6 key issues to watch at the 78th World Health Assembly

It’s that time of the year again when the global health community gathers in Geneva for the 78th World Health Assembly to tackle pressing global health challenges. This year’s WHA is taking place amid seismic shifts in global health. The pause and succeeding termination of thousands of programs run by the U.S. Agency for International Development have led to health facility closures and disrupted many health programs, from HIV and AIDS prevention and treatment to a range of health care services for women. Donor funding cuts have also forced many health organizations, including United Nations agencies and programs, to substantially reduce their workforce. UNAIDS is letting go of more than 50% of its staff, and the World Health Organization is shrinking its workforce, including senior management. But while the pie for global health funding is becoming smaller, the challenges are ever-growing. Countries are dealing with a rise in noncommunicable diseases and more frequent extreme weather events that increase people’s risks of death and diseases, and the comeback of vaccine-preventable diseases, such as measles, in places where it was once eliminated. This year’s WHA will consider about 75 items and sub-items, according to Dr. Catharina Boehme, WHO’s assistant director-general for external relations and governance. It will also approve dozens of resolutions and decisions, including on antimicrobial resistance, rare diseases, kidney health, climate change, strengthening the health and care workforce, regulating the digital marketing of breastmilk substitutes, and the importance of mental health and social connection. Here are six key issues to watch at #WHA78: 1. Pandemic treaty After more than three years, the Intergovernmental Negotiating Body tasked to negotiate and draft a pandemic treaty is coming to WHA with an agreed pandemic treaty text for adoption. While the text is far from perfect, many countries and experts say it’s evidence that multilateralism still thrives. The adoption of the treaty at WHA will be an important milestone, but it’s not the end of the process. After adoption, member states are expected to create another intergovernmental working group to negotiate the details of the pathogen access and benefit sharing system — which links the sharing of pathogen data to benefits such as access to vaccines and treatments made using that data — that will serve as an annex to the pandemic treaty document. The PABS annex will also require adoption, potentially at next year’s WHA. PABS was among the most contentious issues during the yearslong treaty negotiations. But Nina Schwalbe, CEO and founder at Spark Street Advisors, who has closely followed the treaty process from its inception, is optimistic that countries would reach an agreement on it, especially since countries have already discussed details of how PABS should work over the past three years. “They have another year to reach political agreement on what they want. It's not the technicalities, it's the political agreement. Agreeing to the treaty was the first step that they're getting there,” she told Devex. She said countries “need more time to continue to really negotiate in a place of trust to get to an outcome that's acceptable” on PABS. Once the PABS annex is adopted, at least 60 countries need to sign and ratify the full agreement for it to come into effect. The conference of the parties, which will oversee the implementation of the treaty, will meet a year after the agreement comes into force. In the best-case scenario, the earliest this can happen is in 2027, Schwalbe said. But countries can already start implementing parts of the agreement before it comes into effect. That includes the development of national policies ensuring there are attached conditions to publicly funded research and development. 2. WHO’s budget WHO was among the first casualties of the Trump administration. The withdrawal of the U.S. — which Trump announced on his first day in office — has huge ramifications for the agency. WHO didn’t just lose its biggest donor, but also the expertise that the U.S. government experts provide. WHO has since taken cost-cutting measures. But with a $600 million shortfall for 2025 alone, and faced with a huge funding gap for the next two years, the agency is forced to restructure. Its proposed budget for 2026-2027 will see cuts across WHO. That will impact funding for country offices, which in real terms will decline from $2.44 billion to $2.09 billion. WHO is hoping the WHA — its ultimate decision-making body — will approve a second increase in assessed contributions next week, although the overall amount will be $303 million less, largely due to the U.S. withdrawal. WHO is also hosting its last investment round event on Tuesday evening. The investment round has so far raised $1.7 billion in pledges against an initial target of $7.1 billion to fund WHO’s work until 2028. 3. WHO’s new structure Just days before the opening of WHA, WHO Director-General Tedros Adhanom Ghebreyesus announced the composition of his new leadership team as part of an ongoing restructuring of the agency forced by the funding cuts. Most of Tedros’ assistant directors-general are not part of the new leadership team, with a few exceptions. Dr. Chikwe Ihekweazu is staying on to lead the health emergencies program, succeeding Dr. Mike Ryan. Ihekweazu is currently serving as acting regional director for WHO in Africa. Meanwhile, Dr. Yukiko Nakatani will become assistant director-general for health systems, and Raul Thomas will remain as assistant director-general for business operations and compliance. Dr. Razia Pendse will also stay on as Tedros’ chef de cabinet. Dr. Jeremy Farrar will take over as assistant director-general for health promotion and disease prevention and control, while Dr. Sylvie Briand, WHO director of global pandemic preparedness and monitoring, will take on his role as chief scientist. The new team will start on June 16, but the new structure and WHO’s ongoing restructuring will likely be a topic of conversation at and in the hallways of WHA. WHO will make a decision on who will lead its remaining departments — which will shrink from 76 to 34 — after the assembly. 4. New WHO Africa regional director The election for the next WHO regional director for Africa takes place in Geneva on May 18, a day before the official opening of WHA. The chosen candidate will start in June. This is the second time African member states are voting to select the region’s leader in less than a year. They elected Dr. Faustine Engelbert Ndugulile, a career politician from Tanzania, in August 2024, but he unexpectedly died three months later in November. In February 2025, Tedros appointed Ihekweazu to serve as acting regional director for the Africa regional office, while the agency kickstarted the process for selecting Ndugulile’s replacement. In March 2025, WHO revealed the five candidates vying for the position, including former nominees Dr. Boureima Hama Sambo from Niger and Dr. N'da Konan Michel Yao from Côte d'Ivoire. The other three are Dr. Mohamed Lamine Dramé from Guinea, Moustafa Mijiyawa from Togo, and Mohamed Yakub Janabi from Tanzania. Niger’s Sambo has since withdrawn from the race. The list of candidates received criticism for the lack of women in the lineup. According to Dr. Magda Robalo, interim executive director of Women in Global Health, there are also a few women leading WHO country offices — five out of 47 WHO country offices in the African region in 2024. 5. Global health financing WHO isn’t the only cash-strapped entity. Countries are also struggling with their health budgets, which were further exacerbated by the U.S. funding terminations. Health financing is likely to be a key topic of discussion around WHA, where a resolution about strengthening health financing globally is also up for consideration. The resolution is both timely and significant, as the world responds “too slowly to the current global health crises,” according to Pete Baker, deputy director of the global health policy program at the Center for Global Development. “This resolution not only raises the profile of this vital issue, but [also] includes some valuable solutions, such as health taxes, new health financing compacts between donors and governments, and maintains a strong focus of the WHO on health financing,” Baker said. The resolution urges member states to raise their domestic financing for health, including through tax revenues on sugar, tobacco, and alcohol, and reduce the need for people to spend out of pocket for health expenses. It asks them to design processes to “transition smoothly and sustainably from external assistance for health to sufficiently robust domestic financing for health,” including through health compacts, such as the Sector-wide Approach, or SWAp, in Nigeria that seeks to align donor-funded programs with national government priorities. As for WHO, it asks the agency to keep health financing among its priorities, including preparing a twice-yearly report on health expenditures and the state of global health financing, and supporting improvements in the quality and availability of health financing data. 6. Noncommunicable diseases It’s a big year for NCDs as governments are scheduled to make new commitments to address the growing burden of noncommunicable diseases at the fourth high-level meeting on NCDs and mental health taking place in New York in September. Every year, 43 million people die from an NCD, accounting for 75% of all deaths globally. NCDs are projected to increase to 52 million deaths by 2030. WHA can help “shape the tone, identify technical priorities, and signal expectations for global leadership” in the lead-up to the high-level meeting, according to Alison Cox, director of policy and advocacy at the NCD Alliance. The zero draft of the political declaration on NCDs has been published this week, and the WHA serves as an opportunity for member states and civil society to exchange views and feedback on the draft, and to dispel myths and counter misinformation about NCDs. WHA is also an opportunity for health ministers to address the range of issues linked to NCDs. Next week, countries will consider several resolutions related to NCDs, including the prevention and control of kidney disease, prevention and care for vision and hearing loss, an integrated approach to lung health, the importance of mental health and social connection, the establishment of Nov. 17 as World Cervical Cancer Elimination Day, and an updated road map to respond to the adverse health effects of air pollution. The NCD Alliance is hopeful that a day dedicated to cervical cancer elimination would help countries progress to end cervical cancer as a public health problem by 2030, while the resolutions on mental health and kidney health highlight their importance within the broader NCD agenda. The road map linked to air pollution meanwhile sets an ambitious global target to reduce air pollution-related mortality by half by 2040. “This is a crucial opportunity to build more momentum for air pollution action in the context of the HLM and in-country responses to the NCD burden. Despite air pollution being recognized as a major NCD risk factor in the HLM in 2018, air pollution interventions are not becoming aligned with NCD responses at the scale or pace of change needed,” Cox said.