As the World Health Assembly opens on Monday in Geneva, it will have to grapple with shrinking global health budgets, new outbreak threats, including a new WHO declaration of a public health emergency in Africa over an Ebola virus strain that lacks any vaccine, and an increasingly fractured geopolitical space with deep disputes over Iran, Ukraine, Gaza and Taiwan spilling into debates. 

With less than 24 hours before the opening of this year’s World Health Assembly, WHO Director General Dr Tedros Adhanom Ghebreyesus was faced with a new crisis-in-the making – declaring a new Public Health Emergency of International Concern (PHEIC) over an outbreak of a little-known Ebola virus strain in the Democratic Republic of Congo (DRC), which had already killed 87 people. More cases are now surfacing from Kampala in Uganda linked to the DRC outbreak. 

After having consulted the #DRC and #Uganda where the #Ebola disease caused by Bundibugyo virus is known to be currently occurring, I determine that the epidemic constitutes a public health emergency of international concern (PHEIC), as defined in the provisions of IHR.

My full… pic.twitter.com/zhYVEyxSI8

— Tedros Adhanom Ghebreyesus (@DrTedros) May 17, 2026

“Unlike for Ebola-Zaire strains, there are currently no approved Bundibugyo virus-specific therapeutics or vaccines. As such, this event is considered extraordinary,” concluded the Director General. 

The outbreak is but one indication of the formidable challenges WHO member states face as they convene on Monday for the 79th session of the WHA – in a world of deepening geopolitical fissures over regional conflicts, shrinking global health budgets, and sharp differences between rich and poor nations over how to even share vaccines and medicines during global health emergencies. 

Pathogen sharing annex to Pandemic Agreement delayed by a year 

The new Ebola outbreak, following an outbreak of the deadly hantavirus aboard the Hondius cruise ship as it sailed from Argentina across the Atlantic, has underlined once more the vulnerabilities that the world faces in confronting epidemic and pandemic threats. 

Both dramas began to unfold shortly after WHO member state talks stalled in early May over a critical agreement on pathogen and benefit sharing (PABS), intended as an annex to last year’s WHA Pandemic Agreement, and hailed then as a milestone of global solidarity. 

Given the impasse, PABS negotiators will propose a one-year extension to the talks at this year’s WHA, buying time to reach a critical accord that must be finalised before the overall agreement can begin to be ratified by member states.  

The PABS system aims to ensure that the genetic blueprints for dangerous pathogens are rapidly shared during the most severe, pandemic emergencies – but also the critical medicines and vaccines that lower-income countries need to confront such threats. 

The current deadlock, mainly between developed and developing countries, hinges on how countries with information on emerging pathogens might also benefit from any vaccines, therapeutics or diagnostics developed as a result of their help. Low-income countries aim to establish a baseline for the mandatory sharing of such benefits in standardized contracts between the WHO and pharmaceutical companies. But developed countries argue that compulsory benefit-sharing will stifle R&D for new products at the very time that the world needs it the most.

See related story:

Pandemic Talks Extended – But Colombia Appeals for New ‘Method’ to Settle Differences

Consensus is increasingly difficult at the WHA 

In the last round of PABS talks in early May, some member states led by Colombia appealed for a ‘new method’ for approving the agreement that departs from the traditional “all or nothing” consensus modes of negotiations – including voting in stages over portions of the text where there is general agreement. 

Consensus has become increasingly difficult to reach in a sharply polarized world, said WHO’s former Legal Counsel, Gian Luca Burci, speaking at a high-level WHA preview event convened on Sunday by the Global Health Centre of the Geneva Graduate Institute.  

“Consensus is difficult, and it can create imbalances,” Burci observed, noting that just one or two powerful nations can block agreement by all of the remaining WHA member states. “There are many different views. Is that a good approach, or is it sometimes better to vote? Because consensus gives a veto, and vetoes sometimes are used by big, powerful countries. It’s very difficult for a weak country to stand in the way, and so, in a way, it creates imbalances.”

The increased politicization of global health agendas has also led to more stalemates, stand-offs, and bitter member state confrontations, leading to more voting as well,  Burci noted. This year’s 79th session is likely to continue that trend. 

This session there will likely be the perennial debates over Taiwan’s WHA participation as a WHA  observer, including a draft resolution submitted this year by Belize and about a dozen other countries, primarily Caribbean and Pacific Island states; the health impacts of Russia’s war on Ukraine; and two overlapping reports on health conditions in the occupied Palestinian territory (OPT) – including one more focused on the immense toll of the recent Gaza war and increasing Israeli military and settler violence affecting West Bank Palestinian communities. 

Adding yet another conflict to the fraught list, the Gulf Cooperation Council’s member states last week asked the WHO’s Director General to hold a WHA discussion over the impacts of Iran’s recent attacks on the region’s states. The attacks have threatened vital health and water supplies; global trade in energy, fertilizer and medicines; and temporarily halted the operations of the WHO Hub for Global Health Emergencies Logistics in Dubai, the message stated.

“Disruptions to airspace and transport routes may affect the timely delivery of health assistance to countries in conflict or in need. Taken together, these dynamics may place additional strain on health systems globally, particularly in low- and middle-income countries,” the member states noted. 

A preliminary closed-door member state debate over the inclusion of Iran and Taiwan items, which are not on the formal WHA agenda, is thus set to consume most of Monday morning, on opening day. 

Responding to the US and Argentina withdrawal – and its financial fallout

WHO member states will also debate how to respond to the withdrawal of the United States and Argentina from the member state body last year. 

While both countries view their moves as final, other WHA member states could still refuse to recognize Argentina’s departure – insofar as the WHO constitution doesn’t really make provision for member states to leave.

The sole exception to that is the United States, which made the right to leave a condition of joining the WHA in 1948. But due to the non-payment of some $260 million in outstanding dues for 2024-2025, the US hasn’t legally fulfilled its own set of rules, under which it would withdraw from the global body. And that leaves the WHA response in uncharted waters.  

When the WHO Executive Board discussed the issue inconclusively in February, they did so on the basis of a WHO legal review, which was  “a rather forceful document saying that the conditions for withdrawal have not been met either by the United States or by Argentina,” Burci noted.

Even so, he anticipates that this week “a draft decision at the Assembly that basically acknowledges the withdrawal of Argentina.”  But as regards the US with its unpaid dues, “we’ll see what happens. People are exploring various possibilities to avoid antagonizing unnecessarily important countries… but you cannot kick the can down the road.”

One hint of an approach could be buried in another draft decision also before the WHA. This would “suspend”the  US voting privileges if the back dues are not paid by the opening of the next Assembly in May 2027 – in language that ignores the US announced withdrawal altogether. But in this case, the WHO’s largest member state donor would not be singled out alone. The suspension would likewise be imposed on eight other developing countries with unpaid dues, including: Burundi, Djibouti, Equatorial Guinea, Nigeria, Panama, San Tome and Principe, Timor-Leste, and Turkemistan.

WHO’s finances and global architecture reform

WHA members will also hear more about the state of financial play at WHO following the agency’s dramatic budget rollbacks that followed the departure of the US, until then the WHO’s largest member state contributor.    

The good news is that following reductions of nearly a quarter of its workforce, WHO’s $4.2 bilion budget for 2026-27 is now 90% funded, according to a report by the Director General to the member state Planning and Budget Committee (PBAC), which met just ahead of WHA. At the same time, the figure includes $739.8 million in projected resources from commitments that have not yet been definitively secured, the WHA report notes.

Meanwhile, WHO and other global health institutions have yet to respond actively to the challenges posed by the larger global health funding squeeze faced by low-and middle-income countries in an era of sharply declining aid contributions by major donors, including the United Kingdom and Germany, as well as the USA.  

And increasingly, donors as well as developing countries have clamored for reforms in the way global health and aid programmes are organized and managed. Developing nations want to restore national “sovereignty” over health systems – while donor nations, under increased budget strains of their own, want to make programmes more financially self-sustainable over time.

 “The language that … I’ve been using in the past two years with my member states, is: How can I help you get rid of us? How can I help you not need us anymore?” said Hanan Balkhy, Regional Director of the Eastern Mediterannean Regional Office, a keynote speaker at the Graduate Institute event. Balkhy has also been mentioned as a potential candidate in the elections of the next WHO Director General in 2027 – and her carefully calibrated remarks, moving from regional to global challenges did not dispel that impression.

“We are living through the most significant reconfiguration of the multilateral system since the inception in 1945 and let’s be honest, if we were designing the global health architecture today, its mandates, financing structures, and governance arrangements, we would build it differently,” said Balkhy, arguing for a kind of back-to-basics approach where global institutions refocus on “norms and standards, surveillance, emergeny preparedness and equitable access to innovation,” while countries regain control over their own national priorities and service delivery.

“The old order is not coming back. We should not mourn it. Nostalgia is not a strategy.”

WHA initiative on global health architecture reform ‘lacking ambition’ 

This week the Asssembly is due to review and approve a joint UN-WHO process to support review and reforms in the “global health architecture” .  It represents the first formal WHO foray into the much-hyped ‘global health architecture’ arena – one which has already spawned its own new acronym – GHA.  

But the WHO initiative lacks ambition in terms of actually taking a hard look at the institutional mandates and how they could be streamlined, said Wellcome’s CEO, John-Arne Røttingen, also speaking at the GHC event. He noted that the WHA mandate doesn’t extend to any serious examination of the oft-competing roles and responsibilities of the UN’s global health institutions. These institutions include not only the WHO, but also UNAIDS, UNICEF, UNDP, UN Women, and the UN Population Fund (UNFPA).  

“I am concerned about the risk being that we are not bold enough, really, and that we become incremental instead of going for bolder reforms,” Røttingen observed. “I’m really concerned about the current drafted mandate for the joint WHO process, because it’s really, from an architecture point of view, about changing the wallpaper and the colors of the painting.

“It’s clearly said that the process should not look at roles and responsibilities for the individual organizations, it should not propose any institutional change across organizations. In a way that takes out all of the ambition of the process,” he said, then issuing a challenge to: “member states in the room, you still have five days to fix that – go ahead.”

Reforms also need to go far beyond the UN and the global health sector 

At the same time, reforms need to go far beyond making global health institutions more efficient. They need to ensure that national health systems regain “sovereignty” over their health services in terms of both financing and programmatic control, pointed out Magda Roballo, co-chair of the UHC 2030 Steering Committee, also speaking at the GHC event. 

And that can only happen through bigger changes in trade, debt structures, and employment.  

“The health ecosystem depends on structures that have been built over eighty years,” she noted, “and they all have a major influence on health. If we don’t look into the bigger picture, that’s a very high risk to health reform,” she said. 

“It is true that as health agents we don’t have the power to change what is going to happen in the fiscal and the financial space, but we need to interact with the reforms in the global financial architecture and the UN 80 initiative, if we are going to change what is the landscape for the future of the health sector.”

Speaking later to Health Policy Watch, Roballo cited the dominance of informal labor systems in Africa and other LMICs, and related to that, outflows of untaxed revenues and capital from industries and commerce as key issues. These, in turn, are closely tied to global trade and tax policies and norms, as well as financing frameworks. 

“There is no way we can generate domestic resources and break the cycle of dependency if we are not able to reform the financial system,” she said. 

”There is more money that goes out of our continent than what comes in as ODA, which means there is money,” she said.  “We just need to find better ways of using that money, generating more money, fresh money, not just recycling, in order to invest in our health systems,” she said. 

“You’re talking about intellectual property, about market forces that don’t make it easy for Africa to build its own industries, and then be able to generate not only employment but locally produced goods, rather than spending money importing things that we can produce locally.

“It’s a matter of Health sitting in [meetings of] Foreign Affairs because they understand that health is an important foreign relations topic, … and in finance, security and other platforms.” 

Health sovereignty, yes, but we can’t really do it alone? 

More profoundly, both rich and poor nations still have to come to terms with the fact that while health ‘sovereignty’ is an increasingly popular slogan today in many nations, countries remain deeply interdependent in terms of the health security everyone craves, added GHC Director Suerie Moon, at the event. 

And this requires cooperation on almost every front – from the financing of health systems to the health products nations produce and consume, the capacity to conduct surveillance, research, and collaborations that protect everyone better from disease threats. 

“COVID kick-started this move towards “health sovereignty,” and recent events have made some hit the accelerator,” she said. “However, the desire for health sovereignty is bumping up against the hard reality of health interdependence. No country can fully protect the health of its people on its own. 

“Just two recent examples illustrate how. The closure of the Strait of Hormuz is disrupting supply chains for lifesaving pharmaceuticals and humanitarian assistance. It also means fertilizers will not reach many farmers during planting season, creating acute food insecurity for 45 million people. A war taking place in one region is posing new challenges for health worldwide.

“As a second example, passengers and crew of the MV Hondius where the hantavirus outbreak occurred, were of 23 different nationalities. Efforts to repatriate them and contain the outbreak have involved around 30 [countries]. Within a short timespan, this outbreak on a single ship directly affected the Americas, Africa, Europe, and Asia.

“Both of these examples remind us that countries cannot address health threats without relying somewhat on others. The paradox is that health sovereignty can only be achieved by strengthening how we govern health at the international level.”

–Updated 18 May.

Image Credits: @WHO African Region, BBC, Diana Jalea, GHC , Anonymous/HPW, Health Policy Watch .