By Beth Stinchcombe and Catarina Soares
With thanks to Harpreet Kaur, Lucy Singh, Brian Wong, Layth Hanbali, Rhiannon Osborne, and Katie Hussleby (AfGH)
This year, there has been unprecedented interest in the World Health Assembly and the World Health Organisation (WHO), as we face one of the greatest health crises of our time and the role of the WHO has been thrust into the spotlight. Welcome to the first part of our two-part blog on what happened and our take on it. First up is a summary of the most noteworthy moments to help you understand this year’s events and giving you the tools to help others understand. Look out for part two, where we’ll talk about what we as SfGH think should have happened and how you can get involved.
What is the World Health Assembly and how was it different this year?
The World Health Assembly (WHA) is the WHO’s general assembly. Convening every year in May in Geneva, Switzerland, it brings together the Ministers for Health of all WHO Member States along with their accompanying delegations to discuss the work of the WHO that year, decide on policies, and approve the WHO budget. The WHA (i.e. WHO voting members – the Member States) is also responsible for electing the Director-General every five years and ten Executive Board members every year. The event is also attended by non-state actors (NSAs), such as the International Federation of Medical Students’ Associations (IFMSA, of which SfGH is a member organisation), who can deliver statements but do not have voting rights.
Usually, the WHA is a complicated and large scale event with many important conversations happening at the same time. There are two Committees, A and B, that discuss technical items (i.e. health-related content) and financial and business matters respectively. There are also technical briefings by UN agencies and side events by NSAs, UN agencies and even Member States, during which specific topics are discussed, and can serve as a platform for advocacy on different issues by NSAs and UN agencies. As well as all these meetings and events, there is a plenary where decisions are voted on by Member States. Last minute discussions happen between countries behind closed doors to ensure support for tabled motions but the majority of the discussions and planning happen in the months preceding the assembly. As well as all the formal meetings, a lot happens in informal settings such as coffee breaks: often the prime opportunity to find highly sought-after officials whose schedules are very busy. These informal discussions, especially for advocates from NSAs, can be just as important as formal discussions.
This year, the WHA was held virtually due to the COVID-19 pandemic. It was shortened to only two days, rather than the usual one week, since the online platform doesn’t lend itself to these events and discussions very easily, and meeting in person was out of the question in these circumstances. The focus of this WHA was to discuss COVID-19 and to elect the new members of the Executive Board, and the rest of the agenda items originally planned will be discussed later in the year.
Reviewing the WHO’s actions
This WHA came at a time of controversy about the role of the WHO during this pandemic. President Trump (USA) had been accusing the WHO of being too “China-centric” and mishandling the pandemic, and froze US financial contributions to WHO temporarily, culminating in his announcement that the US will be withdrawing from the WHO. The International Health Regulations (IHRs), the legally-binding agreement between all Member States of the WHO to address communicable diseases, became part of the general public’s lexicon as world leaders, global health experts and journalists dissected what the WHO did and did not do, should and should not have done, said and did not say.
A resolution proposed by the European Union and co-sponsored by many other countries calls for an independent and comprehensive review into how effective the tools available to the WHO had been, the role of IHRs (most recently revised in 2005 following the SARS epidemic) and how they were followed, and the actions of the WHO during the pandemic.
Throughout the WHA many Member States and the Director-General himself commented on the need for an independent and impartial review into the events and lessons learned from this pandemic, to consider modernising the WHO or the tools at its disposal, and the first Interim report on WHO’s response to COVID-19 (January-April 2020) by the Independent Oversight and Advisory Committee has already been published. Notably, although the resolution and many stakeholders called for a review of the actions of the WHO, a similar measure has not been taken in relation to individual countries, who have evaded the same scrutiny for their decisions during this crisis.
The role played by international conflicts once more took centre-stage. Health and healthcare are, of course, deeply political and we saw a geopolitical struggle for power play out at this year’s WHA. The US focussed on condemning the WHO’s attitude towards China and the actions of China itself, as well as expressing their support for Taiwan’s participation as an observer despite an earlier motion passed (and a request by Taiwan itself to the international community) to table this at the next in person WHA. Many other countries echoed the sentiment, namely the Pacific island nations.
Another important issue raised in this arena were the sanctions imposed by the US on Iran, Syria and Cuba – all three countries pointed out that these sanctions affect their ability to deliver healthcare to their population and have hindered their efforts to manage the COVID-19 crisis. The US maintains that there are exceptions for humanitarian aid in these sanctions, and the target countries insist that the exceptions don’t truly allow for unencumbered delivery of healthcare.
Lastly, the conflict between Russia and Ukraine also reared its head, in response to Russia’s election to the Executive Board. Ukraine raised the deterioration of the healthcare facilities in occupied territories, the difficulties assessing the impact of COVID-19 in the occupied territories and the denial of access to Ukrainian and independent humanitarian medical teams to these areas. Russia denies many of these charges but this back-and-forth is demonstrative of how tensions in the region are affecting the health of the population.
As some commentators have noted, observing the 73rd World Health Assembly gave a glimpse of the post-American world: “A confident and assertive China with a clear strategic approach. A Europe trying to rescue what’s left of global cooperation. And a disruptive USA more keen on fighting China than fighting COVID19” – Carl Bildt.
Access to a new vaccine or treatment
Another big topic was the need for novel treatments or vaccines to be equitably distributed globally. Access to essential medicines is already a complex issue (head over to our affiliate UAEM to find out more), and there has been a lot of focus on ensuring access to any new medicines or vaccines are universal. Many Member States highlighted the importance of any potential product being affordable and accessible to all as a global public good, and we were glad to see high-income countries pledging to make sure this holds true when the time comes. As it became apparent in bidding wars for personal protective equipment, the richest nations can source the necessary goods much more easily than low- and middle-income countries and outbid them, worsening global shortages and driving inequity worldwide.
There has been much debate about the accessibility and universality of a novel vaccine or treatment. Costa Rica has led the charge, calling for the WHO to take command of a voluntary patent pool for all COVID-19-related technologies, which has now been launched. However, many people in the global health field feel that this is not enough: current and former heads of state of many countries, former executive directors for UN agencies, heads of non-governmental organisations, academics and activists signed an open letter calling for mandatory worldwide sharing of all COVID-19-related data, establishing a global and equitable rapid manufacturing and distribution plan fully-funded by wealthy countries, and guaranteeing all diagnostics, treatments and vaccines are free of charge and universal.
The resolution that passed at the WHA calls for countries to make full use of the flexibility afforded to them by TRIPS, the international treaty on intellectual property, which allows them to force manufacturers to give up their patent rights, although they may still receive royalties from the product. Unfortunately, even this paragraph has been mired by controversy as the US positions itself against it due to perceiving it as an “unbalanced and incomplete” approach that risks undermining innovation. It should be noted that other high-income countries have also been said to have pushed back on that paragraph, although none publicly, and that more progressive drafts did not make it past negotiations for these reasons.
Connectivity and audio issues played a significant role during the WHA. Unstable internet connections resulted in lots of difficulties hearing speakers clearly, and left a couple unheard altogether as no solution was found for this. Statements by Member States are later published on the WHO website, but not all can be found there so we’re left without knowing what some countries had to say.
Before this WHA, there were a lot of discussions about the participation of CSOs. The Executive Board proposed changes to how civil society engages with the WHA in 2019, as a response to the length of sessions at the WHA and the long list of NSAs. This is definitely a space to watch in the future.
CSOs would normally have the opportunity to deliver spoken statements but this year the vast majority were limited to written statements submitted in advance. A few NSAs delivered oral statements, namely the International Federation of Red Cross and Red Crescent Societies (IFRC) and Gavi (the Vaccine Alliance), and various UN agencies, but the wealth and breadth of NSA interventions was lost.
Following WHA, Action for Global Health and other partners co-hosted a webinar with Dr Tedros on civil society engagement in the Covid-19 response, attended by more than 100 civil society organisations.
The Civil Society Engagement Mechanism for UHC2030 presented their findings from a recent survey on social participation. Analysis of Covid-19 Task Forces of 24 countries found almost no representation from civil society or community representatives, and a rapid survey of 175 civil society organisations from 56 countries found that the majority of respondents found little or no opportunity for civil society to contribute to their government’s response.
Dr Tedros recognised the lack of civil society and community participation in the global, national and local response to Covid-19 so far, and committed to fortnightly meetings with civil society moving forwards. He also committed to using WHO platforms to encourage NSA participation at the national and local level, in order to ensure no-one is left behind.
During the Q&A, Dr Tedros was also asked about the role of youth in the Covid-19 response, and he welcomed suggestions from participants on successful examples of meaningful youth involvement in Covid-19 responses at follow-up meetings.
The WHA, as always, has been a very eventful time for global health – tensions between countries boiled to the surface, inequity in health was once more highlighted. The main sticking points, that were being discussed before and are still being discussed after, is how we’ll address this inequity: how will we ensure a universal vaccine? How will people in conflict zones access the care they need? How will civil society make itself heard?
As a student organisation invested in “a fair and just world in which equity in health is a reality for all”, we have a responsibility to speak up and fight for these questions to be answered. Stay tuned for part 2, where we’ll dissect the events of the WHA and link you to tools to be part of the change.