesus, the Director-General of WHO, reported that funding cuts have led to significant disruptions in health services across nearly three-quarters of the 100 countries surveyed. A quarter of these nations are at risk of closing health facilities, a crisis that has been intensified by job losses and a lack of available medicines.
Health’s Last Stand: Crises Outrun Cures
Currently, the world is not on track to achieve the United Nations’ Sustainable Development Goal for maternal survival. UN agencies have raised concerns about a possible setback in progress due to unprecedented reductions in global aid. The goal is to lower the global maternal mortality ratio to below 70 deaths per 100,000 live births by 2030, but as of 2023, the ratio stands at an estimated 197, a slight improvement from 211 in 2020 and 328 in 2000. Besides, in its first-ever comprehensive report addressing the alarming shortage of medicines and diagnostic tools for invasive fungal diseases, the WHO said fungal infections continue to rise globally, affecting vulnerable populations. Another recent report mentions that in some countries, up to 90% of people with severe mental health conditions receive no care at all, while many existing services rely on outdated institutional models that fail to meet international human rights standards. Recent reports from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) reveal a troubling decrease in global financial backing for essential child survival programmes. This decline is resulting in a lack of healthcare professionals, the closure of clinics, disruptions in vaccination efforts, and a critical shortage of necessary resources such as malaria treatments.
The health situation is deteriorating further in conflict-affected regions. In Gaza, a blockade that has been ongoing since March 2, 2025, has led to a critical shortage of food and medical supplies, with 75% of UN missions facing significant challenges last week. The remaining supplies from a previous ceasefire are dwindling, with a complete shortage expected in two to four weeks. Moreover, over 180,000 doses of childhood vaccines are currently stuck, jeopardising the health of 60,000 children. Since the ceasefire’s conclusion, the humanitarian crisis has deepened, displacing 400,000 individuals and resulting in 1,500 fatalities, including 500 children, while the health system is under immense strain.
Policymakers must shift to systemic overhauls, increasing health budgets, enforcing vaccine equity, and prioritising rural and conflict-zone access. Binding international agreements, not voluntary pledges, are essential to prevent future crises from deepening divides. India’s Ayushman Bharat, covering 100 million families, shows what’s possible with political will, but it’s not enough. Integrated policies across health, climate, agriculture, and technology are crucial to address these interconnected challenges.
Health is a global security issue, demanding coordinated, equitable action. From heatwaves to polio, COVID-19 to malnutrition, reveals a world grappling with interconnected emergencies, yet slowed by systemic unpreparedness. These crises demand not just plans but action—shelters, clinics, doses, and food for those on the frontlines of survival. Until then, the world remains on the brink, its health hanging in the balance. The warnings—on heat stress, polio’s persistence, pandemic unpreparedness, and nutritional gaps—are a call to move beyond pilot projects to transformative change. Investments in rural infrastructure, secure vaccine delivery, subsidised nutrition, and universal sanitation are non-negotiable. The time for incrementalism has passed; bold, systemic reform is required to ensure health systems protect the most vulnerable and withstand future crises.
The warning of heat stress, WHO’s push for IHR reform, and the call for balanced diets underscore a shared challenge: responses are too slow, too uneven to match the crises’ scale. Heat action plans protect some but not all; polio vaccines reach many but not the last mile; COVID-19 reforms promise change but lag in delivery; nutritional awareness grows but can’t outpace hunger. The advancements—adaptation strategies, IHR reviews, vaccination campaigns, dietary promotion—are steps forward, but the urgent tone betrays their limits.
