World Health Assembly Closes Session with Biggest Challenge Still Looming
World Health Assembly
World Health Assembly 76 in progress.

Pandemic treaty negotiations need to be completed by member states and there’s just one year left to meet that deadline, warns the World Health Organization’s Director General.  

As the World Health Assembly closed its doors on it’s 75th Anniversary edition (WHA 76), which had to be extended by an extra day due to the prolonged debates last week over Russia’s invasion of Ukraine, Palestine and other geopolitical disputes, Director General Dr Tedros Adhanom Ghebreyesus reminded delegates of two things.

First, the first WHA in 1948 took four weeks. Second, the biggest challenge facing delegates still lies ahead: reaching agreement on a draft pandemic accord, which is supposed to be submitted to the next WHA in exactly one year’s time.

“Your challenge as Member States states is to negotiate a strong accord for approval, just 12 months from now,” he said. 

“This accord is a generational opportunity that we must seize. We are the generation that lived through the COVID-19 pandemic, so we must be the generation that learns the lessons it taught us and makes the changes to keep future generations safer.

“In particular we must work hard to counter the misinformation about the accord that is circulating among member states,” he stressed. “The idea that this accord would cede authority to WHO is simply fake news. This is an accord by member states and will be implemented in member states in accordance with their own laws.”

Accomplishments despite geopolitical division 

In his closing remarks, the Director General recapped the accomplishments of this year’s Assembly, which marks 75 years since the creation of the WHO.  Those, he said, included the approval of a 20% increase in assessed contributions by WHO member states that puts the organization on a more sustainable financial footing. 

Member states also approved, in principle, the creation of a new WHO “investment fund” that aims to complement existing WHO resources, the details of which will be worked out over the coming year.  Simultaneously, they rejected the idea of a “replenishment fund” similar to those organized by UNAIDS and The Global Fund, which recruit billions from countries and philanthropies every few years in glamorous bidding events graced by heads of state and celebrities.     

“Both the increase in assessed contributions and investment fund are historic,” said Tedros adding that WHO would work with member states to bring the latter idea “to fruition.”

He cited other key accomplishments of this year’s WHA as resolutions and decisions bolstering the integration of the behavioural sciences into the work of WHO and a set of updated “Best Buys” for countries’ NCD policies.

WHA actions addressed a range of issues, including one on drowning prevention that caused over 230,000 deaths annually.

This year’s WHA actions also addressed standardization of medical diagnostics, more inclusion for people living with disabilities, drowning prevention, critical and operative care in emergencies, food fortification with micronutrients, indigenous health, improving infection prevention and control, maternal and child health, medical oxygen, primary health care, refugee and migrant health, rehabilitation services, and traditional medicine.

Geopolitical divisions take center stage to the very end

“The challenges we face are daunting and complex. They are made harder by the geopolitical context in which we live,” Tedros observed, referring to the political debates that at times delayed discussion on more technical issues for hours or days.  

The delegate from Azerbaijan defends his country’s policy on border crossings, on Tuesday.

Even the Assembly’s final hours saw one last spat erupt, this time between Azerbaijan and Armenia.  The two countries sparred for about 15 minutes in the plenary over arrangements at border crossings in the Azerbaijan controlled region of Nagorno-Karabakh, which Armenia said hinders freedom of movement by the region’s ethnic Armenians between the two countries. 

“We live in a world of deep divisions, and at times those divisions have been evident at this health assembly. We cannot pretend they don’t exist, nor can we be paralyzed by them. When we agree, you must work with full determination and cooperation,”  Tedros observed shortly after the volleys of accusations ceased.  

“And when we disagree, we must continue to work to find common ground. As we do, we will often find that our disagreements can be overcome, and our divisions can be narrowed. In other words, we will find that health can be a bridge to peace.” 

Health as a bridge to peace 

One of the challenging moments Tuesday was a fight over the deadlock on a new WHO Global Health and Peace initiative, which Tedros has made a flagship of his tenure. The decision on the initiative finally was approved after a prolonged closed door session Tuesday morning (see related story).

“The vital connection between health and peace is not a new idea,” said Tedros, who himself hails from a war-torn Tigrayan region of Ethiopia. 

Global Health and Peace initiative was one of the issues discussed today at the last day at the WHA76.

“And nor is it something that lies outside the mandate of WHO,” he added, rebutting critics who say it risks duplicating roles already being played by various humanitarian relief groups. “It has been there since the very beginning in our Constitution, which says that the health of all people is fundamental to the attainment of peace and security.

“It is dependent upon the fullest cooperation of individuals and states,” Tedros said. “This is what COVID-19 has taught us: that pathogens have no regard for the lines humans draw on maps, not for our politics, nor for our politics, religions, or anything else that we use to divide ourselves from each other. To pathogens, we’re all one.” 

Food fortification and drowning 

Among the less noticed but vitally important resolutions approved by this year’s assembly were ones recommending food fortification to combat micronutrient nutrition, as well as a resolution to combat a widespread but neglected cause of death: drowning

Government moves to increase food fortification with key micronutrients, while not a panacea, can go a long way in combatting the most pressing problems of undernutrition faced today, Lawrence Haddad, executive director of the Global Alliance for Improved Nutrition (GAIN), said in an interview just ahead of the resolution’s approval by WHA last week. 

“It’s very exciting because some three billion people don’t have access to a healthy diet, so they afford to get the nutrients from fruits, vegetables, pulses, eggs, dairy and fish,” Haddad said. “While we are working on how to make these foods more available, affordable, and desirable, in the interim you have a solution, fortification, that adds vitamins and minerals to things that low-income people are already eating, such as wheat, maize, rice and cooking oil.”

Fortified food
Some 372 million preschool children and 1.2 billion women of reproductive age worldwide are at risk of at least one micronutrient deficiency.

Some 372 million preschool children and 1.2 billion women of reproductive age worldwide are at risk of at least one micronutrient deficiency, which can cause a range of conditions from debilitating anaemia to birth defects such as spina bifida and other neural tube disorders. 

Food fortification with vitamin B-9 (folate) is a key measure that can prevent spina bifida from developing in the foetus of pregnant women.  Other common micronutrients that can be added to foods to prevent a range of diseases and conditions include such as, iron, vitamin A, zinc, calcium and vitamin D. 

Many low income countries don’t fortify basic foods 

“While many countries are actually fortifying these basic staple foods, including all of the high income countries, in Latin America and Africa, not that many do,” Haddad observed. 

“And this is a very inexpensive, proven, WHO-approved intervention,” he added, noting that a raft of low and middle income countries, including Columbia, Malaysia, Ecuador, Philippines and Ethiopia had led the work on the resolution’s approval.  

Like virtually all WHA measures, the resolution on food fortification is non-binding. But it will amplify the issue on national agendas, unlock donor funding and a raft of WHO guidance and support, he said, pointing to all of the policy wheels that WHA actions can set in motion.

“This resolution will really help us,” said Haddad.  “It’s a window opening. It’ll mean that countries will report to WHO on their food fortification status. The millers will begin adding micronutrients to their grains, the oils can be fortified by oil refiners cheaply – at just 0.1% of the retail price.”

And non-government actors like GAIN can swing into action with technical support.  

“It’ll facilitate, encourage, inspire more and more governments to do this,” he said. “And GAIN will help any government that wants us to help them with the technical things that they have to get right – like safety, reporting using digital data. It’s exciting. It’s a first-ever.”

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