5 issues to watch at the 77th World Health Assembly

Next week, the global health community will turn its focus to Geneva as leaders and advocates come together for the 77th World Health Assembly, or WHA 77. This gathering serves as the primary decision-making platform for the World Health Organization and brings delegates from its 194 member states together every year. During a recent press briefing, Dr. Tedros Adhanom Ghebreyesus, WHO’s director-general, emphasized the significance of this year's meeting, calling it “one of the most significant in our 76-year history” as member states are expected to finalize negotiations to strengthen global pandemic preparedness and response. Under the theme "All for Health, Health for All," WHA 77 will cover a wide range of topics, including universal health coverage, influenza preparedness, reducing public health risks from live wild animal markets, and the impact of climate change and pollution on health. Here are five key issues to watch at WHA 77. 1. The pandemic treaty The Intergovernmental Negotiating Body on the pandemic agreement failed to agree on a draft treaty during a final round of negotiations ahead of WHA 77. The body has been working on crafting an agreement that would strengthen global coordination in responding to pandemics and ensure equitable access to essential health tools like personal protective equipment, vaccines, therapeutics, and diagnostics. But countries failed to agree on key issues such as pathogen access and benefit sharing — aka PABS — sharing of new health technologies, financing mechanisms, and the concept of One Health — which emphasizes how animal, environmental, and human health are all connected.. The INB will present the results of their discussions to the WHA on Tuesday afternoon to determine the next steps. However, the available options remain uncertain at this stage. According to a report by Health Policy Watch, member states discussed either continuing negotiations during the WHA or extending them by another six months to a year. Ahead of the INB’s failed talks, Tedros described the pandemic agreements as the world's “best shot” and a “generational opportunity” to ensure that when the next virus emerges, there is a plan in place to quickly, effectively, and fairly deliver critical health tools. “It will save lives,” he said. “And I'm asking country leaders to give it one last big push to get it over the line next week.” 2. International Health Regulations amendments In addition to a pandemic treaty, countries have also been working on amending the International Health Regulations — the internationally binding agreement that defines countries’ rights and obligations during public health emergencies. The COVID-19 pandemic exposed critical flaws in the global system for responding to health emergencies, prompting the process in 2022 to craft a new pandemic agreement and amend the IHR. Last week, the Working Group on Amendments to the IHR concluded most of its work, with the vast majority of articles having been agreed on — in principle, at least. Ryan said the group should be able to present a document to the assembly for its consideration. The IHR amendments are expected to improve the interaction that the WHO secretariat has with member states, clarify a lot of procedures, and define the concept of a pandemic emergency, making it easier and more straightforward for the director-general to warn the world of a potential pandemic, he said. “We've used the IHR for 20 years. It served us well,” Ryan said. “But no process, no protocol stands the test of time without needing to be adapted and adjusted.” 3. An investment case WHO will also be launching its investment round at this year’s WHA, with the final investment event expected in November. The agency is looking to secure around $7.1 billion to cover its base budget for the period 2025-2028. The investment round also aims to ensure that voluntary contributions, which currently make up the agency’s main source of funding, will be more predictable, flexible, and sustainable. WHO has increasingly called for more flexible funding which it says allows it to be agile and strategic. But of the voluntary contributions of $2.72 billion made in 2023, only 13% was fully flexible. The agency will plead its cause through its investment case, also entitled “All for Health, Health for All,” which outlines its key role in global health and the economic efficiency of supporting it, estimating a return of $35 for every dollar invested. 4. A new strategy At the assembly, WHO will introduce a new four-year global health strategy, developed with member states and partners, aimed at aligning efforts to achieve the health-related Sustainable Development Goals. Currently, less than 15% of these goals are on track, with over half the global population lacking essential health services in 2023, and 1 in 4 facing financial barriers to health care access. The 14th general program of work, or GPW 14, serves as a high-level road map for global health guiding WHO's actions to support member states and partners from 2025 to 2028. Dr. Bruce Aylward, assistant director-general for universal health coverage at WHO, said the new plan includes six key strategic objectives: responding to climate change, addressing health determinants and root causes of illness, promoting primary health care, enhancing health service coverage, preparing for health risks from all hazards effectively, and responding swiftly to health emergencies. 5. Climate change and health Yes, climate will be top of the agency’s agenda for the next four years, but delegates are also expected to consider a climate and health resolution sponsored by the Netherlands and Peru. Aylward said while there are a few unresolved issues to be ironed out, there was broad consensus on all major elements of the resolution. Modern health systems globally contribute approximately 5% of total carbon emissions, which in turn have adverse effects on public health. This underscores the importance of ensuring that health systems are environmentally sustainable. The draft resolution urges countries to strengthen the implementation of the WHO Global Strategy on Health, Environment and Climate Change — without compromising the resources set aside for primary health care. It also calls for them to conduct periodic assessments on the state of climate change and health, and to work with countries on developing and implementing national action plans. But the Global Climate and Health Alliance, a consortium of more than 160 health professional and health civil society organizations and networks, is concerned that the draft doesn’t mention fossil fuels and the need to transition away from them for the benefit of public health. Update, May 27, 2024: This article has been updated to reflect the outcomes of the final round of negotiations by the Intergovernmental Negotiating Body on the pandemic agreement.