A year after the World Health Assembly (WHA) held its session in the midst of the COVID-19 pandemic, country delegates are once again discussing pandemic response, issues related to health workforce, access to medicines and World Health Organization (WHO) strategies. Over the course of the year, a lot has changed. Since spring 2020, the Biden administration has reaffirmed the US intention to remain a member of the WHO and, more notably, several COVID-19 vaccines have become available.
No adequate solution for WHO’s financial challenges
Other aspects have remained the same, and the WHA is once again in session under the shadow of long-lasting internal challenges. Although many countries have commended WHO for its technical support and guidance during the COVID-19 pandemic, their recognition has not translated into material support for the organization’s core functions.
Last year, assessed contributions (flexible core funds) by member states amounted to approximately 20% of WHO’s budget. In comparison, over 70% of the budget was represented by specified voluntary contributions by a variety of stakeholders, i.e. earmarked funds which can be spent only on specific programs. As earmarking of funds means that WHO is unable to decide which programs get implemented and how, unsurprisingly what began as a financial issue is now a governance problem as well.
A working group on sustainable financing launched in January this year by the WHO Executive Board was tasked to find solutions. It proposed identifying essential functions of the WHO that could be fundraised for and implemented independently. This approach would open the doors to the WHO losing some of its current programs to other organizations that aspire to take a leadership role in global health, mirroring the atomization process many health systems went through as part of veiled privatization agendas.
The Pandemic Treaty
One of the more anticipated discussion points of the assembly was the idea of a binding treaty in the field of pandemic response, supported both by the WHO Director General and some countries, for example Germany and Fiji, who underlined the potential to improve the world’s pandemic response during future epidemics. The US avoided serious consideration of the topic by calling for high-level meetings and careful consideration of what is needed, before proceeding to the drafting of a new international instrument. Civil society also expressed doubts about the true impact of such a treaty if it will be shaped solely through the perspective of health security, and will ignore the importance of strengthening health systems.
The People’s Health Movement (PHM) and Medicus Mundi International (MMI) called upon the WHA to base the Pandemic Treaty on “strengthening public health systems for effective treatment and prevention in all countries, with appropriate infrastructure and resources”. Amid differing points of view, a more substantial discussion on the treaty was postponed to a special session of the WHA to be held in November this year, giving more time for consultations, as well as space for actors other than WHO members to influence its content.
Has the South given up on COVAX?
The long-lasting reform of the WHO is taking place in a more crowded global health arena than before. The rise in prominence of new global health actors such as the Bill and Melinda Gates Foundation and GAVI has been noticeable for a while, yet their might came to the fore with the pandemic. Over the past year, they used their financial and political influence and shifted all eyes from WHO’s feeble attempt to encourage transfer of technology and know-how through C-TAP (COVID-19 Technology Access Pool), and on to the vaccine branch of the ACT-A (Access to COVID-19 Tools Accelerator), COVAX.
Disregarding its failure, rich countries remain happy with COVAX as the main vaccine distribution mechanism during the pandemic, as it reasserts their dominant position towards other countries. It is more surprising that low and middle income countries did not raise any issues on the performance of COVAX during the WHA. In contrast to the discussions last year, they seem to have collectively given up reclaiming a multilateral process, agreeing instead to a multi-stakeholder approach.
Sharing of knowledge, sharing of the benefits
It is in this context, then, that the WHA discussed topics like the global strategy and plan of action on public health, innovation, and intellectual property (GSPOA), and benefit sharing through the Nagoya Protocol. Notably, with the COVID-19 pandemic having underlined the importance of local production of medicines and other health technologies, the discussion on the GSPOA included a draft resolution on the same topic. It is positive that local production of health technologies is being talked about in the context of strengthening local health systems and improving access to vaccines. Yet, the discussion did not edge towards the recognition of the negative effects of the dominance of the pharmaceutical industry on people’s health.
Uncertainties about pathogens and benefit sharing, related to the WHO Secretariat’s BioHub initiative, characterized the discussion on the Nagoya Protocol. As the BioHub initiative was initiated outside of WHO governing bodies, questions about its appropriateness were raised during civil society interventions. MMI and PHM in particular underlined that a future framework for access and benefit sharing of potential pandemic pathogens and seasonal flu viruses should come from a member state-led process, to ensure that it represents the needs of all WHO’s members. A democratic process for creating the framework would also ensure independence from the pharmaceutical industry and the private interests of the different stakeholders trying to get hold of WHO. That way, in addition to enabling concrete progress when benefit-sharing is concerned, WHO’s governing bodies would support the organization in returning to its original member-led structure.
The G20 Global Health Summit: setting the tone for WHA74
It remains to be seen how such a return can be facilitated in the context of other international actors claiming more and more space in health governance. Just a few days before the beginning of WHA74, the European Union and Italy hosted the G20 Global Health Summit, addressing the pandemic response. Quite a few among the G20 countries are still opposing the TRIPS waiver proposal tabled at the WTO, effectively blocking any real possibility of scaling up production and distribution of COVID-19 products in a reasonable time. It did not come as a surprise, then, that their declaration failed to break with a narrative on fighting the pandemic through aid and humanitarianism. In hindsight, this might well have set the tone for the WHA74 deliberations.