WHA member states meet on reform process Tuesday – in half empty room.

A formal procedure for investigating allegations of misconduct against WHO’s Director General got the greenlight from the World Health Assembly on Tuesday – after six years of mostly closed door debate and deliberations.  

The procedure is the first ever to be approved by the global health body for investigating any current or future head of organization – in line with United Nations recommendations to all UN family agencies, first issued in 2019. 

But the process developed for WHO also contains a few key loopholes.  The responsibility for recommending that an investigation begin rests with  WHO’s Office of Internal Oversight Services – which operates under the wings of the WHO Director General – although IOS also files an annual report to the WHO Executive Board.

According to the text of Tuesday’s WHA decision, “Following a prima facie determination from the Office of Internal Oversight Services that indicates further analysis of the allegation is warranted, the Office of Internal Oversight Services will (1) notify the Officers of the Board (Chair, Vice-Chairs and Rapporteur); (2) notify the IEOAC Chair [WHO’s Independent Expert Oversight Advisory Committee]; and (3) transmit the allegation along with any supporting documentation and the Office of Internal Oversight Services’ prima facie determination rationale, to an EIE [an external investigative entity] drawn from a pool of EIEs as provided for in chapter C below, for further analysis.”

WHO’s Secretariat and the EB are gatekeepers of the process.

Effectively, this means that any current or future investigation of allegations against WHO’s top official could not even begin unless WHO’s own in-house investigators first recommend such a step – with all of the inherent conflict of interests involved. 

Moreover, even if such a case went forward, it would be overseen by WHO’s Independent Expert Oversight Advisory Committee (IEOAC). The three-member IEOAC Secretariat includes WHO’s Chef de Cabinet and the ADG for Business Operations – both political appointees and members of the Director General’s leadership team.  

IEOAC, in turn, would be responsible for choosing which “external investigative entity” should pursue any case – should a case be pursued.  And there, too, WHO’s top leadership also appears to have a final say, as per section 3.2 (c): 

“If prioritization… results in two or more equally suitable [investigative] candidates, the WHO Secretariat will further narrow that short list to identify the best candidate on the basis of availability, efficiency, quality and value for money.”

Process contrasts with the UN investigation of WHO sex abuse allegations in DR Congo

The process contrasts sharply with WHO’s management of investigations into sexual harrassment and abuse allegations against agency staff and contractors in DR Congo during the 2018-2020 Ebola outbreak. Following a public outcry over the initial media reports of abuse, those cases were turned directly over to the UN Office of Internal Oversight Services (OIOS) – so as to ensure a more impartial outcome. See related story here:

In WHO’s Internal Justice System, All Roads Lead to Director General

Executive Board can halt an investigation at preliminary stage

Finally, once an preliminary investigation of any alledged misdeed involving the Director General is completed, the Executive Board, a member state body with vested political interests, could choose to halt further action altogether, according to Section B3.12 of the decision agreed to by WHA: 

“In a case where (a) the EIE determines a full investigation is warranted, (b) the IEOAC’s assessment confirms that due investigative procedure has been followed and recommends proceeding to a full investigation, (c) and the Officers of the Board have grave concerns about the EIE preliminary review and the IEOAC’s assessment and recommendation, the Officers of the Board may recommend to the Executive Board not to proceed to a full investigation.”

Demands by some member states to insure a role for the EB in such sensitive investigations, was a major stumbling block issue in the years’ long debate and delays over the final drafting of a investigation procedure – which led to the compromise reached Tuesday. 

 Once a full investigation is completed, the EB would review the results and decide what final actions to take as per Section B.6.1 of the procedure, which states: 

“Upon receipt of the investigation report, the Officers of the Board will review all of these materials and decide whether to close the case or to initiate disciplinary proceedings. The Officers of the Board may request advice from the IEOAC regarding the findings.”  

US objected but is outside of the room

In discussions last year over the process, the United States delegation raised strenuous objections over some of the circularity of some of the proposed procedures – but they were outside the room this WHA, in light of the US decision to withdraw from the global health agency – at least for now. (see related story). 

BREAKING – US Health Secretary Robert F Kennedy Jr Extends Olive Branch to WHO – With Strings Attached 

And at the Executive Board meeting in January 2025, the Representative of the WHO Staff Association raised concerns about the lengthy time required for WHO IOS investigations generally, noting that for rank and file staff, “It can take up to two years for internal justice cases to be resolved.”

Member states were adamant about their role   

Botswana delegate to WHA speaks about importance of member state control over investigative process.

But in the final analysis, member states were adamant about preserving their own right of review and decision at different stages of the process, through the Executive Board gate.

“We believe that the Executive Board and the World Health Assembly remain the appropriate bodies to oversee and manage these matters in accordance with their mandate,” said the WHA delegate from Iraq, speaking on behalf of the Eastern Mediterranean Regions. Members of the Africa group, echoed similar sentiments. 

“We welcome the decision to say that the governing bodies over five while maintaining the independence, integrity and confidentiality of the investigative process,” said Botswana.  

Need for independent oversight   

Poland’s WHA delegate speaking on behalf of the European Union.
Norway’s delegate calls the decision a milestone moment.

Other member states appeared relieved to have settled on a formal procedure that included any role at all for external investigators – should the need arise. 

“We emphasize the importance of accountability and independent oversight, and strongly believe that an independent body selected and appointed by the EB should investigate allegations against the Director General,” said Poland, speaking on behalf of the European Union member states, nine other European nations and Brazil. 

“We are in the 11th Hour, and we count on member states collective support in finalizing this key aspect of governance reform at the WHA.  We also emphasize the need for specific mechanisms which provide detailed, ongoing oversight over the WHO restructuring and its focus and core priorities, enhancing the organization’s accountability and in the new landscape.”

Meanwhile, Norway, speaking on behalf of a group of seven, primarily Nordic nations, sounded a more positive note. “The proposed procedures… have achieved the necessary balance between independent investigation and Member States visibility, while seeking to avoid politicization of the process. This is a defining moment for WHO and its member states.”

Only Japan seemed to insert a real note of reservation about the new process, saying, 

“We generally support this. However, Japan has three points for further thoughts of implementation. First, the importance of neutrality. Second, the avoidance of politicization. Thirdly, independence of the [WHO] Secretariat, particularly the Internal Oversight Services. 

“We expect this process will be properly implemented based on key principles, and we underscore the need to constantly review and improve the process, taking into account the consistency among the process of the other UN organs.”

Image Credits: Mudassar Iqbal /Pixabay.

Delegates gathered on Tuesday at the World Health Assembly agreed a new WHO budget for the 2026–2027 period which included a rise in membership fees. Photo WHO/Pierre Albouy.

Nations at the 78th World Health Assembly approved a new budget and a 20% increase in annual membership fees for the World Health Organisation (WHO), handing the embattled UN health agency a crucial lifeline as it grapples with the financial bomb dropped on Geneva by the United States’ withdrawal from international institutions.

The vote marks the second consecutive 20% hike in membership dues in as many budgets, which the agency’s member states approve on a biennial basis, the last coming in 2024.

The move is part of a long-term plan to boost mandatory contributions from 16% of WHO’s core budget at the start of the decade to 50% by 2030 to reduce its dependence on the whims of major donors like the now-departed US.

These membership fees provide the organization with flexible funding it can allocate according to its own priorities, unlike the voluntary contributions that typically come strictly earmarked by donors for specific programmes that have historically made up the vast majority of the WHO’s budget.

Under the new budget, assessed contributions will make up 40% of the WHO’s base program budget of $4.2 billion for the 2026-27 period. The core budget does not include emergency humanitarian appeals or polio programmes, which bring the total budget target up to $6.2 billion.

The fee increase, initially mandated in a 2022 resolution at the WHO’s executive assembly, faced an uncertain path to approval on Tuesday, with member nations engaging in tense pre-vote debates over the fairness of regional funding cuts in the new budget – which will run for two years starting in 2026 – and demands for greater transparency in expenditure tracking.

Projected financing for the base programmes segment of the budget for 2026–2027, compared to previous bienniums, in US$ million.

A battle of buzzwords played out during the proceedings: supporters of the fee increase championed “flexible, predictable, sustainable and agile” funding, while skeptics countered with demands for “efficiency,” “transparency,” elimination of “redundancy” and “cost-effectiveness” – signaling clearly that the WHO’s financial reprieve comes with strings and expectations attached.

WHO officials had acknowledged in the budget document they were “cognizant that such an increase will not be automatically granted” amid overlapping global crises straining national budgets worldwide.

In the end, a collective recognition of the existential financial threat facing the agency carried the budget over the line. The chamber fell silent during the vote, with no objections raised. 

“There is a crisis,” WHO Director-General Dr Tedros Adhanom Ghebreyesus declared following the vote. “But we will use this crisis as an opportunity and make sure our organisation emerges sharper and more empowered.”

Germany’s delegation, the WHO’s most important financial backer since the American departure, hailed the decision as “historic” — but not before voicing their support in song.

“I tell you what I want, what I really, really want,” the German representative sang in an awkward rendition of the Spice Girls hit befitting the oft-lively proceedings of Committee A, “and that is that we all indeed are serious about functioning and effective multilateralism.”

“The increase is the best vaccination against the highest financial risk that WHO faces,” he added, “its dependency on a very few donors, and the discrepancy between the expectations we all put on the organisation and its ability to fulfil them.”

Financial triage

Imre Hollo, director of strategic planning and budget at WHO.

The agency has been in financial triage mode since the US exit announcement in November, implementing drastic budget reductions to secure votes that earned praise from member states for its “budgetary realism.” 

Before the US departure, the 2026-27 budget required to fulfill WHO’s core mission was projected at $5.3 billion over the two year period. Following Tuesday’s vote, the target plummeted to $4.2 billion, a 22% cut that will impact the agency’s operations worldwide. 

The revised budget represents a $700 million decrease from projections presented at WHO’s January executive board meeting, but even this diminished figure approved in Geneva remains aspirational. 

Level of projected financing for the base programmes segment of the Proposed programme budget 2026–2027, US$ million.

While WHO secured an additional $170 million toward its 2026-27 budget Tuesday evening following major commitments of $50 million a year from China and first-time donors Mongolia and Cambodia, among others, the agency still faces a $1.5 billion funding shortfall on top of the $1.1 billion decrease from previous budget projections.

The two new donor nations join 42 additional first-time voluntary contributors to WHO, including seven low-income and 28 lower-middle and upper-middle income countries. 

“With the exception of the headquarters and the European region, the allocated or proposed budget for every regional office is currently higher, even after the reduction, than the projected implementation,” explained Imre Hollo, director of strategic planning and budget at WHO.

Without additional contributions, further life-threatening program cuts loom. All of the WHO’s six regions face significant cuts heading into the 2026-27 period covered by the budget. Regional office budgets are set to fall by 14%, with the African region facing the largest total cut of $153 million year-on-year. The agency’s Geneva headquarters will lose nearly a quarter of its annual funding.

China announced it will contribute $500 million to the WHO over the next five-year period, though it was unclear whether this includes the 20% increase in its fee contributions. This will make China, for the first time, the largest fee payer in the WHO, supplanting the US as it exits.

“We can only implement the budget if we have the financing,” Hollo said, noting the “personal sacrifice” that member states will need to make should the funding target remain unmet.

More freedom, less money

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Raul Thomas, the Assistant Director-General for Business Operations at WHO address the committee following the successful vote.

The WHO’s budget victory comes amid a zero-sum competition for international aid dollars, with UN agencies and humanitarian organisations worldwide scrambling to fill gaps left by America’s retreat from global commitments.

Since January, the White House has systematically dismantled the US Agency for International Development (USAID) – historically the world’s largest humanitarian donor – while slashing support for the United Nations and WHO’s sister agencies. By March, over 80% of USAID programs had been shuttered, punching a $60 billion hole in global aid budgets.

This broader retreat from international commitments has left organisations like the UN Refugee Agency and Office for Humanitarian Affairs and non-governental humanitarian organisations scrambling for resources just as the WHO does the same, creating unprecedented competition for a dwindling pool of donor funds that no single government appears willing or able to replenish.

In the latest sign of distress, top UN officials told staff at a town hall in New York City Tuesday that the organization is considering a 20% reduction across every secretariat under the UN umbrella for 2026 — from humanitarian affairs, to human rights, peacekeeping operations, and development programs — heightening the financial crisis in the world of international institutions and those who depend on them.

Several major financial contributors to WHO, including Germany, France, and the EU delegation, pressed the agency to develop contingency plans for potential fundraising shortfalls as the UN system creaks under the weight of the US withdrawal. 

“Should the resources, the $1.65 billion, not materialise, the idea is that we will be in a position to actually scale back or ramp up,” said Raul Thomas, WHO’s Assistant Director-General for business operations who led the budget consultations with member states. “We never know – I’m the eternal optimist. Maybe we’ll get much more money than the 1.65 million. That’s the gap right now.”

Image Credits: WHO/Pierre Albouy.

Saima Wazed, daughter of deposed Bangladesh leader Sheikh Hasina, sworn in as Director of WHO’s South East Asia Region in February 2024.

Saima Wazed, WHO’s South East Asia Regional is attending the World Health Assembly in Geneva, and presiding over official events, even while her home country, Bangladesh, has a warrant outstanding for her arrest. 

The warrant follows the filing of charges in March against Wazed in March by Bangladesh’s Anti-Corruption Commission (ACC) alleging fraud, forgery and misuse of power, including in connection with her controversial 2023 campaign for election as WHO South East Asia Regional Director.

After being elected in October 2023, Wazed commenced her five-year term in February 2024.  

Following the flight of her mother, Prime Minister Sheikh Hasina, from Bangladesh last August, Saima Wazed remained in India on a diplomatic passport. In January, Bangladeshi authorities have called for her extradition, but that went unheeded in light of her diplomatic immunity.

In the latest developments, Bangladesh police were due to report on 25 May on their progress in executing an arrest order against Sheikh Hasina and her daughter Wazed, on one of the pending charges, related to allegations of land fraud, a national media outlet reported on Sunday.  

Country won’t acknowledge RD 

WHO Regional Director for South East Asia leading a regional member state briefing last weekend, on the eve of the World Health Assembly.

Bangladesh’s Ministry of Health has reportedly refused to work with Wazed since October 2024, bypassing her office and communicating directly with WHO Headquarters.  For instance, in a 19 March letter, obtained by Health Policy Watch, a Ministry of Health advisor asked WHO Director General Dr Tedros Adhanom Ghebreyesus to directly appoint a new Representative  to the country’s WHO office – a task that normally would be filled by the RD. 

“Her appointment has been the subject of widespread public scrutiny, due to allegations of nepotism and potential irregularities.  Right now, she is facing investigations by the Anti-Corruption Commission of Bangladesh,” stated the 19 March letter to the Director General from Nurjahan Begum, a Ministry of Health advisor, sent just before the formal charges against Wazed were filed.

March 19, 2025 letter to WHO’s Director General

“Consequently, we find ourselves in an embarrassing position working with her,” the letter further stated.  “A direct nomination from WHO Headquarters of Dr Jamsheed for the position of WHO Representative to Bangladesh would help us to get rid of the embarrassment linked to the incumbent RD. We would greatly appreciate if you allow us to communicate directly to HQ on issues of concern in the future.”

Last week in Geneva, Wazed attended a closed door member state Planning, Budget and Administration meeting (PBAC), and then led a weekend briefing for SEARO member states in Geneva on the WHA agenda – posted on the WHO SEARO LinkedIn page.  

WHO: no comment on investigations while in process

Asked why Wazed was continuing to act in her role even after the police investigation had been concluded and formal charges had been filed against her in Bangladesh, a WHO spokesperson said: 

“We are aware of allegations relating to the period before Ms Wazed took up her position as Regional Director for South East Asia, including in respect of activities during the election campaign for that position. 

“We understand that these allegations are the subject of investigation by the relevant authorities in Bangladesh.  We do not comment on such investigations or any consequential legal processes while they are ongoing.”

The charges against Wazed, who took office as Regional Director in January 2024 following her election by SEARO member states, are the culmination of an ACC investigation that began in January 2025, as reported by Health Policy Watch.

Already in 2023, Wazed’s election campaign was shadowed by charges that her influential mother, former Bangladesh Prime Minister Sheikh Hasina, had used her influence to gain her daughter’s election to the post. Then, only a few months later after Wazed took office, widespread protests prompted Hasina’s abrupt resignation and flight from the country in August 2024.

Second case recently involving a WHO Regional Director  

The charges against Wazed follow on a crisis involving former Western Pacific Regional Director Takeshi Kasai, who was put on administrative leave by the Director General Dr Tedros Adhanom Ghebreyesus in August 2022 after initial allegations of misconduct against the RD surfaced, and following preliminary investigations by WHO’s Office of Internal Oversight Services (IOS).

The IOS investigation culminated in a recommendation that he be dismissed. WPRO member states then voted to recommend his contract be terminated, culminating in his dismissal by the WHO Executive Board. 

In the case of Wazed, however, the charges against her have emanated from her home country – as compared to internal WHO staff complaints against Kasai. 

And high-level WHO officials typically enjoy diplomatic immunity from prosecution, unless those privileges are waived or revoked by the Director General. 

Waivers of immunity are not uncommon, in fact, for small violations by diplomats, like traffic accidents. Waiver of immunity for more serious offenses is a much bigger, and largely unprecedented occurrence – at least for WHO, expert sources told Health Policy Watch. 

“If Bangladesh requests a waiver of the RD’s immunities to have her prosecuted in her country and the DG accepts, he can waive her immunities and probably place her on administrative leave without firing her,” one expert said.  

“Immunities are not an intrinsic component of the position, they are again a protection of an international function against interference by states, but they can and should be waived to facilitate the course of justice if it doesn’t compromise WHO’s interests.  

At the same time, the political context of the accusations against Wazed, whose mother is a deposed former head of state, add layers of complexity to any DG decision – along with the basic legal principle of “presumption of innocence until there is a final conviction.”.  

While the new, interim Bangladesh government has reportedly asked the DG privately  to take action on various occasions – it has so far hesitated from making the affair public. 

And no other SEARO member states have addressed the issue publicly either – and it’s not. clear that they will. Notably, Wazed’s mother, Sheikh Hasina, historically maintained close political ties with the Indian government, which is a powerful member of the 11-nation SEARO region, as well as hosting the WHO Regional Office in Delhi.  

Regional impacts?

Even so, there are signs that the issue is making waves in SEARO. In an unprecedented move, Indonesia, Southeast Asia’s largest country, recently decided to transfer its regional affiliation from SEARO  to the Western Pacific Region (WPRO), a move due to be confirmed at the current World Health Assembly session. Reportedly, Timor-Leste may be considering a similar move.

A WHO spokesperson denied that Indonesia’s request, initiated in June 2024, had anything to do with Wazed, citing “the epidemiological situation in the country (which is similar to others in the WHO Western Pacific Region) and the geographical location of Indonesia (proximity to others in the WHO Western Pacific Region)”. 

But the extract of the SEARO Regional Committee meeting of October 2024 highlights the strenuous appeals by SEARO’s other 10 member states to Indonesia to reconsider or delay its decision, including Bangladesh, which asked it to delay a final decision “ keeping in view the bilateral and regional interests.”  

There are meanwhile reports that Bangladesh could seek to leave SEARO to join the Eastern Mediterranean Region (EMRO) – another heavy blow for the SEARO region that has the fewer number of member states in the entire WHO regional constellation. 

Uncharted territory 

Overall, independent legal experts call the Wazed case “uncharted” territory, and different from the case brought against WPRO’s Kasai, which emanated from internal allegations brought against him by other WHO staff, during his tenure as RD. 

“In this case, we have a difficult interface between actions at the national level against her as a Bangladeshi national (and daughter of the former PM), and her status as an elected RD within WHO, in particular taking into account the rather collusive culture within SEARO with a lot of mutual deference among states and a strong power imbalance between the few big powers like India (and in a lesser way Bangladesh) and the many small and more vulnerable countries like Bhutan, Timor Leste or the Maldives.” said one experienced analyst who requested anonymity.  

“As a WHO staff member, the RD is protected by diplomatic immunities precisely to shield her from political interference from her country or any other countries. The fact that her election campaign may have been influenced by her mother doesn’t mean that she is breaching WHO’s rules and regulations once she has been regularly nominated by the whole Regional Committee. And frankly political maneuvering is the order of the day in RD nomination campaigns.  WPRO offers even worse examples and that is one of the original sins of the WHO constitution and maybe of some reluctance to really address this case.” 

A credibility crisis for WHO

At the same time, critics inside the Organization and out, have also said that the optics of Wazed’s case bode ill for the organization, at a time when it is already navigating stormy waters: a $2.3 billion 2026-27 funding shortfall, increasing geopolitical tensions, and growing skepticism among Member States about institutional impartiality. 

In a period of reform, the case of the SEARO RD, following on from that of WPRO’s crisis, raises long-standing questions about the transparency and efficacy of the current process for electing WHO Regional Directors – who may be chosen on the basis of their national affiliation and political connections, as compared to administrative competencies. 

And in the case of acute crises, such as the one seen now, the questions raised are even more serious.  

“The presence of a Regional Director under criminal investigation—disavowed by her own country, rejected by others, and linked to serious human rights concerns—undermines WHO’s very foundations: neutrality, legitimacy, and trust,” said one critic, who asked to remain anonymous for fear of retaliation. 

“To preserve institutional integrity and regional stability, WHO should immediately place Saima Wazed on administrative leave pending the outcome of judicial processes. This is not about guilt or innocence—it is about governance, ethics, and safeguarding WHO’s future. If WHO fails to act decisively now, it risks complicity in a case that blends authoritarian impunity with multilateral decay.”

Image Credits: WHO, WHO SEARO/LinkedIn.

WHO officials including the co-chairs of the Intergovernmental Negotiating Body (INB) Ambassador Anne-Claire Amprou and Precious Matsoso (right) celebrate the World Health Assembly’s adoption of the pandemic agreement.

Presidents, prime ministers and even opera singers, celebrated the unanimous adoption of the world’s first Pandemic Agreement by consensus at the World Health Assembly (WHA) plenary on Tuesday morning.

Despite the 11th-hour insistence of Slovakia on a vote on the agreement in Committee A on Monday night, none of the World Health Organization (WHO) member states obstructed the agreement’s adoption at the plenary.

Instead, it was presented as a rare example of successful multilateral engagement in a world of heightened conflict.

Head of the African Union and Angolan President João Lourenço commended the WHO’s resilience in the face of “unfair and unjust criticism”, and pledged an additional $8 million from his country to the WHO.

Head of the African Union and Angolan President João Lourenço

Speaking on behalf of the 55 AU member states, Lourenço said the continent is “united in supporting the proposal to increase assessed contributions” [membership fees] as “the WHO is the only institution with a universal mandate to protect global health and promote equity”.

China’s Vice-Premier Liu Guozhong pledged an “additional quota of $500 million over five years” to the WHO, at the plenary, and urged all countries to “support the WHO to play a central coordinating role in global health governance” and enable it “to perform its duty in an independent, professional and science-based manner”.

Croatian Prime Minister Andrej Plenković, also in the room, described the WHO as “a beacon of hope and a guardian of humanity’s right to health”. 

Plenković described sustainable financing of the WHO as “a strategic imperative” to enable “timely responses to emergencies and meaningful support where it is needed most”. 

Egyptian opera singer Farrah El-Dibany and soprano singers Elaine Vidal and Eunice Miller of the Philippines also performed for the assembly.

Macron appeals to US scientists

Emmanuel Macron addresses the WHA plenary in a recorded message.

“Our first line of defence is the WHO,” said French President Emmanuel Macron in a recorded message. He then appealed to “all those researchers who want to freely continue to do their work” – a veiled reference to US scientists dismissed during US President Donald Trump’s massive budget cuts – to move to Europe.

“We will be happy to welcome you in Europe, because that will be good for Europe, for medical research, for you and for everyone. It’s not a question of ‘if’ we will have a new pandemic. It’s a question of ‘when’ we’ll have it,” said Macron.

South African and G20 President Cyril Ramaphosa, and the leaders of the Philippines, Peru, Mongolia and Senegal also sent recorded messages of support.

The UN Secretary-General Antonio Guterres called for a coherent global health architecture and described the pandemic agreement as “historic”.

As one leader after another defended the WHO and multilateralism, Trump’s withdrawal from the WHO loomed as the elephant in the room – and the target of unspoken rebuke. So it was timely – but also surprising – that US Health and Human Services Secretary Robert F Kennedy Jr also sent a recorded message to the plenary.

Unlike the other messages, however, Kennedy claimed that the WHO “has become mired in bureaucratic bloat, entrenched paradigms, conflicts of interest and international power politics”.

“The WHO has not even come to terms with its failures during COVID, let alone made significant reforms. Instead, it has doubled down with the pandemic agreement, which will lock in all of the dysfunctions of the WHO pandemic response,” he added, without articulating any specific US objections to the agreement.  

‘Eyes on the prize’

Namibian Health Minister and chair of Committee A, Dr Esperance Luvindao, Dr Tedros and Dr Mike Ryan applauding the vote on the pandemic agreement in Committee A on Monday night.

Addressing the plenary after the leaders’ messages, WHO Director General Dr Tedros Adhanom Ghebreysus paid tribute to those who negotiated the pandemic agreement.

“You have engaged in very tough negotiations. Sometimes the disagreements were sharp, the discussions heated and the frustration evident. Sometimes it seemed the distance between you might be too great to overcome. But you kept your eyes on the prize, and did not stop until you had achieved it,” said Tedros, adding that sometimes delegates had talked all night in the windowless basement room of the WHO headquarters where the Intergovernmental Negotiating Body (INB) met.

“The pandemic agreement has been negotiated by countries for countries, and will be implemented in countries in accordance with their own national laws,” stressed Tedros, referring to the “torrent of mis- and disinformation” that claimed the agreement will “infringe on national sovereignty” and  give the WHO Secretariat “power to impose mask or vaccine mandates or lockdowns.

“Today, you have sent a loud message that multilateralism not only works, but is the only way to find shared solutions to shared threats. Let’s not understate what you have achieved. You have made the world a safer place,” stressed Tedros.

Pathogens ‘won’t wait’

The agreement was welcomed by the co-chairs of The Independent Panel for Pandemic Preparedness and Response, Ellen Johnson Sirleaf, former President of Liberia, and Helen Clark, former Prime Minister of New Zealand.

“Consider this agreement a foundation from which to build, starting today,” said Clark. “Many gaps remain in finance, equitable access to medical countermeasures and in understanding evolving risks. Don’t wait to get started. Dangerous pathogens are looming, and they certainly will not wait.

The Third World Network said that the “next phases of negotiations, beginning with the Pathogen Access and Benefit-Sharing System (PABS), will determine whether this agreement becomes a meaningful tool for equity or if it remains merely symbolic”.
“At stake is the ability of developing countries to access affordable vaccines, treatments, and diagnostics swiftly and fairly during health emergencies and to realize the ambition of a fairer and more effective global health architecture that can equitably prevent, prepare for and respond to pandemics,” said TWN.

Dr David Reddy, director-general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), said that, as the next level of detail of the agreement is worked through, it is essential that the experience of  pharmaceutical companies is drawn upon “so that their expertise can be mobilized when needed”.

This includes how the PABS will work “where we must make sure that companies are able to access the pathogens and sequence information as quickly as possible to undertake scientific research and avoid unnecessary conditions that make it harder for companies to do so”, Reddy stressed.

He added that “intellectual property protections that are essential for pharmaceutical companies to invest in high-risk R&D, must not be eroded and instead should enable partnerships on voluntary and mutually agreed terms, in a way that draws on the expertise and networks of each company.”

‘US is not indispensible’

Public Citizen Access to Medicines Director Peter Maybarduk said that “WHO member states chose health and justice today, despite RFK’s cheap insult, the reckless US withdrawal and Trump’s deadly neglect of infectious disease threats.

“The world moved forward without the US today. Trump’s devastating cuts cast a shadow on the talks, and are on course to cost millions of lives, including the lives of Americans made more vulnerable to infectious disease,” said Maybarduk. “Still, countries came together amidst scarcity to commit themselves to a more just and healthy world, and that is worth celebrating.”

Matthew Kavanagh, director of Georgetown University’s Center for Global Health Policy and Politics, said that the US “did not show up for the final negotiations but it turns out the US is not indispensable and, in fact, perhaps not having the US engaged is what enabled more cooperation.”
“With the current administration seemingly intent on dismantling global public health efforts, it may be the best case scenario if the rest of the world can come together. In that way, this new agreement is a spot of light in and otherwise dark geopolitical environment for fighting pandemics,” Kavanagh told Health Policy Watch.

Image Credits: WHO.

“WHO under pressure from China, suppressed reports at critical junctures, of human-to-human transmission,” Robert F Kennedy Jr in an address to the World Health Assembly Tuesday

In a surprise appearance Tuesday before WHO member states via pre-recorded video, new US Health and Human Services Secretary Robert F Kennedy Jr extended a kind of olive branch to the World Health Organization, calling for “a new era of international health cooperation, free from political influence and corporate bias.”

While Kennedy did not say that the US would rejoin the organization after announcing it would withdraw in January, he seemed to hold that out as a possibility, if WHO were to reform. But he also suggested that the US might lead the creation of “new institutions” should that effort fail.  

And he lashed out at the just-approved WHO pandemic agreement, something most member states view as a huge achievement, calling it an accord that would “lock in all of the dysfunctions of the WHO [COVID] pandemic response” – without explaining why or how. 

“We want to free international health cooperation from the straitjacket of political interference by corrupting influences of the pharmaceutical companies from adversarial nations and their NGO proxies,” Kennedy told Tuesday’s World Health Assembly, adding: 

“I would like to take this opportunity to invite my fellow health ministers around the world into a new era of cooperation. 

“Let’s create new institutions or revisit existing institutions that are lean, efficient, transparent and accountable, whether it’s an emergency outbreak of an infectious disease or the pervasive rot of chronic conditions that have been overtaking not just America but the whole world, we’re ready to work with you.”

Like many legacy institutions, WHO “has become mired in bureaucratic bloat, entrenched paradigms, conflicts of interest and international power politics, while the United States has provided the lion’s share of the organization’s funding,” Kennedy charged, while paying homage to most WHO staff as “conscientious people who believe in what they are doing.”

Revives charges against China over COVID pandemic 

China’s delegate lodges strong protest about Kennedy’s statements on the COVID pandemic, just after his remarks.

Kennedy also slammed China, saying that the country had “exerted undue influence over its [WHO] operations in ways that serve their own interests and not particularly the interests of the global public.

“This all became obvious during the COVID pandemic, when the WHO under pressure from China, suppressed reports at critical junctures, of human-to-human transmission, and then worked with China to promote the fiction that COVID originated from bats or penguins, rather than from a Chinese government sponsored research at a biolab in Wuhan.”

“Not only has the WHO capitulated to political pressure from China. It’s also failed to maintain an organization characterized by transparency and fair governance by and for its member states. The WHO often acts like it has forgotten that its members must remain accountable to their own citizens and not to transnational or corporate interests,” Kennedy said.

The US Health Secretary’s remarks brought a sharp cry of protest from China, who called for a point of order just after the remarks.

“Cease smearing and shifting blame onto other countries,” said China’s delegate, charging that the US, as well, failed to “proactively share data on its early suspected [COVID] cases” with the World Health Organization.

Unsettled questions over COVID-19 virus origins and WHO response in early days

WHA plenary Tuesday morning where historic Pandemic Agreement was approved.

While the US sits out this year’s WHA, China has sent its largest delegation ever of more than 180 people. Beijing is also increasing its funding to WHO by $100 million a year, over the next five years, Vice-Premier Liu Guozhong said at Tuesday morning’s plenary.

That represents a huge new commitment from Beijing – although it was not immediately clear if the $100 million-a-year pledge includes the $50 million annual increase in assessed contributions that would be levied on Beijing in 2026-27 as part of a step-wise increase in member state fees, that is up for approval at this WHA.

As for the origins of the virus that sparked the COVID-19 pandemic, the question of whether the highly transmissible form of the virus, SARS CoV2, escaped in a lap leak from the Wuhan Institute of Virology‘s which was studying the virus in bats, or spread from an infected animal through the teeming live animal market in the same city has been hotly debated by scientists the world over, but never definitely decided.

Wuhan’s Huanan seafood market that was closed in early 2020 after one of the first clusters of COVID-19 cases were detected there.

There’s no question, however, that the outcomes of the initial WHO fact-finding mission to Wuhan in 2021, were hotly criticized as orchestrated by Beijing. Following that,  China prevented a second WHO mission from returning again to conduct more detailed follow-up surveys and field research that could have helped answer the question more definitively.

Independent of China, WHO was also later criticized by other member states as well as independent experts for failing to call out earlier in 2020 patterns of person-to-person virus transmission, or a few months later, to confirm that SARS-CoV2 was airborne and recommend masks as a public health measure.

Calls WHO treaty an extension of COVID-era mistakes

Kennedy also slammed the just-approved WHO pandemic agreement, which was hailed as a crowning achievement of the global health agency and multilateralism by dozens of member states in remarks yesterday and earlier today. See related story:

Presidents and Prime Ministers Celebrate the Passing of the Pandemic Agreement 

“Global cooperation on health is still critically important to President Trump and myself, but it isn’t working very well under the WHO, as the failures of the COVID era demonstrate,” Kennedy said, adding that, “the “WHO has not even come to terms with its failures during COVID, let alone made significant reforms.

“Instead, it has doubled down with the pandemic agreement, which will lock in all of the dysfunctions of the WHO pandemic response.

“We’re not going to participate in that,” Kennedy asserted, repeating a US position adopted by the new administration of Donald Trump in January – which framed the new agreement as an infringement on sovereignty, a charge robustly denied by WHO and other participating member states.

Kennedy also slammed WHO’s priorities as “increasingly reflecting the biases and interests of corporate medicine” and letting “harmful gender ideology” hijack its core mission.

“Too often… it has become the tool of politics and turned its back on promoting health and health security,” the Health Secretary charged.

Shifting priorities to address chronic diseases

obesity
Obesity epidemic has spread worldwide. Shopping for sugary drinks in Bothlokong, South Africa.

Kennedy pointed to the US plans to shift its national health focus to the epidemic of chronic diseases, as a way forward, and he invited global health leaders to follow a similar course:

“We need to reboot the whole system, as we are doing the United States,” he said, saying that the nation was “fundamentally shifting the priorities of our health agencies to focus on chronic diseases.

“It’s the chronic disease epidemic that is sickening our people and bankrupting our health care system. We’re now pivoting to make our health care system more responsive to this reality. We’re going to make health care in the United States serve the needs of the public instead of industry profit-taking. We’re removing food dyes and other harmful additives from our food supply. We’re investigating the causes of autism and other chronic diseases. We’re seeking to reduce consumption of ultra processed foods, and we’re going to support lifestyle changes that will bolster the immune systems and transform the health of our people.

“Few of these efforts lend themselves easily to profits or serve established special interests. These changes can only occur through the kind of systemic overhaul that President Trump has brought to our country. We’d like to see a similar reordering of priorities on the global stage.”

But infectious diseases also need to remain a priority

Witkoppen Clinic’s HIV services in Gauteng were among many in South Africa that were financed by the US PEPFAR programme, with funds distributed via USAID – prior to the dismantling of both agencies.

At the same time, he acknowledged that infectious disease “and pandemic preparedness,” need to remain national and global priorities. He did not explain how pandemic preparedness could be improved or advanced without global consensus around an accord such as the new Pandemic Agreement.

“Indeed the WHO has, since its inception, accomplished important work, including the eradication of smallpox,” Kennedy stated. “With the leadership of the United States and funding from our country over the past 25 years, millions of global citizens have seen a reduction in premature death due to HIV, TB and malaria,” he added without any reference to the drastic Trump Administration reductions in funding for programmes like the President’s Emergency Plan for AIDS Relief (PEPFAR) as well as the shuttering of the US Agency for International Development, which were responsible for those achievements.

“Let’s return to the core focus of global health and global health security, back to reducing infectious disease burden and the spread of diseases of pandemic potential,” Kennedy said. “I urge the world’s health ministers and the WHO to take our withdrawal from the organization as a wake up call.”

Image Credits: Deutsche Welle, Witkoppen Clinic.

Digital blood pressure monitoring devices have now become widely available

The pace of technological change today is nothing short of revolutionary, according to Dr Douglas Bettcher, Senior Advisor in the Director-General’s Office at the World Health Organization (WHO).

“I think we find ourselves very strangely in the last couple of years, in what seems to be a really brave new world, brave new reality,” he told attendees at Monday’s Global Self-Care Federation (GSCF) event, which focused on how digital innovations could help prevent and manage noncommunicable diseases (NCDs).

“A case can be made that this communications revolution is even greater and more mind-boggling than what we’ve seen in the past,” Bettcher continued. “Even some pundits in the know compare this to the 19th-century industrial revolution. And what must be clear to us, being confronted with these very, very rapid changes, is that we in the public health community cannot be left standing during this digital innovation, this mass revolution.”

Bettcher, who discussed WHO’s Be He@lthy, Be Mobile (BHBM) program, stressed that the train has already left the station. Industries that harm health are already leveraging artificial intelligence and related technologies. Now, he said, it’s time for those working to improve health to use them too.

The Monday event—hosted as a side event of the 78th World Health Assembly—was a collaboration between GSCF, WHO, and the International Telecommunication Union (ITU). Titled “Empowering Self-Care: Digital Innovations for NCD Prevention and Management,” it highlighted the vital role of self-care and digital technology in tackling NCDs, emphasizing cross-sector collaboration.

Keynote addresses were given by H.E. Honourable Tuafafa Latasi, a member of the Tuvalu parliament, and Dr Dympna Kavanagh, the Chief Dental Officer of Ireland’s Department of Health.

“Digital innovation has the power to transform healthcare and how we look after ourselves,” said moderator Shiulie Ghosh. “That is the role of digital innovation in preventing and managing some of the biggest causes of death across the globe.”

She emphasized that digital tools can improve access to self-care and empower individuals living with NCDs to monitor and manage their conditions effectively.

GSCF Director-General Greg Perry added, “We are at a pivotal moment in NCDs,” referring to WHO’s release last week of the zero draft of the political declaration on NCDs and mental health. The draft was published in preparation for the upcoming High-Level Meeting on September 25.

Greg Perry (center)
Greg Perry (center)

The declaration outlines proposed global targets for 2030:

  • 150 million fewer people using tobacco
  • 150 million more people managing their hypertension
  • 150 million more people gaining access to mental health care

The 10-page draft includes a set of five sub-targets, offering a roadmap for reaching these ambitious goals.

“Digital tools can play a very, very important part,” Perry told the audience. “When we talk about self-care, we’re not just about keeping fit, eating correctly, or even brushing our teeth. We’re talking about the necessary tools for people to self-care.”

These tools may include medicines and digital applications from the industry’s perspective.

“If you add AI and digital applications together with the current and future self-care tools that are available and will be available, we are on the verge of almost a self-care revolution,” Perry said. “These [tools] will be accessible, they’ll be self-managed, and they will have a very high impact.”

Making digital self-care tools useful and trusted

One key challenge with emerging digital self-care tools is the lack of guidance on how to incorporate them into people’s daily lives.

Luis Lourenço of the International Pharmaceutical Federation noted that pharmacists are often the first point of contact when individuals seek advice or support related to digital tools.

“When you talk about the impact of digital tools on primary health care, you can focus on four major areas: prevention, health literacy, diagnosis, and the management of a chronic disease,” Lourenço said.

He added that health literacy is often one of the most complicated aspects.

While having access to information is essential, Lourenço emphasized that it’s not enough. People also need to understand the information and apply it in their routines.

“What’s the point of having information about your blood pressure if you don’t understand what it means or when to incorporate it?” he asked. “What we have today is a lot of access to information, but people rely a lot, mostly on their healthcare partners, healthcare professionals, and pharmacists.”

Without that support, he said, people may have information but not know how to use it effectively.

Lourenço also pointed out that people want to be sure the tools they use are evidence-based and trustworthy.

However, Debbie Rogers, CEO of Reach Digital Health, offered a slightly different perspective, suggesting that if digital tools provide enough value, people will ultimately trust them.

Addressing accessibility, accountability, and inclusion

Another key challenge is user hesitation, particularly among specific populations, about whether they want to use digital tools at all.

“On one hand, we have developed countries. We have higher literacy levels. We have digital-savvy sort of people,” explained Hussain Jafri of the World Patient Alliance. “They are using [digital tools] and giving us very good results. But then you look at the other populations—at the lower- and middle-income countries and the elderly population, the people who are not tech-savvy. They are not really using them.”

Jafri shared that he once downloaded an app designed for people with pre-diabetes but found it too complicated and deleted it after only a few days.

Experts said encouraging adoption also depends on better integration of these tools into healthcare systems, where people feel accountable for the data they enter.

Lourenço noted that if patients knew their doctors were reviewing the data collected in an app, it would likely motivate them to use the tool more consistently.

Jafri stressed that companies developing digital health technologies must involve users, patients, and providers early in the design process, rather than waiting until products are already on the market.

“I think they also need to take into account our input—the input of the people who are going to use [the tools] should also be there while they’re developing these products, so that, you know, once it is out there, people are happy using it,” he said.

Language accessibility is another barrier. Jafri emphasized the importance of localization.

“These [tools] need to be in multiple languages, not just English,” he said, adding that companies should also provide training for providers and patients to ensure successful adoption.

Empowering mothers through technology: South African case study

A pregnant woman in Africa (illustrative)

There are already promising examples of how digital health tools are making a difference, as illustrated by Rogers of Reach Digital Health. She shared a case from South Africa, where hypertension during pregnancy is one of the leading causes of maternal mortality.

“We have a program called MomConnect, where every mother who comes into the clinic can sign up to receive messaging throughout her pregnancy and until her baby is two years old,” Rogers explained. The mothers receive both information and behavior-change tips. They can also ask questions and provide feedback to the system.

Because hypertension is such a critical issue, the National Department of Health wanted to better understand the root causes. They started by asking mothers about their experience during their first antenatal visit: Did they have their blood pressure taken? Were they told what the results were? If so, were they prescribed the appropriate medication?

“It was important to understand that patient journey, understand where the challenges were, and to do this at a national scale,” Rogers said.

Based on the insights gathered, the department introduced targeted training for healthcare workers. This effort helped drive increased demand for quality care from the patients themselves.

“We got mothers to go back to their clinic and say, ‘You didn’t take my blood pressure last time. I want you to take my blood pressure,’ or ‘you didn’t put me on the right medication.'”

Rogers concluded that this initiative “shows the power of being able to empower people, both with information and behavior change, communication knowledge, so they knew what they had to ask for and what they were looking out for.”

Carl Massonneau, Technical Officer for Sexual and Reproductive Health and Research for the WHO, speaking from the audience, explained that another tool recently released by the World Health Organization is the Digital Adaptation Kit for Antenatal Care. The kit translates WHO recommendations into machine-readable formats, making integrating them into digital health systems easier.

Carl Masano of the WHO
Carl Massonneau of the WHO

One specific feature of the kit is a tool for self-monitoring blood pressure among pregnant women diagnosed with hypertensive disorders. That tool will be released next week.

“It’s the first time we’re putting a step in this world and trying to provide standards to improve the quality of digital health interventions we have,” Massonneau said.

He acknowledged that although a growing number of digital technologies are available, there are still major challenges in ensuring they are evidence-based, equitable, and accessible.

Integrating Digital Tools Into Broader NCD Strategies

As the conversation around digital health tools evolves, experts caution that no single solution will address the full complexity of noncommunicable diseases.

Lourenço noted that while some aspects of NCDs fall under primary prevention, where individuals can be empowered to make healthier choices, others require more structured support. He said that strategic outreach, including digital media, can help move people from “pre-contemplation to contemplation,” encouraging them to recognize risks, develop motivation, and ultimately commit to change.

However, he emphasized that many behaviors tied to NCDs cannot be addressed through self-care alone. These require ongoing guidance and system-level support. Effective management, Lourenço said, demands full integration within a broader framework—” at the policy level, at the health system level, [and] at the community level.”

In this context, digital innovation is not a silver bullet but a key part of a larger ecosystem—one that must be built with intentional design, inclusive access, and cross-sector collaboration to truly transform outcomes in global health.

Image Credits: Marco Verch/Flickr , Provided by Global Self-Care Foundation, Elizabeth Poll/MMV, Elaine Fletcher.

 

Countries indicating their wish to speak about the pandemic agreement in Committee A

An enormous list of World Health Organization (WHO) member states, 173 in all, lined up to speak in favour of the pandemic agreement at the World Health Assembly (WHA) on Monday – an extraordinary demonstration of the breadth of support for the document.

By the end yesterday’s meeting of Committee A, member states passed the pandemic agreement resolution by vote not consensus – at the insistence of Slovakia – with 124 in favour, zero objections, and 11 abstentions. The WHA plenary is due to consider the resolution on Tuesday.

But between the cheers were reminders that the talks are not yet done. An annex still needs to be negotiated to establish the mechanisms for a pathogen access and benefit-sharing (PABS) system – the most controversial aspect of the three-year talks.

The PABS system will develop a mechanism for how countries that share information about pathogens with pandemic potential may benefit if pharmaceutical products are developed as a result.

“As a country that has shared its pathogens, often without equitable returns, the PABS system is paramount in rectifying these imbalances and ensuring the realisation of genuine equity and equitable access,” said South African Health Minister Aaron Motsoaledi, speaking for the Africa region in Committee A, where the document was being discussed.

The Africa region sees the target of 20% of pandemic products being reserved for the WHO for distribution to low- and middle-income countries (LMICs) by manufacturers participating in PABS, with at least 10% as a donation, during future pandemics, as a “positive first step”, added Motsoaledi.

Speaker after speaker urged countries to maintain their political commitment to the PABS negotiations and reach an agreement on the annex before next year’s WHA.

Even Hungary, a staunch ally of United States President Donald Trump, welcomed the agreement – and stressed that it did not infringe on countries’ sovereignty, a key claim of disinformation about the pandemic.

Trump distanced the US from the pandemic agreement at the outset of his presidency in January, and many of his MAGA supporters claim it is a “power grab” by the WHO.

Iran and Paraguay said they could not support the current pandemic agreement draft – reserving support until after the PABS negotiations. Meanwhile, Slovakia, which is led by Prime Minister Robert Fico who has spoken out against COVID-19 vaccines, demanded that the agreement be put to a vote during the committee session.

Delegates at WHA’s Committee A after it adopted the pandemic agreeemnt by vote

First ‘One Health’ agreement

Germany said it “would have welcomed stronger provisions, particularly regarding prevention,” but “recognise this agreement as a critical and timely step toward global solidarity and multilateralism”. 

“We urge all member states to engage in the upcoming annex negotiations with the same political will and unity that have brought us this far. Let us continue to invest in international cooperation and global solidarity, not only to protect our citizens, but also to lay the groundwork that future generations can benefit from,” said Germany.

Switzerland, which has sought to protect its pharmaceutical sector during talks, said it supports “a pragmatic, voluntary approach within existing frameworks, that take into account the advice and contributions from experts”. 

The European Union said that the agreement “marks an important accomplishment for global health security and cooperation” and “can bolster country capacities to prevent and prepare for pandemics using the One Health approach”.

Ireland added that “the commitment to [pandemic] prevention through a One Health approach is the first of its kind to recognise the interconnectedness of human, animal and environmental health in our response to emerging health trends”. 

“The establishment of a global supply chain and logistics network and a pathogen access and benefit sharing system will ensure that the response to future health threats will be faster, more effective and more equitable,” it added. 

China said the agreement “will contribute to the fair distribution of health products, relevant technologies and resources to help developing countries enhance their capacities for prevention, preparedness and response” – but that it needed “some follow-up mechanisms, as well as sustained investment and capacity building efforts from all countries” to be effective. 

Kazakhstan said that “this is not just a global legal document. It is our collective response to a future where everybody will be protected, regardless of their economic position or status. We must underscore that the success outcome will be defined not only by its content, but also by its ability the state’s ability to implement it.”

Jamaica, speaking for 22 countries in the Americas and Caribbean (excluding the USA), said the region was ready to do the work to finish the pandemic agreement.

“We remember too vividly the oxygen shortages, the overwhelmed hospitals and healthcare workers, and over seven million lives lost during the COVID-19 pandemic,” said Jamaica. “For the Americas,  this agreement means stronger commitments to regional manufacturing capacity, coordinated surveillance, research and development and transfer of technology, especially for developing countries.”

‘The worst of times’

INB co-chairs Anne-Claire Amprou and Precious Matsoso

Co-chairs of the Intergovernmental Negotiating Body (INB), South Africa’s Precious Matsoso and French Ambassador for Global Health Anne-Claire Amprou, also addressed the session, expressing appreciation to member states for their commitment.

Matsoso reminded the WHA that the special assembly called to establish the INB was convened “at a time when we all wore masks, we practised social distancing, and we had face-to-face meetings that were highly restricted”. 

“It was the worst of times, the season of despair, of tragic losses, immeasurable devastation – all associated with COVID-19,” said Matsoso.

She praised delegates for working through “13 formal rounds of negotiations, many of them extended, producing various iterations of draft pandemic agreement and proposals that have culminated into what we have before us as a consensus draft”.

Amprou, who took over as co-chair from Roland Driece of the Netherlands in July 2024, said that the process involved “three years of dialogue, of compromise, of debates, of sleepless nights, but above all, three years guided by a common conviction that health is a common good”.

“The COVID-19 pandemic was a shock for us all. It was a brutal reminder of the fact that viruses know no borders. No country, however powerful, can address a global health crisis on its own,” said Amprou.

Meanwhile, former co-chair Driece spoke for the Netherlands, expressed his appreciation that the long process had resulted in an agreement.

 

Image Credits: WHO.

The World Health Organization (WHO) is confronting an unprecedented financial crisis.

The World Health Organization (WHO) is confronting an unprecedented financial crisis, with a projected shortfall of $2.5 billion for the 2025–2027 period. In his official remarks to the Programme, Budget and Administration Committee (PBAC) on 14 May 2025, WHO Director-General Dr Tedros Adhanom Ghebreyesus stated that the Organization may be forced to close certain country offices as a cost-saving measure, a signal of just how serious the current funding crisis has become.

In addition, senior WHO officials have also spoken recently about the possibility of moving more key WHO functions and staff from Geneva headquarters to WHO regional or country offices, both as a cost-saving measure and to be more responsive to needs at the grassroots.  So a closer look at WHO’s country office structure is important to evaluate if, how, and in what way such shifts might make sense programmatically as well as economically.

110 WHO country offices – dispersed in countries rich and poor

WHO currently operates 110 country and territorial offices globally. Among these, at least 11 high-income countries (HICs) host full-fledged WHO country or liaison offices, such as Cyprus, Greece, Chile, Uruguay, and Panama, as well as several Eastern European states.

In addition to these formal offices, WHO also maintains technical hubs, project offices, or collaborating centres in other high-income settings, including Denmark, France, Germany, Italy, Japan, South Korea, the United Kingdom, and the United States, in addition to its headquarters in Geneva, Switzerland.

Taken together, this amounts to 17 WHO institutional outposts in HICs, when counting both full-fledged country offices and other technical or liaison presences.

In addition, WHO has 36 offices in upper-middle-income countries (UMICs), such as Argentina, Brazil, China, Indonesia, Mexico, South Africa, and Turkey.

The health body has offices in 57 lower-middle-income countries (LMICs), including India, Bangladesh, Kenya, Nigeria and Nepal, according to publicly available data on WHO’s country presence portal and World Bank income classifications. Many of the latter are large-scale operations that play critical roles in strengthening national health systems.

Traditionally, countries host WHO offices through basic legal agreements, which grant privileges but rarely entail financial responsibilities. In practice, WHO is usually left to fully fund its own in-country presence.

Particularly for high-income countries, this is no longer sustainable in light of the current budget crisis. And even in the case of middle-income countries, an argument can be made for recruiting more national support to WHO country offices, especially when many host governments, some with substantial fiscal capacity, leave large portions of their national health budgets unspent each year.

Hundreds of young tuberculosis advocates participate in a WalkTheTalk rally in Kathmandu to commemorate World TB Day, organized by the National Tuberculosis Control Center, Ministry of Health and Population–Nepal, and WHO Country Office for Nepal.

When Contributions Fund the Contributor: The HIC Paradox

In high-income countries (HICs), the conversation around WHO country office sustainability should begin not with unspent national health budgets, which are closely monitored nationally, but with a sharper look at how much of the country’s assessed contribution to WHO is being consumed by maintaining their own WHO office.

While data on country office costs are not always available, an analysis of selected offices, in comparison with available data, suggests that some HICs hosting WHO country offices are effectively seeing a significant share of their own assessed contributions to WHO consumed in maintaining those offices.

This raises questions about equity and strategic allocation of WHO resources in a time of budget constraints.

For example, this analysis found that of five HIC countries considered, all had country offices financed by the equivalent of half or more of their assessed contributions. In the case of Cyprus and Panama, most of the assessed contribution was spent, effectively, on the country office.

Note: Country office cost figures referenced in this article are conservative estimates based on publicly available data from WHO’s Programme Budget Portal (2024–2025), the Proposed Programme Budget (A76/4), and WHO’s official summary table of Assessed Contributions Payable by Member States and Associate Members in 2024–2025. As WHO does not publish disaggregated office-level expenditures, proportional estimates were calculated using regional budget allocations and typical country office structures, adjusted by office type, regional context, and known staffing patterns. Source: WHO Assessed Contributions (2024–2025); WHO Voluntary Contributions – Specified; WHO Programme Budget Portal.

While exact breakdowns of country office costs remain limited due to confidentiality or aggregated budget reporting, it appears that at least in some countries, a considerable portion of HIC contributions to WHO may be locally absorbed in cases where country offices are maintained – limiting the net benefit to global health of country contributions.

In these contexts, a paradox emerges: a portion of these countries’ assessed contributions, meant to support global health efforts, is effectively recycled to maintain WHO’s presence in their own territory. This raises legitimate questions about cost-efficiency and fairness, particularly when lower-income countries face operational cuts to WHO support that is often vital to their national health systems.

The paradox of unspent national budgets and an underfunded WHO

A similar, though more complex, case can be made for certain upper-middle-income countries (UMICs)—such as Mexico, Brazil, or China—which have increasing fiscal capacity, growing health budgets, and an ability to co-finance WHO presence.

While in the case of MICs, it could be argued that host governments simply can’t afford to support WHO country offices, in light of their own significant public health needs, data from WHO’s Programme Budget Portal and the World Bank provides a somewhat different narrative.

That data reveals that quite a few UMIC and LMIC host governments consistently leave large portions of their health budgets unspent – even while WHO country offices in those same countries face curtailed operations due to the budget crisis.

Unspent National Health Budgets (%) by Country

This paradox becomes even more striking when comparing these unspent funds with WHO’s modest operating budgets in those countries.

Unspent Health Budget vs WHO Country Office Budget by Country

Note: Fiscal calendars and reporting periods vary by country, causing comparability limitations. While the symbolic bar segments in the figure visually represent office costs, they are not to exact scale.

This comparison, based on budget figures, shows that in countries like Brazil, Egypt, and Mexico, WHO’s country office budget accounts for less than 5% of their unspent national health budgets, demonstrating potential fiscal space to fully support WHO’s presence.

Even in more financially strained countries, such as Pakistan or Kenya, WHO’s needs represent only a modest share of what goes unused.

Why a new cost-sharing model is urgent and fair

These findings underscore the importance of considering a new cost-sharing model for WHO’s country office presence – one that looks transparently at costs versus ability to pay and ensures all countries, especially those with fiscal space, contribute to WHO not just as hosts, but as true global stewards.

It also underscores the need, as the WHO Director General has rightly asserted, to reassess whether WHO presence in HICs is cost-efficient and programmatically justified when compared with needs in lower-income settings.

But rather than arbitrary office closures, a transparent assessment should first be undertaken to evaluate:

  • How much each HIC’s country office cost relative to its assessed contribution?
  • What is the critical regional or global health mission of the WHO country offices located in HICs, and could funds spent there be more effectively used to support countries with urgent health capacity gaps?
  • In the case of UMICs, and some LMICs, what is the fiscal space, based on unspent health expenditures or other indicators for exploring cost-sharing arrangements?

Other UN agencies have embraced cost-sharing frameworks

Other UN agencies have already embraced cost-sharing frameworks with host countries.

For example, in 2023, UNICEF required 23 UMIC host countries to cover 30–100% of their office operational costs, including Brazil and Mexico contributing 40% toward local staff salaries. In Turkey, the government financed 40% of UNICEF’s Syrian refugee health response (UNICEF Executive Board Report, 2023).

WHO has lagged behind in this regard. While WHO Member States have committed to incrementally increasing assessed contributions to cover 50% of the organization’s core budget by 2030, progress has been slow. WHO Director-General Dr. Tedros Adhanom Ghebreyesus has publicly stated that “WHO cannot fund itself to perform its mandate,” and has called for sustainable financing.

The time has come for a clear, equal cost-sharing model across all income groups based on the principle that every host country, whether HIC, UMIC, or LMIC, should contribute to WHO’s operating costs, based on its capacity.

High- and upper-middle-income countries should provide full or majority financial support to country offices based there. Lower-middle-income countries may contribute partially, in-kind, or through shared infrastructure support.

Countries that host WHO offices, especially those with significant unspent health funds, should consider that supporting WHO’s presence is not a budgetary burden, but a strategic investment in global and national health security. The alternative is an organization diminished in reach and relevance, unable to operate effectively where it’s needed most.

This model reflects a principle of shared responsibility, while still recognizing economic diversity. Countries like India, South Africa, Thailand, and Mexico, each with substantial national health budgets, regional leadership roles, and established WHO country offices, are well-positioned to illustrate how contributions from LMICs and UMICs can be both feasible and impactful.

No health without sustainable finance

WHO’s country offices have played indispensable roles, from controlling pandemics and delivering vaccines to strengthening primary health systems and guiding policy.

The HPV vaccination campaign reaches Mustang district in the Himalayas, bringing life-saving vaccines to girls aged 10–14.

But the idea that WHO alone should shoulder the financial burden of country offices from its central budget allocations is outdated.

As the 78th World Health Assembly (WHA) opens in May 2025, Member States have an opportunity to consider this issue, the status quo, and potential alternatives, including a capacity-based cost-sharing model.

Any discussion of the division of budget responsibility should also be accompanied by a review of accountability mechanisms. Basic agreements between WHO and host countries must ensure that country offices retain their independence, not always a given even today. WHO country offices should be funded and empowered to act on behalf of the Secretariat, in response to country needs, while maintaining their distinct institutional mandate.

With the pending WHO reorganization and the likely relocation of certain HQ functions to the country or regional level, it’s a timely moment to take a closer look at how country offices are budgeted, governed, and empowered. Their future, as one of WHO’s core pillars of delivery, will depend not only on technical necessity but on whether Member States are willing to back that presence with a financing model grounded in both equity and economic realism.

Pragyan Ghale

Pragyan Ghale is a global health policy consultant, affiliated with the  Public Health and Infectious Diseases Research Center (PHIDReC), Nepal. He holds a master’s degree in Global Health Policy from the London School of Economics and Political Science (LSE). 

Image Credits: WHO Nepal / Facebook post, WHO Assessed Contributions (2024–2025); WHO Voluntary Contributions – Specified; WHO Programme Budget Portal., Photo credit: WHO Nepal / Facebook post.

Dr Tedros addresses the 78th WHA

The World Health Organization (WHO) faces “significant challenges” amid “significant achievements”, characterised by a 21% budget cut alongside the imminent adoption of a pandemic agreement, Director-General Dr Tedros Adhanom Ghebreyesus told the opening of the World Health Assembly on Monday.

Tedros appealed to member states to support its “extremely modest” budget, reduced from $5.3 billion to $4.2 billion for the 2026-2027 biennium as a result of the United States’ withdrawal from the global body.

But this modest amount isn’t even in the bank yet.  It relies on member states agreeing to increase membership fees and receiving more donations via the WHO’s next Investment Round to be held in Geneva on Tuesday.

“Assuming you approve the increased assessed contributions [membership fees], and thanks to the investment round, we’re confident that we have already secured more than $2.6 billion of the funding for the next biennium. That leaves an anticipated budget gap of more than $1.7 billion,” said Tedros.

He added that raising that amount in the current landscape would be a challenge but described the figure – $2.1 billion a year – as “extremely modest” for an organisation “working on the ground in 150 countries with the vast mission and mandate that member states have given us”.

“$2.1 billion is the equivalent of global military expenditure every eight hours,” said Tedros, and “a quarter of what the tobacco industry spends on advertising and promotion every single year”. 

The 78th WHA opened in Geneva on Monday.

Reducing costs has led to a reformulation of the organisation and with significant staff layoffs ahead.

The WHA gave a round of applause to outgoing executive team members Dr Mike Ryan, Dr Samira Asma, Dr Bruce Aylward, Dr Catharina Boehme, Dr Li Ailan and Dr Jerome Salomon, who will be leaving the WHO as part of this process.

“A reduced workforce means a reduced scope of work. The organisation simply cannot do everything member states have asked it to do with the resources available,” he added.

Steep bilateral aid cuts

However, the dismantling of the US Agency for International Development (USAID) and deep cuts to the US President’s Emergency Plan for AIDS Relief (PEPFAR) have strained the finances of many member states, some of which may not be in a position to increase their contributions to WHO.

“Many Ministers have told me that sudden and steep cuts to bilateral aid are causing severe disruption in their countries and imperilling the health of millions of people,” Teros acknowledged.

“In at least 70 countries, patients are missing out on treatments. Health facilities have closed, health workers have lost their jobs, and people face increased out-of-pocket health spending.

“Although this is a challenge, many countries also see this as an opportunity to leave behind an era of aid dependency and accelerate the transition to sustainable self-reliance based on domestic resources.”

But at the same time, several countries were doubling and tripling their defence spending, spending “vast sums protecting themselves against attacks from other countries, but relatively little on protecting themselves from an invisible enemy that can cause far more havoc and damage,” said Tedros, pointing out that COVID-19 killed an estimated 20 million people.

Key achievements

Tedros described the pandemic agreement as a “historic moment” amid “significant opposition”.

In the past year, the WHO coordinated the response to 51 graded emergencies in 89 countries including “outbreaks, natural disasters, conflicts and more”.

It delivered urgently needed specialist medical supplies worth $196 million to 80 countries, supporting countries to address cholera, Marburg and Ebola.

WHO is poised to resume aid to Gaza as soon as Israel lifts its blockade, said Tedros, who  appealed to member states to assist the more than 10,000 patients who need medical evacuation out of Gaza. 

“War is not the solution. Peace and political solutions are the solution,” he stressed.

Tedros stressed that the WHO’s “increased focus on science, data and digital health” is “the future of the organisation”.

“WHO’s normative standard-setting work is its bread and butter, and we have streamlined processes to give member states the highest quality, evidence-based advice as fast as possible,” said Tedros. “Last year, there were 65 million downloads of WHO publications, guidance and other materials.”

Swiss support

Welcoming delegates to Geneva, Swiss Federal Council member Élisabeth Baume-Schneider stressed that her country was committed to supporting the WHO, and would contribute $80 million to the organisation over the next four years.

“The WHO is the only real global platform for cooperation on health matters which has legitimacy, respect and can do the job,” said Schneider.

“It is the only international organisation dealing with health which is run by its member states, and that means shared responsibility… We, as her member states, need to demonstrate that we are ready to reconsider our relationship with the organisation and ensure that we offer our full support.”

WHA president, Dr Teodoro Herbosa of Philippines, urged the assembly to be focused on “unity not unilateralism, solidarity not isolation”.

US and Chinese flags side by side; the US may sit out this year’s World Health Assembly while China sends over 180 delegates to Geneva.

The United States appears set to skip this year’s World Health Assembly at a historic moment when other WHO member states are expected to agree to a Pandemic Agreement, that has been nearly three years in the making.

A provisional list of WHA delegates, published late Sunday night by WHO, included no reference at all to a US delegation.  

China, meanwhile, will be sending what may be their largest-ever contingent to the assembly, which runs from 19-27 May. The list of China’s 180-plus delegates includes not only dozens of senior and mid-level experts from Ministry of Health and Centers for Disease Control, but also leading academics and experts from universities across the country.  

Former WHO Legal Counsel Gian Luca Burci drew the contrast at a WHA preview session Sunday, co-hosted by the Geneva Graduate Institute’s Global Health Centre and the United Nations (UN) Foundation. 

Geneva Graduate Institute legal expert Gian Luca Burci, a former WHO chief legal counsel.

“It would be the first WHA since 1948 without the USA,” he said, if there is no last-minute reversal in position. Meanwhile, the dispatch of such a large Chinese delegation to Geneva is not only a display of global health prowess but “a big logistic achievement,” Burci said, “although apparently China always has a huge delegation because they want to cover everything going on at WHA, including side events.” 

The US Mission did not respond to Health Policy Watch queries about whether it would indeed skip the event. Even after US President Trump’s January announcement that he was withdrawing from WHO, a small US delegation attended WHO’s Executive Board meeting in February, although they remained largely on the sidelines, making only one or two statements. 

Legally, the US withdrawal only becomes effective in January 2026, although the Trump administration has not paid the $260 million in WHO membership fees for 2024-2025 – and there are no signs it intends to do so. 

Seventy-five items on packed agenda

Last year’s 77th session of World Health Assembly in May 2024 in Geneva, Switzerland.

Some 75 agenda items are to be considered by the WHA’s 194 member states during the marathon eight-day session.  They will range from the highly political, and now perennial debates, over Russia’s war in Ukraine, Israel’s war in Gaza, and a proposal to grant Taiwan observer status (over Chinese objections) – to policies and progress reports on dozens of diseases, health risks and the health workforce. The Assembly will also consider new strategies and action plans for climate and health, air pollution, antimicrobial resistance, and mental health, amongst others.  

Along with voting to approve the Pandemic Agreement, expected on Tuesday, member states also need to approve a new 2026-27 budget, which has been trimmed radically since the US, WHO’s largest donor, announced its withdrawal.  

The total budget envelope has been slashed from some $7.4 billion to $6.2 billion, in the wake of the funding crisis that ensued following the US retreat.  

WHO’s “base budget” (excluding $2 billion for polio eradication, health emergencies appeals and special programmes), has been pared from $5.3 to $4.2 billion – a move likely to mean a 20% reduction in WHO’s 9463 staff globally, according to initial WHO estimates. See related story:

WHO Budget Cuts May Slash 30% of Mid-Level Staff, Spare Most Senior Roles

Turn challenge to opportunity  

Against the somber spectre of layoffs and programme cancellations,  WHO Chief Scientist Jeremy Farrar told the Graduate Institute gathering that the global health agency and its supporters need to transform the current crisis at WHO, and in global health institutions more broadly, into an opportunity.

Farrar was recently named to head a new division of Health Promotion, Disease Prevention and Control, in a major WHO leadership shake-up that will see WHO’s 10 programme divisions at headquarters contract to just four, as the organization seeks to streamline and economize.

See related story:

BREAKING – WHO Director General Shakes Up Agency with Brand New Leadership Team

“I look forward to what I think is going to be very tough next six months, 12 months,” Farrar said.  “But organizations have to reform, they have to evolve, and they have to emerge stronger, and that’s not a corporate view. It’s not an institutional view. It’s a personal view.

“Unfortunately, very few organizations do that… But if you can’t do that, the next best time to reform is as soon as the pressure is on, and that is now.”

He said that the reforms underway now at WHO have involved “a very detailed bottom up exercise across the whole organization, countries, regions and headquarters, as to what is the real role of WHO? 

“And now we need to take that and add on to that strategic overlay with [what] member states have to say.”

WHO will emerge in 2026 smaller but better, says Chief Scientist Jeremy Farrar.

Consolidating WHO’s divisions could help eliminate duplication and competition between teams – allowing for a less vertical and more “horizontal” organization, Farrar argued.  

While the corporate pain may be enormous, he urged people to remember that the pain to low-income communities worldwide from abrupt cuts in funding for HIV drugs and testing, not to mention other vital health assistance programmes, has been far greater.  

“We shouldn’t just focus in a complacent way on how this is affecting those of us in WHO or in other UN agencies…. The impact of the country level is very profound. It will be more challenging than people think, and it will be more long term,” Farrar said. 

“If you think 20%-25% of colleagues lose their jobs, that’s extraordinarily difficult for any organization. It will be a human issue, not a technical issue, and we should never forget the human side of it. But we will emerge, I believe, in 2026 smaller, more focused, back to our core mandate, and I believe, better.” 

Increase in membership fees?   

From left to right: Germany’s Björn Kümmel; Global Health Center founder Ilona Kickbusch; Thailand’s Suwit Wibulpolprasert and UN Foundation’s Cecilia Mundaca Shah.

Against the dark budget horizon, there is one bright spot. Hopefully at this year’s WHA, the WHO member states will agree to raise their own assessed annual contributions by 20% for yet a second time over the past two budget cycles. 

But a positive WHA decision shouldn’t be taken as a given, warned Germany’s Björn Kümmel. The senior global health advisor in the German Health Ministry has been the leader of an longstanding initiative to raise member state fees, and thus put WHO on a more stable financial footing.

The negotiations finally led to a 2022 WHA agreement in principle to increase assessed contributions in a step-wise manner over a period of years, to a level equalling about 50% of WHO’s budget by 2030.  But the plan has to be reaffirmed at each new rung in the ladder.  

“We are keeping our fingers crossed that we will have a consensus on this in the assembly,” he said, of the pending increase. “But it’s not a given that it will happen.”

“The African countries, the European countries and many Asian countries are in favor, but there are also other countries who remain very quiet and who naturally do not want or have challenges in their domestic settings to argue in favor of a 20% AC [assessed contributions] increase.

“I think there’s still work to do, even during this assembly, to lobby,” he said, warning that if the increase is not approved, “WHO will be even in a deeper financial crisis.” 

WHO’s faltering investment round 

Brazil’s President Lula da Silva with WHO Director General Dr Tedros Adhanom Ghebreyesus at a WHO “Investment Round” pledging session on the margins of the G20 in Rio in November 2024. Neither Brazil nor other countries in the Americas have yet made pledges.

Member states in other middle- and even high-income regions also need to step up  to the bat with more voluntary donations to WHO’s new “investment round” mechanism, Kümmel said, noting that since the US departure, roughly 80-90% of voluntary funds for WHO is coming from Europe alone. 

“We have a complete imbalance between the membership of this organization and the financial contributions, and that will not be sustainable for the future,” he said. 

“Emerging economies need to come in. It’s completely unsustainable if a number of five, six or seven member states pays for us all,” Kümmel warned. 

“Plus, there is one region that doesn’t contribute at all to the financing of WHO,  at least through the investment round. And we need to say: why is that? How can we incentivize that region to do so, I don’t know.” 

According to the WHO list, the Americas is only region not to have made voluntary funding commitments to the investment round. Along with the USA, that region includes other high-income countries like Uruguay and Canada, as well as upper-middle-income Chile, Mexico and Brazil. Brazil even hosted a WHO funding event on the margins of November’s G20 Summit, in Rio but has made no pledges itself. 

At the same time, WHO’s Regional Office of the Americas/Pan American Health Organization (PAHO), is almost wholly funded by member states in Latin America and North America. And PAHO is reportedly facing its own funding challenges although the US has not technically withdrawn from the continental body, which it helped found over a century ago. 

Pandemic agreement: still a way to go even once its approved by WHA

Jubilant and exhausted WHO member state negotiators on 13 April, after marathon talks finally result in a draft pandemic agreement to submit to WHA.

As for the Pandemic Agreement, WHA approval of the instrument this week will not be the final stop. Another round of negotiations on an annex that would develop e pathogen access and benefit-sharing (PABS) system is required before it can actually be ratified by member states, Burci explained.

Such a system has been difficult to devise due to the complex set of interests at stake. Developed countries are concerned about ensuring free access to pathogen samples and their genetic sequencing to accelerate the development of medical products urgently needed in a pandemic.

Developing nations want an assured supply of “benefits” in terms of medicines and vaccines if they share pathogen information, which were often scarce during the COVID pandemic. At the same time, fixed formulas for “benefit sharing” are also challenging to devise, given the variables that can emerge during a pandemic in terms of medicine and vaccine needs.

“While we will adopt the agreement, we will not open it for signature right away,” Burci said. “Why? Negotiators could not reach agreement on the details of the [PABS] arrangement in time for the WHA.  That will be negotiated after the adoption of the main text of the Pandemic Agreement.  

“Once the annex is adopted, the agreement will be unfrozen and open for signature, together with the annex. So it’s quite an unusual process, but it was the only way to have this political package come together.”

Big achievements despite all 

WHO’s Geneva Headquarters

With all of the caveats that still involved, “I think it is important just to reflect that.. at a time of fragmentation and geopolitical tensions, the fact that 193 [out of 194] countries have come together to, in theory, approve a pandemic accord is a remarkable achievement,” added Farrar. 

That, together with an agreement on raising member state levels of assessed contributions would spell success, he said, for this year’s WHA. 

“Those two things together really have to give you a sense that [speculation over] the death of multilateralism is actually grossly exaggerated,” observed Farrar.  

“Yu have to hold on to that optimism and hope, because otherwise it’s difficult to see anything other than a slightly nihilistic future.

“And if you give in to nihilism and pessimism, then the arguments for a better world are lost. So no matter how hard it is, …and what the impact the current disruption is having, you have to come through that.

Because otherwise you will not, at least, I personally cannot, be creative in terms of thinking of how to address future challenges.”

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