Sexual Health Derailed the Last World Health Assembly; What Are This Year’s Flashpoints? World Health Organization 18/05/2023 • Kerry Cullinan Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Last year’s WHA late on the Saturday night, as Committee A struggled to reach agreement. Much of this year’s WHA agenda, being held in Geneva between 21 and 30 May, should be preoccupied with pandemic preparedness and the WHO’s budget. But there are some obscure items for anti-rights conservatives to latch onto if they want to derail discussion – and there is growing appetite for such disruptions throughout all UN agencies. While officially, this year’s WHA is supposed to focus on a wide range of policy issues around the three pillars of WHO’s “Three Billion” strategy, which include emergencies and pandemics, non-communicable diseases and healthier populations, a few hidden minefields scattered in the agenda threaten to create unexpected flashpoints which could divert attention from the substance of the meeting. They include, once again, language around sexual health, but also as well as concerns about the place of states’ sovereign rights in the pandemic treaty, an initiative on a new WHO replenishment fund, as well as the perennial debates around the demand by Taiwan to be reinstated as a WHA observer, and the status of health in the Occupied Palestinian territories. What are the potential red-herring flashpoints lurking in the shadows of a dry and detailed agenda? Here´s a brief review of the landscape: Anti-rights red flags? At last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event. Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. This forced talks late into the night and, finally, an unprecedented vote on the vexatious guide after numerous compromise clauses failed. The Saudi delegate in a heated WHA debate over sexual rights and terminology. If the conservatives are scanning assembly documents for men having sex with men, they’re unlikely to find any references. But if they are intent on looking for polarising needles in the agenda haystack, some might take issue with the report on the Global Strategy for Women’s, Children’s and Adolescents’ Health. This refers to the WHO’s updated handbook on family planning, which contains references to post-abortion care and gender identity. These are red flags for the right-wing UN coalition of member states, Group of Friends of the Family, founded by Egypt, Belarus and Qatar to advocate for the “natural family” that is becoming more vocal and more closely aligned with US rightwing Christian groups through annual World Congress of Families gatherings. Multilateralism under fire This year’s WHA takes place in an even tougher environment. Russia’s ongoing war in Ukraine has polarised the international community, compounding the economic struggles wrought by three pandemic years. “The multilateral system is under greater strain than at any time since the creation of the United Nations,” UN Secretary-General Antonio Guterres warned in an address to the Security Council last month. “We are witnessing a deepening climate crisis, soaring inequalities, a rising threat from terrorism, a global pushback against human rights and gender equality, and the unregulated development of dangerous technologies,” he added. “All these global challenges can only be solved through respect for international law, adherence to global commitments, and the adoption of appropriate frameworks of multilateral governance.” Heightened US-China tensions may well be inflamed by the large presence of Taiwan at this year’s WHA. The US appeal for it to be reinstated as an observer has been followed by a formal request from Belize for this to be included on the agenda. The health of Palestinians, with an unprecedented rise of Israeli settler violence accounting for 25% of casualties, is also a geopolitical flashpoint. National sovereignty and pandemic response Much of this year’s WHA, themed “Health For All: 75 years of improving public health”, will be around measures to counter the next pandemic – particularly universal health care and health and how to increase WHO’s finances. The assembly will hear and comment on progress made on two pandemic-related processes: one to amend the International Health Regulations (IHR) to make them fit for the next pandemic and the other, to draw up a pandemic accord. But both negotiations are ongoing with a deadline of next year’s WHA, so it is unlikely that conflicts will climax at this session. However, concerns about member states’ sovereignty are likely to be expressed, something that Russia and China have stressed in previous discussions. Meanwhile, misinformation continues to churn outside of the WHA from those who opposed COVID-19 vaccines and lockdowns who claim that the pandemic accord will give WHO superpowers, and could lead to international “vaccine passports”. Anti-vaxxer and US presidential hopeful Robert F Kennedy and his organisation, Children’s Health Defense, are key sources of this misinformation and have organised global protests aimed at urging countries to exit the WHO on Saturday 20 May, the day before the WHA opens. WHO finances in the spotlight Members of the WHO Working Group on Sustainable Finance hammer out an agreement on increasing member state contributions this week, with Germany’s Björn Kümmel on far left. As with last year, moves to increase the WHO’s budget ceiling are also likely to be a focus of animated discussion. Member states are supposed to be increasing their assessed contributions in line with a resolution passed last year. The 2024/ 25 proposed budget is therefore based on the portion of members’ contributions being raised from a dismal 12% of the budget to 20%, which the WHA budget document on the budget describes as “marking a historic move towards a more empowered and independent WHO”. During the Executive Board discussion in January on increasing WHO contributions, the Africa region expressed the expectation that WHO would channel far more resources to country and regional offices – something that the WHO has tried to do and reports that country allocation had increased from 39% in the 2018/19 to 50% in the proposed 2024/ 25 budget. The Agile Member States Task Group on Strengthening WHO’s Budgetary, Programmatic and Financing Governance has worked hard to find a way to stabilise WHO income, making it less dependent on donors and also more efficient. Replenishment Fund The assembly also will discuss a proposal from the WHO’s Executive Committee for the establishment of a replenishment fund. Most member states accept that the WHO is underfunded and over-reliant on donors’ conditional grants, slanting the work of the body. While a replenishment fund, effectively, also involves recruiting more in voluntary donations, the process is public and therefore potentially more transparent – similar to the periodic replenishment drives conducted by organisations such as The Global Fund and Gavi, the Vaccine Alliance. Also, typically such funds are not designated for specific donor projects – but able to be used flexibly by the organisation involved. Ahead of the January Executive Board meeting, the WHO’s Programme, Budget and Administration Committee (PBAC) “acknowledged WHO’s need for more flexible, predictable and sustainable financing and considered that a replenishment mechanism provided a possible solution, especially for chronically underfunded areas of the organization’s programme budget”. Meanwhile, a fascinating recent analysis of all WHA resolutions between 1948 and 2021 was recently published in the BMJ. It notes: “While the WHO has been criticised for its siloed approach to address global health issues, the analysis suggests that this approach is not the collective will of the WHA but may relate to the way the WHO has been increasingly funded through earmarked voluntary contributions to specific programmes.” Whatever decisions are taken, the attention of the international global health sector will be in Geneva over the next 10 days. Image Credits: Germany's UN Mission in Geneva . 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