A week long meeting of WHO’s Executive Board kicked off on Monday with plans for a fresh WHO multi-year strategy, a new “Investment Fund” to help finance it – and a warning by Director General Dr Tedros Adhanom that he was “gravely concerned” that WHO member states would fail to adopt a global pandemic accord by the May 2024 deadline. 

 “At the political level, world leaders at the UN General Assembly High-Level Meeting agreed [to] a strong political declaration, including a commitment to conclude negotiations on the pandemic agreement and amendments to the International Health Regulations by May this year,” said the WHO Director General in his opening remarks to the 34-member governing body.

“But I must say I am gravely concerned that Member States may not meet that commitment. Time is very short, and there are several outstanding issues that remain to be resolved,” he said adding that “in my view, a failure to deliver the pandemic agreement and the IHR amendments will be a missed opportunity for which future generations may not forgive us.”

The week-long EB meeting faces an agenda packed with nearly 50 items – from the new WHO General Plan of Work 2025-2028 (GPW14) to WHO finance, climate change and health and progress reports in over a dozen disease themes as well as health emergencies.  Draft WHO strategies, member state decisions and resolutions that received EB approval then go on for consideration by the full World Health Assembly in May. While the pandemic accord negotiations, as such, are not formally part of the week’s agenda, the issue is sure to be a key focus of private member state discussions as delegates meet face to face in Geneva.  

 ‘State of the Union’ address

In what constituted a sort of  ‘State of the Union’ address by the WHO Director General, Tedros recited a long list of global health accomplishments from 2023 – while looking ahead at the complex challenges faced this coming year. Among the bright spots, he cited, was the approval of a second malaria vaccine, the R21-Matrix M vaccine, followed by the historic rollout of the first approved vaccine, RTS,S, for routine vaccination in Cameroon, beginning Monday.  

Some 20 African countries in all are set to received supplies of one or the other of the two vaccines over the course of 2024 and 2025, Tedros said, in a new thrust against one of the biggest childhood killers on the continent. See related story here: 

Cameroon Becomes the First of 20 African Countries to Roll Out Routine Malaria Vaccination in 2024

Pandemic fund and other measures ‘up and running’  

Despite the lack of progress over a pandemic accord, a new ‘Pandemic Fund’ has meanwhile been set up under World Bank auspices, Tedros remarked. 

“The Pandemic Fund is up and running, and has made its first round of disbursements, of US$ 338 million to 37 countries. The second round is now underway, with funding of US$ 500 million,” he said. 

He cited “progress” in developing other mechanisms that could anticipate needs and support the supply medicines and medical tools more quickly, including a new Global Health Emergency Corps, a global network aimed at strengthening health emergency response, a  Universal Health and Preparedness Review, mechanism for country’s peer review of preparedness; as well as a new International Pathogen Surveillance Network, under the auspices of the new Berlin-based WHO Hub for Pandemic and Epidemic Intelligence and the Preparedness and Resilience for Emerging Threats Initiative. 

Additionally, there is the new Swiss-based WHO BioHub System, for safe storage and voluntary sharing of biological materials and the SouthAfrica-based mRNA Technology Transfer Hub, which aims to support African development of mRNA vaccines and expertise. 

All in all, he said, there are  “more than ten initiatives actually, based on our experience during the COVID-19 pandemic.”

See related story:

‘Lies’ and Entrenched Positions Undermine WHO Pandemic Negotiations

2024 opens with big challenges

Alongside the positive milestones, however, 2024 begins with an imposing list of challenges, the WHO Director General acknowledged. These range from climate and conflict-linked health emergencies to ongoing disease outbreak threats ranging from mpox to COVID. There are longstanding challenges such as  TB and polio eradication, as well as the growing epidemic of non-communicable diseases and antimicrobial resistance that could render existing antibiotics impotent. All of these are represented in the heavy EB agenda, in one way or another.

“In all, WHO responded to 65 graded emergencies, from earthquakes in Türkiye and Syria, to conflict and insecurity in the Democratic Republic of the Congo, Ethiopia, Haiti, Myanmar, Sudan, Ukraine, and of course the occupied Palestinian territory, especially Gaza,” said the Director General.

“After almost three and a half years, in May I declared an end to both COVID-19 and mpox as global health emergencies, although both remain global threats,” he stated.

Kenya, in its remarks, meanwhile, called upon WHO to “call for greater focus to be given to the greater Horn of Africa region, which is currently facing severe flood insecurity and a Grade Three Health Emergency” – triggered by a mix of climate-related factors and conflict. 

“To prevent further deterioration of the health situation, these urgently need sustained funding, including human resources, supply chain and logistics management,” said the Kenyan delegate. 

New WHO Global Plan of Work – 2025-2028

Amongst the core strategic initiatives on the EB agenda for this year, the new WHO Global Plan of Work (GPW 14), appeared to already enjoy broad support among member states, with key blocs making positive mention of the strategy in the opening session. 

The draft GPW 14 is set to be reviewed by the EB this week, and then approved by the WHA in May.     

Adoption of the new strategy would also conclude the existing GPW13 a year early.  This,  after it became clear that the world would fall far short of two of the three GPW 13’s  “Triple Billion” goals,  ensuring 1 billion more people get access to universal health coverage and 1 billion more  protected from health emergencies. WHO claims to have helped the world meet the  third goal, 1 billion people enjoying healthy lives, with 1.26 billion more people enjoyed better health in 2023 as compared to 2018.

However, “this progress, even if continued at the current rate,” is insufficient to reach the Sustainable Development Goals by 2030, noted the WHO report to the EB, referring to still-rising rates of adult obesity and air pollution exposures – among the SDG health-related targets being measured.   

The “Triple Billion” formula has been criticized by WHO insiders for having targets that are unwieldy to measure – distracting  from the already detailed set of health targets and indicators  in the UN Sustainable Development Goals – which WHO is also obliged to track. 

The new strategy, while still referring to the “Triple Billion” goals, sets out six strategic objectives, directly relevant to WHO programmes as well as linked to the SDGs, including: 

• Transformative action on climate change and health;
• Ensure health is at the centre of policy agendas that drive determinants and root causes;
• Address inequities in the coverage of essential health services and interventions;
• Reverse the trend in catastrophic health spending;
• Ensure all countries are prepared to prevent and mitigate health risks; and
• Rapidly detect and respond to acute crises and ensure essential services in protracted crises.

“Work is under way with Member States to recalibrate the triple billion indices in order to account for changes in the health context and improve impact measurement for 2025–2028,”  states the report by the Director General. 

“The updated targets – measured in billions – will set a common aspiration for the number of additional people who will need to enjoy better health and well-being, access to universal health coverage without financial hardship, and protection against health emergencies in order to get the health-related Sustainable Development Goals back on track through the draft GPW 14 agenda,” it adds. “Proposals are being developed to better track the coverage of essential health services and financial hardship, as well as areas such as climate and health, mental health, disability, physical inactivity and foregone care. An updated set of indicators to measure functional readiness and response is being developed for health emergency preparedness and response, based on lessons learned from the COVID-19 pandemic.”

Support appears widespread

The new strategy appeared to draw strong support from both high-income nations like the United States as well as developing countries at the opening EB session. 

“We welcome the 14 general program of work, which I believe we could use from the lessons learned and the only finished agenda with a team’s general program of work, including challenges brought by COVID-19 pandemic,” stated Tanzania’s delegate, in the opening session. “The 14th general program of work will …  also be an agenda setting instrument for the member states… in the national plans, translating… to the national contexts.”

“We applaud and strongly welcome the draft GPW14 outline, including the proposed strategic objectives, its renewed focus on improving the monitoring and evaluation of results, as well as reference to noncommunicable diseases (NCDs), including mental health and neurological conditions, throughout the text,” stated the NCD Alliance in a statement published last year. 

Climate and health – Russia tries to squash discussion 

Although climate and health is an explicit pillar of the draft GPW14 strategy, the Russian Federation attempted to remove the issue as a separate item from the EB agenda, where a report by the Director General is due to be discussed Friday. 

The DG’s report is expected to pave the way for a new World Health Assembly resolution on climate and health. The first resolution on the topic since 2008, a draft resolution now being negotiated amongst potential member state sponsors, with hopes it might be considered in the WHA’s May 2024 session.  Russian opposition to a discussion may have been aimed at heading off a new WHO statement on climate issue – which indirectly strikes at oil and gas interests – even if the focus is health.    

“WHO is already working on climate and health,” said the Russian delegate, supported by the Democratic Peoples’ Republic of Korea (DPR Korea). 

“Many proposals from countries related to these health issues were actually rejected for the agenda, and the pretext was that they are already included within some WHO strategies.. WHO is already working on climate and health within the framework of an adopted global strategy of this organization,” the delegate added. 

There was speculation that Russia was, in fact, referring to moves afoot by some countries to advance a new WHO resolution on climate and health – in the wake of the first official Health Day at COP28.  While the draft resolution has not yet been published, it would potentially strengthen WHO’s leadership role in addressing the issue within the health sector.  

The move to squash a debate was quickly opposed by a wide range of countries – including the United States and  Peru, as well as a number of African and European nations.

“I would also like to echo to our colleagues from the United States,” said Nora Kronig, the Swiss delegate to the EB. “Climate change has an impact on a daily basis on people’s health, as well as systems as a whole. Within this body we need to address this issue of climate change which is why we believe items should be kept on the agenda.” 

Image Credits: Rana Hajjeh/WHO/EMRO .