Ending nuclear weapons, before they end us

This May, the World Health Assembly (WHA) will vote on re-establishing a mandate for the World Health Organization (WHO) to address the health consequences of nuclear weapons and war.¹ Health professionals and their associations should urge their governments to support such a mandate and support the new UN comprehensive study on the effects of nuclear war.

The first atomic bomb exploded in the New Mexico desert 80 years ago, in July 1945. Three weeks later, two relatively small (by today's standards), tactical-size nuclear weapons unleashed a cataclysm of radioactive incineration on Hiroshima and Nagasaki. By the end of 1945, about 213,000 people were dead.² Tens of thousands more have died from late effects of the bombings.

Last December, Nihon Hidankyo, a movement that brings together atomic bomb survivors, was awarded the Nobel Peace Prize for its “efforts to achieve a world free of nuclear weapons and for demonstrating through witness testimony that nuclear weapons must never be used again”.³ For the Norwegian Nobel Committee, the award validated the most fundamental human right: the right to live. The Committee warned that the menace of nuclear weapons is now more urgent than ever before. In the words of Committee Chair Jørgen Watne Frydnes, “it is naive to believe our civilisation can survive a world order in which global security depends on nuclear weapons. The world is not meant to be a prison in which we await collective annihilation.”⁴ He noted that our survival depended on keeping intact the “nuclear taboo” (which stigmatises the use of nuclear weapons as morally unacceptable).⁵

The nuclear taboo gains strength from recognition of compelling evidence of the catastrophic humanitarian consequences of nuclear war, its severe global climatic and famine consequences, and the impossibility of any effective humanitarian response. This evidence contributed significantly to ending the Cold War nuclear arms race.^{6, 7}

While the numbers of nuclear weapons are down to 12,331 now, from their 1986 peak of 70,300,⁸ this is still equivalent to 146,605 Hiroshima bombs,⁹ and does not mean humanity is any safer.¹⁰ Even a fraction of the current arsenal could decimate the biosphere in a severe mass extinction event. The global climate disruption caused by the smoke pouring from cities ignited by just 2% of the current arsenal could result in over two billion people starving.¹¹

A worldwide nuclear arms race is underway. Deployed nuclear weapons are increasing again, and China, India, North Korea, Pakistan, Russia and UK are all enlarging their arsenals. An estimated 2,100 nuclear warheads in France, Russia, UK, US and, for the first time, also in China, are on high alert, ready for launch within minutes.⁸ With disarmament in reverse, extensive nuclear modernisations underway, multiple arms control treaties abrogated without replacement, no disarmament negotiations in evidence, nuclear-armed Russia and Israel engaged in active wars involving repeated nuclear threats, Russia and the US deploying nuclear weapons to additional states, and widespread use of cyberwarfare, the risk of nuclear war is widely assessed to be greater than ever. This year the Doomsday Clock was moved the closest to midnight since the Clock's founding in 1947.¹⁰

Led by Ireland and New Zealand, in late 2024, the United Nations General Assembly (UNGA) voted overwhelmingly to establish a 21-member independent scientific panel to undertake a new comprehensive study on the effects of nuclear war,¹² with its final report due in 2027. Noting that “removing the threat of a nuclear war is the most acute and urgent task of the present day”, the panel has been tasked with examining the physical effects and societal consequences of a nuclear war on a local, regional and planetary scale. It will examine the climatic, environmental and radiological effects of nuclear war, and their impact on public health, global socioeconomic systems, agriculture and ecosystems.

The resolution calls upon UN agencies, including WHO, to support the panel's work, including by “contributing expertise, commissioned studies, data and papers”. All UN Member States are encouraged to provide relevant information, scientific data and analyses; facilitate and host panel meetings, including regional meetings; and make budgetary or in-kind contributions. Such an authoritative international assessment of evidence on the most acute existential threat to humankind and planetary health is long overdue. The last such report dates from 1989. It is shameful that France, UK and Russia opposed this resolution.¹³

In 1983 and 1987,¹⁴ WHO convened an international committee of scientists and health experts to study the health effects of nuclear war. Its landmark, authoritative reports were influential and an excellent example of WHO fulfilling its constitutional mandate “to act as the directing and coordinating authority on international health work”. In 1993, WHO produced an additional shorter report on the health and environmental effects of nuclear weapons, which included discussion of the production chain of nuclear weapons, including processing, testing and disposal.¹⁵

However, despite WHA having mandated WHO to report periodically on relevant developments, no further work was undertaken and in 2020 WHO's mandate on nuclear weapons and health lapsed.

The Marshall Islands, Samoa and Vanuatu, supported by seven co-sponsoring states and International Physicians for the Prevention of Nuclear War (IPPNW), are working to renew WHO's mandate. They are seeking wide support for a resolution on the health effects of nuclear weapons/war at this year's WHA in Geneva on 19–27 May.¹ WHO would then re-establish a programme of work on this most critical threat to health, and be able to lead strongly in providing the best health evidence to the UN panel.

Health professionals are well aware how crucial accurate and up-to-date evidence is to making good decisions. We and our organisations should support such a renewed mandate by urging our national WHA delegates to vote in support and commit the modest funds needed to re-establish WHO's work programme, especially now, as the organisation faces severe financial strain with the US decision to withdraw its membership.

Our joint editorial in 2023¹⁶ on reducing the risks of nuclear war and the role of health professionals, published in over 150 health journals worldwide, urged three immediate steps by nuclear-armed states and their allies: adopt a “no first use” policy, take their nuclear weapons off hair-trigger alert, and pledge unequivocally that they will not use nuclear weapons in any current conflicts they are involved in. We also urged nuclear-armed states to work for a definitive end to the nuclear threat by urgently starting negotiations for a verifiable, timebound agreement to eliminate their nuclear arsenals, and called on all nations to join the Treaty on the Prohibition of Nuclear Weapons.¹⁷

It is an alarming failure of leadership that no progress has been made on these needed measures, nor on many other feasible steps away from the brink, acting on the obligation of all states to achieve nuclear disarmament. Nine states jeopardise all humanity and the biosphere by claiming an exclusive right to wield the most destructive and inhumane weapons ever created. The world desperately needs the leaders of these states to freeze their arsenals, end the modernisation and development of new, more dangerous nuclear weapons, and ensure that new technology such as artificial intelligence can never trigger the launch of nuclear weapons.

The UN scientific panel and a renewed mandate for WHO's work in this area can provide vital authoritative and up-to-date evidence for health and public education, evidence-based advocacy and policies, and the mobilised public concern needed to trigger decisive political leadership. This is a core health imperative for all of us.

Respective authors were paid by their employers. Chris Zielin-ski's time was funded by International Physicians for the Prevention of Nuclear War.

KB-D is a full-time employee of the American Medical Association, working as the Editor-in-Chief of JAMA and the JAMA Network. AH is principal investigator of the Pathfinder Initiative 2020–2025, co-investigator of Sustain-able Healthy Food Systems research programme 2017–2023,and co-investigator of Complex Urban Systems for Sustain-ability and Health 2017–2023, all funded by the Wellcome Trust, with additional funding from the Oak Foundation for the Pathfinder Initiative, and he reports royalties from Cam-bridge University Press for the coauthored book Planetary Health; consultancy fees paid to his institution from the Well-come Trust for his role as Senior Advisor on Climate Change and Health in 2021; travel/meeting support from WHO and Human Frontiers Science Program; and he is a member of the Cool Roofs trial steering committee Nouna Research Centre, Burkina Faso/University of Heidelberg, is Co-chair of the International Advisory Committee, NIHR Clean-Air (Africa)Global Health Research Unit, is a member of the Independent Advisory Group, Collaboration for the Establishment of an African Population Cohort Consortium, and he was Co-chair of the InterAcademy Partnership, Climate Change and Health Working Group 2019–2022 and Co-chair of the Academy of Medical Sciences/Royal Society working group on “A healthy future—tackling climate change mitigation and human health together” 2020–2021 (all unpaid). IH reports honoraria for several speaking engagements, all donated to Back from the Brink, the International Physicians for the Prevention of Nuclear War, or Physicians for Social Responsibility; travel/meeting support for Nobel Peace Laureates'Summit, the World Federation of Public Health Associations World Congress, and the UN Human Rights Commission Youth Summit; and he is a member of the steering committee of Back from the Brink and the International Steering Group of the International Campaign to Abolish Nuclear Weapons, a Board member of the International Physicians for the Prevention of Nuclear War and Physicians for Social Responsibility,and a Trustee of the Phillips Exeter Academy (all unpaid). MGMOR reports research grants from the Dutch Research Council, NOW (grant number COMPL.21COV.001) and from the Netherlands Organisation for Health Research ZonMw (grant number 09120012010063) and he is Chair of the Dutch guideline committee on cognitive impairments and dementia. TR reports a contract with the Institute for Energy and Environmental Research (USA) for papers addressing the health and environmental consequences of nuclear testing in multiple locations, including Australia, French Polynesia, central Pacific, and China; honorarium from The Choisun Ilbo media group in South Korea for a lecture on nuclear weapons in 2022 and for nuclear weapons presentations from Hyogo Medical Practitioners Association (Japan), Peace Boat (Japan),and the University of Sydney; he was an expert witness on radiation and health for Environmental Justice Australia acting for Mine-Free Glenaladale regarding proposed Fingerboards Mineral Sands Mine to the Victorian Government Fingerboards Inquiry and Advisory Committee; he is a member of RV3 Rotavirus Vaccine Development Scientific Advisory Board, Murdoch Children's Research Institute/RoyalChildren's Hospital; he is a member of the Committee of Inter-national Campaign to Abolish Nuclear Weapons Australia;he is a member of the Internet Peace Prize Award Committee (Sunfull Foundation, South Korea); he was a member of the Victorian International Humanitarian Law Advisory Committee, Australian Red Cross; he is a Board member of the Initiative for Peace building, Faculty of Arts, University of Melbourne; he is an At-large Board member of the International Physicians for the Prevention of Nuclear War; he was Co-president of the International Physicians for the Prevention of Nuclear War 2012–23; and he is Honorary Principal Fellow, Melbourne School of Population and Global Health, University of Melbourne. PY reports grants from Atea Pharmaceuticals; honoraria for lectures, presentations, and educational events from bioMérieux and Pfizer Pharmaceuticals; fees for participation on an advisory board from Pfizer Pharmaceuticals; and he is a member of the Antimicrobial Stewardship Study Group Executive Committee (2022–2024)and the Clinical Practice Guideline Panel on Vaccinations in Immunocompromised hosts for the European Society of Clinical Microbiology and Infectious Diseases. CZ reports consulting fees for his role as senior adviser on the international journals project from the International Physicians for the Prevention of Nuclear War. All the other authors declare no competing interest. [Correction added on 29 May 2025, after first online publication: The co-publication statement, COI statements and Funding Information have been added to this version.]