The World Health Organization’s (WHO) Executive Board will hold its 152nd session in the week between January 30 and February 7. The meeting is taking place as the world enters the fourth year of the COVID-19 pandemic, and only days after the Emergency Committee on the COVID-19 pandemic discussed the possibility of declaring an end to the health emergency this year.
Global outbreaks set the stage for Executive Board
The outcomes of the Emergency Committee’s discussion were less optimistic than what could have been hoped for, considering the rising numbers of COVID-19 infections and deaths over the last weeks. COVID-19, however, will not be the only health emergency setting the stage for the Executive Board’s meeting. Global and local outbreaks of a variety of diseases, including monkeypox and cholera, and hindrances on the way to eradication of polio or reducing global tuberculosis infections, will also have to be taken as important indicators of the world’s preparedness to deal with extreme health events.
Not only have these events put local health systems’ capacities at test, but they have also shown that the experience of COVID-19 has done little to change high-income countries’ understanding of how health emergencies should be tackled. The global monkeypox outbreak, which drew much attention while the number of cases in the Global North grew, quickly dropped off from the news once these came under control.
Incidentally, countries in the Global North hold most of the vaccine stocks needed to contain monkeypox – health systems in West and Central Africa struggled with the virus for decades before it made headlines and, in many cases, did so without access to a single vaccine dose. Because of this, the global monkeypox outbreak was a painful reminder of the widespread inequities between the Global North and the Global South where the distribution of medical products, ranging from personal protective equipment (PPE), vaccines, medicines, and diagnostics is concerned. The WHO Executive Board will touch upon these problems through several of its agenda points, and it remains to be seen whether it will open the door to addressing such discrepancies.
Outbreaks of cholera – including in countries which had not faced the disease for decades, like Lebanon – and the emergence of cases of poliomyelitis in countries like the United States and the United Kingdom, have to be taken as a warning of the deteriorating living conditions of millions of people around the world. To prevent them from spreading, it will be as crucial to strengthen public health systems as it will be to improve the social determinants of health, and the WHO will have a say in how both of these lines of action evolve.
Ensuring adequate funding for WHO and health systems alike
The Executive Board will continue to discuss WHO’s perpetual funding crisis, caused largely by a freeze on assessed contributions that the organization has struggled against for decades, and which has pushed it towards closer collaboration with philanthro-capitalist funds and the private sector. After the 75th World Health Assembly finally took steps, albeit limited, towards an increase of assessed, non-earmarked contributions, the Executive Board will be looking at how this can be combined with the introduction of a replenishment fund.
Such a fund would not be open to members of the WHO alone, but also to other actors. Introductions to this agenda item have made it a point to underline that contributions by so-called Non-State Actors would be subject to existing frameworks for addressing conflict of interest. Still, the proposal has led to doubts both inside and outside the WHO, with health experts wondering if the model would truly lead to an adequate and stable budget for the UN agency without compromising on its integrity.
Problems with budgets are not ailing the WHO alone. In fact, health systems all over the world are still being weakened by austerity measures, often associated with loans granted by international financial institutions. The lack of resources – financial, human, and other – has already proven to be an insurmountable obstacle in the way of implementing sound public health policy, and it will continue to do so until a more significant change of course occurs. This is likely to affect the possible implementation of some of the documents discussed at this Executive Board, including proposals to mainstream a social determinants of health approach in all WHO operations, address challenges in the field of nutrition, strengthen rehabilitation services, and build local capacities for infection prevention and response.
Securing more equitable access to diagnostics, local clinical trials
The meeting will also see discussions on topics that have been taken up at other forums, including those related to ensuring more equitable access to diagnostics and other medical products. Executive Board members will be looking at a proposal tabled by Swaziland which, if passed, could boost local production and reduce dependence on multinationals.
The topic was previously discussed by the World Trade Organization (WTO) as part of the debate on a TRIPS waiver proposal for COVID-19 medical products. While the WTO adopted a completely different document than the original proposal submitted by India and South Africa, the WHO still has an opportunity to take a somewhat different turn, as Priti Patnaik explains. The adoption of such a resolution would be even more significant as the WTO document has still not been extended to cover diagnostics and therapeutics in addition to vaccines.
WHO’s Executive Board will also be discussing substandard and falsified products, and the modalities of implementation of clinical trials. Under both agenda points, board members will have the opportunity to consider structural factors that promote the production and distribution of counterfeit drugs and hinder the conduction of clinical trials for the benefit of the majority of the world’s population – namely the existing intellectual property framework and a profit-driven research and development system.
Universal Health Care remains priority for health activists
Another important topic on the Executive Board’s agenda will be the progress towards Universal Health Coverage (UHC), a concept that, over the last years, has been promoted as the main way to address health inequities. Yet, recent data shows that such progress is actually non-existent. Despite the fact that UHC is supposed to increase access to health care, since 2019, there has been no change where health service and delivery are concerned. When it comes to another important UHC indicator – catastrophic healthcare expenditure – it has actually increased instead of falling as foreseen.
Such data generally corresponds to what many health activists have been warning about since UHC started to be championed over the WHO’s original dedication to Comprehensive Primary Health Care and Health for All. According to the People’s Health Movement (PHM), when we talk about UHC: “The lack of progress is not due to failed implementation, but due to the correct implementation of a wrong strategy.”
One of the bigger problems with UHC remains its heavy reliance on the private sector, still present in the documents to be discussed by the Executive Board. Similarly to what it has done in the field of medicine production, the private sector has rarely proven itself to be a reliable partner in strengthening health systems. Instead, it has pursued its own interests, often siphoning public resources and disregarding the wellbeing of the people health systems are supposed to serve.
There still remains space for the WHO to steer back towards frameworks that would truly put people’s health first – Universal Health Care and Comprehensive Primary Health Care – but it remains to be seen if recent experiences with health emergencies and data on UHC will be enough to push the Executive Board’s discussion in this direction.
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