Tedros
Djibouti Health Minister and World Health Assembly President Dr Ahmed Robleh Abdilleh and WHO Director-General Dr Tedros Adhanom Ghebreyesus sign a new contract for the second term

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus has been re-elected unopposed to spend another five years at the helm of the UN health agency, after receiving the World Health Assembly’s overwhelming endorsement as a health diplomat fluent in war and a pandemic.

Tedros, a former Ethiopian health minister and the first African to lead WHO, ran unopposed for a second term. He was re-elected in a secret ballot vote in accord with Assembly procedures that required at least two-thirds of its 194 member nations to endorse him. A key donor nation, the United States, expressed support in February.

Although it initially appeared that all regions had endorsed his nomination, an indignant Ethiopia berated Botswana after it had delivered a message of support for Tedros on behalf of the Africa region. Neither Ethiopia nor Eritrea support Tedros as he has been outspoken about their blockage of Tigray, his home territory in Ethiopia. After Tedros’s re-election, Botswana then delivered a message of support on behalf of 45 African states – not 47.

Tedros began his first five-year term on July 1, 2017, and since 2020 he has been the public face of the world’s response to the COVID-19 pandemic, including its delays and failures at vaccine equity. 

Immediately after the secret ballot vote, which lasted without explanation for a couple hours longer than had been scheduled, Tedros entered the Assembly hall to a rock star’s welcome, surrounded by delegates, well-wishers and photographers on his way to the podium. 

“The Health Assembly has just decided to appoint you,” Djibouti Health Minister and World Health Assembly President Dr Ahmed Robleh Abdilleh said. “In congratulating you, the Health Assembly fully acknowledges the challenges ahead of you.” Immediately afterward, Tedros took a brief oath of office and, also in front of the Assembly, signed a new contract that runs from 16 August, 2022 to 15 August, 2027.

“This is overwhelming. I’m really grateful and very humbled for your confidence and trust. It was not just today. During my nomination, all regions have nominated me,” he told the Assembly. “This is for the whole team.” Tedros laid out his previously established main priorities for his second term, ranging from primary care to pandemic preparedness to accountability. 

He became teary-eyed recalling being a seven-year-old boy living in Ethiopia in a poor family when his younger brother died of a disease later suspected to be measles, a preventable condition, and it could have just as easily been him. 

“So I hope peace will come,” he said. “Let peace and understanding be the antidote to war.”

Dr Tedros visited Kyiv in Ukraine earlier this month.

Vaccine equity

He has repeatedly called out wealthy nations for taking first dibs on most of the world’s vaccine supplies, leaving poorer nations years behind in getting their first shots. Amid the media focus on Ukraine, he has kept reminding people of the suffering in Afghanistan, Syria, Tigray, Yemen and other conflict zones. 

Throughout his first term, the 57-year-old Tedros projected empathy. In his opening remarks to the Assembly, he spoke of his visits to see first-hand the effects of conflict.

“In both Yemen and Ukraine, and in other countries I have visited in between during my first term, I saw the profound consequences of conflict for health systems and the people they serve. More even than pandemics, war shakes and shatters the foundations on which previously stable societies stood,” Tedros said.

“And it leaves psychological scars that can take years or decades to heal. For me, this is not hypothetical or abstract; it’s real, and it’s personal. I am a child of war,” he recalled. 

“The sound of gunfire and shells whistling through the air; the smell of smoke after they struck; tracer bullets in the night sky; the fear; the pain; the loss – these things have stayed with me throughout my life, because I was in the middle of war when I was very young.  … Not only a child of war, but following me throughout. But my story is not unique.”

He also has been harshly criticized for his agency’s dealings with China soon after COVID-19 was first discovered, and for early statements against mask-wearing. And, under his tenure, WHO has also been criticized for failing to hold its staff accountable for sexual abuse and other misconduct.

Trump challenges

Perhaps his stiffest challenge came from former US President Donald Trump, who withdrew the US from the WHO after numerous broadsides about the body’s capabilities – a decision that was swiftly reversed by President Joe Biden.

As the ninth director-general of WHO, Tedros is the only one since the agency’s creation in 1948 to not hold a medical degree. Instead, he has a doctorate in philosophy. 

In his second term, Tedros will continue to have to deal with the global response to the pandemic and new health threats such as monkeypox and hepatitis. He said he had been humbled by the Executive Board’s decision to nominate him for a second term, and, as he reflected on the past five years, realized they have been “bookended” by two visits to war zones.

 

“I made my first trip as Director-General to Yemen in July 2017, a country which was, and remains, mired in civil war. While I was there, I met a mother and her malnourished child who had travelled for hours to reach the health centre I was visiting in Sana’a,” he recalled. 

“Then two weeks ago, I was in Ukraine, visiting bombed hospitals and meeting health workers. I visited a reception center for refugees in Poland, where I met another mother, from the Mariupol area, who told me that when the shelling began, her young daughter was very scared. … I met people who have lost loved ones; lost their homes; lost their sense of security – and yet somehow, have not lost hope.”

 

 

Image Credits: WHO.

Bjorn Kummel

Björn Kümmel, chair of the World Health Organization’s (WHO) working group on sustainable financing, wants to complete two marathons this year: an actual road race in Berlin – and the adoption of proposals to improve the WHO’s financing at the World Health Assembly (WHA) currently in session.

For 18 months, Germany’s Kümmel has steered discussions aimed at reforming the WHO’s finances as chair of the working group on sustainable financing. 

Only around 16% of the WHO budget is predictable, derived from member states’ fees, called “assessed contributions”. The other 84% comes from grants and voluntary contributions from members, skewing the global body’s programmes and making it hard to respond with speed and flexibility to health emergencies.

‘Severe risk’

“This situation has put WHO at severe risk, including its independence, its integrity, its agility and certainly also it’s mandated role to be the world’s leading and coordinating authority in global health,” Kümmel told the WHA’s meeting of Committee A on Monday.

He was reporting on the consensus reached by the working group last month on a package of measures, including that 50% of the WHO’s budget should come from assessed contributions by 2030, starting with an increase to 20% by next year’s WHA.

This is not a technical issue but a “gamechanger”, Kümmel told the committee. 

“It was clear for the working group that what we were discussing is nothing less than the future role of the WHO and global health and even beyond. Namely, the question, what kind of global health architecture do we envisage: a less fragmented, better coordinated, more efficient and truly inclusive global health governance with a fundamentally strengthened WHO at the centre as the enabled, leading and coordinating authority.”

 

WHO staff tied up with grant management

Earlier in the day, WHO Africa director Dr Matshidiso Moeti told a WHA roundtable meeting on WHO financing that the global body was managing around 3,000 grants.

“Many of our staff members are spending a disproportionate amount of their time processing these grants,” said Moeti. 

In addition, said Moeti, Africa was seen by donors as being “overwhelmed by communicable diseases” and this has resulted in a lack of funds for non-communicable diseases.

WHO Regional Director for Africa Dr Matshidiso Moeti.

If there was more flexibility in funding, the WHO could “address the health systems needs of the countries for preparedness, for providing essential health care services, for being resilient when we have to encounter such a problem as the pandemic we’re experiencing now”, she added.

She compared WHO’s funding model to that of “an average African country, which is highly dependent on donor funding” and “structured in this very vertical fragmented manner”.

This was inefficient, and made countries vulnerable rather than resilient to a pandemic, she said, appealing to member countries to support the changes being proposed by the working group.

Supporting her in the session, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that it was “not about the money” as the WHO had received significant donations during the pandemic – but rather the flexibility to spend the money where it was most needed.

‘Constructive multilateralism’

Describing the process of reaching consensus in the working group as “constructive multilateralism”, Kummel told the WHA committee that “any substantive AC increase would need to be supported by concrete steps to ensure that agility of the WHO, therefore the working group on sustainable financing also recommends the establishment of an agile member states task group”.

This was well-received by member states, with unanimous support for the financial reforms – to the relief of Kummel who described the process as “a marathon run” at the roundtable event before the committee.

“But it was a good run because we ran as a team, and we are still running as a team. There are two things on my to-do list for this year. The one is the Berlin marathon that is in September. The other one is to get this over the finish line and we will have the chance to get this over the finish line, most likely this afternoon,” he told the roundtable.

The WHA will vote on a resolution based on the working group’s decision later in the week.

Image Credits: WHO.

France at the WHA75.

France led the call for a more integrated approach to ameliorating the global burdens of non-communicable diseases at the World Health Assembly (WHA) on Monday, appealing for climate change and environmental issues to be factored into the global response.

Speaking on behalf of some countries in the European Union at Monday’s WHA75 committee session to discuss the follow-up to the political declaration of the third high-level meeting on the prevention and control of NCDs, France said that NCDs were increasing and affecting more and more people of all ages around the world, in particular, the most vulnerable. 

“NCDs already place a large burden on future generations as well as the budgets of states. We must have efficient programs based on an integrated health approach,” the government of France told the WHA committee session.

It called for urgent action, financing and mobilization of stakeholders to be facilitated by the global coordination mechanism. While describing WHO’s roadmap as a basis to work on, it also called for the inclusion of climate change and environmental factors which it described as being of determining importance for NCDs.


Decrying the impacts of the COVID-19 pandemic on global and local initiatives to address NCDs, France said the interruption of prevention and treatment over the course of the pandemic has led to greater inequalities in health.

France then highlighted the importance of improved pandemic preparedness in order to intensify the efforts against NCDs. This, it said, should include promoting patient-focused health education; and policies that prioritize early detection, diagnostics and better treatment in the framework of continued treatment.

Shift to primary health 

In his opening address at WHA75, WHO DG revealed that over the past five years, the global health body has supported 36 countries to integrate services to prevent, detect and treat NCDs into primary health care programmes. He added that health systems are being reorientated towards primary health care as the foundation of universal health coverage.

He revealed that 90% of essential health services can be delivered through primary health care. And investing in primary health care could increase global life expectancy by as much as 6.7 years by 2030.

“We need a radical shift to accelerate progress towards universal health coverage, with a significant increase in investments in primary health care in all countries – high, middle, low income. We have seen globally that the weakness is in primary health care,” the Director-General said.

France agrees. It told the assembly that primary healthcare needs to be strengthened to be able to give people the means to better control their health and in containing the risk factors of NCDs such as the effects of alcohol, tobacco and other addictive substances, diets and sedentary lifestyles.

“Countries rely on the support of WHO and it’s essential that the preparedness and response to NCDs is also part of all emergency responses in order to allow essential healthcare services to be provided in a multi-sectoral way,” it added.

Insights from the war against diabetes 

Diabetes is one of the NCDs that its control could have far-reaching impacts on the global NCDs agenda considering its association with other health conditions and socioeconomic impacts. 

In January 2022, WHO Executive Board proposed several global targets including diagnosing 80% of people with diabetes, 80% of people with diagnosed diabetes have good control of glycaemia, 80% of people with diagnosed diabetes have good control of blood pressure, 60% of people with diabetes of 40 years or older receive statins, and 100% of people with type 1 diabetes have access to affordable insulin treatment (including devices for insulin delivery, such as syringes and needles) and blood glucose self-monitoring.

National diabetes policies and guidelines in Kenya, Mali and South Africa. Source: MSF Access Campaign.

But Dr Helen Bygrave, Chronic Diseases Advisor for Medicins Sans Frontieres (MSF) Access Campaign said while setting global targets for response is strongly supported, more investments will be required, especially in the areas of monitoring and surveillance.

“In countries where MSF works, we have witnessed the challenges faced by people with diabetes receiving care in the public health system, who often don’t have access to the bundle of insulin, medical supplies required to inject it, and tools to monitor their blood glucose levels. It is imperative that countries consider this ‘diabetes bundle’ and its price, when forecasting, budgeting and procuring,” Bygrave stated.

Pandemic
WHO DG Tedros Adhanom Ghebreyesus at 75th WHA

GENEVA – The world is still not ready to handle pandemics despite all of the international efforts to improve health care in recent years, Dr Tedros Adhanom Ghebreyesus warned in a wide-ranging opening address to the World Health Assembly’s 194 member nations.

The World Health Organization must respond to dozens of global emergencies — cyclones, volcanoes, earthquakes, outbreaks, wars – while handling the COVID-19 pandemic, and it created a new hub for pandemic and epidemic intelligence in Berlin earlier this year.

And yet it is not enough because “it’s clear that the world was – and remains — unprepared for a pandemic,” Tedros said. “The pandemic is far from over. And even as we continue to fight it, we face the task of restoring essential health services, with 90% of member states reporting disruption to one or more essential health services.”

More optimistically, Tedros said the world’s needs “remain daunting and complex. But none of these challenges are insurmountable. For every challenge, there are solutions. If there is a will, there is a way.”

His opening speech on the second day of the Assembly began with a look back at the UN health agency’s past five years, during which Tedros’ first term as director-general has been marked by “many calls for WHO to change,” he noted, in its work methods and culture.

“And there is no question that more change is needed,” said Tedros, who is widely expected to be appointed to a second five-year term. “Allow me now to look forward to where I believe we need to go in the next five years. … We are calling on every government to put the health of its people at the center of its plans for development and growth.”

Tedros said the pandemic shows not only why the world needs WHO but also why it needs to be “stronger, empowered and sustainably financed.” To that end, he welcomed a working group’s recommendation to raise assessed contributions to 50% of the core budget over the next decade. These fixed contributions only comprise 17% of WHO’s budget, leaving it to a few rich countries and philanthropies to voluntarily cover most of WHO’s costs.

“You elected me five short years ago, with an ambitious agenda for universal health coverage; health emergencies; women’s, children’s and adolescents’ health; the health impacts of climate and environmental change; and a transformed WHO,” he noted, adding those priorities evolved into the five-year plan for achieving its “triple billion” targets that the Assembly adopted in 2018.

They aim by 2023 to help 1 billion more people benefit from universal health coverage; 1 billion more people be better protected from health emergencies; and 1 billion more people enjoy better health and well-being.

Pandemics progress still slow

“Progress isn’t always fast or easy to measure. But in ways small and large, seen and unseen, I am proud to say that this organization is making a difference. Let me start with our efforts to see 1 billion people enjoying better health and well-being,” he said. “Our projection is that we will almost reach this target by 2023, but progress is only about one quarter of what is required to reach the relevant SDG [Sustainable Development Goals] targets.”

For examples of other global health progress, Tedros also pointed to declining tobacco use, less industrially-produced trans fat in the global food supply and more excise taxes on at least one health-harming product, such as tobacco, alcohol or sugary drinks.

He also cited new WHO limits for air quality “based on mounting evidence of the harms to health of air pollution at even lower concentrations than previously thought” and new WHO health guidelines or tools that 71 countries are using to respond to violence against women.

But on the universal health coverage goal, he said, the world is “far behind, and progress is less than one quarter of what is required” to reach the target.

“Even before the pandemic, we estimated that only 270 million more people would be covered by 2023, a shortfall of 730 million people against the target of 1 billion,” said Tedros. “Disruptions to health services during the pandemic have sent us backwards, and we estimate the shortfall could reach 840 million.”

But there has been a 29% global increase in the number of health workers between 2013 and 2020, he noted, in contrast to previous projections for a global shortage of 18 million health workers by 2030. “That projected shortage has now shrunk to 15 million but it is still a massive shortage,” he added.

Tedros said that in the past five years there has been “significant progress in expanding access to medicines and other essential health products” – such as 53 prequalified vaccines, 50 in-vitro diagnostics and 288 medicines, including new therapies for HIV, hepatitis, TB, malaria, NTDs and COVID-19 – and two prequalified biosimilar cancer medicines along with a pilot program to prequalify human insulin.

Since the start of the pandemic in March 2020, WHO approved emergency use listings for 12 COVID-19 vaccines and 28 in-vitro diagnostics. And within 15 days of those vaccine listings, he said, 101 countries were “illustrating the weight that these countries place on WHO’s stamp of approval” through their own regulatory authorizations of those vaccines.

He said the UN target on hepatitis B — part of the U.N.’s 17 SDGs that contain 169 targets – has been met, and since 2015 the number of people who got treatment for hepatitis C increased ninefold to 9.4 million, reversing the trend of increasing mortality for the first time. And for the first time, the world has a malaria vaccine, enabling more than 1 million children in Ghana, Kenya and Malawi to receive at least one of 4 doses recommended for them from 5 months of age. Each year more than 260,000 African children under five die of malaria.

And on non-communicable diseases, he said, WHO helped 36 countries over the past five years to integrate services to prevent, detect and treat NCDs – one or more chronic conditions, like obesity, heart or kidney disease, or cardiovascular diseases – into primary health care programs, and supported 25 countries with rehabilitation services. WHO also helped 31 more countries to integrate mental health services into primary health care. “Child survival has improved dramatically over the past 20 years,” he said, “although 54 countries are off track to meet the SDG child survival targets.”

Ukraine
Djibouti Health Minister and World Health Assembly President Dr Ahmed Robleh Abdilleh in action on Monday

GENEVA – Russia’s attacks on healthcare facilities amid its war in Ukraine took center stage on the first full day of the World Health Assembly (WHA), where 46 mostly European nations including Turkey, Ukraine, and the United States proposed a draft resolution “condemning in the strongest terms” Russia’s invasion and the attacks on health facilities, calling on all 194 of the World Health Organization’s (WHO) member nations to “maintain or increase support for the UN-led response” to the war in Europe.

The resolution emerged from WHO’s Regional Committee for Europe, which adopted it at a special session on 10 May. It calls on WHO’s Regional Director for Europe to consider temporarily closing Russia’s regional office and suspending all regional meetings in Russia, including technical and expert meetings. 

It also urges Russia “to fully respect and protect all medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment” and to show “respect for and protection of the sick and wounded, including civilians, health and humanitarian aid workers, healthcare systems consistent with the Geneva Conventions and their additional protocols, and with broader international humanitarian law.”

The resolution also urges all WHO member nations to “adhere to international humanitarian law, international human rights law, and WHO norms and standards; to allow and facilitate safe, rapid and unhindered access to populations in need of assistance by staff deployed by the World Health Organization on the ground, and by all other medical and humanitarian personnel; [and] to ensure the free flow of essential medicines, medical equipment and other health technologies in all conflict and non-conflict areas.”

Ukraine war scarier than a pandemic

Ukraine’s First Lady, Olena Zelenska, told the Assembly that Ukraine and WHO have had years of “fruitful relations” and, at least until recently, nothing could have been scarier than a pandemic.

“But it turned out differently. Russia’s war has shown horrors we could not have imagined,” she said by videoconference. “WHO is committed to protecting the most crucial human rights – to life and health. Now they are both being violated in Ukraine. No Ukrainian, neither adults nor children, can be sure that they will wake up tomorrow, that a missile will not fly into their house. Doctors cannot be sure that their ambulances will not be bombed on the way to a patient.”

On the same day, her husband, President Volodymyr Zelensky, spoke by videoconference to the World Economic Forum in Davos and called for help to come “as fast as possible” to arm Ukraine for victory and help rebuild the country after the war.

The draft resolution put forward by Ukraine was co-sponsored by Albania, Andorra, Australia, Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Canada, Colombia, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Guatemala, Iceland, Ireland, Italy, Japan, Latvia, Lithuania, Luxembourg, Malta, Moldova, Montenegro, Netherlands, New Zealand, North Macedonia, Norway, Peru, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Turkey, United Kingdom and United States.

Russia appeals for ‘non-politicized’ discussion

Among the holdouts from the co-sponsor list were Hungary – the only one missing from the 27-nation EU bloc – along with Israel and Switzerland.

Russia won some scattered applause in the Assembly when one of its diplomats urged colleagues not to allow WHO to become “politicized” – in keeping with the nations’ social media posts. 

Russia’s Mission in Geneva tweeted that “Russia looks forward to forging common solutions to the pressing global health challenges. We expect non-politicized, constructive and consensual deliverables of #WHA75, moving us towards a healthier planet.”

Separately, a Russian diplomat at Russia’ Mission in Geneva said he was resigning his position because he was ashamed of his government’s invasion of Ukraine. In a letter posted on his LinkedIn account, Boris Bondarev, a counselor for arms control, disarmament, nonproliferation and export control, said he resigned on Monday.

“Long overdue, but today I resign from civil service. Enough is enough,” he began. “For twenty years of my diplomatic career I have seen different turns of our foreign policy, but never have I been so ashamed of my country as on February 24 of this year. The aggressive war unleashed by [Russian President Vladimir] Putin against Ukraine, and in fact against the entire Western world, is not only a crime against the Ukrainian people, but also, perhaps, the most serious crime against the people of Russia, with a bold letter Z crossing out all hopes and prospects for a prosperous free society in our country.”

“Those who conceived this war want only one thing – to remain in power forever, live in pompous tasteless palaces, sail on yachts comparable in tonnage and cost to the entire Russian Navy, enjoying unlimited power and complete impunity,” he continued. “To achieve that they are willing to sacrifice as many lives as it takes. Thousands of Russians and Ukrainians have already died just for this.”

As the Assembly got underway, WHO said it verified 30 additional attacks on health care facilities in Ukraine. As of Monday, it said, 75 deaths and 59 injuries can be traced to 248 verified attacks on health care facilities in Ukraine from February 24, the day that Russia invaded, until May 19.

“It is a true catastrophe for millions of people. The World Health Assembly needs to discuss this,” Germany’s Health Minister Dr Karl Wilhelm Lauterbach urged colleagues.

“I call on everyone to support the resolution presented by Ukraine to this assembly.” Norway’s Health Minister Ingvild Kjerkol said her nation strongly supports Ukraine and WHO has a strong role to play in helping maintain peace. When nations stand together, she said, they are stronger and “that is what this time calls for.”

Child infected with monkeypox in Liberia – since smallpox vaccinations were discontinued children may be even more vulnerable

Fifteen non-endemic World Health Organisation(WHO) member states have reported 95 confirmed cases of monkeypox between 13-22 May – but the language and imagery used to report the outbreak has raised concerns over the reemergence of disease-related stigma against LGBTI and African members of society. 

Based on currently available information, the WHO said that cases have mainly but not exclusively been identified amongst men who have sex with men seeking care in primary care and sexual health clinics.

“While we’re seeing cases amongst men who have sex with men, this is not a gay disease, as some people on social media have attempted to label it. It is just not the case. Anybody can contract monkeypox through close contact,” said Andy Seale, Advisor at the WHO, in a live Q&A on Monday.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) also raised concerns over the portrayal of LGBTI and African members in the commentary and reportage being circulated in the media. 

UNAIDS said that such language and imagery can reinforce racist and homophobic stigma. “Experience shows that stigmatizing rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures,” said Dr Matthew Kavanagh, UNAIDS Deputy Executive Director. 

The current images used to portray monkeypox rashes belong to members of the African community based on the documentation over the last decades on cases in the African region where this disease is endemic. 

Seale re-emphasised that communities are the WHO’s main concern and it was working on getting more accurate information to better understand and manage the health risks of this disease.

“There’s a lot of stigma and discrimination that surrounds many diseases. And I think the key thing we need to look out for is WHO working with our partners in communities and elsewhere, to make sure that their messaging is correct.” 

The WHO expects more cases of monkeypox to be identified as surveillance expands in non-endemic countries. As per available evidence, those who have had close physical contact with someone with monkeypox symptoms are the most susceptible to contracting the disease which is endemic to West Africa. 

US orders freeze-dried smallpox vaccines 

As the reportage and awareness of the outbreak gains momentum in Europe and North America, US President Joe Biden said the current scale of the disease was something “everyone should be concerned about.” “It is a concern that if it were to spread, it would be consequential,” he said.

The US has exercised its options under an agreement with the Copenhagen-based Bavarian Nordic company to order a freeze-dried version of JYNNEOS® smallpox vaccine. According to the company, the first doses of this vaccine version will be manufactured in 2023 and 2024 and will cost US$119 million.  

Bavarian Nordic said that additional options on the contract, valued at US$180 million, would support the conversion of up to a total of approximately 13 million freeze-dried doses of the vaccine that are expected to be manufactured in 2024 and 2025. “The majority of the bulk vaccine for these doses has already been manufactured and invoiced,” the company’s press release said. 

monkeypox
A table showing the recent outbreak of WHO between 13-22 May in non-endemic countries.

According to the US Centers for Disease Control and Prevention, the smallpox vaccine is at least 85% effective against monkeypox. It also said that the U.S has licensed two vaccines to prevent smallpox, with one being authorized specifically for monkeypox.

Vaccine efficacy, and access

This 85% vaccine effectiveness is attributed to the older version of the vaccine, said Dr Maria van Kerkhove, WHO Technical Lead on COVID-19.

“We now have new vaccines. Although smallpox was eradicated, research has continued for the last 40 years… [because] these viruses are closely related to each other and now we have the benefit of all those years of research diagnostics and treatments in vaccines,” she said. 

However, she warned that since these are relatively newly discovered products, they are not yet widely available. “They are available to some Ministries of Health and National stockpiles, but they’re not yet widely available commercially.”

This highlights the US decision to exercise its options in light of the scarcity of vaccines in even regions where monkeypox is endemic. 

According to a paper published in February 2022, the cessation of the smallpox vaccine in 1980s caused a minimum of 10-fold increase in cases in 2010-19 compared to the 1970s. The smallpox vaccines provided some cross-protection against monkeypox. The paper had warned at its time of publication that monkeypox is gradually evolving to become of global relevance and surveillance and detection programs are essential tools for understanding the continuously changing epidemiology of this resurging disease.

How worried should one be about contracting monkeypox? 

“Monkeypox and COVID-19 are not the same disease,” said Dr Rosamund Lewis, head of the Smallpox Secretariat at the WHO Emergencies Programme.

“Monkeypox spreads through close physical contact, which includes touching the rashes developed in this disease,” she said. 

While COVID-19 and monkeypox are zoonotic viruses, the latter is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. The disease has symptoms that are similar to those seen in smallpox patients, although the former is clinically less severe and has an incubation period of 6 to 13 days. 

Dr Van Kerkhove said that the WHO has been working with Ministries of Health in countries to expand surveillance in order to look for people who have a rash. This means broadening the radius of alertness to dermatology clinics, emergency departments, infectious disease clinics, and sexual health clinics to effectively understand the extent of infection.  

She brought to light that the current outbreak seen in non-endemic countries is “a containable situation” but warned that “we can’t take our eye off the ball on what’s happening in Africa as well as in endemic countries”.

“So this gives us an opportunity to talk about what monkeypox is and what it isn’t, so you can be very well informed,” she added.

All you need to know about monkeypox 

There are currently 12 monkeypox endemic countries in the WHO Regional Office for Africa: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan. 

If you are in a non-endemic country, the symptoms to watch out for are an acute rash with the combination of one or more of the following: headache, acute onset of fever, swollen lymph nodes, muscle and body ache, back pain, and weakness.

Image Credits: US Centres for Disease Control , WHO.

(On right): Magda Robalo, Global Managing Director at Women in Global Health outlines gender and sex abuse issues facing WHO, hours before the 75th World Health Assembly convened.

Over 20 babies have been born as a result of sexual exploitation and abuse by World Health Organization (WHO) staff and contractors in the Democratic Republic of Congo (DRC), and the global health body, cannot yet move on from the two-year-old scandal.

Addressing the WHO’s stained record of sexual exploitation abuse and harassment remains unfinished business for the global health body – in the wake of the scandal that plagued the World Health Organization’s (WHO) Ebola response in the Democratic Republic of Congo (DRC) between 2018 and 2020.

That was just one of a number of key messages to emerge from Sunday’s pre-World Health Assembly briefing, organized by the Geneva Graduate Institute’s Global Health Centre and the United Nations Foundation. 

Charting a path to the Triple Billion

Open Briefing to 75th WHA:  Agnes Soucat of the French Development Agency (center) and WHO’s Abdou Salam Gueye (right) discuss the global architecture for health emergencies response.

The briefing focused around WHO’s ‘Triple Billion targets’, looked at how the global health agency could achieve universal health coverage for 1 billion more people worldwide in coming years (Pillar 1); improved emergency response (Pillar 2); and better health and wellbeing (Pillar 3); with key speakers from WHO, donors, and civil society.

At the sessions, new modes of financing UHC access were explored by Kate O’Brien of WHO and Ghitnji Gitahi, of Amref Health Africa. WHO’s Abdou Salam Gueye and Agnes Soucat of Agence France du Developpement discussed a White Paper proposal by the WHO for reforms that would, among other things, support a new World Bank fund for ready finance of vaccines and treatments in low- and middle-income countries during future outbreaks and pandemics.

Gueye also stressed the need for more coordination between WHO’s Africa Regional Office and the African Centers for Disease Control to advance a wide range of agendas, from health systems strengthening to medicines access. He said that he recently visited Africa CDC at its Addis Ababa headquarters to discuss the possibility of a new coordination mechanism between the two groups.

“We said what we want to do and they said what they want to do. When we checked, it was so interesting and we could complement each other at many points. We need better streamlining in order to know what the other is doing, and where we can really put our forces together and succeed,” Gueye told the audience in Geneva. “What we need is just to have a coordination mechanism where what needs to be done will be clarified, and also people will work together in a complementary manner.”  

Meanwhile, WHO’s Ben McGrady and Mohammed Eissa, part of the student-driven International Federation of Medical Students Associations (IFSMA) talked about how to better integrate environmental factors driving ill health, such as air pollution, as well as commercial drivers, such as the aggressive marketing of tobacco, alcohol and sugary drinks, into WHO’s own agenda as well as country priorities.

Ensuring justice for DRC victims

Better WHO governance was a “fourth pillar” discussed at the briefing – including follow-up on the still outstanding questions around the investigation into the DRC victims of sexual abuse and exploitation by WHO staff and consultants during between 2018 and 2020. Some 75 Congolese women were reportedly sexually exploited, abused, and/or harassed by 25 WHO workers deployed to assist the DRC in its response to the Ebola outbreak that occurred in eastern DRC between 2018 and 2020.

Magda Robalo, Global Managing Director for Women in Global Health, noted that the WHA’s 75th session, which began Sunday, would need to review progress made so far to address the DRC scandal, and ensure that WHO investigations bring justice to the victims and prevent the abuse of vulnerable populations in the future. 

“The drama around sexual exploitation, abuse and harassment is one of the issues that we need to collectively work together on eliminating. When we say eliminating, we know we cannot eradicate it. The DRC Ebola case brought to light something that happens every single day in humanitarian emergency situations, but also in development contexts. There are other cases in other countries where this is happening,” said Robalo. 

“There is no justice for the victims. And that’s totally unfair.” 

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The DRC sexual exploitation and abuse scandal occurred during the WHO’s response to the 2018 – 2020 Ebola outbreak.

The global health body has admitted to failures in its response to sex scandals following accusations of “common sexual exploitation and abuse”, leading to calls for reform of internal justice at the WHO. A final report by an Independent Oversight Advisory Committee (IOAC) of the WHO Health Emergencies Programme also advised the global health body to reform accountability systems to prevent sexual exploitation and abuse.

Robalo emphasised that the WHO and other development bodies needed to ensure that workers hired to protect vulnerable populations do not abuse them because they have power.

WHO quickly addressed  the DRC scandal

WHA75 which commenced Sunday afternoon, is expected to discuss sexual harrassment, abuse and exploitation, among other issues.

Once the sexual abuse came to light, the WHO “quickly developed a management response plan to address the situation”, according to Robalo, who reported on a town hall meeting addressed by WHO Director-General Tedros Adhanom Ghebreyesus a month earlier on progress made to address the issue and protect the populations that are at risk of becoming victims. 

“They established the department for preventing sexual exploitation, abuse and harassment with an interim director. We hope that there will be a permanent appointment so that the department can be staffed and work on these issues,” she said. 

Pressure to see justice for victims 

Even though the WHO can still do more, she observed that WHO’s member states also have a role to play. 

“Very often, when these cases are coming to light, you see a disconnect between the outcomes and recommendations from the reports and action from the Ministries of Justice and the structures in the countries where those victims are living, which needs to be taken on board by the government,” she added. 

Addressing this, she said, would require continuing working on ensuring that the right policies and right actions are in place to prevent sexual exploitation, abuse and harassment in humanitarian emergency settings, but also across the development world.

“We need to continue putting pressure, following up and demanding that action is taken until the response management plan is implemented, but also that we see justice for the victims. That’s very important for the survivors,” she concluded.

Image Credits: WHO AFRO.

WHO DG Tedros Adhanom Ghebreyesus at the 75th World Health Assemby in Geneva, Switzerland, in the Palais des Nations.

GENEVA – Opening the World Health Assembly under a “health for peace” banner that is this year’s theme, Dr Tedros Adhanom Ghebreyesus warned WHA member states that achieving ambitious global health goals – from snuffing out COVID-19 to expanding universal health coverage – will be virtually impossible if regional conflicts like ones ongoing in Ukraine, Yemen,  and elsewhere continue to smolder and burn. 

War was not far away, however, as the ceremonial session saw leaders such as French President Emmanuel Macron and Croatia’s President Zoran Milanović issue strong denunciations of Russia’s invasion of Ukraine.  

“France & the EU stand in full solidarity with Ukraine,” said Macron, one of a number of heads of state to make videotaped remarks. “We condemn in the strongest possible terms the military aggression committed by Russia by the complicity of Belarus.”

French President Emmanuel Macron speaking at the 75th World Health Assembly.

Even so, a more serious confrontation was avoided after Moscow remained silent over a move by WHO’s European member states to place Armenia, instead of Russia, on the powerful “General Committee” that will decide behind closed doors tonight on the finalized agenda of the week-long WHA meeting.  

“War is bad enough, but it’s made worse because it creates the conditions for disease to spread,” said Tedros, who has been WHO’s director-general since 2017 and whose remarks dwelt mostly on the continuing challenges of snuffing out the COVID-19 pandemic – while grappling with a worrisome new outbreak of monkeypox, which continues to spread.  

“In war, hunger and disease are old friends… Ultimately the one medicine that’s needed is one that WHO cannot deliver – peace.  Peace is a prerequisite for health,” said Tedros, who also spoke movingly of his own experiences growing up in the Tigrayan minority area of conflict-ridden Ethiopia “as a child of war … with the sound of gunfire and shells whistling … tracer bullets in the night sky, the fear, the pain, the loss.”

Meeting face to face for the first time since 2020

75th World Health Assemby at the Palais des Nations, Geneva, Switzerland.

For the first time since 2020, WHO’s annual meeting of its 194-nation governing body at Geneva’s Palais des Nations was once again a physical gathering, largely reflecting the unprecedented speed of vaccine development since WHO declared COVID-19 a pandemic in March 2020. 

Sunday morning, in the streets around the global gathering place, WHO sponsored a “Walk the Talk: Health For All Challenge” event where delegates and others began the day with exercises and ran or walked for several kilometers to emphasize the importance of physical activity and other measures for combating non-communicable diseases that are the cause of two-thirds of premature deaths today globally.

Yet the continuing catastrophic damage to health and economies of the COVID-19 pandemic, and the widening injustices and inequalities it has brought on, along with Russia’s invasion of Ukraine – is expected to dominate debate at the assembly’s seven-day meeting.

WHA Resolutions by both Ukraine and Russia circulating 

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Refugees leaving Ukraine. A resolution denouncing Russia’s aggression on Ukraine is expected to take considerable time during the 75th World Health Assemby.

A resolution denouncing Russia’s aggression on Ukraine, co-sponsored by Ukraine, Canada, the United States and the European Union is expected to take considerable time on the agenda later this week. And Russia was now also said to be circulating its own resolution among member states with its own narrative on the still-raging conflict. 

The opening of the WHA also coincided with Israel’s first reported case of monkeypox in a man who returned from overseas, in what apparently was the first case in the Middle East. WHO says it has identified about 92 cases around the world in nations such as Canada, Italy, Portugal, Spain, Sweden, the United Kingdom and the United States. 

Until now outbreaks of the virus had been confined largely amongst rural residents of central and western Africa where the virus circulates in rodents, monkeys and other non-human primates – with only isolated cases seen abroad in travelers arriving from endemic countries.  

Incremental progress on pandemic reform 

While there has been considerable media focus on the prospects for a new and potentially sweeping international pandemic treaty, delegates at this session are only expected to make incremental moves toward that long term goal – likely agreeing, first, to a process for amending the existing binding rules that govern health emergencies: the International Health Regulations (IHR).

A new WHO “White Paper” does, however, outline a vision for strengthening its emergency response with a 10-point plan submitted by Tedros calling for the establishment of a Global Health Emergency Council that would involve heads of state, under WHO’s auspices, as well as a World Bank-hosted Financial Intermediary Fund (FIF) to maintain a standing pool of resources for purchasing treatments and vaccines.  The aim is to avoid the kinds of delays and inequities that have occurred with the lagging distribution of COVID-19 vaccines to low- and middle-income countries.. 

And a draft resolution co-sponsored by the United Kingdom and Argentina calling for greater transparency in clinical trials reporting – with both negative and positive results – was reportedly now finalized after weeks of closed door discussions. Proponents have said that the resolution is critical for ensuring more harmonized reporting of clinical trial results so that there will be a faster uptake of new treatments, particularly during disease outbreaks and health crises.  

Along with those big ticket items, the Assembly will debate more than two dozen other issues such as polio eradication, cervical cancer elimination, a roadmap on reducing non-communicable diseases, how to better coordinate research priorities in clinical trials, eradicating polio, and cases of sexual exploitation by WHO staff.

See Friday’s full report on what to expect from the WHA here:

More Reliable Funding for WHO, Slow Progress on Pandemic Reform & Ukraine Controversy – What to Watch at the World Health Assembly

Increasing fixed member state contributions to WHO

Members of the WHO Working Group on Sustainable Finance hammer out the final agreement on increasing member state contributions, Germany’s Björn Kümmel on far left.

In another significant move, delegates are expected to approve a move to gradually increase the proportion of fixed assessments that member states must pay annually towards WHO’s budget. 

The assembly’s anticipated new formula for fixed contributions to WHO’s budget – which only covers 17% of its costs – is intended to raise its member nations’ annual “assessed” contributions to as much as 50% of its core budget by 2030. 

Most of the agency’s budget now is covered by a handful of wealthy “voluntary” donors: Germany, Japan, the United States, Korea, the European Commission, Australia, the COVID-19 Solidarity Fund, the GAVI Alliance, U.N. Development Program, the Bill & Melinda Gates Foundation, the United Kingdom and New Zealand.

Tedros and other WHO leaders have repeatedly asked for this move, saying that the agency’s long standing over-reliance on the voluntary funding it receives from countries and charitable donors makes the agency too dependant  upon the whims of donors.

A plea to continue fighting COVID

Yemen’s ruined health system struggles to cope with COVID alongside other diseases.

Tedros, who is expected to be re-elected for another term during this WHA session, set the stage for the weeklong discussions by acknowledging that the COVID-19 pandemic has “turned our world upside down” and continues along an unpredictable path still today. “Reported cases are increasing in almost 70 countries in all regions,” Tedros warned. “And this is in a world in which testing rates have plummeted and reported deaths are rising in my continent [Africa]. The continent with the least vaccination coverage. 

“This virus has surprised us at every turn – a storm that has torn through communities again and again. And we still can’t predict its path or its intensity. We lower our guard at our peril.”

More than 6 million COVID-19 deaths have been reported to WHO. Earlier this month, however, WHO provided new estimates showing the full death toll associated both directly and indirectly from the continuing pandemic was almost 15 million people in 2020 and 2021 alone. This also is a  dramatic illustration of the need for far greater investment in resilient healthcare systems, WHO officials say.

 “People have lost their lives, loved ones and livelihoods. Health systems have been strained to breaking point, and in some cases, beyond. Health workers have laboured under extreme circumstances. Some have paid the ultimate price, and we have lost others to stress and depression,” said Tedros.

“Communities have faced great disruptions to their lives, with schools and workplaces closed, and the burden of isolation and anxiety. And you, as governments, have been at the center of the storm, facing multiple challenges,” Tedros said. “I know that’s not the message you want to hear, and it’s definitely not the message I want to deliver,” he said. “There’s no question we have made progress, of course we have: 60% of the world’s population is vaccinated, helping to reduce hospitalizations and deaths, allowing health systems to cope, and societies to reopen. But it’s not over anywhere until it’s over everywhere.”

Image Credits: People in Need, Germany's UN Mission in Geneva , ReliefWeb.

A field worker in Pakistan administering polio drops

[ISLAMABAD] Despite gains made to end polio during COVID-19, Pakistan has  recently reported a resurgence of the virus after a gap of fifteen months. The sobering news comes just ahead of the start of the World Health Assembly in Geneva -which will review progress on polio eradication – including a recent polio wildvirus outbreak in Malawi; transmission of vaccine-derived polio elsewhere in Africa; and continuing challenges in war-weary Afghanistan.  

Pakistan has so far reported three wild poliovirus cases in the months of April and May from its western un-settled region of North Waziristan bordering Afghanistan and authorities fear more are to appear.

Reacting to the reports, Pakistan’s government officially reaffirmed its commitment to end transmission of the virus – and announced a new vaccine campaign. 

But senior officials attached with the polio program fear that the dream of eradicating the disease from Pakistani soil in the near future has been lost. 

Failed to maintain immunity wall created at height of pandemic

Pakistan is one of two countries where polio remains endemic.

“[The] program has miserably failed to maintain the immunity wall erected during the previous year,” lamented a senior official of Pakistan’s polio program wishing not to be quoted. 

He said the aggressive emergence of the virus in the high transmission season happening now, reflects gaps in the 2021-2022 anti-polio drive – which failed to keep up with the good record of the 2020-2021 campaign – conducted at the height of the COVID pandemic. 

Pakistan and Afghanistan were the only two countries left fighting to end the wild poliovirus from Asian region – although the outbreak in Malawi, reported by WHO in 2022, also is said to have originated in a Pakistani strain of the virus from an unknown source. The report of the wildpolio virus case in a young child in Lilongwe, has triggered a massive immunization campaign in both Malawi and neighboring states, which is still ongoing.  

Door-to-door immunizations need to maintain ‘immunity wall’ 

Children in Pakistan show proof of vaccination against polio.

In order to maintain the ‘immunity wall’, continuous immunization among vulnerable populations is needed, specifically in southern and central Pakistan, said the unnamed official, in reply to a query made by Health Policy Watch. 

“Polio authorities should have kept focus in the regions of South of Khyber Pakthunkhwa province, Central Pakistan and traditional core reservoirs of Khyber-Peshawar, Karachi and Quetta block,” he said. 

He said synchronised high quality door to door campaigns would also have to be conducted, not only across Pakistan but in Afghanistan as well.

After the COVID-19 interruption, the Pakistan programme in July 2020 restarted door to door campaigns along with enhanced outreach for essential immunisation across Pakistan. 

The efforts were undertaken in close coordination with Afghanistan through synchronised campaigns which resulted positively and the country reported zero polio cases for 15 months till April 2022. 

“Good approaches and efforts practiced during the low transmission season of August 2020 to March 2021 should have [been] replicated during August 2021 to March 2022,” he said.

Anti-polio drive for children announced 

A countrywide vaccination drive against polio has been announced in Pakistan, beginning next week.

In an effort to combat the further spread of polio, the ministry of National Health Services Regulations and Coordination (NHSR&C) has now announced a countrywide anti-polio drive beginning next week, to immunize around 43 million more children in Pakistan. 

Official statements say 340,000 polio workers will participate in the door-to-door countrywide anti-polio drive which was earlier limited to some regions. 

The ministry has also requested parents, civil society and religious clergy to cooperate with authorities in this campaign. 

Polio in Pakistan due to parents’ refusal to vaccinate 

Meanwhile, the Pakistani Medical Association (PMA) demanded stronger legislation regarding parents who refuse to immunize their children – which they say is a leading source of new cases. 

“There must be some law for those who refuse to immunize children,” said secretary general PMA Dr Qaiser Sajjad.

He also said it is the time to strengthen the screening system for polio cases along the Afghanistan border and within cities where polio samples are found, adding that such screening measures worked during COVID-19.

According to Dr. Sajjad there is also a need for aggressive media campaigns to create awareness and convince the communities to bring their children for polio drops. 

“All the hard work done to eradicate polio is on stake now,” he said.

Global Polio Eradication Initiative calls for nearly $5 billion in new funds 

To end polio, the Global Polio Eradication Initiative (GPEI) has also called for renewed commitments to meet a $4.8 billion global budget that would fund the implementation of a new strategy to eradicate the deadly infectious disease. 

However, money is not the only issue. The Pakistan polio program has been struggling for decades to overcome the social and security challenges that immunization campaigns face, especially in ‘war on terror’ areas. That is despite sponsorship of campaigns by global donors  including the Bill and Melinda Gates Foundation – whose co-founder Bill Gates visited the country only recently.

Polio campaigns in Pakistan were heavily disrupted after al-Queda leader Osama Bin Ladin was killed in an operation carried by US forces in the Khyber Pakthunkhwa province in May 2011.  Following that, al Queda groups also started attacking polio workers as perceived representatives of U.S and western influence. 

Since then, both US and Pakistan military forces also have committed to a ‘war on terror’ which has further impeded the work of polio campaigns. 

The North Waziristan region of Khyber Pakthunkhwa province, where all three recent polio cases in two boys and a girl were confirmed, was one of the hotbed ‘war on terror’ areas where Pakistan military carried operations while US forces held drone attacks. 

After the resurgence of polio cases in North Waziristan, Gates even reportedly called Pakistan Army Chief General Qamar Javed Bajwa to discuss the situation. 

In a statement, the Inter-Services Public Relations (ISPR) reported that the billionaire philanthropist had expressed his appreciation to the army for supporting the country’s polio drive and ensuring proper reach and coverage. The army chief responded that polio eradication was a national cause, adding that “credit goes to all involved in the process”.

Downsides of downsizing program 

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Minister Patel and WHO Pakistan Palitha Mahipala

Some  polio workers believe that downsizing of lower staff also brought harmful results for the program.

Anil Kumar, one polio worker interviewed by Health Policy Watch, said that around 800 Union Council Polio Officers (UCPOs) are registered across the country. But many of them were not offered contracts for the year 2022 – he among them. 

“Indeed uncertainty and job insecurity in lower staff can impact reporting and surveillance in the polio program,” he said.   

Meanwhile, the Pakistan federal health minister Abdul Qadir Patel and the World Health Organization’s representative in Pakistan, Palitha Mahipala met in the wake of the three polio cases, reaffirming their commitment to work together to end polio. 

The head of WHO’s Pakistan country office welcomed the decision of Pakistan’s health minister to visit the affected families as a move to underline the government’s support for ending the disease. 

Human cost of not eradicating polio in Pakistan 

Minister Patel meeting families affected by polio

“Every polio case is a huge tragedy,” said Patel in a statement about the outbreak.  

“Since January, Pakistan has taken emergency measures in the southern districts of Khyber-Pakhtunkhwa to save children from wild polio and these measures have been further extended and intensified,” he added.

Every child must be reached by polio vaccine 

Political map of Pakistan. The KP province has reported a resurgence of polio.

Despite the setbacks, rank-and-file officials say they remain determined to vaccinate all children in the country against the virus. 

Polio workers on the frontlines continue to reach out to children in North Waziristan in spite of  challenging circumstances in hard-to-reach areas, said Dr. Shehzad Baig, National Coordinator for Emergency Operations Centre (NEOC), adding, “We fear that more children from the same area may be affected as the virus circulates.”

Additionally, to address the challenges in Southern KP – unsettled and settled tribal areas that include North Waziristan, South Wajiristan, and Bannu, the Pakistan government and global polio partners had already initiated an emergency action plan to address the challenges in this part of the province.

Federal health secretary Aamir Asharaf Khawaja, in a statement from the health ministry, said after the first child was paralyzed [in Pakistan], “we feared that there would be more polio cases because of how infectious this virus is.”

Environmental samples of wild poliovirus in Khyber-Pakhtunkhwa have also been found in the Dera Ismail Khan and Bannu divisions of the region, he noted adding:  

“Unfortunately, there may be more until every child is reached by the vaccine.”

Image Credits: Sanofi Pastuer/Flickr, Pakistan Polio Eradication Program, UNICEF Pakistan.

who
Members of the WHO Working Group on Sustainable Finance hammer out the final agreement on increasing member state contributions in late April. Germany’s Björn Kümmel, who led the negotiations, on far left.

More stable funding for WHO, but only incremental progress on reforms in global pandemic response are expected out of the upcoming World Health Assembly, where member states also will debate and discuss over two dozen other critical health issues that don’t always make the headlines.  

The 75th World Health Assembly, WHO’s annual meeting of member states, opens Sunday with the prospect of diplomatic fireworks over Russia’s invasion of Ukraine and only incremental progress likely on reforms that critics say are urgently needed to strengthen the health agency’s hand in preparing for, and responding, to pandemic risks.

On the brighter side, a draft member-state agreement to bolster the WHO’s financial stability is expected to win approval after months of closed-door negotiations. The new formula involves a commitment to raise member state annual “assessed” contributions to 50% of WHO’s core budget by the end of the decade. 

Currently such fixed contributions only comprise about 17% of WHO’s budget, while a handful of rich countries and philanthropies cover an outsized portion of the global health agency’s costs – also exerting untoward influence over priorities, some critics say.  

The past two WHAs – held virtually during the pandemic – both saw demands for reforms at the top, tensions over the WHO’s investigation into the origins of SARS-CoV-2, calls for better global emergency and pandemic preparedness, and pleas for more funding to both WHO and low- and middle income countries to address widening health inequalities. 

The theme of this year’s WHA, which runs from 22-28 May,  is “Health for peace, peace for health”, given the emergency in Ukraine, just how much uptake there will be of the theme, in spirit as well as in name, remains to be seen.

Other core issues risk being sidelined

A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer 2021 – since then a months-long blockade on all health supplies has devastated the region even more.

Alongside that bloody conflict, there are worries that other urgent issues risk being sidelined at the conference. These range from burning health and humanitarian crises in places like Tigray and Afghanistan, but also other core health issues, from neglected tropical disease to the worldwide epidemic of non-communicable diseases, as well as longer-term plans to improve pandemic response.

Indeed,  in a moment of big expectations where delegates meet face to face for the first time in two years – actual results may be disappointing to those hoping for swift reforms in global rules around pandemic response. 

UN-wide, Russia’s invasion of Ukraine has diverted attention from the pandemic which was an overriding focus of politics and media for nearly two years. That, in turn, leaves a “closing window of opportunity” for key reforms, said Olaf Wientzek, Director of Multilateral Dialogue at the Geneva-based branch of Konrad-Adenauer-Stiftung, a German foundation, in an interview with Health Policy Watch ahead of the WHA.

Pandemic preparedness: A closing window for change

Former Liberian President Ellen Johnson Sirleaf (left) and Former New Zealand Prime Minister Helen Clark (right), co-chairs of The Independent Panel.

In a stiffly worded update, released just ahead of the WHA meeting, the former co-chairs of the Independent Panel on pandemic preparedness and response said the world is little more prepared to cope with a pandemic threat today than it was when the COVID-19 crisis began.

“Should a new health threat arise this year, the world would largely have to draw on the same tools it had at the end of 2019,” Helen Clark, former prime minister of New Zealand and co-chair of the Independent Panel for Pandemic Preparedness and Response, told a pre-assembly press briefing. 

Their scathing original report, released at last year’s WHA, levelled criticism throughout, from an “under-powered” WHO to “absent” global political leadership.

“The weak links that we identified then still exist today, and without more concrete efforts to fix them, we could find ourselves once again scrambling to protect people from a new pandemic threat,” added Clark, who co-authored the report with Ellen Johnson Sirleaf, former president of Liberia.   

Timing: Reforms could take years

At the current pace, processes likely to be initiated by the World Health Assembly this session “could take many years”, Clark and Sirleaf warned, citing as examples: 

  • The increase of assessed contributions to cover 50% of WHO’s base budget, which may not take full effect until 2030. 
  • Amendments to the International Health Regulations that govern WHO’s emergency powers, which have been proposed as a short-term fix in a broken system, “may take until May 2024 to be agreed, and then another year to come into force”, they added. (The timetable to negotiate and ratify a comprehensive new global pandemic convention or accord would be even longer. 
  • At the same time, efforts to include all pandemic reform issues into a new legal instrument, whether it turns out to be a convention or a treaty, could result in a “watered-down instrument, or none-at-all.” 

Along the way, ”critical issues, including WHO’s authority to report, and investigate health threats based on the precautionary principle, may be lost in negotiation,” the former Panel co-chairs stated. 

Real reforms in IHR unlikely before 2025

Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, addresses the WHO Executive Board meeting, 24-29 February, 2022.

Yet despite all the flashing warning lights,  the inherently slow and conservative nature of WHA assemblies, along with the still-evolving humanitarian emergency in Ukraine – will make faster action by WHO member states highly unlikely.

As just one example, the United States had in January submitted a draft WHA proposal for a series of pinpoint amendments to the International Health Regulations, the 17 year-old set of rules currently governing countries’ responses to health emergencies. Key among those was a tight 48- hour timetable for countries to report emerging threats – and another 48 hours for WHO to respond – something that can take weeks or months now.  

But final agreement on any IHR amendments is now likely to be punted to 2024, confirmed Switzerland’s Ambassador for Global Health, Nora Kronig Romero, in a media briefing on Wednesday.  

Agreement on a process for a process  

This year’s WHA is expected to agree only a process for making new IHR amendments – inviting all member states to throw their own reform proposals into the ring by 30 September, 2022.  

The proposals would then be negotiated, with hoped-for adoption by May 2024, according to the draft WHA decision, which has been leaked and circulated by civil society.  

It would be at least another year before any agreed-upon reforms actually take effect – keeping the status quo until 2025.  And that is only if this WHA session agrees to a companion measure that would reduce the waiting period in which new IHR amendments would actually come into force from two-years to one year.  

The conundrum of a pandemic treaty 

People wear face masks to prevent the spread of coronavirus as they commute inside a metro station at the height of the COVID-19 pandemic.

To make matters more complex, a separate, but related, Intergovernmental Negotiating Body (INB) operating under WHA mandate is supposed to be guiding the more comprehensive effort to  negotiate a new pandemic convention, treaty or other legal instrument. WHA agreed to take steps toward creating such a legal instrument in a special session in November 2021, and to set the stage for the INB negotiations, public hearings were held in April. 

The risk, however, is that member states may be forced to negotiate in two parallel processes, one supposedly “short-term” reforms in the IHR and the other a longer term process to create a new convention – without real clarity about how they are really related. 

That would be confusing for everyone – and particularly challenging for low- and middle income countries with more limited capacity, Dame Barbara Stocking, of the ad-hoc Panel for a Global Health Convention, told Health Policy Watch. 

“We’ve got concerns that we must not get two lines of negotiations going, because it makes it really difficult for low-income countries with limited mission staff in Geneva to keep up,” she said.  

To avoid duplication, member states need to decide firmly and soon if and how existing IHR rules, and any new amendments to the IHR, might be taken up into a new pandemic convention –  perhaps as a wholesale “protocol.” 

Leadership: Status quo at the top, and a reshuffle just below

WHO Director General Dr Tedros Adhanom Ghebreyesus is poised to be reelected for another term during this WHA session.

Against the paralysis of member states over pandemic reform, WHO Director General Dr Tedros Adhanom Ghebreyesus is expected to be re-elected for another five-year term during the WHA. Paradoxically, while Tedros is the first Director-General to be elected from an African state, his nomination to a second term was co-sponsored by Germany, France and other European states after he fell out of favour with the government in his home country, Ethiopia, due to his Tigrayan identity. 

There could, however, be changes elsewhere in senior leadership, in an effort to show major donors like the United States that the WHO is intent on becoming more “fit-for-purpose” in responding to emergencies, diplomatic sources have told Health Policy Watch. A reshuffle is likely to include the departure of Mike Ryan, who has led the agency’s pandemic response through two years. 

While supporters see Ryan as a dedicated professional, critics also say he has been unduly slow and cautious at key moments, as a loyal footsoldier to Tedros.

This has included criticism that it took too long for the WHO to declare a public health emergency for COVID-19, and then, the agency took months to acknowledge that the virus is “airborne”, leading to a very delayed recommendation for the public use of face masks.

Non-communicable diseases and more: The health crises that don’t make headlines

A draft WHO roadmap to reduce deaths from non-communicable diseases is expected to be discussed at the WHA.

Meanwhile topline issues like Tedros election, Ukraine and the COVID-19 pandemic may grab the limelight, but there are more than two dozen other core health issues before the Assembly, in what may be the heaviest agenda yet seen by the global health body.

These range from progress reports on cervical cancer elimination, polio eradication, and maternal and child nutrition, to neglected tropical diseases and ways to advance “One Health” approaches to reducing outbreak risks through better management of environmental risks. 

The WHA also will discuss a draft WHO roadmap for reducing deaths from non-communicable diseases (NCDs) by one third by 2030. Non-communicable diseases kill about 41 million people each year – equivalent to about 7 in 10 global deaths, according to the WHO.

The Sustainable Development Goal target 3.4 for reducing NCDs is already wildly ambitious in light of the world’s increasing taste for ultra-processed foods and unhealthy diets, sedentary lifestyles, as well as toxic chemical and air pollution exposures. But the roadmap, however detailed on traditional health issues like smoking cessation and screening, barely touches these other problems – mentioning air pollution, which kills 7 million people every year from NCDs, only in passing. 

There is also diminishing support from donor countries for initiatives to combat NCDs in low- and middle-income countries, where the highest proportion of deaths now occur – due to the huge drain on resources created by the Ukraine war. 

Resolution on clinical trials transparency  

Nathalie Strub-Wourgaft, Director of Neglected Tropical Diseases at DNDi.

Another initiative, being closely watched by medicines access advocates, is a resolution sponsored by the United Kingdom asking member states to require greater transparency in the reporting of clinical trial protocols and results from publicly funded research. 

Informal drafts of the resolution, which is not yet finalized, include measures asking member states that fund clinical trials to require: public posting of trial protocols in a reputable online database; and reporting of negative trial results – which often are buried. 

Civil advocates say such requirements are critical to ensuring research results can be relevant to the broad public good, and particularly low- and middle income countries. 

And to prepare for future pandemics, protocols for clinical trial reporting should also allow researchers to quickly and accurately aggregate from small trials of new treatments to better assess their impact,  Nathalie Strub-Wourgaft told Health Policy Watch, in an exclusive interview.  

DRC sexual abuse: New details

Ebola response workers in the DRC

The WHA will also review  a report from WHO Director General Tedros about the measures it has taken to respond to the sexual exploitation and abuse scandal involving WHO staff and consultants in the Democratic Republic of Congo, which was first reported in September 2020 by The New Humanitarian and the Thomson Reuters Foundation.

The update contains details of WHO’s measures taken to overhaul its culture and operations, including:

  • The WHO has funded support for 92 victims and survivors and children born as a result of abuse.
  • The WHO intends to enlist a women-led legal aid NGO to provide “full legal aid to up to 25 victims and survivors” in 2022.
  • As of February, some 13,000 staff and non-staff worldwide had completed a new, mandatory training programme on preventing sexual exploitation and abuse. 
  • There’s a new, global team of 15 people who are experts in conducting sexual misconduct investigations. About 70 percent of them are women.

An dedicated unit has been created in WHO’s Office of Internal Oversight Services (IOS) “to investigate the allegations of sexual exploitation, abuse, harrassment.” The creation of a  separate judiciary channel reporting directly to the Director General, generated some debate at the January Executive Board meeting, although EB members agreed to it exceptionally.  

The politics of procedure: Ukraine and Russia

A Ukrainian refugee family with 11 children entering Romania at the Isaccea border crossing in March 2022.

Before delegates even get to the core issues at stake at the WHA, however, they will have to get past the contentious issue of Russia’s invasion of Ukraine. 

That could rear its head on Sunday’s ceremonial opening day, when member states must approve the WHA’s “General Committee” that oversees the week’s proceedings. 

That committee was originally supposed to include Russia. But the WHO’s European member states, most of which staunchly back Ukraine, substituted Russia for Armenia at the last minute.  

Meanwhile, the General Committee will then be in charge of approving the agenda, likely to include a resolution being circulated by Ukraine, Canada, the United States, and the EU condemning the Russian invasion and calling for more WHO measures to address the health impacts. 

So if Russia objects to being excluded from the powerful committee, the assembly will face a very long roll call vote by all 194 WHA members – with African, Asian, and Latin American states forced to take sides over the geopolitical conflict on the opening day of the gathering. 

And if that is not enough, there may also be a dispute at the outset of the WHA over Taiwan’s request to be seated as an observer – a status that it was granted until 2016 at the invitation of the WHO Director General.

Since the election of a more hardline Taiwanese government, China has however opposed this ceremonial gesture, and Tedros has not dared to defy Beijing.  However, more recently a growing list of countries worried about China’s geopolitical ambitions have begun to support Taiwan’s quest for a seat.  This year, it includes the parliamentary reprsentatives of Germany’s governing coalition parties, who even made their support public.

See the links to the WHA agenda here and proceedings here: 

Image Credits: WHO, Germany's UN Mission in Geneva , UNICEF/Christine Nesbitt, @TheIndPanel, Flickr: IMF Photo/Joaquin Sarmiento, NCD Alliance, WHO AFRO, UNICEF.