The 75th World Health Assembly (WHA) is about to kick off on 22 May in Geneva, Switzerland. As the annual meeting of the World Health Organization (WHO), the WHA sees participation from 194 countries that form the WHO, civil society organizations and other non-state actors. After two and a half years of the COVID-19 pandemic, the Assembly is taking place in person, although with restrictions on the number of delegates and participants.
The agenda reflects some of the core issues that the world has been facing since the pandemic started. While “health emergencies” remain a major topic of discussion in the light of continuing pandemic, the Assembly will also focus on diseases such as meningitis and non-communicable diseases (NCDs), which faced acute neglect during the pandemic. Given the prolonged financial crisis that the WHO has been living through before and during the pandemic, sustainable financing of the WHO is slated to be a hot topic for discussion as well.
Discussing health emergencies in the light of COVID-19
Health emergencies will be under discussion through various agenda items – the report of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Program (IOAC), Strengthening WHO preparedness for and response to health emergencies, and WHO’s work in health emergencies and Implementation of the International Health Regulations (2005).
The one most worth watching out for is the report of the IOAC, which is the annual review of progress of WHO’s work in health emergencies from May 2021 to April 2022. Whilst there is a major focus on the progress of WHO’s response to COVID-19 since the last report, it also highlights recurring issues observed since the Committee’s inception in 2016. The report notes that “these issues were again brought to the forefront of discussions during the COVID-19 pandemic and should be prioritized in the future.” The report highlights that the WHO’s Health Emergencies Program (WHE) has been facing an ever-increasing workload and demands, particularly during the pandemic. The chronic staffing and financial constraints, including at the regional level, impact emergency operations in fragile contexts, undermining the key aims of the Program.
Importantly, the report emphasizes that the WHO should be in the leadership role during health emergencies and that the governance of the global health architecture should be anchored in WHO. It also calls for promoting equitable access to medical countermeasures, which include medicines, vaccines, and blood products among other things.
However, the report limits itself to addressing the role and responsibilities of the WHO. It is silent on the responsibilities of the countries in fighting back the emergencies. Despite noting that it incorporates lessons learnt from COVID-19, it does not touch upon fundamental issues that were detrimental to an effective global response to the pandemic. For example, the Covax facility, in which WHO was involved and which was responsible for ensuring equitable access to vaccines, failed to deliver due to trade barriers such as patents and other forms of intellectual property. The ACT Accelerator met the same fate. There is no recognition of the detrimental role of Big Pharma which acted in greed and continued business as usual, even at the cost of numerous lives.
The report does not note that governments are responsible for health and should provide affordable medicines, ensure oxygen stocks and deliver in public interest. It also does not take into account the misery that was created due to economic sanctions imposed on countries such as Iran, Venezuela, Cuba and North Korea by the US.
Because of the underfunding of public health that preceded the pandemic and Big Pharma’s pressures, COVID-19 disrupted access to essential health services and overburdened health systems globally. This is reflected in the high number of excess deaths we have witnessed as a result of the pandemic. All of this shows that the vested capitalist interests did not work in solidarity with the people, rather against them. Without recognising and addressing these issues, the world will never be prepared enough to deal with future catastrophes. The WHO should take such matters into account in its report.
Embracing a vertical approach for dealing with illnesses
Many of the documents being tabled for discussion at WHA emphasize the need to strengthen health systems. However, in general WHO seems to be embracing a vertical approach to dealing with diverse conditions like meningitis, maternal and child nutrition, and NCDs. For example, the roadmap for NCDs uses a disappointing individualized approach, ignores the commercial determinants of health and doesn’t address any structural issues of healthcare systems. Additionally, WHO is encouraging countries to adopt a model of Universal Health Coverage (UHC) that focuses on increasing health insurance coverage instead of ensuring comprehensive and universal health care.
Overall, neither the vertical approach, nor the insurance-based model of UHC, result in greater investment in and strengthening of public health services. Without greater support for public health systems, the people and institutions that were overburdened during the pandemic will not receive the resources needed to “build back better”.
The vertical approach also obscures the role that commercial determinants of health play in shaping health outcomes. Processed food, large agricultural farms promoting monoculture, promotion of harmful food substitutes are some examples of impacts of commercial determinants of health. By focusing on specific conditions, these determinants are considered on a case by case basis, for example with respect to breastmilk, alcohol consumption, or diabetes. At most, corporate behavior that is harmful to health is considered with respect to specific issues, thereby foreclosing more comprehensive analyses of the systemic nature of commercial determinants of health.
WHO’s funding crunch
To work on these issues more independently and in consultation with health movements and civil society, the WHO’s decision-making needs to be without any fear or favor. Thus, the funding of WHO becomes crucial. WHO has been facing a funding crunch for a long time. The proportion of untied funds, called the assessed contributions (AC), has been declining for years. There has been a tendency to prefer voluntary contributions which are meant for specific programs. This hampers WHO’s ability to decide priorities independently.
The WHO will place a report on Sustainable Financing of WHO during the Assembly. It notes that the funding needs to increase substantially, especially the coffers of AC, in order to allow better functioning of the WHO. It suggests a roadmap for the same, charted out in the table below:
While it is a welcome step to put concrete efforts in place to solve the existing problems, the report falls short of suggesting effective measures to ensure that real issues are addressed. Firstly, increasing the base budget of AC to 50% by 2030 is too low. It ignores the call by the Independent Panel for Pandemic Preparedness and Response that had proposed lifting ACs to 67% of the base segment. It also does not take into account inflation which will render the 50% increase even less significant.
An even more fundamental issue is the recommendation that WHO accept private sector funding “in accordance with Framework for Engagement with Non-State Actors (FENSA).” FENSA lacks effective probity protections. Even if contributions by pharmaceutical contribution were seemingly untied, the WHO would still face consequences of running policy initiatives against industry interests, as the financing from the private sector could easily get canceled over such moves. This puts the whole exercise of trying to keep WHO’s functioning independent, redundant.
Other agenda items on the table are election of new Director-General; HIV, viral hepatitis and sexually transmitted infections; tuberculosis; Neglected Tropical Diseases; immunization; infection prevention and control; standardization of medical devices nomenclature and human resources of health.
Overall, the WHA is going to discuss topics of great relevance for the present times. But the WHO has to step up in recognizing the fundamental issues plaguing global governance of health and address them more strongly.
The WHO Watch team members are Abhishek Royal, Alan Rossi Silva, Aletha Wallace, Anton Sundberg, Ben Verboom, Dian Maria Blandina, Jasper Thys, Maria Alejandra Rojas, Marta Caminiti, Sarai Keestra, Sopo Japaridze, Lauren Paremoer, Jyotsna Singh, and Gargeya Telakapalli.
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