MANILA — While the world’s elite gathered atop the snowy mountains of Davos, health ministers and other stakeholders spent last week in Geneva, hammering out the details of a number of global health priorities.
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The meeting, set specifically for the World Health Organization Secretariat and executive board members to discuss the agenda for the annual World Health Assembly in May, tackled issues such as WHO’s next program of work, the future of polio, and the polarizing topic of access to medicines.
Though a stark contrast to the flashy, fast-paced atmosphere of the World Economic Forum, the deliberations at the WHO headquarters in Geneva had their own share of entertaining and intense moments.
Here’s what to know from WHO’s weeklong 142nd executive board meeting.
1. A step forward for WHO’s draft 13th general program of work.
After a series of revisions, member states agreed to put forward WHO’s draft 13th general program of work for consideration at the 71st World Health Assembly in May.
To some, the consultations may have been a little too hurried, with others voicing the need for more time to take in the changes. But in general, member states seemed to understand the urgency the new leadership has attached to the document. Director-General Tedros, in an effort to ensure the GPW sails through the WHA, even cancelled travel to Davos, where he was scheduled to make an appearance midweek.
But the GPW is far from final, and member states are keen to see other elements that make up its entirety, including the Impact Framework, the financial estimate and investment case for the plan.
2. The heated debate around access to medicines.
The GPW may be the central theme of this year’s meeting, but it is the discussions on access to medicines that inspired some of the most impassioned speeches and heated dialogue during the week.
Some member states raised questions and disappointments on some elements of the WHO’s report on the topic, but in the end they agreed on a proposed decision point that asks the director-general to work on a roadmap report outlining WHO’s work on access to medicines and vaccines for the period 2019-2023.
But it’s when the discussions turned to patent protection, housed under the global strategy and plan of action on public health, innovation, and intellectual property — or GSPoA to those who’ve followed and advocated for its implementation for a decade at WHO — that tensions arose. A number of member states led by the Brazilian delegation were pushing for others to take forward a revised set of recommendations from the GSPoA. Others, including the United States and Japan, were fighting the proposed decision carrying the revised set of recommendations, which include promoting transparency on the research and development costs of health products.
The debate led to the creation of a drafting group outside of the formal executive board sessions to find consensus, but the difference in opinions led the discussions to run until late evening Thursday, without any decision. On Friday morning, the group reached consensus, but it was clear that Brazil and the others who were fighting hard for the recommendations were not happy with the end result, which some argue contained watered down responsibilities for member states.
3. Preparations for NCDs and TB high-level meetings.
In the run-up to the third high-level meeting on noncommunicable diseases taking place in New York during the United Nations General Assembly, member states have expressed concerns on lack of significant investments in NCDs and challenges in implementing a multisectoral approach to address them. Some note these pose risks in attaining Sustainable Development Goal 3, which includes specific targets on NCDs.
But Tedros argued what’s missing is action and political will. He made an example of the Protocol to Eliminate Illicit Trade on Tobacco, which is still short of six countries necessary to become an international treaty. He challenged member states, in particular board members, to take action and ratify the protocol before the deadline in July.
Meanwhile, the director-general told member states that tuberculosis has been one of his priorities since taking office, and in the run-up to the first high-level meeting on TB — also during the U.N. General Assembly in September — he said WHO is working to build strong partnerships will all stakeholders, including with civil society, and putting a focus on high-burden TB countries. He said the world needs to move with a “sense of urgency” in addressing TB, and put a strong focus on prevention.
4. WHO’s emergency funds.
A new report by the Independent Oversight and Advisory Committee details WHO’s progress in implementing its health emergencies program, as well as areas for further improvement.
Tedros acknowledged the challenges, including on procurement. To illustrate, he recalled WHO’s experience in Yemen, where staff received vaccines for cholera when they were no longer needed. But he also called attention to WHO’s emergency funding. The contingency fund for emergencies is almost drained, and WHO’s core funding for the program is nearly empty.
Member states, meanwhile, noted the importance of the “health army reserve” that Tedros mentioned in his speech to fill in gaps in health workforce as a result of recruitment delays and funding uncertainties.
5. Governance reform proposal.
In November, during the special session of the board, Tedros remarked on issues of WHO’s governing structure and how they are contributing to inefficiencies. During meetings of the board, member states often make lengthy, repetitive interventions, leaving few opportunities at times for real dialogue between the WHO Secretariat and member states.
That may soon change if member states consider a governance reform proposal that, among other things, seeks to amend how interventions are made during sessions. That discussion has been moved to May at the 143rd session of the board, which takes place right after the 71st WHA.
6. Appointments and evaluation of the director-general election.
The executive board confirmed the reappointment of Carissa Etienne to a second, five-year term as regional director for the Americas.
In a closed-door session, which the WHO Secretariat ironically referred to as “open,” the board also discussed the process and rules surrounding the director-general election in which Tedros won by an overwhelming margin. Details of what went on in the meeting were not made public, but in the document that contained the election’s evaluation, there were questions raised on the amount of travel that candidates went through during the campaign period. There were also suggestions for disclosure of campaign funding and sources of funding of candidates in future elections.
7. A focus on climate change and the U.S. response.
Member states supported a proposal for WHO to develop, in consultation with a wide range of stakeholders, a draft comprehensive global strategy on health, environment, and climate change that will be considered at the 72nd World Health Assembly in 2019. They’ve also asked WHO to develop a draft action plan to address the health effects of climate change on small island developing states, or SIDS.
In discussions, the representative from Fiji raised concerns on WHO expanding coverage of its focus on small island developing states to include “other vulnerable states,” arguing that in doing so, it “risks diluting efforts and spreading limited resources too thinly.” In the first draft of WHO’s 13th GPW, WHO’s focus on this area was only on SIDS, but the revised draft submitted to the board last week included “other vulnerable states.”
In response, Tedros agreed with Fiji, noting the importance of applying “focus” in WHO’s work.
Meanwhile, the representative from the U.S. argued the report presented by WHO needs to focus on “facts” and “robust data,” arguing that the common rhetoric of rich nations and multinational companies being responsible for the pollution in poor nations “doesn’t show complexities.” The representative also said the organization should work within its mandate and not duplicate efforts by environmental organizations.
8. Pay cuts and staff association requests.
Midway through the sessions, several WHO staff held silent protests in the vicinity of the WHO office, calling attention to a proposed pay cut by the International Civil Service Commission for U.N. staff based in Geneva, which is set to take effect February 1.
Staff members have raised questions on the methodology the commission used that led to the recommendation and appealed to the WHO executive board to allow the deferment of the decision’s implementation until issues raised have been cleared. The Program, Budget and Administration Committee of the Executive Board however expressed to the secretariat to implement the ICSC decision “in due time and form.”
This is not the only item staff members have asked the board to consider. In a statement delivered by a representative of the WHO staff association, they were also asking the board to create more entry level professional positions, provide pay for interns, and widen the scope of parental leave, among other items.
9. WHO as a health “role model.”
With the board sessions extending until late in the evenings, some member states and WHO staff started to show signs of sluggishness midway through the sessions. The representative from Thailand, a member of the board who expressed his dislike for evening sessions, expressed his disappointment to the WHO Secretariat.
The secretariat needs "to seriously think about being the role model of health," the representative said, and asked the Secretariat if they would consider serving fruits during the sessions, promote some form of physical activity, and allow member states enough rest to continue on with the deliberations.
The secretariat responded to the request. While evening sessions were inevitable, fruits were served in later sessions, and breaks were coupled with dancing sessions, much like during Margaret Chan’s time as director-general.
10. Polio transition planning and financial implications for WHO.
With polio endemic in only two countries, member states are keen for WHO to work on a transition plan that takes stock of polio assets and infrastructure in countries and globally, and what to make of them once polio is eradicated.
The polio transition has significant operational and financial implications for countries as well as WHO, which makes use of polio funding to address other public health issues, including on various immunization programs as well as in surveillance during disease outbreaks like Ebola.
Member states are asking WHO for a fully costed transition plan to be submitted at the WHA, and others have warned WHO not to assume current polio funding will continue to serve other public health programs, to which the director-general replied: “Some of you said whatever money we have for polio … you said will be withdrawn. The assumption from our side is not that.”
11. Snake and scorpion bites.
The problem of snake bites doesn’t often get as much attention in global health discussions, but during the board meetings, over 40 member states made the case on why this needs to change. Around the world, member states note that envenoming, or the life-threatening disease resulting from a poisonous snake bite, kills as much as 138,000 men, women, and children a year, and causes permanent physical disabilities as well as psychological damage to those who survive but are unable to receive treatment. Most of these are preventable, but there is a short supply of antivenoms worldwide. With several manufacturers having ceased production, antivenom drugs have become difficult to procure, and expensive.
Several countries have also asked WHO to help increase attention on scorpion bites. In Algeria, 57,000 people get bitten by scorpions in a year, while in Brazil the figure is more than 100,000, but the board has decided to focus on the problem of snakebite envenoming in the meantime for the upcoming WHA.
12. Attention on cholera.
While discussing the provision agenda for the 71st WHA, the representative from Zambia called the board’s attention to include a resolution on cholera. The country is currently dealing with a cholera outbreak, as well as other countries, including Yemen. A number of African member states have supported the proposal, but it’s not yet clear whether this will officially be taken up at WHA.
A member of the board who wishes to do so will have until the end of the first day of the WHA to submit the proposal for consideration under the organization’s rules.
13. Engagement with the private sector.
WHO’s engagement with non-state actors has been a point of discussion in various sessions. But it’s not only about WHO increasing its engagement with nongovernmental organizations and members of civil society. There is also a question on engaging the private sector, a strategy that has many civil society actors wary of the potential conflicts of interest that may arise from those engagements.
Tedros acknowledged the need to avoid conflicts of interest, but he said “disengaging” with the private sector isn’t an option either. He sees engaging with business as an opportunity to “show them the truth” and “challenge them morally.” During the WHO Global Conference on NCDs in Montevideo, Uruguay, in 2017, Tedros said he asked those from the food and beverage industry, “Would you willingly give trans-fat to your child?”
Read more Devex coverage of the World Health Organization.