Holding a global in-person meeting like COP26, the annual UN meeting on climate change due to be held in Glasgow in November, is a major challenge in the middle of a pandemic. But, as things currently stand, the necessity of the nations of the world doing everything possible to counter the climate crisis justifies the risk.

As I write, there are about 4000 new cases of covid-19 each day in Scotland, but the numbers are falling from a peak of nearly 7000 cases a day at the beginning of September. Cases were expected to rise after children went back to school in August. Around 70% of people in Scotland are fully vaccinated.

But many of the 25 000 or so people who will attend COP26 will be coming from countries where rates of covid are still high and vaccination rates low. It is delegates from these countries, mostly low-and-middle-income countries, who are potentially at most risk of both catching and spreading covid. But it is people from these countries who are also most at risk from climate change, and they are taking the lead on wanting an in-person meeting. The success of COP26 will depend on high income countries agreeing to make bigger cuts in greenhouse gases than lower income countries and agreeing to transfer funds, know-how, and support to the lower-income countries. As they were at COP21 in Paris, these negotiations will be difficult and likely to go round the clock.

There is no doubt that COP26 meeting is crucial: the world is running out of time to make the cuts in emissions that are needed to stop the global temperature rising by more than 1.5C above pre-industrial levels. On the current trajectory it will rise above 3.0C with catastrophic effects on health and food and water systems. An editorial published simultaneously in The BMJ and over 220 other health journals argued that we must do everything possible to stay below 1.5C and emphasised that this will be possible only with richer countries making bigger cuts and helping poorer countries.

The UK government is thus keen for COP26 to go ahead as an in-person meeting, although, as everybody recognises now, covid can always surprise and it may be necessary to cancel the meeting or make it an online-only meeting. All those who have experience of tough negotiations are, however, sure that success at the meeting is much more likely if it can be held in-person.

The members of the UK Health Alliance on Climate Change (UKHACC), which I chair and includes most of the royal colleges, have had a chance to meet with health officials from Scotland and the Cabinet Office and hear the plans for making COP26 as safe as possible.

Ideally everybody attending the meeting will be vaccinated, and the UK government has arranged to vaccinate their own countries delegates who have not been vaccinated. Everybody will have to show evidence of a negative covid test before arrival. People who come from red-list countries, most of which are low-and-middle-income countries, will have to quarantine for 10 days in approved hotels, although it will be shortened to five days for those who are fully vaccinated. The UK government will fund the hotel costs where necessary.

All the delegates who will be in the secure blue zone (the UN controlled area where the negotiations happen) will have to sign a code of conduct and will have to show a negative lateral flow test each day to be admitted to the blue zone. There will also be a specific test, trace, and isolate regimen, social distancing, enhanced ventilation, and face coverings.

Despite all these precautions there are likely to be cases of covid, and these cases will be treated locally. The biggest risk arises from delegates mixing as they travel to and from the conference and their hotels.

The Cabinet Office have consulted widely with the chief medical officers alongside public health and clinical leads across England and Scotland to ensure the concerns of the medical profession are heard and inform planning of the event. The members of UKHACC, which included a doctor from Glasgow who could be involved in responding to an outbreak, had a chance to quiz the staff from Scotland and the Cabinet Office and reached the conclusion that the importance of the meeting justified the risk that remains despite all the precautions.

Doctors are very used to balancing benefits and risks, and the members of the Alliance are well positioned to make a judgement on the meeting because of their understanding of the risk from both covid and climate change. Some members of the public and the media will make different judgements, but members of the Alliance support the meeting going ahead in-person. And may it be successful. 

Richard Smith was the editor of The BMJ until 2004.

Competing interest: RS is the unpaid chair of the UK Health Alliance on Climate Change and gravely concerned about climate change. He plans to attend COP26 at his own expense but does not currently have a ticket for the blue zone. He has been fully vaccinated. UKHACC plans to hold a dinner for health leaders with the Royal College of Physicians and Surgeons of Glasgow at the College during COP26.