“From conflicts to economic crises to climate change and aid cuts, we live in difficult, dangerous and divisive times,” World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus told the opening plenary of the World Health Assembly (WHA) on Monday.

While geopolitical disagreements have delayed Tedros’s official WHA address until Tuesday morning, the Director General acknowledged in a brief welcome that the WHO “has been through a difficult period as a result of sudden and steep cuts to our funding”.

The organisation’s budget is 90% funded, although some of the funds are pledged rather than in the bank.

Spain’s Prime Minister Pedro Sánchez, a WHA special guest speaker, appealed for solidarity and multilateral support for global health to combat “the pandemic of egotism and selfishness”.

Sánchez said that Spain had increased its official development aid (ODA) by 30%, explaining: “No country can save itself. Protecting others is the best way to protect ourselves.”

Without naming the United States, he added: “The greatest risk for global health is no longer the lack of science, but rather the lack of conscience. In just a few months, the same country that cut $18 billion from global public health and ODA has spent more than $29 billion on war, the humanitarian and geopolitical consequences of which will also be devastating.”

Sánchez, who received a standing ovation, also appealed for countries in the Global South to “have the role that they deserve in decision-making”, and that the reform of global health needed to be focused on strengthening national health centres.

Reforming global health

The WHA is considering how to reform the “global health architecture”. Ghanaian President John Dramani Mahama, also a special guest speaker at the plenary,  appealed for a more inclusive system of multilateralism.

“I’m concerned about whispers I have heard that the draft resolution [on global health reform] seeks to protect existing organisational mandates and prohibit the recommendation of mergers or consolidations,” said Mahama, who is championing Africa’s health sovereignty through the Accra Reset Initiative.

“If we launch a process of reform that is prohibited from recommending actual reform, we are merely performing a ritual. We cannot prioritise institutional comfort over human survival. The WHO’s legitimacy is not served by protecting silos. It is served by a fearless analysis of what works,” Mahama warned.

Barbados’ Prime Minister Mia Mottley also appealed for a more responsive global health system: “Small states are not asking for pity. We’re asking for a system that recognises reality. Vulnerability is not measured by income alone. Fiscal space must be judged alongside climate risk, debt burden, disease burden, and yes, the cost of survival.”

Motley also stressed that emergency funds must move with the speed of an emergency. “The WHO must not be asked to protect eight billion people on Planet Earth on the basis of uncertain contributions and political mood swings,” she said – a reference to the withdrawal from the WHO by the US.

Syrian President Ahmed Hussein al-Sharaa, who until December of last year was on both the UN and the US list of global terrorists facing sanctions, also addressed the plenary via video.  

Shortly after the opening, the business of the WHA was delayed by several hours by geopolitical disagreements, with some issues going to a vote. 

Member states decided against including Taiwan as an observer, but voted overwhelmingly in favour of a request by the Gulf Cooperation Council to discuss the impact of Iran’s recent attacks later in the week.

Israel’s objection to the tabling of two separate reports on health conditions in the occupied Palestinian territory (OPT) – including one on the immense toll of the recent Gaza war and increasing Israeli military and settler violence affecting West Bank Palestinian communities – also delayed proceedings.

The WHA has a massive agenda, including approving a new tuberculosis strategy and a plan on combating strokes; a global action plan on antimicrobial resistance (AMR) – still outstanding since the AMR UN high-level meeting two years ago; and how to improve emergency care.