Adopting a pandemic agreement and securing a 20% increase in member states’ fees to support the World Health Organization (WHO) were the 78th World Health Assembly’s greatest achievements.

“The words ‘historic’ and ‘landmark’ are overused, but they are perfectly apt to describe the adoption last Tuesday of the WHO pandemic agreement. Likewise, your approval of the next increase in assessed contributions was a strong vote of confidence in the WHO at this critical time,” said WHO Director General Dr Tedros Adhanom Ghebreyessus at the end of the WHA on Tuesday.

Other significant decisions involve new targets to reduce the impact of air pollution; the first ever resolutions on lung health and kidney health, measures to restrict the digital marketing of infant formula and baby food – and even a strategy on traditional medicine.

But the United States’ absence from the WHA cast a long shadow over proceedings, not least of all because it has left a 21% hole in the WHO’s budget.

Despite increased disease outbreaks and the proliferation of non-communicable diseases, the global body has to retrench staff and merge departments.

The WHO’s 36-year-old polio eradication programme faces a budget cut of 40%

Numerous member states are also reeling from significant cuts to their own health budgets since the Trump administration’s shuttering of the US Agency for International Development (USAID), downscaling the US President’s Emergency Plan for AIDS Relief (PEPFAR), and outlawing its National Institutes of Health from contracting foreign sub-grantees.

‘Mired in bureaucratic bloat’

The only contact the US had with the assembly was via a six-minute video message at the opening plenary from Health Secretary Robert F Kennedy Jr. 

In contrast to messages of support and appreciation for the WHO from world leaders, Kennedy described the body as “mired in bureaucratic bloat, entrenched paradigms, conflicts of interest and international power politics.”

Accusing the WHO of being beholden to China and “corporate medicine”, Kennedy invited member states to join the US in creating “new institutions”.

Then, on the final day of the WHA on Tuesday, Kennedy posted pictures on social media with Argentinian President Javier Milei and a gold chainsaw, saying that they’d had a “wonderful meeting … about our nations’ mutual withdrawal from the WHO and the creation of an alternative international health system based on gold-standard science and free from totalitarian impulses, corruption, and political control.”

I had a wonderful meeting with Argentine President @JMilei about our nations’ mutual withdrawal from the WHO and the creation of an alternative international health system based on gold-standard science and free from totalitarian impulses, corruption, and political control. pic.twitter.com/08VLQgxrgK

— Secretary Kennedy (@SecKennedy) May 27, 2025

Given the intensity of member states’ discussions about increased assessed contributions (membership fees) and their across-the-board expressions of gratitude for WHO guidance in tackling a range of health challenges, it is unlikely that many countries will leave the WHO to join a Trump-Kennedy alternative.

Throughout the WHA, member states expressed appreciation for the WHO, particularly its technical assistance and support in addressing specific health challenges.

‘Weaponising food’ in  Gaza

Votes rather than consensus decided two major tension points during the WHA. The first involved the occupied Palestinian territory, particularly in light of Israel’s 80+-day aid blockade.

The WHA eventually passed an updated version of a 2023 measure denouncing the devasting impacts on Palestinians the war, and a decision on “health conditions in the occupied Palestinian territory and occupied Syrian Golan”. This requests the WHO Director-General to monitor and report back on a range of issues including “acts of violence against the wounded and sick, medical personnel and humanitarian personnel exclusively engaged in medical duties”; malnutrition and famine; Palestinian access to water, sanitation and shelter, as well as Israel’s obligations to the territory.

In solidarity with Palestine, which is not a full member state, the WHA raised its flag at the assembly, and a tearful WHO Director-General Dr Tedros Adhanom Ghebreyesus appealed to Israel to allow sufficient aid into the territory where half a million people face immediate starvation, stating: “It’s really wrong to weaponise food, to weaponise medical supplies.”

Tension over climate action

However, by far the biggest tensions emerged during discussion on a WHO Draft Global Action Plan on Climate Change and Health, with Saudi Arabia – backed by Russia and the Eastern Mediterranean Region (EMRO) – trying to delay its approval for another year.

Despite WHO consultations on the plan since last July, the Saudi alliance claimed insufficient consultation as the reason for trying to block the plan.

The 15-page plan hinges on three action areas: 

• Leadership, coordination and advocacy, aimed at ensuring “the integration of health in national and international climate agendas and vice versa”;
• Evidence and monitoring, aimed at creating “a robust and relevant evidence base”  for  policy, implementation and monitoring;
• Country-level action and capacity-building to “promote climate change adaptation efforts to address health risks and support mitigation efforts that maximize health benefits”.

Debate on the plan pitted African nations that are part of EMRO against the 47 African countries in the Africa region, with the role of Egypt being particularly noteworthy.

During the pandemic agreement negotiations, Egypt chose to negotiate alongside the Africa region yet on climate, it switched back to EMRO and was a vociferous campaigner for delaying the plan.

While EMRO deployed various procedural moves to delay the plan, the Africa region supported its full adoption, said Mozambique on behalf of the 47 African member states.

“The African region is disproportionally impacted by climate change, and although our continent contributes minimally to the global emission, it bears the greatest burden,” said Mozambique.

However, when the final vote was called, the EMRO group decided to abstain rather than vote against the plan, which was passed by 104-0 with 19 abstentions.

Katarzyna Drążek-Laskowska, director of the Polish health ministry’s International Cooperation Department, who chaired the mammoth climate discussion in Committee B, praised delegations, saying that multilateralism meant “unity not uniformity”.

“Consensus may not always be easy, but it remains our strongest foundation,” said Drążek-Laskowska, who also chaired the budget discussions that saw member states agree to a 20% increase in their membership fees.

Under the new budget, assessed contributions (member states’ fees) will make up 40% of the WHO’s base programme budget of $4.2 billion for 2026-27. The core budget does not include emergency humanitarian appeals or polio programmes, which bring the total budget target up to $6.2 billion.

Now that the WHA has ended, two crucial processes lie ahead. The first involves concluding negotiations on the annex to the pandemic agreement dealing with the Pathogen Access and Benefit Sharing (PABS) system.

‘Critical’ pandemic agreement annex

Namibian Health Minister Dr Esperance Luvindao, who chaired Committee A that adopted the pandemic agreement, said that the outcome “reflects compromise, while it advances global collaboration, equity and access”. 

“We also look ahead to the next phase of negotiation on the pathogen access and benefit sharing (PABS) system, which will be critical to the success of future preparedness efforts,” said 31-year-old Luvindao, who assumed her position as the youngest ever African health minister in March.

An Intergovernmental Working Group (IGWG) will guide the PABS negotiations, and is due to conclude talks on annex by next year’s WHA. Only then will the pandemic agreement be open for ratification and once 60 countries have ratified it, the agreement will enter into force.

UN High-Level meeting on NCDs

The other process involves concluding negotiations on the political declaration for the United Nations High-Level meeting on NCDs and mental health in September.

A significant portion of Committee A’s time was devoted to discussion on NCDs, as countries across the globe struggle to curb these.

Only 19 countries – 10 from Europe – are on track to reduce NCD-related mortality by 30% by 2030, and the WHO has spent decades working on strategies to assist member states, including its 16 Best Buys interventions to address NCDs.

Kennedy told the WHA in his video address that the US is “fundamentally shifting the priorities of our health agencies to focus on chronic diseases”. This would include removing food dyes and other harmful additives; investigating the causes of autism and other chronic diseases; seeking to reduce consumption of ultra-processed foods, and supporting “lifestyle changes that will bolster the immune systems and transform the health of our people”, he said.

But the US could learn from nations that have spent decades tackling NCDs, including European nations that have substantially fewer harmful food additives than the US because of EU laws.

Interference in countries’ policies from harmful industries, particularly the tobacco, alcohol and ultraprocessed food industries, are a major obstacle to reducing NCDs – and high taxes on these is a significant deterrent to their consumption.

Paying tribute to WHO member states at the close of the WHA, Tedros said that all the resolutions adopted “express the collective will of the nations of the world, the United Nations, to work together on a shared approach, to share problems”.

No nation can address the magnitude of health challenges facing the world alone.

Image Credits: WHO, WHO/X.