On 75th Anniversary World Health Assembly Must Confront New and Growing Threats
Member states attending the World Health Assembly’s high-level opening on Sunday, 21 May in Geneva.

The World Health Assembly opened its annual meeting of member states Sunday on a celebratory note marking the 75th anniversary of the World Health Organization’s foundation in 1948.

Eradicating smallpox, eliminating polio in most countries worldwide, and dramatic reductions in deaths from once-deadly childhood diseases preventable by clean water, basic medicines and vaccines are among a few of the historic accomplishments the Organization will be celebrating as this year’s 76th WHA session begins, said WHO’s Director General Dr Tedros Adhanom Ghebreyesus in opening remarks at the WHA.   

“Smallpox is history and polio is on the brink. And epidemics of malaria, HIV and tuberculosis have all been pushed back,” said Dr Tedros. 

Thanks to the Framework Convention on Tobacco Control, smoking rates have declined in dozens of countries worldwide, with strict policies on tobacco advertising and taxes on tobacco products.  

He was speaking Sunday at a WHA preview event at the Geneva Graduate Institute’s Global Health Center, just before the official WHA curtain-raiser; the latter featured a lineup of high-level figures from around the world, including India’s Prime Minister Narendra Modi and former New Zealand Prime Minister Jacinda Ardern. 

Pandemic treaty negotiations set against regional conflicts

The number of people living in zones of combined conflict and health emergencies has doubled since 2015 – Kate Dodson, UN Foundation

But against those successes, this year’s WHA is taking place against the background of complex, ongoing negotiations over an ambitious new pandemic treaty and, in parallel, talks over revisions to the 2005 International Health Regulations that aim to supplement and replace archaic rules on international emergency response. 

The WHA also is taking place in a second year of war between Russia and the Ukraine – whose bitter dispute was the subject of competing WHA resolutions last year – and which will likely again surface in debates by the global health body this year.  

And the Ukraine-Russia war is only one of multiple conflicts destroying lives and global health. As this year’s WHA considers a new “Health for Peace Initiative”, some 39 million people are – or almost one in 20 of the world’s population – living in fragile and complex settings that combine conflict with health emergencies. 

“That’s an increase of 25% since just last year, and double since 2015,” noted Kate Dodson, vice president for global health at the United Nations Foundation, a co-sponsor of the Graduate School WHA opener.   

And while this week’s WHA session is set to approve update guidance to countries on “best buys” for reducing non-communicable diseases, NCD disease rates are soaring worldwide, with heart disease having increased by 60% in the last 30 years, according to data published by the World Heart Summit, also convening this weekend in Geneva.  

Meanwhile, the WHO remains financially challenged. For the first time ever, this year’s WHA is supposed to approve stepped up rates of annual contributions by member states to the global health organization. 

It will also debate a January Executive Board recommendation to establish a “replenishment fund” for voluntary contributions by donors and member states that could be used in a more flexible way by the Organization than “earmarked” donations that make up the bulk of its budget today. 

Challenges moving far beyond the health sector  

Non-communicable diseases now account for 70% of deaths globally – WHO Director General Dr Tedros Adhanom Ghebreyesus at the opening of the 76th WHA.

Overall, as it enters its 76th year of existence, the Organization is increasingly challenged by the need to respond coherently to an increasingly broad and complex portfolio of  emerging disease threats – over which it often has little influence or control. 

Those include obesity, heart disease and hypertension stimulated by sedentary lifestyles and fast food diets; antimicrobial resistance from misuse and overuse of antibiotics in both the human and  animal health sector; the climate crisis and air pollution; and as COVID-19 demonstrated to the world – vast disparities in access to health care including vital medicines and vaccines. 

“Non communicable diseases now account for some 70% of deaths globally,” noted Tedros in his opening WHA address. 

“Antimicrobial resistance threatens to unwind centuries of medical progress.  Vast disparities in access to health resources exist between and within countries and communities. And the existential threat of climate change is jeopardizing the very habitability of our planet.

“WHO has grown enormously but our resources have not,” Tedros added. “There is the challenge of being a technical scientific organization in a political, and increasingly politicized, environment.”

“These are daunting and complex challenges. We will not solve them at the World Health Assembly and we will not solve them in our lifetimes, but we’re building a path that our children and grandchildren will walk down and that they will continue to build,” Tedros said. 

“The challenges of today are very different to those we faced in 1948. But the vision is the same.”  

1969 International Health Regulations only covered four diseases

In 1969 the International Health Regulations only covered four disease – former WHO official David Heymann (on left) speaking at WHO preview event at the Geneva Graduate Institute

“When the [WHO] International Health Regulations were developed back in 1969, their goal was really to stop disease at borders,” pointed out David Heymann, a former high-ranking WHO official, at the Geneva Graduate Institute’s WHA preview event Sunday morning. 

“If a country reported one in four infections, cholera, yellow fever, plague or smallpox, then countries that were receiving passengers from those countries could request a vaccination certificate.  There were pre-determined measures to stop disease transmission, and at that time, WHO was the exclusive owner of much of the information because countries reported to WHO, WHO did a risk assessment, and provided its recommendations.”

While the IHR finally  underwent a major update in 2005, greatly broadening the scope of what was to be reported –  and empowering WHO to declare a “Public Health Emergency of International Concern (PHEIC),” the regulations have failed to keep up with the pace of change in the real world, he pointed out. 

The biggest failure, he contends, was in “the most important part of the IHR, which was the requirement of countries to establish core capacity in public health to be able to detect, respond and prevent national disease spread and death, and eventually prevent international spread by this rapid reaction.”

In terms of risk assessments as well, as the digital transformation accelerated the spread of information, WHO was no longer the exclusive arbiter of risks from pathogens that appeared.

“As we saw in the COVID pandemic, countries really preferred doing their own risk assessments. They had access to data which they had never had before – all respectable medical journals were publishing peer reviewed information in front of their paywall. So any government advisory group could get that and could make recommendations to their own government as to what to do. 

As a result, WHO lost its authoritative position in making recommendations, countries devised their own policies, and what ensued was “confusion, utter confusion” over global response, Heymann contended. “The [IHR] regulations to me, they’re really a vestige of the past.”

Negotiations over pandemic accord will be on sidelines of formal WHA    

Gian Luca Burci, former WHO chief legal counsel describes the workings of the World Health Assembly – and what to expect at this session.

This year’s WHA is set against the backdrop of ongoing negotiations over IHR revisions as well as the development of a new pandemic accord. 

Both are mired in controversial debates by member states over language on reporting outbreaks- including proposals for requiring countries to report emerging pathogen threats within hours. With respect to the pandemic accord, while all countries have paid lip service to the need to ensure more equitable distribution of drugs and vaccines in the next pandemic – they are at odds about draft language that would commit them, in advance, to set aside of fixed quantities of health tools for developing nations. 

Insofar as those negotiations are only due to conclude by May 2024, the most meaningful talks are likely to be in the corridors and on the sidelines of the WHA – rather than in the formal chambers of the meeting, being held at Geneva’s UN headquarters, said Gian Luca Burci, former chief WHO legal counsel at Sunday’s Graduate Institute session.  

“For [WHA] action, there is nothing specific on the IHR, Burci observed. With regards to the pandemic accord, the only main formal item explicitly on the agenda is the potential treaty’s cost.”  

“But there will be a Secretariat Briefing on the negotiations, and I’m sure there will be a lot of discussions, a lot of side conversations among delegates looking to break some of the deadlocks, and so forth.”

Meanwhile, WHO continues to move ahead with voluntary initiatives aimed at improving outbreak detection and response. For example, just ahead of the WHA’s opening, WHO announced the launch of a new International Pathogen Surveillance Network, that aims to detect and report infectious disease threats in real time, making better use of digital and genomic tools that many countries still lack.    

The new network represents an ambitious effort to fill a critical gap in WHO’s existing system of disease outbreak alerts – which can right now be delayed by weeks or even months if countries resist disclosure. But without revisions to the IHR, such networks will remain purely voluntary. So the key question, as always remains: will all countries join, collaborate and cooperate  – and who will support the improved capacity of low income countries for detecting and reporting new threats? 

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