Egypt [portayed here] and Qatar threaten to “escalate” issue of Center’s recognition to World Health Assembly.
A  bitter debate over proposed WHO recognition of a non-profit center for reproductive health rights, erupted in full force at the WHO Executive Board on Monday – after a tumultuous week of the World Health Assembly where member states largely skirted the increasingly contentious issue of sexual and reproductive health rights.

The proposal by the WHO Secretariat the US-based Center for Reproductive Rights be designated as a non-state actor in “official relations” with WHO – drew fierce opposition from member state blocs of the Eastern Mediterranean and African region – with Qatar threatening to escalate the issue and potentially the criteria for admitting non-state actors into official relations to the World Health Assembly if the WHO recognition of official relations with the organization is approved by the EB.

Qatar, speaking on behalf of the Eastern Mediterranean Region, which extends from Tunisia to Afghanistan, also rejected a compromise proposal by WHO Director General Dr Tedros Adhanom Ghebreyesus to admit the Center on a one-year trial basis – pitched by the DG as the deadlocked session drew to a close, and postponing a decision until Tuesday.

“We are against the introduction of official relations with the Center for Reproductive Rights, with all means give the controversial concepts they promote. And regardless of the decision of the esteemed executive members in this regard, we will seek further discussions on this matter within the wider quora of the WHA,” said Qatar’s representative.

His remarks were echoed by Egypt, Tunisia, Iran, Morocco, Pakistan, Yemen and Senegal, speaking on behalf of 47 African member states, as well as the Russian Federation.

“We firmly stand against the introduction of official relations with the Center for Reproductive Rights due to the controversial concepts they promote,” Egypt said, warning that: “Regardless of the outcome of the decision by the board today, we will seek to escalate this matter to further discussion within wider quorum of the World Health Assembly.”

Some 217 non-state actors, ranging from non-profits advocacy groups to professional associations of doctors, nurses and other health workers, as well as agro- and pharma industry-backed federations, are currently recognized as being “in official WHO relations.”

Raises broader questions over WHO’s entire process for engaging with NSAs

Chile, along with seven other Latin American countries supported the Center’s recognition by WHO.

The designation, which allows the NSAs to participate as observers at the WHA, as well as opening a door to WHO technical and working groups, is only granted after a proven track record of collaborations with the global health agency. The designation is granted in accordance with a strict criteria, known as the Framework for Engagement with Non-State Actors (FENSA), intended to protect the organization from vested interests, especially industry influence.

The FENSA framework was painstakingly negotiated and approved by member states nearly a decade ago, so as to create an even playing field for organizations to work with the global health agency. It includes a lengthy and rigorous trial period, and agreement with a WHO technical unit on a collaboration plan, so that in fact, only a handful or less of new non-state actors are approved every year. Member state review of new, proposed NSA actors, has therefore been largely perfunctory – following the recommendations set by the WHO administration.

Rejecting WHO’s recommendation would set a dangerous precedent

Mexico speaks out in favor of recognition of the Center, saying rejection would set an “unhelpful” precedent.

A large number of European Union member states, as well as the USA, Canada, Australia and a broad non-EU group of member states led by Mexico, expressed concern that the divisive debate could also rip across the entire FENSA process, paintstakingly developed over a number of years by WHA together with legal advisors. It could make any new organization’s candidacy  for the treasured “in official relations” designation, subject to a diverse range of political pressure and influences – rather than technical criteria, they warned.

“We share concerns regarding the negative precedent it would set, we would say if the EB decided to reopen that recommendation in any way,” Mexico’s delegate said. “We member states negotiated and agreed to it by consensus having a robust framework of this nature provides value to the organization, but only if we use it. We are therefore deeply concerned that despite the non state actors having fulfilled the necessary requirements… the EB in January, did not agree.

” We agreed to postpone the decision until this session. Five months have passed, during which the EB  chair conducted extensive and inclusive consultations to find a solution… which resulted in an adequate, good faith proposal,” she said, apparently referring to Tedros’ compromise proposal for a one-year trial period of recognition – as compared to the normal multi-year term.

“‘We regret that this proposal has not been accepted,” added Mexico’s delegate. “We acknowledge the concerns of some allegations on the work of this particular NSA.

“It is worth recalling that ultimately, it is the state-led WHO governing bodies which direct the work of this organization. Therefore, applying a selective approach to the work of single entities undermines well-established and effective governance procedures. It risks setting an unhelpful precedent negatively impacting the efficient and effective, effective governance of the organization –  and politicizing routine decisions that we should trust the Secretary to make in the framework of its mandate,” Mexico said, in a statement supported by other non-EU European countries as well as a seven other Latin American countries including Chile,  the Dominican Republic, Ecuador, Panama, Peru, Uruguay – and echoed separately by Brazil.

Morocco sounds softer note – Thailand and Israel also support

Thailand says recognition of the Center, would expand social inclusion – in line with a WHA resolution approved just last week.

Israel, whose appointment to the EB was bitterly denounced last week, and again this morning by rival states, including Palestine, also expressed support for admitting the Center, saying “We regret the exclusion of important stakeholders, and we believe that a dialogue with all relevant stakeholders is essential.”

Thailand, meanwhile, pointed to a new WHO resolution approved only last week promoting “social inclusion” and said that recognizing the Center would walk the talk on that issue:  “Approving the Center of Reproductive Rights as an entity in official relations would be a concrete example of expanding social participation in WHO’s work, or commitment to involve non state actors in meaningful ways and showing the broader perspective, a more comprehensive approach in global health.”

Morocco, meanwhile, appeared to break ranks with other Arab and African states, appealing for consensus around the WHO Secretariat’s proposal to extend official relations to the Center.

While “there are national laws and concerns to be considered, my delegation would like to reiterate its  trust in the application of eligibility criteria and due diligence when it comes to collaboration of NSAs with the WHO,” Morocco’s delegate stated.

“I note that collaboration between the WHO and the Center has been established and for years work has been carried out on the ground. That’s the reality. Our discussions today are a second stage, we’re opening up new prospects when it comes to artificial relations, in processes led by member states.

“So my delegation is strongly attached, and promoting, the consensus based adoption of this proposal, noting similar cases, with a view to strengthening the credibility of our work and the constructive cooperation spirit that has always prevailed within our Executive Board.”

Tedros proposes a one-year trial period for Center

WHO’s Dr Tedros Adhanom Ghebreyesus appeals to the EB to recognize the Center for Reproductive Rights, even for a one-year trial.

In a late afternoon intervention, Tedros proposed to the EB that opponents of recognition consider a one-year trial period for the Center, as a recognized WHO NSA – rather than the usual multi-year term. But as of early evening, that compromise proposal also seemed doomed to failure. Meanwhile, the EB suspended its discussion until Tuesday, with members on both sides  loathe to continue debating after a string of late nights at last week’s WHA.

Tedros, speaking before critics of the Center’s recognition, said that WHO member states that WHO’s work needs to “stick to science and evidence.”  And according to that evidence, efforts to repress access to abortion only leads to more maternal and newborn deaths, he said, also citing his own experience as Minister of Health in Ethiopia.

“The Ethiopian Parliament passed a law on abortion when I was Minister of Health,” Tedros related.  “That law was passed because of practical problems we were facing. The maternal mortality rate was very, very high. And two of the leading causes of death were postpartum hemorrhage and unsafe abortion. Of course there were other reasons. But the Parliament was very courageous, and since the bill was passed, the maternal mortality rate has declined.”

Two decades later, the very same drivers remain an issue in many countries today, he said, citing a meeting with ministers of health last week on the sidelines of the World Health Assembly, on their high maternal mortality rates, “And in many of the countries, the two leading cause of deaths for mothers are postpartum hemorrhage and unsafe abortion,” he related, noting that even if women are not supported by legal abortion frameworks, “they will do it [seek abortions] anyway. That’s a real problem in some countries.”

Ultimately, it  is poor women, not the rich, who die from illegal abortions, Tedros pointed out, adding: “when a mother is dying, and when we know that why they are dying, we cannot just look the other way.”

WHA delegates spend hours debating and voting on two measures addressing the crisis in Gaza.

WHA delegates spent over 10 hours in diplomatic maneuvers, debates and painful rollcount votes Friday, finally approving two measures that decried the humanitarian crisis in Gaza in sharply different, and sometimes  contradictory terms.  

One motion co-sponsored by a coalition of Algeria, Russia, China, Cuba, Iran, Egypt and other Middle Eastern allies, condemns “indiscriminate attacks” by Israel on medical and humanitarian facilities “used exclusively for humanitarian purposes.”  A second resolution approved in December at a special meeting of WHO’s 34-member Executive Board, including EU countries and the United States, called for a “humanitarian ceasefire”, using more neutral language. 

Both measures ultimately passed with large majorities – but with a raft of abstentions as well as objections on all sides of the aisle. 

The bitter, 10-hour long debate over Gaza, Palestine and Israel, followed a mere two hours of attacks and accusations around a new draft resolution over the Ukraine humanitarian and refugee crisis, with a title referencing “the Russian Federation’s aggression”.   The new Ukraine resolution proposed by European states, with United States support, won WHA approval by a vote of 72-10.  A  counter resolution proposed by the Russian Federation, Syria, North Korea and Belarus, failed to pass, garnering only 13 votes.  

It also came on a day when Palestine was awarded quasi-member state status by the World Health Assembly – in all regards except the right to vote and hold positions on the governing board or other governance instruments. [see related story]

Palestine Granted Quasi WHO Member State Status – Without Voting Rights  

First OPT decision, subject to numerous amendments by bitter rivals

The first Gaza measure, was built around a perennial, stand-alone “decision” on the “Health Conditions of the Occupied Palestinian Territory (OPT), including East Jerusalem and the Occupied Syrian Golan” that is voted on, and approved, every year by the WHA.  The long and rambling text, in fact, addresses a very mixed bag of settings, populations and health conditions.  

This year’s version called out Israel as the occupying power to address “the threat of famine” water and sanitation, and ensure adequate supplies of fuel, medicines and humanitarian aid to Gaza.  A raft of other provisions  mandate WHO to report on “wanton destruction of health facilities”; “acts of violence against the wounded and the sick and medical personnel”, and “results from the use of starvation of civilians.”  

The decision also calls on WHO and Israel to ensure “unhindered access” for Palestinians in the occupied territory including East Jerusalem, to a full range of health products and services. In fact, East Jerusalem Palestinians, are typically enroled in, and served by, Israeli health funds – although if they are not formally registered by Israeli authorities as Jerusalem residents, then access to medial services can be hampered.

However, along with the acute crisis in Gaza, West Bank Palestinians have suffered from oft-serious problems accessing services due to a tough Israeli military crackdown since the war in Gaza began. That has hindered travel to West Bank Palestinian hospitals, private or public, as well as to Jerusalem-based Israeli and Palestinian facilities that are common destinations for more advanced services, like cancer treatment.

Finally, the decision calls upon the WHO to conduct an assessment of health conditions in what it describes as the the “Occupied Syrian Golan”, where communities of Druse, an ancient Middle Eastern religious minority, have lived under civilian law, with access to Israeli health funds, since 1981.  Those Golan communities, like other Jewish, Druse and Palestinian communities in pre-1967  northern Israel, are however, facing physical risks, stress and economic disruptions from the low-level war raging in the north between Israel and the Hamas-aligned Hizbullah, based in southern Lebanon.

Technical or political?

US delegate votes “No” on the first of two WHA measures addressing Gaza – the US abstained on the second measure, a resolution approved at a special December Executive Board session.

Described by supporters as a “technical” measure, the decision was criticized by the US and some European member states, and Israel, as a largely political instrument, singling out one WHO member state amongst 194, and mixing the dire realities faced by Palestinians in Gaza and the West Bank with rhetoric unique to a single conflict.

“The decision before us today has been presented year after year since 1968. Since then, Palestinians and Syrians have used this annual ritual to attack Israel and to absolve the Palestinian Authority of its responsibility for governance,” said Israel’s delegate to the WHA.  

“It has also been used to divert attention from decades of atrocities committed by the Syrian government. This decision has never been about health. If this decision was about health, it would address the systematic and deliberate militarization of health facilities in Gaza by Hamas and by the Islamic Jihad. Health facilities in Gaza are used as hideouts and launch sites for terrorism…. Hamas is deliberately putting the safety of patients at risk. Everyone in this room is well aware of it. Evidence of this militarization was found in every hospital in Gaza and Shifa Hospital for example, there were more terrorists than patients; Israeli forces apprehended some 500 terrorist and eliminated hundreds more.” 

The decision ultimately passed but with the addition of four amendments tacked on by diametrically opposed geopolitical blocs of member states. 

Firstly, an amendment proposed by Israel, which won approval 50-54 in the surprise outcome of a member state vote Wednesday, called for the Hamas release of hostages, as well as condemning the militarization of Gaza’s health facilities.  

In response, Bahrain and 18 other co-sponsors proposed and won approval Friday for three new amendments, including one directly condemning Israel’s  “indiscriminate attacks on medical and humanitarian facilities”.  

Sponsors like Iran abstained because of a mention of hostages

Qatar disassociated itself from an amendment added by Israel, which denounces Hamas militarization of health facilities and calls for the release of Israeli hostages and

As a result of Israel’s amendment, some co-sponsors of the original measure, such as Iran and Libya, ultimately abstained from the final vote on the decision, which passed 102-6.  

“Recent gross violations of international humanitarian law, particularly war crimes, crimes against humanity, genocide, ethnic cleansing, mass disruption of health infrastructure us and enforced displacement committed in Gaza demonstrates as an absolutely unleashed nature of this regime in committing atrocities in an unprecedented manner,” said Iran’s delegate. 

Others, including Mediterranean and Gulf powers, such as Egypt, Turkiye, Tunisia, and Qatar, voted for the measure but explicitly “disassociated” themselves from the Israeli-added reference to Hamas holding of hostages and militarization of health facilities.  Oman complained that the reference to calling for the releease of hostages failed to also refer to the conditions of thousands of Palestinian prisoners who have been detained by Israel before and during the Gaza war – “and are held in inhumane conditions where international representatives are not allowed to visit them.” 

European states distance from some of the decision’s provisions 

Argentina: nothing justifies violence, but if you ignore what happened on October 7, you will have an unbalanced picture.

Meanwhile, a number of European nations and allies that ultimately voted for the Algerian-sponsored measure, or abstained, later sought to distance themselves from some of the stronger language condemning Israel unilaterally for the crisis in Gaza, and particularly for the destruction of health infrastructure.  

Norway, which recently recognized the state of Palestine, called both out “the misuse of hospitals for military purposes” on the one hand, a clear reference to Hamas, as well as “indiscriminate attacks on hospitals” on the other, referring to Israel. 

“Such facilities, for medical purposes, must be respected and protected in all circumstances and by all the parties to the conflict,” Norway’s delegate said.  

The United States, Israel’s staunchest ally, opposed the first, Algerian-sponsored measure, outright.

“We believe the current draft decision does not help advance the cause of a lasting and comprehensive peace between the Israelis and the Palestinians,” the US delegate said in the  debate. 

“Nothing justifies violence on any side, in any part of the world… but we are only going to get to the truth if people start speaking it,” said Argentina. 

 “If you ignore what happened on the seventh of October in Israel. If you ignore the fact that hostages were taken as a result of that, you will be politicizing a situation. You will be giving a distorted, unbalanced picture of what happened – and that will also lead to a complete and utter loss of impartiality.” he said, referring to the Hamas incursion into Israeli border communities that killed some 1200 Israelis, mostly civilians.  

‘Gazans and the people of Israel have both suffered’ 

US votes no on the first of two measures addressing Gaza – and abstains on the second measure.

The late evening WHA session saw the final vote on the second resolution decrying the Gazan humanitarian crisis – this one the product of a consensus reached between G-77 nations, the European Union, the United States and its allies at the December Executive Board meeting.  

But in a surprise move, the United States also abstained from voting on the EB-approved measure, due to what it said was a continuing “lack of balance” with reference to the absence of a reference there to Hamas-held  hostages. 

 “Citizens in Gaza and the people of Israel have both suffered in this conflict. Our top priority is a ceasefire agreement that leads to the release of hostages and creates conditions to facilitate a surge of additional humanitarian assistance into Gaza,” said the US delegate to the WHA in the debate that took place just as  President Joe Biden was anouncing a new US proposal for a Gaza cease-fire and hostage exchange deal.

Allegations of genocide and concerns about hostage release

Belgium, on behalf of the European Union, reaffirms commitment to the release of hostages held by Hamas.

In a debate that preceded a roll call vote, Turkiye, Egypt, Cuba and other bitter critics of Israel, decried what some described as a genocide in Gaza, and others, “war crimes against humanity” in the words of Cuba. 

Meanwhile, European Union delegates and allies, led by Belgium, “urged the Israeli Government not to undertake a ground operation in Rafah, which would worsen the already catastrophic humanitarian situation.”

And they stressed the importance of “respecting and implementing the orders of the International Court of Justice,” which are legally binding. 

The EU also expressed “grave concern” over the “safety and well-being of hostages held by Hamas, calling for their “unconditional release.”

Situation on the ground

An esetimated 1 million displaced Palestinians have now fled Rafah, due to the Israeli operation there, said WHO’s Mike Ryan.

Late Friday evening, and only after hours of bitter member state political sparring, did WHO’s Executive Mike Ryan, provided a brief update of the actual situation in Gaza on the ground. 

“An estimated 1 million people have left Rafah in search of safety that does not exist anywhere in Gaza,” he said, adding the recent Israeli evacuation order affects 17 hospitals including three field hospitals to the north and the loss of more than 600 hospital beds.”

 The flow of health supplies and humanitarian aid remains paralyzed due to the closure of the Rafah crossing into Gaza, following Israels take over of the area. WHO missions to embattled hospitals, particularly in northern Gaza, continue to be cancelled, impeding the flow of health aid within the enclave. 

“The health system degradation continues. The system is winding towards zero humanitarian access,” Ryan warned.

No time left for discussion of other humanitarian crises 

Grade 3 emergencies in late 2022 – before the crisis in Gaza erupted. Most are still ongoing.

Aside from the discussion of Ukraine, the day-long debate left no time for discussion of more than a dozen other  acute crises and conflicts raging in the world today, defined by WHO as Grade 3 emergencies  – and the increased burden of emergency health and humanitarian needs that they have generated. Observed Slovenia’s delegate as the evening discussion on Gaza continued into the late night hours:  

“Slovenia is deeply concerned about the increasing frequency complexity and duration of health emergencies, resulting from conflicts which have led to a significant rise in global humanitarian health needs, affecting people in Afghanistan, Haiti, Somalia, Ukraine, Sudan, Gaza. And elsewhere. The growing number of attacks on healthcare facilities and personnel is unacceptable.”

Gaza transfixes WHA 

WHO Director General Dr Tedros Adhanom Ghebreyesus appeals for a cease-fire – saying it’s good for Israel and the Palestinians.

If it proved anything, the long-winding debate demonstrated the unique and enduring ability of the Israeli-Palestinian conflict to transfix diplomats, defy solutions and polarize WHO member states more than almost any other conflict in the world – captivating the hearts and minds of countries thousands of miles away from the war’s epicenter.  

Said the representative from Cook Island, the dicussion continued towards midnight, “We ae a small island state, and our primary fight is against climate change. We are17,000 kilometers away from Gaza. However, we cannot and won’t ignore the dire humanitarian crisis affecting our fellow human beings, civilians and hostages. And we will support all genuine efforts to address these issues as well.” 

In an emotional late night statement, close to midnight, and just prior to the final vote on a secod resolution, WHO Director General Dr Tedros Adhanom Ghebreyesus, directly appealed to Israel, who he said “held the keys” to a ceasefire call. 

“I ask Israel and appeal to Israel to stop this war,” said Tedros, in a voice hoarse from speaking throughout the week. “For the sake of humanity, I think the key holder should stop the war. 

“It’s in the interest of Palestine in the interest of Israel to go for a political solution,” Tedros  added, while also calling for the  “safety of the hostages, support of medical care, and of course their release.” 

Correction- The correct vote count on the amendment calling for release of Hamas held hostages was 50-44, not 54-50. 

Image Credits: OHCHR , https://cdn.who.int/media/docs/default-source/documents/emergencies/who_ghea-2022_grade3-emergencies-map.pdf?sfvrsn=7215a303_7.

WGIHR co-chairs Dr Ashley Bloomfield and Dr Abdullah Asiri and INB co-chair Precious Matsoso.

After two years of intensive negotiations – including long nights this week – the World Health Assembly (WHA) finally passed amendments to the International Health Regulations (IHR)  and committed to completing pandemic agreement talks within a year. 

After failing to agree on the amendments before WHA opened on Monday, member states have been racing to the finish in a drafting committee during this week in meetings that often went into the early hours.

“Tonight we have all won and the world has won. You have made the world safer,” said a hoarse WHO Director-General Dr Tedros Adhanom Ghebreyesus, who lost his voice during the late-night sessions.

The IHR is a legally binding international instrument aimed at preventing the international spread of disease, and requires countries to conduct surveillance for potential international health threats of all kinds and report those to WHO.

The COVID-19 pandemic showed weaknesses in the IHR, including that it did not mention “pandemic”. Member states submitted over 300 proposed amendments to the Working Group on Amendments to the IHR (WGIHR), chaired by New Zealand’s Dr Ashley Bloomfield and Dr Abdullah Asiri of Saudi Arabia.

“The amendments to the International Health Regulations will bolster countries’ ability to detect and respond to future outbreaks and pandemics by strengthening their own national capacities, and coordination between fellow states, on disease surveillance, information sharing and response,” said Tedros. 

WHI Director-General Dr Tedros Adhanom Ghebreyesus: Hoarse but happy

New ‘pandemic emergency’ defined

The amendments include the definition of a “pandemic emergency” – the highest level of alarm – that will trigger more effective international collaboration in response to a disease outbreak that may become a pandemic. 

“Solidarity and equity on strengthening access to medical products and financing” will be strengthened by a “coordinating financial mechanism” to help to “equitably address the needs and priorities of developing countries” to prevent, prepare and respond to pandemics

A States Parties Committee will be set up to facilitate the effective implementation of the amended Regulations, including the creation of National IHR Authorities to improve coordination of implementation of the Regulations within and among countries.

WHA President Dr Edwin Dikoloti strikes the gavel to indicate the passing of the IHR amendments and extension of the INB’s mandate.

“The experience of epidemics and pandemics, from Ebola and Zika to COVID-19 and mpox, showed us where we needed better public health surveillance, response and preparedness mechanisms around the world,” said Bloomfield, who also co-chaired the drafting group.

Countries also agreed to extend the mandate of the Intergovernmental Negotiating Body (INB) established in December 2021, to finish its work to negotiate a pandemic agreement by the World Health Assembly in 2025, or earlier if possible at a special session of the Health Assembly in 2024.

“There was a clear consensus amongst all member states on the need for a further instrument to help the world better fight a full-blown pandemic,” said Precious Matsoso of South Africa, co-chair of the INB and drafting group.

Credit to multilateralism

Member states generally expressed satisfaction with the final agreement, with the European Union and China describing it as proof of the success of multilateralism.

Ethiopian Health Minister Mekdes Daba, on behalf of Africa group, supports the IHR amendments and urges speedy adoption of pandemic agreement

However, Ethiopia’s Health Minister, Mekdes Daba – representing the 47 African member states and Egypt – urged all countries to use the momentum from the adoption of the IHR amendments to propel agreement on the pandemic accord. The INB meets again in July.

When parallel negotiations on a new pandemic agreement sailed into heavy water, there was a risk that the IHR amendments might become a casualty in the bargaining process – particularly from African member states pursuing equitable access to health products in the pandemic agreement.

They feared that the powerful Western countries pushing for the IHR to be passed – the US, European Union, Japan and the UK – would be less inclined to continue negotiating in good faith on the pandemic agreement once the IHR amendments have been passed. 

Meanwhile, Slovakia dissociated itself from the resolution, and Russia and Argentina said they reserved the right to implement amendments – or not – according to their national sovereignty. Costa Rica also expressed reservations about the extension of the INB’s mandate.

Reactions to amendments

Former Prime Minister of New Zealand Helen Clark, who chaired the Independent Panel for Pandemic Preparedness and Response, welcomed the adoption of the amendments.

“These amended International Health Regulations, if fully implemented, can result in a system that can better detect health threats and stop them before they become international emergencies,” said Clark.

“I congratulate WHO member states for agreeing to regulations intended to improve information-sharing about outbreaks, and action to ensure that countries have access to health products to contain outbreaks, including to the financing required. It’s excellent that a pandemic emergency is now defined in the IHRs.

“The world must now urgently make the investments needed to implement them, including in low- and middle-income countries, with the objective of stopping pandemic threats in their tracks.”

However, Nina Schwalbe, CEO of Spark Street Advisors and an independent observer of the pandemic negotiations, expressed “deep disappointment” that all references to compliance have been dropped in the IHR.

“The amendments do not include any provisions for a compliance mechanism. How can countries be held accountable to their commitments with a compliance mechanism?”

This story was edited to add reactions.

Civil society observers Yassen Tcholakov, MSF’s YuanQiong Hu, and KEI’s Thiru Balasubramaniam and Jamie Love outside the negotiating room

GENEVA – There were claps and cheers from inside Room XXVI of the UN’s Palais des Nations as World Health Organization (WHO) member states finally agreed on amendments to the International Health Regulations (IHR) after over two years of negotiations.

After failing to reach an agreement on the amendments before Monday’s start of the World Health Assembly (WHA), member states agreed to try to race to the finish during this week.

A drafting committee has been in intensive talks ever since, and its co-chair, Dr Ashley Bloomfield, told Health Policy Watch on Saturday that he had barely slept for the past few  days.

The IHR is a legally binding international instrument aimed at preventing the international spread of disease, and require countries to conduct surveillance for potential international health threats of all kinds and report those to WHO.

The COVID-19 pandemic showed weaknesses in the IHR, including that it did not mention “pandemic”. Member states submitted over 300 proposed amendments to the Working Group on Amendments to the IHR (WGIHR), chaired by New Zealand’s Bloomfield and Dr Abdullah Asiri of Saudi Arabia.

When parallel negotiations on a new pandemic agreement sailed into heavy water, there was a risk that the IHR amendments might become a casualty in the bargaining process – particularly from African member states pursuing equitable access to health products in the pandemic agreement.

They fear that the powerful Western countries pushing for the IHR to be passed – the US, European Union, Japan and the UK – will be less inclined to continue negotiating in good faith on the pandemic agreement once the IHR amendments have been passed. 

It is much harder for wealthy nations to buy into an agreement that involves compelling pharmaceutical companies to share their products – and the know-how about to make these – with companies and countries in the global south.

At the time of publication, the WHO still had to outline the process to conclude the pandemic agreement negotiations, but this is expected before the WHA closes at midnight on Saturday.

The fight against malaria is facing a new and urgent challenge as climate change and extreme weather events threaten to undermine decades of progress, according to warnings from several countries at the 77th World Health Assembly this week.

“Recent extreme weather events such as flooding in Malawi and other countries have intensified malaria transmission, disproportionately affecting vulnerable populations,” Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, told the assembly on Thursday.

France, a leader in the fight against malaria, expressed concern over the lack of funding for malaria response and called for integrating anti-malaria efforts into national health plans, emphasizing that the need for funding has become more urgent as climate change is “increasingly impacting health systems and making them more fragile.”

“We wish to highlight the importance of the One Health approach and the key role of community health workers in local surveillance and awareness of malaria,” the delegation said.

The introduction of new malaria-causing parasite species due to climate change is also putting populations at risk, particularly transitory migrant groups, Costa Rica warned. “We believe it’s essential for international bodies to take these variables into account when allocating resources, both for dealing with public health problems and regional and extra-regional migration,” the country’s delegation said.

Colombia echoed those concerns, noting that “rapidly changing ecosystems are increasing vulnerability and giving rise to new malaria transmission dynamics,” a problem compounded by “increasing migration patterns.”

Eliminating Malaria

Despite the challenges, several countries, including Egypt, Ecuador and Malawi, renewed their commitment to eliminating the disease. Papua New Guinea said partnerships had been crucial to its malaria control initiatives, which focus on prevention, diagnosis, treatment and community engagement.

Malawi is implementing a plan to eliminate malaria by 2030, while Cabo Verde recently became malaria-free, joining just 43 countries worldwide to achieve the milestone and be recognized with this certification by the WHO.

The WHO is adopting a multi-faceted strategy to fight malaria, including new guidelines for countries to prioritize interventions in resource-limited settings and a focus on emerging threats like drug resistance, Dr. Jérôme Salomon, the organization’s assistant director-general for universal health coverage, communicable and non-communicable diseases, said Thursday.

Salomon, reflecting on the achievements of malaria-free countries, stated that key strategies to accelerate progress include introducing new tools like a malaria vaccine and ensuring wider access to existing ones.

“Recent extreme weather events such as flooding in Malawi and other countries have intensified malaria transmission, disproportionately affecting vulnerable populations,” Salomon said, emphasizing the urgency of addressing climate change through proactive mitigation, adaptation, and research.

Investments in primary health care are fundamental, he added, as are efforts to address various factors impacting malaria transmission, including inequities, conflicts, migration, the Covid-19 pandemic and climate change.

Although new tools are becoming available to fight malaria, several challenges are limiting their use, especially in Africa, said a representative from Chad, speaking on behalf of the 47 member states of the WHO’s African region. Chief among them, the delegate said, are shortfalls in funding.

In a joint statement, African countries pressed for greater political commitment and self-reliance in the fight against malaria, appealing for more predictable international aid that aligns with their national policies.

Sudan stressed the importance of tackling security issues to enable far-reaching malaria interventions, while Guinea urged partners to keep supporting immunization efforts and help end repeated malaria outbreaks.

Image Credits: WHO.

Rüdiger Krech, Director of Health Promotion at WHO showing examples of nicotine products with toy-like designs created to attract children.

The tobacco industry is deliberately targeting children with nicotine products, using targeted marketing to lure the younger generation into smoking while publicly promoting e-cigarettes as a less harmful alternative for smokers, according to a new report by the World Health Organization (WHO) and STOP, a tobacco industry watchdog.

The report, released ahead of World No-Tobacco Day on May 31, analyzes ways in which tobacco and nicotine companies design products, implement digital marketing campaigns, and shape policy environments to help them addict youth globally.

“The industry is peddling a narrative that denies or underplays youth addiction,” Jorge Alday, Director of STOP at Vital Strategies, told Health Policy Watch. “If we don’t establish a comprehensive approach and work across agencies, the industry will exploit any loophole or any new opportunity to reach young audiences.”

The report accuses the tobacco industry of targeting children and young people with over 16,000 e-cigarette flavours, employing colourful branding, influencer partnerships, and innovative digital marketing tactics, including the Metaverse.

“The Metaverse could eventually become a virtual shop window like physical or e-commerce stores,” Alday told Health Policy Watch about how the tobacco industry is using new digital forms of marketing.

The tobacco industry is attempting to “replace tobacco users lost to death and disease with a fresh wave of users trapped in addiction,” said Rüdiger Krech, WHO’s Director of Health Promotion, during the report’s launch press conference.

“We see tobacco products taking the shape of chocolates and sweets, candy, taking the form of toys,” Given Kapolyo, the global youth ambassador of the year and an anti-tobacco activist, told reporters. “They’re going out of their way to ensure that they make this product seem very cool.”

The tobacco industry bombards youth with branding, Kapolyo added, targeting areas close to schools, along routes used by young people, and in the digital space.

“These industries are actively targeting schools, children and young people with new products that are essentially a candy-flavoured trap,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, commenting on the youth-targeting strategies of tobacco firms. “How can they talk about harm reduction when they are marketing these dangerous, highly addictive products to children?”

Fewer smokers, more vapes

Christian Lindmeier, WHO’s Spokesperson and Rüdiger Krech, Director of WHO Health Promotion during a press conference launching a report on tobacco firms targeting children in their marketing

While the global number of smokers is declining, with one in five adults smoking in 2020 compared to one in three in 2000, eight million people still die annually because of tobacco use.

The number of e-cigarette users, meanwhile, is growing, especially among the youngest generation. Globally, 37 million children aged 13–15 years use tobacco, and in many countries, vaping is more popular than traditional cigarettes among adolescents. In the WHO European Region, one in five 15-year-olds surveyed reported using e-cigarettes in the past month.

The tobacco industry often frames vaping as a way to reduce the harmful health effects of carcinogenic substances present in cigarettes, but research shows e-cigarette use actually increases conventional cigarette use nearly three times, according to the WHO.

The US Food and Drug Administration says that nicotine-mimicking substances used in vapes to avoid product regulation can be even more addictive than normal nicotine, Reuters reported.

Curbing the industry’s influence

Introducing tobacco taxes in New Zealand successfully lowered the cigarette consumption, also among the youth

Controlling marketing strategies, including digital ones, is an important way to limit tobacco firms’ influence on youth, the report’s authors said.

“How we define terms like advertising, promotion and sponsorship set the stage for what can be regulated now and in the future. This means that regulators should update rules to cover any and all platforms – physical and virtual,” Alday told Health Policy Watch.

Alday cited the recent example of Nigeria, which announced new regulations that will require health warnings for films that contain tobacco imagery. The regulation covers movies, music videos and skits produced in Nollywood, one of the world’s biggest movie industries, Alday said.

The WHO recommends not only a ban on marketing, advertising, and promotion but also creating 100% smoke-free indoor public places, banning flavoured e-cigarettes, and imposing higher taxes, among other strategies.

The latter strategy has shown significant results, as Vital Strategies’ Jeffrey Drope, co-author of the Tobacco Atlas, demonstrated during the State of Tobacco Control press briefing on May 21.

“Raising taxes [is] arguably the most effective and most straightforward solution,” said Drope. With higher prices, “young people don’t start to use tobacco products [and] people who already smoke or use tobacco stop, or cut down.”

New Zealand’s tax policy effectively drove down youth smoking prevalence as prices doubled between 2009 and 2019. It was also able to make a step towards bridging societal gaps between the general and Maori smoking populations.

The UK’s total ban on cigarettes for people born after 2009 is another example of an ambitious health policy, aiming to gradually raise the minimum age required for buying cigarettes until eventually, they become illegal. The regulation law passed its second reading in April, but has been postponed until after the general elections, BBC reported.  The bill has support from the opposition Labour party, a likely winner of the vote, which gives it much chance to be passed in the next term.

“This really has an enormous effect on consumption,” Drope said.

In their closing remarks, speakers at the press conference emphasized the essential role of youth leaders in shaping the future of global tobacco consumption and policy. “Youth leaders have a key role to play in communicating their reality to policymakers, that use of nicotine products is growing rapidly and these products are harming youth, now,” Alday told Health Policy Watch.

“What young people have is … they have each other,” Kapolyo added. “When young voices unite, even governments listen.”

Gavi, the Vaccine Alliance, addresses countries at the 77th World Health Assembly.

At the 77th World Health Assembly, Gavi, The Vaccine Alliance, urged nations to prioritize vaccinating “zero-dose” children, particularly those in regions affected by humanitarian crises and complex emergencies. These children have not received any shots, putting them at a higher risk of preventable diseases.

“We are scaling up routine immunization and reaching the estimated 14.3 million zero-dose children worldwide, recognizing that most polio cases are in subnational areas with the highest proportion of unvaccinated and under-vaccinated children,” Gavi representatives told the assembly.

Gavi’s 2021-2025 strategy focuses on reaching zero-dose children and missed communities who have not received any vaccinations. The organization aims to reduce the number of zero-dose children by 25% by 2025 and by 50% by 2030.

The World Health Organization reported a decline in the number of zero-dose children from 18.1 million in 2021 to 14.3 million in 2022, nearing the pre-pandemic level of 12.9 million in 2019. The percentage of children receiving their first dose of the measles vaccine increased from 81% in 2021 to 83% in 2022, still falling short of the 86% achieved in 2019.

During Committee A’s discussion on poliomyelitis, Gavi called on member states to integrate polio funding into existing national health systems to promote and accelerate essential polio and broader immunization functions.

Progress and challenges in the Eastern Mediterranean

Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean, highlighted the region’s progress in ending poliovirus transmission but noted that the poliovirus persists in mobile, border, and migrant populations.

“To end polio, we must reach all children, keep strengthening surveillance, address community resistance and disinformation, and continue leveraging polio resources as we build a resilient health workforce across our region,” Balkhy said.

Iraq and Libya have taken full financial responsibility for sustaining polio essential functions, demonstrating what can be achieved when countries commit to transition. In Yemen, the WHO is negotiating with northern authorities to stop outbreaks of polio and other vaccine-preventable diseases this year.

Global efforts and country commitments

Australia pledged $43.5 million to bolster the Polio Eradication Strategy (2022-2026), underscoring the urgency to ramp up efforts to halt vaccine-derived transmission and concentrate on critical regions. The nation also backed routine immunization, emphasizing the importance of partnering with WHO, UNICEF, and Gavi to expedite advancements in achieving the Immunization Agenda 2030 objectives.

Countries spanning the globe, from Sudan and Chad to Guinea, Senegal, Pakistan, India, the Philippines, Kenya, Bangladesh, and Morocco, shared their initiatives, obstacles, and advancements in the fight against polio. All stressed the importance of integrated strategies, community involvement, targeting zero-dose children, and fortifying immunization systems.

African member states, having ended the wild poliovirus outbreak, remain uneasy about polio’s persistent status as a public health emergency of international concern. avi noted that “the 47 countries remain concerned by the ongoing transmission of circulatory poliovirus and by the low level of vaccination in areas that are difficult to access.” Vaccine supply problems and financial limitations were partly to blame for the type two poliomyelitis outbreaks.

African nations have started transition planning for poliomyelitis and post-certification activities, prioritizing indicators for monitoring and evaluation to uphold program quality. However, unstable health systems, coupled with political and economic challenges, may slow down several countries in the region from assuming complete technical and financial responsibility for all polio eradication functions.

United for Self-Care Coalition hosts a WHA side-event in Geneva.
United for Self-Care Coalition hosts a WHA side-event in Geneva.

Costa Rica’s and Malawi’s ministers of health, along with global health and policy experts, gathered in Geneva to discuss self-care.

At an event organized by the Global Self-Care Federation (GSCF), participants advocated for a World Health Organization (WHO) resolution on self-care. Costa Rica, Egypt, and Malawi, the three countries that co-hosted the event, are working to elevate self-care.

Ministerial representatives from Guatemala, Belize, Panama and El Salvador were also in attendance.

“The potentials for self-care are enormous,” Iain Chapple, Professor of Periodontology at the University of Birmingham and one of the summit’s panelists, told Health Policy Watch. However, he said the approach “needs to be multidimensional,” with collaboration from different fields.

“We need self-care embedded in public health policy,” said GSCF Director-General, Judy Stenmark. She explained that a WHO resolution “could lead to meaningful policy change” and cost-savings for healthcare systems.

“We want to save time and money for individuals, healthcare professionals and healthcare systems, and we have the evidence and data that demonstrates that self-care can do all that,” Stenmark said.

According to a policy brief published by the United for Self-Care Coalition, implementing self-care protocols can generate as much as $119 billion annually in savings for health systems.

The WHO estimates that there will be a global shortage of 18 million health workers by 2030. In 2022, WHO said at least 400 million people worldwide lacked access to the most essential health services. The organization put self-care among “the most promising and exciting approaches to improve health and well-being.”

One key aspect of the conversation this week was making self-care accessible to all. Every year, 100 million people are plunged into poverty because of high healthcare expenses, WHO has said.

“A comprehensive approach to self-care should encompass cultural sensitivities, holistic practices and community engagement,” said Wendy Olayiwola, president of the Nigerian Nurses Association UK and Professional Midwifery Advocate.

Self-care can complement other public health services by being integrated into general health coverage plans, especially for people who “fall through the cracks” of the system, said Dr Manjulaa Narasimhan, WHO’s Sexual and Reproductive Health and Research Unit head.

She said that making menstrual products more available across different contexts is a powerful example of self-care implementation.

“Self-care is about how people lead their lives and can care for themselves,” Narasimhan said.

Dr Mary Munive Angermüller, Vice President of Costa Rica and Minister of Health added: “Self-care is not an individual action, it requires a confluence of different circumstances from health literacy to public health policy, in order to realise its potential.”

Putting People at the Center

Another “concrete” benefit of self-care is that “patients take an active role in their health,” said another summit panelist, Ellos Lodzeni, Chair of the International Alliance of Patients’ Organisation. He said patients also make more informed decisions.

“When we put people in the center of healthcare, self-care is inherent,” added Narasimhan.

A big focus of the Global Self-Care Federation’s efforts is education.

Educating people about ways to take care of their health and new tools that can help them with it brings many advantages, said Chapple, who spoke with Health Policy Watch.

Moreover, Narasimhan said that education about where to find accurate health information is essential. She said that sometimes people can find false information online, for example. She said it would be better to provide “good education on self-care, starting from the very beginning.” This means across the life course from the prenatal stage to older adulthood.

Benefits of Self-Care

Various benefits of improved self-care enumerated in the WHO guidelines
Various benefits of improved self-care enumerated in the WHO guidelines

“Self-care can also be discussed in the context of health insurance,” said Dr Mariam Jashi, Chair of the Eastern Europe and Central Asia chapters of UNITE, an international consortium of present and ex-parliamentarians.

She spoke to Health Policy Watch. She said she sees much potential for policy-making regarding health coverage and prevention as essential components of self-care. Screening, for instance, for breast cancer, is “a classic example of self-care. It makes it possible to identify potentially deadly diseases with timely detection [and] increase the chance of survival and quality of life.”

Yet Jashi said we need to agree, “specifically on the international level,” about defining self-care. The summit was an excellent start, Jashi said, “but more work is needed for better framing.”

To find out more about self-care and the work of the United Self-Care Coalition, visit www.unitedforselfcare.org.

Image Credits: Zuzanna Stawiska, World Health Organization.

Palestine’s delegate, Ryad Awaja, a counsellor in Geneva’s UN Mission, applauded as he moves to a seat for member states at final WHA Plenary Saturday evening after Friday’s vote to elevate Palestine’s status to that of a member state – except for voting rights.

Palestine moved close to full recognition by WHO on Friday evening- with the broad approval of a World Health Assembly resolution that gives the Ramallah-based Palestinian Authority, which has limited governing authority in parts of the Israeli-occupied West Bank, all the rights of WHO member states – short of the vote.

The resolution, on “aligning Palestine” status in the WHO with its newly elevated status in the UN General Assembly, was approved Friday by a vote of 101 in favor, five against and 21 abstaining.  

The vote signified an important diplomatic victory for the Ramallah, West Bank-based Palestinian National Authority – which holds the official reins of internationally-recognized Palestinian institutions.  Until now, the Palestinian delegation had been attending WHA as “observers” by special invitation of the WHO Director General Dr Tedros Adhanom Ghebreyesus. The same status  was held by Taiwan until 2016- when WHO ceased issuing invitations under pressure from Beijing. 

The PNA has been progressively marginalised over the past two decades by a succession of hardline Israeli governments as well as by its Hamas rivals in Gaza –  which expelled its leadership in 2007 and launched the bloody invasion of Israel on 7 October 2023, triggering Israel’s devastating invasion of Gaza. The PNA’s ageing political leadership also hasn’t held elections in the West Bank for over a decade. 

Paradoxically, the vote to enhance Palestine’s status also came on a day which began with the appointment of Israel to a new three-year term at the WHO Executive Board – following its nomination by WHO member states of the European Region. Despite protests, bitter critics and rival member states in the Health Assembly agreed to go with protocol and let the decision stand. 

Friday’s WHA – framed by the Gaza crisis and Israeli-Palestinian conflict

WHA member states raising their name plates in the air in a show of “ayes” for expanding Palestine’s membership rights

And this all happened in a day at the WHA that was bookended by over 10 hours of debate over two different resolutions, including four competing amendments, on the humanitarian crisis in Gaza. 

One motion co-sponsored by a coalition of Algeria, Russia, China, Cuba, Iran, Egypt and other regional allies, slammed the “wanton destruction” of Gaza’s health and other infrastructure by Israel.  But the final version also carried an Israeli-backed amendment calling for the Hamas release of some 121 hostages still in captivity, and condemning Hamas militarization of Gazan health facilities.

A second resolution approved by consensus in December at a special meeting of WHO’s 34-member Executive Board, including EU countries and the United States, called for a “humanitarian ceasefire”, using more neutral language but without any mention of the hostages. 

Both measures ultimately passed with large majorities – but also with a raft of abstentions as well as objections on all sides of the deeply divided WHA member state body.  

Applause upon expanded role 

Egypt says vote by WHA member states on expanded rights for Palestine places them at the “right side of history.”

The expansion of Palestine’s role in the WHO, won a round of applause by WHA member states, with countries such as Egypt saying that the WHA had stood on the “right side of history.”

The Palestinian Ambassador to the UN in Geneva, Ibrahim Khraishi, pledged to “cooperate and work alongside WHO, whose role we highly value… even [working] with those who say that Palestine doesn’t have the right to vote.”

He was referring to the risk that any bolder move by WHO member states to grant full rights could also jeopardise funding from the United States. In 2011, a Republican-controlled Congress cut off financial support to UNESCO, after the UN body recognised Palestine as a member with full voting rights. The US left the UN Educational, Scientific and Cultural Organization altogether in 2017, under the administration of former President Donald Trump, which accused it of anti-Israel bias.

Although the US committed to rejoin the Paris-based organization in June 2023, WHO’s leadership would be wary of teasing fate on the issue, given the Republican majority in the US House of Representatives and an uncertain horizon for Democrats in the looming November US elections. WHO also needs to raise some $11.1 billion more in donor funds from member states for its four-year budget plan – part of which will have to be recruited from the US and allies.

Bitter Israeli-Palestinian exchange during the vote

Israel’s Ambassador Meirav Eilon Shahar says Palestinians have failed to show leadership.

At Friday’s vote, the United States opposed the WHA move to enhance Palestine’s status right now, saying that while it supports the eventual creation of a Palestinian state alongside Israel, Palestine’s aspirations for statehood can only be realized as a result of negotiations – rather than unilateral moves.

Meanwhile, Israel’s Ambassador, Meirav Eilon Shahar, deplored the WHO move, saying that PNA had failed to offer “a true alternative” to Hamas, which rejects Israel’s right to exist.      

“What the Palestinian people need is leadership,” Shahar declared. “Leadership means educating your children for peace instead of indoctrinating them to hate…investing and not rewarding them for martyrdom. 

“Not a single Palestinian leader has condemned the October 7 massacre, not the slaughter of families, the sexual violence, the mutilation and torture by Hamas. We have yet to hear the Palestinian delegation question why Hamas builds terror tunnels instead of building a future for Palestinian children,” she said. “The Palestinian delegation and all those who support this today will pat themselves on the back for this World Health Assembly decision.” 

“But in reality, until the Palestinian leadership offers their people a true alternative, rather than supporting Hamas, a symbolic gesture in this UN Forum will do little to better the lives of Palestinians.” 

‘Don’t give us lessons in ethics’ 

Palestinian Ambassador Ibrahim Khairshi at the WHA vote expanding Palestinian rights in the WHO

Khraishi retorted that Israel “should stop giving us lessons in ethics… seeing the way in which they [Israelis] educate their children…

“We’ve seen with our own eyes the violations perpetrated by Israeli settlers. These things have been clearly documented and shown in the media,” he said, referring to the recent, sharp increase in attacks by extremist Israelis on Palestinians – particularly Orthodox Jewish settler youths in the West Bank.  

The Ambassador added that he was also perplexed by the United States’ position that Palestinian statehood could only be achieved through negotiations. 

“I am also perplexed with regard to the position with regard to the two-state solution that can only be through negotiation,” Khraishi said. 

“As we know we are now approaching the Fourth of July of 1776, when the US was able to get his independence without having negotiated with the occupier, with the colonial state. 

“This is an inalienable right and an absolute right for us when we are faced with genocide, for us to be able to exercise our right to self-determination. 

“And we are calling for cooperation. We are against this viciousness that is being perpetrated by the State of Israel and their supporters -where they are trying to disfigure the image of the Palestinian people. We are the indigenous people of this land, before even all religions, and we shall remain there. And soon enough we will celebrate with you [WHO] the end of this vicious and brutal occupation.”

Wellcome Trust CEO John-Arne Røttingen and Africa CDC executive director Dr Jean Kaseya

GENEVA – For two years, the family of a soldier in the DRC army could not trace him until they discovered that he had been imprisoned – not for doing anything wrong but because he had a mental illness.

“When we speak of disorders, we forget these affect human beings. People who need to be in hospital should not end up in prison,” said the soldier’s brother, Dr Jean Kaseya, the executive director of Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya spoke at the launch of an African mental health leadership programme to establish a cohort of mental health advocates across the continent, held on the sidelines of the World Health Assembly in Geneva this week. Supported by Wellcome Trust, the goal of the initiative is to train leaders in the health sector to understand and address mental health “through a public health and human rights lens”.

Although the program cannot help Kaseya’s brother, who died soon after his family found him in 2020, it hopes to benefit some of the estimated 120 million Africans struggling with mental health.

Mental health is the stepchild of health programmes on the African continent, receiving just 2% of health budgets. This neglect is reflected in the significantly lower annual outpatient mental health visits in Africa, with only 14 per 100,000 people, compared to the global average of 1,051 per 100,000.

The result of this lack of investment is a vast shortage of mental health workers – 1.4 for every 100,000 people compared to the global average of 9 per 100,000.

Burkina Faso, for example, has only 12 psychologists.

Outdated policies

Cabo Verde Health Minister Filomena Gonçalves

“Mental health policies in Africa are mostly outdated and poorly implemented,” Kaseya told the launch, attended by several African health ministers including those from Burkina Faso, Burundi and Cabo Verde.

“This programme will create a cohort of leaders who understand and can advocate for context-specific, evidence-based approaches to mental health in their countries,” said Wellcome Trust CEO John-Arne Røttingen.

Wellcome’s mental health programme, which has funded numerous African mental health research projects and initiatives, concentrates on anxiety, depression, and psychosis. Røttingen stressed that an integrated approach, with scientists working hand-in-hand with policymakers, is essential to ensure research addresses the right questions and breakthroughs are implemented when tackling these conditions.

“That’s why we are so excited to be working with Africa CDC on this programme,” Røttingen said. 

Cross-sectoral, human rights approach

The World Health Organization’s (WHO) Mark van Ommeren told the launch that effectively addressing mental health required cross-sectoral collaboration across different departments.

Addressing suicide, he explained, means engaging with the Department of Justice for gun control and Agriculture to restrict access to hazardous pesticides that are banned in many countries but still available on the continent, and education to ensure young people have life skills to cope with life challenges.

David Bainbridge and Michael Njenga from CBM Global

David Bainbridge, the executive director of CBM Global, an international organisation that advocates for the involvement of people with disabilities, said the programme could “make a significant impact not only on the wide treatment gap in access to mental health services but also to apply good public health practice to reduce the drivers of mental health conditions and the negative impact on well being.”

“We underscore the need to take a human rights approach to mental health which means that, in addition to the personal suffering that results from experience of mental health symptoms, we’re particularly concerned about the experiences of stigma, social exclusion and abuse experienced by people affected. You’re often denied access to basic rights like family life, livelihoods, even personal autonomy and freedom,” explained Bainbridge.

Michael Njenga, the Africa co-ordinator for CBM Global, said the inclusion of people with lived experience of mental illness in policy making was critical for successful implementation.

Some countries barred those with mental illness from voting or standing for office, while Kenya classified a suicide attempt as a “misdemeanour”, added Njenga.