Indonesia delivering a statement at IGWG5 on behalf of the Group of Equity.

Powerful member state blocs at the World Health Organization (WHO) stressed on Monday that they will not compromise on the final outstanding piece of the Pandemic Agreement simply to meet the May deadline.

The Group of Equity and the WHO’s Africa, Eastern Mediterranean and South-East Asia regions stated that they wanted a Pathogen Access and Benefit-Sharing (PABS) system with legal certainty at the second-to-last meeting of the Intergovernmental Working Group (IGWG).

“PABS is the heart of the Pandemic Agreement. If the heart is weak, the body cannot function, and the agreement will not deliver equity,” said Indonesia on behalf of the Group of Equity, and the three regions – collectively representing over 80% of the world’s population.

The PABS system aims to set out how countries can share information about pathogens and their genetic sequence data and ensure that those sharing this information get access to the benefits developed as a result, such as vaccines, diagnostics and therapeutics.

But the current PABS draft contains “major loopholes” that will prevent the system – an annex to the Pandemic Agreement – from functioning effectively, Indonesia added.

“The annex must articulate the operational details of the PABS System, and provide legal clarity on the rights and obligations of the providers of PABS material and sequence information, as well as various users of the system. We also question how any terms and conditions can be enforced when users are permitted to remain anonymous,” stressed Indonesia.

“We understand the pressure of timelines. But we should be clear about the choices and decisions in front of us: We are aiming for an annex by [the World Health Assembly in] May, that can actually deliver a functioning PABS System in totality. But if we cut too many corners now, we will pay for it later in credibility and implementation.”

Zimbabwe – speaking for the Africa Group – stated that “a system that safeguards some while leaving others exposed is not only unjust, it is ineffective”.

“For the Africa Group, equity and benefit-sharing must be operational, enforceable and central to Pandemic Agreement, including the PABS annex. These elements cannot be aspirational, deferred or left to voluntary implementation. Past experiences has shown the consequences of such approaches.”

Pragmatism and speed

The EU representative and France’s Anne-Claire Amprou.

However, the European Union, backed by G7 leader France, called for pragmatism and speed.

“We remain deeply committed to work towards an effective, workable and implementable PABS system in the remaining 12 Days of negotiations that we have at our disposal,” said the EU representative.

“We hope that a sense of pragmatism and common sense will help to guide us towards convergence on the key remaining outstanding areas for the purpose of bringing this process to a successful conclusion within the timeframe.”

Speaking for France, Anne-Claire Amprou, a former co-chair of the Pandemic Agreement negotiations, urged “quick progress” to adopt the annex by the World Health Assembly in May. 

“Given the time remaining, we need to be reasonable in terms of the amendments we make to the text,” said Amprou. “We invite member states not to reopen subjects or provisions which were already adopted as part of the Pandemic Agreement.”

The Pandemic Agreement cannot be endorsed or operationalised without the PABS annex, which means there is no global agreement on how to approach the next pandemic – which can strike at any time.

Benefit-sharing demands

India warned against adopting an ambiguous annex.

But for many low- and middle-income countries (LMICs), the bitter memory of being unable to get access to vaccines during the COVID-19 pandemic – even for health workers and their most vulnerable citizens – was a sobering lesson.

Some indicated that they would be prepared to miss the May deadline rather than budge on their demand for a legally binding PABS system that balances access and benefit-sharing.

India, speaking for the South-East Asia region, stated that “it is essential that quality is not compromised by the pressure of timelines”. 

“Our priority must be an annex that provides clear legal certainty with minimum room for interpretive ambiguity. Such clarity is critical for effective implementation and long-term trust in multilateralism, “ said India.

“Benefit-sharing obligation must be proportionate to access and cannot be voluntary, aspirational or based on ‘best endeavours’. 

Non-monetary benefits

Some LMICs also stressed – as India did – that benefit-sharing must extend “beyond monetary contributions and donations of vaccines, diagnostics and therapeutics”. 

“Non-monetary benefits, including timely capacity development, technical assistance and non-exclusive manufacturing licences for developing countries, must be clearly specified and applied both during pandemics and during the inter-pandemic period,” said India, for the South-East Asia region.

Indonesia said that, while equitable access to vaccines, therapeutics and diagnostics (VTDs) is essential, “we should also be serious about benefits that support timely diversified regional and local production, including non-exclusive licensing to manufacturers in developing countries, transfer of technology, and meaningful collaboration in R&D.”

“Benefit sharing cannot depend on purchasing power, ad hoc arrangements or discretionary decisions taken during emergencies,” said Namibia.

“It must be triggered by access, governed by multilateral rules and delivered when it matters most. Namibia also places strong emphasis on technology transfer and regional manufacturing capacity. Strengthening local and regional production is essential to reducing dependency and building real resilience.”

Way forward

The IGWG meeting – the fifth of six – ends on Saturday, and while it plans four evening sessions, co-chair Tovar da Silva Nunes reminded delegates that the meeting’s access to interpreters is limited, a casualty of WHO budget cuts.

There are 100 days to the deadline, and by the end of this week’s talks, it should be clear whether the annex is on track for adoption in May.

Mexico, meanwhile, indicated that it is available to facilitate “dialogue between blocs of countries”.

“We are convinced that, with political will and pragmatism, we can reach the necessary consensus so that we can allow this process to conclude successfully and strengthen our multilateral stance for future pandemics.” said Mexico.

Egypt leads the charge Friday against renewing WHO relations with NGOs working in the sexual and reproductive health rights space.

After fits, starts, hours of back room negotiations and hesitations, the closing day of WHO’s Executive Board session Friday saw agreement on a number of small – but potentially meaningful – efficiency measures aimed at saving booth member states and the financially-strapped agency a time and money in preparing for and responding to member state mandates.  

The changes come amidst mounting geopolitical and social tensions amongst member states, with an increasing share of discussion time consumed by a handful of highly politicized items, including the wars in Ukraine and Gaza, as well as sexual and reproductive health rights. 

At the same time, the Executive Board and the annual World Health Assembly (WHA) have become overloaded with a growing volume of draft decisions and resolutions – many costly to implement and not always aligned with established strategic plans.

Among the key reforms is an initiative to streamline timelines and criteria for the submission of proposed draft resolutions and decisions by member states. This could curb the proliferation of proposals seen over the past several years.

Streamlining discussion on Palestine and de-escalating flashpoints

WHO Director General Dr Tedros Adhanom Ghebreyesus Friday evening in emotional appeals for streamlining debates around divisive issues such as reproductive health rights and Palestine.

Another small efficiency steps for the upcoming WHA include a compromise on language, which enabled the approval of  WHO’s continued engagement with five NGOs working on sexual and reproductive health rights.

In addition, a plan to consolidate discussion around two overlapping reports on the thorny question of health conditions in the “Occupied Palestine Territory (OPT)’’ into a single WHA agenda item avoids duplications that have consumed hours of WHA time since 2024. That is when the Israel-Hamas war led to the development of a second WHO report on health conditions in the OPT, in addition to the annual report that has been a perennial feature on the WHA every year since Israel occupied the territories in 1967. 

Addressing the Executive Board on Friday, WHO Director-General Dr Tedros Adhanom Ghebreyesus framed the latter consolidation as both an efficiency gain and a confidence-building measure.

“As you know, the UN Security Council welcomed the comprehensive plan to end the Gaza conflict last November through Resolution 2803. This holds the real promise for advancing peace and …in a region with such urgent needs, peace is built one brave step at a time. It’s a commitment we renew every day. Peace endures only when we carry it forward together. Each of us can contribute through our decisions in the EB and the WHA,” Tedros said.

“Today, I propose one concrete step combining the two WHA agenda items… into a single discussion. …By taking this step together, we not only foster a more constructive environment for our governance deliberations, but also contribute, in a small way, to the success of the peace initiative.” 

More efficient process for advancing WHA resolutions  

Administratively, the Board also backed proposals to enforce stricter timelines for submitting draft resolutions and decisions, along with closer WHO Secretariat supervision to ensure their alignment with agency priorities and budgets, and manageable meeting agendas.

While current rules hold that zero drafts should be submitted several months before a session – and final drafts no later than 15 days ahead – in practice, many proposals have arrived late, leaving little time for review by the WHO Secretariat or member states.

In a draft decision Friday, Board members also agreed to advance a proposed rule change whereby three WHO member states from at least two regions must agree to co-sponsor any new decision or resolution. The innovation aims to curb member states’ debate on measures with little real backing. 

But the provision remains bracketed  in the draft text, which also refers to the  “piloting” of the reform measures, signalling the long road that remains to actual approval.  

Opposition to WHO’s engagement with reproductive health NGOs 

Norway’s EB representative, Cathrine Lofthus, Ministry of Health Director General, led negotiations with the Egyptian-led bloc on WHO collaborations with reproductive health NGOs.

The Executive Board also reached a time-saving agreement on another topic of frequent WHA conflict – WHO engagements with non-state actors that work on sexual and reproductive health rights (SRHR). 

Egypt, where abortion is illegal unless a woman’s life is at risk and is even subject to a jail sentence,  has long been a leader in opposing WHO’s engagements with NGOs working in this space. 

This year, that included opposition to WHO collaborations with five groups whose terms of engagement with WHO are due to be renewed this year, as part of a routine, triennial review process.

The groups are the International Planned Parenthood Federation, American Society for Reproductive Medicine, Family Health International, the Population Council and the World Association for Sexual Health. 

Speaking for the Organization of Islamic Cooperation (OIC), which includes states from WHO’s Eastern Mediterranean Region as well as countries in North Africa and Asia, Egypt’s delegate declared that continued engagement with the five NGOs is “contrary” to WHO’s Framework of Engagement with Non-State Actors (FENSA), which aims to ensure the agency’s “integrity, independence and credibility is not compromised” and that non-state actors do not wield undue “influence” in setting “policies, norms and standards.”

Norway, leading the EU and other supportive member states, spent several hours negotiating an addendum that effectively renews collaboration while taking “note” of reservations and affirms that “member states have full sovereign rights over which non-state actors operate within their national territories,” in line with their “national context and legislation.”

Addendum to EB decision renewing WHO’s collaboration’s with reproductive health NGOs de-escalated potential controversy at the upcoming World Health Assembly.

Here too, Tedros added his own support, recalling how parliamentary reforms liberalizing Ethiopia’s abortion laws during his tenure as health minister helped cut maternal mortality fivefold, as many deaths were linked to unsafe abortions.

“I myself invited not only WHO, but other international organizations for help, and it’s during that time, our Parliament passed a bill on how to handle unsafe abortion, because nobody wanted for our mothers to die, our sisters to die,” Tedros said.  

“We don’t allow our norms and standards to be influenced by anyone. We take sides with science,” Tedros affirmed. “Any country has sovereignty, either to invite us or not invite us [to support them]. But whatever relationship we have, it will not be forced on any country.” 

The EB negotiations and word-smithing, while tortuous and time-consuming, may help avert an even larger debate at the WHA.

Temporary fixes? 

Palestinian EB representative Ryad Awaja: consolidated discussion on health conditions in the Occupied Palestinian Territory is an “exceptional” move.

Despite the budget pressure that helped push member states toward incremental reforms, most changes remain tentative—preliminary or applicable only to the upcoming WHA.

Agreeing to combine discussions on the two overlapping WHO reports on “health conditions in the Occupied Palestine Territory (OPT)” into one dedicated discussion on the WHA agenda, Palestine’s EB representative Ryad Awaja stressed that the arrangement was temporary. 

He attributed it to logistical constraints facing this year’s WHA, with some meetings shifting to WHO headquarters during renovations at Geneva’s UN Offices in the Palais des Nations.

“To know this is exceptional,” Awaja said of the consolidated discussion. “It’s not …forever. It’s just an exception from Palestine to help for this time.”

An infographic titled Global Maternal and Child Health Targets “Off Track” showing six key nutrition indicators. From left to right: Anaemia in women (rising from 27.6% to 30.7%), Childhood overweight (stagnating/rising at 5.5%), Low birth weight (stagnating at 14.7%), stunting (improving but off track at estimated 136.3 million by 2030), wasting (off track at 6.6%), and Exclusive breastfeeding (improving but off track at 47.4%).
The current status of six global maternal and child health targets as of 2023.

The World Health Organization (WHO) Executive Board faced a grim reckoning on Thursday in a report detailing how global progress on maternal, infant and child nutrition has largely stalled or even regressed.  Notably, six critical nutrition targets remain “off track,” with rising rates of anaemia and childhood obesity sliding back, threatening to reverse years of development gains, according to a report reviewed by the EB.

“Malnutrition is really a silent epidemic today in Africa,” stated the representative of Cameroon. “Despite all that has been done, we still see stunting, anaemia, and lack of certain nutrients.”

International commitments aim to halve the prevalence of anaemia in women of reproductive age by 2030, as part of Sustainable Development Goal 2 (Zero Hunger). However, rates have climbed from 27.6% in 2012 to 30.7% in 2023. Driven by factors ranging from food insecurity and infectious diseases to poverty, this leaves millions of women without enough healthy red blood cells.

Global targets for tackling the double burden of malnutrition, which includes both undernutrition and overweight, are similarly off-track.

The global prevalence of childhood overweight has crept up to 5.5%, as food systems struggle to provide healthy options, the WHO report notes. Stunting, a measure of undernutrition, still affects 150.2 million children under five, with an estimated 136.3 million more children likely to face stunting by 2030. And low birth weight rates have barely improved, inching down just 0.3% to 14.7% of newborns between 2012 and 2023. Meanwhile, childhood wasting remains stubbornly high at 6.6% of children under the age of five years of age – well above the 5% threshold required to ensure child survival.

Maternal and child health is crisis of inequality 

Delegates from Cameroon, Cabo Verde, and Algeria seated at a World Health Organization Executive Board meeting, discussing the global crisis in maternal and child health.
The delegation from Cameroon highlighted the ‘silent epidemic’ of malnutrition and the urgent need to prioritise maternal and child health amidst stalling global progress.

In the first comprehensive debate since member states pledged to extend and accelerate action on maternal, infant and young child nutrition in a 2025 World Health Assembly resolution, delegates called out the stagnation as a systemic crisis of inequality deepened by conflict and climate change.

Speaking on behalf of the 47 Member States of the African Region, the delegation from Lesotho warned that the continent bears the highest global burden of stunting and anaemia, a situation that persists, despite ongoing interventions, delegates from Cameroon added.

Somalia, speaking for the Eastern Mediterranean Region, highlighted the devastating impact of climate and conflict-driven instability, noting a “complex nutrition burden driven by conflict, displacement, and climate shocks.”

The delegation reported that 24.3 million children under five in the Africa region are currently stunted, urging prioritised support for fragile and conflict-affected settings.

Outrage over ‘savage marketing’ of formula

A medium shot of a female delegate with long brown hair and glasses, wearing a white blazer. She sits behind a laptop and microphone.
The Norwegian delegation joined the European Union and African nations in calling for stricter regulations on the formula industry’s digital marketing following recent safety recalls.

A major point of contention during the session was the aggressive commercialisation of infant nutrition. In a sharp rebuke of the formula industry, the Central African Republic condemned “savage marketing for breast milk substitutes.”

The delegate noted that these practices are “undermining breastfeeding and taking advantage of communities that are already poor and fragile”, putting industry interests over public health.

This concern bridged the divide between the Global South and wealthy donor nations. Norway joined African nations in demanding stricter regulation, specifically targeting the digital sphere. The Norwegian delegation raised alarm over “recent large-scale recalls of breast milk substitutes,” arguing that food safety and robust monitoring must be paramount.

Advocacy groups demand industry accountability

In the foreground, a man representing the Central African Republic speaks into a microphone while holding a document. To his left sits a woman representing Chile working on a laptop, and to his right is a man representing Cameroon. The table features official nameplates and microphones for each delegate.
The delegate from the Central African Republic condemned ‘aggressive’ and ‘savage marketing for breast milk substitutes.’

The tension between public health priorities and commercial interests was palpable in statements from non-state actors.

The International Baby Food Action Network (IBFAN) hit back at the formula industry. The advocacy group warned that recent contamination cases exposed “systemic failures” in formula production. IBFAN argued that cross-border social media marketing exacerbates food safety risks by allowing unregistered products to enter countries, demanding that governments take the lead in verifying safety rather than trusting manufacturers.

Meanwhile, the Global Self-Care Federation, representing the consumer health industry, argued that policymakers also “must prioritise the provision of micronutrient supplements”  to women. A statement by the group noted that iron, folate, iodine, and calcium supplementation can help reduce anaemia prevalence, and therefore maternal mortality and pre-term birth, as well as some “life-long NCD risks.” Such supplementation is thus a “cost-effective public health investment”, the group stated.

Rising stakes in a climate of receding aid

A wide-angle view of the World Health Organization (WHO) Executive Board meeting in a circular assembly hall, where delegates are gathered to debate global progress on maternal and child health.
The WHO Executive Board convenes in Geneva to address a critical report revealing that most global maternal and child health targets are currently off track.

The United Kingdom called the report “sobering,” noting that “no country is on track to meet the targets” and flagging worsening trends in minimum dietary diversity even within its borders. Canada emphasised the need to “step up nutritional interventions” that are based on evidence and take gender into account.

Speaking for the 27-member European Union, Bulgaria admitted the world is “far off track.” However, the bloc reiterated its financial commitment, noting that Europe has pledged €6.5 billion to fight malnutrition up to 2029. The EU called for increased coordination on data collection to better target the most vulnerable populations.

While officials figures are yet to be finalised, international development assistance for nutrition declined by an estimated 9% to 17% in 2025. In light of this, the Board faces the difficult task of reversing these trends in a constrained financial environment.

Such reductions in donor aid threaten to “reverse hard work and increase preventable child deaths,” warned Nigeria, saying that nutrition needs to be considered an “essential” organising principle of primary health care.

Image Credits: Felix Sassmannshausen, HPW/Felix Sassmannshausen.

In the foreground, a man representing the Central African Republic speaks into a microphone while holding a document. The delegate from the Central African Republic advocated for slower, more meaningful consultations on the global indigenous health plan.
The delegate from the Central African Republic advocated for slower, more meaningful consultations on the global indigenous health plan.

The World Health Organization (WHO) has slowed the pace on the development of a Global Plan of Action to advance the health of indigenous peoples globally, with the Executive Board voting on Thursday to delay the plan’s final consideration until May 2027.

The draft strategy aims to address the stark health inequities faced by many indigenous communities, focusing on priority areas such as access to services, recognition of traditional knowledge, and climate resilience.

The decision to extend the deadline of the indigenous health plan by a full year reflects a consensus among member states to prioritise the legitimacy of the process over speed. By stepping back from the original 2026 target, the Board aims to ensure the “free, prior and informed consent” of the very populations addressed by the policy – indigenous communities that may be harder to reach or become engaged.

“Strengthening consultation mechanisms that are tailored to cultural and linguistic realities remains vital to guarantee effective participation,” stated the delegate for the Central African Republic, speaking on behalf of the 47 Member States of the African Region.

Fighting ‘digital barriers’ to enable real inclusion

A medium shot of two delegates seated behind a desk labelled at a World Health Organization meeting. A woman with long reddish-brown hair is on the left, looking toward a speaker while holding a tablet.
The Brazilian delegation expressed concerns that relying exclusively on online consultations could silence Indigenous voices due to digital divides.

Delegates in favour of the delay of the global indigenous health plan argued that a program built on a more limited engagement would fail.

Brazil reinforced the African Group’s stance, warning against the exclusion inherent in modern diplomatic processes. The Brazilian delegation noted its concern regarding the “limitations of consultations conducted exclusively online,” arguing that digital divides could silence the very voices the plan aims to empower.

Non-state actors also urged the Board to use the additional time to bridge the gap between western medicine and traditional practices. Médecins sans Frontières (MSF) welcomed the proposal but stressed that the delay of the indigenous health plan must be used to centre “social participation and meaningful leadership.”

“Failure in protecting health holistically can result in severe health consequences,” the MSF representative stated, calling for a plan that respects “traditional medicines and knowledge encouraging dialogue with traditional healers”.

Indonesia rejects fixed ‘indigenous’ label, citing colonial history

An infographic titled “Trading Speed for Legitimacy” showing a timeline for the Global Indigenous Health Plan. The graphic illustrates a shift from an original 2026 target to a revised consideration date of May 2027 to allow for an extended consultation window. Three panels below the timeline outline the rationale, the mandate for inclusion, and regional support from the Central African Republic.
A new timeline for the Global Indigenous Health Plan extends the consultation window to May 2027, aiming to secure “free, prior and informed consent” from affected communities.

While the delay was driven by a desire for inclusion, the session also exposed deep-seated political fault lines regarding what is an ‘indigenous’ community in the first place.

In a pointed intervention, Indonesia challenged the applicability of the term within its national context. As a multicultural and multi-ethnic country that obtained independence in 1945 after nearly 350 years of Dutch colonial rule, the concept of “indigenous peoples” does not fit their demographic reality, Indonesia’s delegate stated. The country is one of the world’s most ethnically diverse nations with over 1,300 ethnic groups that are largely native to the archipelago, but also significant minorities of Chinese-, Indian- and Arab-Indonesians.

While Indonesia voted in favour of the UN Declaration on the Rights of Indigenous Peoples (UNDRIP) in 2007, it did so with a formal explanation that it would limit the declaration’s application within its borders.

“There is no one fixed definition of indigenous people and that concept is not applicable in our national context,” the Indonesian delegate to the EB stated, he underscored their position regarding the indigenous health action plan.

This statement has strong political implications, as conflicts between land claims put forward by local Indonesian communities faced with massive deforestation by the palm oil industry have intensified recently, human rights groups point out. Communities across Africa and Latin America’s Amazonia region also face massive health challenges due to incursions by the oil and gas industry, leaving health impacts not only from the loss of food sources and biodiversity due to deforestation but also from gas flaring, contamination of waterways and more.

The debated reflected the complexities the WHO Secretariat faces in drafting a global strategy that satisfies protects some of the world’s most vulnerable communities – facing challenges from powerful economic interests and political constituencies.

Image Credits: Felix Sassmannshausen.

Argentina’s Ambassador to the UN in Geneva, Carlos Mario Foradori, affirms his country will remain involved with WHO’s regional arm, PAHO,

Although Argentina is withdrawing from the World Health Organization’s global body, it intends to remain an active member in WHO’s regional affiliate, the Pan American Health Organization (PAHO),  the country’s representative told the WHO Executive Board on Friday. 

His comments came in the course of a discussion on the legal and policy impacts of Argentina’s declaration in February 2025 that it would leave WHO, following that of the United States last January. Argentina’s official notice, made in March, is due to be discussed at the May World Health Assembly along with the United States withdrawal. 

But the two countries are in somewhat different legal positions vis a vis any WHA response.  In terms of Argentina, there is no explicit provision in WHO’s  Constitution for member states to withdraw, with the exception of the United States, which reserved that right explicitly when it joined in 1948. As for the United States, the US also owes WHO some $260.6 million in unpaid dues for 2024-2025, on which WHA member states could feasibly demand payment before its withdrawal is legally “accepted.”   See related story.

Stars and Stripes No Longer Flying at WHO – But US Can’t Really Leave Until Dues are Paid, Agency Says

Argentina will continue to abide by International Health Regulations on Emergencies

Regardless of the formalities, Argentina’s Ambassador to the UN in Geneva, Carlos Mario Foradori, affirmed that the country would continue to abide by International Health Regulations whereby WHO must be notified of an infectious disease outbreak of epidemic potential. 

“We will not be isolated from the world. We will continue to respect all the rules that exist. We cooperate very closely with the Pan American Health Organization, and we will strengthen this even further,” Foradori said, adding that PAHO’s Director Jarbas Barbosa, is in fact visiting Argentina next week. 

“And it should be clear to the whole membership that we’re not leaving this world. To be very clear, as was mentioned, the pandemic knows no borders, and as a Western civilized country, we understand that we need to respect rules, and work with the whole world.”  Some WHO observers called out Foradori’s reference to a “western civilized country” was as a slight on non-western regions of the world.

So far, the US also has remained in PAHO, of which it was a founding member, and whose existence predates the 1948 formation of WHO by nearly half a century. Historically, the US is also PAHO’s largest funder. 

However, currently the US owes PAHO some 78.5 million in unpaid dues for the 2024-25 fiscal year, and a total of $136.5 million including 2026 dues. In August, meanwhile, the White House ordered cuts in some $45 million to already approved PAHO allocations in protest over a now-discontinued PAHO programme supporting the deployment of Cuban doctors to rural areas of Brazil at sub-market wages and with Cuba’s government reaping financial benefits.  See related story: 

Pan American Health Organization Targeted in New Round of US Funding Cuts

This week’s Congressional passage of a $9.42 billion global health appropriations bill , meanwhile, contained no explicit mention of funding to PAHO. And so it remains to be seen the cutbacks previously ordered by the White House are indeed implemented – as well as how PAHO will be funded for 2026. 

Legally, PAHO is an anomaly amongst WHO’s six regional offices insofar as it operates with its own budget and decision-making structure as a semi-autonomous entity – even though it also serves as a WHO Regional Office. This anomaly, in turn, opens up the unique possibility for nations in the Americas to retain their affiliation with PAHO as a regional organization, whilst disassociating themselves from WHO as a global body.  

No clear way forward on response to member states that withdraw 

Costa Rica’s delegate at the EB was one of several member states that expressed regret at Argentina’s withdrawal from WHO.

The EB discussion did not yield a unanimous recommendation on whether the World Health Assembly should actively ‘accept’ Argentina’s withdrawal – or how to respond to the US withdrawal at a time when Washington stills owe WHO some $360 million in past dues. 

While many WHO member states at the EB meeting stressed that countries had the sovereign right to determine whether they remain in an international organization – others stressed the legal complexities around the issue and the need for further consideration before the WHA must take a position in May.    

Ultimately, the EB agreed to pass onto the WHA a draft resolution co-sponsored by Argentina and Israel, calling on WHO member states to formally acknowledge Argentina’s withdrawal. But some leading member states reserved their final position, asking for further legal analysis and clarification. 

“Argentina’s notification of withdrawal raises numerous issues that do require careful consideration,” said Australia’’s delegate.

Said Switzerland, “We hear that there are still different legal, political, technical questions on the conditions and the implication in this context, on this agenda. ..We would all benefit from additional clarity for the WHA to be able to take an informed decision.”

A report submitted to this Executive Board meeting has already has laid out the key issues relateld to the withdrawal of both Argentina and the US. Effectively, there is no legal provision in the WHO Constitution for a member state to withdraw  – with the exception of the United States, which made that right an explicit condition of its joining in 1948, WHO’s paper notes. 

At the same time, Argentina and other member states argued that broader international legal principles guarantee a country the sovereign right to determine its affiliations in multilateral organizations like WHO.

Australia, Costa Rica, Zimbabwe and other member states also expressed regret over Argentina’s departure from the global body, asking for continued dialogue over its decision and describing Argentina as a valued partner in global health. 

“We request them to reconsider in view of global health security,” said Zimbabwe. 

China says US withdrawal shows lack of ‘leadership’

China’s EB delegate describes US withdrawal from WHO as a lack of leadership.

No such regrets were expressed at Friday’s meeting regarding the US departure. But China described the US move as a lack of leadership, saying:  

“As the most representative and authoritative intergovernmental, international health organization, the WHO bears a significant responsibility in global health governance….Major countries in particular, should lead by example. They should not treat the WHO as something to be used as it fits and abandoned when it does not. Nor should they bypass the WHO and set up alternative mechanisms,” China’s delegate said. 

“Countries should adhere to the rule of law and should not selectively fulfill their international obligations and commitments, and should not place [their] domestic political agenda above international law and governments.”

At the same time, China called for a re-evaluation of WHO rules around the entry and exit of member states from the organization, for which WHO’s 1948 constitution made few provisions, saying: 

“The issue of withdrawal is complex and sensitive. Members cannot enter or exit at their will. At present, there are certain gaps and ambiguity in the WHO’s rule regarding membership changes based on fairness and transparency, necessary adjustments and improvements should be made to better respond to the new circumstances and requirements on global health governance.” 

Israel, meanwhile, said that WHA members should accept the US notice of withdrawal without hinging it to other issues – an indirect reference to the unpaid US dues for 2024-2025.

Said Israel, “Any attempt to compel states against the national decisions is an infringement of their sovereign rights. There is no valid reason to further discuss this matter in any WHO forum. Further discussions only consume the limited resources this organization has without carrying any actual impact on the ground. Other issues of dispute between a member state and the organization do not affect the right of withdrawal in the context of the WHO,” Israel’s delegate said, an apparent reference to the outstanding, unpaid WHO dues still owed by the US.

At Monday’s Executive Board opening, Israel’s EB Representative, Asher Salmon, warned that his country, a close ally of the US, is also under pressure to withdraw from WHO, saying, “in Israel, there are also, unfortunately, strong public voices calling for us to leave the organisation.” 

Claiming that the WHO had become “too politicised,” he called for a “brave conceptual overhaul” of the organization. See related story: 

Days After US Leaves WHO, Israel Warns it Faces Pressure to Withdraw

 

Image Credits: DavidRockDesign/Pixabay.

Spanish Prime Minister Pedro Sanchez at the World Governments Summit in Dubai

Spain announced this week that it would tighten its social media laws, aiming to ban access for children under the age of 16 as part of a global tide against electronic platforms.

Last year, Australia became the first country to restrict social media for children, while French lawmakers voted to follow suit last month. So far, the UK, Denmark, Norway, Greece and India are considering similar moves, while German lawmakers are considering a digital law to contain the anti-competitive behaviour of global digital platforms.

There is growing evidence of the harmful effects of social media on children, including depression, anxiety, stress and cyberbullying – alongside evidence that digital platforms such as X are influencing political outcomes by manipulating content and algorithms.

“First, we will change the law in Spain to hold platform executives legally accountable for many infringements taking place on their sites,” Spanish Prime Minister Pedro Sanchez told the World Governments Summit in Dubai on Tuesday.

“This means that CEOs of these techno platforms will face criminal liability for failing to remove illegal or hateful content,” said Sanchez.

“Second, we will turn algorithmic manipulation and amplification of illegal content into a new criminal offence,” he added. “No more hiding behind code. No more pretending technology is neutral.

“Third, we will implement a hate and polarization footprint system to track, quantify, and expose how digital platforms fuel division and amplify hate. For too long, hate has been treated as invisible and untraceable, but we will change that.”

Sanchez added that Spain “will ban access to social media for minors under the age of 16” and platforms“will be required to implement effective age verification systems”.

“Today, our children are exposed to a space they were never meant to navigate alone. A space of addiction, abuse, pornography, manipulation… we will protect them from a digital wild west.”

“Fifth and last, my government will work with our public prosecutor to investigate and pursue the infringement committed by Grok, TikTok, and Instagram. We will have zero tolerance and protect our digital sovereignty against foreign coercion.”

Elon Musk, the owner of social media platform X, responded by describing Sanchez as “dirty” and a “tyrant and traitor to the people of Spain”.

 

However, X faces global probes after it emerged that the platform’s AI chatbot, Grok, is generating deepfake pornography, including involving children.

Australia provides global example

Australia’s ban on social media for children aged 15 and under came into effect on 10 December last year. It affects platforms including Tiktok, X, Facebook, Instagram, YouTube, Snapchat and Threads.

While children and their parents are not sanctioned for breaking the ban, the Australian government will impose heavy fines on companies that allow children to have accounts.

Days before the ban came into effect, Meta – owner of Facebook, Instagram and Threads – said it had deleted about 550,000 accounts.

A representative survey of children aged 10-15 commissioned by the Australian government in 2024/5 found that 96% used social media, and that 71% had experienced harmful content.

“This included exposure to misogynistic or hateful material, dangerous online challenges, violent fight videos, and content promoting disordered eating and suicide,” according to a media release on the survey.

One in seven children reported experiencing online “grooming” from adults or children at least four years older, which included being asked questions about their private parts or to share nude images.

Growing evidence of harms to children

Meanwhile, global evidence keeps growing of the negative effects of social media use – particularly on the developing brains of children.

A scoping review of multiple studies published last year in PubMed linked social media to bullying, and prolonged use to depression, anxiety, and stress.

The review notes the “alarming” increase in mental health disorders among youth and adolescents, particularly “anxiety, depression, attention deficit hyper-reactivity disorder, autism spectrum disorder, and body dysmorphic disorder”.

“One contributing factor that has received growing attention is the role of social media and technology in shaping adolescent brain development, behaviour, and emotional well-being,” the researchers note.

“While digital platforms provide opportunities for social connection, self-expression, and mental health support, they also introduce significant risks, including compulsive social media use, cyberbullying, unrealistic beauty standards, and exposure to substance-related content.”

A meta-analysis of 143 studies involving over one million adolescents, published in JAMA Pediatrics in 2024, found “a positive and significant meta-correlation between time spent on social media and mental health symptoms”, particularly depression and anxiety.

Image Credits: Unsplash.

The Ukrainian delegate pushed for a model that takes traumatic injuries, amputations, and strokes into account.
The Ukrainian delegate pushed for a model that takes traumatic injuries, amputations, and strokes into account.

The publication of the World Health Organization’s (WHO) first “Global Status Report on Rehabilitation” has been effectively paused after the Executive Board concluded that the proposed methodology for measuring progress failed to capture the complex realities of health systems, particularly those in conflict zones.

In a politically charged debate on Thursday, member states argued that simplifying global rehabilitation metrics to “chronic low back pain” as a primary tracer condition could inadvertently distort health priorities and funding allocations.

The Secretariat had proposed low back pain as a reasonable proxy due to its status as the leading contributor to years lived with disability. Delegates contended that this indicator was insufficient for measuring the diverse and acute needs found in crisis regions and many low- and middle-income countries.

Accepting the limitations of its approach, the WHO Secretariat had asked the Board to approve postponing the report’s publication, originally mandated for release before the end of 2026.

Dr Jeremy Farrar, WHO Chief Scientist, conceded that while low back pain was a reasonable starting point, member states had raised valid concerns regarding “more complex issues to take on.”

Distorting priorities in war zones

According to critics, the rehabilitation report must adhere to the complex realities of crisis and war-torn regions.
According to member states, the rehabilitation report must adhere to the complex realities of crisis and war-torn regions like Syria.

The most significant critique focused on the “complexity gap” between the proposed metric and the reality of trauma care.

Against the backdrop of the ongoing war, the Ukrainian delegate warned that a target focused on low back pain might incentivise health systems to prioritise low-intensity services over the complex, multidisciplinary care required for crisis and war-torn regions. A multi-tracer model that includes stroke, traumatic injury and amputation would be more appropriate, he argued.

This position was reinforced by Israel, whose delegation noted that while the low back pain indicator might suit community care settings, it is “less applicable to hospital care” and fails to capture the realities of acute and complex disorders requiring specialized rehabilitation.

For the Eastern Mediterranean Region, an area where an estimated 190 million people require rehabilitation, delegates highlighted that technical guidance must address fragmented governance and weak information systems.

They stressed that in crisis regions, resource-constrained and fragile settings, indicators must be feasible to integrate into existing health information systems.

Calls for ‘evidence-based’ and flexible approaches

This infographic illustrates the updated schedule for the WHO’s rehabilitation reporting framework.
The WHO has postponed the publication of its first Global Status Report on Rehabilitation to ensure metrics accurately reflect the needs of conflict zones and complex trauma care.

Beyond conflict settings, a broader coalition of member states questioned the readiness of the data. Thailand advocated for postponing the report, insisting that indicators must be “evidence-based and adaptable to national contexts”.

Nigeria, aligning with the African region, supported this delay. The delegation argued that the collection of more complete and robust baseline data would ultimately strengthen the “credibility and usefulness” of the global monitoring framework.

While the delay was driven by a desire for better data, Ethiopia expressed concern regarding the loss of political momentum, and proposed establishing a “clear timeline” instead of “indefinite postponement.”

The Handicap International Federation, supported by the World Rehabilitation Alliance, warned that funding cuts and reduced engagement are already threatening progress in low- and middle-income countries.

They urged member states to ensure that the delay in reporting does not lead to a delay in investment.

The Executive Board formally noted the report without objection. However, the debate resulted in a clear directive to the Secretariat to refine its data collection before going to print.

Isolation declared a structural rather than individual failure

The Chair of the Executive Board formally notes the report of the WHO Commission on Social Connection.
The Chair of the Executive Board formally notes the report of the WHO Commission on Social Connection.

In a parallel discussion regarding the report on the “Outcome of the WHO Commission on Social Connection”, the board moved decisively to reframe loneliness from a personal struggle to a structural failure of governance and modern technology.

In the debate, the European Union and its member states declared social isolation an “urgent public health issue.” They emphasized that the issue affects “people across all ages and demographic categories” and is inextricably linked to mental health problems.

The Brazilian delegation asserted that digital technologies must be regarded as a “new determinant of health.” They argued that algorithmic management and the spatial separation of workers are actively weakening social bonds, urging the WHO to monitor the relationship between digital transformation and isolation.

However, the consensus was challenged by Movendi International. The civil society organization criticized the Secretariat’s report for framing alcohol merely as a “coping mechanism” for loneliness.

They argued that the alcohol industry’s products and practices are structural drivers of social disconnection, demanding that alcohol be explicitly recognized as a risk factor interacting with loneliness across the life course.

The board formally noted the report without objection, endorsing the Secretariat’s roadmap for the next phase of implementation.

Image Credits: Felix Sassmannshausen, Pexels/ali Saleh.

WHO Member States pack Executive Board meeting for a grueling debate over procedures for reporting on health conditions in the Occupied Palestinian Territory on Thursday morning.

A contentious debate at the World Health Organization’s Executive Board exposed the continued deep divisions between Israel and most other member states over the health situation in Gaza and the occupied Palestinian territory, with delegates trading starkly different assessments of humanitarian conditions, access to aid, and the reliability of WHO reporting.

Saudi Arabia’s delegate, speaking on behalf of Eastern Mediterranean member states, described a catastrophic death toll from the two-year Israel-Hamas conflict, saying, “More than 70,000 killed and more than 170,000 injured. Over 18,000 patients are left with life threatening conditions. 4000 of them children, and they await medical evacuation.”

Gaza tent camp amidst rain and rubble in January 2026.

Israel countered that the reporting on aspects of the Gaza situation was outdated as well as distorted, asserting it had approved the exit of thousands of injured Palestinians for medical treatment but there were insufficient places in countries abroad to receive them. Hungary echoed those concerns, with its delegate stating it did “not consider the report comprehensive, as it does not include statistical data beyond September 2025 and does not meaningfully assess the impact of the ceasefire.”  The US-brokered Israeli Hamas ceasefire entered into force in October 2025. A second phase was announced by the United States in January, which is supposed to lead to the demilitarization of the enclave, a new technocratic governance authority, and ultimately physical reconstruction.  

The EB debate culminated in a failed Israeli proposal to consolidate reporting on health conditions in the occupied Palestinian Territories back into one annual WHO report – instead of two – a situation that evolved since the start of the 7 October 2023 war.  

After a long roster of procedural disputes — including a rejected attempt to hold a secret ballot — the proposed Israeli amendment to cancel the second annual report was defeated, and the Executive Board approved the existing two-reportframework by 26 votes to one with four abstentions.   The mandate is unique among WHO health emergencies, where a dedicated report on Ukraine has been produced since 2022, but otherwise, WHO’s emergencies work in 72 other countries and territories, including about 18 other conflict zones, is consolidated into one single annual report. 

Health system remains in shambles  

Ambassador Ibrahim Khraishi, Palestine’s representative to the Executive Board.

Delegates from member states in WHO’s Eastern Mediterranean region, as well as Europe, painted a dire picture of Gaza’s health sector, repeatedly emphasizing the widespread destruction of hospitals and clinics in the 365 square kilometer, repeated displacement of most of the population to tent camps cluttered with rubble, waste and inadequate sanitation, and a wide range of infectious disease and chronic disease risks with which the crippled health system cannot effectively cope.

While massive aid deliveries have resumed since the October cease-fire, it remains “humanitarian access remains dangerously constrained” the Saudi delegate said, adding: “In the 80 days following the ceasefire, only 19,764 aid trucks entered the Gaza Strip. That’s fewer than half of the 48,000 that were agreed upon.”

Added Palestine’s delegate to the EB, Ambassador Ibrahim Khraishi, “It’s difficult to describe the catastrophic health situation in Palestine…More than 1600 health workers killed,  over 90% of hospitals destroyed by Israel. More than 200 ambulances attacked.”

Describing living conditions, Saudi Arabia stated, “Over 80% of all infrastructure in the Gaza Strip is damaged. People are living in flooded tents without clean water, sanitation or heating.” Disease risks were described as “extremely high, including acute respiratory infections, hepatitis and measles.”

The report also cites problems with physical barriers and restrictions on movement hindering access to health care for West Bank Palestinians, particularly for specialized services mostly available in East Jerusalem.

Calls to Israel for free access to health facilities in Jerusalem and West Bank

A Palestinian girl on bus from Gaza to Israel’s Ramon airfield for a medical evacuation to the United Arab Emirates in July 2024.

Palestine’s Khraishi also underscored evacuation constraints, stating, “More than 18,000 patients are in need of medical evacuation. Just about five every day are allowed to be evacuated.”

Bulgaria, speaking on behalf of the European Union and eight other member states, called for Israel to expedite medical evacuations via all available routes, saying, “Medical evacuations of patients from Gaza should be facilitated, which requires additional evacuation routes to hospitals in East Jerusalem and the West Bank, and the ability for patients to voluntarily return to Gaza.”

Norway added, “Patients requiring treatment in East Jerusalem and Ramallah should be provided with access in and out of Gaza.” It added, “Also, patients in the West Bank should be granted safe and unhindered passing to health facilities.”

Now that the Rafah border crossing to Egypt has reopened, medical evacuations also must be expedited via that route Canada said, saying it, “welcomes the reopening of the Rafah border crossing, a key element under the gas at peace plan, their crossing must remain open without undue restrictions to enable freedom of movement for Palestinians.”

The appeals were also echoed by the African Group of 47 member states that called for “setting up permanent, safe, predictable mechanisms… to ensure rapid evacuation of patients and critical situations, particularly children, on the basis of medical conditions,” and for “setting up coordinated medical transport system supported by the international community.”

Israel says WHO report is outdated and misleading 

Waleed Gadban, political counselor at Israel’s Mission in Geneva

Israel argued that the report, which only covers January-31 August 2025,  failed to reflect changing realities following the October 2025 ceasefire – which included a dramatic increase in aid deliveries, and just this week, a reopening of the Rafah crossing from Gaza to Egypt.

“By focusing largely on the first half of 2025 the report is irrelevant to the current needs,” said Israel’s political counsellor in Geneva, Waleed Gadban. “It fuels yet another politicized discussion, while deliberately ignoring crucial facts on the ground.” 

Gadban insisted that Israel had continued to facilitate medical assistance and patient evacuations: “In relation to the facilitation of the departure of patients from Gaza Strip… this claim is a clear distortion of fact,” the delegate said, arguing that “thousands of patients have been cleared for exit to Gaza the delays occur on the receiving side.”

With respect to food security, hunger and malnutrition, he also criticized the WHO report for relying on data from earlier in 2025, before aid deliveries increased.  “Most bluntly, it ignores the most recent UN publication confirming that 100% of food needs are met.” In a 5 January statement by UN Spokesperson Stephané Dujarric stated:  “The January round is the first since October 2023, in which partners had sufficient stock to meet 100 per cent of the minimum caloric standard.”

Finally, as the cease fire enters a second phase, he called for attention to “demilitarization, de radicalization, allowing the reconstruction of Gaza.” 

Egypt’s heated rebuttal 

Egypt’s delegate in the EB discussion Thursday on health conditions in the Occupied Palestinian Territory.

Egypt, meanwhile, forcefully rejected Israeli suggestions that the continued slow pace of medical evacuations were largely related to “delays on the receiving side” – an allusion to Egypt, which shares Gaza’s Rafah border crossing. 

“Egypt rejects in the strongest terms, the allegations made by the delegation of Israel regarding Egypt’s position on humanitarian evacuations from Gaza,” Egypt’s representative said. “These claims are not only factually incorrect, but represent a deliberate attempt to deflect responsibility.

“The primary obstacle to safe evacuation is not Egypt,” he underlined.  ““Egypt has consistently worked under extremely difficult circumstances to facilitate humanitarian access, protect civilians and support life saving medical evacuations.”

Militarization of health facilities 

Israel also argued that its critics had ignored evidence of Hamas militarization of Gaza’s health facilities.

“If anyone here actually cared about the health situation in Gaza, someone would surely condemn the systematic use of ambulances by Hamas to move terrorists and weapons…the deliberate strategic strategy of using medical facilities to military purposes,” Gadban asserted. 

The remarks triggered another heated response from Egypt which said it “categorically rejects allegations that hospitals and ambulances in Gaza are being used systematically for military purposes,” calling such claims “unproven, politicized.”

“Any claim to the contrary requires independent verification, which hasn’t been once provided,” the delegate said, adding, “Health care is not a battlefield.”

New Israeli requirements that Gaza NGOs register names of local staff 

Related to that, Israel’s Gadban defended its new requirement that international NGOs register the names of their local employees in Gaza, as a means of ending “the abuse of humanitarian organizations by Hamas. …We call on organizations to check who they employ.”

On Monday, Médecins Sans Frontières said it had not found a way to comply with the new Israeli rules, citing a lack of assurances that the information they might provide would not be misused.

“We were unable to build engagement with Israeli authorities on the concrete assurances required,” MSF said. “These included that any staff information would be used only for its stated administrative purpose and would not put colleagues at risk; that MSF would retain full authority over all human resource matters and management of medical humanitarian supplies; and that all communications defaming MSF and undermining staff safety would cease.”

MSF, which operates a network of Gaza health clinics and field hospitals, as well as supporting six public hospitals, made no statement of its own during the Executive Board debate, despite being a WHO-recognized non-state actor entitled to speak. Reached for comment by Health Policy Watch, two MSF spokespeople did not reply in time for the publication of this article. 

Member states push back

Canada’s EB delegate pushes back against new Israeli rules that NGOs in Gaza register their local employees.

During the EB discussion, however, several member states pushed back against Israel’s new requirements for NGOs operating in Gaza – requirements that have thrown the continued activities of some three dozen NGOs, as well as MSF, into jeopardy. 

Canada urged Israel “to reverse its policy on deregistration of international NGOs and its policies intended to undermine the UN’s work throughout Palestine, noting that many of these INGOs work in the health sector.” 

Added Saudi Arabia: “37 international non governmental organizations have been notified by Israel that their work will be forced to stop across the occupied Palestinian territory. The consequences are very severe, particularly for the health sector.”

Spain and Norway, meanwhile, protested the recent Israeli destruction of the Jerusalem headquarters of the UN Palestinian Refugee organization (UNRWA), saying it impinges on UN diplomatic  privileges as well as hindering Palestinian  aid relief.  

Israel decided to close down UNRWA”s operations in Jerusalem after identifying some 19 UNRWA employees alleged to have participated in the initial 7 October 2023 Hamas invasion of Israeli communities near Gaza, which triggered the wider war.  Following an internal UNRWA investigation, nine employees linked to alleged involvement were fired.   

“We have condemned the new aggressions against the UNRWA facilities perpetrated by the Israeli authorities, which are an unacceptable violation of the privileges and amenities of the United Nations,” Spain said.

Norway urged Israel “to respect the mandate of UNWRA, which was renewed by the UN General Assembly as recently as December, and to allow the organization to operate and provide services to the Palestinian people.”

Together, the statements highlighted the gap between Israel’s stated security rationale for tighter controls on UN and NGO operations – and the concerns of member states that the measures would further undermine humanitarian and health activities in the West Bank as well as Gaza.

Amendment to cancel dual Palestine reporting requirement defeated after procedural fight

As for the defeated proposal to cancel the second WHO reporting requirement on health conditions in the ‘Occupied Palestinian Territory, including East Jerusalem’, both Israel and its challengers accused each other of wasting WHO time and resources. 

Egypt described Israel’s proposal as procedural maneuvering leading to “a waste of time, and it’s just procrastination for the whole process.”

Israel, meanwhile, said that the creation of a second report on the Palestinian territories after the October 2023 war began is redundant – in light of the fact that a dedicated report on Palestinian health conditions has been produced annually for  the World Health Assembly  – since Israel first took over the West Bank and Gaza in the 1967 Arab-war.

“When it comes to Israel, there are endless funds and resources for duplicity and exceed reporting,” Israel’s Gadban said. “The members of the board are saying that when it comes to Israel, they want to discuss three times rather than one.”

In his closing remarks, Khraishi came to a different conclusion:  “This reaffirms that Palestine is still in an emergency situation. We need all of you. We need your organization. We need your efforts, WHO efforts to improve the health conditions in Palestine.”

Meanwhile, the Central African Republic appealed for more understanding on all sides in the bitter conflict, Speaking on behalf of WHO Africa’s 47 member states, the delegate said: 

 “We can have various religions, various languages. I’d like too say different ideologies, different colors of skin. But we are all humans. We’re all we all belong to the human race. We all have the same royal blood in our body.”

Image Credits: Palestinian Water Authority , X/@Dr Tedros.

WHO Regional Director for Europe Dr Hans Henri P. Kluge addresses the Executive Board.
Hans Kluge, WHO Regional Director for Europe, warns that digital tools and AI may widen health gaps without proper governance and trust.

A stark debate over who owns the data in the future of AI and digital health emerged at the World Health Organization (WHO) Executive Board on Wednesday.

Low and middle-income countries warned that the rapid deployment of new technologies risks accelerating data extraction and increasing inequality, cautioning that – without strict AI governance, sustainable financing and equitable guardrails – the implementation of AI in health systems would compromise “data sovereignty”.

The debate centred on a WHO report outlining the framework for a digital transformation strategy spanning 2028 to 2033. Highlighting the profound shifts driven by AI and genomics, the report notes that many member states remain paralysed by “fragmented systems with limited interoperability.” And it warns that without reliable, representative data, AI risks amplifying biases and inefficiencies.

“Innovation alone is not enough,” stated Hans Kluge, WHO Regional Director for Europe. “Without skills, governance and trust, digital tools widen gaps instead of closing them.”

Kluge also warned that “the risk of a new digital divide is real”.

Based on the deliberations, the Secretariat will continue its technical work on the strategy. To this end, the WHO has established a tripartite collaboration with the International Telecommunication Union and the World Intellectual Property Organization.

The board also decided to move forward on consultations to strengthen the global health workforce code, while the fight against substandard medicines moves to a new operational phase under an approved work plan. 

Closing the rift in AI regulation

A male delegate representing Cameroon speaks into a microphone at a World Health Organization Executive Board meeting.
The representative from Cameroon, speaking for the African Region, shifted the focus from technical standards to ownership at the WHO Executive Board session on Wednesday.

Regarding AI and digital health, a regulatory rift is opening as high-income regions press forward. While the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) have established guiding principles on AI, a formal global standard remains elusive.

The European Union, represented by Bulgaria, argued that health data and information systems are the “essential foundation”, calling for the WHO to lead harmonisation efforts. These ought to focus on autonomy, safety, well-being of patients and health care professionals. Israel supported this, proposing “regulatory sandboxes” to test technologies safely while integrating economic considerations.

However, the African Region and other LMICs shifted the focus from technical standards to ownership. Cameroon, speaking for the region, called for rigorous ethical governance. The prevailing fear is that international companies will harvest data from the Global South to train AI models or develop products that are then sold back for profit.

Barbados reinforced this, rejecting the model of “donor-funded surveys”. The delegate argued that health data must be treated as a “national asset” under local control.

Positioning the country as a “living laboratory” for digital innovation, Barbados demanded sustainable financing models to advance universal health coverage rather than short-term extraction.

Rich nations urged to ‘pay up’ for imported health talent

The representative for Zimbabwe sits at a WHO conference table behind his country's nameplate, speaking into a microphone to demand co-investment from wealthy nations.
Zimbabwe’s representative calls for co-investment from rich nations to address the crisis of health worker migration.

The board also confronted the escalating crisis of health worker migration, reviewing new data confirming that active recruitment from nations with fragile health systems is intensifying ‘brain drain’ to plug staffing gaps in the Global North.

Zimbabwe, speaking for the African Region, issued a sharp rebuke of current practices. “Targeted recruitment continues to strain our fragile health systems,” the delegate warned. The region demanded that development banks and donor agencies move beyond rhetoric to “co-invest” in the education and retention of the workforce in source countries.

Pakistan amplified this, arguing that while the principle of co-investment is recognised, there is currently a lack of “binding commitment to deliver it”.

The United Kingdom, a major destination country, maintained that the Global Code of Practice remains “central to ethical international recruitment.” However, the UK acknowledged the need for clearer guidance on safeguards and supported a process to refine the Code’s application.

To bridge this divide, the Secretariat, and member states agreed to launch informal consultations to draft a decision for the World Health Assembly in May. The talks will focus on specific additions to the Code, such as co-investment mechanisms and protections for care workers.

Debate on ‘scourge’ of substandard medicines ongoing

A clear plastic bottle containing orange liquid medicine stands in sharp focus in the foreground, with several amber glass medicine bottles blurred in the background.
The WHO is intensifying surveillance of medical products following a deadly spike in contaminated products containing toxic chemicals like cough syrups.

On a last item, the board confronted the lethal proliferation of substandard and falsified medical products, a crisis described by delegates as a critical threat to both public health and economic security. The WHO’s surveillance system has recorded over 10,000 suspect products since 2013, with the Secretariat highlighting a recent, deadly spike in contaminated medical products containing diethylene glycol, like cough syrups.

Togo, speaking for the African Region, characterised the issue as a “scourge,” exacerbated by open borders and informal markets. The region called for “innovative financing” to support regulatory authorities in resource-poor settings, where the risk of infiltration into public supply chains remains high.

Ukraine shifted the focus to modern distribution channels, warning of the specific threat posed by “unregulated online sales.” The delegate urged the WHO to help secure supply chains for high-risk excipients – inactive ingredients often implicated in contamination cases.

The International Pharmaceutical Federation backed these concerns, emphasising that the workforce must be trained to detect fakes before they reach patients. “Protecting patients requires safeguarding the quality of medicines,” the Federation argued.

To close the detection gap, the Board noted the urgent need to roll out market surveillance technologies, specifically the Epione reporting tool, to track suspect products in real-time.

The Secretariat will now develop the draft global strategy for 2028 to 2033, which is scheduled for submission to the board at its 160th session in January 2027 before final consideration by the 80th World Health Assembly.

Image Credits: Felix Sassmannshausen, WHO/Christopher Black , Pexels/Towfiqu barbhuiya.

WHO Diector-General Dr Tedros and IGWG co-chair Matthew Harpur (right)

World Health Organization (WHO) Director General expressed confidence that member states would agree on the last outstanding part of the Pandemic Agreement by the “absolute deadline” of May at the body’s Executive Board meeting on Wednesday.

“This year’s World Health Assembly [in May] must receive a text that member states can consider and act upon. There is no scope for delay because the next pandemic will not wait,” Tedros urged.

But questions by Pakistan, part of the Group for Equity negotiating bloc in the negotiations, indicated a lack of agreement on several key issues relating to how pathogens should be shared.

Member states only have two more weeks of formal negotiations before the deadline – with the next round starting on Monday. However, the talks are also affected by WHO budget cuts which have limited their access to translators.

Countries are hammering out a Pathogen Access and Benefit-Sharing (PABS) system, deciding on how materials and sequence information from pathogens with pandemic potential can be shared fast and fairly – and how countries sharing this information can also benefit from any products that are developed as a result.

The Group for Equity and Africa Region want draft contracts to be included as part of the deal to set out the terms for those who want access to pathogen information – for example, pharmaceutical companies in order to make vaccines, therapeutics and diagnostic tests.

The Pakistan delegate said that the two groups – representing 80% of the world’s population – had come up with a standard material transfer agreement based on other international agreements, and a draft contract for digital sequence information.

“We have had only one informal discussion on the draft contracts,” said Pakistan, urging those in charge of the process to organise more consultation on the contracts.

“In order to complete the exercise, to have full legal clarity and certainty we would like to have a pandemic agreement with draft contracts.”

Three key areas for talks

Matthew Harpur, co-chair of the Intergovernmental Working Group (IGWG) overseeing the negotiations, outlined the three key areas for the talks.

“Firstly, we have the scope and objectives and the use of terms,” said Harpur, who added that by last meeting, “it was really good to see some progress”. 

“Secondly, we have the implementation and the operation of the PABS system,” he added. This includes the issue of “equal footing” – namely, that rapid access to pathogens information and how the benefits deriving from this sharing are of equal importance.

“How do we how do we swiftly share that information that keeps us all safer and but how do we also ensure equity,” said Harpur, adding that issues such as monetary contributions had to be agreed on to ensure equity. 

The third part is “governance and enforcement”. 

“You can have the best words on paper, but if they’re not enforceable, if they don’t work in practice, it is meaningless,” said Harpur.

“So how do we ensure an effective governance system, with the advisory group, the role of the [Conference of the Parties] and, of course, the role of the Secretariat.”

The next IGWG meeting runs from 9-14 February.