The United States described a four-pronged strategy to accelerate the eradication of polio globally at the WHO Executive Board session on poliomyelitis on Thursday.

No. 1: Halt circulation in Afghanistan, Pakistan

The first action, the U.S. representative said, would be the intensification of efforts to halt the circulation of the wild poliovirus in Afghanistan and Pakistan by the end of December 2024. Synchronised campaigns across borders would be imperative, with the representative noting, “Decisive action now can pave the way for a polio-free future.”

No. 2: Surveillance, campaigns, community engagement

The second action would be closing surveillance gaps, conducting high-quality campaigns and community engagement in the African region, where there continues to be persistent variant polioviruses.

“These are not just strategies; they are indispensable keys to our success in eradicating polio globally,” the representative said.

The U.S. also urged member states to support incremental measures for rebuilding capacity in high-risk countries. The representative highlighted the unique challenges faced by these countries, calling for solidarity and support to rebuild health infrastructure.

The United States speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
The United States speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

No. 3: Alignment of eradication, containment efforts

The third pillar calls for alignment of eradication and containment efforts.

“Eradication and containment must go hand-in-hand,” the representative said.

All member states were urged to intensify actions to speed up the progress of poliovirus containment and certification.

No. 4: Immunisation

Lastly, the U.S. underscored the importance of integrating polio eradication efforts with routine immunisation activities.

Recognising the challenges of reaching communities not responsive to standalone polio campaigns, the representative said, “Integration with routine immunisation is crucial to reaching every child, even in the most remote areas.”

Reiterating support for a comprehensive approach, the U.S. urged donors to expedite and increase their contributions to polio eradication.

“Continued investments are not just essential; they are the lifeline that ensures we reach all children, multiple times, and ultimately end the polio scourge globally,” she said.

Tackling persistent challenges

WHO member states stressed the global commitment to fighting the spread of polio.

The Afghan representative addressed the specific challenges his country faces in eradicating the disease from the country. He said that despite some successes, the country faces several impediments to implementing crucial house-to-house campaigns, an important component of any polio eradication strategy.

“The inability to conduct these campaigns jeopardises the effectiveness and efficiency of our collective effort to eliminate polio on the ground,” the representative said.

He added that there was a negative impact from not being able to reach vulnerable children specifically. And he stressed the need for national ownership over the polio eradication program and collaboration with international institutions, as well.

Afghanistan speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
Afghanistan speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

The Afghan representative also called for investments in human capital, highlighting the pivotal role that the right professionals can play in eradicating the disease and ensuring it remains eradicated. The representative also noted that technology could revolutionise the program, making data collection, monitoring, and response strategies more efficient.

Challenges in the Eastern Mediterranean region

Yemen, speaking on behalf of the member states of the Eastern Mediterranean region, acknowledged the progress made in reducing poliovirus circulation in 2023. However, challenges persist, the representative said, particularly in preventing the virus from gaining a foothold in previously identified reservoirs.

The representative stressed, “We must reach all children with polio vaccines and strive to prevent other vaccine-preventable diseases.”

The call for global solidarity and action was reinforced, urging the WHO to provide financial assistance to countries facing internal and external obstacles, including those managing refugee influxes. The importance of routine immunisation and vaccination campaigns against polio was emphasised, particularly in regions like Yemen.

African region’s concerns and call to action

Representatives from the African region expressed gratitude for poliomyelitis being placed on the WHO Executive Board agenda, highlighting the collective efforts to end polio circulation. Concerns were raised about the persistent circulation in specific regions of the Democratic Republic of the Congo. Delays in introducing the polio vaccine and challenges in the move to the novel oral polio vaccine were also noted.

Comoros speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
Comoros speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

Comoros, speaking on behalf of the African region, urged countries to act on recommendations, improve information campaigns, and ensure vaccination coverage, especially for low or zero-dose children. The increased risk of a major epidemic outbreak due to a drop in immunity across the continent was described as a significant concern. The representatives called for further mobilisation of resources to implement strategies preventing cross-border and international transmission.

The world’s only public health emergency of international concern

Aidan O’Leary, director of Polio Eradication at WHO, while commending member states and partners for their commitment and support, highlighted the significance of the ongoing efforts.

“Polio is the only public health emergency of international concern in the world as we speak today,” O’Leary said.

He emphasised the collaborative nature of the fight against polio, noting the vaccination of over 800 million children globally in 2023.

The director also stressed the importance of vigilance in surveillance in the face of emerging variants concentrated in specific regions. He reiterated the challenge of reaching zero-dose children and the necessity of maximising coverage through innovative delivery modalities. O’Leary also emphasised the ongoing innovation at every level, citing the prequalification of the novel oral polio vaccine as a significant milestone.

“We are committed to making every effort [in] … 2024,” O’Leary said.

Meanwhile, WHO Director-General Dr. Tedros Adhanom Ghebreyesus described the final leg of the polio eradication journey as the most challenging.

Despite the difficulty, he conveyed optimism, stating, “The finish line is within reach.”

WHO Director-General Dr. Tedros Adhanom Ghebreyesus reveals the WHO report on poliomyelitis eradication at the Executive Board meeting on January 25, 2024.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus reveals the WHO report on poliomyelitis eradication at the Executive Board meeting on January 25, 2024.

In his report on poliomyelitis eradication, Tedros called for the implementation of risk mitigation strategies in highest-risk polio-free areas, notably in the Afghan city of Kandahar. He also revealed the ongoing conflict in Sudan “continues to hamper the response to the new outbreak of circulating vaccine-derived poliovirus type 2, detected in 2023.”

To direct future polio transition efforts, Tedros’ report revealed a post-2023 strategic framework for polio transition is already being developed, and it is based on a theory of change and will build upon lessons learned from the strategic action plan on polio transition (2018–2023).

“The operationalisation of the framework will begin in 2024; it will be closely aligned with evolving epidemiology and polio eradication timelines, and will address the recommendations of the Polio Transition Independent Monitoring Board outlined in its most recent report published in July 2023. This work is essential to ensure that the eradication gains once made are sustained,” the report stated.

Focus for 2024 and beyond

In 2024, the report revealed the focus of the WHO will be on updating the polio post-certification strategy, with the aim of “aligning it with updated eradication timelines and reflecting new developments in post-certification policy, strategy and research.”

The strategy will also be aligned with the post-2023 strategic framework for polio transition.

“Working groups have been established for each key thematic area. During this process, efforts will be made to identify and apply lessons learnt from the 2016 switch from trivalent oral polio vaccine to bivalent oral polio vaccine in routine immunisation programmes, in support of preparations for the eventual cessation of all oral polio vaccine use from routine immunisation programmes,” the report stated.

Following the successful eradication of wild polioviruses globally, the report revealed that the use of all remaining oral polio vaccines in routine immunisation programmes will end. The aim of this action, the DG reported, is to eliminate the risk of vaccine-derived polioviruses.

Image Credits: Screenshot.

WHO Director General Dr Tedros Adhanom Ghebreyesus  choked back tears at end of lengthy EB session, during appeal for peace in Gaza.

Poland on Thursday suggested that it might be better to delay the approval of a new World Health Organization (WHO) pandemic accord, beyond the planned May 2024 deadline – so as to get to an “ambitious, clear and consistent” agreement.  

The Polish trial balloon seemed to break ranks with the drumbeat of recent statements by WHO and other member states that negotiations should conclude this year – even if the present pathway to rapid agreement seems strewn with obstacles – including only a few more planned meetings of WHO  member state negotiating teams.   

Poland’s comment came during a marathon 12-hour WHO Executive Board meeting Thursday that veered sharply from topics such as pandemic preparedness and biosafety to the Gaza and Ukraine war, with the latter dominating most of the day’s session. 

‘Lies’ and Entrenched Positions Undermine WHO Pandemic Negotiations

“It’s very important, especially in reference to a future pandemic treaty, to have an ambitious, clear and consistent document, which will really contribute to the prevention of future crises,” said the Polish delegate in remarks about the member state negotiations over a new pandemic accord and revisions in the International Health Regulations (IHR), which are supposed to be completed by May 2024.  

“And here I would like to share with you our concern that it would not be beneficial if time pressure leads to a weakening of our ambition, and the quality of the final document.  It is time to ask if we will be ready to present an agreement on a draft pandemic treaty by May 2024?” 

Norway, however, appeared to push back against Poland’s suggestion that the deadline for conclusion of a pandemic accord be delayed. 

“The deadline for INB and IHR negotiations must be used as a historic opportunity to ensure the world is better able to prevent and respond to pandemics,” said the Norwegian delegate. 

Other countries reaffirmed their commitment to reaching an accord without stating a date. 

“On the pandemic accord, the United Kingdom remains committed to reaching agreements with other member states,” stated the UK. 

Palestine accuses Israel of genocide; Israel charges WHO of ‘collusion’ with Hamas

Gaza and Ukraine are only two amongst the more than dozen Grade 3 health emergencies related to conflict, climate and disease outbreaks that the organisation is coping with right now.   The EB discussions reflected the deep demands now being generated by conflicts – as compared to a virus – on the time of the WHO governing bodies, as well as the technical work of the global health agency.  

And the sharp geopolitical rifts that seem to have plagued the global body even more severely since the winding down of the COVID pandemic were again plainly evident Thursday.

Listing of WHO Grade 3 Emergencies as of September 2023, before the outbreak of the Hamas-Israel war

In the EB debate over Gaza, Palestine, a WHO observer state, accused Israel of carrying out deliberate attacks on civilian populations and health facilities during its invasion of Gaza in military actions amounting to “genocide” – an issue now before the International Court of Justice in The Hague. On Friday, the ICJH issued an interim ruling that Israel must take more active measures to prevent indiscriminate killing and ensure basic services and humanitarian reaches Gaza Palestinians – although the court stopped short of ordering Israel to halt its military campaign.

Israel, meanwhile, accused WHO of  “collusion” with Hamas, turning a blind eye to the use of hospital infrastructure for military aims and concealment of Israeli hostages.  

Neither WHO Health Emergencies Director Mike Ryan nor Director General Dr Tedros Adhanom Ghebreyesus responded to the Israeli charges against the global health agency at the EB session, although Tedros on Friday issued a denial on X (Twitter). 

“No one and nowhere is safe in Gaza. So far around 26,000 people have died, 8000 are missing, and close to 64,000 are injured in the conflict, and 1.7 million people are displaced,” said Tedros, repeating calls for a cease fire.

“If we look for a solution, it’s always possible. It’s only the will that’s required, and I’m a true believer because of my own experience that war doesn’t bring solutions – except more war, more hatred, more destruction.

Fighting back tears at the reference to his own childhood in a war-torn region of Ethiopia, now in Eritrea, he pleaded: “So let’s choose peace. Let’s resolve this issue politically.”

Gaza humanitarian crisis 

France calls for “immediate and sustainable cease-fire” in Gaza.

Discussions on Gaza focused on WHO’s latest report on Health Conditions in the Occupied Palestinian Territories, describing barely functioning Gaza hospitals, and a civilian population trapped by war, hunger, thirst and displacement. A slight technical revision to an EB resolution on more humanitarian aid to Gaza, already approved in a special EB session in December, was approved. 

A large bloc of Islamic and Middle Eastern countries, supported by the African Region, and Cuba, Colombia, Nicaragua and Venezuela, blasted Israel’s conduct of the war, with some, such as Cuba and Colombia, also describing Israel’s actions in Gaza as tantamount to war crimes. 

The United States, Germany and most other European nations focused on the urgency of getting more humanitarian aid into Gaza. They also called for Hamas to release the more than 100 Israeli and foreign hostages still held in Gaza, after a November cease-fire broke down. Around 240 hostages were taken by Hamas in its bloody 7 October incursion into Israeli border communities, which killed 1,200 people and triggered Israel’s military invasion. 

France called for an “immediate, sustainable cease fire” while the United Kingdom spoke in terms of an “immediate humanitarian pause as a vital step towards building a sustainable, permanent cease-fire.” 

A few states, notably Germany, Belgium and New Zealand denounced Hamas actions, directly or indirectly.  

“We reiterate our condemnation of Hamas terrorist attacks, including the systematic use of sexual violence and the abuse of hospitals and civilians as human shield,” stated Germany, which also referenced “the right of Israel to defend itself in line with international humanitarian law.”

“Medical facilities must never be used for military purposes, and must never be the object of attack,’’ added New Zealand’s delegate.  

Gazans have no health or human dignity 

Ryad Awaja Aouadja, Consul at the Palestinian Mission to the UN in Geneva

For their part, both Israeli and Palestinian delegates described the impacts of the war-time violence in highly emotive terms.  

Palestinian delegate, Ryad Awaja Aouadja, described the how a young female double amputee had to be carted to a makeshift toilet in a refugee camp by her parents.

“I have no words to describe what is happening in the occupied Palestinian territories,” said Aouadja.  

“The whole world knows about the humanitarian disaster there, the catastrophic health situation in the Gaza Strip. And we’re still hearing pretexts, justifications, supposedly for the occupation, justifications for the destruction committed by the occupying power,” he said. 

“How can we accept this devastation, this genocide, the total destruction of health establishments and facilities?

“How can you talk about health and human dignity when what you are seeing is a situation where the rights of Palestinian women and girls to get sanitary napkins to get nappies are being denied?…. And you have so many dead, most of them women and civilians? 

“Where is health? Where is hygiene? Where’s dignity when you have a young girl who’s had to have her legs amputated and be carried by her parents to some kind of toilet? … We have 1.5 million people who’ve had to leave their homes because their homes have been destroyed by the occupying powers and they’ve had to go and live in overcrowded refugee camps,

“We know that for 75 years now, we’ve had the occupation going on there,” added Aouadja, referring to the 1948 Arab-Israeli war that followed the UN partition of Palestine and the creation of the state of Israel.

“…Talking about self defense no longer makes any sense. We’re just talking here about collective punishment about vengeance, about genocide against the Palestinian people,” Aouadja added.

“If you look anywhere on the internet, you can see that that is the case…. I therefore call on the international community to shoulder its humanitarian, ethical and moral responsibility to put an end to this military aggression to put an end to this violence,” he concluded, drawing applause from several dozen EB participants at the end of his comments. 

Israel – WHO ‘collusion’ with Hamas 

Waleed Gadban, Consul at the Israeli UN Mission in Geneva

Israel’s ambassador, Meirav Eilon Shahar, quoted testimony by former Israeli hostage Moran Stela Yanai, who described being taken to a Gaza hospital on 7 October, after being beaten and abducted from a music festival – where she was examined by a Gazan physician who “knew I was kidnapped and did not do anything.”

Shahar also cited Israeli military reports of Hamas tunnels, munitions and weaponry found in and under at least five major Gazan hospitals, including Shifa and the Indonesian Hospital, where corpses of five Israeli hostages also were found. “Every single hospital that the IDF searched in Gaza, it found evidence of Hamas’ military use,” charged Shahar. “Hamas has militarised the entire civilian area of the Gaza Strip, as a matter of premeditated strategy.”

View interactive compilation of Hamas abuse of hospitals >> 

“These are undeniable facts that WHO chooses to ignore time and time again. This is not incompetence; it is collusion. The WHO knew hostages were held in hospitals and that terrorists operated within. “Even when presented with concrete evidence of what was happening below ground and above ground, about the weapons, the headquarters, the closed rooms, WHO chooses to turn a blind eye, jeopardising those they are meant to protect,” she said. 

Her comments were refuted by Tedros in an X post on Friday – sparking yet another round of exchanges.  

At the conclusion of Thursday’s session on Gaza, Israeli delegate Waleed Gadban, described the EB debate on Gaza as a “masquerade with no limits.” 

“Syria bombarded more than half of its own civilian population and Israel facilitated access to more than 10,000 trucks into Gaza and no one has mentioned that,” said Gadban, an Israeli Druze who delivered his closing remarks in Arabic.

“In Yemen, people are suffering from famine… We need to call a spade a spade. Iran launched a humanitarian appeal for the people in Gaza. I can tell you that the people in Gaza would be better off if Iran didn’t furnish weapons to terrorists.”  

Russia and Ukraine 

Ukraine’s delegate to the WHO Executive Board

Later Thursday, a WHO update on the health and humanitarian situation in Ukraine, following on from  2022 and 2023 World Health Assembly resolutions denouncing Russia’s 2022 invasion, served as the focus for yet another politicized debate over health as a casualty of war during the Thursday session. 

Russia blasted the WHO follow-up  report as unnecessary and “politically motivated” by NATO allies.

In his closing remarks, Tedros told the Russian Federation that WHO had maintained “strict neutrality” in its follow-up on the Ukraine health and humanitarian situation.  

The WHO report details some 1,300 Russian attacks on health care facilities in Ukraine, since the start of the conflict. However, the health system, while damaged, remains functional with “92% of all health facilities intact,” said WHO’s Ryan. He noted that over $72 million worth of medical supplies has been delivered to health facilities and another $51 million is in the pipeline, with nearly 200 aid convoys and 100 WHO missions since the conflict began.  

“This represents one of the most intense,  one of the most sustained, comprehensive responses to any humanitarian crisis. I believe that WHO has ever been able to mount,” he said. 

Both Moldova and Denmark expressed concerns about the safety of Ukraine’s Zaporizhzhia  nuclear reactor in the wake of Russia’s purported destruction of the Kakhovka dam in June, 2023, which lowered water levels in a reservoir around the nuclear power plant that supplies cooling water for the reactor and its spent fuel. 

Denmark, speaking on behalf of Ukraine, the European Union and about dozen other non-EU European states, noted that over the past weeks, Russia has intensified its attacks in Ukraine “As a consequence, Ukraine’s health system and access to critical health care services, medicines and treatment are severely compromised.” 

Other European countries denounced the ongoing conflict, with Poland describing it as an “illegal and unprovoked” war perpetrated by Russia.

Slovakia, however, also called on the international community for renewed efforts at peace negotiations in a war-weary region “to support the end of this conflict which is putting at high risk of death or certainty, unsafe environment for the house the development of children and adolescent and promoting the health of families that are divided and experiencing poverty due to social determinants, and worsening mental health.” 

Russia denounces WHO report as ‘politically motivated’  

Russia denounces the EB debate as politically motivated.

The Russian Federation, meanwhile, denounced the WHO report and debate as indulgence in “anti-Russian propaganda” saying that “representatives of NATO countries for the second year in a row are insisting on the inclusion of this item on our agenda, with only one purpose, that of getting airtime to allow them to recite a litany of baseless allegations against Russia. 

“Their governments at the same time, are supplying Ukraine with lethal weaponry that is being used against civilians in peaceful towns, and also against health infrastructure,” said the delegate to the EB. 

“The fact is that in accordance with data from the International Statistical Institute, in the world, in 2023, there were 183 regional conflicts, apart from Ukraine. Judging by the WHO classification, there are 16 acute and protracted emergencies that are grade three for emergencies.

“Just a little earlier, countries were obliged to cram into three minutes, their position on all these emergencies, on the work of WHO, and also on the pandemic agreement and amendments to the IHR [international health regulations]. And now they have another three minutes on Ukraine alone,” said Russia’s delegate.  

Board makes only fleeting reference to health crises triggered by other global conflicts

Dr W. Majrooh, Afghan delegate to the EB

Meanwhile, amongst the nearly dozen conflict-related Grade 3 emergencies cited in the WHO report, only fleeting reference was made by Board delegates to other global hotspots, such as Sudan, Syria, Afghanistan, Yemen and Haiti at the EB session on health emergencies that continued for hours throughout Thursday.     

“It seems that Afghanistan has dropped off the map,” complained Dr W. Majrooh, the delegate of Afghan’s government in exile, at one point. He noted that Afghanistan continues to face “historical susceptibility in both man-made and natural disasters.” 

Majrooh urged WHO to “not only keep the health emergency preparedness and response capacity in Afghanistan, as it is top priority but to actively engage with the current leadership to make them realise the significance of this matter.”  

  • Updated on 27 January with references to official quotes and news developments on Friday.
Swiss global health ambassador Nora Kronig Romero speaks about the Health and Peace initiative at the WHO Executive Board meeting Thursday.

WHO Executive Board delegates on Thursday gave the green light to a draft proposal by Switzerland cementing the framework for a new WHO “Health for Peace” initiative.

The move marked a bright spot in a day otherwise marked by heated debates over regional conflicts, including Gaza and  Ukraine. 

The Health and Peace initiative was first proposed in 2020 by WHO’s Director General, who grew up in a war-torn region of Ethiopia, now in Eritrea, whose remarks then – “there can be no health without peace and no peace without health” – became a slogan for the initiative. 

A “roadmap” for rolling out the initiative came before the World Health Assembly in May 2023, and was “noted” by the member state body.

The draft decision, which provides a more framework for the WHO approach to the issue, would represent a more formal seal of approval by member states, should it get the go-ahead in May.

And that approval has been slow in coming due to member state fears that such an initiative could be politicised and overlap with the work of other UN agencies.

“Our Constitution, your constitution, says the health of all peoples is fundamental to peace and security. Therein lies the mandate for this activity,” WHO’s Executive Director for Health Emergencies Mike Ryan told the EB, summarising the rationale for the initiative. 

“Health can build trust, helps prevent conflict. Health can sustain peace.” 

WHO Executive Director of Health Emergencies, Michael Ryan

In his remarks, Ryan pledged that the initiative would build locally-relevant programs that support peace-building while avoiding further politicisation of the health sector and its role. However, some countries were still not convinced.  

China, while not directly opposing the initiative, reflected some of still lingering reservations amongst some member states, stating,  “We should follow the principle of the member states-driven respect to national sovereignty, non- interference in internal affairs and the member states consensus. 

“We should have respect for different national conditions,” said the Chinese delegate, urging further clarification of “specific goals…content and outcome evaluation indicators,” as well as analysis of the “division of labor of other UN agencies and global health organizations, to avoid duplication by WHO and resource waste. 

Brazil expressed hesitations as well, saying:  “Let me reiterate the concern of my country with the securitization of the health agenda. 

“We have seen in our debate on the previous item. How issues of health continue to be used by some members to advance political speeches, the same members that selectively complain about the politicization of the EB agenda and say it needs to be streamlined. 

“Health is not and shall not be a security issue, but instead should be considered as a core part of the sustainable development agenda.” 

The decision, which still must go before the full World Health Assembly in May, received strong support from many other diverse quarters ranging from the Maldives to the United States and Afghanistan. 

“As we have heard repeatedly throughout the interventions in the preceding agenda items today, the importance of global peace and its intricate correlation to help cannot be overstated. The roadmap would pave the way for the creation of health programs that are both conflict sensitive, to focus on young persons’ awareness and capacity building in mainstream directions are important,” stated the Maldives delegate to the EB. 

“We find ourselves at a historical juncture where the world is stuck in unprecedented global disorder,” said  Dr W. Majrooh, representative of Afghanistan’s government in exile, “A mess created by politicians – in this climate the only community that spans from the village to the international level and is still fairly trusted, is the health community. It is not just a privilege but a historical responsibility.

“I implore you to recognize the untapped potential within our healthcare community, from the frontline campaigns to the institutional capacity of the World Health Organization. 

“Now more than ever, we must step out of our comfort zones, fill the gaps left by violence and politicians and  become the bridge to the real advocates of health and  peace.”

Image Credits: WHO/Sean Hawkey .

WHO executive board members take an exercise break.

Discussion about non-communicable diseases (NCDs) opened a Pandora’s Box of problems at the World Health Organization’s (WHO) executive board meeting on Wednesday.

Not a single country is on track to achieve all nine voluntary global NCD targets for 2025, according to the Director-General’s report, which appealed to member countries for input on how they can accelerate progress towards reducing premature mortality from NCDs by one-third by 2030 (Sustainable Development Goal target 3.4).

New proposals to improve measures to protect mental health in armed conflicts, and increasing the availability of organ transplants in global NCD measures were also presented for further discussion.

“The mental health and psychological needs of people affected by armed conflict. natural and human caused disasters and other emergencies require actions beyond those identified by the WHO comprehensive mental health action plan 2013-2030,” said Ukraine, which has proposed a new resolution, supported by the Netherlands, which will be tabled at the World Health Assembly (WHA) in May.

However, most member states acknowledged that efforts to address mental health in everyday life was inadequate.

“Mental health conditions encompass a multitude of illnesses that need to be recognised, diagnosed and treated,” noted Denmark, which urged WHO to work to “better ensure that mental health is recognised in its own right as a key global health agenda”. 

“Mental health is essential but constantly constantly challenged by stigma, discrimination, conflict and dynamics and natural hazards. We owe it to our children and young people to take this seriously,” Denmark concluded, thanking WHO for it’s recommendation to decriminalise suicide.

Organ transplants

Spain, supported by Brazil and China, co-sponsored a recommendation to “increase the availability, ethical access and oversight of transplantation of human cells, tissues and organs”. 

Spain told the EB that only around 10% of transplant needs were met globally, and that expanded access could reduce NCD mortality.The resolution, which has consensus, will be tabled at the WHA.

A plethora of other concerns were raised by countries, including lack of access to oral care globally, inadequate targets for dementia.

Many countries also focused on how to address key NCD drivers more efficiently – tobacco, alcohol, poor diet and lack of exercise.

While many countries have been successful in reducing tobacco consumption, less progress has been made against alcohol consumption and poor diet.

Senegal, for the 47 Africa region members, called for support to collect data on NCDs “so that policies can be based on under scientific evidence”.

It also called for  “more financial resources to promote health and prevent these conditions through strengthening innovative financing mechanisms including tobacco taxation, and the taxation of sugary drinks and alcohol and indeed, developing public-private partnerships,” noted Senegal.

Japan pointed out that targets in the dementia global action plan for diagnosis and treatment would be missed in 2025, and  requested that the plan be extended after 2025. 

A fourth United Nations high-level meeting on NCDs has been planned for September 2025, and the current WHO decisions on NCDs will feed into this.

Test tube rack stocked with electronic cigarettes.

World Health Organization’s (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus lauded the success of tobacco control measures at the Wednesday evening session of the Executive Board meeting, but expressed concerns about the growing use of harmful products like e-cigarettes among youth.

He urged member states, “to take swift action to counter this emerging threat” of children being targeted and potentially being made to be customers of the tobacco industry for life.

“Children as young as 10-14 years are vaping because it’s fashionable and it comes in different flavours and colours,” he said, adding that peer pressure was driving this trend – as it had driven cigarette smoking.

“History is repeating itself — the same nicotine but in a different form, a different packaging. And the sad part is this: the industry is saying it’s harm reduction but what has harm reduction got to do with children? To call it harm reduction and deliberately recruit children and use schools as a battleground is dishonest,” he added.

WHO Director-General Dr Tedros Adhanom Ghebreyesus

China showcased its commitment to combating Non-Communicable Diseases (NCDs), placing particular emphasis on tobacco use.

“China has established a sound mechanism for the comprehensive prevention and treatment of chronic diseases,” said the Chinese representative. They highlighted efforts in “improving monitoring systems, early screening, and comprehensive interventions for major health concerns.”

Although progress continues to be recorded in declining the use of tobacco, member states called for strengthened regulations around tobacco and nicotine products, considering that the efforts are crucial for the health of future generations.

Denmark, meanwhile, threw its full support behind the European Union’s focus on tobacco control and mental health.

The country highlighted a recent political agreement aimed at reducing the consumption of alcohol, nicotine products, and tobacco among children and adolescents. Denmark emphasized the importance of addressing risk factors like tobacco use, with a representative stating, “Ambitious control policies, especially concerning emerging tobacco products, are essential to protect the health of our younger population.”

Maldives also expressed its commitment to addressing tobacco use. The Maldives representative highlighted the nation’s national high-level coordination mechanism, recognizing the challenges faced by small island states in tackling commercial determinants of NCDs.

“Often, we are helpless in addressing the determinants of NCDs, particularly those commercial determinants,” said the Maldives representative, urging WHO to work closely with small island states.

According to the DG’s report on the prevention and management of non-communicable diseases, promotion of mental health and well-being, and treatment and care of mental health conditions, reducing exposure to risk factors in the population is essential for the cost-effective reduction of NCD burden and mortality.

Even though the report stated that 56 countries are currently on track to meeting the voluntary global target of a 30% relative reduction in tobacco use between 2010 and 2025, the DG noted that the rate of decline in the prevalence of tobacco use in all WHO regions and globally is insufficient to meet the voluntary global target for 2025, especially among men. Of around 1.3 billion people still using tobacco, 82% (1.1 billion) are males.

WHO’s Executive Board discusses the prevention and control of non-communicable diseases.

En route COP10

Meanwhile, country representatives are gearing up for the upcoming Conference of the Parties (COP10) in Panama, where discussions around cigarette regulations will be at the forefront. The focus is expected to be on the accountability of tobacco companies and the detrimental impacts of extensive lobbying by the tobacco industry.

Sabina Timco Lacazzi, WHO’s Legal Officer, emphasized that “Tobacco is and continues to be a threat” not only to human life and health but also to the planet.

The meeting will take place from 5 – 15 February, bringing parties together for the tenth time to oversee the implementation of the WHO Framework Convention on Tobacco Control (FCTC) and its special protocol on illicit tobacco trade.

Over a fifth of the world’s population, with the majority in low- and middle-income countries, uses tobacco, leading to over eight million deaths annually, according to the WHO. Despite a decline in the number of tobacco users, the industry’s lobbying efforts often hinder regulatory measures and information campaigns.

Image Credits: Unsplash.

WHO Executive Board discusses Universal Health Coverage.

The World Health Organization’s (WHO) executive board discussed ways to deliver Universal Health Coverage (UHC) on Wednesday, and while most member states expressed support for UHC, they highlighted bottlenecks of lack of finance and  trained healthcare workers for being off track with its implementation.

In its report to the board, the WHO estimated that over half of the world’s population is not covered by essential health services, and a quarter face financial hardship due to out-of-pocket health spending.

In the past two decades, due to a combination of conflicts and the impact of the COVID-19 pandemic, financial availability for health has worsened, the discussions revealed.

Small island nations, developing countries, countries with high levels of migration of health workers as well as those with ongoing conflicts, voiced a range of challenges that they face, and need support to address.

“In 2019, 1.3 billion people incurred impoverishing health spending at the relative poverty line, and 344 million people faced impoverishing out-of-pocket health spending at the extreme poverty line of $2.15 a day in 2017 purchasing power parity,” the WHO report noted.

For UHC to be implemented, there needs to be an increase in health funding, it needs to be used efficiently and equitably, the health and care workforce needs to be strengthened, and primary healthcare (PHC) needs to be expanded, according to WHO.

“Investment in health is actually on the decline now, and many governments are shifting towards other sectors,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “It is the continued investment in health that can help us in preventing the next pandemic. And it’s the continued investment in health and in UHC that will help us to respond,” he said.

Tedros reiterated that both low-income and high-income countries need to focus on strengthening PHC.

Delivering UHC requires countries to invest more in primary healthcare.

High debt burden is stunting progress 

WHO has found that the current expenditure on health is not adequate. “Emerging evidence shows increased financial hardship, especially among the poorest, with an uneven recovery post-2020/2021. A notable concern is the higher public spending on national debt over health in developing countries,” the report said.

Rwanda, speaking on behalf of the 47 countries in the WHO African region, drew attention to the burden of debt repayments on poor countries.

“The African neighbour states also note with great concern that, as noted by the UN Secretary-General, many countries are forced to spend more on servicing debt than on health and education. In this regard, the IMF has reported that the average debt ratio in Sub-Saharan Africa has doubled in the decades from 30% of GDP at the end of 2013 to almost 60% of GDP by the end of 2022,” he said.

Meanwhile, Yemen’s representative said that 70% of health expenses in his country are borne by individuals and they face tremendous financial hardship as a result.

Pressure placed by conflicts

Palestine, which is currently facing intense and deadly aggression from Israel, said that it has no functional public health system left. “We are facing several challenges and obstacles to maintain the primary healthcare and minimum services using the available resources,” the representative of Palestine said, adding that any discussion on UHC can only be had after their destroyed health system is rebuilt.

Yemen, which has seen several years of conflict, spoke of the additional pressure placed by people displaced by war: “There are a great many displaced persons in our country…internally displaced, in particular, approximately three million of them. We are also facing an influx of refugees and migrants, which is of course a tremendous burden for our health system and makes it more difficult for us to achieve UHC.”

Afghanistan also spoke of the resource crunch and the lack of female healthcare workers. The representative bravely asked member countries for help in advocating for women’s rights and access to education, which has been severely restricted under Taliban rule in the country.

Conflict-ridden Syria said it was aware of the challenges its citizens were facing in accessing healthcare but expressed an inability to do more.

“Because of the conflict that has been raging in our country for more than 12 years now, the work of our health ministry has been made much more difficult. And we now have to give top priority to emergency response rather than UHC because of the war,” the country’s representative said, while asking for support from the global community.

Syrian refugee camp

Lessons from countries with UHC

On the other hand, countries that have achieved UHC fell into two buckets: those who are looking to build on the progress and those struggling to keep the level of progress up.

The expansion of UHC was a key issue for the elections of the new Regional Directors taking place in three new regions last year, as the new appointees needed to have enough knowledge on how to help countries expand access to healthcare, and the different models that can be employed to reach there.

The new Regional Director of the Western Pacific region Dr Saia Ma’u Piukala also said that expanding UHC access would be one of his key priority areas, as Health Policy Watch reported earlier.

Malaysia that achieved UHC in the 1980s said it planned to further, “expand coverage to quality health services through primary healthcare [by] increasing funding, improving the distributions of primary healthcare facilities, ensuring adequately trained human resources for health and facilitating Public Private Partnership moving forward”.

Small-island nations who are at the forefront of climate change are struggling with the rising extreme weather events that have increased pressure on health systems, while simultaneously also damaging the economy.

Maldives spoke of the challenges of continuing the high level of investment on healthcare as climate change and global conflicts hit its two main sources of income – tourism and fishing.

“Therefore Maldives is taking a two-pronged approach. One is to further strengthen PHC with low-cost intervention, including multi-tasking multi-discipline health workforce, early detection for NCDs and timely reference. The other is investing more in health promotion, including digital health literacy and promoting a healthy lifestyle in healthcare settings,” the country’s representative said.

Healthcare workers
Several countries suffered during the COVID-19 pandemic due to shortage of healthcare workers.

Shortage and safety of healthcare workers

A key challenge for many countries in the developing world, and those at the forefront of facing climate impacts, is the shortage of healthcare workers, as well as threats to their safety.

“Barbados continues to grapple with a shortage of nursing personnel and allied professionals. The country currently makes up for this by recruiting nurses from Ghana and Cuba, but a long-term solution is required to ensure sustainability,” the representative from the island nation said.

In addition, retaining the workforce in rural areas is a challenge. “The most willing to leave the health system is the medical staff in primary care, especially in rural areas. Being a difficult speciality, family medicine became almost completely feminized,” said the representative from Moldova.

Increases in resources and infrastructure improvement could help with some of these challenges, with Ethiopia stressing that it is crucial to ensure the safety and security of health and care workers.

The Philippines too said that out migration of healthcare workers has hit its ability to deliver UHC hard and that destination countries needed to play a role in supporting the source country’s health systems through investments.

Tedros acknowledged this in his remarks by pointing out that while migration cannot be stopped as it is human to want to migrate, more health professionals can be trained to handle this shortage.

Denmark, speaking on behalf of the European Union, expressed concerns over the lack of consensus on several issues, and Germany reiterated that comprehensive sexual and reproductive health and rights are an essential part of UHC.

“While many of the member states have highlighted the bleak situation globally in terms of half the world’s population not having access [to essential health services] and another quarter suffering financial hardship, I think we should remember as well [that] 30% of the countries for which we have data, have been able to make progress on both of those indicators,” said Dr Bruce Aylward, WHO’s Assistant Director-General of UHC, as the report was noted by the executive board.

Image Credits: WHO, WHO, Mercy Corps, Photo by Carlos Magno on Unsplash.

A lack of investment in vaccine and therapeutics R&D is undermining global pandemic preparedness.

There is a global lack of preparedness and reactive responses when confronted with emerging epidemic threats, a concerning lack of investment in the R&D vaccine and therapeutics pipeline, and signs of waning focus on pandemic preparedness, according to a new report by the International Pandemic Preparedness Secretariat (IPPS).

The IPPS launched its third annual report on the 100 Days Mission (100DM) for pandemic preparedness at the Accademia dei Lincei in Rome on Wednesday.

The report assesses how much progress has been made toward ensuring the global availability of diagnostics, therapeutics, and vaccines (DTVs) within the first 100 days of a pandemic threat. It also evaluates progress toward 100 Days Mission target of two antiviral therapies for each high-risk viral family, ready for Phase II/III clinical trials by 2026.

“In 2021, a group of G7 scientific advisors and experts came together to set out the recommendations that would form the basis of the 100DM,” explained 100DM outgoing chair Sir Patrick Vallance in the report’s introduction.

“Since then, the world has changed. We are no longer in the throes of a global pandemic; world leaders are dealing with multiple competing crises, and the global health landscape appears increasingly complex as organisations grapple with optimally prioritising limited funds and contend with multiple needs and threats. But we know that future epidemics and pandemics are not just likely; they are inevitable.”

He said IPPS’ annual reports are an opportunity to reflect on progress made the year before and set priorities for the following year.

What happened in 2023?

In 2023, progress was made in several areas, the report highlighted, including the first US Food and Drug Administration-approved Chikungunya vaccine and Phase 1 trials for Crimean-Congo Haemorrhagic Fever (CCHF) vaccines. Moreover, the report showed solid political support for the 100DM from the G7 and G20.

“2023 saw strong progress in epidemic and pandemic vaccine research in support of the 100 Days Mission, including investments to advance the next-generation of mRNA and thermostable technologies, a groundswell of support for regionalised manufacturing and the growing use of artificial intelligence to accelerate vaccine design,” said Dr Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations (CEPI).

Therapeutics Roadmap & Scorecard

Two other publications were launched alongside the report on Tuesday: The 100DM Therapeutics Roadmap and the 100DM Mission Scorecard.

The roadmap was developed with advisors and partners, including the INTREPID Alliance, Unitaid, the Drugs for Neglected Diseases Initiative (DNDi), the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), the Medicines Patent Pool (MPP) and the Rapidly Emerging Antiviral Drug Development Initiative (READDI).

“The roadmap marks the start of a more coordinated approach to pandemic therapeutics development,” IPPS explained. “It aims to provide a springboard for action and collaboration, with a headline goal of developing at least two ‘Phase 2 ready’ therapeutic candidates for each of the top 10 WHO priority pathogen families, while also focusing on the optimisation of monoclonal antibodies and the promotion of new, disruptive technologies.”

The scorecard aims to evaluate the pipeline thoroughly concerning WHO R&D Blueprint pathogens with pandemic potential. Policy Cures Research’s analysis reveals a scarcity of approved products beyond COVID-19 and the Ebola virus Zaire strain. Furthermore, it underscores a worldwide demand for increased funding for WHO Blueprint pathogens, excluding COVID-19.

From 2019 to 2022, COVID-19 witnessed an investment of US $14.5 billion, a figure eight times higher than the combined investment in the other nine pathogens, the scorecard showed. This stark contrast underscores the imperative for more diversified funding sources, emphasising a potential risk to global preparedness.

Reactive funding

The scorecard showed that funding for epidemic diseases is also highly reactive.

“We have not yet adopted a preparedness approach for Research and Development,” the scorecard said.

Most of the available funding is generally provided by public funders, mainly the United States, which makes this funding vulnerable to political shifts. Moreover, regarding funding, vaccine R&D is the most advanced space. There is also more product R&D and WHO Target Product Profiles (TPPs) for nearly all pathogens.

In contrast, the scorecard showed that therapeutics R&D lags with few approved products, clinical candidates, and only one WHO TPP. The analysts indicate this is likely because of a lack of unified leadership around therapeutics, such as CEPI providing vaccines and FIND providing diagnostics.

Pathogens with more significant outbreaks and perceived as a greater risk to national biosecurity have more mature pipelines. In addition, funding for platform technologies to support “Disease X” has grown since 2019, and these are being used to develop products for eight priority pathogens.

“These should benefit R&D for other pathogens, but this is not yet routine,” according to the scorecard.

“The 100 Days Mission is a welcome complement to WHO’s work with partners on the diseases that pose the greatest pandemic risk, for which there are no or insufficient countermeasures,” noted Sir Jeremy Farrar, Chief Scientist at the World Health Organization (WHO). “To rapidly and equitably prepare for and respond to outbreaks of pathogens with pandemic potential, we must now sustainably invest, particularly in basic science, R&D and distributed manufacturing, including the neglected areas of pandemic therapeutics and diagnostics, as well as vaccines.”

What’s next?

The 100DM team will urge the G7 and G20 to catalyse coordinated international action and will call for political commitment to building virtual prototype libraries of pandemic therapeutics, diagnostics, and vaccines. It will also push the need to work with the private and philanthropic sectors.

The IPPS identified four goals for 2024:

  • Greater coordination and investment in the therapeutics pipeline to operationalise the 100DM Therapeutics Roadmap due to the need for more funding and coordination. The report asserts that a coalition is growing around the 100DM Therapeutics Roadmap, which sets out an end-to-end plan and investment case of what is needed to reach the updated goal of at least two ‘Phase 2 ready’ therapeutic candidates for the top 10 priority pathogen families.
  • Sufficient funding to implement the 100DM diagnostics framework, including supporting FIND’s initial ask of US $80-100 million. There are only four WHO priority pathogens for which they are approved diagnostics, and funding is waning.
  • Greater regulatory alignment and adoption of preparatory regulatory approaches. The world would start collecting data on the safety and efficacy of prototype pandemic countermeasures when a pandemic is declared.
  • Strengthening of sustainable regional and global clinical trial infrastructure to enable the rapid testing of products in humans during an outbreak.

“In 2024, under WHO leadership, practical discussions on pre-agreeing master trial protocols for emergency use should take place alongside support for regional authorities to maintain sustainable clinical trial capacity with joint ethics reviews,” according to IPPS.

“We hope that by the end of 2024, each of the four areas will have a clear overall lead, a credible plan, and the funding necessary to make progress,” Vallance said.

“Infectious diseases are one of the greatest health challenges of our time, causing around a quarter of all deaths around the world and particularly impacting vulnerable populations in low-income countries,” added Dr John-Arne Røttingen, CEO of Wellcome.

“It’s vital that pandemic preparedness stays on the agenda in 2024, with governments, industry, and philanthropy stepping up to invest in the development of new diagnostics, treatments, and vaccines.”

“Today’s report should act as a clarion call for global leaders, who must now urgently refocus on the practical steps needed to better prepare for the next pandemic, concluded Thomas Cueni, IFPMA Director General.

“Science and innovation delivered at record speed and scale against COVID-19. We must preserve what made this possible whilst taking practical steps to address the inequity we saw in the rollout of vaccines and treatments if we are going to meet the ambitious goals set out by the 100 Days Mission.

“Pharmaceutical companies have backed the ambition of the Mission since it was set out in 2021. It’s becoming increasingly clear that governments must learn the right lessons from our collective response to the COVID pandemic if we are going to achieve this shared goal.”

Image Credits: Nana Kofi Acquah.

WHO Director-General Dr Tedros Adhanom Ghebreyesus with Hanan Balkhy of Saudi Arabia, taking the oath as the new WHO Eastern Mediterranean Regional Director.

The World Health Organization’s (WHO) executive board confirmed the appointment of three new regional directors on Tuesday, which are both controversial and historic.

The election of Saima Wazed,  the daughter of Bangladesh’s prime minister, to lead the South-East Asia region has already been mired in allegations of nepotism.

Tonga’s Dr Saia Ma’u Piukala steps into his role as the head of the Western Pacific office, following his predecessor’s dismissal for alleged racism. He has his work cut out in the region with many small-island nations weathering climate impacts, and the added pressure to restore trust among the staff in the regional offices.

The Eastern Mediterranean has its first female leader in Hanan Balkhy of Saudi Arabia. Balkhy takes charge as the region is experiencing a staggering humanitarian crisis in Gaza which has left over 25,000 dead, and in Sudan where an estimated 11 million people are in need of urgent healthcare.

The three regions are home to around 60% of the world’s population and face a range of health challenges from climate change to infectious disease as well as conflict, making the appointments critical in the delivery of healthcare.

WHO Director-General Tedros Dr Tedros Adhanom Ghebreyesus remarked that it was the first time a high-profile post was being transferred from one woman to another, as Wazed took over from India’s Poonam Khetrapal, who was the first woman in the post of South-East Asia’s Regional Director.

“The success of this organization depends on close collaboration, co-operation, co-ordination, and trust between headquarters and the regional offices and country offices,” Tedros said, assuring the new directors all the support they needed from him as well as the colleagues in the WHO offices.

While the elections for the regional directors were conducted last year, the appointments were confirmed at the ongoing 154th executive board meeting of the world health body that will continue until Saturday.

The new appointees spell out priority areas

All three appointees spelt out their priority areas for their region reflecting the health challenges the countries in their region face, as they took charge.

Balkhy said her region had a large number of displaced populations, with both strong and fragile economies. “We aim to enhance end-to-end supply chains, ensuring essential medicines and supplies reach all populations, not an easy task for many in the region. Additionally, we will foster collaborations to build skilled and sufficient health workforce to serve diverse populations across the regions,” she said.

Wazed highlighted improving mental health awareness and services as one of her key priority areas, along with women and children. “I look forward to devising and implementing specific interventions for women and children, including pregnant women. This will be created with education, empowerment and prevention in mind, structured with the life course approach,” she said.

In his emotional speech, Piukala said that his journey from a small island to his current role showed that everyone can have something to contribute. He listed strengthening primary healthcare as a key priority area as well as bringing more people in the region under the ambit of universal healthcare.

“In recent years, our region accounted for 80% of the total global new displacement related to disasters, becoming the world’s most climate-vulnerable region. Critically, every person deserves access to basic preventive care,” he said.

Dr Tedros with Dr Saia Ma’u Piukala, the new Western Pacific Regional Director. Piukala is the first Pacific Islander to be appointed to the post.

Conflict of interest

The WHO election in South-East Asia region has been mired in controversy, with Bangladesh allegedly using its political clout to get Wazed elected. Unlike in other regions, she only had one other competitor, Shambhu Prasad Acharya, a WHO and public health veteran.

Wazed is now tasked with providing WHO policy advice to her mother’s government, but the WHO has not addressed the potential conflict of interest.

Within the public health community concerns were raised about the lack of transparency in the elections and there have been a call for reforms. Medical journal The Lancet also carried an editorial on the need to protect the integrity of WHO’s regional offices.

New South-East Asia Regional Director Saima Wazed and WHO. Director-General Tedros Dr Tedros Adhanom Ghebreyesus.

In her first speech on appointment, Wazed paid tribute to her mother. “I’d like to express my big thanks to Prime Minister Sheikh Hasina, not only for the leadership she has demonstrated over the decades of governance in our country and in our region, but also as my mother for teaching me how to lead with compassion and care,” she said.

Image Credits: WHO, WHO, WHO.

Canada expressed concern that the EB might be over-prescriptive.

Variation between the six regions of the World Health Organization (WHO) on how their regional directors are nominated – and whether these should be standardised – generated substantial discussion at the body’s executive board (EB) meeting on Tuesday.

A report from the WHO’s legal counsel on regional nominations noted key areas where a  lack of alignment between the regions could be addressed, including on the scrutiny of candidates and transparency of procedures.

For example, criteria for the assessment of candidates are inconsistent, with some not specifying educational qualifications, professional experience or managerial skills. The Africa region is alone in specifying “a medical background”.

The Pan American Health Organization (PAHO) does not have a code of conduct for the nomination process, aimed at promoting an open, fair, equitable and transparent nomination process.

South-East Asia Region does not specify the shortlisting of five candidates if there are more than five candidates for the position, or how this would take place.

All regions provide for the interviews of candidates with the exception of the European Region, where the interviews take place at a private meeting of the Regional Committee. 

Only PAHO and Europe hold a live candidates’ forum, comprising an oral presentation and a question-and-answer session between candidates and members of the region.

All regions except Europe and the Western Pacific Region explicitly limit nominations to people from the region.

Too prescriptive

However, Canada contended that “a minimum common standard beyond the current direction from the EB regarding criteria might be found to be too prescriptive or limiting” and “would also represent a considerable extension of the board’s authority over these processes”. 

Instead, it proposed that the EB put forward “a menu of best practices that regions can draw on from as appropriate”.

Australia contended that any minimum common standard “should be supported by accepted best practice” and also “protect autonomy to account for regional contexts”.

It supported the proposal for the WHO Secretariat to prepare documents for regional committees on “ways to enhance transparency, accountability and integrity of the election process”.

Meanwhile, Comores on behalf of the 47 African members, rejected a “single approach which will be to the benefit of some regions but not necessarily to the benefit of all”. 

Later, the Africa region represented by Ethiopia said it would support “measures to enhance transparency, accountability and integrity of the election process” for the WHO Director General. Ethiopia previously contested the reappointment of Dr Tedros Adhanom Ghebreyesus.

The board deferred any decision on regional director election processes at the request of Denmark, which asked for more time to achieve consensus. 

Wide support for measures to stop sexual exploitation 

The Director-General’s report on the implementation of measures to prevent and respond to sexual misconduct was also discussed on Tuesday, receiving appreciation and support from a wide range of EB members.

The implementation plan focuses on a range of issues including accountability, policies, investigation capacity, training, dedicated human resources, victim- and survivor-centred support and culture change. 

“The Secretariat is ensuring alignment and consistency between the implementation plan and the three-year strategy on preventing and responding to sexual misconduct, 2023 to 2025,” according to the report.

Commending the WHO secretariat’s efforts to root out sexual exploitation, the EB’s programme, budget and administration committee (PBAC) proposed “a comprehensive stocktaking review no later than January 2025 to assess whether the key actions and the reforms contained in the three-year strategy had led to the intended results”.

German’s Björn Kümmel has a key driver of the investment round proposal.

By hosting a high-level “investor round” to raise flexible funding for its operations, the World Health Organization (WHO) will address one of its “greatest overall risks, namely dependency on the very few number of donors”.

This is according to Germany’s Björn Kümmel, chair of the WHO Working Group on Sustainable Financing, who told the WHO’s executive board meeting on Monday that there is “completely fragmented resource mobilisation” throughout the global body.

Executive board members supported the proposal for an investor round – likely to be held in November – with uncharacteristic enthusiasm on Monday.

The idea of a WHO investment jamboree similar to those hosted by the Global Fund and Gavi, was accepted in principle by last year’s World Health Assembly, but it charged the WHO Director-General with investigating how it would operate, including costs versus potential income.

Dr Tedros Adhanom Ghebreyesus reported back to the board that the “expected benefits outweigh the additional costs of the investment round”.

WHO finances is largely earmarked

Currently, the majority of WHO funding comes from donors for earmarked projects which can distort the global programme of work.

To correct this distortion, the WHA resolved that member states need to increase their  “assessed contributions” – currently barely covering 16% of WHO’s budget – and the WHO needs to raise more flexible donor funding.

Not sustainable

“The average length of a grant in WHO is 13 months. This is everything else but predictable,” Kümmel told the board.

“There are 3,300 grants in this organisation with individual reporting requirements with the consequence that the technical staff, that needs to provide norms and standards for the world, is raising earmarked funds for their units in order to be paid and to be able to run the programmes. This is not effective, and this is certainly not sustainable,” added Kümmel, whose working group has been working on reforming WHO’s financing since 2021.

Meanwhile, Tedros told the board that he was embarrassed by the fact that the many WHO staff members were on 60-day rolling contracts due to financial restraints, which made them vulnerable and undermined stability.

“If you talk about motivated and fit-for-purpose workforce, retaining and attracting talent without sustainable financing is impossible,” said Tedros.

 Kümmel asserted that the investment round has the potential to be “truly catalytic” for all reforms that the board is pushing, and  has the potential to introduce more flexible and predictable financing.

The WHO Working Group on Sustainable Financing’s report to the 2023 WHA highlighted that WHO’s budget is “up to 86 % dependent on generous donors and that only roughly 14 % of WHO’s finances are truly predictable”.

“This situation has put WHO at severe risk, including its independence, its integrity, its agility and certainly also its mandated role to be the world’s leading and coordinating authority in global health,” said the report.

While board members accepted the proposal for an investor round, they want input on the investor case due to be developed by May, and urged that the case should be closely linked to the WHO’s 14th global programme of work (GPW), which was also discussed on Monday.

WHO investment round timeline

Image Credits: WHO.