Towards a Health-Informed Approach to ASEAN Transboundary Haze Coordination

Executive Summary

On 22 April 2026, Indonesia inaugurated the physical office of the ASEAN Coordinating Centre for Transboundary Haze Pollution Control (ACC THPC) in Jakarta, twenty-four years after the ASEAN Agreement on Transboundary Haze Pollution (AATHP) was signed, and twenty-one years after Indonesia first offered to host the Centre. Its establishment marks an important milestone in ASEAN environmental governance and reflects the region’s long-standing commitment to patient, consensus-based cooperation.

As the Centre’s institutional design is still being finalised, the present moment may also offer a constructive opportunity to consider whether health considerations could, over time, be reflected more systematically within the broader regional haze architecture. The ACC THPC’s three planned divisions: Monitoring and Assessment, Technical Cooperation, and Knowledge Management, are primarily environmental and meteorological in orientation. At present, there does not yet appear to be a dedicated health function, a health-related indicator in the Second Haze-Free Roadmap, or a formalised linkage between the ACC THPC and ASEAN health-sector mechanisms.

This is relevant because transboundary haze is also widely recognised as a significant public health concern in Southeast Asia. Published studies have linked the 2015 haze episode to substantial mortality impacts across Indonesia, Malaysia, and Singapore, while more recent regional assessments continue to underscore the broader health burden associated with landscape-fire air pollution. Other research has further suggested that a significant number of premature deaths could be avoided through proven clean-air interventions.

This brief suggests that the current treatment of haze, principally as an environmental matter, is best understood not as a limitation in institutional intent but as a reflection of how regional mandates have developed over time. Precisely for that reason, the current period of institutional development may provide a timely opportunity to consider complementary additions. The brief outlines four practical, relatively low-cost options for consideration: (1) a modest health function within the ACC THPC, (2) health-related indicators in the Haze-Free Roadmap, (3) a formal liaison between the ACC THPC and ASEAN health bodies, and (4) an annual Regional Haze Health Burden Report. Each would appear institutionally feasible, particularly while the Centre’s design is still being finalised.

Underlying all four options is a single principle: a planetary health approach, in which environmental monitoring and human health are treated as interconnected rather than separate policy domains. In that spirit, the ACC THPC, as a coordinating centre rather than a health agency, would not replace ASEAN’s existing health institutions but could usefully serve as a bridge between environmental monitoring and health governance.

This brief draws on the author’s nearly two decades of professional engagement with transboundary haze and environmental governance across Indonesia and Southeast Asia. The analysis that follows is offered as an independent and constructive contribution grounded in publicly available evidence.

1. The ACC THPC: A Significant Institutional Achievement

The AATHP, signed on 10 June 2002 in Kuala Lumpur, remains the only legally binding environmental treaty concluded among the ten ASEAN Member States of that period. Its mandate covers the monitoring, prevention, and mitigation of transboundary haze pollution arising from land and forest fires. Article 5 of the Agreement establishes the ACC THPC as the coordinating body for implementation.

The Centre’s journey from treaty provision to physical office has understandably been a lengthy one, reflecting the complexity of building consensus across sovereign states with differing institutional contexts and capacities. Indonesia offered to host the Centre in the mid-2000s, and COP-11 in 2015 formally endorsed that hosting arrangement. The Establishment Agreement was concluded at COP-18 in Vientiane in August 2023. As of late 2024, seven of the ten ASEAN Member States had signed the Agreement, and COP-19 in Bangkok in December 2024 encouraged the remaining parties to complete the process.

The regional context has also evolved. In October 2025, Timor-Leste was admitted as ASEAN’s eleventh Member State, the bloc’s first enlargement since 1999. As its newest member, Timor-Leste is still acceding to ASEAN’s legal and institutional frameworks, including in the environmental domain. This presents a timely opportunity to ensure that the haze architecture it is joining is able, over time, to reflect health considerations in a manner consistent with ASEAN’s broader institutional development. Over time, Timor-Leste’s own land-use and fire dynamics will also become part of the broader regional picture the ACC THPC is intended to monitor.

The April 2026 inauguration marked an important step toward operationalisation. At the time, the Minister noted that a ratification protocol was still being finalised, that an Executive Director had yet to be appointed, and that the Centre would formally begin operating once all parties had ratified. In other words, the institution is now physically established, but still in a formative phase.

2. What the ACC THPC Is Designed to Do

The ACC THPC’s planned structure comprises three divisions:

• Monitoring and Assessment Division: real-time hotspot and air-quality data aggregation, satellite monitoring, and alert systems.
• Technical Cooperation Division: exchange of expertise and equipment, joint firefighting capacity, and technology transfer among Member States.
• Knowledge Management Division: database maintenance, learning and communication, and documentation of best practices.

These are essential and well-conceived functions. Together, they help track where fires are occurring, how air quality is evolving, and what forms of support are available for response.

3. A Dimension That Could Further Complement the Architecture

One dimension that may be further reflected, over time, is the health dimension of the same event: who is becoming unwell, what pressures are being placed on health systems, and how social disruption is experienced through school closures and lost workdays. There is not yet a health division or a formal health advisory function. The Second Haze-Free Roadmap (2023–2030) sets targets for hotspot reduction and peatland management, rather than for outcomes such as premature deaths avoided, disability-adjusted life years, or respiratory hospitalisations. ASEAN health-sector mechanisms do not currently appear to have a formal role in the COP-AATHP process, and haze governance remains primarily situated within the environmental track of the ASEAN Socio-Cultural Community.

This should not be viewed as a weakness in design, but rather as an institutional inheritance, a reflection of how the original mandate was framed. It is also, for that very reason, something that may be revisited constructively as the architecture continues to evolve.

4. The Health Evidence: What Haze Means for People

The scientific evidence on the health impacts of transboundary haze in Southeast Asia is substantial and broadly consistent. Integrating it more directly into governance would not alter the environmental mandate of the ACC THPC, but could strengthen the preventive case that mandate already seeks to advance.

4.1. Mortality

Koplitz et al. (2016, Environmental Research Letters), using atmospheric modelling and epidemiological exposure-response functions, estimated approximately 100,300 premature deaths attributable to the September–October 2015 haze event across Indonesia, Malaysia, and Singapore, with South Sumatra identified as the single largest source region. The study’s authors include Samuel S. Myers, Director of the Planetary Health Alliance.

The December 2024 Lancet health impact assessment (Xu et al.) quantified the global mortality burden from landscape-fire air pollution at 1.53 million deaths per year over 2000–2019, with Southeast Asia accounting for approximately 206,817 annual deaths. PM2.5 contributed 77.6 percent and ozone 22.4 percent of these deaths, with over 90 percent occurring in low- and middle-income countries.

4.2. Morbidity and Economic Costs

Cheong et al. (2019, International Journal of Environmental Research and Public Health) reviewed the acute health impacts of haze and found consistent associations with respiratory illness, including asthma exacerbations, pneumonia, and chronic obstructive pulmonary disease, as well as cardiovascular events, neurological effects, and psychological distress.

The economic costs are likewise considerable. The World Bank (Glauber & Gunawan, 2016) estimated the total economic cost of Indonesia’s 2015 fires at approximately US$16 billion, or around 1.9 percent of GDP, a figure also cited by Edwards et al. (2020). The 1997–98 fires were associated with an estimated US$9 billion in regional damage, based on one of several published estimates. IIASA and UNEP (Policy Brief No. 40, October 2023) estimated that by 2030, 130,000 premature deaths per year in Indonesia could be avoided through twelve proven clean-air interventions.

4.3. Connecting Evidence to Governance

To date, these landmark health-impact studies do not yet appear to have been formally incorporated into the ACC THPC’s monitoring framework, the Second Haze-Free Roadmap, or the AATHP’s reporting indicators. In practical terms, the evidence exists, and there may be value in considering how its policy relevance could be reflected more systematically over time.

There is also a useful parallel in Indonesia’s domestic climate policy, where major programmes often track carbon outcomes more directly than health outcomes, even though the same peatland fires that emit CO2 also generate smoke that affects communities. The ACC THPC may offer an opportunity to consider a similar question at the regional level.

5. Why 2026 Presents a Timely Policy Window

5.1. The Dry-Season Outlook

Bloomberg reported on 31 March 2026 that Indonesia and Malaysia had recorded a seven-year high in fire hotspots. On 7 May, Singapore’s Minister for Sustainability, Grace Fu, cautioned about the possibility of a strong El Niño cycle that could intensify drought and fire risk across Southeast Asia, while the ASEAN Specialised Meteorological Centre has issued elevated alerts for the Mekong sub-region.

5.2. The Land and Peatland Context

Recent reporting suggests that land-use change and peatland vulnerability remain relevant considerations in parts of the region ahead of the 2026 dry season. Because drained peatlands are a major source of haze, these trends may be read as early indicators of elevated seasonal risk and a reminder of the continued importance of prevention and preparedness.

5.3. Sustaining Institutional Support

Some of the regional programmes that provided technical support to ASEAN’s regional haze institutions and peatland management efforts have concluded. At the time of writing, a permanent, funded successor dedicated to operational support for the Centre had not yet been publicly announced. Continued partnership at this stage could therefore be especially helpful in supporting full operationalisation.

5.4. The Fiscal Context

Across the region, fiscal pressures and competing public-policy priorities continue to shape the pace and scope of institutional development. In such a constrained environment, relatively low-cost, high-leverage interventions of the kind proposed here may be particularly relevant.

6. Proposed Health Integration: Four Practical Options for Consideration

Because the ACC THPC’s institutional design is still being finalised, this may be the most cost-effective point at which to consider modest additions. Once divisions are fully staffed, mandates codified, and reporting templates standardised, introducing a health-related function may become more administratively demanding. The four options below are relatively low-cost, institutionally feasible, and likely easiest to explore before the Centre becomes fully operational.

A single principle underpins all four proposals. The ACC THPC is a coordinating centre, not a health agency, and should neither duplicate nor replace the institutions ASEAN already has in the health sector. Its comparative advantage lies in serving as a bridge, connecting the environmental monitoring it coordinates with the health bodies equipped to interpret and act on health outcomes, including the ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), the ASEAN Health Ministers Meeting (AHMM), and the Senior Officials Meeting on Health Development (SOMHD). Each of the proposals below is therefore intended to strengthen intersectoral coordination rather than create a parallel mandate.

6.1. A Health Function Within the ACC THPC

At minimum, a senior Health Adviser post could be considered within the Monitoring and Assessment Division, with responsibility for translating hotspot and air-quality data, much of it supplied by the ASMC, into health-impact projections using established epidemiological models, including those developed by Koplitz, Xu, and IIASA. Such a function could potentially be supported through secondment from WHO SEARO or through existing ASEAN Health Cluster cooperation mechanisms. The resource implication would likely be modest, potentially limited to one international professional post.

6.2. Health-Related Indicators in the Haze-Free Roadmap

The Second Haze-Free Roadmap (2023–2030) could consider incorporating selected health-related indicators alongside existing hotspot- and hectare-based targets:

These indicators would complement, rather than replace, the existing hotspot and PM2.5 targets.

6.3. A Formal ACC THPC–Health Liaison Mechanism

Haze governance currently reports through environment ministers via the COP-AATHP, with no formal linkage to the ASEAN Health Ministers Meeting or the Senior Officials Meeting on Health Development. A formal liaison mechanism, modelled on the emergency-health coordination already established under AADMER for disaster management, could help ensure that haze-related health information informs both environmental and health policy responses.

The ASEAN Secretariat in Jakarta, given its cross-pillar role and service to both environment and health tracks, would appear to be a natural convener for such a mechanism. It is also well placed to help ensure that cross-sector issues do not fall between mandates.

The ACC THPC likewise sits within a wider ecosystem of ASEAN institutions. It already depends on the ASEAN Specialised Meteorological Centre (ASMC) in Singapore for real-time hotspot and meteorological data, and it stands alongside other specialised ASEAN bodies, including ACPHEED, the ASEAN Centre for Climate Change (ACCC) in Brunei Darussalam, the ASEAN Centre for Biodiversity (ACB) in the Philippines, and the AHA Centre in Jakarta for disaster response. A more formalised data- and knowledge-sharing arrangement across this network, not only with health ministers but also with related technical bodies, could help embed health within the wider architecture rather than adding it as an external annex. It would also allow the ACC THPC to draw more systematically on ASMC monitoring, ACPHEED health surveillance, and ACCC climate projections as part of a connected regional system.

6.4. An Annual Regional Haze Health Burden Report

The Knowledge Management Division could be tasked with producing an annual Regional Haze Health Burden Report, using the Koplitz, Xu, and IIASA methodologies as reference points and updating them with each dry season’s PM2.5 data. If published openly and presented to both the COP-AATHP and the AHMM, such a report could serve as a useful regional reference for haze-related health governance across ASEAN.

To reinforce methodological independence, technical hosting or academic partnership with a regional university or school of public health, such as NUS Saw Swee Hock School of Public Health, Universiti Malaya, or the Faculty of Public Health at Universitas Indonesia, may also be considered.

7. A Planetary Health Framework

The argument advanced here, that haze governance may be strengthened by integrating health, forms part of a wider proposition: that environmental governance in Southeast Asia often addresses environmental indicators more directly than health outcomes, and that a Planetary Health approach could help close that gap.

Indonesia’s FOLU Net Sink 2030 does not yet formally track health outcomes. The Global Biodiversity Framework’s 30x30 target does not include indicators for food security or dietary diversity. The AATHP and ACC THPC do not yet include health outcomes. In each case, governance mechanisms have understandably focused on their core environmental metrics, carbon, hectares, hotspots, while the human-health outcomes that may offer some of the strongest social and political incentives for action remain less visible within the framework.

A Planetary Health approach begins with the recognition that forests are not only carbon stocks but also part of the infrastructure that supports respiratory health; that peatlands are not only methane sources but also water and ecosystem regulators; and that haze is not only an air-quality issue but also a public health issue. When health costs are brought into view, the case for prevention often becomes even stronger. As a newly established institution still in its formative stages, the ACC THPC is particularly well placed to become an early example of such integration in ASEAN governance.

This direction is also gaining momentum in regional policy discussions. In April 2026, an analysis published by the S. Rajaratnam School of International Studies (RSIS) argued that ASEAN could benefit from adopting a Planetary Health approach as a natural progression beyond its One Health architecture, with transboundary haze identified as a particularly relevant test case. What this emerging discussion still needs is institutional-level operational detail, precisely the gap this brief seeks to address. Two factors make the present moment especially promising: ACPHEED offers a ready health-sector counterpart for the liaison proposed above, and the incoming Philippine ASEAN chairmanship may provide a useful political platform for advancing this conversation.

8. Conclusion

The ACC THPC represents a significant and hard-won institutional achievement. More than two decades of negotiation and the steady work of consensus-building among ASEAN Member States have brought the region to a point where a physical coordination centre now stands in Jakarta. That progress deserves clear recognition.

The next step is therefore not to revisit that achievement, but to consider how it may be further supported as the institution evolves. A coordination centre that counts hotspots and tracks PM2.5 is already undertaking essential work. Over time, connecting that work more directly to hospital admissions, school closures, and premature mortality may allow it to reflect more fully the wider human implications of the issue it was created to address. The four options outlined here: a health function, health-related indicators, a health liaison mechanism, and an annual health burden report, are modest in cost and appear feasible within the existing architecture. They may also be easier to consider now, while the institution is still in development.

The coming dry season warrants close regional attention. Hotspots are already increasing in some areas; many peatlands remain vulnerable, and the El Niño outlook continues to be monitored closely. With the Centre now open, there is, for the first time, an institutional home through which this question may be addressed more coherently. Reflecting health considerations within that effort could help ensure that the Centre is able, over time, to respond to the issue in its fullest regional context.

References

• ANTARA News (2026). ‘Indonesia inaugurates ACC THPC Secretariat Office in East Jakarta.’ 22 April 2026.
• ASEAN (2002). ASEAN Agreement on Transboundary Haze Pollution. Kuala Lumpur, 10 June 2002.
• ASEAN (2023). Operationalisation of the ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED).
• ASEAN Secretariat. ASEAN (2024). Media Release of the 19th Meeting of the COP to the AATHP. Bangkok, 18 December 2024.
• ASEAN Centre for Climate Change (ACCC) (2026). Hosted at Universiti Brunei Darussalam; instrument of ratification deposited 20 April 2026.
• ASEAN Specialised Meteorological Centre (ASMC). Meteorological Service Singapore, regional hotspot and haze monitoring.
• Auriga Nusantara (2026). Indonesia Deforestation Status (STADI) 2025. 31 March 2026.
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• Xu, R. et al. (2024). ‘Global, regional, and national mortality burden attributable to air pollution from landscape fires.’ The Lancet, 14 December 2024.

About the Author

Dr. Ekoningtyas Margu Wardani is an independent policy analyst and anthropologist with more than twenty years of experience across Indonesia and Southeast Asia, including on transboundary haze governance. Her doctoral research at Leiden University (2022) focused on food security among the Orang Rimba in Jambi, Sumatra. She writes a public series on integrated health–environment–food governance in Indonesia and Southeast Asia. She is a contributor to Geni Lintang.

Contact: wardani.e.m@gmail.com · genilintang.work@gmail.com · Yogyakarta, Indonesia