Please see the full Volume 138 IARC monograph that was recently published, which contains the full evaluation by the Working Group: https://publications.iarc.who.int/652

It had been 37 years since the International Agency for Research on Cancer (IARC) last evaluated whether automotive gasoline causes cancer. That was in 1988 and since then a large number of new scientific studies on the subject have been produced worldwide. IARC convened 20 experts from 16 countries in February-March to critically review the total updated scientific evidence base. I had the distinct privilege and pleasure of chairing the Working Group meeting, where we evaluated the studies according to strict and established criteria.

Sufficient evidence that automotive gasoline causes bladder cancer and leukaemia

In 1988, automotive gasoline was previously classified (volume 45) as possibly carcinogenic to humans (also known as Group 2B). This year, we concluded that overall there was sufficient evidence for cancer in humans. Therefore, the answer to the question is indeed, yes, there is convincing evidence that automotive gasoline causes cancer. Automotive gasoline exposure causes urinary bladder cancer and acute myeloid leukaemia in adults. The official classification is known as a Group 1 classification, that automotive gasoline is carcinogenic to humans. This is the highest level used by IARC when evaluating whether an agent is carcinogenic to humans.

Source: IARC.

The studies in exposed humans mainly included people exposed to automotive gasoline fuel and vapours as part of their job. Automotive gasoline is a complex mixture, and occupational exposure occurs during the production and transport of gasoline and during vehicle refuelling. Service station attendants are also exposed to higher levels of gasoline than the general public.

One of the major epidemiological studies assessing gasoline exposure, which contributed to this evaluation, was conducted by researchers now at ISGlobal (formerly at IMIM during the study).

Limited evidence that automotive gasoline can cause other types of cancer

Studies of other types of cancer were also reviewed, and it was determined that the evidence was limited. This means that there were some studies that showed that automotive gasoline was associated with an increased risk of other types of cancer, but the evidence was not strong enough to make a clear conclusion at this moment in time. There was limited evidence in humans for non-Hodgkin lymphoma (including chronic lymphocytic leukaemia), multiple myeloma, myelodysplastic syndromes, and cancers of the stomach and kidney. There was also limited evidence for acute lymphoblastic leukaemia (ALL) in children, including from studies of children living in close proximity to service stations.

Gasoline causes genetic damage, oxidative stress and chronic inflammation

In addition to evaluating studies of cancer in humans exposed to automotive gasoline, we also found that there was sufficient evidence for cancer in laboratory animals (studies of mice and rats) and strong mechanistic evidence in exposed humans. There was strong evidence that gasoline is genotoxic (causes genetic damage), that it induces oxidative stress, and it induces chronic inflammation in exposed humans, mainly service station attendants. There was also convincing mechanistic evidence in experimental systems for endpoints associated with oxidative stress and chronic inflammation.

More research is needed

Although automotive gasoline is now classified as a Group 1 agent, there is still much more research that can be done to provide an even more complete picture of the cancer risk to humans. More research can be done to provide more evidence as to whether automotive gasoline causes cancer at other sites, beyond urinary bladder cancer and acute myeloid leukaemia in adults, including in new large-scale studies in humans. It is important that research is conducted independently, is unbiased, and free from potential conflicts of interest.

What about gasoline additives?

In addition to automotive gasoline, we also evaluated whether oxygenated gasoline additives cause cancer. Oxygenated gasoline additives are used to enhance octane rating and to increase combustion efficiency, as well as minimize atmospheric pollution. The additives evaluated included methyl tert-butyl ether (MTBE), ethyl tert-butyl ether (ETBE), tert-butyl alcohol (TBA), diisopropyl ether (DIPE), and tert-amyl methyl ether (TAME). The evidence for the different oxygenated gasoline additives was weaker than it was for automotive gasoline and classifications ranged from Group 2B (possibly carcinogenic to humans) to Group 3 (not classifiable as to its carcinogenicity to humans).

For more information please also see the IARC Monographs website.

IARC is the specialised agency of the World Health Organisation (WHO) that focusses specifically on cancer research and prevention. The IARC Monographs Programme has coordinated to date, 138 cancer monograph evaluation meetings in its more than 50-year history. These evaluations are often used for national and international policies, guidelines, and recommendations to minimize cancer risks.

Reading time: 3 min

[This post was written by Aina Nicolàs, Camila Picchio and Anthony Armenta, from the Public Health Liver Group at ISGlobal.]

A vaccine, rapid diagnostic tests and effective treatment options exist. You’d think that viral hepatitis must be close to elimination, but it’s far from over.

The latest World Health Organization (WHO) Global Hepatitis Report has shown that viral hepatitis infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV), continue to cause over one million deaths annually. At the same time, most people living with chronic viral hepatitis remain undiagnosed or untreated, revealing a disconnect between the tools already available and better health outcomes. When we look more closely at Europe, the picture is equally striking: elimination targets remain far out of reach, with a strong gap in both diagnosis and treatment rates.

The challenge, then, is not simply whether effective medical tools exist. It is whether people can actually access, understand and navigate the services that provide them.

The challenge is not simply whether effective medical tools exist. It is whether people can actually access, understand and navigate the services that provide them.

This is particularly important for migrant communities in Europe, who may face barriers that traditional clinic-based approaches do not adequately address. These communities are disproportionately affected and account for an estimated 25% of HBV infections and 14% of HCV infections. This happens because of a complex interplay of factors, including limited availability of preventive strategies in their home countries, and substantial barriers to access and navigate their host health systems, which are further compounded by cultural and linguistic barriers.

For someone trying to access care in a new country, these barriers can be structural as well as personal: not knowing where to go for testing, struggling to understand health information in an unfamiliar language, navigating appointments and referrals, or facing stigma and misconceptions around viral hepatitis.

Early diagnosis and timely care are therefore essential to prevent serious health problems and reduce further transmission.

The consequences of being missed by the health system can be serious. A delayed diagnosis often leads to the infection being detected only after advanced liver disease has developed. This means an increased risk of cirrhosis, liver cancer, and, ultimately, death. In parallel, when people don’t know they have the infection, they may not take the precautions needed to protect others, allowing it to spread within the community unknowingly. Early diagnosis and timely care are therefore essential to prevent serious health problems and reduce further transmission.

Bringing care closer to where people live

Reaching people who are not accessing traditional health services requires us to rethink where and how care is delivered.

According to WHO, simplifying and decentralising how we deliver screening and care services is central to viral hepatitis elimination efforts. This means moving some services beyond specialised clinical settings and closer to the communities that need them, while making it easier for people to move from testing to appropriate care.

Community health workers and other community facilitators can make this possible.

In practice, their role is very tangible. These frontline public health professionals may explain why testing matters in a language and context people understand, answer questions and address stigma and misconceptions, help someone find or access a testing service, guide them through appointments or referrals, and connect them with the formal health system when further care is needed. Because they often come from, work closely with, or have established trust within the communities they serve, they can bridge cultural, linguistic and structural gaps that healthcare services may struggle to overcome on their own.

Frontline public health professionals may explain why testing matters in a language and context people understand, answer questions and address stigma and misconceptions, help someone find or access a testing service, guide them through appointments or referrals, and connect them with the formal health system when further care is needed.

This is not a new idea.

Across different health systems, community health workers have helped extend care to communities that might otherwise be missed. In Rwanda, for example, community health workers have been instrumental in strengthening primary healthcare, with their responsibilities expanding from basic health promotion to integrated community case management. Their experience shows what can happen when community-based workers are recognised as a core part of how people reach and use health services.

Despite the substantial contribution of community health workers in health systems among low- and middle-income countries, their potential to support health systems in high-income countries is immense.

In Europe, a stronger and more integrated role for community health workers could help address persistent challenges in migrant health, including unequal access to services and growing cultural and linguistic diversity. Yet their roles are not consistently embedded within formal healthcare systems. Some countries and regions–like Belgium and the United Kingdom–have taken steps to connect community health workers more closely with primary care, while elsewhere their involvement remains fragmented or dependent on individual pilot programmes and research projects.

Realising their full potential therefore requires more than simply recognising that community-based approaches work. The people delivering these services also need the knowledge, practical tools and support to carry out their roles effectively and link communities with the wider healthcare system.

Turning this approach into action through HEP-HOP

This is one of the challenges that the Health Equity Programme: Hepatitis Outreach for Migrant Populations (HEP-HOP) project aims to address.

Leaving no one behind is at the heart of HEP-HOP, an EU-funded project focused on improving access to viral hepatitis care among migrants across Europe.

Because bringing services closer to communities must involve communities themselves, a central component of the project is decentralised, point-of-care testing for viral hepatitis, delivered with the involvement of community health workers and other community facilitators, including peer navigators, social mediators and civic integration teachers.

ISGlobal and the University of Antwerp are developing a structured training curriculum to equip frontline community workers with practical skills.

These are people who are already well positioned to build trust, communicate in culturally appropriate ways and help individuals navigate services. But for this model to be effective and scalable, they also need structured preparation for the responsibilities they are being asked to take on.

That is why ISGlobal and the University of Antwerp are developing a structured training curriculum to equip frontline community workers with the practical skills needed to:

• conduct decentralised screening,
• tackle stigma and misconceptions,
• engage with migrant communities in culturally appropriate ways, and
• increase awareness of viral hepatitis among migrants in Europe.

Designed with sustainability and scalability in mind, the curriculum has undergone an expert-led revision process involving community representatives as well as global advocacy organisations, including the World Hepatitis Alliance and the Hepatitis B Foundation, alongside other researchers and experts.

The goal is to strengthen the connections between communities and the health services already available, so that people can access testing, care and treatment earlier and more easily.

Eliminating viral hepatitis will depend on making existing tools work for everyone. Trusted community support, accessible services and stronger links to care can help ensure that no one is left behind.

Reading time: 3 min

[This post was jointly written by Manolis Kogevinas, Emeritus Professor at ISGlobal, an Neil Pearce, Professor of Biostatistics and Epidemiology at the London School of Hygiene and Tropical Medicine. It is based on their academic paper "Football, fossil fuels, and public health in the era of climate crisis", published in Environmental Epidemiology.]

In December 2022, millions of people watched Lionel Messi lift the World Cup wrapped in a bisht (a traditional garment) placed on him by the Emir of Qatar. The image became a global symbol, not only for its sporting value, but because it revealed something deeper: the growing fusion between the planet's most popular sport and the economic interests of major fossil fuel producers.

In the 2026 World Cup, one of the sponsors was Aramco, Saudi Arabia's state oil company, and furthermore, the 2034 World Cup will take place precisely in Saudi Arabia.

But this article is not about football. It is about how fossil fuels shape our daily lives, our cities, our climate, and ultimately, our health. Football is simply the most visible mirror of a much broader phenomenon: the ability of certain industries to influence culture and public perception through platforms of massive reach.

A link that goes far beyond sports

For decades, major oil companies and states whose wealth depends on oil and gas have invested billions in projects with global visibility. Some estimates place this annual investment at around 6 billion dollars. Sport, and especially football, is one of the most effective vehicles for this. It is no coincidence that some of Europe's most successful clubs are controlled by sovereign wealth funds from oil-producing countries, nor that state airlines or energy companies appear on jerseys, stadiums, and broadcasts. The result is a constant presence, almost invisible due to its normality, of industries responsible for a substantial share of global emissions.

It is no coincidence that some of Europe's most successful clubs are controlled by sovereign wealth funds from oil-producing countries, nor that state airlines or energy companies appear on jerseys, stadiums, and broadcasts. The result is a constant presence, almost invisible due to its normality, of industries responsible for a substantial share of global emissions.

Even the most admired managers in contemporary football, Pep Guardiola, until recently at Manchester City, and Luis Enrique at Paris Saint-Germain, work on sports projects whose excellence is sustained by capital originating from fossil fuel-based economies, through the sovereign wealth funds of the United Arab Emirates and Qatar, respectively. This is not a criticism of them, but an observation: sporting talent today coexists with financial structures that have profound implications for the climate and public health.

But reducing this strategy to a matter of image would be naive. What is at stake is the ability of these industries to maintain their social legitimacy at a time when science is unequivocal: the burning of fossil fuels is the primary driver of climate change, and climate change is already the single greatest threat to public health in the 21st century.

Public health in the era of extreme climate

Climate change is not an abstract phenomenon. Its effects on health are documented and intensify every year:

• More frequent and deadly heatwaves.
• Air pollution causing millions of premature deaths.
• Extreme events—floods, fires, droughts—that disrupt ecosystems and displace populations.
• Infectious diseases expanding into new regions.

These risks are documented in multiple reports, such as the Lancet Countdown, one of the most comprehensive evaluations on climate and health, in which ISGlobal researchers actively participate.

While the impacts of climate change increase, the industries responsible for the majority of emissions continue to find privileged spaces to project an image of modernity, dynamism, and progress.

And yet, as the impacts increase, the industries responsible for the majority of emissions continue to find privileged spaces to project an image of modernity, dynamism, and progress.

The power of normalization

This is where the link to sports, and to other cultural spheres, becomes relevant. Advertising and sponsorship do not just sell products: they shape mindsets. Associating fossil fuels with success, excitement, or sporting excellence helps maintain the idea that these industries are a natural and inevitable part of our lives.

Sportswashing is not just an ethical issue. It is a commercial determinant of health, because it indirectly influences health risks by delaying or weakening environmental protection policies.

This phenomenon has a name: sportswashing, a form of reputational laundering that uses sports to soften the public perception of activities with negative environmental impacts. But sportswashing is not just an ethical issue. It is a commercial determinant of health, because it indirectly influences health risks by delaying or weakening environmental protection policies.

An uncomfortable parallel: tobacco

History offers a clear precedent. For decades, the tobacco industry used sports to associate its products with vitality and success. The result was a significant delay in the adoption of tobacco control policies.

Today, no one would accept a cigarette brand sponsoring a major club's jersey. Yet, we continue to accept, and even celebrate, industries responsible for a climate crisis with massive health consequences occupying that very space.

Is this dependency inevitable?

A widespread idea is that sports, and by extension other cultural activities, need this type of funding to survive. But this narrative ignores something fundamental: the economic system of sports has been built on a spiral of rising expenditure, where additional revenues do not stabilize the model, but rather feed permanent inflation in salaries, transfers, and operational costs.

In other words: it is not that sports need fossil fuels; it is that the current sports model needs a constant flow of capital, wherever it comes from.

A moment for collective responsibility

The debate over the role of fossil fuels in sports is not a debate about fandom. It is not about stopping watching matches or giving up the thrill generated by the game. It is about recognizing that culture is also part of the system that determines our health.

It is not about stopping watching matches or giving up the thrill generated by the game. It is about recognizing that culture is also part of the system that determines our health.

Scientific societies have already proven that they can lead profound ethical changes, as occurred with tobacco. Today, the challenge is greater and more urgent. The question is not whether sports should divest from fossil fuels, but when and how.

Because, just as in the 20th century it became unacceptable for sports to serve as a platform to promote products that killed, in the 21st century it should be unacceptable to us that it contributes to normalizing the industry that is destabilizing the planet's climate.

Reading time: 5 min

When most people think about viruses, they think about disease. But viruses are everywhere: in oceans, soils, forests, wastewater, and on the surfaces we touch every day. In fact, there are an estimated 10³¹ viruses on the planet, of which only a tiny fraction has been identified.

This vast unknown viral diversity has been dubbed the “viral dark matter”. Thanks to recent advances in sequencing technologies, scientists are beginning to uncover the vast diversity of viruses present in soil, oceans, wildlife and other environments. One particularly fascinating study used samples from African army ants to characterise viral populations in a remote tropical forest in Gabon.  

Another remarkable study, this time focused not on forests but on cities globally, involved Xavier Rodó, ICREA researcher at ISGlobal. The study set out to map the diversity of RNA viruses across urban environments worldwide.

The hidden world of urban viruses

RNA viruses are of particular interest given their high mutation rates, which allow them to adapt quickly to new environments and hosts. Importantly, they account for two thirds of known human pathogens (HIV, influenza viruses, dengue, Ebola and SARS-CoV-2 are only some examples). Yet, few studies have looked at their diversity, especially in urban settings, where 56% of the world population now lives. 

The international MetaSUB consortium tackled this question by examining the diversity of RNA viruses in 102 cities and surrounding environments, across 31 countries. To do so, they analysed 2,922 genetic samples collected between March and July 2020, from a wide variety of urban and peri-urban environments: from handrails, benches or ticket machines in hospitals, banks and public transport stations, to nearby soils, green spaces and wastewater.

Key findings

These are some of the most noteworthy findings:

Thousands of previously unknown RNA viruses

The analysis uncovered 54,945 RNA viruses, 77% of which had not been previously reported. Two dominant classes of RNA viruses were observed across most countries, especially in environments closely associated with human activities. SARS-CoV-2 was also frequently observed, likely due to samples being collected during the pandemic.

Lower viral diversity in urban environments

Another clear finding was that viral diversity is lower in urban samples (streets, banks, subway stations) compared to those from peri-urban or natural environments, including sediment, soil or grasslands. This suggests that urbanization and human activity, whilst leaving a characteristic fingerprint, may “homogenize” viral communities. Wastewater also emerged as a major reservoir of viral populations, confirming its importance for viral monitoring.  But even in cities, the diversity remained huge- the analysis did not reach saturation, meaning that many more viruses likely remain undiscovered.   

New branches on the viral tree

The analysis also revealed evidence for two potentially new viral phyla, or major evolutionary branches, one new class and several previously unclassified groups. The study also found evidence that the emergence of double-stranded RNA genomes in the Duplornaviricote phylum may not have been a unique evolutionary event, as previously thought. Furthermore, by zooming in on a key viral enzyme (RNA-dependent RNA polymerase or RdRp), the researchers found evidence of directional selection, i.e. mutations that may provide the virus with selective advantages. Tracking these molecular signatures can help scientists understand viral evolution and adaptability, detect potentially pandemic strains, and guide vaccination strategies.

Urban viruses mostly infect bacteria

Most RNA viruses uncovered in the study are hosted by bacteria, fungi and plants, contrary to previous homocentric assumptions that RNA viruses mainly infect eukaryotes. In fact, more than half of the viruses for which a host could be identified were bacteriophages. This highlights the important ecological role these organisms play in shaping viral populations in cities and the complex eco-evolutionary dynamics that have shaped these relationships over time. Still, the researchers found over 100 viruses capable of infecting vertebrates, including families that contain well-known human pathogens such as rhinoviruses, polioviruses and enteroviruses. They also identified 166 RNA viruses associated with four major antibiotic-resistant bacteria known as ESKAPE pathogens: Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. These viruses could eventually open the door to virus-based therapies against antibiotic-resistant bacteria. In addition, the team uncovered viruses capable of infecting human gut bacteria such as Clostridia and Bacteroidia, two major components of our microbiota.

Socioeconomic factors may influence viral abundance

By correlating viral diversity with World Development Indicators, the study also found that urban areas in less developed countries tended to show a higher burden of vertebrate-associated viruses than those in more developed settings. For example, hospital samples from Islamabad and São Paulo showed higher viral abundance than those from Baltimore and Seoul.  

A call for viral discovery and monitoring

True, as the researchers caution, the study has important limitations. For example, sampling was uneven across countries and environments, making it difficult to determine whether observed differences reflect geography or simply differences in what was sampled (e.g. public transport stations in Poland versus greenhouses in France). Much more work lies ahead to investigate in full host-virus associations and the role this viral dark matter has in ecosystems and in human health.

Studies like this one will help improve our understanding of viral hosts and evolution, strengthen environmental surveillance, and support preparedness for future outbreaks.

Even so, the study is one of the most ambitious efforts to date to map the hidden world of RNA viruses in human-associated environments and sets a new standard for viral discovery by developing a robust pipeline for viral discovery, host prediction and phylogenetic analysis. It also provides one of the most comprehensive catalogues of environmental RNA viruses assembled to date (named UPVAtlas), providing a valuable resource for future research. Studies like this one will help improve our understanding of viral hosts and evolution, strengthen environmental surveillance, and support preparedness for future outbreaks.

Reading time: 5 min

Sometimes a UN resolution goes unnoticed. The one on July 7 should not. It changes the playing field for more than one billion people because, from now on, neglected diseases cease to be just a health issue and also become a human rights concern.

It is not the same to demand political, financial, and medical attention for a forgotten disease as it is to denounce the violation of a fundamental right. That is the difference after July 7.

The news should have reached the speakers of each of the more than one billion affected people in the world by one or more of the 21 neglected tropical diseases (NTDs), according to the UN classification. It is a long list that includes diseases such as leishmaniasis, leprosy, lymphatic filariasis, Chagas, etc. Most of these ailments share features of exclusion, stigma, and discrimination, as well as a heavy impact on women and children.

Many of these diseases stopped being exclusively rural or tropical problems a long time ago. Chagas disease is a good example. Migratory movements and other global changes have turned it into a public health challenge also for countries like Spain, where an estimated 80,000 affected people live. In the United States, there are 300,000. Furthermore, it can be transmitted from mother to child during pregnancy, although this transmission is preventable through timely diagnosis and treatment.

A Matter of Human Rights

Since July 7, neglected diseases have become something more: they are a matter of human rights. This means that failing to properly treat these diseases will no longer be just a problem of health or political negligence, but a violation of human rights.

Since July 7, neglected diseases have been a matter of human rights. This means that failing to properly treat these diseases will no longer be just a problem of health or political negligence, but a violation of human rights.

The resolution was promoted by a group of African countries led by Malawi and had the support of dozens of organizations, among which was ISGlobal together with the Global Chagas Coalition.

In the absence of a report detailing what the inclusion of neglected diseases in Human Rights will consist of, we can anticipate an impact on strengthening the advocacy work of groups and associations of affected people. But even before knowing the practical scope of this resolution, something has already changed.

21 Diseases, One Billion People

For those who research, those who train, and those who develop therapeutic and logistical tools against neglected diseases, we are in a new era. They are not only working towards a goal of justice and equity in health, but for an officially recognized human right.

But we should not get carried away by enthusiasm. Because, honestly, who believes that states are trembling at the news right now? Do you think they are calculating the resources and millions in compensation they would have to pay to every person who has not been properly treated for a neglected disease?

It is true that, in legal terms, a public health issue is not the same as a human rights issue. These types of rights are inalienable and belong to each and every person.

In part, the UN resolution changes the names of neglected diseases: They are no longer "helminthiasis, filariasis, yaws, or onchocerciasis". Now their names are Yusuf, Amelia, Ibrahim, Wole, or Chantal.

In part, the UN resolution changes the names of neglected diseases: They are no longer "helminthiasis, filariasis, yaws, or onchocerciasis". Now their names are Yusuf, Amelia, Ibrahim, Wole, or Chantal. Addressing them is not just a public health duty but a right of Yusuf, Amelia, Ibrahim, Wole, or Chantal. A right belonging to each and every one of us.

The Worst Time for Human Rights

This is no time for high hopes. The 1948 Declaration emerged right after a world at war. Once again, we find ourselves in a world at war, with growing funding for the military sector and a fundamental cut in global health aid.

And regarding human rights, one only needs to look at what is happening in Gaza, right before our eyes, as well as in other parts of the world—north, south, east, and west. And violations of these rights are no longer even masked or concealed. At least, not yet.

We are in one of the worst moments for human rights. So, approving the inclusion of neglected diseases as part of them seems more like a poisoned gift.

We are in the "yet" phase, in one of the worst moments for human rights. Thus, the approval of neglected diseases becoming part of them seems more like a poisoned gift from a bankrupt bank choosing an unsuspecting director without informing them of the account statement.

But time passes and the weight of the dead remains. We will see a return to sanity, in that relentless pendular cycle of human beings between violence and common sense. We will read every article of the Human Rights declaration again as if it were the only border in the world.

What matters is that when that day comes, neglected diseases will already be in the articles of the Declaration, where they always belonged, with the eyes and mouths of each of the affected people, but finally cared for. For one morning, for one afternoon, that of July 7, we were not forbidden to dream. "There was evening, and there was morning—the first day."

[This text was co-written by Elsa Carbonell, field technician, and Albert Bach, postdoctoral researcher.]

Reading Time: 3 min

When you enter a park after a stressful day, what makes you feel better? The shade of the trees? The chirping of birds? The feeling of being surrounded by nature? Or the combination of freshness, nature, and calm that makes that park function as something more than just a place to pass through?

In a context of climate change, water scarcity, and urban growth, green spaces can no longer be understood merely as recreational areas or as elements with a single function. They are urban infrastructures that can simultaneously contribute to retaining water in the soil, hosting biodiversity, improving environmental comfort, and fostering the mental and emotional well-being of citizens.

The urban parks of the future will have to respond to many challenges at once. BioWater provides a baseline to think of them not as separate pieces of greenery, but as living spaces where soil, water, biodiversity, and well-being are interwoven.

With this vision in mind, the BioWater project emerged as a pilot test developed in ten urban green spaces in Barcelona. The goal has been to explore how vegetation characteristics relate to three key dimensions: soil water content, biodiversity, and the mental and emotional restoration of the people who use these spaces.

How Do Vegetation Characteristics and Soil Moisture Relate to Each Other?

The project has studied parks with different vegetation configurations: spaces dominated by herbaceous plants, shrubs, trees, and mixed combinations of vegetation. It has also incorporated various biodiversity indicators, such as birds, lichens, and hoverflies. Hoverflies are pollinating insects, often resembling small bees or wasps, which can provide information about habitat quality. Additionally, the project gathered the perception of users through surveys and participatory sessions.

The results of BioWater suggest that, in order to generate more resilient green spaces, it is necessary to better understand soil characteristics, restore it, and improve its water retention capacity.

One of the main results is that the relationship between vegetation and soil moisture is not as simple as it might seem. In the parks studied, soil moisture was primarily associated with soil characteristics (soil texture and temperature), environmental conditions such as relative humidity, and vegetation.

This is especially important in a city like Barcelona, where urban green management has been conditioned by drought. The results of BioWater suggest that, to generate more resilient green spaces, it is necessary to better understand soil characteristics, restore it, and improve its water retention capacity.

How Do Vegetation Characteristics Relate to Biodiversity?

In the case of biodiversity, the results also point to a nuanced interpretation. Spaces with a greater richness of shrubs and trees tend to feature a greater richness of birds. However, the biodiversity perceived by citizens does not depend solely on the total number of plant species. In the analyzed parks, the biodiversity perceived by citizens seems to be associated with spaces where vegetation is distributed across a greater diversity of layers and heights, and where these layers have a well-represented coverage (structural complexity of vegetation). Perceived biodiversity was also associated with a greater sense of naturalness.

How Do Vegetation Characteristics Relate to Our Well-Being?

This point is crucial: the way people perceive a green space is also part of its urban function. A park may have ecological value, but for it to be experienced as a restorative space, we must consider how people move through it, how they spend time there, and which elements foster a sense of nature.

The results on mental well-being point in this same direction:

• Mental restoration is associated with the structural complexity of vegetation, perceived naturalness, and connection to nature.
• Emotional regulation through nature—meaning the use of green spaces to calm down, reduce tension, or feel more energized—shows a more consistent relationship with total species richness.
• The length of time spent in the park seems particularly relevant to achieving calmness.

The main conclusion is that parks should not be planned by looking at a single variable. It is not just about increasing vegetation, nor just about maximizing biodiversity, nor just about creating pleasant spaces. The challenge is to integrate these dimensions.

How Should Parks Be Planned, Then?

The main conclusion is that parks should not be planned by looking at a single variable. It is not just about increasing vegetation, nor just about maximizing biodiversity, nor just about creating pleasant spaces. The challenge is to integrate these dimensions.

1. Vegetation, soil, and water must be considered together. This implies incorporating soil diagnosis into the design and maintenance of green spaces, reducing bare soil, encouraging protective organic covers, and exploring nature-based solutions for water catchment and storage.
2. More diverse, heterogeneous, and naturalized spaces must be promoted, avoiding overly homogeneous configurations and combining herbaceous, shrub, and tree layers according to the conditions and uses of each space.
3. Parks must be designed for daily use and well-being: providing shade, paths that are not just transit zones, resting spots, spaces for calm, meeting areas, and infrastructure for care and comfort, such as benches, public restrooms, lactation rooms, or spaces adapted for children, the elderly, and caregivers.

Finally, since BioWater is a pilot test, these guidelines should initially be applied in sentinel spaces or pilot actions, followed by monitoring. This would make it possible to verify which measures work best before expanding them to other areas of the city.

The urban parks of the future will have to respond to many challenges at once. BioWater provides a baseline to think of them not as separate pieces of greenery, but as living spaces where soil, water, biodiversity, and well-being are interwoven.

This study was carried out within the framework of project 24S05864-001, funded by the Barcelona City Council through the 2024 Young and Emerging Research Grant.

Reading Time: 4 min

That summer in Mavrovouni refugee camp on Lesvos, Greece - one of the Aegean Sea’s fraught portals into Europe for people denied the possibility of travelling through regular routes - the temperature reached 40°C. Heat rose from the gravel, babies cried in stuffy tents, people were stuck for hours in food lines, Wi-Fi disappeared, and someone we had spent days trying to find for an interview had suddenly been transferred away.

We were trying to do something not yet done: carry out a comprehensive sexual and reproductive health analysis in a European refugee camp, not simply about the people living there, but with them leading the work. When I arrived in Lesvos, I had no idea I was entering a community of women whose faith, humour, discipline, care for one another, and refusal to give up would transform the way I saw the world.

I still remember my astonishment when, every time something went wrong, Kowthar, one of the women representing the Somali community - who would later become my sister – would serenely say, “No problem, we fix it.”

The Knowledge Was Already There

This can-do attitude carried the project. And a few years later, as our research article from the quantitative arm of the project was published last week - part of a larger participatory mixed-methods study led by Dr. Jamilah Sherally - I think about how impossible the work would have been without the 9 refugee co-researchers who represented the languages and communities living there.

I think about how impossible the work would have been without the 9 refugee co-researchers who represented the languages and communities living there. They were not there as translators or assistants, but co-producers of knowledge in a situation where they were the experts.

They were not there as translators or assistants, but co-producers of knowledge in a situation where they were the experts. After 3 weeks of discussion, training, disagreement, and 7 drafts, the household survey went from 232 questions to 119. It remained ambitious, covering maternity care, contraception, menstruation, abortion, female genital mutilation and much more.

The long discussions were not an unnecessary delay, but collective labour that made the study rigorous and honest enough to reflect women’s actual sexual and reproductive health needs in Mavrovouni. Without that process, we would have asked narrower questions and received narrower answers. For more on how the co-researchers shaped the study from design to dissemination, see How to practise what you preach: practical considerations for participatory global health research.

In a camp shaped by deprivation, uncertainty, and bureaucratic violence, our team ended up managing to interview 247 women of reproductive age, marking the first situation analysis in a European refugee camp.

When Health Is Treated as an Emergency, and Violence as Policy

The findings echoed what humanitarian sexual and reproductive health literature has long shown: emergency care is prioritised while preventive, long-term, rights-based needs disappear. Significantly, our study found that more than half of the women had experienced at least one pushback before reaching Lesbos, and 2 women reported losing a child during the sea journey. These findings cannot be separated from the European border system in which they occurred: human rights organisations have repeatedly documented violent pushbacks in Europe, while EU documents show billions of euros in support to Greece for migration and border management.

Justice Does Not Have to Wait

We could not have done this research without Kowthar and the other co-researchers; that is a methodological fact. But the project also mattered because it recognized their value in a system where asylum procedures create gaps in people’s CVs and force futures into waiting. Hiring refugee women said: your knowledge and skills count now, and your future does not begin after a government decides you can have one.

Audrey Benson and Kowthar Mohamed presenting the quantitative study at the ECTMIH congress in Hamburg, and accepting the award for best poster.

Like many others, Kowthar eventually moved on from Greece and applied for asylum in Germany. Later, Jamilah invited us to present two studies from the larger project at ECTMIH in Hamburg. Just days before we travelled, Kowthar received a rejection on her asylum application, but she came anyway. She stood in an academic space and presented evidence produced by women whose stories are so often doubted or minimised, while her own story had just been doubted by the asylum system.

Participatory Action Research taught me that while we fight for structural change, we are still responsible for smaller forms of justice already within reach: who is paid and credited, who speaks and is listened to, who gets to be believed, and who is given room to grow into a future beyond survival.

And when our poster presentation won an award, going to the stage to accept it felt complicated. We knew an award did not stop violent border policies. But if justice is only imagined at that scale, it can become so vast that people feel paralyzed by it. Participatory Action Research taught me that while we fight for structural change, we are still responsible for smaller forms of justice already within reach: who is paid and credited, who speaks and is listened to, who gets to be believed, and who is given room to grow into a future beyond survival.

The Wound Is The Place Where The Light Enters

A few weeks ago, Kowthar called me. After years of rejection, fighting and prayers, she had received asylum. We cried at the relief that there was another small piece of justice.

Kowthar should not have had to be brave in the ways she has been forced to be brave. But if she can live under the weight of rejection and still show up to study the system, name its violence, and demand better, then we can do the same. We can refuse to wait until results are published before pursuing justice, recognizing participation as an ethical and human commitment.

Even though everything may seem broken now, we can look at one another and say what Kowthar taught us to say: “We fix it.”

6 minutes read

On 25 June I woke up to dozens of WhatsApp messages. I thought they were friends wishing me a happy birthday. That was not the case. The messages came from people wondering if my family and loved ones were OK. As I quickly learned, the night before, at 18:04 local time, and 38 seconds apart, two of the most powerful earthquakes recorded in Venezuela’s last hundred years had hit the country.

My family was fine. Mérida, the city where I come from, was spared the damage. Much of the country's northwestern coast was affected, though, with most of the destruction concentrated in the capital, Caracas, and the nearby port city of La Guaira.

At the time of writing, at least 1,450 people have died, including 17 Spanish nationals, while more than 3,000 have been injured. More than 46,000 people remain missing, and the death toll is expected to rise as rescue operations continue. International assistance and donations are proving essential to support the response on the ground.

Tragically Unprepared

After more than two decades of political, social and economic crisis, Venezuela was tragically unprepared to respond to a disaster of this magnitude. The reasons behind this are complex and extend far beyond the scope of this article. Nevertheless, the country's limited preparedness has been laid bare by the slow and insufficient response of the Venezuelan authorities. In the immediate aftermath of the earthquakes, survivors relied largely on volunteer groups, local fire brigades and neighbours, many of them searching through the rubble with their bare hands and little or no specialist equipment.

Large-scale rescue operations did not begin until international teams arrived around 48 hours after the earthquakes. That support has since been substantial, with more than 2,200 rescuers from 27 countries deployed to the affected areas. Their work is proving indispensable in locating survivors and will almost certainly need to continue over the coming days and weeks if further progress is to be made.

How to Help

Collection centres have been established around the world, including several in Barcelona. However, financial contributions remain the most direct and effective way to help, as shipments of supplies often face logistical bottlenecks and significant distribution challenges.

Campus Clínic Solidari, a joint initiative involving several institutions, including Hospital Clínic Barcelona and ISGlobal, is coordinating one such campaign and is in direct contact with teams deployed in Venezuela to identify priority needs and ensure that resources are allocated effectively. In addition, a list of other verified fundraising campaigns can be found on Caracas Chronicles, an independent media outlet that has specialised in covering Venezuela since 2002.

Support Venezuela. Campus Clínic Solidari campaign

Beyond Emergency Relief

Beyond emergency donations, the international scientific community also has an important role to play in supporting Venezuela's recovery. Even before the earthquakes, the country faced profound challenges in the provision of essential public services, including electricity, access to clean water, healthcare and the control of communicable diseases.

Since at least 2016, the United Nations has classified Venezuela as facing a Complex Humanitarian Emergency (CHE): a protracted crisis that has overwhelmed the state's capacity to perform its core functions. At the same time, years of economic collapse, political repression and persecution have driven a sustained exodus of scientific, technical and healthcare professionals, severely weakening the country's institutional capacity.

These structural challenges will make reconstruction considerably more difficult in the years ahead. They will also test the willingness and capacity of funding agencies, multilateral organisations and the international scientific community to support long-term solutions to the many problems that Venezuela already faced before the disaster, and which the earthquakes have now dramatically intensified.

At a time when global aid budgets face unprecedented financial pressures and uncertainty, Venezuela demonstrates just how much is at stake

Meeting that challenge will require sustained investment in both infrastructure and scientific research within Venezuela. This should include training local medical and scientific professionals, modernising epidemiological surveillance systems, and strengthening primary healthcare networks. Equally important is maintaining support for programmes already operating in the country, including those led by the Global Fund to Fight AIDS, Tuberculosis and Malaria and Médecins Sans Frontières. Continued funding will be essential to preserve recent progress in controlling infectious diseases such as malaria while minimising the disruption that the earthquakes are likely to cause to local NGOs and public institutions.

Ultimately, however, long-term recovery will also depend on the consolidation of transparent, accountable and effective public institutions capable of implementing these reforms. For that reason, supporting the conditions for a peaceful and orderly democratic transition is inseparable from supporting the country's long-term health and development. Global health institutions cannot remain indifferent to this broader context.

A stark reminder

The earthquakes are a stark reminder not only of the devastating consequences of institutional fragility and years of underinvestment, but also of the indispensable value of international solidarity. At a time when global aid budgets face unprecedented financial pressures and uncertainty, Venezuela demonstrates just how much is at stake.

International cooperation is saving lives in Venezuela today. As members of the global health and scientific community, we have a responsibility to help ensure that it continues to do so, both in the immediate response and throughout the long process of recovery that will follow.

Juan Carlos Gabaldon is a Venezuelan medical doctor and parasitologist based in Barcelona. His work mostly focuses on understanding the pathogenesis of Chagas disease. He has previously studied the epidemiology of malaria in southern Venezuela.

[This article was co-authored by Marta Pinto da Costa and Augusto Anguita-Ruiz, Junior Research Leader at ISGlobal.]

Reading time: 4 minutes

Over the past decades, a worldwide declining tendency in the age at menarche and the onset of puberty has been observed. Although genetic factors have been described as the main determinants of pubertal timing, a growing body of evidence suggest that children’s early-life environmental exposures and lifestyle may also influence this biological process. Understanding these potentially modifiable risk factors is important, as earlier pubertal timing has been linked to several adverse health outcomes, including an increased risk of metabolic disorders, cardiovascular disease, and breast and other reproductive cancers. Earlier pubertal timing therefore represents an important public health concern.

Researchers at ISGlobal and at the Insitute of Public Health of the University of Porto (Portugal) are currently exploring how children’s early-life living environments and early life nutrition may influence pubertal timing, using data from to European birth cohorts: the Portuguese population-based birth cohort Generation XXI and the Spanish INMA Project. Both cohorts have followed thousands of children from pregnancy into adolescence, collecting detailed data on health status, sociodemographic characteristics, living environments and lifestyle factors.

How Was the Study Conducted?

In the present study, the researchers focused on early-life urban environmental exposures, including air pollution, traffic, built environment and natural spaces, measured from pregnancy through early childhood. Rather than focus on a single exposure in isolation, an exposome approach was adopted, allowing the researchers to consider how multiple exposures coexist and their potential combined influence on pubertal timing. Exclusive breastfeeding duration and childhood diet quality were also considered. Pubertal timing was assessed at 9-10 years of age through clinical Tanner staging and/or parental report of the child’s pubertal status based on the Pubertal Development Scale (PDS). Girls also reported their age at menarche during later follow-ups.

Breastfeeding and Pubertal Development

Early-life nutrition seems to play a role on pubertal timing. A longer exclusive breastfeeding duration was associated with less advanced pubertal development among girls. This finding aligns with previous evidence suggesting that breastfeeding may have a potential protective role against earlier pubertal onset. In contrast, childhood diet quality was not associated with pubertal development in this study.

Traffic and Air Pollution: The Strongest Associations

Preliminary results also suggest that early-life urban environmental exposures may play a role in shaping pubertal timing. Children living in less favourable urban environments, mainly characterised by higher building and population density, heavier traffic and higher levels of air pollution, together with lower access to natural spaces, tended to show signs of more advanced pubertal development and age at menarche.

Exposure patterns related to traffic and air pollution emerged as the most consistently associated with earlier puberty-related outcomes

In particular, exposure patterns related to traffic and air pollution emerged as the most consistently associated with earlier puberty-related outcomes. Urban air pollution is a complex mixture of particles and chemicals, some of which are known to interfere with endocrine pathways involved in growth and reproductive development.

For instance, epidemiological studies suggest that Particulate Matter (PM) may influence estrogen-related signalling pathways, which may play a key role on the release of kisspeptin and subsequently trigger gonadotropin-releasing hormone secretion, a central regulator of pubertal onset.

The Potential Protective Role of Green and Blue Spaces

In addition, access to natural spaces also appeared to be relevant. Children growing up in areas with less surrounding green and blue spaces tended to show more advanced pubertal development in some analyses. Natural environments may help reduce stress and promote physical activity, both of which have been linked to hormonal regulation and child development.

Access to natural spaces also appeared to be relevant. Children growing up in areas with less surrounding green and blue spaces tended to show more advanced pubertal development in some analyses

Early childhood appears to be a sensitive period for pubertal development, since exposures occurring during pregnancy and early childhood may have later consequences for biological development. From a public health perspective, these findings represent an important step towards understanding how combinations of environmental and lifestyle factors in early life may shape pubertal timing, and suggest that improving air quality, reducing traffic-related pollution, increasing access to natural spaces, and promoting longer durations of exclusive breastfeeding may contribute to more favourable developmental outcomes for future generations.

Estimated reading time: 4 minutes

A smile of relief lights up Hassan Edries' face: “This is the first time I’ve told it like this, straight from the heart.” He is referring to his escape from Sudan, a story he has unfolded with a distant gaze. We are saying goodbye after an hour-long conversation at the ISGlobal office in Barcelona where he works, and he thanks me for the chance to express himself: “Nobody had ever talked to me about this before.”

Throughout our chat, he repeatedly mentions the two nights he spent sleeping rough in Port Sudan, waiting to board one of the few buses leaving for Egypt. Two nights out in the open, lying on the ground in a city where thousands of Sudanese were arriving, fleeing the violence that had just erupted in their country. No water, no food, no sockets to charge his phone.

Then came the long bus journey and the chaos at the Egyptian border, followed by two harsh years in Cairo living in fear of deportation, and another long year in Barcelona under the care of the Red Cross until he finally obtained political asylum. Nothing has been easy for him. Yet, it is the days following the outbreak of the war that seem to return to his memory over and over again. He had left behind the city of Wad Madani and the green lands of the Gezira State, where his parents grew tomatoes and other vegetables. From that moment on, everything ahead became a complete question mark—a pure struggle for immediate survival.

Fleeing Sudan

In April 2023, when one of the worst humanitarian crises in recent decades broke out in Sudan, Hassan had just begun his PhD within the framework of the MENA-Migrant Health project, led by ISGlobal and coordinated by researcher Ana Requena. He was interested in public health, a field he had trained in in the capital, Khartoum, before completing a master’s degree in infectious disease control at the University of Gezira in Wad Madani. Eman Elafef, also from Sudan, found herself in the same situation as a doctoral student on the project. She was right beside him in Port Sudan during the escape to Egypt, which Ana had coordinated from Barcelona.

In April 2023, when one of the worst humanitarian crises in recent decades broke out in Sudan, Hassan had just begun his PhD within the framework of the MENA-Migrant Health project, led by ISGlobal

After a long bus journey, they reached the Egyptian border, protected by their mission to collect health data on the migrant population for the project. They managed to enter the country and were given a SIM card, allowing them to finally call Ana, who had been very anxious for days. Hassan is well aware of his good fortune: “I’ve lost track of many of my colleagues from Darfur; I still know nothing about them.”

Hassan cannot emphasize enough how grateful he is for Ana’s dedicated support throughout these years. “She has helped us with our studies, finding a flat, whenever we’ve had health issues, with paperwork… How can you ever repay support like that?”.

The Long Wait

Hassan’s situation has gradually improved since those first tense, sad years in Egypt—far from his family and lost in bureaucratic limbos for many long months. He was able to travel to Spain following the granting, in February 2025, of the visa for which Ana had prepared the paperwork.

But the visa expired shortly after, leading to another wait, first for a residence permit and, ultimately, for political asylum, which was finally granted to him a month ago. He says that on Spanish soil, he has finally felt safe, with access to basic services.

In a few months, he will defend his doctoral thesis at the University of Barcelona, which he has dedicated to HIV and hepatitis B and C in migrant populations. Coming from a transit country crossed for decades by thousands of Eritreans, Ethiopians, and South Sudanese on their way to Libya and Egypt, he has now also become a migrant himself. Every day, he sends out fellowship applications to European countries, “especially Germany and the Netherlands.”

A Future in Suspense

Although the situation has improved in some regions of the country, with the conflict now centered in Darfur, Hassan does not plan to return to Sudan in the coming years. Not only is he unable to, but he does not wish to. The friends he has back home tell him, whenever an internet connection is possible, that the situation remains difficult: supply shortages persist, and meeting basic needs is a struggle. However, Gezira is safe again, he tells me; it has entered a reconstruction phase, and his family is beginning to return home after spending some time in Saudi Arabia.

But not all of his siblings are making the journey back. His twin brother, with whom he shares a very close bond, remains in Saudi Arabia working as an agricultural engineer. Hassan shows me his photo on his mobile phone. He looks very different from him, but Hassan assures me that in high school, nobody could tell them apart except their mother. They had even swapped identities at times! “We shared absolutely everything until we went to university: games, our bedroom, secrets. He knows everything about me, and I know everything about him.”

Hassan does not yet know what the next stage of his life will look like, but if he has to sum up what these years have taught him, it is that achieving your goals requires patience, knowing how to wait. “In the end, you achieve them, but you have to wait. Most people will help you if you respect them.”

Reading time: 4 minutes.

“Take my other side,” Adil told me, turning slightly before I took the photograph. “The one without cuts.”

He was sixteen, although he looked younger, one of the smaller boys living on the street in Ceuta, and like many of the boys we met that summer he had learned to carry himself with a kind of hardness. But in that moment, something shifted. The cuts were no longer only a sign of survival, or toughness. They were also something he wanted hidden, something he wanted to leave behind.

What has stayed with me since leaving Ceuta is not only what he said, but the way he moved his body before I took the picture, almost instinctively turning away from the scars. In public health, we have language for the forces that shape wounds like these: structural violence, institutional neglect, trauma, harm reduction, the social conditions that make self-harm and substance use more likely. But in that moment there was also something more intimate and more difficult to sit with: a boy trying to be seen beyond the wound, and carrying shame for scars that should have made the rest of us ashamed of the conditions that produced them.

1. An NNK basketball game in Ceuta gave the boys a chance to play together and shake off the day. 2. A packet of Lyrica (a medication widely misused in Ceuta), and a boy holding a cigarette with a bandaged hand. Substance use and self-harm often overlapped among unaccompanied minors navigating prolonged precarity, grief, and exclusion. 3. Healing and recent self-inflicted wounds on the arms of boys living on the street in Ceuta. These patterns of self-harm emerge as coping responses to chronic stress, violence, and systemic neglect. These are not marks of “ teenage rebellion,” but of survival. 4. Audrey Claire Benson in Ceuta. 5. A protest in Ceuta on June 24, marking the anniversary of the 2022 Melilla massacre. The sign reads in Arabic: “There is no illegal person. Freedom for all.” 6. The fortified border wall at Benzú, one of several barriers separating Ceuta from Morocco. Many unaccompanied minors attempt to climb these walls when they can’t swim across to reach Spanish territory.

On the Ground in One of Europe’s Most Invisible Borders

As a predoctoral epidemiologist at ISGlobal, I see borders not as abstract policy spaces, but as places where global inequalities, colonial histories, national decisions and transnational power structures become painfully visible in people’s bodies: as exhaustion, untreated wounds, hunger, anxiety, fear, substance use and self-harm.

Last summer, I went to Ceuta to understand what was happening at one of Europe’s most important and least discussed borders, a place that is Spanish territory and European territory and yet often remains politically and emotionally far away from the peninsula.

I worked with No Name Kitchen (NNK), a grassroots movement that supports people on the move across Europe’s borders. In Ceuta, we focused specifically on unaccompanied minors, most of them Moroccan boys living either in overcrowded protection centres or on the street. We organised simple activities, helped them access showers at a local mosque, distributed basic supplies, and spent a lot of time doing what sounds small but matters enormously in a context of abandonment: listening, remembering names, noticing when someone looked different, and trying to create moments where boys treated as problems could simply be children.

The Wounds that Made us Look Closer

As the health focal point, I handled first aid. Although most wounds were “normal”, it slowly became impossible for me to ignore the fresh cuts and old scars on arms and hands, often hidden beneath long sleeves despite the heat. We also noticed that these young boys were constantly under the influence of substances like hashish, pregabalin, or clonazepam.

What saddened me most was the mental state around these habits: exhaustion, rage, grief, boredom, fear, shame and a deep sense of having no agency. These were children who had crossed borders alone, many by swimming, and had arrived in Europe only to find themselves stuck in Ceuta, unable to legally move to mainland Spain. Adil was one of them. He was often under the influence when we saw him, but he was also proud to tell us that he had stopped taking pills, which he associated with cutting, and that now he was “only” smoking marijuana.

Substance use and self-harm in Ceuta should not be read as teenage rebellion, individual pathology or cultural deviance. They are coping strategies shaped by the conditions these boys are forced to live in. This matters because the way we name a problem shapes the way we respond to it. If we call these boys dangerous, we justify surveillance. If we call them disobedient, we justify punishment. If we call them broken, we risk reducing them to their wounds. But if we understand substance use and self-harm as responses to abandonment, then the question changes. It is no longer, “What is wrong with these children?” It becomes, “What have we allowed to happen around them, and what would it take to make survival not only less painful, but an act of joy and dignity?”

Why we wrote Sobrevivir al limbo

In public health, we often say that what is not counted does not count (inspired by Albert Einstein’s famous quote), and in Ceuta and Melilla the absence of data is itself part of the violence. There is almost no routine monitoring or peer-reviewed research on mental health, substance use or self-harm among unaccompanied minors in these border enclaves, yet on the ground, the pattern was visible every day.

That is why we wrote Sobrevivir al limbo, No Name Kitchen’s report on substance use and self-harm among unaccompanied minors in Ceuta. Based on daily field observation and spaces of trust, the report documents a reality that institutions should no longer be able to ignore. For me, this was personal. I delayed the start of my PhD writing it because I felt that what I witnessed could not remain invisible.

Documentation does not solve those failures on its own, but it can make denial harder. It can turn scattered observations into evidence, evidence into public responsibility, and public responsibility into pressure on the institutions that are legally and morally obliged to protect these children.

Holding the line for human rights-based public health

This reflection comes at a moment when migration discourse in Europe and across the Global North is becoming increasingly hostile, not only in the language of political debate but in the legal and administrative architecture being built around borders, returns, deterrence and control. Our standards should not become lower simply because the political debate has become more dehumanising; because once cruelty becomes normalised as policy, public health cannot pretend to remain neutral.

Pedro Sánchez’s recent regularisation measure matters, and it is important to recognise policies that expand rights rather than shrink them. But we cannot celebrate an isolated policy win while ignoring what is happening to children at Spain’s border; a society can recognise a positive policy and still demand better.

What helps is not mysterious

One of the painful things about what is happening in Ceuta is that what helps is not mysterious. We saw that when boys had access to safe spaces, sports, showers, conversation, games and trusted adults who returned day after day, there were visibly fewer crises. Connection and non-judgmental support did not erase trauma, but it interrupted it.

Spain must treat substance use and self-harm among unaccompanied minors as a public health and child protection emergency, not a police problem. That means urgent healthcare without delay, culturally adapted harm reduction, early detection of self-harm and problematic substance use, real mental health care, trained staff, safe complaint mechanisms and structured activities inside and outside the protection system.

Beyond healthcare, it requires faster regularisation before boys turn 18, stronger oversight of privately managed centres, accountability for rights violations, and European monitoring of what border policies are doing to children’s bodies and mental health. The message is simple, even if the politics are not: these boys need protection, care, safe spaces and futures.

When witnessing begins to bear fruit

I am grateful that this witnessing is beginning to bear fruit. This story was recently selected as one of the grand-prize winners of the 2026 Untold Global Health Stories Contest, organised by Global Health NOW and the Consortium of Universities for Global Health. This means that journalists will now investigate further and, I hope, help bring more attention to a reality too often absent from public debate.

My hope is that this attention does not stop at recognition, but becomes pressure, and that pressure becomes protection. Boys like Adil in Ceuta do not need to be turned into symbols of suffering; they need adults, institutions and societies willing to see them fully, beyond the wounds and beyond the behaviours that have been used to mark them as difficult, dangerous or undeserving. What we owe them is protection, care, safe spaces, futures, and the courage to insist that even at Europe’s borders, especially at Europe’s borders, human rights still apply.

Reading time: 2 minutes.

As the world gets warmer, our environment may be changing the way young people move. A mild, sunny day can make walking to school, cycling to a friend’s house, or spending time outdoors feel more appealing. But when temperatures keep rising, does warmer weather still encourage teenagers to be active, or does it eventually become a barrier?

Physical activity during adolescence is essential for physical health, mental well-being, and the development of habits that can last into adulthood

This question matters. Physical activity during adolescence is essential for physical health, mental well-being, and the development of habits that can last into adulthood. Yet many young people do not reach the recommended activity levels set by the World Health Organization. At the same time, climate change is making warmer days and heat extremes more common. Understanding how temperature affects daily movement is therefore not just a lifestyle question, but also a public health and climate adaptation one. In our study of teenagers in the Netherlands and Spain, we found that warmer days were linked to more light and moderate physical activity, such as walking and cycling, but not to more vigorous activity, such as running or intense sports.

Beyond Questionnaires: Tracking Movement with Wearable Tech

We looked at how everyday temperature exposure was related to the time adolescents spent being physically active at different intensity levels: light (like yoga and walking), moderate (like cycling), and vigorous (like playing soccer). We used data from two European cohorts: The Generation R Study in the Netherlands and the INMA Project in Spain.

Warmth may invite adolescents to move more, to walk, cycle, stroll, play casually, or be outdoors, but it does not seem to push them towards higher-intensity activity such as running, fast sports, or strenuous exercise

Instead of relying on questionnaires, we used wrist-worn motion sensors, which is wearable technology that records movement throughout the day. We also linked each teenagers’ activity data to temperature levels at their home address. Importantly, we did not only look at the temperature on the day of the activity, but we considered the temperatures of the previous days, because yesterday’s weather may still influence how much someone feels like moving today.

Warmth Encourages Light Activity…

The main finding was clear: adolescents spent more time in light and moderate physical activity on warmer days. In the Dutch cohort, a 5 ºC increase in temperature was linked to around 11 extra minutes of light activity and 5 minutes of moderate activity per day. In the Spanish cohort, the increases were even larger: around 16 minutes of light and 14 minutes of moderate activity. These may sound like small numbers, but when it comes to daily movement, small increases matter and can contribute to meaningfully healthier routines.

…But it Doesn’t Boost Vigorous Activity

But here comes the interesting part: warmer days did not lead to more vigorous activity. This is the paradox at the heart of the study. Warmth may invite adolescents to move more, to walk, cycle, stroll, play casually, or be outdoors, but it does not seem to push them towards higher-intensity activity such as running, fast sports, or strenuous exercise.

Several possible explanations

There are several possible explanations. Light and moderate activities are easier to fit into daily life and are often linked to being outside: walking to school, cycling, meeting friends, or spending time in parks and streets. These activities may feel more attractive when the weather is pleasant. Vigorous activity, on the other hand, may be more structured, such as organized sports or training sessions, which could be less dependent on the weather.

We had limited data from very hot summer days, which means we may not have captured the conditions under which heat becomes a stronger barrier. This is an important point for future research

Another possibility is more biological: as temperatures rise, higher-intensity exercise becomes less comfortable and may place more strain on the body. At some point, heat may stop being a motivator and start becoming a warning signal.

Our study did not find a clear temperature threshold where activity started to decline. One likely reason is that the temperatures observed in our data were moderate. We had limited data from very hot summer days, which means we may not have captured the conditions under which heat becomes a stronger barrier. This is an important point for future research, especially as climate change increases the frequency and intensity of heat events.

Building Climate-Adapted Environments for Healthy Teens

So, what does this mean in practice?

1. Temperature should be considered when designing strategies to promote physical activity among young people. A campaign encouraging teenagers to move more may work different in spring than during a heatwave.
2. Schools, sport clubs, and city councils need to think seriously about climate-adapted activity environments. Shade, trees, drinking water, cooler playgrounds, safe cycling routes, and access to indoor or shaded sports spaces should not be luxuries. They are part of the essential infrastructure needed to help adolescents stay active safely.

Warmer days may encourage teenagers to engage in more light and moderate physical activity, but if we want young people to remain active, healthy, and protected as the climate changes, we need to plan for the heat. Supporting active lifestyles in a warming world means creating environments where all adolescents can move comfortably and safely.

[This post was jointly written by Denise Naniche and Elizabeth Diago, respectively Co-Director and Coordinator of the Preparedness and Response Hub at the Barcelona Institute for Global Health (ISGlobal).]

As of today, May 21^th, there have been approximately 600 suspected cases and 139 suspected deaths from the deadly Bundibugyo ebolavirus in the northeastern Ituri province in the Democratic Republic of Congo (DRC). The first reported case was a health worker who died on April 24^th; then on May 5^th the WHO was informed of a cluster of an unknown illness with high mortality in health workers, and dispatched a rapid response team. The epidemic was declared a public health emergency of international concern (PHEIC) on May 15th. Since then, the WHO and international organizations have launched emergency control activities.

The lost weeks between the first death and declaration of the PHEIC allowed the virus to spread to a wide network of contacts and across borders. While the DRC has experience managing past Ebola outbreaks, the current crisis presents unique challenges. Unlike the more common Zaire ebolavirus, there are no commonly used diagnostic tests which significantly delayed the identification of the disease, nor approved vaccines or specific therapeutic treatments for the Bundibugyo strain. Consequently, management relies on public health measures: active operational case detection based on symptoms and epidemiological links, isolation, contact tracing, and safe burial practices.

A perfect storm

If we rewind a bit, we can see elements of a perfect storm. First, the capacity to respond to and contain an outbreak depends heavily on pre-existing infrastructure. The Ituri Province has experienced decades of armed conflict, creating a prolonged humanitarian crisis that complicates healthcare delivery.

Second, this fragile health system was further strained in July 2025, by the United States administration’s elimination of its approximately $9 billion in aid funding destined for the DRC. These funds were vital for essential health services, HIV programs, and disease surveillance. Local health systems were thus forced to scale down basic operations, which likely included reducing expenditures on infection control and surveillance networks: the very tools needed to sound the alert for the initial cases in Ituri.

Finally, while public health professionals were attempting to contain the spreading Bundibugyo virus in DRC, a separate health event occurred in another part of the world. On May 2^nd, the WHO received reports of a cluster of the deadly Andes hantavirus disease among passengers on the cruise ship MV Hondius. The international response was rapid: by May 10^th, the affected individuals, primarily from Europe and North America, were evacuated and quarantined in their respective home countries. As of today’s, date, the hantavirus outbreak has resulted in 11 cases and 3 deaths, and the WHO classified the global risk to the general population as "low."

Hantavirus-Ebola: two crises, two standards

While the hantavirus cases received swift and extensive media attention across global outlets, coverage of the Ebola outbreak in the DRC appeared less visible and delayed until having reached a dramatic death toll and the WHO declaration of Public Health Emergency of International Concern. This brings us to the overarching theme of equity.

While the hantavirus cases received swift and extensive media attention across global outlets, coverage of the Ebola outbreak in the DRC appeared less visible and delayed until having reached a dramatic death toll and the WHO declaration of Public Health Emergency of International Concern

The apparent difference in media attention is not new. Global news priorities can be influenced by geographical proximity or by the origin of the populations affected, rather than by the level of public health risk. When this trend is replicated in access to resources such as vaccines, low- and middle-income countries are directly disadvantaged, as we witnessed during the Covid-19 pandemic. We need to ensure that the trend in media coverage is not mirrored by international political will and mobilization of resources for the current Bundibugyo-ebolavirus outbreak.

Putting the '100-Day Mission' to its ultimate test

The declaration of a PHEIC on May 15 activates international frameworks and specifically the 100-Day Mission which is a global initiative spearheaded by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by international organization, global political leaders and the private sector in 2021. The objective of this mission is to develop diagnostics, initial therapeutics, and vaccine candidates within 100 days of an outbreak declaration.

We have a responsibility to treat every outbreak as though it were occurring in our backyard

This framework was utilized for the first time during the 2024 Marburg virus outbreak in Rwanda, facilitating clinical trials for investigational vaccines for an epidemic that remained local and was rapidly contained. The current outbreak in the DRC may represent a more stringent test of the 100-day mission due to the magnitude of its spread and the absence of a specific rapid diagnostic test. As the WHO assembly convenes this month and discusses aspects of equity in the pandemic agreement and benefits sharing across the north and south, we have a responsibility to treat every outbreak as though it were occurring in our backyard, because in an interconnected world, it actually is. 

[Elizabet Diago is the coordinator of the Preparedness and Response Hub at the Barcelona Institute for Global Health (ISGlobal).]

Reading time: 7 minutes.

On May 10, the cruise ship MV Hondius anchored at the port of Granadilla de Abona, in Tenerife. Spain. On board were 151 people from 23 nationalities and an outbreak of the Andes virus, the strain of hantavirus capable of human-to-human transmission. The outbreak has already caused three deaths and 10 confirmed cases, while dozens of people remain under monitoring.

It is a scene nobody expected in the Canary Islands: personnel in protective suits, buses from the Military Emergency Unit (UME), staggered evacuations, and protests outside the port.

The MV Hondius crisis is not only a health emergency. It is also an urgent lesson in why pandemic preparedness matters, why international response mechanisms are indispensable and, above all, why the failure to properly fund these systems is a mistake we could pay dearly for in the near future.

Why Spain had to respond

There has been debate over whether Spain was obliged to receive the cruise ship. The answer is clear: Spain acted in compliance with the legal obligations derived from the International Health Regulations (IHR), created in 2005 in response to another international health emergency, the 2002–2004 SARS coronavirus outbreak. The World Health Organization (WHO) simply invoked them when formally requesting support to receive the vessel. The IHR are not an external imposition: they are a treaty ratified by Spain (and 195 other WHO member states) that reflects a basic principle of global health: a health emergency anywhere is a shared responsibility.

This crisis should not make us question whether welcoming the ship was the right thing to do —it was— but rather why the global system, which should have contained this outbreak much earlier, still has so many gaps

Article 13.1 of the IHR requires states to develop core capacities to respond to public health emergencies, including diagnostic laboratories, adequate isolation units, properly trained personnel and international evacuation logistics. WHO considered that the Canary Islands had these capacities. Cape Verde, the first port the ship attempted to approach, did not. This asymmetry in capacities between countries is exactly the problem the IHR were designed to correct, and we still have not solved it.

Spain’s response followed a fundamental principle, expressed by Prime Minister Sánchez in recent days: “ask for help when needed and offer it when capable.” In this sense, the operation has been exemplary. This crisis should not make us question whether welcoming the ship was the right thing to do —it was— but rather why the global system, which should have contained this outbreak much earlier, still has so many gaps. One of the most evident relates to the Pandemic Agreement.

A historic agreement stranded by political differences

In May 2025, WHO member states adopted by consensus the first global Pandemic Agreement, the result of more than three years of negotiations. Its purpose was to address the gaps and inequalities revealed during the international response to COVID-19. It was real progress. But the agreement still lacks a critical piece: Article 12, dealing with the pathogen access and benefit-sharing system (PABS), without which the text cannot be opened for signature or enter into force. Negotiations have stalled over disagreements between high-income and low- and middle-income countries regarding equitable access to vaccines and contributions from the pharmaceutical industry, extending negotiations until May 2027. Once these differences are resolved, the agreement will still require ratification by 60 countries to enter into force.

The road ahead is long and the context is not helping: Argentina announced its withdrawal from WHO in March, following the steps of the United States. Health multilateralism is not only unfinished: it is under direct attack from some of the most relevant actors, precisely when it is most needed

The road ahead is long and the context is not helping: Argentina announced its withdrawal from WHO in March, following the steps of the United States. Health multilateralism is not only unfinished: it is under direct attack from some of the most relevant actors, precisely when it is most needed.

Aid cuts threaten to turn the IHR into dead letter

The IHR and the Pandemic Agreement are only as strong as the health systems implementing them. And those systems are losing funding at an alarming speed.

The United States accounted for approximately 40% of all global development aid. The dismantling of USAID is leaving a gap that nobody has filled. On top of that, its withdrawal from WHO has resulted in the loss of nearly 15% of the organisation’s total budget, forcing it to cut almost 3,000 jobs (22% of its workforce) by mid-2025. These cuts directly affect the strengthening of health systems in developing countries: nearly 24 million people are at risk of losing access to essential health services, and more than 2,600 facilities have already suspended services in crisis areas. And it is not only the United States: the United Kingdom, France, Germany and the Netherlands have also reduced their global health cooperation budgets.

The IHR and the Pandemic Agreement are only as strong as the health systems implementing them. And those systems are losing funding at an alarming speed

What is being cut is not abstract aid. These are surveillance systems and laboratories that detect outbreaks before they reach a cruise ship. It is community health personnel identifying index cases and having the resources needed to manage them safely and effectively. These are the data systems that make coordinated responses like that of the MV Hondius possible. Without this infrastructure, the IHR become dead letter.

The lesson from Tenerife

The management of the MV Hondius crisis is still ongoing and it is too early to draw definitive lessons. But the mere fact that Spain was able to respond with laboratories, protocols, specialised personnel and international coordination demonstrates the difference that prepared systems make. That difference is precisely what the IHR and the Pandemic Agreement seek to guarantee for all countries, not only those that already have the necessary resources.

Recent studies estimate nearly a 50% probability that within the next decade we will face another health crisis comparable in scale to COVID-19. In this case, hantavirus arrived from the South Atlantic aboard a cruise ship. The next threat will come from somewhere else, under another name. We cannot control when it will appear, but we can control the investment in systems, agreements and coordination that allow us to prevent, prepare and respond together. What happened ten days ago demonstrates that a better prepared world is possible. But it cannot be built by stripping it of financial and legal resources.

Reading time: 10 minutes.

The global average temperature has already temporarily exceeded the 1.5°C threshold above pre-industrial levels, a central limit of the Paris Agreement. Crossing this level permanently increases the risk of triggering major climate tipping points. Humanity appears to have taken stable climate conditions for granted.

Recent landmark international rulings, among which the 2025 International Court of Justice Advisory Opinion on climate change, confirm that States are legally bound to prevent foreseeable harm to the global climate system. Moreover, the Paris Agreement’s 1.5°C target has now solidified into binding international law, even as the global average temperature has already exceeded this threshold for three consecutive years.

The right to self-determination is now threatened by greenhouse gas emissions from high-emitting States. As climate change submerges islands, thaws the Arctic, and renders regions uninhabitable, it is breaking the promise of self-determination. What is needed is a decisive legal movement to drive climate action, prioritizing survival, dignity, equal rights, and a habitable planet for all.

When changes to the climate system become irreversible

The EU-funded TipESM project is generating critical data on early warning signs of climate tipping points such as the collapse of the Atlantic Meridional Overturning Circulation (AMOC) or the dieback of the Amazon rainforest, and their impacts on ecosystems, health, society, and habitability.

Extreme weather events like the 2024 Valencia floods (12% more intense due to climate change) and 2025 LA fires (36% more likely as a result of climate change) are making the reality of climate change impossible to ignore. Meanwhile, climate tipping points, irreversible shifts in the Earth system, are approaching. The AMOC, Greenland and West Antarctic ice sheets, and the Amazon rainforest are among the most concerning.

If the Amazon collapses, for example, it could add up to 0.5°C of additional warming. The AMOC may stop by century's end, with devastating effects on Europe.

If the Amazon collapses, for example, it could add up to 0.5°C of additional warming. The AMOC may stop by century's end, with devastating effects on Europe. Greenland holds enough ice for 7 metres of sea level rise. Once these systems tip, there's no going back. Cutting greenhouse gases can still reduce the future likelihood of climate extremes. However, once certain tipping points are crossed, they will trigger a new set of climate extremes that we cannot reverse, even if we later lower emissions. That's why tipping points pose a greater threat than climate change on its own.

The tipping of the Amazon rainforest

Climate change, combined with human-driven Amazon degradation (already 38% degraded and ~17% cleared), could push the forest toward partial or complete collapse, turning lush rainforest into savanna. This tipping point may occur at 2-4°C of warming, making the Paris Agreement's 1.5-2°C target a safe boundary, only if additional deforestation stays below 20%. An Amazon collapse would threaten water and food security, increase warming, drive species extinction, spread infectious diseases, and trigger mass migration and political crises. Advanced models already suggest partial dieback may begin this century, although regional dynamics remain uncertain.

No one should be expected to live under deadly heat

A fundamental question also emerges: “What legal framework exists for loss of habitability caused by climate tipping points or extreme heat?” While some low-lying island nations have relocation plans tied to sea-level rise, extreme heat, a major driver of climate-related deaths, remains dangerously under-monitored, especially in the Global South. In spring 2024, West Africa and the Sahel experienced unprecedented heatwaves, with half the continent seeing anomalies of 10°C above average. Yet we know little about the human impact.

Adaptation is feasible at 1.5°C, difficult and costly at 2°C, and beyond 3°C we hit a hard adaptation limit or a tipping point. Current pledges put us on track for 2.6-2.8°C of warming by late century.

For example, one African region recorded a full month above 30°C Wet Bulb Global Temperature (WBGT; which is considered very dangerous), with half the days exceeding 33°C WBGT (which is considered extremely dangerous). By comparison, Paris's 2003 heatwave, which caused 1,000 excess deaths, never crossed 30°C WBGT. Heat deaths in African nations remain largely uncounted.

At 3°C of warming, 1.7 billion people, mainly in West Africa, the Arabian Peninsula, Northern India, and Southeast Asia, would face at least one week per year of deadly heat stress. Impacts vary by age, health, work, acclimatization, and access to water. Having this in consideration, scientists and legal experts must work together to define vulnerability thresholds and assess survivability. No one should be expected to live under deadly heat. On the current emissions path, certain areas will exceed survivable thresholds, leading to higher mortality, illness, livestock loss, and crop failure. Better heat-health warning systems are therefore urgently needed. Adaptation is feasible at 1.5°C, difficult and costly at 2°C, and beyond 3°C we hit a hard adaptation limit or a tipping point. Current pledges put us on track for 2.6-2.8°C of warming by late century.

The right to a dignified, livable existence

As Elisa Morgera (UN Special Rapporteur on Climate Change) notes, although scientists and legal professionals operate under different standards of certainty, international law clarifies that all States have an obligation to apply the highest ambition to prevent significant environmental harm.

Tipping points have measurable impacts on all human rights, among them access to water, food, health and dignified, livable existence, which are threatened beyond precedent. States must therefore monitor these risks to develop targeted protections.

Even if we don't know exactly when tipping points will be crossed, there is enough evidence that we are heading toward irreversible, significant harm and we should act now. The precautionary principle applies. Moreover, different climate tipping points are intricately connected, meaning their impacts transcend borders and challenge traditional domestic versus extraterritorial human rights frameworks.

Breaking the addiction

A rational person slows down in the face of danger, but an addict keeps going. This powerful metaphor, used by Benjamin Schachter (from the Office of the UN High Commissioner for Human Rights) highlights our addiction to fossil fuels. The AMOC and Amazon are Earth's vital organs –if we damage them irreversibly, we head toward a "life-support planet" or a fundamentally different state of being.

And yet we are not reducing emissions. Human rights offer a framework to turn science into better policy. Even if some tipping points have already been triggered, we can still change course, provided decision-making is informed by human rights. The precautionary principle says higher risk demands greater prevention. Yet we pour money into humanitarian disasters while neglecting far more effective and economical prevention. Human rights-based measures are more sustainable. We need to break our addiction to the fossil fuel economy before large parts of the planet cease to be safely habitable.

[This article draws on discussions held during a side event on “Human Rights and Climate Tipping Points” at the 61st session of the UN Human Rights Council (March 2026), with the participation of the UN Special Rapporteur on Climate Change and Human Rights, as well as scientists and legal experts from the Climate and Planetary Change Hub at ISGlobal, the IRD France, the UK Met Office, Just Atonement Inc. and the UN Human Rights Office.]

The event was organized within the EU-funded TipESM project and the recording can be watched here:

During pregnancy, the fetus may be exposed to invisible chemicals present in everyday products, some of which can interfere with development even before birth.

The endocrine system is a chemical messaging network in the body made up of glands, hormones, and receptors that regulate essential functions such as metabolism, sleep, growth, and reproduction.

During pregnancy, this system plays a particularly critical role. It is one of the most sensitive stages of human life, during which essential biological processes for adult life are “programmed.” The placenta itself acts as an endocrine organ, coordinating hormonal signals between mother and fetus to ensure proper fetal development, maintain a healthy pregnancy, and prepare the body for birth and breastfeeding.

In this context, environmental exposures may interfere with the developing endocrine system and disrupt this delicate biological balance.

What are endocrine disruptors?

Endocrine-disrupting chemicals are substances capable of interfering with the normal functions of the hormone system. They may imitate, block, or alter the signal of certain hormones in the body. Endocrine-disrupting chemicals are found almost everywhere in everyday products, including plastics, food packaging, cosmetics, and cleaning products. Unfortunately, the science is increasingly clear that pregnant persons and their babies are exposed to these chemicals and that their effects can last far beyond the delivery room

Why pregnancy is a particularly vulnerable period

Pregnancy is one of the most hormonally sensitive periods in human life, thus it is also one of the most vulnerable. Endocrine-disrupting chemicals have been detected in the placenta, cord blood, and amniotic fluid, showing that they can directly reach the developing fetus. After pregnancy, they can also appear in breast milk. Research has linked prenatal endocrine-disrupting chemicals exposure to a range of health effects in newborns and children such as decreased birth weight, altered growth trajectories, poorer lung function, metabolic syndrome, and even differences in brain development.

Plastics as a major source of chemical exposure

Plastics are one of the most significant sources of endocrine-disrupting chemical exposure in daily life, and they are almost everywhere during pregnancy: food containers, water bottles, the lining of canned foods, and in personal care products that we apply to our skin. Bisphenols, like BPA and BPS, phthalates, and PFAS ("forever chemicals") are among the most studied plastic chemicals known to have endocrine disrupting effects. Heating or blending food in plastic containers accelerates the migration of these substances into food and is associated with higher levels of these chemicals in the body, as well as increased consumption of fast food or prepared food.

The “mixture effect”: understanding real-world exposure

What makes this especially complex is what scientists call ‘the mixture effect’. In real life, we are never exposed to just one endocrine-disrupting chemicals at a time, but rather, we are exposed to dozens or more simultaneously, each arriving from a different source. These chemicals enter our body via inhalation of the air, orally through consumption of food and water, and by dermal absorption when we apply products or wear synthetic fibers. Researchers have specifically studied how multiple combinations of endocrine-disrupting chemicals affect children's health, offering a more realistic picture of actual human exposure. One such analysis found that a mixture of persistent organic pollutants was associated with a greater risk of accelerated BMI gain in children. This is an important finding because rapid increase in BMI is linked to obesity, cardiovascular disease, and diabetes later in adulthood.

What is science doing to understand these risks?

Two major European-funded research projects taking place at ISGlobal and other research institutions across Europe are working to fill critical knowledge gaps:

• ATHLETE — Advancing Tools for Human Early Lifecourse Exposome Research and Translation — aims to better understand and prevent health damage from numerous environmental hazards and their mixtures, starting from the earliest stages of life during pregnancy. The project is building on data from existing exposome cohorts that cover the first 18 years of life. 
• AURORA is the Actionable European Roadmap for Early-life Health Risk Assessment of Micro- and nanoplastics. Its focus is specifically on microplastic and nanoplastic particles in the placenta, an issue of increasing concern given the ubiquity of plastics in the environment. The project investigates plastic exposures and health effects during pregnancy, in utero, and in early life and establishes a framework for plastics research in the future. Researchers have already found microplastics in the placenta and umbilical cord, underscoring the urgency of understanding their impact on reproductive health and infancy.

Together, these projects represent a significant European investment in understanding not just individual chemicals, but the full complexity of what we are all exposed to.

How to reduce exposure during pregnancy

Our health is shaped by many factors, and small steps in daily life can genuinely reduce exposure without uprooting your routine. We don’t have to change everything all at once. We can choose wisely when it's time to buy something new, or avoid daily use of products that we know can be harmful. Some practical choices that matter most during pregnancy:

• Avoid heating food in plastic containers; use glass or ceramic instead. Avoid take-away food as much as possible, or bring your own containers
• Choose glass, stainless steel, or ceramic water bottles and cookware
• Use a water filter at home instead of drinking water from plastic bottles
• Opt for fragrance-free personal care products and check labels for parabens, phthalates, and triclosan, or reduce daily use as much as possible
• Limit processed and canned foods; choose fresh, organic, and locally grown produce whenever possible.
• Ventilate your home regularly (2x per day) and clean dust thoroughly using a wet, cotton cloth as many EDCs and microplastics accumulate in indoor dust
• Choose natural fabrics when possible (cotton, linen, wool) and avoid polyester

Beyond individual choices: a collective approach

Beyond individual choices, systemic change requires collective action. Supporting stricter endocrine-disrupting chemicals regulation and choosing brands with transparent ingredient policies are all ways of supporting systemic change. How we care for pregnant persons and our children contributes to the future of everyone. Extending that care to the everyday choices we make from what we choose to put on our skin, where we source our food, or the products we purchase all matters more than we might think for our daily well being and for future generations. Reducing exposure during pregnancy is not about perfection — it’s about bringing more awareness to our daily habits and protecting the earliest stages of life.

Reading time: 5 minutes

The evidence is getting sharper, but our attention is drifting. The 2026 Lancet Countdown Europe Report arrives at a critical crossroads: climate impacts are hitting health systems harder than ever, yet political urgency is stalling.

For the EU, and specifically for Spain, the "health window" is narrowing. Here is what the data tells us about our path forward.

1) Heat is no longer seasonal - it’s structural;

Rising heat‑attributable mortality and the surge in extreme heat warnings are more than simple alarming statistics. Heat is already an environmental hazard for our health. It changes who can work safely outdoors, when and how people move, sleep, learn, and exercise, and how health systems plan capacity and response across the region.

Heat needs to go beyond the seasonal planning. It needs to be treated as a cross‑cutting determinant of health

Heat needs to go beyond the seasonal planning. It needs to be treated as a cross‑cutting determinant of health, embedded into urban planning, labour regulation, housing standards, and health system resilience. As such, when we work on climate adaptation and resilience, we need to incorporate health at the center of such policies, as already requested by numerous civil society organisations.

The practical question for Spain is whether heat-health plans are supported with resources and financing to the level that matches the risk, and whether they reach the people least able to self‑protect

In Spain, this is even more immediate. Spain already experiences some of Europe’s most severe heat extremes, and the exposure concentrates in vulnerable groups: older adults, infants, workers exposed to outdoor heat, and households in poor-quality housing. The practical question for Spain is whether heat-health plans are supported with resources and financing to the level that matches the risk, and whether they reach the people least able to self‑protect.

In practice this means:

• Heat-health plans that are operational, local, and evaluated, not just published.
• Enforceable occupational heat protection, e.g. schedule shifts, hydration, and appropriate shade (also for informal and seasonal workers)
• Health-protective infrastructure (housing, shading, ventilation, cooling)

2) Europe is paying twice for fossil dependence

One of the most policy-relevant findings in the report is that Europe’s fossil fuel exposure is not only a climate problem; it is also an economic fragility point that shows up in household bills, government budgets, and health outcomes. The spike in subsidies during recent energy price shocks illustrates the trap we are in: when energy systems are dependent on volatile fossil markets, governments end up spending public money to buffer citizens from those markets. That is politically understandable in the short term, but it also delays the structural fix.

One of the most policy-relevant findings in the report is that Europe’s fossil fuel exposure is not only a climate problem; it is also an economic fragility point that shows up in household bills, government budgets, and health outcomes

The report’s new indicator on solid biomass adds onto this point. Treating high‑pollution household fuels as “renewable” in practice can shift emissions categories without delivering the health benefits that we expect from clean energy. That shows up in residential air pollution and avoidable mortality, reminding us that inequalities shape this difference, making it a priority to governments to transition to cleaner energy sources in the residential sector.

At the national and the EU level, energy security, affordability, and health are now inseparable policy objectives. If subsidy regimes are needed, they should be designed to accelerate the energy transition, with investment in efficiency, heat pumps, grid upgrades, rather than locking into fossil fuels’ consumption.

If subsidy regimes are needed, they should be designed to accelerate the energy transition, with investment in efficiency, heat pumps, grid upgrades, rather than locking into fossil fuels’ consumption

Certainly Spain has had a lesser impact of ongoing conflicts that have driven energy prices up, due to the large investment in renewables earlier in the century. Fossil fuel reliance contributes to this fluctuation, and accelerating transition to clean and sustainable energy can counter this and avoid overburdening citizens and governments’ pockets alike. 

3) Attention is declining while risks are rising 

The report’s observation that climate-health engagement is stalling in key political spaces and public opinion matters because attention is an upstream determinant of action. When the health case is not consistently made, climate policy becomes easier to frame as a cost rather than a protection strategy. That framing tends to weaken ambition precisely when the benefits of action, such as cleaner air, fewer heat deaths, and lower inequalities, are most tangible.

When the health case is not consistently made, climate policy becomes easier to frame as a cost rather than a protection strategy

At EU level, climate and health must move beyond episodic messaging into institutional anchoring, through health impact assessments embedded in climate, energy, transport, and fiscal policy, tighter integration between public health and climate governance, and health metrics tracked alongside emissions in mainstream policy review cycles. As mentioned before, frameworks on climate adaptation and resilience must place the health and well-being of their populations at the centre of such policies.

Bringing health co-benefits into climate policies must also be applied at national and local levels. That is a narrative that can be adopted in municipal governments when designing cooler neighbourhoods; regional health services planning for heat seasons; and national economic policy prioritising resilience and clean energy investments, and decreasing funding for fossil fuel subsidies.

4) Europe has the evidence - now it needs the attention

The Lancet Countdown’s value is that it makes the links visible: between temperature and mortality, between energy and public budgets, between policy priorities and preventable health impacts. The strategic choice for Europe is whether to keep treating these as parallel problems or to act on them as one integrated agenda that keeps impacting one another. Spain, given its exposure to heat and its capacity for renewables-led transition, has both a strong incentive and a credible platform to lead on that integration.

Reading Time: 4 minutes.

Imagine Spencer Silver, a chemist in the 3M company laboratory in Minnesota, back in 1968. He has a special assignment: to find the strongest and most resistant adhesive possible for the aerospace industry. However, during one of the tests, he finds quite the opposite: a glue made of acrylic microspheres that peels off very easily. A setback? Well, a scientist is used to failure.

Let's fast forward a few years. 1974. Now you see Art Fry, another researcher who sings in his church choir once a week. What annoys him most is that every time he leaves small pieces of paper to mark the song pages, they disappear by the following week, and he has to start searching for every page all over again. Art Fry also works at 3M and has attended several of Spencer Silver's seminars where he uses that "useless" adhesive, but Fry finds it perfect for sticking small notes.

Art Fry believes they will work as bookmarks for his hymnal. He tries it out and sees they can be removed without tearing the pages. He meets with Silver and they brainstorm. They have something small yet big at the same time. The Post-it was born—that sticky note that has helped us so many times not to forget important tasks.

New solutions to old problems

From that Post-it idea, the ISGlobal Note-olvides initiative was also born now, in 2026, to raise awareness and funds for scientific research seeking answers to malaria and neglected diseases, as they are often called, even though they affect more than a billion people, especially in developing countries.

Fry says that research consists of finding new solutions to old problems. That’s what Hernando del Portillo must have thought, leading the malaria and neglected parasitic diseases program in the midst of a global funding crisis for medical research on these ailments.

Fry says that research consists of finding new solutions to old problems. That’s what Hernando del Portillo must have thought, leading the malaria and neglected parasitic diseases program in the midst of a global funding crisis for medical research on these ailments. “What can we do?” he asked. Immediately, Rafa Vilsanjuán and the entire ISGlobal team bet on an awareness and fundraising initiative that would reach the public.

I have been fortunate enough to collaborate on the creation of this campaign with Jorge Martínez, a highly experienced creative, who connected the concept of forgetting with humor, which is so closely linked to science. Without humor, it would be impossible to deal with failure.

But don't forget about...

Jorge remembered a phrase by the unforgettable Antonio Fraguas (Forges) that was a recurring theme in some of his cartoons: “But don’t forget about…” The first one was after the earthquake in Haiti (“But don’t forget about Haiti”) and he later used it for many other neglected causes.

And here comes the wonderful coincidence that happens when things get moving. Berta Fraguas, Forges' daughter, is a friend of Irene Losada, a doctor and researcher at ISGlobal specializing in Chagas disease, and the current director Quique Bassat. In fact, Forges drew a cartoon for Bassat’s medical school promotion. Thanks to the Forges family, we have a cover cartoon for the project.

From then on, we contacted dozens of graphic humorists from Latin America, Spain, and the United States who collaborated without hesitation. From Peridis to Nani, from Julio Rey to Eneko, among many others, each sent a drawing related to neglected diseases painted on a Post-it. We even discovered an illustrator working at ISGlobal, Alba García. All of this is collected in a wonderful little book published by the Lunwerg label (Planeta Group), available in both print and online formats. The book features short texts by scientists like María Elena Bottazzi or the director of Gavi, Sania Nishtar, and storytellers like Cuban author Leonardo Padura or the comedian and trained doctor Gran Wyoming. After a presentation at Casa del Libro in Madrid, it will continue to be presented at various fairs and events across Spain. You can buy the book in print or online. You can also contribute to this initiative to raise funds for research into malaria and neglected diseases by making a donation via Bizum to 02948.

When it matters, stick with it

By the way, you are also in time to bid online for some of the original cartoons remaining in an online auction. The proceeds will go to the research projects carried out by ISGlobal.

And I don't want to forget (I have it written down on a Post-it) to tell you something beautiful that happened to us. During the campaign's development, we managed to contact Art Fry. He is still in Minneapolis at 95 years old. He had the wonderful gesture of sending us a Post-it, not with a drawing, but with this phrase: “When it matters, stick with it”

Reading time: 5 minutes.

[This excerpt is from the book “Graphic Humour Against Forgetting” (Lunwerg Editores, Grupo Planeta), which features the illustrations created for the Note-olvides campaign. Leonardo Padura and El Gran Wyoming wrote the foreword and epilogue respectively.]

The word “Chagas” was first a night and a child. A night in 2005, in Managua, Nicaragua. A 9-year-old child in his mother's arms.

His mother lays him in a casket and places beside him, one by one, the toys he had kept since he was little: stuffed animals, a small baseball, and something I cannot identify. Belongings of his history, companions for the passage, with which the pharaohs' children were also buried. His mother is a doctor and a friend. Her son had undergone emergency surgery for appendicitis, but his heart could not take it. They said he had a previous condition that went undetected. Another doctor said: “It is possible he had Chagas.” 30% of those who contract it can develop severe heart problems, among other pathologies. Occasionally, it can cause sudden death.

I have never seen a pain more silent, more invisible, than that of a mother laying toys beside her child's body

The boy used to spend weekends at a small family farm in an endemic area, inhabited by kissing bugs, the vector (triatomine) that transmits the parasite. Since that night, I tell myself that I have never seen a pain more silent, more invisible, than that of a mother laying toys beside her child's body. And I relive it in every image of war, natural disaster, or any other tragedy.

Two words that weigh like stones

Since its discovery by the Brazilian doctor who gave it its name, more than a hundred years ago, Chagas has been described in two words that weigh like stones: invisible-silent. Because its symptoms often go unnoticed until it is too late. A treacherous disease. And somewhat strange. Many other people live with the infection and are never affected. It is as if it chose its victims by some unknown chance. The insect, which inhabits rural and urban areas in 21 Latin American countries and the southern United States, usually bites at night; it defecates over the bite, introducing the infection into the body, especially if the person accidentally scratches it. Other times it infects food and drinks, as happens in some Amazonian regions.

Its symptoms often go unnoticed until it is too late. A treacherous disease. And somewhat strange. Many other people live with the infection and are never affected

In Europe, there are tens of thousands of people living with Chagas, with Spain leading the way due to migratory movements. But beyond insect transmission, it can also be contracted congenitally, through laboratory accidents, blood transfusions, or organ transplants that have not been screened.

Fortunately, there are treatments and diagnostics. They are not perfect, but they work, especially at early ages and when the infection is detected in time. However, most do not receive them.

"This girl is not going to die of Chagas on my watch"

When I started working at Doctors Without Borders (MSF), I learned more about this disease, which is the metaphor for neglect and loneliness in Latin America. And later, for me, Chagas became a woman. Another woman and mother.

I met her in Mexico, seven years ago. Her name is Elvira. Her daughter, the only girl of three siblings, was diagnosed with Chagas at eighteen, just as she was deciding what to study. The doctors who treated her lacked knowledge about the disease and told her not to make many plans for the future. The young woman did not back down and trusted her mother. So Elvira moved heaven and earth; she searched the internet until she contacted an Argentine doctor who guided her through the process. “This girl is not going to die of Chagas on my watch,” she promised herself. Today, Yaya, her daughter, is a lawyer in her thirties, healthy and infection-free after completing her treatment.

The young woman did not back down and trusted her mother. Today she is a lawyer in her thirties, healthy and infection-free after completing her treatment

I am not a doctor or a scientist, but an intruder in global health coming from communication and philology—from the world of words. But I have worked to translate the complicated words of science into a closer language. It is like searching for hidden words. For this, I have also collaborated with the Global Chagas Coalition, alongside ISGlobal. And that is why, for me, Chagas now also means “the second chance.” After more than a hundred years of patients, researchers, and clinicians fighting the disease, we know that it can be eliminated as a public health problem. And that allows us to dream of the magic of scientific work. An hypothesis is, after all, the formulation of a hope.

García Márquez, in his Nobel Prize for Literature speech, claimed the right to believe “that it is not yet too late to engage in the creation of a new utopia of life, where no one can decide for others even how they die, and where the races condemned to one hundred years of solitude have, at last and forever, a second chance on earth.”

I believe in that. And when I don’t, I read it again, to remember what is kept there, hidden, without being caught by silence or oblivion.

Reading time: 3 minuts

[This text is a collaboration between Women in Global Health (WGH) Spain and ISGlobal.]

Imagine a woman arriving at the emergency room with fatigue, nausea, and persistent pain in her jaw or back. It hasn't even crossed her mind that it could be a heart attack, because she has always heard that she would feel the classic pain in her chest or left arm. It is very likely that the medical staff won't suspect it at first either. However, she may be suffering from a heart attack.

On the occasion of Public Health Week 2026, we are shining a light on women's cardiovascular health. We cannot continue to ignore the fact that the leading cause of death in women remains under-researched, underdiagnosed, and underestimated.

Cardiovascular diseases are the leading cause of death for women worldwide (responsible for 8.6 million deaths per year), and yet they remain largely "invisible." Modern medicine was built on a male standard model and today, in the heart of 2026, women continue to pay the price of this heritage with their own lives.

The research gap: women absent from the evidence base

For decades, clinical research has been developed under an androcentric bias: men were studied and it was assumed that the results were applicable to the entire population. By not including enough women in clinical trials, much of the evidence used for the diagnosis and treatment of current diseases comes mainly from male populations. This has created a fundamental problem. We are applying medical evidence that does not adequately represent half of the population: women.

For decades, clinical research has been developed under an androcentric bias: men were studied and it was assumed that the results were applicable to the entire population

This historical exclusion has created what we know as the invisible burden of disease. It is not that women do not suffer from cardiovascular diseases; it is that science has not looked at their cardiovascular system through the same lens.

When symptoms deviate from the "classic"

The research gap translates into a dramatic reality in the doctor's office:

• Misleading symptoms: Women often present with cardiovascular symptoms that differ from the “classic” signs described in men. Instead of the characteristic chest pain, a heart attack in women can present as fatigue, nausea, jaw pain, shortness of breath, or back pain.
• Diagnostic errors: Due to these different symptoms, it is estimated that up to 50% of women are misdiagnosed or diagnosed at stages that are far too advanced.
• Misperception: A survey of 8,000 people revealed that only 34% identified cardiovascular disease as the leading cause of death in women. They wrongly believed that breast cancer was more lethal.

This lack of awareness, both in the general population and among healthcare professionals, means that symptoms can be overlooked, prevention strategies delayed, and resources allocated to other health areas considered higher priorities.

Three pillars for change

To close the gender gap and end gender inequality in research, we must transform the structure of global health—the evidence base.

1. Breaking with the standard model: We cannot apply the male model as the “only” or generalized one. We need to apply science using data that is disaggregated by sex in every clinical trial.
2. Funding with a gender perspective: Investment in women's cardiovascular health remains insufficient compared to the actual magnitude of the problem. We need resources specifically dedicated to understanding women's specific risk factors, clinical symptoms, how to diagnose them optimally, and their response to treatments.
3. Female leadership: Although women make up 70% of the healthcare workforce, we only hold 25% of leadership positions. This lack of female representation in senior research positions influences which research questions receive funding, which studies are prioritized, and how evidence is translated into public policy.

A call to action

Closing the gender gap in cardiovascular health is not just a matter of gender equity; it is an urgent public and global health necessity. To overlook the particularities of the female cardiovascular system is to ignore half of the world's population. Only by transforming the way we research, fund, and diagnose will we ensure that the leading cause of female mortality finally ceases to be an invisible burden.

[This post was jointly written by Raül Toran and Minerva López, science communicators at the Scientific Culture Unit (UCC+i) of ISGlobal.]

What do a series about a transgender activist, a movie about a wealthy 1950s housewife, and a drama about a police officer in northern India have in common? More than it seems. Cinema and series allow us to see how inequalities intersect in people's lives and condition their opportunities, their well-being, and even their health.

Gender, origin, social class, sexual orientation, or age do not act in isolation: they combine and reinforce each other, leading to very different experiences of vulnerability or privilege

Gender, origin, social class, sexual orientation, or age do not act in isolation: they combine and reinforce each other, leading to very different experiences of vulnerability or privilege. This approach, known as intersectionality, helps us understand precisely how these inequalities cross paths.

In scientific research —and especially in the field of global health— this perspective is fundamental. Ignoring the intersection of social factors can lead to incomplete studies and interventions that do not reach those who need them most. Incorporating it, however, allows us to move towards a more rigorous, inclusive, and equitable science.

From ISGlobal's Scientific Culture and Innovation Unit, and within the framework of the European project INCLUDE, we bring together a selection of films and series that invite reflection on these issues from different perspectives.

1. Hidden Figures

This 2016 film tells the unknown story of three African-American female scientists, Katherine G. Johnson, Dorothy Vaughan, and Mary Jackson, who worked at the NASA space agency in the early sixties on the project to put the first American, John Glenn, into orbit.

Scientific knowledge is not neutral

This serves as an example of how intersectionality allows for a critical rereading of the history of science. It shows how scientific knowledge is produced within institutional contexts shaped by hierarchies of gender and racialization. The systematic exclusion of highly qualified African-American women highlights how structural racism and sexism operate together to invisibilize key scientific contributions. For contemporary research, this work invites us to question the criteria for merit, authorship, and recognition, and to reflect on how current scientific systems continue to reproduce inequalities under seemingly objective logic.

Where to watch: RTVE, YouTube, Google Play, Apple TV, Rakuten TV, and Prime Video.

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2. Rurangi

This production, awarded the International Emmy for Best Series, tells the story of Caz Davis returning to his hometown, Rurangi. It is a conservative New Zealand town with an economy based on dairy farming. Caz wants to reunite with his father, whom he hasn't seen since before his transition.

Identity, territory, and indigenous roots

Recognized in festivals such as San Francisco, Melbourne, and LesGaiCineMad, the series explores the difficulties faced by the LGTBIQA+ community when coming out in rural environments. Furthermore, it focuses on the Māori community, showing the daily challenges they face in achieving respect for their language, traditions, culture, and territory.

Where to watch: Filmin.

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3. Far from Heaven

A 2002 American film set in the 1950s in the United States. It tells the story of a wealthy woman whose seemingly perfect life begins to unravel following a marital crisis.

The silent oppression of social norms

Far from Heaven offers a critical look at how dominant social norms generate inequalities at the intersection of gender, race, class, and sexual orientation. The film demonstrates that oppression is not only manifested through direct exclusion, but also through the imposition of life models considered "acceptable," which cause silencing, suffering, and social vulnerability.

Where to watch: Movistar Plus+.

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4. Moonlight

This film, which won the Oscar for Best Picture in 2017, follows the life of Chiron, a gay African-American young man, from childhood to adulthood. It shows his process of identity construction and his relationships in a complex environment in Miami. The work addresses, among other topics, the intersection between homosexuality, racism, and social discrimination in the United States.

Surviving violence, stigma, and precariousness

Moonlight offers an intimate approach to identity construction at the intersection of racialization, masculinity, social class, and sexual dissidence. The film is especially relevant in demonstrating how structural violence, stigma, and precariousness impact mental and emotional health in a cumulative way. It invites us to think about the social determinants that shape these experiences.

Where to watch: Filmin, Amazon Video, and Apple TV.

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5. Santosh

After her husband's death, Santosh inherits his position as a police officer in a police station in a rural area of India. The station is led by Inspector Sharma. The film was the UK's candidate for the Oscar for Best International Feature Film in 2024.

Gender, caste, and institutional power structures

This work highlights how gender inequalities are reinforced by economic precariousness and deeply rooted hierarchical systems. For scientific research, it is particularly relevant as it shows how institutions —including those responsible for ensuring justice and security— can reproduce violence and exclusion, a key aspect for studies on governance, ethics, and equitable access to rights and services.

Where to watch: Filmin.

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6. Master

A 2022 thriller in which two African-American women, a professor and a freshman student, share strange experiences in a predominantly white university in New England (USA).

The hostility of seemingly neutral spaces

Master exposes in both symbolic and explicit ways the tensions that cross academic spaces when gender and race combine as axes of exclusion. The film questions the supposed neutrality of the university environment and reveals how structural racism and sexism affect the experience of students and researchers. Its contribution to the scientific debate is clear: it invites a critical review of institutional cultures, evaluation mechanisms, and the conditions of knowledge production in contemporary academic contexts.

Where to watch: Amazon Prime.

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7. Norwegian Dream

The story focuses on Robert, a Polish immigrant working in a fish factory in Norway to pay off his mother's debts. Despite the harshness of the work, he discovers he feels an attraction to Ivar, a colleague at the plant. He decides to hide his feelings for fear of rejection from his Polish coworkers. When a strike breaks out, loyalties between employees are tested, revealing aspects such as the power of desire, solidarity, and the hope for a better life.

Sexual identity in migratory contexts

This film articulates migration, the working class, sexual dissidence, and national belonging, showing how labor precariousness and migratory status condition the possibility of living one's identity openly. From an intersectional perspective, the work is especially relevant for research in occupational health, mental health, and social rights, by evidencing how structural determinants influence well-being and the support networks available to migrant populations.

Where to watch: Filmin.

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8. Ciao Bambina

This documentary short film, nominated for the 2025 Goya Awards and co-directed by Afioco Gnecco and Carolina Yuste, follows the gender change of Rafi, who began his transition ten months ago. His testosterone treatment is not being easy as no one told him about the emotional changes this process involved. Together with his friend Carolina, who has accompanied him since the beginning of his transition, he will try to reconcile with his current and former self to finally be able to swim in the sea.

Social determinants and the trans experience

The short film provides a sensitive and rarely represented look at the emotional processes associated with gender transition. By focusing on the subjective experience, it questions reductionist biomedical approaches that address transition exclusively from clinical parameters. From intersectionality, it underscores the importance of integrating psychological, social, and relational dimensions in research and healthcare for trans people, avoiding linear or simplified narratives.

Where to watch: Filmin.

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9. 20,000 Species of Bees (20.000 especies de abejas)

This film, nominated for 15 Goya Awards, was one of the great successes of Spanish cinema in 2024. It reveals the necessary story of Cocó, a trans girl in search of her identity. The protagonist achieved a great milestone by winning the Silver Bear of Berlinale at just 10 years old.

Supportive environments and well-being in trans childhood

The film offers a delicate approach to trans childhood, placing gender identity in relation to family, rural environment, and social expectations. Its relevance to the scientific community lies in how it visibilizes early identity construction processes and the importance of supportive environments. The film invites reflection on childhood, gender, and care, fundamental aspects for research in health, education, and public policy.

Where to watch: Movistar + Plus.

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10. Carmen & Lola (Carmen y Lola)

Carmen and Lola are two young Roma women. Carmen is about to get married. Lola, an independent girl who only wants to study, is pressured by her father to find a good Roma husband. One day, the two girls meet while selling at a street market. In a culture where homosexuality is a taboo and young women are destined to marry and have children, this film delves into the challenges the two young protagonists face in maintaining their relationship. This film won two Goya Awards: Best New Director (Arantxa Echevarria) and Best Supporting Actress (Carolina Yuste).

Sexual diversity in specific cultural contexts

Carmen & Lola allows for an analysis of how sexual dissidence is experienced specifically at the intersection of gender, ethnicity, social class, and cultural tradition. The film challenges homogeneous readings of the LGTBIQA+ community and highlights the need for intersectional approaches that recognize the internal diversity of communities. For research, it underscores the importance of avoiding generalizations and incorporating methodologies sensitive to cultural context.

Where to watch: Movistar + Plus.

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Towards a Science That Sees Us All

This selection demonstrates that the stories we consume are, in reality, mirrors of the structural barriers that science tries to break down. From the INCLUDE project, in which ISGlobal participates, we work to ensure that research leaves no one behind, understanding that to improve global health, we must first understand the complexity of human lives.

Would you add any other movie to this list?

Reading time: 4 minutes

As we celebrate World Tuberculosis Day (24 March), it is important to recognize the progress and challenges in the fight against tuberculosis, the disease caused by the bacteria Mycobacterium tuberculosis. Over the past decade, global efforts against tuberculosis have delivered meaningful advances, including expanded access to rapid molecular diagnostics, shorter and more effective treatment regimens, especially for drug resistant tuberculosis, and strengthened political and scientific commitment. These advances have improved case detection, treatment outcomes, and preventive therapy coverage, reinforcing tuberculosis as a central priority in global health. However, persistent knowledge and funding gaps continue to limit the impact and coverage of these public health interventions.

Asymptomatic tuberculosis is a relatively new scientific discovery and a deeper understanding of this disease state could carry significant implications for disease control

Tuberculosis control has traditionally relied on a binary classification of the disease into two tuberculosis states, the so-called “latent” tuberculosis infection and “active” tuberculosis disease. In the last few years, however, several studies have challenged this dichotomous paradigm, suggesting instead that tuberculosis exists along a spectrum of disease. Within this continuum, some individuals have asymptomatic tuberculosis, where Mycobacterium tuberculosis is present and detectable but the individual does not report the typical tuberculosis symptoms, including cough, fever, weight loss, or night sweats. Asymptomatic tuberculosis is a relatively new scientific discovery and a deeper understanding of this disease state could carry significant implications for disease control. That’s where our TB QUEST team comes in.

From left to right: Amuly Chilopola, clinical coordinator of the study, discussing screening and treatment plans with the TB QUEST clinical team; in Manhiça. Joanna Ehrlich, a Research Fellow and scientific coordinator with the TB QUEST project working with the field team to collect data from trackers that objectively monitor symptoms of the project’s patients. Amuly Chilopola carries the portable X-ray machine to the clinic for another day of TB QUEST screenings.

Modeling studies have suggested that up to 68% of global tuberculosis transmission could be attributed to an asymptomatic source. However, there is currently not a single study that shows a secondary tuberculosis case originating from an asymptomatic tuberculosis case. So, the vital question to answer is: does asymptomatic tuberculosis play an important role in global tuberculosis transmission? Excitingly, the epidemiological design of TB QUEST will identify whether asymptomatic tuberculosis transmits similarly to symptomatic tuberculosis with very strong certainty. Recognizing asymptomatic tuberculosis transmission could change global tuberculosis control efforts, highlighting the limitations of symptoms-based case-finding strategies and the urgent need for more sensitive detection methods.

Recognizing asymptomatic tuberculosis transmission could change global tuberculosis control efforts, highlighting the limitations of symptoms-based case-finding strategies and the urgent need for more sensitive detection methods

Diagnosing asymptomatic tuberculosis is far less simple than symptomatic tuberculosis. Despite these difficulties, recent prevalence surveys have uncovered that around 50% of tuberculosis cases are asymptomatic. TB QUEST will also provide key insights to optimize the detection of asymptomatic tuberculosis, combining artificial-intelligence (AI) software, radiological evaluations and bacteriological tests.

Pushing the boundaries of what is known

Researchers at ISGlobal in Barcelona, Spain and the Centro de Investigação de Saúde de Manhiça (CISM) in Manhiça, Mozambique are working together to bridge the research gap through the TB QUEST project, funded by the European Research Council (ERC) and led by Alberto Garcia-Basteiro. Pushing the boundaries of what is known, the TB QUEST project will answer these key questions about asymptomatic tuberculosis and help us understand the role of asymptomatic disease within the natural history of tuberculosis disease development.

Next generation diagnostics, treatment, and active case finding strategies depend heavily on what we know about asymptomatic transmission

Using the highest scientific standards and technological advances, TB QUEST design will allow for maximizing the scientific outputs from the study:

• Firstly, a very large sample of HIV+ participants is being screened, which will provide the number of asymptomatic and symptomatic cases required to observe sufficient secondary transmission, leading to high statistical power and a true representation of variability.
• Secondly, exciting advances in genomic epidemiological methods will help us identify asymptomatic tuberculosis transmission links with strong certainty, and understand the timing and circumstances surrounding transmission events.
• Thirdly, we will identify and explore clinical considerations for multiple asymptomatic tuberculosis phenotypes, including newly postulated stages that may evade common screening strategies using chest x-ray.
• Finally, the inclusion of new, cutting edge tools using AI software will contribute to the objective characterization of asymptomatic tuberculosis, solidifying our understanding of the disease stage within the natural history of tuberculosis.

All in all, it is time to stop focusing solely on the tuberculosis that willingly shows itself to us through symptoms. On this World Tuberculosis Day, we are reminded why this shift in focus is so urgent. Next generation diagnostics, treatment, and active case finding strategies depend heavily on what we know about asymptomatic transmission, which is where the project gets its name: a quest is defined as a search or pursuit made to find or obtain something. TB QUEST searches for the responses to these vital queries and the results will reveal the best path forward for accelerating progress towards tuberculosis elimination.

Reading time: 5 minutes

Accompanied by a local team of translators, health personnel, and boat drivers, and with the support of local indigenous organizations, Guilherme Queiroz and I spent two months conducting fieldwork in the forests of the Bajo Urubamba region, in Peru. This work is part of the INDILEAD project, which assesses exposure to toxic metals in indigenous communities in tropical countries. The project is led by ISGlobal, the Open University of Catalonia, and the University of Barcelona. The images, names, and details of the rest of the local team have been limited to ensure their privacy and safety.

Urubamba River as it passes through Sepahua (Peru). Photo: Guilherme Queiroz.

This is a land far from tourist circuits, where small rivers converge into the mighty Urubamba as it leaves the foothills of the Andes and enters the Amazonian plain. It is also a land where, to the naked eye, the contradictions of the contemporary world collide with the extraordinary beauty of a jungle in constant change.

Camisea is one of the largest gas projects in Latin America. It was financed by the World Bank under the pretext of stimulating local development

Here lies one of the largest gas projects in Latin America, the Camisea Project, financed by the World Bank under the pretext of stimulating local development. On its own, the complex generates 2% of the national GDP.

The dynamics of this industrial development intertwine with the daily activities of local inhabitants. During the day, artisanal fishermen work on a river shared with the engines of modern barges transporting heavy machinery. At night, the sky turns red as the flames of gas flares reflect on clouds drifting over the jungle.

From left to right, top to bottom: impact of the oil industry on block 8. ISGlobal team (Guilherme Queiroz and Guillem Rius) at the Huitiricaya River (Peru). Tapirus terrestris consuming salts from an abandoned oil well. An unfinished and abandoned gas pipeline on hunting grounds in the Camaná Native Community (Peru). A fisherman from the Yine ethnic group with his catch. Repsol facilities on the left bank of the Urubamba River (Peru). Photos: Martí Orta, Guilherme Queiroz, Guillem Rius and image taken from Orta-Martínez et al. (2018), with permission of the authors.

The constant flow of people and materials by air, land, and river shows no sign of stopping. Qualified personnel from outside the region, unaccustomed to the humid climate and the relentless mosquitoes, work tirelessly to keep the numerous wells and the network of gas pipelines running, transporting this valuable fuel to the Pacific coast and from there to distant countries such as Spain. When their monthly shifts finish, they return by helicopter and charter flights to the metropolises where they live.

The richest citizens of Peru?

As you can imagine, gas extraction has transformed the landscape of this region. Today, the inhabitants of the Bajo Urubamba communities are, on paper, the wealthiest citizens in all of Peru. Their per capita GDP surpasses that of the richest neighborhoods in Lima. And it’s true—they are wealthy, but not in the Western sense of the word. They are rich because they live in a communal system where private property matters little, and where human capital is measured by shared knowledge, cooperation, and mutual respect within a family that reaches beyond blood ties. The impact of their way of life and knowledge also spreads globally, as their practices and worldview help safeguard fragile ecosystems that are crucial for the health of the planet—and, by extension, for the survival of humanity..

We have witnessed the enormous social complexity associated with this type of industrial activity, in areas where the main economic activities are limited to agriculture, fishing, and subsistence hunting

Despite this role, for the authorities they are second-class citizens, excluded from the political and legal processes concerning matters in their territory. Their demands are as simple as having access to running water, electricity, and basic health services. Negotiations drag on and the years go by without these basic rights being realized.

And for years now, promises of prosperity and so-called development have been heard. The project's origins date back to the 1980s, when the British-Dutch company Shell began exploring for gas in the area. The arrival of settlers brought infectious and respiratory diseases, causing the death of 50% of the Nahua-Nanti population during the first year of contact. The subsequent creation of the “Kugapakori, Nahua, Nanti and Others Territorial Reserve,” covering half a million hectares to protect indigenous communities in voluntary isolation, did not prevent the development of gas wells in the heart of the reserve or the extensive network of pipelines linking them.

Camisea, a representative case

Today, two companies—Repsol and Pluspetrol—neither of which is Peruvian, operate primarily in Camisea. Little is known about the project's real socio-environmental impact. Spills occur repeatedly, the most recent on March 1. In terms of health, there is evidence of high mercury blood levels among the Nahua population, which a Ministry of Health report—never published and leaked by The Guardian—links, among various hypotheses, to the project. The lack of public information about the origin of these impacts and the absence of independent monitoring prevent the implementation of effective protective measures. This opacity, by both the companies and the government, leaves indigenous communities in an extremely vulnerable situation.

We have been told personal stories about spills, rivers full of dead fish, and a lack of repair. We have witnessed how the construction of an unfinished gas pipeline destroyed prime hunting areas

Our experience over these months is, until samples are analyzed, qualitative, but no less important to share. We have witnessed the enormous social complexity associated with this type of industrial activity in areas where the main economic activities are limited to agriculture, fishing, and subsistence hunting. Gas extraction creates complex relationships of dependence and unequal power between companies and communities, in a context of state absence and concessions contractually protected for decades. This leaves little room for negotiation. We have also seen how the influx of foreign currency from the project fractured social cohesion, especially in communities near the wells. We have been told personal stories about spills, rivers full of dead fish, and a lack of repair. We have witnessed how the construction of an unfinished gas pipeline destroyed prime hunting grounds. We have also witnessed infantilizing treatment of the communities when they reiterate their demands to the companies, and, in general, a sense of opacity and lack of transparency.

An unfinished and abandoned gas pipeline on hunting grounds in the Camaná Native Community (Peru). Photo: Guilherme Queiroz.

Viewed in perspective, Camisea is part of a pattern that repeats itself along the extractive frontier, where today 20% of the Amazon region is leased for fossil fuel exploration and extraction. The fossil lobby's race to find new deposits, whether in Venezuela, Nigeria, or Peru, pushes companies into territories considered, according to neocolonial logic, as “inhabited.” Through unequal free trade agreements and contracts that protect companies from changes in the environmental and social laws of Global South countries, large corporations, mostly based in the Global North, secure access to natural resources. These rules of the game favor a model of dependency in which wealthy countries continue to extract value from former colonies, while local and indigenous communities bear the costs.

These rules of the game favor a model of dependency in which wealthy countries continue to extract value from former colonies, while indigenous communities bear the costs

Tactics of impunity

Our research team, led by Cristina O'Callaghan-Gordo (ISGlobal/UOC) and Martí Orta-Martínez (University of Barcelona), has worked for years alongside indigenous populations in extractive contexts. The team has documented elevated levels of arsenic, cadmium, mercury, and lead in indigenous populations and wildlife living near oil extraction areas in the northern Peruvian Amazon, where oil spills and contaminating produced water regularly occur.

These impacts are not accidental but are the result of a deliberate strategy of not investing in the maintenance of oil infrastructure. In this regard, the research team recently published a scientific article identifying impunity strategies used by companies to externalize the social and environmental costs associated with their activities in two oil concessions in Peru.

In two oil concessions in Peru, we identified that 83% of the 1,184 spills and leaks reported result in no sanctions for the companies

The study concludes that 83% of the 1,184 spills and leaks identified end without any sanctions for the companies. These practices include, among others, hiding information about spills to authorities and appealing rulings for years until administrative cases expire. The case of Pluspetrol Norte S&A—whose business group also operates in Camisea and one of the companies with the most fines for environmental misconduct—is paradigmatic. Despite making $437 million in 2018, the company refused to pay the fines imposed by the Peruvian government and, through a corporate liquidation strategy, has managed to disappear off the map without being held accountable.

In this context, it is necessary to question the activities of companies that violate environmental and social regulations and to reform the legal frameworks, both national and international, that allow them.

Considering that burning fossil fuels generates 70% of anthropogenic CO₂ emissions, leaving oil or gas in the ground is imperative, especially in areas where the social and environmental benefits of doing so are greatest. Decisions affecting the territories of indigenous communities must respect their sovereignty and autonomy. Communities must be free to determine how to manage their resources and protect their environment, without external impositions or coercion. Guaranteeing this right is not just a matter of justice, but a fundamental right to preserve the cultural wealth, the environment, and the functional ecosystems that ensure the planetary health.

[This text was written by Eva Damkjær Thorsen (WGH Spain) and reviewed by Julia Pedreira and Silvia Gómez (ISGlobal).]

In September 2023, several teenage girls in Almendralejo (Badajoz) discovered that images of their naked bodies were being shared among classmates. They were not real photographs: they had been created and disseminated using artificial intelligence from images taken from their social media accounts, without their consent. Although the images were fake, the harm was immediate and real: fear, shame, anxiety, public humiliation, and serious consequences for their emotional well-being.

The case sparked a strong social reaction and opened a public debate about the risks of these technologies. But it also raises a deeper question: what happens when digital spaces become unsafe environments for the health, safety, and well-being of women and girls?

Digital environments as determinants of health

We have long known that health is shaped by factors that go beyond the healthcare sector. The social, economic, and environmental conditions in which we live shape our opportunities for well-being. Today, in deeply digitalised societies, digital environments are also part of this set of determinants.

However, not everyone inhabits these spaces under equal conditions. For many girls and women, participation in digital environments involves constant exposure to specific forms of violence that affect both their online experience and their lives offline.

For many girls and women, participation in digital environments involves constant exposure to specific forms of violence that affect both their online experience and their lives offline

Data show the scale of the phenomenon. According to the United Nations, millions of women and girls (between 16% and 58%) have experienced some form of digital violence. This wide range reflects both the diversity of abuse and its growing normalisation.

The consequences are not only emotional or temporary. We know that prolonged exposure to hostile environments can lead to chronic stress, anxiety, or social withdrawal. We see how many women modify their online behaviour, limit their public presence, or withdraw from debate spaces to avoid attacks. In this sense, digital violence not only affects specific individuals but also shapes who can fully participate in social life.

New forms of violence in the digital environment

When we speak about digital violence, we see that it does not follow a single pattern but manifests through multiple practices that intertwine and evolve alongside technological development.

Online harassment is one of its most visible expressions. UNESCO research indicates that three out of four women journalists have experienced some form of digital violence related to their work. Threats, insults, or coordinated campaigns affect their well-being and limit their public presence.

Algorithmic systems tend to prioritise content that generates interaction, often favouring polarising or aggressive messages

The generation of manipulated images without consent – as in the case of Almendralejo – transforms the nature of gender-based violence. Tools capable of creating sexualised content from a single photograph make it possible to violate people’s privacy with unprecedented ease.

At the same time, we see that the design of digital platforms can contribute to intensifying these phenomena. Algorithmic systems tend to prioritise content that generates interaction, often favouring polarising or aggressive messages. In this way, certain forms of violence are not only possible but can be structurally amplified, reinforcing pre-existing gender inequalities.

Social and health consequences

The reduction of women’s presence in public debates, professional spaces, or digital academic environments limits the diversity of voices and contributes to reproducing existing inequalities. Digital violence thus acts as a mechanism of exclusion that affects both individual health and the functioning of societies.

The reduction of women’s presence in public debates, professional spaces, or digital academic environments limits the diversity of voices and contributes to reproducing existing inequalities

Psychological well-being, social participation, and access to opportunities are fundamental components of collective health. Ignoring the impact of digital environments in these areas means overlooking an increasingly relevant determinant of public health.

Towards a collective response

Recognising digital violence as an emerging determinant of health requires us to rethink how digital environments are governed through public policy. Regulating platforms, protecting against the non-consensual use of images, and demanding accountability from technological actors are key preventive measures. For these responses to be effective, we also need to incorporate a gender perspective into the development and governance of digital spaces.

Regulating platforms, protecting against the non-consensual use of images, and demanding accountability from technological actors are key preventive measures

For us, understanding digital violence against women as a determinant of health does not artificially expand the concept of public health but rather acknowledges the changes accompanying the digital transformation of our societies. The challenge now is to develop responses capable of protecting well-being in a world increasingly mediated by technology and to ensure that women and girls can inhabit digital spaces freely and without fear.

[This article has been written by Desislava Petrova, Pau Rubio, Ivana Cvijanovic and James Begg.]

It is highly likely that in the coming years the Tour de France will run into a wall. And we are not referring to the slopes of Alpe d’Huez. In a study we have recently published in Scientific Reports, we show how extreme heat is closing in on the race to the point where its current format and timing are becoming questionable, due to the high risk of heat stress this would pose for cyclists, teams and the general public.

We describe the Tour de France as an extraordinarily fortunate race because, despite the growing number of extreme heat episodes, it has managed to avoid the most adverse conditions

But let us start at the beginning. In this study, we set out to assess how the risk associated with extreme heat has changed over the decades in the world’s most famous cycling race. To do so, we selected 12 locations that are typical of the Tour, such as Bordeaux, Lyon and, of course, Paris, as well as the Col du Tourmalet and Alpe d’Huez. We then gathered meteorological data for the month of July between 1974 and 2023. Using all these data, we calculated hourly heat stress risk for each date and location.

The results allow us to draw three main conclusions:

• Heat stress risk has increased steadily over the years.
• The most recent decade concentrates the highest number of extreme-risk episodes.
• The Tour de France has been very lucky — but it is only a matter of time before it hits the wall.

Let us develop this third point.

Why has the Tour de France been lucky?

We describe the Tour de France as an extraordinarily fortunate race because, despite the growing number of extreme heat episodes, it has managed to avoid the most adverse conditions. The route and the race dates are planned months in advance, while reliable weather forecasts are available maximum 14 days beforehand.

Between 2014 and 2023, the city of Paris experienced maximum heat risk conditions on up to four occasions during the month of July, but never on the date of a Tour stage. A similar pattern is observed in other cities analysed in the study, where extreme risk has been avoided. However, given the trends in the data, it would be naïve to assume that this good fortune will continue for another five decades.

Which regions face the highest risk?

What we observe in the data is that risk is not evenly distributed across locations. In cities in southwestern France, such as Toulouse, Pau and Bordeaux, and in the southeast, such as Nîmes and Perpignan, heat stress risk is higher. Others, including Paris and Lyon, are emerging as new heat stress hotspots, crossing the high-risk heat threshold with increasing frequency.

At the other end of the spectrum, mountain locations such as the Tourmalet or Alpe d’Huez have historically remained within low to moderate risk thresholds.

What do we consider extreme heat and extreme risk?

Heat stress risk is not determined by air temperature alone. Other meteorological variables —such as relative humidity, solar radiation and wind— play a crucial role in determining how dangerous heat can be for human health. The Union Cycliste Internationale (UCI) already has a safety protocol based on an index that incorporates all these variables, known as the Wet Bulb Globe Temperature (WBGT). In our study, after calculating WBGT values, we analysed the occasions on which the highest risk category defined in the UCI protocol was reached.

The issue is that temperatures have not yet peaked, and they threaten not only the Tour, but also the Olympic Games and the Football World Cup. It is time to sit down, conduct sport-specific research and make bold decisions

What measures do we recommend?

If the Tour de France is to remain the great sporting spectacle that it is while also being held under safe conditions for the health of all those involved, certain decisions will need to be made. Just as some regions are more prone than others to heat episodes, the times of day at which stage finishes are scheduled also tend to coincide with higher risk, while early morning hours are safer. Event organisers will need to adapt schedules, routes and safety protocols.

Will we see a Tour de France that is no longer raced in summer?

What about the Olympic Games or the Football World Cup?

Although this study focuses on the Tour de France, its conclusions apply to any other sporting event held in summer in Europe or in other regions facing high heat stress risk. Many sports federations already have their own protocols in place —FIFA, for example, introduced hydration breaks in football. The issue is that temperatures have not yet peaked, and they threaten not only the Tour, but also the Olympic Games and the Football World Cup. It is time to sit down, conduct sport-specific research and make bold decisions.

Reference

Cvijanovic I, Begg JD, Mistry MN, Petrova D, Brimicombe C, Sultan B. The future of European outdoor summer sports through the lens of 50 years of the Tour de France. Scientific Reports. 2026 (in press).

More information

Global warming and heat stress risk close in on the Tour de France

I never imagined that a childhood flu would end up shaping my scientific career. I was ten years old, at home, lying on the sofa with a fever and bored, and the only book within reach was The Hot Zone. The title did'nt sound promising, but there was no alternative. I started reading without really knowing what a virus was, what “Ebola” meant, or how an invisible threat could bring entire countries to their knees. I didn’t understand all the details, but I did grasp something fundamental: that virus was real, it was deadly, and it was deeply unsettling.

For weeks, I had nightmares. But I also felt curiosity. A lot of it. How could something so small cause so much damage? Why couldn’t the human body defend itself? Without realizing it, that book planted an obsession that has never left me.

Today, I still believe that curiosity —even the kind born out of fear— can be one of our best defenses against viruses. Because understanding them is, in itself, a way of protecting ourselves.

Years later, I studied Health Biology, and when the time came to choose an Erasmus program, I knew I wanted to get closer to that virus that had fascinated and terrified me in equal measure. I went to Lyon for six months but stayed eight years in France and another seven in Germany. The initial plan quickly dissolved: first a PhD, then a postdoc, and finally becoming a team leader in high-containment laboratories. All because of —or thanks to— viruses like Ebola… and Nipah.

The day I met Nipah

The Nipah virus is not as well-known as Ebola, but that doesn’t make it any less dangerous. My first encounter with it was almost accidental, when I began working with highly pathogenic viruses. It immediately caught my attention for several reasons: its high lethality, its ability to infect different animals and humans, and above all, because it remains largely unknown to the general public.

Nipah virus particles. Photo: NIAID.

Nipah is a zoonotic virus: its natural hosts are fruit bats, and humans are accidental hosts. It is not a new virus —it was first identified in 1998— but it reappears almost every year as outbreaks, mainly in South and Southeast Asia. In some of these outbreaks, Nipah’s fatality rate has even exceeded that of Ebola.

And yet, until recently, hardly anyone had heard of it.

Pressurized suits and negative pressure

Working with the Nipah virus (and with Ebola) is not exactly like it appears in the movies, but it is far from routine. These viruses can only be handled in biosafety level 4 laboratories, the highest level that exists. These facilities use a negative-pressure cascade to prevent any leaks, and scientits work wearing pressurized suits that puff up like the Michelin Man. No, they are not sexy at all, but even if they won’t win any fashion contests, they fulfill their essential purpose: improving safety and minimizing risks when working with these viruses.

These viruses can only be handled in biosafety level 4 laboratories, the highest level that exists. These facilities use a negative-pressure cascade to prevent any leaks, and scientifs work wearing pressurized suits that puff up like the Michelin Man.

But safety does not depend on technology alone. I have worked many times in Africa, where such infrastructure does not exist, and there I learned a key lesson: working safely is, above all, working rigorously and understanding what you are dealing with. Biosafety starts in the mind.

What makes the Nipah virus so special?

As a scientist, what hooked me on the Nipah virus was a disturbing combination of factors. Its lethality is very high, and it has a remarkable ability to infect different mammals, including humans. In addition, the Nipah virus is particularly effective at disabling the immune system defenses, allowing it to spread rapidly through the body. It can cause severe respiratory symptoms, but it can also affect the central nervous system and lead to potentially fatal encephalitis. To date, there are not widely approved vaccines or treatments, which, combined with its high lethality and its ability to jump between species, makes it a threat science cannot afford to ignore.

Will we keep hearing about Nipah?

Probably yes. Not because it is a newly emerging virus, but because the increasing close contact between animals, humans and the environment facilitates its spillover between species and its recurrent re-emergence.

The good news is that, so far, Nipah outbreaks have been managed reasonably well: human-to-human transmission is limited, surveillance systems have improved significantly, as of today, there are two vaccines in phase I and one in phase II of clinical development, a crucial step in improving preparedness for future outbreaks.

How can we prepare?

Investing in research, strengthening epidemiological surveillance (including surveillance in animal reservoirs such as bats), and fostering international cooperation all helps improve preparedness for outbreaks and pandemics, while promoting global health. Understanding that viruses know no borders and that prevention starts long before the first case appears. And above all, not waiting for a virus to have a movie-worthy name before paying attention to it.

It all began with a forgotten book lying next to a sofa. Today, I still believe that curiosity —even the kind born out of fear— can be one of our best defenses against viruses. Because understanding them is, in itself, a way of protecting ourselves.

Emmanouil (Manolis) Kogevinas speaks very good Catalan, which, influenced by his native Greek, sounds rhythmic and musical. In his expressive modulation, you can feel the sun, countless islands, and, letting your imagination fly, the 150 olive trees of Corfu that he tells me he inherited from his family. Manolis is essentially Mediterranean: warm, approachable, passionate.

Research professor at ISGlobal, he has received international awards as an environmental epidemiologist, including the John Goldsmith Prize 2020 and the honorary doctorate from Democritus University of Thrace. He worked at the International Agency for Research on Cancer (IARC), co-directed CREAL, advised the WHO, led the Severo Ochoa distinction at ISGlobal, and presided over the International Society for Environmental Epidemiology (ISEE), among others. He has also led impact studies that helped control dioxins, improve tap water quality, or allow indigenous populations in the Peruvian Amazon to demand government changes in oil extraction. His interests have extended wherever his scientific curiosity has called him: circadian rhythm disruption or, more recently, the ecological effects of wars.

About to conclude his active research career, he welcomes us to his office at the Barcelona Biomedical Research Park.

-We pronounce your name wrong, right?

-In Greek, names are conjugated. My name is Manolis, but if people call me, I’m Manoli: “Manoli, come here!”. Or: “Manoli’s phone”. But since Manoli here is a female name, I am Manolis for everyone, and that’s it.

-Are you from Corfu?

-My family. I was born in Athens, although I spent my early years in Jakarta (Indonesia) due to my father’s work. He died in an accident when I was seven, and my mother took us three children back to Athens. So, I grew up in Athens.

-What a start in life!

-Special.

-Do you remember Jakarta?

-Yes, but it is a traumatic memory, associated with my father’s death.

-Was he a doctor?

-No, no! My father came from one of the good families of Corfu. He spoke English well, which was unusual in Greece at the time, and therefore he interacted with Americans and English settled in the country after World War II. He went to Jakarta for business. My mother also spoke English because my grandmother, anticipating that the Allies would win the war, had her children learn English during the war with the Nazis. My parents met working with the English and Americans. She had studied nursing in England on a scholarship, but once married became a housewife, as was common at the time.

-She seemed interested in health. Where did your desire to study Medicine come from?

-I wanted to help people in disadvantaged countries. I also had an uncle who took good care of us when we returned to Athens and was a doctor. I went with him and watched him operate and make rounds.

The Titanic lesson

-Why did you choose to become an oncologist?

-I started Radiotherapy, but not fully convinced. At that time, after the dictatorship, we were very involved in politics, and at some point I even abandoned my studies to work full-time in a left-wing party. It wasn’t until I went to London that I discovered Public Health, which was not studied in Greece at that time. Another world opened to me. I left my Oncology specialty unfinished and, with a scholarship, went to the London School of Hygiene and Tropical Medicine (LSHTM) to do a master’s. Afterwards, I stayed for the PhD.

It wasn’t until I went to London that I discovered Public Health, which was not studied in Greece at that time. Another world opened to me.

-What is it about Public Health that interests you?

-It takes you out of a purely clinical view focused on the patient, which is important and I like, but opens you to social factors affecting health. Now everyone knows that many more third-class passengers died on the Titanic than first-class, but in the late 1980s, before the movie, we were just discovering it: social factors affect you from fetus to old age. That struck me a lot at that moment when I was so politicized: you can influence population health, not just individual patients. If you want to prevent disease, you have to change society as a whole.

-Recently some students from that 1983-84 course have reunited.

-Yes! In Bilbao. We had exceptional professors. Geoffrey Rose, head of Epidemiology, who had been a cardiologist and had seen that the English population suffered cardiovascular diseases compared to the Kenyan population, which at that time did not have such problems. He was the first to speak of “populations at risk.” We also had Michael Marmot and Valerie Beral. Very, very good people.

-Did all the students pursue a career?

-There were about twenty-five of us, and two or three are more well-known. We hadn’t seen some of them for forty years, but within minutes we reconnected, because for all of us it was a master’s that changed our lives.

Two Mediterraneans in London

-You, moreover, because in London you met your wife, Silvia de Sanjosé.

-Yes. When I was starting my PhD, she came to do the master’s. In student circles, the Mediterraneans gathered, and we connected quickly. Six months later we were living together.

-Shortly after you move to Lyon.

-One Wednesday afternoon I submitted my thesis in London, and the following Monday I was in Lyon leading a small team at IARC. Tremendous stress, because I was not fully prepared. I went from being a PhD student, responsible only for myself, to having a team to supervise. My thesis had been on social inequalities and cancer survival, that is, how being rich or poor affected the chances of surviving cancer in England. And in Lyon I was hired to conduct studies on occupational cancer, basically. The first six months were quite stressful. Later I learned to work in a team.

One Wednesday afternoon I submitted my thesis in London, and the following Monday I was in Lyon leading a small team at IARC. Tremendous stress, because I was not fully prepared.

-And you liked it.

-I learned a lot. There I connected with many people, because IARC was then one of the few centers conducting large international studies. It had a status, being part of WHO. And I learned a lot, a lot, a lot. For example, we knew dioxins were very toxic but had no evidence they were carcinogenic in humans. We provided it, with a very large and innovative study. I learned to do impactful studies, studies that lead to change.

Carcinogenic dioxins

-Where are dioxins found?

-We are all exposed, but at very low levels. They were in the herbicides used by the Americans in Vietnam to clear the forests where the North Vietnamese army was hiding. And, in large amounts, in the Baltic Sea, where the paper industry discharged dioxins generated in the chlorine bleaching of paper.

-Is the Baltic still so contaminated?

-Yes, because they are persistent. Pollution has been controlled for some time, but in the 1990s, when studies were done with people eating Baltic fish, it was clear that those who ate more fish had more dioxins in their bodies. Very clear.

We knew dioxins were very toxic but had no evidence they were carcinogenic in humans. We provided it, with a very large and innovative study.

-And more cancer?

-Indeed. We conducted studies with workers who had very high levels of dioxins. Occupational studies have an advantage over general population studies: they allow you to see what happens with very high exposure.

-And how are we exposed to dioxins now?

-Mostly by eating meat, cheese… anything fatty, because dioxins are lipophilic and have an affinity for fat. And they come from incinerators, industry, etc. Now there is much more control, and this is a great success. In 1997 they were classified as carcinogenic, largely thanks to the studies I coordinated with others, and many measures were taken in the US, Europe, and other places. Filters were added to incinerators, for example. However, many are still produced in many places, and they are found even in surprising amounts in isolated populations such as the Inuit, who have no industry but eat fatty animals. This can only be explained by wind transmission. There is global contamination.

The broad view of the exposome: everything is connected

-I imagine that, as a scientist, the more you study, the more you see the complexity of life.

-From this arises the concept of the exposome. From the need to evaluate more globally everything that affects us. Around 2005, Chris Wild, director of IARC, said that much money had been spent studying the genome, but we knew little about how external exposure affected internal balance. The idea resonated widely, and studies began assuming that our exposures are complex and everything matters because everything is connected: how we sleep, how we eat, whether we exercise…

Chris Wild, director of IARC, said that much money had been spent studying the genome, but we knew little about how external exposure affected internal balance. The idea resonated widely, and studies began assuming that our exposures are complex and everything matters because everything is connected: how we sleep, how we eat, whether we exercise…

-So it is a fairly recent concept.

-Since the late 1990s, molecular epidemiology was discussed, which now forms part of the exposome. When I was at IARC, molecular biology evolved rapidly and gave us tools to evaluate carcinogens and other toxic agents. We conducted studies to demonstrate their effects on the body before clinical disease appeared. For example, there were animal studies showing ethylene oxide was carcinogenic, but at that time studies were conducted with nurses using it to sterilize medical tools, and it was observed to cause DNA changes.

IMIM running group in the mid-1990s: Joan Soriano, Manolis Kogevinas, Jordi Sunyer and Rosa Lamarca.

Barcelona 1994

-How many years did you spend in Lyon?

-Five and a half years. Quite a few, because WHO is very special as an organization. Very interesting, but very bureaucratic. However, the main reason we left was personal. Silvia and I had good salaries and were conducting good studies, but we had our first child, Niko: I spoke to him in Greek, she spoke to him in Catalan, and between the two of us we spoke English at that time, and he went to a French school. It was like having the United Nations at home! In 1994 we moved to Barcelona. Silvia got a job at the Catalan Institute of Oncology (ICO) and I had a European fellowship. After one or two years, I joined IMIM. It was fantastic, with Josep María Antó and Jordi Sunyer. We were a small team of ten people.

We had our first child, Niko: I spoke to him in Greek, Silvia in Catalan, and between the two of us we spoke English at that time, and he went to a French school. It was like having the United Nations at home!

-They were already well-known.

-Yes. They had shown that the asthma epidemics of the 1980s in Barcelona were due to inhalation of soybean dust lifted during ship unloading at the port. And I knew a lot about occupational epidemiology. So I joined them working on asthma. It was very interesting to research a disease other than cancer.

Manoli Kogevinas, Josep Maria Antó and Jordi Sunyer, 2016. Photo: Glòria Solsona.

-All three of you got along very well.

-We agreed a lot, we talked a lot! And that’s how CREAL (Center for Research in Environmental Epidemiology) was born. Initially, we were just the three of us. Later, fantastic people joined: Mark Nieuwenhuijsen, Elisabeth Cardis and many more. We expanded the core, but have maintained this friends’ connection.

Nature Briefing forever

-Now the three of you are nearing the end of your professional career. How do you experience it?

-Look, I decided this a long time ago, which is why in the last two years I haven’t applied for any grants. It’s a huge psychological change because I am very interested in research and science. I open Nature Briefing every day and will continue to do so, because it’s the most interesting thing: reading about black holes, crocodiles, or viruses from four thousand years ago. I will never lose interest in science, but I don’t want to continue with active research, grants, and all that. I must accept that I have many study ideas I will never do. Let others do them! I’m entering another phase.

I open Nature Briefing every day and will continue to do so, because it’s the most interesting thing: reading about black holes, crocodiles, or viruses from four thousand years ago.

-And is it hard?

-Of course. At seventy, it’s difficult to start another career in a different field.

-You would do it!

-I would, I would! But I have few years left; I should have stopped working at sixty. The thing is that then I would have missed everything we did in these last ten productive years (and difficult, with COVID-19). They have been wonderful years of work, with ISGlobal studies in the Amazon, long COVID, the Severo Ochoa award, and so many other things done with my group.

The disaster, also ecological, of wars

-What would you study now?

-Something artistic. I have been doing ceramics for a long time, and I used to paint as well. I will never be a very famous ceramist, but it doesn’t matter—I'll make hundreds of bowls and high-quality pieces! I really enjoy it. And I also have to read quite a bit. Regarding work, I am interested in continuing to study how armed conflicts affect the environment and environmental health, and how they interact with climate change: because climate change causes wars, but wars also significantly affect climate change. They probably emit 5% of CO₂. But this is neither measured nor considered in any international agreements. I chair, with a U.S. epidemiologist, a committee of the International Society of Environmental Epidemiology and we are trying to work on this. For example, to see what can be done in Gaza, with all the waste everywhere. What happens there, besides being a war crime, is an ecological disaster that will last many years.

I am interested in continuing to study how armed conflicts affect the environment and environmental health, and how they interact with climate change: because climate change causes wars, but wars also significantly affect climate change.

-Will you be able to go there to take samples?

-Now it is impossible. Colleagues of Arab origin have managed to extract water samples from the occupied part of Palestine, although clandestinely. But there are other places where we can do it: Congo or Ukraine. This is the only organized activity I will maintain. And it connects with my political past.

-Your science has this connection with society.

-It’s one of the important things at ISGlobal. Besides being open to the world and not closed to Europe, it has all the translational and policy aspects much more developed than CREAL. I really appreciate that ISGlobal cares so much about the impact of research.

Peruvian amazon 2016 study with Cristina O'Callaghan.

Dinner alone at eight or accompanied at ten?

-Have the results of your studies changed anything in your daily life?

-The problem is that everything I find in my circadian cycle studies I cannot apply at home, partly because Silvia works with America and has an afternoon schedule. My studies say you should have an early dinner and not go to sleep immediately. We have dinner at ten at night, you know? Life is like that. You have to make decisions, and for me it would be much worse to have dinner alone at eight.

My studies say you should have an early dinner and not go to sleep immediately. Silvia and I have dinner at ten at night, you know? Partly because she works with America and has an afternoon schedule. Life is like that. You have to make decisions, and for me it would be much worse to have dinner alone at eight.

-Are you happy with your professional career? Did you expect it to be so fruitful and stimulating?

-You never know. You do studies and some turn out well and others don’t. I have done some big ones, also with WHO, that didn’t work out: too much effort for few findings. And other studies have been fantastic: the one on water with Cristina Villanueva, for example. We changed knowledge, the way chemical contamination studies in water are conducted. We were the most powerful team in the world in this area! In occupational asthma, we also made important findings. And in the circadian cycle. That was what I wanted: studies that change knowledge or have an impact on the way we live. Later, there are other studies that could have been better published but were important, like the one we did with Cristina O’Callaghan in the Amazon, which gave tools to indigenous populations in Peru to request improvements in their horrible living conditions. We achieved it, and that is an important impact.

We changed knowledge, the way chemical contamination studies in water are conducted. We were the most powerful team in the world in this area! In occupational asthma, we also made important findings. And in the circadian cycle. That was what I wanted: studies that change knowledge or have an impact on the way we live.

-Is this the most rewarding part of your work?

-There are many things: sitting with a good PhD student and seeing what we find, interpreting the data, trying to summarize it in a table, that is very rewarding, very much! Young researchers come with a clear mind, have new ideas, and we, as mentors, have the experience to guide them. That’s what happened with Cristina Villanueva: she had an idea, and we worked a lot together, but it was her idea. We changed all the water and chemical contamination studies.

-And policies too.

-Of course. Here, until the early 2000s, chemical levels were higher than those established by European legislation. Now it has improved a lot.

-How would you summarize what you have learned as a scientist?

-To do well-conducted studies and be very demanding in everything. In Epidemiology, you have to do large studies and have good funding. And I have learned to do studies that have an impact, even if before conducting them you cannot always evaluate the impact they will have. But you must want to do big things that change people’s lives. And work a lot in a team.

At ISGlobal’s Communications Department, we have decided to join the OFF February initiative.

What is OFF February?

It is a global initiative that encourages setting limits on social media in favour of wellbeing, with the aim of helping people regain control over their time.

What are we going to do?

As proposed by this campaign, the communications team has uninstalled all social media apps from our corporate and personal phones, as we have also agreed to take part on an individual basis.

This is not about deleting social media altogether, but rather about removing it from our pockets as a response to hyperconnectivity and the compulsive use of tools that increasingly rely on addictive design patterns.

This does not mean that we will stop publishing on these channels. As OFF February proposes, during the month of February we will access them exclusively through web browsers and, in addition, we will reduce the volume and frequency of posts across all our social media channels.

Why are we doing this?

Because social media are increasingly less social and becoming more like spiderwebs. Because since we opened our first account in 2011, we have seen increasingly clearly the phenomenon that Cory Doctorow coined as “enshittification”, whereby platforms and their algorithms have progressively degraded to a stage where profit and data extraction are prioritised above all else, pushing people and their health to the very bottom of the list.

Gone are the days when we turned to social media to stay connected with friends and contacts or to be better informed. The diversification of platforms has also faded away. Now, it seems that almost all of them serve the same slurry of superficial, extreme and often toxic content, produced by people you have probably never spoken to and whom you likely never intended to follow.

The ISGlobal paradox

Those of us in the Communications team are aware that we live in a constant contradiction in pursuing ISGlobal’s goals, as a centre for research and translation in global health. Our role corresponds to the second of these pillars: translating to society the knowledge generated by the approximately 400 scientists who work alongside us.

This task, already challenging in itself, has become even more difficult at a time when fewer and fewer people turn to the news media for information, and more and more do so—at least they believe they do—via social media. In other words, there are entire segments of the population we will never reach unless we engage through social media.

However, the mission of ISGlobal is “to improve global health and promote health equity”. And this is where the paradox becomes evident. We know—better than anyone—that science is slow in building consensus and always lags decades behind industry. But there is already evidence that social media are not exactly good for health: studies have directly or indirectly linked them to mental health problems, problematic or addictive use, sleep disruption, and overweight and obesity, among other outcomes.

Moreover, infinite scrolling and other addictive design patterns used by major tech companies that own social media platforms exploit vulnerabilities in our brains and push us towards compulsive consumption of fast food for the intellect, with potentially catastrophic consequences for our attention span and our capacity for deep thinking. Some authors are already talking about post-literacy. We leave for another day the debate on how this dangerous cocktail may be affecting the health of democracies.

Knowing all this, how is it possible that an institution dedicated to improving global health and promoting health equity makes use of these tools? That is the question we ask ourselves. And the truth is that no one forces us to use these platforms. As professors Cristina Fernández and Santiago Giraldo so eloquently argue in their latest book, we are held hostage by social media and, we would add, we also suffer from Stockholm syndrome.

A lose–lose dilemma

Given the hand we have been dealt, it does not seem possible to win in the short term. If we truly want to reach people, we have to go where they are. And although we like it less and less, social media as a whole are currently estimated to have more than 5.6 billion users, equivalent to almost 70% of the world’s population. There is a great deal of work to be done there to act as an anchor against disinformation and to try to establish ourselves as a reliable source, especially for younger and less educated audiences. Leaving now would mean abandoning them to their fate and perhaps condemning ourselves to irrelevance.

Staying, however, means walking the tightrope of contradiction.

For now, and in the absence of comprehensive solutions, we are joining OFF February and welcoming the month with the intention of following a diet rich in cognitive nutrients and low in scroll.

[This article was jointly written by Virginia Rodríguez, Policy Advocacy Coordinator at ISGlobal, and Marta Ribes, postdoctoral researcher in noma epidemiology.]

Years after the term Neglected Tropical Diseases (NTDs) entered the global agenda, millions of people continue to live with diseases that are barely talked about, under-researched, and insufficiently treated. And this neglect is not accidental: it is the result of decisions—or the lack of them—within a global system that is currently undergoing profound reconfiguration.

For months now, we have been witnessing and trying to adapt to the deep transformations reshaping the international global health system. Practically all key actors are undergoing restructuring processes and reprioritising their agendas as a result of cuts to Official Development Assistance. NTDs are, as their name suggests, among the most likely to fall through the cracks of these processes. Not only is it difficult to quantify the number of people affected, but they also disproportionately affect the poorest and most vulnerable populations on the planet. In the current turmoil, using equity as a guiding compass helps answer the fundamental question of what kind of world we want to emerge from this transformation. We want a fairer world.

The Spanish Coalition against Neglected Tropical Diseases, of which ISGlobal is part of the founding group, has been launched to raise awareness of NTDs and mobilise resources, knowledge, and political will in Spain.

One of the NTDs since 2023 is noma, which offers a clear example of how injustice is perpetuated and deepened. This disease affects children living in conditions of extreme poverty, malnutrition, and lack of hygiene. The growing number of conflicts and the climate crisis only increase the number of people at risk. This breeding ground is further intensified by recent cuts to official development aid programmes. These growing social inequalities are likely to translate into a rising number of noma cases, aptly described as a “biomarker of poverty”.

Science, commitment, and coalitions

Noma also offers a powerful example of what is needed to break this vicious cycle. First and foremost, science: knowledge as the foundation for the most effective interventions to diagnose and treat the disease. This knowledge gives a voice to the children who have suffered from noma and those who continue to do so, and survivors have become key actors in raising awareness.

Secondly, the commitment of individuals and institutions determined not to remain indifferent to this injustice. This is the kind of commitment that, 30 years ago, led a Mallorcan organisation—the Fundació Campaner—to take action. Since then, it has mobilised resources and capacities to care for children affected by noma and to raise awareness about the disease. One of the initiatives they are currently promoting is the designation of 3 December—the day their founder Josep Campaner passed away in 2023—as the International Day to Fight Noma. This week, they presented their delegation in Madrid and convened a meeting with parliamentary groups to promote unanimous support for this initiative in the Spanish Congress.

Launch of the Spanish Coalition against NTDs at the Carlos III Health Institute in Madrid. Bottom right, members of Fundació Campaner and researcher Marta Ribes at the Spanish Congress of Deputies, where they promoted the declaration of 3 December as the International Day to Fight Noma.

Thirdly, coalitions that bring together the efforts of organisations and institutions, such as the Spanish Coalition against Neglected Tropical Diseases, which was officially launched on 29 January at the Carlos III Health Institute in Madrid. This initiative—of which ISGlobal is part of the founding group—aims to raise awareness of NTDs and mobilise resources, knowledge, and political will in Spain. Its goal is to support efforts to prevent, control, and eliminate these diseases, in line with the objectives of the World Health Organization, the Sustainable Development Goals, and Spain’s global health vision as reflected in the Global Health Strategy approved in 2025.

Science, commitment, and coalitions—with equity as an unwavering compass in these turbulent times.

Imagine a room filled with doctors, psychologists, and epidemiologists, architects, economists, management and communication experts, along with citizens from Barcelona and municipal technical staff. Inside, a meaningful and complex conversation is unfolding about how to adapt to climate change.

The nature of climate change makes it a "wicked problem", as Reiner Grundmann and other experts have defined it. This means that solutions are difficult to achieve and sometimes contradictory due to interdependencies between the climate and society, as we know it. Added to this complexity is a global political context that is unfavorable for climate action and multilateralism, characterized by rising conflicts and a renewed interest in oil and mineral extraction.

To address these challenges, during the second half of 2025, 80 people met in eight thematic workshops at the Palau Macaya in Barcelona. The project Voices for Health: narratives and action against climate change from “La Caixa” Foundation with the scientific direction of ISGlobal, promoted spaces for reflection and dialogue on political, urban, social, and public health solutions to climate change.

First session: extreme heat and urban health

On June 25th, during the first heatwave of the year, the workshop on the impact of extreme temperatures on health was held. Extreme heat poses a significant health risk, as reflected in the increase in heat-related mortality in recent years. The most at-risk groups include older adults, children, people with comorbidities, and those highly exposed to heat due to inadequate housing or work conditions. Days later, we received the tragic news of the death of Montse, a municipal cleaning worker in Barcelona, after her work shift. This was the first of several news stories we would receive throughout the summer about outdoor workers dying due to the combination of structural vulnerabilities and extreme temperatures.

In response, during the workshop several priority areas were identified. One is the update of emergency protocols for heatwaves, which determine exceptional measures, such as canceling work shifts. Another is improving risk communication to citizens, using alerts and accompanied by culturally adapted health recommendations. These actions form part of the emergency response—how we act and the resources we need to face a heatwave.

The city that harms or protects us

But we didn’t stop at response; we also discussed prevention and how our environment, Barcelona’s urban design, can make us sick. The urban heat island effect can raise temperatures by up to 2.5 ºC above average in some city areas. We noted how nature is a powerful ally for climate regulation, air quality improvement, and mental health. Along with reducing motorized transport and increasing active transportation, these measures are part of a healthier urban model. Superblocks and green corridors are examples of this, although as pilot projects they have clear limitations in terms of scale and impact. The restoration and renaturalization of green and blue spaces, such as the Besòs River Park or the Catharijnesingel canal in Utrecht, also served as inspiration.

Besòs River Park. Photo: Vicente Zambrano González / Barcelona City Council.

The role of citizens in decision-making and city design is increasingly relevant. In another workshop, we reflected on the accessibility, use, and perception of Montjuïc, one of Barcelona’s largest green spaces. The potential of Montjuïc as a provider of ecosystem and health services is huge, but in practice, tourism pressure, low connectivity, and landscaping limits its benefits. Redesigning public spaces and parks with citizen participation and through a lens of equity brings us closer to a healthy urban model, provided citizen participation is meaningful.

Common challenges for climate action

Amid whiteboards, post-its, and papers, many solutions were shared along with scientific evidence of health benefits, and consensus on the political urgency was palpable. Still, we identified common obstacles hindering urban and health action.

Fragmented governance. Delays in approving general government budgets and a lack of continuity in urban and environmental policies after government changes hinder implementation and effectiveness. Lack of resources and coordination across departments and government levels is a major obstacle in preparing for and responding to climate-related emergencies, as seen with the 2024 dana in Valencia or the 2025 forest fires in Spain. Prioritizing climate and health agendas requires securing municipal, national, and European funding, implemented with a health equity perspective.

Social and economic inequalities. Climate risks multiply existing inequalities and create new vulnerabilities. In Barcelona, green urbanism, through actions like housing rehabilitation or new parks, accelerates gentrification, raising housing prices. This unintended impact impedes access to housing for low- and middle-income residents. Access to quality housing is a determinant of good physical and mental health. Hence, in order to prevent displacement due to these measures, the right to housing must be protected.

Anthropocentric view of nature and individualism. Seeing nature as a resource to exploit prevents understanding the eco- and interdependencies sustaining the city. A paradigm shift is needed to see nature as part of the city by applying urban ecology principles. Adaptation solutions also require behavioral changes and collective care and responsibility for public spaces and services.

Learnings and motivation: the value of plural dialogue

The sessions ended with participants eager to continue discussions and drive actions for a healthier city and society. This shared motivation highlights an important learning: diverse dialogue and meeting spaces are valuable in themselves and also drive action. The main challenge of these workshops was to ensure plural participation, with the representation of experts, citizens, and public administration. When one of these pillars was missing, sessions were not representative and less productive. As one participant, a Barcelona City Council officer, noted, it is essential to strengthen the relationship among these three spheres and facilitate dialogue and knowledge exchange. To which another participant responded, next time we should invite the private sector.

His down-to-earth attitude and simplicity are striking. Francis Mojica keeps his feet on the ground despite having advanced biology by leaps and bounds and being considered a potential Nobel Prize candidate for years. In the early 1990s, he discovered genetic sequences that repeated at regular intervals — CRISPR, short for Clustered Regularly Interspaced Short Palindromic Repeats — and a decade later he understood that they were part of a bacterial adaptive immune system against viruses: bacteria incorporated fragments of their invaders’ DNA into their genome to keep a record of infections, allowing them to recognize, bind, cut, and destroy those sequences in the future using the Cas protein.

These findings, resulting from the study of microorganisms in the salt flats of Santa Pola, not far from his hometown of Elche, Spain, had a global impact: they opened the door to a revolutionary technology that allows cutting and pasting DNA sequences from any living organism precisely, easily, and affordably. Today, it is used in laboratories worldwide, with applications in medicine, agriculture, and biotechnology that promise to transform humanity. Emmanuelle Charpentier and Jennifer Doudna received the 2020 Nobel Prize in Chemistry for developing CRISPR/Cas9 techniques.

But Francis Mojica is less interested in awards — which he also has, and very prestigious ones — than in understanding. He feels comfortable researching in Alicante, Spain, far from any ambition other than pure knowledge, while enjoying the pleasures of the Mediterranean.

He gave us this interview before the keynote lecture he delivered at CosmoCaixa in Barcelona, as part of the Great Minds of Science series and on the occasion of the 2nd Citizen Science Congress, co-organized by ISGlobal, Science For Change, and Ideas for Change.

-Do you remember that August day in 2003 when it was very hot in Santa Pola and you decided not to accompany your wife to the beach?

-I sure do. I like Santa Pola a lot in winter and less in summer, but you take vacation when you can. I took the opportunity to go to the university to analyze the genomic sequence data of Escherichia coli we had obtained months earlier. When I realized what I had discovered, I ran to the beach and told my wife, “Geli, I’ve found something that will appear in textbooks one day.”

-You saw it clearly.

-I realized it was something big, an impressive contribution to scientific knowledge because nothing like it had ever been described. I explained the discovery a little to my wife: I thought microorganisms had memory, they were capable of learning. She, not being a scientist, said, “I don’t understand anything, but it must be very important by the way you’re telling me.”

-Indeed, you’ve gone down in history.

-Yes. Without seeking it. But that’s almost better.

The Eureka Moment

-How did you get there?

-Ten years earlier, I had come across repeated sequences in the genome of archaea living in the Santa Pola salt flats. They were perfectly ordered repeats, at fixed distances from one another. Initially, we thought the repeats themselves were the important part, but later we realized that the “spacers,” the sequences between repeats, were the key. Each isolate had different spacers, even isolates of the same species. Where on earth did these curious spacers come from? We were determined to find out, and we did. We discovered they were information storage units.

When we discovered it was the only acquired immune system with memory in prokaryotes, it blew my mind! And I won’t even start on what came after. We immediately saw applications in microbiology, health, clinical work, and biotechnology...

-How did you see it?

-One of those E. coli spacers we were analyzing matched the sequence of a virus infecting the bacterium. We knew that particular strain was resistant to infection by that virus, while other E. coli isolates without the spacer were susceptible. We analyzed CRISPR sequences from bacteria and archaea in available databases and found that what we saw in E. coli appeared in about 2% of the 4,500 sequences we examined. Enough to know we were onto something. We concluded that the bacterial strain had “photographed” a virus that infected it and stored it as a spacer. From that moment, it and all its descendants became resistant to that virus.

Democratizing Genetic Engineering

-Your discovery has had global implications.

-It was completely unexpected. When we realized it was the only acquired immune system with memory in prokaryotes, it blew my mind! And everything that came after… immediately, we saw applications in microbiology, health, clinical work, biotechnology. Remember, bacterial populations, and prokaryotes in general, are controlled by viruses. Most pathogenic bacteria, like those causing tetanus, botulism, or diphtheria, produce toxins because they have viruses integrated in their genome. If we can prevent these bacteria from becoming toxic, imagine the possibilities. For example, we can protect yogurt-producing bacteria from viral infections, which are very common.

-Thousands of laboratories now use CRISPR as a key tool.

-Not only to modify microorganisms and make them virus-resistant but also to generate sequence-specific antimicrobials that kill only the target bacteria. CRISPR is widely used in genetic modification, improving crop productivity and quality, in animals, and to identify therapeutic targets. For instance, if a genome region is responsible for a disease, blocking that gene or its expression can eliminate the disease.

From Shoemaker to Scientist

-Aren’t you proud?

-Yes.

-But you remain very humble.

-Ah, my wife keeps me grounded. Whenever I start to get a bit carried away, she reminds me: “Francis, remember who you are!”

-And who are you?

-I’m the son of a very humble family of shoemakers who, unfortunately, couldn’t study. I was lucky to listen to them: when I thought I would stay in my parents’ factory gluing and covering heels, they convinced me to continue studying. Honestly, I never believed I could finish a degree. I thought scientists were very special people, with abilities I certainly didn’t have. But then you realize that if you work hard, you eventually get there.

I’m the son of a very humble family of shoemakers. I thought I would stay gluing and covering heels, but they convinced me to continue studying. I never thought I could finish a degree

-You stayed at the University of Alicante even though you are internationally recognized and presumably receive tempting offers.

-I’m happy there. The University of Alicante is good. And it’s not all work: the climate is nice, I’m close to family, the food is excellent, I earn enough to live comfortably and afford a couple of beers occasionally… I don’t need more. In life, you don’t have to be ambitious. Otherwise, you’re miserable.

An Elusive Nobel

-How did you feel when, in 2020, two scientists received the Nobel Prize in Chemistry for developing a technology based on your discovery?

-Thrilled! I was convinced someone from the CRISPR field should receive the Nobel. It was awarded for developing a very specific technology, not for discovering the prokaryotic acquired immune system. I would have been very surprised if it had been otherwise! For one, there’s no Nobel Prize in Biology. Right now, I’d say even more prizes could be awarded for CRISPR, because there’s the genetic editing tool, and then many more, for molecular diagnostics, for example, or as antimicrobials. That could also become a revolution.

There’s the genetic editing tool, and then many more, for molecular diagnostics, for example, or as antimicrobials

-Where could this lead us? Could we cure genetic diseases?

-Leukemia, deafness, blindness, heart disease, diabetes, hypercholesterolemia… you name it, are already being treated.

CRISPR vs. CRISPR

-After contributing to this discovery and seeing how it flourishes, what do you work on now? What else can be done?

-We are now working on the most exciting part. For ten years, we searched without knowing what we would find. Now we know where we are and can choose where to go. We are working with CRISPR systems very different from all others. They lack “components” of typical CRISPR systems. We believe they are mischievous CRISPRs, viral CRISPRs that inhibit the host bacterium’s CRISPR defense system. We are super excited: CRISPR vs. CRISPR. We also collaborate with companies and other universities to improve crops with CRISPR tools.

-How many are in your team?

-Five.

-Only five?

-Yes. I’ve never had more. It’s ideal.

-Why?

-With more people, the chances of having a “rotten apple” increase.

-So a good team atmosphere is very important.

-Essential. It’s better to have a small team that collaborates and has a good vibe. Unfortunately, that’s hard with large groups.

-How would you like to see yourself in the future?

-Oh, I’d like to continue like this as long as my body allows and my mind keeps working. Sometimes it’s not as fast as before, and I can’t keep up with everything because technology advances incredibly fast. When I see I no longer contribute to the group, I’ll step back discreetly. But as long as I can, I’ll continue. Research is a joy.

[This text was jointly written by Lalama Jabby and Consuelo Bautista.]

Accessing healthcare without facing financial hardship should be a guaranteed right. Yet, for millions of people —especially women and girls— this right remains far from reality.

On December 12, the International Universal Health Coverage Day was celebrated, a commitment made by the United Nations in 2012 to ensure that all people have access to essential, quality health services without financial hardship.

Despite progress made between 2000 and 2015, recent years have seen worrying stagnation. Globally, the number of people facing “catastrophic” health expenditures continues to rise. Catastrophic expenditures are defined as those exceeding 10% of a household’s total budget. In 2021, these costs affected nearly 2 billion people. Behind these numbers are everyday realities: families having to choose between paying for treatment or rent, young people interrupting their education to contribute to household income, or individuals choosing between food and medicine.

In this context, ISGlobal published a policy brief in 2024 analyzing key initiatives to achieve and consolidate universal health coverage in Spain, as well as outlining a commitment to advance this goal.

Women, girls, adolescents, and other vulnerable groups face greater structural obstacles in accessing basic health services. Effectively incorporating a gender perspective into universal health coverage strategies is therefore essential to building more equitable and resilient health systems.

Gender inequality in health coverage affects women the most

Even in contexts with near-universal health coverage, gender inequality continues to shape access, quality, and health outcomes.

In the European Union, 41% of women report difficulty covering an unexpected dental procedure, and 39% consider mental health services unaffordable

In many European Union countries, despite nearly universal population coverage for essential health services (OECD, 2024), women more frequently report unmet healthcare needs due to financial reasons, distance to services, or long waiting lists. They also perceive lower quality of care and face greater obstacles in diagnosis and treatment processes.

These inequalities are amplified in areas marked by stigma, such as mental health and sexual and reproductive health. There are still areas where a male-centered view of biomedicine persists, with differences in clinical presentation of diseases being overlooked, treatment effects insufficiently studied in women, and limited inclusion of gender diversity in health research.

Unmet health needs are closely linked to economic instability. In the EU, 41% of women report difficulty covering unexpected dental procedures, and 39% consider mental health services unaffordable. Although the EU prohibits sex-based differentiation in private insurance access, specific exclusions still disproportionately affect women, such as restrictions during pregnancy or lack of fertility-related benefits in basic insurance.

Without financial protection, inequalities multiply

Without economic protection, universal health coverage becomes a fragile promise, especially for women.

Social determinants of health, such as socioeconomic status, intersect with gender roles and cultural factors to create inseparable networks of inequity. Many women combine precarious jobs with unpaid care work, limiting their economic autonomy and reducing access to health services.

These inequalities have structural and historical roots: women’s traditional role as caregivers, shorter and fragmented work trajectories, and lower pensions further hinder continuous access to care

People with low incomes, living in rural areas, or in households with at least one older adult are particularly exposed to economic barriers and lower coverage of essential services. These inequalities have structural and historical roots: women’s traditional role as caregivers, shorter and fragmented work histories, and lower pensions further complicate continuous access to care.

The gender gap in health is also digital

The rise of artificial intelligence (AI) in health professions risks amplifying existing gender biases. AI relies on previously published content, which is historically male-centered and exclusionary, perpetuating patterns of inequality and discrimination.

One key current challenge is promoting the development of AI applications that integrate a gender and intersectional perspective from the outset, helping to reduce access barriers and promote greater equity in the use of these technologies.

The conclusion is clear: advancing universal health coverage requires integrating gender justice into the design, implementation, and evaluation of public health policies. Without this perspective, universal health coverage will remain a partial and incomplete goal.

This year, I have been able to experience and share the daily life of a Romanian teenager through a social mentoring programme. Week after week, over many months, I shared his difficulties, achievements and setbacks. During the same year, I also accompanied a second-year Peruvian medical resident through the exhausting process of renewing her residence permit, with all its associated frustrations. Supporting people both socially and personally has given me a perspective that helps me reflect and apply these learnings in my daily practice as a family physician and as a researcher in the field of migrant health. In both cases, despite their very different socioeconomic backgrounds, situations of structural racism appeared far too often.

A diverse society that does not always recognise itself as such

With these realities so close at hand, I am struck by the recurring headlines that describe our “new” society as multiracial and ageing. I am struck because it stopped being new a long time ago: it is a society diverse in its identity. More than 36% of the population living in Spain under the age of 20 has at least one parent born abroad.

Despite this, media narratives do not always reflect this everyday reality. Migrants feature prominently in headlines, but real coexistence rarely does, nor do second generations (generally identifying with the Spanish society in which they have grown up), or the fact that opportunities for social mobility remain strongly shaped by families’ educational and socioeconomic conditions.

Real migration, beyond the headlines

Every year, on 18 December, we mark International Migrants Day. The International Organization for Migration (IOM) defines migration as the movement of people from their usual place of residence to a new one, either across an international border or within the same country.

Contrary to what major headlines often suggest, most migration takes place within the same country or to neighbouring countries. The majority of movements are orderly and driven by family, work or study reasons. They do not generate major problems nor fit the crisis narratives that often dominate media discourse, although none of them is free from challenges.

Forced migration, or when migrating is not a choice

Difficulties arise especially in economic or forced migration, which often occurs under extreme conditions and, in many cases, outside the legal frameworks that facilitate privileged forms of migration while complicating or preventing less advantaged ones.

This includes people who move due to economic hardship, climate crises, armed conflicts or deprivation of freedoms. Many had no prior intention of migrating, but circumstances force them to do so.

Over the past year, international responses to forced migration have hardened, both in the United States and across several European countries, as well as at the European Union level.

Migrant health: barriers and opportunities

At ISGlobal’s multidisciplinary and multinational Migrant Health group, our main goal is to improve both access to and the quality of healthcare for migrant populations.

Research into access and the management of specific needs has identified barriers and facilitators for the detection of female genital mutilation. Community health work has also been carried out through participatory processes aimed at promoting mental health among migrant women.

Innovation for safer and more effective care

In clinical practice, we are developing an innovative multiple screening tool to detect migrants who are inadequately immunised against vaccine-preventable diseases. At the same time, we continue to implement ISMiHealth, a multiple disease screening tool that supports primary care professionals in addressing migrant health.

Working conditions and health: an urgent challenge

Another line of research focuses on working conditions and their impact on health among certain migrant groups, such as the heat stress experienced by many agricultural workers. Studying these realities allows us to design interventions to mitigate their effects and improve wellbeing.

Towards a truly equitable health system

Improving migrants’ access to the health system and providing care better suited to their needs, through jointly generated and shared knowledge, is both an achievable and necessary goal.

Only in this way can we build a health system that is equitable and aligned with the diverse society in which we live: a society that is no longer “new”, but simply real.

Emotions have played a crucial evolutionary role in the survival of our species (and many others), allowing us to respond quickly and efficiently to external threats and opportunities. Even today, in “modern” society, it is often emotion- more than reason- that shapes our values and guides our behaviour, decisions and social interactions.

Global health is no exception. Its story is not only written in data, policies, guidelines; it’s also written in emotions. And 2025 has been an emotional whirlwind. Here are some of the year’s key events, felt through the lens of six basic emotions:

Fear – Disinformation in the age of AI

2025 has been frequently referred to as “the year of AI”. Exciting as it may be, the rapid progress in Artificial Intelligence also arouses fear for its potential to fuel disinformation.

Disinformation, which is the deliberate spreading of false information with the intent to deceive or manipulate, poses a major threat to society. It erodes trust, undermines democracy, and encourages polarisation and instability. It also is one of the most quietly dangerous public health threats today. AI-generated conspiracy content and deepfakes on social media are making vaccine hesitancy more widespread, eroding trust in science and health authorities, and hampering outbreak responses.

Fear is a survival mechanism, preparing the body to “fight or flee”. It also promotes social learning and caution. As society, this should guide us toward vigilance and discernment. As scientists, we have a responsibility to fight mis- and disinformation. And few topics have been hit so hard by falsehoods than climate change. Here, fear gives way to anger. 

Anger – Governments’ inaction on climate change

Despite some hopeful signals at the recent COP30, including agreements on financial aid mechanisms, the summit ended once again without a clear roadmap to phase out fossil fuels and halt deforestation, blocked by powerful lobby interests.

Meanwhile, emissions continue to rise and are expected to peak too late to keep warming to 1.5 C above pre-industrial levels - current estimates put us on track for 2.6C warming by 2100. The cost of inaction is already huge: 250 million people were forced to flee their homes by weather-related disasters. Vector-borne diseases are spreading faster than predicted, heat-related deaths continue rising, and air pollution remains catastrophic in many cities. It’s infuriating that, with so much at stake, decisive action is not taken.

Anger helps us mobilise energy to confront threats or defend against harm. So why aren’t we holding governments accountable? Why aren’t we mobilising the energy needed to confront the greatest threat to life as we know it?

Disgust – The cruelty of aid cuts

Disgust serves as a protective mechanism against toxic elements by eliciting feelings of revulsion. And it is hard not to feel disgust when one of the richest men in the world (and who was recently awarded a $1 trillion compensation plan by his company) single-handedly decides to cut lifesaving programmes like USAID in the name of “government efficiency”. These decisions are already costing thousands of lives and could lead to more than 14 million preventable deaths by 2030. Sadly, the US is not alone. Across Europe, right-wing policies are also slashing foreign aid, reversing decades of progress in diseases such as malaria, tuberculosis and AIDS, and putting more than 22 million lives at risk, including 5.4 million children under-five. This takes us to the next emotion.

Sadness – Childhoods stolen by conflict

Sadness helps us cope with loss and prompts more vigilant and thoughtful behaviour. What is sadder than the terrible toll that children are bearing in the ongoing conflicts across the world?

In Sudan, millions of people have been displaced, leaving 7.4 million children with no access to safe drinking water, 4 million suffering from acute malnutrition, and 2 million missing critical vaccinations. In Gaza, 64,000 children have reportedly been killed or maimed, and those who survive are in desperate need of food and healthcare. In Ukraine, around 3.000 children (the equivalent of about 150 classrooms) have been killed or injured and countless more have been robbed of their schools, their homes, and even their families.

Sadness should not be passive; it should be a call to stop these atrocities and protect the most vulnerable.

Joy – Changing the game for malaria

For the first time in more than 20 years, a next-generation anti-malarial drug is on the horizon. GanLum, which combines a new drug (ganaplacide) and an existing one (lumefrantine), represents a critical development as resistance to current artemisinin-based treatments continues to rise. Developed by Novartis and Medicines for Malaria Venture (MMV), GanLum gave highly promising results in a phase III clinical trial across 12 African countries. 

Malaria vaccine programs are also finally scaling up: in 2024, over 12 million doses of malaria vaccine reached 17 African countries and by April of this year, 25 countries had been approved for Gavi funding to introduce malaria vaccines into routine immunisation programs. Furthermore, a deal to cut the price of the R21/Matrix-M vaccine to under $3 per dose could protect an additional 7 million children by 2030, and 21 countries have already rolled out the vaccine since its introduction in 2024.

Joy motivates behaviours that increase our chances of survival, such as social bonds and collective wellbeing. After years of stalled progress in the fight against malaria, the lives that can be saved by these advances certainly give us a reason for joy.

Surprise – Faster than expected

Surprise forces us to pay attention to unexpected events. In last years’ post, I wrote about lenacapavir as a gamechanger for HIV prevention, if it could reach the countries that need it most. The good news is that this has started to occur faster than anticipated. The drug arrived to South Africa, Eswatini and Zambia just months after U.S. approval. Lenacapavir, given as a twice-yearly subcutaneous injection, is the closest thing we have to a vaccine: it was shown to reduce HIV transmission by more than 99.9%. Gilead Sciences has agreed to provide the drug at no profit to two million people in countries with a high HIV burden over three years, and generic versions are expected to be available from 2027 at around $40 per year per person, in more than 100 countries.

Surprise offers an opportunity to drive learning, adaptation and find new solutions. Here’s to hoping 2026 brings a few inspiring surprises.

P.S. A heartfelt thanks to my comms colleagues for their valuable ideas that inspired this post!

World AIDS Day is a time to recognise progress—and to draw attention to the blind spots that still shape the health of people living with HIV. Spain’s HIV system is one of the most robust in Europe: data collection is strong, retention in care is high, and the collaboration between clinicians, researchers, and community organisations has driven decades of achievement. Yet even within such a well-structured system, one of the most common comorbidities continues to remain largely unnoticed.

A Plena Vista, the Campaign Highlighting Liver Health in HIV

That’s why the Public Health Liver Group at ISGlobal has launched the campaign A Plena Vista (“In Full View” in Spanish) after a simple but critical realisation: in Spain, liver disease remains out of sight within HIV care, even though it is one of the leading comorbidities affecting people living with HIV. While HIV programmes have made extraordinary progress in managing coinfections such as hepatitis C, the next major challenge—steatotic liver disease, particularly its metabolic forms (MASLD/MASH)—is still not being diagnosed enough in most clinical settings.

This reflects a systemic gap: even the most advanced health systems can overlook what they do not routinely measure. And in health, as in art, what stays out of focus often falls out of care. A Plena Vista was created to bring liver health into sharp view in Spain.

The campaign takes inspiration from Las Meninas, chosen because it’s widely recognized by its Spanish audience—from the general public to clinicians and academia. Spanish artist Diego Velázquez shows the king only as a reflection: present, easily missed, and ultimately overlooked. 'A Plena Vista' uses this familiar metaphor to reflect a similar truth in HIV care in Spain—the liver is essential, and yet frequently overlooked.

Las Meninas. Velázquez, Diego Rodríguez de Silva. Image: ©Museo Nacional del Prado.

A major milestone came in October 2025, when the European AIDS Clinical Society (EACS) updated its guidelines to include, for the first time, a dedicated Diagnostic Flow-chart to Assess and Monitor Disease Severity in Suspected MASLD and Metabolic Risk Factors in people living with HIV. This new pathway offers clinicians a practical, evidence-based guide for integrating liver screening and non-invasive fibrosis assessment into routine HIV care—tools that the Spanish system is ready to adopt.

Spain has the tools; integration is still missing

The ISGlobal-led campaign underscores that Spain already possesses the infrastructure and expertise to monitor liver disease in HIV populations. What is missing is integration. The pieces exist, but they are not yet connected. By aligning HIV services with the new EACS recommendations, Spain can reduce missed opportunities for early diagnosis and ensure that liver health becomes a standard part of the HIV care continuum.

HIV care can no longer remain siloed. Liver disease in people living with HIV can be both infectious (such as HCV coinfection) and non-communicable (involving steatosis and metabolic dysfunction). Building on Spain’s leadership in viral hepatitis elimination, A Plena Vista invites the voices of hepatologists, HIV clinicians, NCD specialists, researchers, and community leaders to advocate for a coordinated response that reflects the dual infectious–metabolic nature of liver disease.

Emerging Spanish evidence shows that many comorbidities affecting quality of life are preventable when identified early

The campaign’s message is clear: preventive hepatology must be embedded in HIV care. Non-invasive fibrosis tools, metabolic assessments, and structured clinical pathways like the 2025 EACS flow-chart can be seamlessly integrated into routine monitoring. Emerging Spanish evidence shows that many comorbidities affecting quality of life are preventable when identified early.

This World AIDS Day, A Plena Vista invites Spain to bring into focus what has long remained unseen—and to transform visibility into action that strengthens the lifelong health of people living with HIV.

When the first International AIDS Day was marked in 1988, I had just completed my first immunology course, where we were beginning to learn more about a mysterious virus — the human immunodeficiency virus (HIV). At the time, nobody knew much about this stealthy virus.

Three years later, Freddie Mercury’s death brought global attention to an epidemic that had already taken millions of lives. Most died anonymously, leaving behind unfinished lives and grieving loved ones. None of them lived to see the breakthrough of 1996: triple antiretroviral therapy (combining three drugs into one treatment). For those living with HIV, this moment was as momentous as humans landing on the moon —HIV went from an automatic death sentence to a chronic, manageable condition.

A Revolution Unevenly Shared

Yet this revolution remained a privilege of wealthy countries. It took nearly a decade for this life-saving treatment to reach low-income regions, especially sub-Saharan Africa. While people in wealthier countries were reclaiming their lives, around 30 million people worldwide were living with HIV, mostly untreated, and 3.8 million were newly infected each year. In countries like South Africa, Mozambique, and Zambia, HIV remained a death sentence — the epitome of global inequity.

Two Game-Changers That Saved Millions

So, what changed around 2002–2003 to make HIV treatment available to tens of millions? Two major initiatives reshaped the global response:

• The Global Fund to Fight AIDS, Tuberculosis and Malaria, and
• PEPFAR, the US President’s Emergency Plan for AIDS Relief

These huge coordinated efforts poured in unprecedented resources, and continue to do so. By the early 2020s, they jointly contributed around $10 billion annually, while HIV research funding continued to increase — leading to major advances in prevention, diagnosis, and clinical management.

Since the rollout of antiretroviral treatment across regions hardest hit by HIV, more than 20 million lives have been saved and nearly 40 million new infections prevented. With treatment, people on the brink of death literally came back to life within weeks of starting their pills — many called it a miracle. Even being a rational non-miracle minded scientist, I could understand how the dramatic return to health could be seen as the work of a supernatural power.

We are so close to ending HIV — of ensuring that millions can live full, healthy lives. To pull back now would be both a moral and strategic failure

Every year, UNAIDS consistently reported progress: fewer new infections, fewer AIDS deaths, and major drops in mother-to-child transmission — while treatment evolved from multiple doses per day to a single tablet. And, what went up was life expectancy. In South Africa, it went from about 56 years in 2000 to 67 years today.

Science moved forward too. In the past few years, breakthroughs in prevention such as injectable pre-exposure prophylaxis (PrEP) with cabotegravir every two months, and twice-yearly lenacapavir — have brought us closer than ever to ending AIDS by 2030.

2025: A Dangerous Step Backward

Then came 2025. The U.S. administration under Donald Trump dismantled key international aid mechanisms, hacked away most of USAID, and slashed funding for PEPFAR and the Global Fund.

Only months after the cuts, the effects are already visible: health workers let go, clinics closing, and people unable to access treatment. A recent modelling study warned that a 24% reduction in funding could mean 3 million additional AIDS-related deaths and 4–11 million new HIV infections by 2030.

We’re Too Close to Turn Back

We are so close to ending HIV — of ensuring that millions can live full, healthy lives. To pull back now would be both a moral and strategic failure.

It’s like building your family’s house from the ground up, spending years laying down the bricks, pouring in your savings, and caring for each detail. You just need to paint the front door and you are finished. Would you really walk away after coming so far? Would you give up your home and lose all of the money and sacrifices you made?

To Finish What We Started

We cannot stop as we near the finish line. Around the world, health systems are moving toward integrated care, managing HIV alongside chronic diseases and infections like tuberculosis and malaria, often through primary care services. These models have been shown to be sustainable, cost-effective, and community-centred and can be generalized.

Ending AIDS by 2030 is still possible. But only if we choose to finish what we started

Ensuring uninterrupted antiretroviral treatment is essential for saving lives and keeping HIV under control. But we won’t end the epidemic if we fail to halt new infections — prevention cannot not be ignored. Promising tools like lenacapavir as PrEP— , the closest we have ever been to a vaccine— must reach high-incidence regions and those most at risk.

We must also tackle stigma and discrimination, as they remain major barriers for many.

Reaching those most in need will require collaboration across governments, global donors, researchers, the pharmaceutical industry, and affected communities.

Ending AIDS by 2030 is still possible. But only if we choose to finish what we started.

[This article was jointly written by Julia Pedreira (ISGlobal and WGH Spain), Silvia Gómez (ISGlobal and WGH Spain), and Anne Thompson (ISGlobal).]

No woman should fear for her life in the search for a more dignified existence. Yet thousands of migrant women cross borders hoping to find safety, only to face new forms of violence—quieter, but just as devastating.

Violence against women crosses borders

Every 25 November, we are reminded that violence against women remains a hidden pandemic in the 21st century. According to UN Women, this violence and insecurity disproportionately affect women and girls, especially in contexts of migration, conflict, or humanitarian crises.

Beyond global figures lie realities that remain outside media and political focus: those of migrant women. Their experience is marked by displacement, ruptures, loss of support networks, and the collision with systems that were not designed for them. At this intersection of gender, migration, and health emerges a double vulnerability: being a woman and a migrant, which means facing forms of structural violence that are often normalized.

Invisible violence, lives in movement

In Europe, 31% of women over 15 have been victims of physical or sexual violence at some point in their lives. Systems often lack the resources and protocols needed to respond to their needs, leaving many women unprotected. This situation worsens for migrant women, for whom the healthcare system reproduces language, administrative, and/or cultural barriers. Institutional violence becomes tangible when a woman fears going to a health centre because of her migration status, when protocols fail to consider cultural diversity, or when support gets lost in bureaucracy.

Migrant women face a particularly high risk of gender-based violence throughout the entire migration process, due to unsafe routes, discrimination, socioeconomic insecurity, and barriers to accessing support services.

These forms of violence—silent but constant—add to labour precarity, racial discrimination, and social isolation. The lack of family networks and the fear of losing economic stability lead many women to remain in abusive situations, without access to protection mechanisms.

Gender-based violence: a wound in public health

According to the World Health Organization (WHO), gender-based violence is a global public health emergency that affects one in three women over the course of their lives. In humanitarian contexts, the figure is even higher: one in five displaced women experiences sexual violence and more than half of migrants arriving in Europe have experienced gender-based violence, the majority of them (69%) women.

Addressing violence against migrant women requires strengthening health systems with a gender and cultural diversity perspective, training professionals to see beyond what is visible, and creating safe spaces where silenced voices can be heard.

These figures show that migrant women face a particularly elevated risk of gender-based violence throughout the migration journey, due to unsafe routes, discrimination, socioeconomic precarity, and barriers to support services. Intersectional discrimination—based on gender, race, ethnicity, or other factors—further increases the risks and severity of the violence they endure.

Injuries, unwanted pregnancies, chronic illnesses, depression, anxiety, or post-traumatic stress are just some of the consequences. If health is a universal right, we cannot continue to ignore how social determinants, violence, migration, and gender profoundly shape it.

Addressing violence through intersection and action

Addressing violence against migrant women requires intersectional approaches and coordinated responses. It means recognising that not all women start from the same place, nor experience the same forms of violence. It implies strengthening health systems with a gender and cultural diversity lens, training professionals to recognise more than what is visible, and creating safe spaces where silenced voices can be heard.

At WGH, we affirm that a more just and healthy society will only be possible if we make these forms of violence visible and work together to transform them. Make visible, listen, and act. Because without health, without equality, and without protection for all women—including migrants—there can be no global justice.

In memory and with hope

This 25N, we raise our voices for those who migrated in search of a better life, for those who endure in silence, and for those who are no longer here. May their strength inspire us to build, starting today, a world free from violence.

The heat of the moment: a poem by Anne Thompson

We share a poem by our ISGlobal colleague Anne Thompson. Her current research project (EARLY-ADAPT) analyses the effects of temperature and air pollution on gender-based violence in Spain. Her text invites us to reflect on the visible and invisible wounds of violence, possible environmental factors that may contribute to that violence, and the collective strength that emerges from sisterhood and care.

Worldwide, one in three women are assaulted

With violence fueled by hatred, by rage, by insecurity,

Armed with weapons of words, of actions, of bodies.

"Look at what you made me do."

"Did you see what she was wearing?"

"She definitely wanted it."

How many times must we hear the words,

"I'm sorry,"

"Forgive me,"

"It won't happen anymore."

Only, it happens

Over

And over

And over again.

A cruel comment today,

A strong, swift fist tomorrow.

Every 10 minutes, one woman is murdered

By a loved one, a partner, a relative.

140 women every day.

No setting is immune from this brutality.

Not a street,

Not a train,

Not a school,

Not a household.

Temperatures and tempers continue to rise.

He says it was just the heat of the moment but

just how often does the heat impact the moment?

The air we breathe is hazy and contaminated but,

just how often does that pollute a man's ability to self-regulate?

In Spain, the numbers 0-1-6 offer support.

A lifeline.

Calls for help continue to rise

As do the numbers of heatwaves

Drops of tears

Beads of sweat

How much worse will this get?

A planet, a home, a body, a woman

Cannot thrive or flourish

In a place that continues to melt

From the oppressive violence of man

And the oppressive heat in the air

Both of which suffocate

And exhaust

And leave one thirsting for safety

For change

For relief

Is it any wonder that

in our androcentric world,

we call our earth a mother,

Yet so many sit back and watch her burn as well?

Walking into the Blue Zone at COP30 in Belém, I was struck by the scale —over 50,000 delegates, from government officials to researchers to youth leaders and Indigenous representatives, moving through a maze of buzzing tents. The urgency of the climate crisis was palpable everywhere. Amidst this chaos, something remarkable was unfolding: for the first time, the world seemed to understand the relationship between climate and health.

A Historic Step: The Belém Health Action Plan

Brazil’s Ministry of Health, together with WHO and PAHO, launched the Belém Health Action Plan (BHAP), the first international climate adaptation framework dedicated specifically to health. Following this, more than 35 global philanthropies announced the Climate and Health Funders Coalition, aligning with the BHAP to accelerate solutions for extreme heat, air pollution, and climate-sensitive infectious diseases while strengthening resilient health systems. These new commitments are the result of years of work.

Why This Matters

These initiatives mark a shift in the global climate-health agenda, highlighting the essential role of research, adaptation, and equity. BHAP outlines a roadmap for strengthening climate-resilient health systems by improving disease surveillance, integrating health into national climate commitments, building health workforce capacity, and prioritizing equity and climate justice for the most vulnerable populations (older adults, people living with chronic illness, and communities facing social marginalization). The Climate and Health Funders Coalition aims to catalyze scalable, evidence-based approaches focusing in on regions where risks are greatest, and its $300 million initial commitment (made by a group of funders including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation) is tied to the BHAP, ensuring some level of actionability.

The Human Side of COP30

Experiencing COP30 firsthand, I observed delegates debate treaty language with painstaking precision. Hours are dedicated to debating wording, such as whether agreements should use “should” or “shall,” or how a single comma might alter meaning. While this struck me as beyond tedious at first, I understood that the fine points of treaty language can determine the strength of commitments, the enforcement of accountability, and the financing that will reach climate-vulnerable populations. These negotiations are proof of how global policy is tightly linked to population health, and how health professionals and researchers can advocate for policies that protect the most vulnerable.

Just outside the negotiation halls, pavilions hosted by countries, research institutes, UN agencies, and NGOs functioned as hubs for advocacy, innovation, and hopefully sparking cross-sector collaborations. The visibility of health across the pavilions was notable. Health ministers joined panels on air quality, heat exposure, water safety, mental health, and resilient health systems. Amidst the frenzy, Indigenous delegates, brought their lived realities of climate change into the global forum through language, traditional clothing, and storytelling, in ways that were difficult to overlook.

A Sense of Possibility

Leaving Belém, I felt a strong sense of possibility. COP30 offered not just recognition of the climate health connection but a concrete plan and coordinated resources to act on it. BHAP, aligned with philanthropic commitments, has the potential for true action. I know that every COP is important, but progress comes from what happens between them, and now is the time to maintain momentum.

My name is Delfina Boudou, and I’m the Programme Manager for ISGlobal’s Public Health Liver Group. Every year on World Diabetes Day, I reflect on my diabetes journey, as well as others’, seeing how far we’ve come — and how far we still must go. For me, this day is personal.

I was diagnosed with Type 1 diabetes when I was sixteen. Until then health had been something I took for granted. I went from worrying about exams to learning how to count carbs and inject insulin. It was a crash course in responsibility. Before I had even finished university, I was diagnosed with another chronic autoimmune disorder, Hashimoto's disease, which affects the thyroid gland. It all led me to see how connected our bodies, our minds and our environments are. One imbalance affects another. Nothing happens in isolation.

Living with Type 1 diabetes and hypothyroidism has made me stubborn in the best way. I don’t believe in perfect systems, but I believe in fair ones. I believe in healthcare that reaches people early, and that doesn’t depend on your income or your postcode

Health can be unfair. Some people have support, some don’t. Some have access to insulin; others fight for it every day. Throughout my life I have lived in various health systems, with varying access to care, and what is clear is that access to proper care greatly defines your health outcomes even if you do everything right.

Living with 2 conditions. Living as 1 person

When you live with multiple conditions, you see how fragmented care can be: doctors treating the same person as separate cases. You also see how privilege shapes everything — who gets diagnosed, who gets time, who gets treatment. I don’t say that as theory. I’ve lived it. And that’s partly why I ended up here in ISGlobal.

When you live with multiple conditions, you see how fragmented care can be: doctors treating the same person as separate cases. You also see how privilege shapes everything

In the Public Health Liver Group, our work has evolved from a primary focus on infectious diseases to a broader commitment to liver health. Our values, nonetheless, remain constant: advancing equity and placing people at the centre of care. We support health systems to address conditions as interconnected rather than isolated.

The META Trial team.

The META Trial is an example of this ongoing legacy. It directly links my professional work to the diabetes community. The study aims to identify a low-cost intervention to prevent or delay the onset of type 2 diabetes in individuals living with HIV and pre-diabetes who are on antiretroviral therapy (ART) in Tanzania. While liver disease may not fall squarely within its scope, the trial embodies the same principle that guides our current work: integration. It shows how understanding the connections between conditions, and preventing illness in one area, can strengthen health across others.

More Than a Research Aim

Because whether it’s HIV, COVID-19, diabetes, or liver disease, the story is often the same: shared roots in metabolic dysfunction, inequity, and limited access to care. That’s why our group works to make liver health part of the broader non-communicable disease conversation, bridging the gaps between infectious and non-communicable conditions. We want systems that reflect how people actually live… that is, often with multiple conditions, not single labels.

Living with Type 1 diabetes and hypothyroidism has made me stubborn in the best way. I don’t believe in perfect systems, but I believe in fair ones. I believe in healthcare that reaches people early, and that doesn’t depend on your income or your postcode.

Chronic conditions aren’t just medical; they’re political, economic, and human.

And for me, they’re also a daily reminder of why I do what I do. Because integration isn’t just a research goal. It’s personal.

[This text has been written by Yvette Moya-Angeler, communications officer at ISGlobal, and Adelaida Sarukhan, scientific writer at ISGlobal. It has been updated on 10/11/2025.]

What is bird flu?

Avian influenza is an infectious disease that affects birds. It is caused by Type A influenza viruses which belong to the Orthomyxoviridae family.

There are several strains of avian influenza virus, depending on the type of surface antigens (H and N) they present. Highly pathogenic avian influenza (HPAI) strains, including some H5 and H7 strains, are highly lethal, especially in domestic birds (geese and ducks seem to be more resistant to disease). Five subtypes (expressing H5, H7 or H9) have been reported to occasionally infect humans.

Avian influenza is highly contagious among birds and can spread from farm to farm through the movement of infected animals or contaminated equipment (products, vehicles, cages, feed, clothing, etc.). The disease can also spread by contact between migratory and domestic birds.

Why have health authorities been sounding the alarm about avian influenza?

Circulation of HPAI viruses is nothing new. However, after a period of epidemiological stability, outbreaks have been on the rise since 2020.

Increase in geographical range

In the past two years, the world has experienced an unprecedented wave of avian influenza (H5N1) that has affected -and killed - a great number of domestic and wild birds in many regions, including the Antarctica. The spread of avian influenza in wild species could have a devastating effect on the biodiversity of our ecosystems.

And a greater number of species

In addition, the H5N1 clade currently circulating worldwide has been able to jump the species barrier and infect a variety of wild and domestic mammals, including bears, sea lions, seals, big cats, racoons, ferrets, dogs, cats, and most recently, hundreds of dairy cows in the USA.

Although mammal-to-mammal transmission of avian influenza is considered to be ineffective, the outbreak of avian influenza in a mink farm in Galicia, Spain, in October 2022, is a worrying development. It is the first outbreak documenting mammal-to-mammal transmission of a highly pathogenic strain (H5N1).

Another worrying development: in March 2024, H5N1 infections were detected in dairy cows in the US. Since then, the virus has spread to a large number of herds, probably through the machinery used to milk them. More than 890 farms in 16 states have tested positive and several dozen infections have been reported in dairy workers, most of them with mild to moderate symptomatology.

In Spain, in November 2025, due to the forecasted drop in temperatures and the rise in avian influenza cases among wild and domestic birds in the European Union, the Ministry of Agriculture, Fisheries and Food implemented preventive measures in high-risk areas, including a ban on raising poultry outdoors.

Photo: Dattatreya Patra / Unsplash

Can people catch avian influenza?

The risk to the general population is, for the time being, considered low. People can become infected by direct contact with infected animals or their droppings, without hygienic and sanitary measures. Therefore, it is recommended to avoid contact with wild birds and, if any sick or dead birds are found, to notify the veterinary authorities so that they can be removed and analysed.

For people working on farms and in contact with birds or other potentially infected animals, the risk is higher, so it is recommended to take extreme precautions and use personal protective equipment.

Since January 2003 and until December 2024, the World Health Organisation (WHO) has recorded 954 human infections with avian influenza A virus (subtype H5N1) in 24 countries, and 464 deaths. Most cases have occurred in Asia and in people in close contact with live or dead infected birds or contaminated environments. In 2024, the US has reported more than 50 human infections, the vast majority of them in personnel exposed to dairy cows. Symptoms have generally been mild (mostly conjunctivitis) and no transmission to close contacts has been identified.

What are the symptoms of avian influenza in humans? Is it dangerous?

A person infected by the avian influenza virus can develop anything from a mild upper respiratory tract infection (fever and cough) to severe pneumonia, septic shock, acute respiratory distress syndrome and even death.

More than half of the people who have been infected with the H5N1 subtype have died (954 reported infections, 464 deaths). It is possible that the host, route of transmission and viral clade determine the severity of the disease. The viral genotype currently circulating in livestock appears to cause milder infections (characterised mainly by conjunctivitis) compared to that circulating in wild birds, which tend to be much more severe.

Can someone infected with avian influenza transmit the virus to another person?

At the moment there are no known cases of human-to-human transmission. The virus currently circulating in birds and livestock does not have the capacity to transmit ‘efficiently’ between humans. But the fact that it is circulating in an increasing number of mammals increases the likelihood that it will, through a few mutations, acquire the ability to do so. Close surveillance in both animals and humans is more necessary than ever.

Photo: Dattatreya Patra / Unsplash

Do I need to take precautions if I eat poultry, eggs or drink milk?

No. So far there is no scientific evidence of avian influenza spreading via the food chain. If living in an area where dairy herds are infected, it is strongly advised to avoid drinking raw milk, since it can contain live virus. Regular pasteurization, however, inactivates the virus.

Why does the virus spread so quickly from one country to the next?

Bird migration routes are thought to play a role in the geographical spread of the virus. Some studies have suggested that members of the Anatidae family (ducks, geese and swans), especially migratory ones, are natural hosts for the virus. Climate change may also play a role: if migration routes change, wild birds carrying the virus may be able to reach new territories.

The disease can also spread from one country to another through the the international smuggling of live birds.

What can we do?

We must continue to work from a One Health perspective, with the understanding that human, animal and planetary health go hand in hand. Three quarters of today’s emerging diseases are zoonotic, meaning that the pathogen jumps from an animal to a human being. Globalisation, aggression against ecosystems, invasion of natural habitats and factory farming make it ever more likely that we will continue to see outbreaks of emerging viruses.

More and more city dwellers enjoy brunch with bowls of açaí, a superfood packed with antioxidants. The açaí eaten mid-morning in Barcelona, Paris or New York mostly comes from the State of Pará, in Brazil — where significant outbreaks of Chagas disease are also found. There, the fruit is usually consumed as a juice, and when contaminated, it becomes a route of oral transmission of the disease — one that can cause some of the most severe and deadly forms of Chagas.

The Amazon: biodiversity and health

The Amazon harbours nearly 25% of all known plant species and around 20% of the planet’s freshwater reserves. Its immense green canopy helps regulate the global climate, but beneath it coexist large cities, small villages, and isolated Indigenous communities. This diversity makes health surveillance difficult and favours the emergence of vector-borne diseases.

The link between the region and Chagas disease dates back to 1924, when Brazilian researcher Carlos Chagas identified the parasite in animals and wild triatomine bugs from the area. For much of the 20th century, human infection was considered exceptional, as local insects were not thought to infest homes. The disease was therefore seen as enzootic but not endemic in the Amazon.

Chagas on the rise

Recent studies have shown that human infections are more common than expected, with active foci and infection rates above 5% in some Amazonian territories. The spread of açaí and other factors — such as deforestation, internal migration, and agricultural expansion — have increased contact between humans, vectors, and wild reservoirs. This indicates that vector-borne, and particularly oral, transmission of Chagas is on the rise, especially in the eastern Amazon.

The expansion of açaí and other factors — such as deforestation, internal migration, and agricultural growth — have fostered contact between humans, vectors, and wild reservoirs. This suggests that vector-borne, and especially oral, transmission of Chagas is increasing, particularly in the eastern Amazon.

In Latin America, almost 100 million people are at risk of infection by Trypanosoma cruzi, with 8 million affected and thousands of deaths each year. Transmission can occur through the bite of triatomine bugs, contact with their faeces, or from mother to child. If undetected and untreated, 4 in 10 people will develop severe complications, mainly cardiac.

Regional cooperation for health

A recent meeting of Chagas control managers from the nine Amazonian countries (Bolivia, Brazil, Colombia, Ecuador, Guyana, French Guiana, Peru, Suriname and Venezuela), held in Belém do Pará, focused on this growing challenge. Together with the PAHO and other organisations, the countries developed a regional strategy to be adapted to each specific territory.

Even if it seems far away, all of us — even those enjoying açaí brunches in Barcelona or Los Angeles — depend on the immense fragility of the Amazon and its ability to survive. Another reminder that the fight for health must always be global, or it is not.

Experts agree that early detection, community education, and cross-border cooperation are essential to prevent Chagas from becoming an endemic threat in the region.

A global reminder

The Amazon is not only a natural treasure but also a reminder of the close relationship between the environment and human health. In the face of Chagas’ expansion, strengthening epidemiological surveillance and scientific research is key to protecting both biodiversity and the populations that depend on it. For this reason, it would be desirable for the health agenda of COP30 to include concern about the spread of Chagas.

At the green heart of our planet, the health of the forest and of humans beat in unison. And even if it feels far away, all of us — even those having açaí brunches in Barcelona or Los Angeles — depend on the immense fragility of the Amazon and its ability to survive. Another reason to understand that the fight for health is always global — or it is not.

For many years, the misuse and overuse of antimicrobials have driven the emergence and spread of resistant microorganisms, to the point of being described as a “silent pandemic.”
But this problem does not only affect people: it also impacts animals and the environment.

One Health.

The role of water in antibiotic resistance

Within the environment, water is considered one of the most important vehicles for bacteria and resistance genes to antibiotics.

Wastewater —coming from households, hospitals, or farms— is treated in treatment plants to remove organic matter, pollutants, and microorganisms. Part of this treated water returns to rivers, and another part is reused to irrigate crops, streets, or parks. With drought episodes becoming more frequent, the use of this reclaimed water will continue to grow.

Although treatment eliminates most fecal bacteria, environmental bacteria persist in reclaimed water (considered “normal” in the environment), and these are capable of acquiring and transferring resistance genes.

Why is it a risk?

These environmental bacteria rarely cause serious infections, except in immunocompromised people, so they are considered opportunistic pathogens. However, they can act as “bridges” of resistance: when in contact with pathogenic bacteria, they can transfer the acquired resistance genes, making them more difficult to treat if they cause an infection.

From water to plate: a foodborne risk

Irrigation with contaminated water can transmit resistant bacteria to food. An example of vegetable contamination was the outbreak attributed to the “Spanish cucumbers” (eventually caused by soybean sprouts irrigated with fecal water in Germany), which affected more than 2,000 people and caused 22 deaths.

Water connects humans, animals, and the environment: it is a key vehicle in the spread of antibiotic resistance. Protecting water resources and improving wastewater treatment are essential steps to curb this global threat.

The role of livestock and chemical pollution

The historical misuse of antibiotics in food-producing animals —including fish— has contributed to this crisis. Although it is now regulated, we are paying the price for previous decades. Antibiotic-resistant bacteria of animal origin can reach water through feces.
In addition, discharges of chemical substances, antibiotics, and other waste into rivers and seas can promote bacterial mutations that increase their antibiotic resistance, as bacteria try to protect themselves from these substances, sometimes by expressing specific genes that confer resistance to antibiotics.

Protecting water, protecting health

Water connects humans, animals, and the environment: it is a key vehicle in the spread of antibiotic resistance. Therefore, protecting water resources and improving wastewater treatment are essential steps to curb this global threat.

To define herself, microbiologist María Elena Bottazzi starts with her multicultural background: she was born in Italy and grew up in Honduras, her father’s country. She fondly remembers the rivers she used to swim in and the horses on her grandmother’s ranch. She had to be careful of intestinal worms and neglected tropical diseases that burdened the lives of many around her. This is how she began to develop her sensitivity to poverty and inequalities.

She loved studying. She earned a degree in Microbiology and Clinical Chemistry at the National Autonomous University of Honduras, from which she graduated, she says, “as prepared as anyone who had studied at a top-tier university.” She then furthered her education in Florida and Pennsylvania: a PhD in Molecular Immunology, two postdoctoral fellowships in Cellular and Molecular Biology, and even started a Master’s in Management.

Meeting Peter Hotez marked a turning point in her career. They began collaborating in 2001 and, ten years later, moved to Houston, the fourth-largest city in the United States, to establish the Vaccine Development Center at Texas Children’s Hospital. Since then, they have led a small team of scientists focused on what other research groups often overlook: neglected, emerging, or re-emerging diseases. Their goal is to design accessible, affordable vaccines for those who need them most on a non-profit basis.

When the COVID-19 pandemic broke out, their lab had already spent a decade studying coronaviruses, focusing on SARS and MERS, which had become neglected diseases. In three months, they developed a recombinant protein-based technology that led to Corbevax, a COVID-19 vaccine free of patents and low-cost, developed in collaboration with Biological E in India. “A vaccine for the world,” Bottazzi sums up. Later, they also collaborated with BioFarma in Indonesia to co-develop Indovac.

As Associate Dean of the National School of Tropical Medicine at Baylor College of Medicine and a Professor of Pediatrics, Bottazzi recently visited Barcelona, invited by the Malaria and Neglected Parasitic Diseases Program of ISGlobal.

The Division of Pediatric Tropical Medicine at Texas Children’s Hospital drives research and vaccine development for neglected diseases. Photo: Baylor College of Medicine.

-In 2020 you were nominated for the Nobel Peace Prize together with Peter Hotez, and that same year Forbes named you one of the most powerful women in Central America. How did that change you?

-The nomination was a recognition of our work seeking solutions for neglected or emerging tropical diseases (at the time, COVID-19). But the visibility also brought responsibility, because suddenly we had our “fifteen minutes of fame” and society was watching what we do. We had to become better communicators, which is not easy.

-What do you feel you have done well?

-Staying anchored in the concept of “non-profit,” remaining true to the goal that our work be accessible and affordable, beneficial to anyone regardless of economic means. Sometimes you can get distracted by opportunities that pull you away from your center, but you quickly return to your purpose.

-I imagine there are discouraging moments. What do you do then?

-In science, discouragement is constant: an experiment fails, a hypothesis doesn’t hold, funding is insufficient, unexpected events occur… But sometimes these difficult moments open doors to opportunities. During the COVID-19 pandemic, for example, when everything stopped abruptly and we couldn’t go to the lab without risk, our team became more empathetic toward one another.

Patent-free technology for a COVID-19 vaccine

-For you it was an opportunity, because it slightly changed your career path.

-We worked very hard, almost 24/7, but Corbevax and Indovac gave us visibility: we were a relatively small lab in Texas, working to benefit the world. The technology we developed has been called “the vaccine for the world.” We gave it away. We focused on how to save the lives of as many people as possible. The opportunity to do this, together with collaborators and groups who shared the same mindset, with vaccine producers in India and Indonesia, was… I don’t even know how to express what we felt. One hundred million doses of our vaccine were distributed to children aged 12 to 14, that is, to our future. That is something I think we will never forget.

-Were you able to see on site how the vaccine was administered?

-At first we kept in touch with our collaborators via Zoom, but later we were able to visit them, yes. It was very beautiful. When we visited Biological E in India, the first lab to adopt our technology, they had us plant a small tree. I have a tree in India with my name on it, which will grow and they will continue caring for it as recognition of all the children we helped save. It was a very special experience.

-Competing with big pharmaceutical companies, did you feel like David versus Goliath?

-Developing any biological medicine, especially vaccines, is a tough process. We see it now as we return to working on vaccines for neglected diseases: after 25 years of work, we are still at the beginning, we haven’t reached the level we did with the COVID-19 vaccine. But we already have a precedent: we know it can be done! Of course, it is possible when groups unite with the same goal, have government and leadership support, the necessary funding… and population acceptance. That is where we need to work a bit more: on how to explain to the public the benefit of vaccination. It is quickly forgotten when terrible infectious diseases disappear against which highly effective vaccines have worked.

-Does a scientist have to do all that? Besides research, do you have to seek funding, explain to the public the benefits of vaccines, etc.?

-For science to truly reach populations, many factors must be considered: social, economic, legal, ethical… It is very important to know how to communicate science and explain its value. Universities should emphasize that science must engage in dialogue with other disciplines.

In search of new vaccines

-Are you working on new vaccines?

-We are working on a group of vaccines against intestinal parasites, which cause many diseases, especially in children. We have made considerable progress on a vaccine against hookworm. We are also working on another for schistosomiasis, for which we are awaiting results from a study in Uganda. We are advancing a vaccine for Chagas disease, for infected patients who do not yet show clinical symptoms. We are waiting for approvals to see if we can start a study in Mexico. Additionally, we are working with other parasites and bacteria. For example, we have a vaccine project against Lyme disease, a bacterial infection transmitted by ticks.

The human factor

-Have you incorporated behavioral psychologists into your teams?

-Yes, with the aim of improving team interactions, addressing daily life stress, and making work enjoyable and productive without neglecting personal life.

-Do you maintain a balance between work and personal life?

-Yes. It is a lot of work. How do you add time to reflect and even understand yourself? I am a woman, Latina, living in the United States, and English is not my first language, so I have to interact with very important people and sometimes I feel a bit of imposter syndrome. I focus on my strengths and not so much on my weaknesses, which my team can complement. I really enjoy rowing at the gym. It’s an interesting sport because you put in your own effort, but it improves collective effort. There is a lot of science behind how exercise helps build those team connections. That is on the physical side. And we should not forget our roots, family, and maintaining that human connection.

-You have been working in tandem with Peter Hotez for 25 years. How is your relationship?

-We share the same passion and vision, but if we did a personality study, we would probably be at opposite ends of the spectrum: I focus on troubleshooting and problem-solving, while he is more of a visionary and excels at social and communication aspects. I implement, organize, and pay attention to details. Our conversations are constructive, even when we disagree. We learn from each other. We support each other; in difficult times, we remind ourselves that the work we are doing is worthwhile, and we transmit that to our teams. Peter has always seen me as an equal, even though I am a woman and younger. He has always put me at the forefront, and I have also taken the opportunity to stand out. So we move forward together. I don’t think we could have achieved what we have separately; I consider myself very fortunate, and I believe he does too.

Would you rather encounter a man or a bear in the woods? This question went viral on social media in 2024. To the surprise of many, thousands of women answered “the bear”. The debate that followed exposed a reality: for many women, the biggest threat in nature is not the wilderness. It is other people.

Spending time in non-threatening green spaces is good for health and wellbeing: it reduces stress, promotes physical activity, fosters better mental health, and lowers the risk of chronic disease. Yet these benefits are not equally shared. Women tend to visit nature less frequently than men and feel less safe in parks.

What makes women feel unsafe in nature?

In our recent study in England, we compared women’s and men’s perceptions of green spaces. Participants viewed images and videos of country parks with varying vegetation density (from open to dense) and different potential threats (from wild animal to social harm).

The results were clear:

• Women consistently reported higher levels of fear and risk than men, especially in dense green settings.
• Social dangers, such as the threat of assault, outweighed physical dangers like wild animals for women — but not for men.
• These perceptions influenced behaviour: women were less likely than men to say they would visit or return to those environments.

In short, women’s relationship with nature is not only shaped by the physical landscape but also by the social risks they anticipate within it.

Why this matters for health and equity?

Feeling unsafe in nature is not just an inconvenience — It is a public health issue.

If half the world’s population feels less able to use these spaces, access to these health benefits becomes profoundly unequal.

This contributes directly to gender inequities in health and wellbeing.

What can be done to improve women’s safety in green spaces? 

Closing this gender gap requires action on multiple levels:

• Landscape design and maintenance: keeping vegetation from becoming overly dense may help. However, the real issue is social — women are not afraid of trees, but of strangers.
• Addressing harassment and gender-based violence must be the real priority. Stronger protections, public awareness campaigns, and a deep cultural change are necessary to make parks safe.
• Promoting green spaces as safe and welcoming for women: social norms influence how boys and girls use outdoor spaces from childhood. Changing these expectations can ensure women feel equally entitled to nature.

And these are not just gender issues. Children, older adults, ethnic minorities, or LGBTQ+ individuals may also feel unsafe in nature — and would benefit from safer, more inclusive green spaces.

Nature for all: making green spaces safe and inclusive

Nature can be a powerful tool for global health. If women and other vulnerable groups avoid nature due to fears of violence, they lose opportunities for wellbeing. Addressing safety in green spaces is therefore not only a matter of urban design but of public health and social justice.

 If we want nature to be source of health for all, then efforts to promote access to green spaces must go hand in hand with efforts to prevent violence. And making nature safer for women means making it healthier for everyone — and building more just and inclusive cities.

[This text was written jointly by Megan Naidoo, a PhD candidate at the University of Barcelona, Elisa Landín Basterra, predoctoral fellow at ISGlobal. Gabriela Santos Jesus, PhD student at the Federal University of Bahia, and Davide Rasella, ICREA Research Professor and head of the Health Impact Assessment and Evaluation Group at ISGlobal.]

For millions of people around the world, an illness can mean choosing between medicine and food — a stark reminder that poverty is a fight for survival. The United Nations’ first Sustainable Development Goal (SDG 1) is to end extreme poverty in all its forms everywhere by 2030. Yet, with only five years left, the world remains far from achieving this goal. Exacerbated by global conflict, climate change, and the COVID-19 pandemic, nearly one in ten people still live in extreme poverty, surviving on less than $3 per day. But poverty is not just about income — it is a struggle for dignity and health.

Poverty as a Determinant of Health

Poverty is one of the most powerful social determinants of health. It limits access to nutritious food, clean water, quality healthcare, and safe housing — the foundations of wellbeing. The consequences are higher rates of infectious and chronic diseases, premature mortality, and mental stress among the most vulnerable communities. Poverty determines who falls ill, who gets care, and who recovers, a reflection of an unjust world where health is a privilege rather than a right.

Universal Social Protection: A Path to Health Equity

Universal social protection is central to achieving SDG 1. These policies ensure that everyone can access income support and essential resources such as housing, food, healthcare, and education, helping to reduce systemic social and economic exclusion. Recognising its importance, one of the targets for SDG 1 is to implement universal social protection systems for all.

Poverty determines who falls ill, who gets care, and who recovers, a reflection of an unjust world where health is a privilege rather than a right

Evidence from low- and middle-income countries (LMICs) shows that social protection programs improve health outcomes and protect against catastrophic health expenditures. For instance, Community-Based Health Insurance, where communities pool resources to cover healthcare costs, has significantly reduced out-of-pocket expenses and increased healthcare utilisation in LMICs.

During the COVID-19 pandemic, governments worldwide implemented over 1,600 emergency social protection measures, reaching nearly two billion people in LMICs. Yet many of these measures were later scaled back, eroding gains. With almost half the global population still unprotected, renewed commitment to universal, shock-responsive systems is essential.

Lessons from Brazil’s Bolsa Família

Cash transfer programs are a type of social protection that provide income support. Brazil’s Bolsa Família, one of the largest conditional cash transfer programs globally, provides financial aid to help ensure children attend school and families use preventative health services. The program has consistently improved economic, health, and educational outcomes, especially among the most marginalized communities. The program significantly decreased malnutrition, infant mortality, and HIV/AIDS and tuberculosis incidence and mortality. Overall, Bolsa Família prevented an estimated 8.2 million hospitalizations and 710,000 deaths from 2000- 2019, with particularly strong benefits among children and older adults. Projections suggest that expanding coverage could prevent an additional 680,000 deaths and eight million hospital admissions by 2030.

Social protection systems are among the most powerful tools to end poverty

Dignity for Everyone, Everywhere

Eradicating poverty ensures that all individuals have the chance to live with dignity. Social protection systems are among the most powerful tools to end poverty. Inclusive social policies can change lives, improve health, and strengthen community resilience. We must move beyond temporary measures and invest in long-term, equitable systems that protect everyone, everywhere. Ending poverty is not only achievable — it is essential for a healthy, fair, and just world.

[This text was written jointly by Anna Lucas, Coordinator of the Maternal, Child and Reproductive Health Initiative, Clara Menéndez, Research Professor, Director of the Maternal, Child and Reproductive Health Initiative and Programme, and Cristina Enguita, Assistant Research Professor at ISGlobal.]

Adolescent Girls at the Center of Health Decision-Making

Promoting adolescent girls engagement in health decisions enables them to gain critical knowledge, develop life skills, and cultivate positive attitudes toward their sexual and reproductive health. When girls have opportunities to be vocal and involved - through group discussions, peer education, and leadership in advocacy- they are more likely to make informed choices, avoid risky behaviors, and demand services that meet their unique needs.

From Beneficiaries to Co-Creators in Reproductive Health

Moving beyond seeing adolescent girls as mere beneficiaries is vital to position them as co-creators, and advocates in reproductive health research and programming and offer adolescents the chance to discuss openly with peers, researchers, health workers, and teachers allowing them to ask questions, express concerns, and support each other in decision-making. Their voices can contribute to inform and shape policies and services, making interventions more culturally relevant, acceptable and responsive to their lived experiences.

When girls have opportunities to be vocal and involved - through group discussions, peer education, and leadership in advocacy- they are more likely to make informed choices, avoid risky behaviors, and demand services that meet their unique needs

Facilitating adolescent involvement can also help de-stigmatize reproductive health issues and reduce harmful practices. Sustainable improvement in adolescent reproductive health relies on supporting girls to act as change-makers within their families, schools, and communities. This requires creating safe environments for self-expression, involving girls in research and program design, and training them to advocate for their rights.

HPV Vaccination and the Case of Sierra Leone

Vaccination against the human papillomavirus (HPV) -that prevents cervical cancer and is aimed primarily at the group of girls between 9-14 years of age per the WHO recommendation- is an intervention where their voices must be heard.

Vaccination against the human papillomavirus (HPV) -aimed primarily at the group of girls between 9-14 years of age per the WHO recommendation- is an intervention where their voices must be heard

In Sierra Leone -as in most low-income countries- cervical cancer, primarily caused by persistent HPV infection, remains a major health challenge. It is the second most common cancer among women and a leading cause of mortality, with approximately 372 deaths each year. The HPV vaccine, introduced in Sierra Leone in 2022 as a key preventative measure, saw early success but uptake subsequently dramatically declined. To ensure cervical cancer elimination targets are met in Sierra Leone, and as the next vaccination campaign expands to older adolescent girls (11-18 years old), understanding the factors influencing uptake is vital.

Understanding Barriers to HPV Vaccine Uptake

Studies investigating the reasons behind low HPV vaccination coverage have indicated structural barriers, including weak health systems, often heavily reliant on external support, limited vaccine supply, geographic inaccessibility, and low school enrolment as the main factors. In addition, uptake-related challenges such as misinformation and mistrust – such as concerns about fertility and vaccine safety but in the case of Sierra Leone also shaped by experiences with past disease outbreaks, especially Ebola-, stigma and socio-cultural beliefs and scrutiny around sexual and reproductive health may influence perceptions of the HPV vaccine and the health seeking behaviors of adolescents and young women. Thus, understanding their views is key for mitigation.

Insights from the SHARE Project

Within the framework of the SHARE project, a mixed-methods formative research evaluation has been recently conducted in Sierra Leone to examine adolescent’s knowledge and awareness of sexual and reproductive health, cervical cancer, HPV, and the HPV vaccine, and to understand the behavioral, social, and structural factors shaping HPV vaccine decision-making. Findings from the study will inform recommendations for a more sustainable, culturally sensitive HPV vaccine campaign.

It is key to include adolescent girls as active participants and prioritize a whole-community engagement approach to ensure effective, sustainable vaccine uptake

Most adolescent girls enrolled in the study showed a generally positive view of the vaccine, perceiving it as effective and trustworthy. However, fear and concerns remained as a barrier to uptake. Knowledge of HPV, cervical cancer and the HPV vaccine and awareness were uneven, shaped by both informal and formal sources, allowing myths, misconceptions and stigma to persist. Girls perceived peers and caregivers as both enablers and barriers to uptake. Teachers, healthcare workers, and adolescents themselves were identified as key engagement figures. A desire for increased community-wide sensitization and vaccine administration was expressed. Among the structural barriers perceived by girls were potential costs, distance, and poor communication infrastructure. In Sierra Leone, HPV vaccine uptake is shaped by an array of factors that can work in favour or against its acceptance and, therefore, its coverage. In this context, it is key to include adolescent girls as active participants and prioritize a whole-community engagement approach to ensure effective, sustainable vaccine uptake.

A Whole-Community Approach for Sustainable Change

On the International Day of the Girl Child, we reaffirm the need to recognize them as active agents in shaping their own reproductive health outcomes, rather than passive recipients of interventions. Their engagement is central to ensuring health programs are effective, sustainable, and respectful of their autonomy and evolving capacities.

[This text was written jointly by Alícia Josa, predoctoral researcher at ISGlobal, Ioar Rivas, Associated Researcher at ISGlobal, and Sarah Koch, Associated Researcher at ISGlobal.]

Physical activity improves health. But in polluted environments, could it actually do more harm than good? When we engage in physical activity, our breathing rate increases. This means we inhale more air and, with it, more air pollutants. Therefore, in polluted environments, practicing physical activity could worsen the effects of air pollution on our health. Given that 99% of the world population lives in areas where air pollution levels exceed the World Health Organization (WHO) guidelines, understanding how physical activity in polluted environments affects our health is paramount.

Measuring the combined effects of exercise and air pollution on health

In the past, research has examined physical activity and air pollution as separate factors. In recent years, a more integrated measure has been emerging: the inhaled dose of air pollution (IDoAP). This parameter is a measure of the exposure to air pollutants that also accounts for current activity levels. It factors in the rate and volume of breathing, and therefore captures the amount of air pollutants that enter the respiratory tract. Expressed in mathematical terms, the IDoAP is estimated as the product of the minute ventilation (how much air we breathe per minute), the air pollutant concentration, and the exposure duration.

The inhaled dose of air pollution (IDoAP) is a measure that captures the amount of air pollutants that enter the respiratory tract

Estimating the health effects in dependence of the IDoAP might help us address the question of whether the benefits of physical activity outweigh the risks of air pollution exposure. To summarise the current evidence on the health effects of IDoAP, we conducted a systematic review that was published in the European Respiratory Review.

What is the inhaled dose of air pollution and how does it affect us?

The review included 25 original-research studies in which participants performed different types of physical activity such as walking or cycling while they were exposed to different types of air pollutants. They included both field and laboratory studies, and mainly measured ozone (O₃) and particulate matter < 2.5 µm (PM_2.5). Ozone is a secondary pollutant formed in the atmosphere from precursors such as nitrogen oxides (NOₓ) and volatile organic compounds (VOCs) in the presence of sunlight. PM_2.5 in turn are tiny particles that can be emitted by several sources, like traffic, factories, wildfires, and even cooking.

It appears that healthy adults should adhere to their physical activity routines, also at higher intensities, while trying to avoid times and areas with peak air pollutant concentrations. This includes morning peak hours and streets with high-intensity traffic. These measures should be accompanied by initiatives that reduce air pollution levels

We found that a greater IDoAP of ozone was associated with an immediate reduction in lung function. Notably, this effect was driven by the concentration of ozone rather than minute ventilation. This means that reducing the IDoAP by lowering the intensity of physical activity and thus reducing the amount of air that we inhale does not appear to be a strategy to reduce the harmful effects of air pollution. Rather, it appears that healthy adults should adhere to their physical activity routines, also at higher intensities, while trying to avoid times and areas with peak air pollutant concentrations. This includes morning peak hours and streets with high-intensity traffic. These measures should be accompanied by initiatives that reduce air pollution levels.

Who’s Missing from the Research on Air Pollution and Physical Activity?

The review also highlighted some gaps in the current research. Most studies focused on healthy adults, while vulnerable or susceptible populations were largely overlooked. This means populations that are more likely to be exposed to air pollution or to suffer the harmful effects of air pollution have not been sufficiently studied yet. This includes:

• Individuals with pre-existing conditions
• Children and adolescents
• Pregnant individuals
• People with significant occupational exposures
• People from low- and middle-income regions

Also, most studies focused on the effects of IDoAP of ozone and particulate matter on lung function. We need further research to understand the effect of IDoAP of other air pollutants, like nitrogen dioxide or black carbon, which are very relevant traffic-related air pollutants and thus of particular relevance in cities or areas where traffic is dense and congestions a daily occurrence. We also need more research on other health outcomes, such as the cardiovascular, cognitive and mental health, to see if IDoAP has different effects on these outcomes.

As research advances, understanding IDoAP could help us maximize the benefits of physical activity, even in polluted areas, while pushing for cleaner air worldwide.

Why We Need to Rethink Cancer Prevention

Cancer does not have a single cause. Instead, it emerges from a complex web of factors that interact throughout a person’s life. This idea is captured by the concept of the exposome, which looks at all the environmental, lifestyle, and social influences we are exposed to from conception onwards. From air pollution and chemicals at work, to lifestyle habits, infections, and even the effects of climate change, these overlapping risks combine to shape who develops cancer and how it progresses. Understanding the exposome is key to prevention—and to reducing the millions of new cancer cases diagnosed worldwide each year.

What Is the Exposome and Why Does It Matter in Cancer Research?

While traditional cancer research often focused on isolating single causes, the exposome provides a new framework. It views human health, and cancer risk, as the result of a lifetime of combined exposures—environmental, lifestyle, and social. It complements the genome and changes the research question from “What single factor caused this cancer?” to “How did a lifetime of interacting exposures lead to this outcome?”

ISGlobal’s Research Areas on Cancer

Cancer Today: Global and Local Trends

Cancer remains a major global health challenge. In 2022, there were nearly 20 million new cancer cases and about 9.7 million deaths worldwide. In Spain, 279,000 new cases and 116,000 deaths were recorded. A worrying trend is the rise of early-onset cancers, such as colorectal cancer in younger adults, linked to lifestyle, obesity, diet, and early-life exposures.

Occupational Cancer: The Hidden Burden

Despite abundant knowledge about workplace carcinogens, occupational cancer remains underdiagnosed in Spain. Officially, only about 50 cases are recognized each year, but estimates suggest the real figure is between 3,000 and 6,000. This gap represents a major public health crisis.

• Workplace carcinogens: asbestos, crystalline silica dust, and others.
• Research findings: occupational exposures linked to bladder cancer.
• The challenge: long latency periods make recognition and prevention difficult.

Circadian Rhythms and Cancer: When the Body Clock Breaks

The body’s 24-hour rhythm regulates many biological processes. Disruption from night shifts or irregular schedules is now considered a “probable carcinogen.” Studies have shown links between long-term night work and higher risks of breast, prostate, and colorectal cancer.

• Night work and health risks.
• Chrononutrition: research shows that earlier dinner times reduce risks of prostate and breast cancer.

The Urban Exposome: How Cities Shape Cancer Risk

By 2030, over 80% of Europeans will live in cities. Research shows that the urban environment—pollution, green spaces, noise, and light at night—affects cancer risk and even prognosis.

• Air pollution, artificial light, and green spaces.
• Social inequalities in exposure and health outcomes.

Climate Change and Cancer: A Multiplier of Risks

Climate change is not a single factor but a “threat multiplier” that amplifies cancer risks through many pathways.

• Air pollution, heat waves, wildfires, and droughts increase carcinogenic exposures.
• New projects are evaluating how climate and workplace factors interact to affect health.

Infections and Cancer: The HPV Example

Infections account for about 16% of cancers worldwide. The link between Human Papillomavirus (HPV) and cervical cancer led to the development of effective HPV vaccines.

• HPV prevention is a global health success.
• Cervical cancer incidence highlights inequities in health systems, especially in low-income regions.

Towards an Integrated Future of Cancer Prevention

Exposome research offers a new, integrated view of cancer. From viruses to climate change, it shows that cancer is driven by combined exposures and must be prevented through multifaceted strategies. The exposome provides a roadmap for bridging science and policy—addressing not only biological causes but also social, economic, and political factors.
The HPV prevention story shows what is possible when knowledge translates into policy. But underdiagnosed occupational cancers are a reminder of the challenges ahead. A proactive, integrated, and equitable approach is essential for the future of cancer prevention.

Why are 2 out of 3 people with Alzheimer’s women? What role do physical activity, education level, or stress play in our brain health? We spoke with neuroscientist Eider Arenaza-Urquijo (ISGlobal) about the latest findings in Alzheimer’s prevention: from the impact of inequality to how midlife exercise can protect us.

You can watch the full interview here:

14 modifiable risk factors for dementia

Science has identified 14 modifiable risk factors that could explain up to 45% of dementia cases. Therefore, there is enormous prevention potential. Among them are low education levels, physical inactivity in midlife, vascular risk factors, or exposure to air pollution.

Women and Alzheimer’s: inequality and brain health

For years it was thought that the fact that two out of three people with Alzheimer’s are women was simply due to their greater longevity, since age is the biggest risk factor for developing Alzheimer’s. But studies suggest there is more to it. Research is starting to explore whether men and women may develop the disease through different biological mechanisms. The menopausal transition may play a role, with brain and vascular changes, but more studies are needed.

Gender inequalities also matter. For example, women have historically had less access to education and physical activity, and face a higher risk of mental health issues. In addition, most caregivers of people with Alzheimer’s are women, which exposes them to depression and social isolation—both risk factors for developing the disease.

Physical activity: a protective factor

Changes associated with Alzheimer’s can begin up to 20 years before symptoms appear. That is why physical activity in midlife is key.

A study of more than 300 people with a family history showed that those who went from sedentary to active accumulated less amyloid protein in the brain, the first to appear in the disease. Those who remained sedentary during those four years showed reduced cortical thickness in memory-related areas. And vigorous exercise is not necessary: walking, swimming, or climbing stairs all count.

Life stress and Alzheimer’s risk

Depression is a risk factor for dementia. That is why the idea is to try to prevent it. We know that living stressful life events, such as losing a partner, facing financial problems, or being a victim of abuse, increases the risk of depression and, therefore, Alzheimer’s.

A recent study found that the accumulation of stressful events throughout life was associated with pathological changes linked to Alzheimer’s in people who developed anxiety or depression. Another study found that grieving the loss of a partner is associated with pathological changes linked to Alzheimer’s, while unemployment and financial loss were linked to brain atrophy in regions related to emotional or stress response.

Education and cognitive reserve

A higher level of education is associated with better-preserved brains in old age: improved connectivity and greater ability to compensate for the buildup of pathological proteins. Studies show that some people can die with Alzheimer’s pathology in their brains without ever developing clinical symptoms. These individuals have greater cognitive reserve, and higher education is one factor that promotes this reserve, allowing the brain to compensate for pathological changes and maintain normal function.

The ‘superagers’: exceptional memory at 80

There are people over 80 with memory comparable to that of much younger individuals. They are called superagers, and many studies are now focused on them. They represent a small percentage of the population, but they help us understand the different ways of aging. Beyond genetics, maintaining cognitive, physical, and social activity has been shown to help preserve the brain. As the saying goes: what’s good for the heart is good for the brain.

Ongoing studies: urban environment and dementia

The team led by Eider Arenaza-Urquijo is studying how the urban environment influences brain health. Walking more thanks to pedestrian-friendly neighborhoods, having more social contact, or enjoying quality sleep (without excess noise) can make a difference in brain aging.

In short, preventing Alzheimer’s is partly in our hands, but also depends on the social and environmental conditions around us. Science is advancing to identify what we can change—both individually and collectively—to age in the best possible way.

Silvia de Sanjosé grew up among the sewing machines of her parents’ textile business, but soon realized she was not interested in production lines, but in getting closer to people and understanding their needs. This led her to study Medicine, a choice she celebrates today: although over time she has steered her career towards the study of populations, she continues to be guided by the same will to value each individual.

Recognized as one of the leading international experts on the human papillomavirus (HPV), her career has been marked by research, vaccine promotion, and the implementation of screening programs. She has worked for the International Agency for Research on Cancer (IARC), the Catalan Institute of Oncology (ICO), and the international organization PATH, and she chaired the International Papillomavirus Society (IPVS). She currently advises the U.S. National Cancer Institute (NCI/NIH), the World Health Organization (WHO), and Médecins Sans Frontières, in addition to being an associate researcher at ISGlobal, affiliate professor at the University of Washington, and chair of the Multidisciplinary Collaborative Group for Scientific Monitoring of COVID-19. This fall, she will receive the Rey Jaume I Award for Clinical Research and Public Health.

-In Spain, women today are much more protected against cervical cancer.

-We have fought a lot, it has taken us many years to get where we are, but I like to acknowledge that, in this cancer, we are on the front line. We are doing things right and just need to remain vigilant.

-Do you feel part of this success?

-Very much so. Together with Xavier Bosch and Xavi Castellsagué we were pioneers. I dedicated myself a lot to the Catalan community, and I am proud that now researchers who did their PhD with me continue the work. Catalonia is very much at the forefront of cervical cancer screening. Scientifically, it is a huge leap to go from publishing the first study that said HPV is the cause of cervical cancer to being concerned about whether to give a single vaccine dose or how we will implement self-sampling screening. Moreover, I am very satisfied to have been part of teams where, besides colleagues, we are friends. The good professional relationship within the papillomavirus community is very rewarding.

-What remains to be done?

-The great achievement has been vaccines. Sweden, Norway, Denmark, England, and Scotland have already published how, in less than twenty years, the incidence of cervical cancer is decreasing in the vaccinated population. It is spectacular. This cancer is the fourth most common in women worldwide and the one that kills the most before the age of 50. In Spain, a very significant decrease in genital warts has been observed when the quadrivalent vaccine was used. But the total reduction of cervical cancer attributable to vaccines will be seen around 2070. Meanwhile, gynecology clinics still see unvaccinated women, in whom it is not unusual to detect a cervical lesion related to an HPV infection, and such a lesion can lead to cancer.

-In Africa this happens often.

-It happens in 90% of women there. The incidence of cervical cancer is a great social indicator. Where rates are very high, there is much poverty or lack of infrastructure.

35 years dedicated to HPV and its impact on health

-Have you always been linked to cervical cancer?

-In 1989 I started working at IARC in Lyon. There I participated in the first studies that demonstrated the relationship between HPV and cervical cancer. Since then, I have been studying how to prevent this cancer!

-And haven’t you grown tired?

-No! Not at all! I was a family doctor. But at a conference, Dr. Armando Martín Zurro told us that what we saw in the consultation was just the tip of the iceberg, and that those who did not go might have more problems than those who did. It was like seeing the light! In 1984 I joined the Municipal Institute of Public Health of Barcelona, to work with Josep Maria Antó. Later I went to the London School of Hygiene and Tropical Medicine to do a Master’s in Epidemiology, and I stayed to complete my PhD.

-So you actually practiced as a family doctor.

-Two years at the General Hospital of Alicante (1981-82) and the third at a primary care center in Cornellà (1983). I have always missed clinical practice, because I really liked contact with people. During my residency at the Emergency Department of the Clínic Hospital in Barcelona, I also did many in-house call shifts. I was happy there, but I found the way patients were treated rather harsh and not very respectful. I always thought that each of them could be my father or mother. That is why I moved towards family medicine, to relate to people in the way I liked. When you do community health, you gain another vision, sometimes a bit too distant from the population. But little by little, I have transformed my way of working and now I do it increasingly closer to the teams and the real needs of people.

Never lose sight of people

-How do you manage to connect with people? For example, you were recently in the Amazon.

-Yes. In the project we are carrying out in nine countries, we work closely with groups that conduct cervical cancer screening. I try to travel whenever I can, although it tires me now, to visit places and have close contact with nurses, field coordinators, gynecologists... It is often difficult to communicate with the local population because of the language barrier, but sitting with them and observing how they interact during visits helps me feel closer to them. I always learn a lot.

-You have come very far professionally while keeping your feet on the ground.

-Look, I was once president of the International Papillomavirus Society. The experience helped me understand that I had to get closer to the problem of health inequality. I needed a personal change. For two years I became involved in a cervical cancer screening project with the NGO PATH, focused on Honduras, El Salvador, Nicaragua, and Guatemala. And as a result of this work, I was contacted by the U.S. National Cancer Institute (NCI) to co-lead the multinational project PaVE, which seeks to validate innovative, low-cost methods for cervical cancer prevention in places with little infrastructure or difficult access to medical services. Since then, I have been working on this project, which did not stop even during the COVID-19 pandemic.

The icing on the cake

-What do you think about receiving the Jaume I Award?

-I see it as recognition of a line of work with both an important international and national dimension. I am proud to have devoted many years to addressing a major public health issue. Approaching it within a public health framework, studying the community as a whole, provides much deeper insights than if we only relied on the clinical perspective of individual symptomatic demand. Being able to predict who might develop the disease and act before it happens—effectively—is both essential and highly motivating. I have been fortunate to meet people along the way who shared this vision of medicine. They supported me greatly, we supported each other, and together we have achieved truly remarkable results. This award is a celebration of all that collective effort. And I like to remember that my mentor Xavier Bosch also received it many years ago, and that it is the second time it goes to ISGlobal, because the award last year went to Jordi Sunyer.

-Should we emphasize that it also awards a woman?

-The visibility of women in research has improved, although parity is not the best goal. I have no doubt that the Jaume I Awards have prioritized science and not the sex of the researcher, but I am glad that four women have been awarded. In medicine and research there are more women than men, so it is to be expected that there is corresponding visibility.

-Do you feel that you have had to put family somewhat aside to dedicate yourself to research?

-Manolis Kogevinas and I have two children, and we did our best to make work compatible with family life. For example, we had a very detailed schedule so that our work trips did not overlap. The first night we left them alone, I think my eldest son was already 16. They complain that we worked too much! It is true that we have lived our work with passion, and it may be that part of our leisure time we also devoted to work more than they would have liked.

The World Health Organization (WHO) considers antimicrobial resistance (AMR) as one of the top ten global health threats. In 2017, it published a list of priority pathogens for which new antibiotics are urgently needed. This list was updated in 2024, and most of the bacteria in the critical and high priority groups are multidrug-resistant.

Many major pharmaceutical companies have reduced or eliminated their antibiotic research and development programs due to high costs and low returns

Discovering new antimicrobial therapies—especially against Gram-negative bacteria—is a complex challenge. Moreover, bacteria often develop resistance shortly after a new antibiotic reaches the market. Currently, the clinical pipeline includes 57 antibiotics and 40 non-traditional antibacterial agents. The latter include bacteriophages, antivirulence antibodies, immunomodulatory therapies, and microbiota modulators. However, only 12 of the 57 antibiotics belong to truly novel classes, meaning they target bacterial mechanisms that have not yet been exploited.

Historically, only around 20% of antibiotics entering clinical trials make it to market, reflecting a discouraging outlook for antibiotic development.

What are the main obstacles?

One of the major challenges is scientific. There are several methods to discover new antibiotics, including:

• Screening synthetic compounds against multidrug-resistant bacteria, especially Gram-negative ones, whose cell walls are more complex than those of Gram-positive bacteria.
• Screening natural products (chemical compounds produced by living organisms in diverse ecosystems). However, this often leads to rediscovering already known compounds or minor variations of existing antibiotics.
• Overcoming resistance mechanisms such as biofilm formation and the rapid emergence of resistant mutants.

Another major obstacle is economic: the lack of return on investment. Many major pharmaceutical companies have reduced or eliminated their antibiotic R&D programs due to high costs and limited profits.

Countries such as the United Kingdom have adopted subscription-based payment models, where companies are compensated based on the value of the antibiotic for public health rather than on sales volume

Developing a new antibiotic can cost between 800 million and 1 billion US dollars. Since antibiotics are used for short periods and their effectiveness declines over time as resistance develops, recouping that investment is difficult.

Reasons for optimism

Despite these challenges, there are promising developments:

1. Innovation from biotech companies. Many small firms are investing in antibiotic development. Although they often face difficulties advancing to clinical trials, they bring innovative approaches to the field.
2. New financial models. Countries like the United Kingdom have adopted subscription-based payment models, where companies are compensated based on the antibiotic’s value to public health, rather than sales volume.
3. Artificial intelligence (AI) and machine learning. Although still in their early stages, these technologies can accelerate drug discovery by identifying promising molecules or repurposing existing drugs to treat infections.
4. International cooperation. The Transatlantic Taskforce on Antimicrobial Resistance (TATFAR), created by the United States and the European Union, promotes collaboration in research, regulation, and funding to overcome scientific and economic barriers.
5. Support initiatives:
   • SPARK (Shared Platform for Antibiotic Research and Knowledge): An online platform for sharing data on Gram-negative bacteria to avoid duplication in research.
   • GARDP (Global Antibiotic Resistance Partnership): A platform that develops strategies against AMR tailored to low- and middle-income countries.
   • ISGlobal (Barcelona Institute for Global Health): Through our Antimicrobial Resistance Initiative, we work on antibiotic development, rapid diagnostics, policy analysis, and technical support.

An urgent cause

The current antibiotic development landscape presents major scientific and economic challenges. However, there are reasons for cautious optimism: innovative financing models, technological advances, and increasing global collaboration offer hope for overcoming the AMR crisis.

The future of antibiotic development will undoubtedly depend on these ongoing efforts and on our collective commitment to this urgent cause.

[Ebenezer Agbana is a physician. He studied the Master of Clinical Research: International Health Track at ISGlobal, University of Barcelona.]

Why Local Partnerships Matter in Primary Health Care

The World Health Organization (WHO) says that to achieve Universal Health Coverage (UHC) by 2030, we need strong primary health care (PHC). UHC means everyone can get basic health services without going into financial hardship. In many low-resource settings like Nigeria, PHCs are the foundation of the health system.

This article explains why we need what I call “360-degree” local partnerships at the PHC level. These include:

• Interinstitutional partnerships–between PHCs and referral hospitals
• Intra-PHC partnerships–collaboration between neighboring PHCs
• Community-level partnerships–cooperation with local leaders and influencers

Together, these layers create a support network that builds confidence in the community health workforce and helps us move closer to UHC.

Based on my work as a National Health Fellow in Northern Nigeria, where I lead social accountability and support PHCs, I’ve seen the importance of building a strong collaboration system. These partnerships improve morale, make health services more effective, and highlight the key role of health workers in achieving health for all

1. Connecting PHCs to Referral Centers: Interinstitutional Partnerships

“We sometimes refer patients to secondary health facilities, but our referrals aren’t honoured. It’s really frustrating. There are cases that are too complex for us to handle, we need help most times,” said a Community Health Extension Worker (CHEW).

This is a common problem. PHCs often rely on referral hospitals to handle difficult cases. But when referral systems don’t work well, patients suffer and health workers feel unsupported.

If referral hospitals inform PHCs about the best days to send patients and which specialists are available, it helps everyone plan better

A strong referral system is key. For example, if referral hospitals inform PHCs about the best days to send patients and which specialists are available, it helps everyone plan better. When referred patients are expected and scheduled, they get quicker care and the system runs more smoothly.

This kind of coordination improves service delivery, reduces stress for patients and health workers, and builds trust between PHCs and referral centers.

2. Sharing Strengths: Intra-PHC Partnerships

PHCs can also partner with each other. Instead of working alone, health workers can share tools, skills, and staff to improve care across communities.

For example, consider immunization. If one PHC does not have a working cold chain (to keep vaccines safe), it can team up with a nearby PHC that does. That way, children in the first area still get their vaccines on time. This helps reduce missed doses and promotes vaccine equity.

Another example: PHCs in hard-to-reach areas, due to security problems or social barriers can pair with more accessible PHCs. If one PHC is often closed due to banditry or flooding, the nearby PHC can help. It might send outreach teams or share medicines. This ensures care continues even in challenging situations.

PHCs can also partner with each other. Instead of working alone, health workers can share tools, skills, and staff to improve care across communities

These kinds of partnerships are practical, flexible, and powerful. They make PHC teams stronger and more responsive, especially in low-resource settings.

As the WHO puts it: “Anchoring the pursuit of health in engaged and empowered people and communities brings to life the commitment of PHC to refocus on the whole person and entire communities rather than diseases.”

3. Working with Local Leaders: Community-Level Partnerships

Local leaders like youth heads, religious leaders, and traditional rulers play a big role in their communities. People listen to them and often trust them more than formal institutions.

That’s why involving these leaders in PHC planning is so important. Their support can make or break a health initiative.

When leaders are included in decisions and planning from the start, they help create programs that fit community needs and values

PHCs should go beyond just informing these leaders. They should include them in decisions and planning from the start. When leaders are part of the process, they help create programs that fit community needs and values.

For instance, in one rural area, when traditional chiefs helped promote a vaccination campaign, turnout increased by 40% in just two weeks. This shows how powerful local leadership can be.

Building a Resilient, Community-Driven PHC System

To reach Universal Health Coverage, we need more than just clinics and policies. We need strong partnerships at every level of the PHC system.

By linking PHCs with hospitals, encouraging cooperation between PHCs, and working closely with community leaders, we create a support system that lifts everyone.

These partnerships help health workers do their jobs better and ensure that people get the care they need, when they need it.

In the end, a strong, connected PHC system is our best chance at achieving equitable, community-driven health care for all.

From Greenland’s melting ice to the Amazon’s growing fragility, the 2nd Global Tipping Points Conference (Exeter, UK, July 2025) sent a stark message: humanity is fast approaching irreversible planetary thresholds. Hosted by the University of Exeter’s Global Systems Institute alongside the Potsdam Institute for Climate Impact Research and the Max Planck Institute of Geoanthropology, this international gathering brought together leading scientists and experts to assess how close we really are to some of Earth’s most dangerous tipping points, and what can still be done.

Four Systems at Highest Risk

New evidence presented at the conference suggests that the West Antarctic and Greenland Ice Sheet, the Amazon rainforest and the Atlantic Meridional Overturning Circulation (AMOC) are worryingly close to breaching critical transition thresholds than previously thought. Tipping points for these systems could potentially be crossed before the end of this century under the current path of greenhouse gas emissions, triggering widespread environmental, economic and health consequences.

• A new study using satellite data reported a substantial increase in surface salinity across the Southern Ocean, which signals that warmer waters reach the surface layer of the ocean and have contributed to sea ice melting near Antarctica since 2015.
• In addition, sea ice in the region has been in systematic decline since 2016 and sea ice equivalent to the size of Greenland has melted during this period, the biggest environmental change on Earth at the moment.
• Meanwhile, the AMOC - one of the Earth’s key ocean currents - is projected to transition to an extremely weak state or to collapse just after the year 2100 under the high-emissions scenario, and possibly even under more moderate future scenarios. Therefore, it cannot be considered a low-probability scenario anymore, and it is even more alarming that there are indications for an even earlier collapse before 2100.
• The Amazon rainforest, too, may suffer large-scale dieback as early as at 1.9°C of global warming, far below the previously assumed threshold of 2°-4°C, due to the combined impact of climate change, land use and deforestation.

The Cost of Delay: Health, Governance and Global Inequity

Tipping points should not be seen as environmental phenomena in isolation - they have very serious implications for human health. Sea level rise, widespread food insecurity, forced displacement and new infectious disease risks are among the cascading consequences that tipping points could unleash.

There appear to be legal grounds to hold governments accountable and force them to mitigate climate change in ways that protect public health

A key takeaway from the conference: there appear to be legal grounds to hold governments accountable and force them to mitigate climate change in ways that protect public health. A growing body of legal scholarship supports the idea that states have a duty to align their emissions policies with a 1.5°C-compatible global carbon budget and keep global warming below 2°C, due to the harmful impact on health that certain climate tipping points may have.

Still, as many speakers emphasized, we are running out of time. A collective statement endorsed by the majority of conference participants called for “urgent, unprecedented action” from political leaders now to prevent climate tipping points and irreversible damages for humanity.

Hope in Action: Science, Society, and Positive Tipping Points

Encouraging signs came from the rapidly growing adoption of renewable energy and electric vehicles, showing that self-reinforcing "positive tipping points" are happening. But current progress is not fast enough and needs to be accelerated in the coming years to avoid catastrophic thresholds.

Scientific collaboration is also advancing. The launch of TIPMIP (Tipping Points Model Intercomparison Project) marks a key step forward. This new Intergovernmental Panel on Climate Change (IPCC)-aligned initiative brings together climate modeling groups to study overshoot scenarios and tipping dynamics. Researchers from ISGlobal’s Climate and Planetary Change Hub are contributing to TIPMIP through the EU-funded TipESM project, analyzing how the Amazon forest destabilization in certain regions and under the influence of El Niño Southern Oscillation might increase pathogen spillover risks - a concern at the intersection of human and planetary health.

A Call for Smarter Communication and Stronger Governance

Participants also agreed that the scientific community must do more to communicate the dangers and urgency of tipping points to the public, policymakers and the media. At the same time, the media is also currently getting it wrong and needs to stop giving equal opportunities to non-scientists to express opinions on this topic. In addition, it needs to focus on educating people about what is known about climate change, and to highlight the connection between climate change and health. The concept of uncertainty should be carefully explained, and should not continue to be a reason for politicians “to kick the can down the road”. Misinformation and underestimation of climate risk, especially by actors in finance and insurance, must also be addressed.

The media is currently getting it wrong and needs to stop giving equal opportunities to non-scientists to express opinions on this topic

There was a discussion over the role of geoengineering, which remains controversial. While some argue that options like solar radiation management warrant exploration, the climate tipping points community emphasized that emissions cuts must come first and foremost, and that geoengineering is associated with conflicting and unknown outcomes, as well as carries complex ethical, justice and governance risks. Only binding (and not voluntary) emissions cuts could lead to meaningful results, and this should be a key message and outset point at the coming COP30 meeting in Brazil.

The window to act is closing. But if we embrace science-based policy, legal accountability, and deep cooperation, we still have a chance to steer the planet toward a more favourable and stable future

Importantly, the conference encouraged rethinking not just technologies, but governance systems themselves. One example came from Malaysia, where a planetary health approach is now embedded in national development planning and undergraduate curricula - showing what is possible with political will and local leadership. In addition, an initiative was presented for building a new Global Constitution to prevent a civilization collapse. Anyone can contribute to it here. Participants at the conference shared the belief that global governance is necessary to implement policies to stop climate change. However, to get there, it might be smart to think about local and community governance first to prevent tipping points that will later galvanize and create a feedback loop towards the international governance that is needed.

The bottom line?

Earth system risks are now at highly alarming levels. As Johan Rockström and others stressed, they now meet the criteria for high-impact global risks, threatening to “kill or seriously harm more than 10% of the human population”. At 1.5°C of warming five and up to seven climate tipping elements are at risk, we are dangerously close to these. Over 2°C we enter a very high risk zone for tipping elements. The window to act is closing. But if we embrace science-based policy, legal accountability, and deep cooperation, we still have a chance to steer the planet toward a more favourable and stable future.

Every year on World Hepatitis Day (28 July), we’re reminded of a sobering truth: we can end a preventable disease — but only if we stop sidelining liver health from the global health agenda. Despite progress in reducing new hepatitis infections overall, 6,000 people are newly infected with viral hepatitis each day and deaths from viral hepatitis are rising. It’s a paradox we can no longer afford to ignore.

Globally, we have what it takes to eliminate viral hepatitis. Novel testing tools, effective treatments, and lifesaving vaccines exist, but access depends heavily on where you live. In many low- and middle-income countries, these tools remain unavailable, unaffordable, or out of reach for those who need them most. That gap in access, combined with low public awareness, stigma, underfunded health systems, fragmented care, and political inertia, continues to cost lives. Even healthcare workers often lack the tools or training to recognize the signs of liver disease early. This year’s theme — “Let’s break it down” — is a call to dismantle those obstacles one by one.

Liver Health: The Bigger Picture We’re Missing

Liver cancer — often the result of undiagnosed viral hepatitis or advanced liver damage, including from MASLD/MASH (formerly known as NAFLD/NASH) — is on the rise. Knowing your status is the first step to stopping liver cancer. We must find the millions of people living with undiagnosed liver disease — both viral and metabolic — and embed liver health into local and global responses that are integrated, equitable, and preventative. Liver disease spans both infectious and noncommunicable causes — and our response must reflect that complexity.

If we continue treating liver diseases in silos, we risk missing the opportunity for a smarter, more sustainable response.

Shared Problems, Shared Solutions

Viral hepatitis and MASLD/MASH may have different origins, but they’re facing the same systemic challenges:

• Late diagnosis due to low awareness, low health literacy, and poor screening;
• Stigma, which is linked to a perceived difference or trait attributable to a behavior that another may deem unacceptable;
• Fragmented and complex health systems that fail to connect the dots between symptoms, risks, and care.

The solution? Integrated liver health approaches that place the person in the center. We need health systems that can screen for hepatitis and steatotic liver disease at the same time, offer clear patient education, and deliver care that doesn't stop at a diagnosis.

Integrated services mean fewer missed diagnoses, more efficient use of resources, and better long-term outcomes for patients.

This World Hepatitis Day, We Call on Leaders to Break the Silence on Liver Disease

From viral hepatitis to steatotic liver disease (SLD), chronic liver conditions are a growing public health challenge, yet liver health remains neglected.

Our call to action:

• Deliver on commitments to eliminate viral hepatitis by 2030 by expanding access to testing, treatment, and care — particularly in underserved communities;
• Invest in liver health as part of primary care and community-led health care systems
• Scale up HBV vaccination, including HBV birth dose vaccination, as liver cancer prevention;
• Recognise that liver health sits at the intersection of infectious disease and NCDs—and that an integrated approach strengthens both responses;
   

By making liver health a priority, we create the conditions needed to reach the WHO viral hepatitis elimination targets — protecting millions of lives and building stronger, more resilient health systems for all.

[This text was written jointly by Enmanuel Cornielle, predoctoral researcher at ISGlobal, Yaiza Gabasa, lab technician, and Sara M. Soto, Associate Research Professor and Director of the Viral and Bacterial Infections Programme at ISGlobal]

In a world where antibiotic-resistant bacteria have quickly become one of the top ten global health challenges, one might assume that new antibiotics are being developed at the same pace. However, the reality is surprisingly different.

Of the thirteen antibiotics that received marketing approval since 2017, only two belong to a novel chemical class not derived from existing molecules, which is one of the four criteria set by the World Health Organization (WHO) for antibiotics to be considered truly innovative. And none of the thirteen met the other three criteria: targeting essential bacterial components not affected by conventional antibiotics, having novel mechanisms of action, and not generating cross-resistance with existing antibiotics. This is deeply concerning.

Why is developing new antibiotics so difficult?

Innovating in antibiotic development also involves numerous scientific and technical challenges, such as:

• the creation of chemical structures that are non-toxic to human cells while remaining active against various pathogens
• economic obstacles like limited investment (chronic treatments tend to be more profitable)
• lengthy regulatory processes
• high cost of preclinical and clinical testing needed to prove efficacy and safety

While we move forward slowly, bacteria are evolving rapidly, indifferent to our efforts

In addition, some bacteria are capable of developing resistance to different antibiotics in just three days, highlighting the stark reality: we are fighting an unequal race. While we advance slowly, bacteria evolve at full speed, unconcerned by our progress.

Gold molecules: a solution against multidrug-resistant bacteria

The ISGlobal research team specializing in the transmission of antibiotic resistance, led by Sara Soto, has achieved a major breakthrough in collaboration with the Organic Chemistry Department of the University of Oviedo. Together, they have developed a new class of chemical compounds: gold (III) complexes, which have shown powerful antibiotic activity. This breakthrough could mark a turning point in the fight against one of the greatest health threats of the 21st century: infections caused by multidrug-resistant bacteria.

Gold (III) complexes are molecules whose chemical properties allow them to act as antibiotics, even against multidrug-resistant bacteria

Gold (III) complexes are molecules with chemical properties that enable them to act as antibiotic agents—even against bacteria resistant to multiple antibiotics. They also meet all four innovation criteria established by the WHO for the development of new antibiotics. In tests conducted by Soto’s team, no development of bacterial resistance was observed even after 30 days of continuous exposure to the compounds. This finding is especially significant, as one of the main issues with current antibiotics is how quickly bacteria develop mechanisms to neutralize them.

In a global context where antibiotic resistance is reaching alarming levels, this discovery represents genuine hope: the possibility of having a new generation of effective and long-lasting antibiotics.

The gold molecules have already been patented, which will allow for further stages of preclinical—and eventually clinical—research. At ISGlobal, this milestone strongly motivates us to keep researching innovative solutions to address one of the most pressing health challenges of our time.

Global warming is raising average temperatures, leading to a decline in cold-related deaths and an increase in heat-related deaths. This trend is expected to keep worsening if no strong adaptation and mitigation strategies are put in place. A recent study estimated that in 2023, heat-related deaths in Europe would have been 80% higher in the absence of historical adaptation efforts.

But here's the catch: these estimations do not consider global and regional events, such as the COVID-19 pandemic, which significantly impacted public health and the broader socio-economic landscape. Such disease caused over 7 million deaths and 777 million cases worldwide, thus impacting health systems, economies, and societal structures.

Missing a huge part of the picture

Given the clear intersection between climate-related and pandemic-related health risks, you would expect more studies to explore what happened with the temperature-related vulnerability during the COVID-19 pandemic. Surprisingly, this hasn’t been the case. A key challenge explaining this gap has been the lack of reliable data on COVID-19 deaths during the early months of the pandemic due to underreporting, as well as the complexity of analysing such mortality disruptions. As a result, many previous studies either excluded data after 2020 or directly removed the COVID-19 deaths from the total mortality counts, with the limitations that this entails.

Many studies either excluded data after 2020 or directly removed the COVID-19 deaths from the total mortality counts, with the limitations that this entails

Nonetheless, researchers can not keep omitting post-2020 data. Someone had to look into this, and at ISGlobal, we have been working on just that. 

Photo: Isaac Planella / Barcelona City Council.
 

In our latest study, we developed an innovative methodology to adjust for COVID-19 deaths, allowing us to take a more accurate assessment of temperature-related mortality. We believe this approach highlights the need for including pandemic data and adjusting for COVID-19 deaths in future research; ignoring it means missing a huge part of the picture.

For instance, to give you an example, other articles predicting pandemic and post-pandemic years, such as the one from Ballester et al, 2023, which estimated a total of 61,672 heat-related deaths during the summer of 2022, used pre-pandemic fittings that no longer capture current vulnerabilities. When comparing this number with the updated methodology, the heat-related mortality in that same period was 14.42% higher, reaching approximately 71,400 deaths.

Who is adapting better in Europe?

However, this wasn’t all! We also explored the change in the mortality risk over time to assess whether the European population has adapted to heat and cold before and after the onset of the COVID-19 pandemic. What we found was concerning: there has been a maladaptation to heat in southern and western Europe, meaning the population in those regions is becoming more vulnerable to high temperatures. On the other hand, we observed some adaptation to cold in northern, eastern, and western Europe.

There has been a maladaptation to heat in southern and western Europe, meaning the population in those regions is becoming more vulnerable to high temperatures. On the other hand, we observed some adaptation to cold in northern, eastern, and western Europe

This paints a clear picture of how adaptation isn’t happening evenly across the continent, thus highlighting the regional differences in temperature adaptation and emphasising the urgent need to strengthen heat-related adaptation and mitigation measures in Europe. These may include early warning systems, public health campaigns and targeted science communication efforts. Most importantly, our results suggest that these adaptation strategies should be targeted to the needs of the most vulnerable regions, particularly in southern Europe, where countries like Spain or Italy are facing increasing heat-related risks.

More effective and responsive temperature-related adaptation plans

Ultimately, I believe the methodology we developed in our study better reflects the current vulnerability, shaped not only by climatic conditions but also by societal responses to crises like the COVID-19 pandemic. This approach offers robust and context-sensitive evidence for policy-makers and institutions to support the design and implementation of more effective and responsive temperature-related adaptation plans.

Adaptation strategies should be targeted to the needs of the most vulnerable regions, particularly in southern Europe, where countries like Spain or Italy are facing increasing heat-related risks

With the hope of supporting well-informed and inclusive action from stakeholders, future adaptation strategies will not only need to be responsive but also equitable to the challenges of our time.

Reference

Paniello-Castillo B, Quijal-Zamorano M, Gallo E, Basagaña X, Ballester J. Regional changes in temperature-related mortality before and during the COVID-19 pandemic: a continental modelling analysis in 805 European regions. Environmental Research 278, 121697 (2025).

The person I am today (with my values, priorities and scientific knowledge) is the result of the opportunities I have enjoyed in countries with limited resources. I am grateful for the people and institutions that opened their doors to me when I was beginning my path as a researcher. These include the Instituto de Inmunología in Colombia, the Centro de Investigação em Saúde de Manhiça in Mozambique and the International Center for Genetic Engineering and Biotechnology in India. I am also very much indebted to them. These experiences have prompted me to question my way of relating to colleagues and friends from less resourced countries, and to identify attitudes, sometimes prejudiced, that condition my scientific work, as well as my personal behavior.

This self-examination led me, a couple of years ago, to share an exercise of reflection with colleagues from Spain, Mozambique, Ethiopia and Benin on the collaborations in which Global Research is usually framed. I have always been concerned about the privileges (in terms of geopolitical location, race, class and gender) that years of colonization have introduced in the relationships we establish. This reflection is more urgent now when solidarity towards the neediest seems to fade on our horizon. It requires our attention not only to research outputs, but also to the process of making and doing research.

Difficult conversations needed

We are still dealing with the aftermath of colonial history. This is clear at the political level (in terms of international relations), the economic level (in terms of funding and resources), and the epistemic level (in terms of beliefs, thinking, and knowledge). This historical imbalance has allowed former colonising countries to tackle health challenges that are commonplace in former colonised countries, creating a foundation for dependent relationships and even subordination. We must break the chains of the colonial mindset to foster more egalitarian relationships. Awareness of these privileges and asymmetries that do not serve all people equally can help us develop strategies that foster more equitable relationships.

Global Health offers a wealth of opportunities for this. Coloniality, power and equity are key concepts that can frame the difficult conversations needed to transform mindset and ways of collaborating. But these concepts have become so integrated in our vocabulary that they have lost their power to stir consciences. The challenge is to transform these abstract ideas into pragmatic action. This requires collaborations between people and countries with profound asymmetries and finding together the way to move from aspirations to tangible changes.

Collective reflection

A transformative collaboration identifies a set of goals toward which the partnership wishes to work and agrees on the process for accomplishing them together. Transformation is achieved through collective analysis and awareness of positionality (to challenge inherent assumptions and privileges), solidarity and togetherness (to create an interconnected view that transcends differences), and shared responsibility for actions and outcomes (to ensure an effective relationship). A collective reflection on how and why the desired changes will occur is needed to plan "who will do what, how and when", and together advance through equity-centred actions. A mutually supportive role, generosity in balancing interests, and adaptability will allow us to adjust our working rhythms to ensure that we all walk together towards a common objective.

It is about what we are willing to do (and how we do it), not what we are able to imagine, that will make a difference in realizing the full societal value of Global Health research

Transformative partnerships enhance mutuality and bilateral benefits, but not in the form of calculated and expected returns. It is vital to plan this reciprocity  carefully and to value it equally to research outputs. The principle of subsidiarity favours filling capacity gaps in less powerful partners working where the health challenge lies. Conducting activities in these contexts, rather than opting for the most cost-efficient approaches such as sending samples or data to well-established institutions, is key to breaking down the barriers that prevent the full potential of the capacities already present within partners. Often the capacities are there: the challenge lies in implementing them.

Complementary attitudes can pave the way to achieve this. The most advanced partners need to empathise with the challenges others may face (technical, contextual, social, political and institutional, among others). The less powerful partner must consider the needs and means (including better governance) of actively gaining agency to play a greater leadership role. Attention is needed to respect commitments, which defines each partner’s level of trust, as the willingness to open up to the other is determined by the other’s sense of integrity, competence and credibility. A science culture that thinks in longer time scales, engages in value-based decision-making and takes responsibility for the power relations embedded in research is key to promoting and fostering a balance based on equity values.

New ways of working and leading

We can accomplish more when we work together toward a common goal that we all believe in. This increases the likelihood of finding solutions and creates a sense of shared satisfaction that enhances our own happiness and well-being. However, working with people who have different perspectives, priorities and capacities requires time and efforts. New ways of working and leadership styles can foster a truly global research environment and sustainable development. These must be more collective than individual, more collaborative than competitive, and more coaching than commanding.

The key to progress lies in shifting from general principles drawn from our desks to specific actions if we want to foster the collective mobilisation of global intellect, ambition, and action that global health requires. It is about what we are willing to do (and how we do it), not what we are able to imagine, that will make a difference in realizing the full societal value of Global Health research.

On a dirt floor, in his perfectly ordered workshop, with machines built by himself, Luis reminds us why we are alive. This young mechanic, father of twin daughters, carries his main tools inside: one is a pacemaker that saved him from the afflictions of Chagas disease and the other is his own luminous heart, capable of inspiring his community and, perhaps, the whole world.

Caused by the Trypanosoma cruzi parasite, Chagas disease can be lethal. In Bolivia, the most endemic country in the world; and in Yacuiba, the Bolivian municipality with the highest risk for the infection; Luis represents the disease's most affected patients. Just before his body broke down, the community helped him to seek help and a foundation allowed the implantation of a pacemaker.

With the support of local authorities and the ISGlobal-Novartis alliance in the Bolivian Chaco, Luis' story is spread in workshops and social networks, encouraging the population to get diagnosed and receive treatment against Chagas disease on time. It is a heavy burden, but the heart of people like Luis, the Double Engine, overcomes fear.

The video was co-created, implemented, and evaluated by the Local Health Authorities of the Territorial Grassroots Organizations of Yacuiba, Villa Montes, and Caraparí, as well as by the Weenhayek Indigenous Community of Breal and the Mennonite Colony of El Palmar (Villa Montes).

Can temperatures in places like Russia still pose serious risks to people’s health? Until recently, most of the evidence about temperature-related mortality in Russia was limited to a few studies based on short time periods or single cities. This left a significant knowledge gap for a country where winters are long and harsh, and summers are short—but becoming increasingly hotter due to climate change.

Through the EARLY-ADAPT project, we analysed over 19 million deaths across 300 Russian cities from 2000 to 2019, covering a wide range of climate zones and socio-economic conditions. We aimed to understand how both cold and heat exposure influences mortality in one of the world’s coldest and most geographically diverse nations.

Heat- and cold-related temperature risks vary unevenly across country

We found that temperature-related health risks differ significantly between cities.

• While heat-related mortality was higher in the European part of Russia, cold-related risks were more evenly distributed across regions.
• Cities with milder winters and hot summers had higher vulnerability to heat, while cities with more continental climates still showed considerable cold-related mortality.
• Cold-related risk did not follow a clear geographic gradient—possibly due to higher levels of infrastructure adaptation across the country.
• In contrast, heat-related risk showed a strong spatial pattern, with southern and western cities being the most affected.

This means that public health strategies cannot be performed as a universal solution – they need to be adapted to the specific regional climate patterns in the country.

Yatutsk. Photo: Alina Makhatyrova / Unsplash. 

Who is most at risk? Age and sex gap

We also looked closely at how temperature-related mortality varies by age and sex.

• Unsurprisingly, older adults—especially those aged 75 and above—were much more vulnerable to both heat and cold.
• But there were also some interesting disparities between men and women. There was notable gap between men and women: the differences in heat-related mortality risk were more pronounced among women than among men. However, among middle-aged men, the risk of heat-related mortality was higher compared to women of the same age group.

These sex- and age-specific patterns have also been observed in European studies, but in Russia, some Siberian cities showed opposite trends: higher heat-related mortality for men in the 0–59 years age group, and higher cold-related mortality in those aged 60–74. These unusual regional patterns might be explained by comorbidities, work-related exposure, or behavioral factors.

Temperature impact: the numbers behind the risk

How much do temperatures contribute to mortality in Russia? We calculated both the attributable number (how many deaths are linked to temperature) and attributable fraction (what percentage of total deaths are due to temperature).

Overall, around 11% of all deaths were linked to non-optimal temperatures, with most of these related to cold. Importantly, even in a country where people are used to harsh winter conditions, cold exposure accounted for 10.47% of all deaths, while heat was responsible for 0.67%. That translates to 99,631 annual deaths from cold and 6,376 from heat.

While cold is still the dominant contributor to mortality in Russia, heatwaves also represent a growing threat, particularly in regions less prepared for them

The difference between cold and heat-related attributable fraction is less when we consider extreme temperatures: 0.65% and 0.40% respectively. This shows that while cold is still the dominant contributor to mortality in Russia, heatwaves also represent a growing threat, particularly in regions less prepared for them.

Moscow. Photo: Aleksandr Popov / Unsplash. 

Regionally specified adaptation plans

One of the study’s key takeaways is the need for geographically targeted health policies. Because the temperature risks vary so much by region—and because age and sex also affect vulnerability—it’s not enough to have a national strategy. Instead, local governments and health systems should create custom adaptation plans based on their specific climate and population. For example, a city in Siberia might need to focus more on the primary causes of high temperature-related risks among middle-age male population, while a city in the south should prepare for heatwaves that threaten the most vulnerable elderly population.

One of the study’s key takeaways is the need for geographically targeted health policies. Because the temperature risks vary so much by region—and because age and sex also affect vulnerability—it’s not enough to have a national strategy.

This kind of accuracy planning is essential for reducing avoidable deaths and preparing for the ongoing effects of climate change. As the climate continues to change, these insights will be crucial for shaping effective, life-saving public health strategies. Even familiar climates can still be deadly—especially for society’s most vulnerable.

Numerous infectious diseases can be prevented or partially prevented by more than one available vaccine, and comparing these alternatives is common practice. However, conducting head-to-head trials is expensive and logistically challenging. As a result, we often rely on comparing vaccine efficacies estimated from different trials. But how reliable are these comparisons, really? In our recent Personal View article published in The Lancet Infectious Diseases, we argue that this approach can be misleading, especially when the disease in question — like malaria — is strongly influenced by seasonal and regional transmission dynamics.

We often rely on comparing vaccine efficacies estimated from different trials. But how reliable are these comparisons, really?

A case in point: comparing the two approved malaria vaccines

In the last few years, the World Health Organization (WHO) has approved two malaria vaccines: RTS,S/AS01E and R21/Matrix-M. Both target the same malaria parasite protein but are formulated slightly differently. They’ve both gone through large-scale phase 3 trials in Africa and shown encouraging results:

• RTS,S: 55% efficacy in the first year
• R21: 72% efficacy in the first year

So, is R21 clearly the better vaccine by more than 15% VE? Not necessarily.

Sure, those vaccine efficacy estimates come with confidence intervals, but what’s often missed is that they’re time-aggregated — basically, they average out all the ups and downs over a full year. But here’s the thing: malaria doesn’t hit evenly year-round — it spikes during the rainy seasons when mosquitoes are everywhere. Meanwhile, vaccine protection doesn’t stay the same either — it wanes over time.

The Problem with Averages

Imagine testing a raincoat by seeing how often you get soaked over a year. Now, say this raincoat starts to fall apart after a few months. If you start testing it in July — right as the rainy season begins — it’s brand new when you need it most. But if you start in January during the dry season, by the time the rains arrive, the raincoat might already be full of holes. Same raincoat, different results over one year trial. Malaria vaccines work the same way — their protection decreases over time, so whether they’re still strong when malaria season hits makes a big difference in how well they perform overall. And that difference isn’t about the vaccine itself — it’s all about when the vaccination happened during the trial.

What Our Analysis Found

We dug into the data from the RTS,S and R21 trials and ran simulations to see what would happen if vaccinations had occurred at different times of year.

Here's what we found:

• In Burkina Faso, RTS,S efficacy could vary by 20 percentage points depending on the month of vaccination — from 46% to 66%.
• For R21, seasonal trial sites reported higher efficacy (75%) than non-seasonal ones (67%), mostly because vaccination was better timed with malaria peaks.

So, the apparent superiority of R21 in some cases and might not be due to better biology only— but better timing.

The apparent superiority of R21 in some cases and might not be due to better biology only— but better timing

Why This Matters

These findings have important implications for how we:

• Compare vaccines tested in different trials
• Compare vaccine efficacies across different population subgroups in the same trial—whether from various geographic regions or vaccinated at different times, such as before or after an outbreak or peak season
• Interpret trial results critically

If we don’t account for how disease transmission fluctuates during the follow-up period of clinical trials, we risk underestimating the efficacy of a good vaccine — or overestimating one that just had lucky timing.

A Better Way Forward

We propose a few simple fixes:

• Use time-specific vaccine efficacy estimates — not just annual averages or averages over long time spans.
• Highlight intensity and changes in transmission — using data from trial control groups.
• Plan vaccine rollouts according to seasons, especially when efficacy wanes quickly.

These ideas aren’t limited to malaria — they apply to many vaccines, from flu to COVID-19, where timing and waning immunity matter.

Next time you see a vaccine touted as “60% effective,” ask yourself: effective when and where? That question might be more important than we thought

Bottom Line

For many infectious diseases, vaccine trial results aren’t just about how well the vaccine protects people—they’re also influenced by how disease spreads over time. By paying closer attention to how vaccine waning and disease transmission interact we can make fairer comparisons and make sure vaccines are used when they’ll do the most good. So next time you see a vaccine touted as “60% effective,” ask yourself: effective when and where? That question might be more important than we thought. 

Reference

Macià, D., Pons-Salort, M., Moncunill, G., & Dobaño, C. (2025). The effect of disease transmission on time-aggregated treatment efficacy estimates: A critical analysis of factors influencing the RTS,S and R21 malaria vaccine phase 3 trials. The Lancet Infectious Diseases. https://doi.org/10.1016/S1473-3099(25)00090-8