South Asia’s worsening air pollution crisis represents one of the most urgent public health and environmental challenges of the 21st century. Nearly two billion people—over one-quarter of the global population—reside in this region, where air quality levels routinely exceed World Health Organization (WHO) guidelines by factors of 10 to 15. This has translated into an unprecedented health burden, with approximately two million premature deaths annually, widespread chronic respiratory and cardiovascular disease, and rising economic losses. According to recent World Bank estimates, welfare losses amount to over 5% of regional GDP, a figure far exceeding the projected costs of coordinated mitigation. Despite this, South Asia continues to lack a binding regional framework capable of addressing its shared airshed. Existing cooperative efforts—such as the Malé Declaration on Control and Prevention of Air Pollution (1998)—have provided a useful platform for dialog and pilot monitoring, but they remain voluntary, under-resourced, and insufficient to manage the transboundary nature of the crisis. National-level programs, including India’s National Clean Air Programme (NCAP), Bangladesh’s National Air Quality Management Plan (NAQMP), and Nepal’s National Air Quality Management Action Plan (AQMAP), demonstrate domestic commitment but are constrained by fragmentation, limited financing, and lack of regional integration. This gap represents the central knowledge and governance challenge that prompted the present commentary. To address it, we propose a dual-track architecture designed to institutionalize binding regional cooperation. Track A would establish a United Nations-anchored South Asian Transboundary Air Pollution Protocol, under the auspices of the United Nations Environment Programme, the World Health Organization (WHO), and the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP). This protocol would codify legally enforceable emission standards, compliance committees, financial mechanisms, and harmonized monitoring. Track B would establish a South Asian Association for Regional Cooperation (SAARC) Prime Ministers’ Council on Air Quality (SPMCAQ) to provide political leadership, align domestic implementation, and authorize rapid responses to cross-border haze events. Lessons from the Indian Ocean Experiment, the ASEAN Agreement on Transboundary Haze Pollution, and Europe’s Convention on Long-Range Transboundary Air Pollution demonstrate that legally binding agreements combined with high-level political ownership can achieve durable reductions in pollution despite geopolitical tensions. By situating South Asia within these global precedents, the proposed framework provides a pragmatic, enforceable, and politically resilient pathway to protect health, reduce economic losses, and deliver cleaner air for nearly one-quarter of humanity.
Sriram et al. (Sun,) studied this question.