MANILA — World Health Organization members will gather for the 72nd World Health Assembly in Geneva, Switzerland, next week, with lively debate expected on a range of internal and external questions facing the United Nations’ health body.
Over 100 civil society organizations and individuals recently published an open letter to WHO member states, urging them to oppose proposed changes to a draft resolution that aims to improve the transparency of markets for medicines, vaccines, and other health technologies. They are concerned the changes proposed by a number of high-income countries weaken the language on transparency, making it “confusing, weak and practically useless in many areas.”
One of the changes involves the costs associated with all human clinical trials, including public funding and tax incentives. The original draft resolution urges member states to require public reporting of this information, but Australia and Germany are proposing to delete this requirement. Their proposed wording is to: “Encourage where appropriate that human clinical trial results be reported publicly.”
Among those who oppose the changes are former WHO officials, such as Hans V. Hogerzeil, formerly WHO director for essential medicines and pharmaceutical policies, and Marie-Paule Kieny, former WHO assistant director-general for health systems and innovation.
Ebola in DRC
The continued rise in Ebola cases in the Democratic Republic of the Congo and the threat of the virus spilling over to neighboring countries is prompting a further rethink of the response. Médecins Sans Frontières has already underscored the need to review community engagement efforts in affected areas, following attacks on two of its Ebola treatment centers in Katwa and Butembo.
But some of the realities on the ground are proving to be difficult and beyond the capacity of responders, including WHO. A report by the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme, to be presented before member states at WHA, noted it is “very concerned about funding gaps and staff exhaustion due to prolonged operations in a highly insecure and complex setting.”
At a Pandemic and Biosecurity Forum last Tuesday in Washington, D.C., Ron Klain, a former U.S. Ebola response coordinator, said WHO is not equipped to deal with the challenges of insecurity and community resistance in DRC.
“That’s not their mandate, and they’re never going to have that capacity. We have a big debate about how [more countries should write bigger checks] to WHO, that certainly would help in the DRC, but it’s not going to solve that core problem,” Klain said.
On WHO reform:
In March, WHO’s senior leadership unveiled the organization’s new structure, with a few surprises. WHO’s senior management was totally revamped, with a few new names. Dr. Zsuzsanna Jakab, regional director of WHO in Europe, became the new deputy director-general, replacing Soumya Swaminathan and Jane Ellison, who were assigned new roles as chief scientist and executive director for external relations and governance, respectively.
Some of Director-General Tedros Adhanom Ghebreyesus’ assistant directors-general remained, most taking on new responsibilities, while others didn’t survive the restructuring.
The overhaul caught a number of WHO’s staff by surprise, with some questioning the appointments. Global health actors that are non-WHO staff meanwhile are curious over the new divisions and initiatives, such as the new “WHO Academy” and digital health department.
Member states are likely to discuss the restructuring in Geneva next week, as well as follow up on a list of questions they posed before the secretariat at the executive board meeting, including a detailed budget breakdown across WHO offices, how the fight against polio will be financed, and the financial impacts of new initiatives such as the WHO academy.
The secretariat has prepared information documents ahead of WHA to address some of these questions, including a “crosswalk” between its 2018-2019 budget and proposed budget for 2020-2021.
WHO made changes to its budgeting structure for 2020-2021, aligning it with the triple billion goals of the organization of protecting 1 billion more people from health emergencies, reaching 1 billion more with health coverage, and improving the health and well-being of 1 billion more people.
This meant that budgets are no longer categorized between communicable and noncommunicable diseases, for example, making it difficult for member states to make comparisons between funding categories.
Last year’s World Health Assembly passed a resolution aiming to reduce the estimated 81,000-138,000 deaths each year from snakebite. Now comes the release of the strategy, which aims to halve deaths and disability from snakebite by 2030.
The executive summary, out earlier this month, indicates four focus areas: working with communities via education and research, including on behavior change; safe, effective treatment, with WHO creating a stockpile of antivenoms; better integrating snakebite into health systems; and “transformational public-private investment.” A 2019-2020 pilot phase targeting 10-12 countries, and estimated to cost $8.96 million, will be scaled up in the next decade “as resources are mobilized and capacity built.”
Expect a lot of talk about how to meet Tedros’ call to avoid the predicted shortfall of 18 million health workers by 2030. A closed meeting between health professionals and youth representatives on Tuesday will inform a public briefing on Thursday on best practice.
A new guideline from WHO looks to improve best practices and working conditions for community health workers.
Delegates will consider three health workforce items, including progress on the WHO Global Strategy on Human Resources for Health, key principles on designing community health worker programs, and national reporting on international recruitment of health workers.
Graeme Chisholm, policy manager at THET, an INGO that facilitates health worker training, told Devex to expect a revival of the ongoing debate about the role of western countries in attracting health workers from poorer countries.
“It’s almost like an arms race where nobody can actually win,” Chisholm said. “If the U.K. encourages health workers from Africa or Asia to come here, then no doubt many will seek opportunities in more lucrative markets, so it is this escalator which we see as unhelpful.”
Preparations for the UHC high-level meeting
Universal health coverage is set to dominate talks at the plenary sessions, where the theme will be “Universal Health Coverage: Leaving No-one Behind;” committee meetings where there’ll be discussions on pandemic preparedness and response, and a new global action plan to protect the health of refugees and migrants; and in numerous side events.
The discussions are meant to feed into the high-level meeting on UHC, taking place Sept. 23, a day before the official opening of the U.N. General Assembly in New York. But the key will be to translate the meeting’s outcomes to meaningful actions in countries. As U.N General Assembly President María Fernanda Espinosa Garcés said during the multistakeholder hearing, Sustainable Development Goal 3 is “one of the most challenging to achieve” in the 2030 Agenda.
Health conditions in the occupied Palestinian territories
In 2017, WHA made several recommendations to Israel and the Palestinian Authority to improve health conditions in the occupied Palestinian territories. However, an update on the recommendations, out early this month, revealed mixed outcomes.
Access for much-needed health care outside the territories remains a “major challenge,” with only 62% of Palestinian patient applications for permits to access health care outside the territories having been approved in 2018. Medical goods, such as vaccines, continue to be subjected to the trade restrictions under the Paris Protocol, according to the report.