World Health Assembly Puts Aside Rivalry Over Taiwan To Move Ahead On WHO Reform And COVID-19 Pandemic Agendas World Health Assembly 73 09/11/2020 • Elaine Ruth Fletcher Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Jens Spahn, Federal Minister of Health, Germany, speaking at the WHA. World Health Assembly members set aside the contentious issue of restoring Taiwan’s observer status at the member state forum – to focus on the challenges posed by the COVID-19 pandemic, and linked to that WHO reform. That was despite a growing push by the United States, backed by Europe and their western Pacific allies for a stronger role for Taipei in WHO fora – an elected government representing some 23 million people which has managed to keep its COVID-19 cases to less than 600. The Taiwan issue was dealt with at a two-hour closed door WHA meeting, then followed by public, declaratory remarks by two countries, Honduras and Marshall Islands, in support of Taiwan’s re-admission, and two opponents, China and Pakistan, and concluding with no action for the moment. Left to unravel, a full-fledged public debate would have consumed a day of speeches, leaving bitter deadlock among member states pro and con, observers said. WHO Reform Agenda But meanwhile, political consensus appeared to be shaping up around initiatives being advanced by both European countries, the United States and other G-7 allies, to strengthen the hand of the WHO signficantly – in terms of its emergencies powers to get data and take action – as well as its technical capacity and created channels for more sustainable financing. “A key lesson of the COVID-19 pandemic is that there is a gap between WHO’s 194 member state expectations, … and its de- facto capacities to fulfill them,” said Jens Spahn, German Federal Minister of Health, speaking on behalf of the European Union, on Monday, the first day of the week-long WHA session, which picks up from a two-day WHA emergency event in May. Referring to a recent report on WHO’s health emergencies operations by an Independent Oversight Advisory Committee, Spahn said that the EU had already launched informal discussions among its member states in October to define a WHO reform agenda. That process will resume soon after the WHA sessions, he said. Virtual World Health Assembly nerve center at WHO’s Geneva headquarters, with only a skeletal staff around the table, due to the pandemic. He said the the EU Council was already supporting a number of concrete measures “to strengthen WHO’s role – without prejudice to the ongoing reviews and evaluations.” Spahn referred to a laundry list of actions needed to strengthen WHO’s mandate in the framework of existing, binding International Health Regulations, “including with regards to travel and trade restrictions, independent epidemiological onsite assessments, reporting by state parties, monitoring and evaluation, and through revision of the PHEIC [Public Health Emergency of International Concern] declaration alert system,” he said. Other tasks, he noted, include “include strengthening WHO’s role in preparedness response, its standard-setting functions, it’s work on zoonotic diseases.” COVID Needs to Be Game Changer- Member States Need to Put Their Money On The Table But equally important to a stronger mandate to act in emergencies, is the degree of funding needed to execute, Spahn said. And for that, member state contributions need to match the size of WHO’s mandate. “Currently there is a major discrepancy in between how we all praise the importance of a well functioning and effective WHO, and our common will to finance WHO, through our membership fees. Let us open our eyes: are US$ 490 million US dollars in [combined global] membership fees per year, adequate to fulfill WHO’s mandated role? Hardly. Germany is ready to explore all possible options to make who stronger. But in the end, this will only be possible. If the 194 members of this organization, take on more financial responsibility. “From Germany’s point of view, the COVID-19 pandemic must be understood as a game changer. None of us was adequately prepared. We will have to change the way we are doing business… Preparing costs billions, responding costs trillions.” Two draft reform plans are already circulating, one as a European Union ‘non-paper‘, and a “WHO Roadmap” published by the United States Department of Health and Human Services, which focuses more narrowly on ways to improve WHO’s emergency response mandate and systems, obliging member states to greater transparency. But diplomatic sources say that there are many points of synergy and convergence between the two. Said one source close to the discussions, both initiatives in fact evolved out of the same conversations among the (G-7) Group of 7 most industrialized countries, and there had been “fairly good consensus on direction and elements”. Even if two concept notes have emerged now, “much of it is the same and includes elements that had been talked about in the broader group.” In a parallel discussion on the WHO budget, Belgium’s WHA representative said that WHO needs to provide more precise and ‘updated reporting’ on its financial status and any shortfalls caused by the pandemic- calling for a longer discussion at the next Executive Board meeting in the context of proposed reform moves. “It would be helpful if the Secretariat could provide us with a short update on how WHO is managing financially during COVID-19, and how gaps caused by retracting donors can be dealt with or not,” the representative said. “Predictable, flexible and sustainable financing is one of the core issues to strengthen WHO and to allow it to act independently,” added Belgium. “We believe that the Secretariat should develop, together with the independent review panel, proposals on the amount and type of funding, especially core funding, that WHO needs in order to be able to fulfill its mission.” Taiwan Set Aside – For Now As for Taiwan, a procedural move by 13 WHA member states to restore its observer status, led by Belize and backed by the United States, Canada and other European and Western Pacific allies was discussed largely behind closed doors, in an early afternoon WHA session. The move was hotly opposed by Beijing as a threat to its sovereignty – even though Taiwan had served as an observer to the WHA until 2017. Following a terse agreement two countries from each side of the divide presented their arguments publicly. Speaking on behalf of Taiwan’s inclusion, Honduras and The Marshall Islands, referred to the Island’s exemplary record in controlling the virus and the technical expertise that it has to share in pandemic control, saying that the Assembly “has continued to exclude Taiwan for political reasons. They are prioritizing poilitical considerations over health considerations here. China, meanwhile, said that including Taiwan as an observer to the Assembly would violate the agreed-upon UN “One China principle … that both sides of the straits belong to China.” Meanwhile US Ambassador Andrew Bremberg issued a video coinciding with the debate, describing Taiwan as “a democratic role model, generous donor and a force for good. Taiwan is an exemplary partner in addressing the world’s most serious challenges- especially during this global pandemic. “We believe Taiwan’s inclusion would benefit the world and the WHO. Taiwan’s model COVID19 response has proteted the health and safety of the 23 miliion people living on the island. Taiwan’s generous efforts to share scientific and technical expertise, and its donations of tens of millions of masks and hundreds of thousands of medical supplies, have saved countless lives. “In preventing Taiwan’s participation, the WHO is allowing some to politicize public health, and allowing its core mission to suffer. The solution is simple, the Director General should invite Taiwan to participate as an observer. This was the status quo from 2009 until 2016. Nothing has changed since them, except the democratically elected leadership of Taiwan, which is not an acceptable reason to block Taiwan’s participation”. Bremberg also said that going forward, the WHO should include “substantively, without limitations, Taiwan health experts with expertise in the COVID-19 pandemic response, including in technical meetings and full accesss to all relevant facilities and virtual spaces. This is a desire shared by a growing number of countries within this body, who respect Taiwan as a responsible and generous actor, with world-class health expertise.” Although WHO has officially stated, throughout the pandemic, that Taiwanese experts do have access to WHO technical consultations, other insiders familiar with the Organization say that any meetings with experts had to first go through WHO’s legal department, technical barriers were placed on virtual consultations, and experts with any government title or ranking had to be screened by Beijing – placing the bar impossibly high. Until 2017, Taiwan had access to the WHA as an observer, upon the personal invitation of the Director General. But following the Taiwanese election of a new government dominated by the more nationalistic, the Democratic Progressive Party, relations with Beijing soured – and the invitations ceased. WHO’s current Director General, Dr Tedros Adhanom Ghebreyesus has been reluctant to buck the pressures from Beijing. We Are Family – Hit Featured In Lighter Moments Of WHA While the bitter Taiwan dispute remained as vivid reminder of the limits of WHO calls for global “solidarity”, the Assembly was marked by lighter moments. Those included the release of a new cover for the classic “We Are Family” hit by Singer Kim Sledge – featuring health workers from around the world singing the classic pop song – and a performance by the Tonga Nurse Choir, in honor of WHO’s Year of The Nurse and Midwife. Pleased to give #Tonga Health Minister Amelia Afuha’amango Tu’ipulotu & 🇹🇴 Nurse Choir the @WHO Director-General Award – they lifted our spirits & touched our hearts with today's performance at #WHA73, to mark the Year of the Nurse & the Midwife.pic.twitter.com/Z8VF3zIkqG — Tedros Adhanom Ghebreyesus (@DrTedros) November 9, 2020 Director General Proposes ‘Peer Review’ of Countries’ Emergency Preparedness Meanwhile, in his opening remarks Dr Tedros also called upon WHO member states to “address the shocking and expanding imbalance between assessed contributions and voluntary, largely earmarked funds,” observing that WHO’s annual budget is equivalent to what the world spends on tobacco products in a single day. And he proposed a new system of “peer review” for emergency preparedness. The Universal Health & Preparednesss Review – would bring countries together for transparent review of each other’s response capacities. He invited Cameroon, the Central African Republic, France and Germany to test the concept in a pilot phase. WHO Director General Dr Tedros speaking at the 73rd World Health Assembly The WHO Director General also warned that “a vaccine cannot address the global under-investment in essential public health functions and resilient health systems, nor the urgent need for a “One Health” approach that encompasses the health of humans, animals and the planet we share.” No Vaccine for Climate Change “It’s time for the world to heal – from the ravages of this pandemic, and the geopolitical divisions that only drive us further into the chasm of an unhealthier, un-safer and unfairer future” he said. Drawing linkages between the current pandemic and the inter-related crises of unsustainable development, he added: “We cannot afford to see health merely as a byproduct of development or a commodity that only the rich can afford. “There is no vaccine for climate change. The world has reached a fork in the road. We cannot afford to pump carbon dioxide into the atmosphere at the same rate, and still breathe clean air, we must chose.” Number of COVID-19 cases against number of deaths reported to WHO as of 8 November 2020. Meanwhile, Michael Ryan, Executive Director, WHO Health Emergencies Programme (WHE), gave an update on the COVID-19 pandemic, noting that the world had reached “the grim milestone” of 50 million cases globally. Sharp increases in cases are being seen right now in Europe, the Americas and the Eastern Mediterranean Region – while cases in Africa, Southeast Asia and the Western Pacific are more stable or even declining. On a brighter note, a senior WHO advisor, Bruce Aylward, briefed Member States on the progress made in organizing global procurement systems for COVID-19 drug treatments, tests and forthcoming vaccines the Access to COVID-19 Tools (ACT) Accelerator. The Accelerator’s multi-pronged strategy aims to create systems for more equitable distribution of life-saving COVID-19 rapid tests, treatments, and future vaccines through a new “COVAX Facility” which over 180 WHO member states have now joined. The Accelerator has raised over US$15 billion in finance already, although billions of dollars still need to be raised, Aylward said. Seehere our Health Policy Watch story on the new drive to build and procure a global toolkit of COVID-19 drugs worth $US 6 billion. As the WHA proceedings were unfolding, more good news came that Pfizer’s COVID19 vaccine candidate had achieved 90% efficacy in its interim clinical trial results. Image Credits: WHO. 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