74th WHA: Historic or business as usual? Experts weigh in

The 74th World Health Assembly was expected to provide solutions to bring an end to the COVID-19 pandemic and ensure the world is prepared for the next one. But some experts argued there was more talk than action.

“The theme of this WHA was ‘Ending this pandemic, preventing the next’ yet the WHA failed to produce any meaningful outcome on either,” said Carolyn Reynolds, co-founder of the Pandemic Action Network.

While adoption of a pandemic treaty at the assembly was unlikely, experts hoped countries would form a task force to draft and negotiate a treaty, or at the very least endorse a resolution in support of a treaty that world leaders could take up at the U.N. General Assembly in September.

But at the conclusion of the WHA on Monday, countries agreed instead to create a member state-led working group that would look at the benefits of a treaty, a convention, or an international agreement, and discuss that at a special WHA session in November.

Reynolds said the decision “essentially kicks the can further down the road on WHO reform, on preparedness, and on a pandemic treaty.”

“In short, there was a lot of talk and then more process. Where is the urgency of political leaders to act like we are in a crisis?” she said.

The missing plan to vaccinate the world

There was so much focus on whether or not to start negotiations on a treaty that countries failed to consider a most important and urgent matter — a plan to vaccinate the world and end vaccine inequity.

While several world leaders who spoke at the opening and closing of the WHA raised the issue of vaccine access, there was no resolution or strategy put forward to address this.

“[The WHA’s] biggest weakness: not agreeing [on] a strategy for vaccinating the world,” said Roopa Dhatt, executive director and co-founder of Women in Global Health.

In his intervention at the WHA, Baba Aye, health and social services officer for Public Services International, said countries have not upheld resolution 73.1 — a resolution adopted at last year’s WHA that seeks to ensure equitable and fair distribution of health products and technologies in response to COVID-19.

According to an EU spokesperson, however, the WHA resolution on strengthening World Health Organization preparedness and response for health emergencies addresses the issue of COVID-19 vaccine access. For instance, there’s a paragraph urging member states to take in the lessons learned from COVID-19 to future pandemics, including ensuring “all countries” have “unhindered access” to vaccines and other health products.

Team Europe has also contributed €2.7 billion ($3.29 billion) to COVAX and aims to donate 100 million vaccine doses by the end of 2021. In June, the European Union will also be coming forward with a proposal to the World Trade Organization on urgent trade policy responses to the COVID-19 crisis, according to the EU spokesperson.

There is hope that the G-7 summit next week will pick up the slack after WHA. In an op-ed published Tuesday, the leaders of WHO, the International Monetary Fund, World Bank, and WTO called for a “new level of international support for — and implementation of — a stepped-up coordinated strategy, backed by new financing, to vaccinate the world.”

This includes WHO Director-General Tedros Adhanom Ghebreyesus’ call at the start of the 74th WHA for vaccinations to reach 30% of populations in all countries by the end of 2021. The op-ed says this can further increase to 40% of populations through “other agreements and surge investments,” with an ambition to vaccinate “at least 60% by the first half of 2022.”

The plan will need $50 billion to execute, a mix of $35 billion in grants, and $15 billion in concessional loans provided by multilateral development banks to national governments.

The road to strengthening WHO

The WHA also agreed for a member state working group to consider the findings of the Independent Panel for Pandemic Preparedness and Response, the IHR Review Committee, and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme.

Kate Dodson, vice president for global health strategy at the United Nations Foundation, told Devex the resolution is, “Hands-down ... the biggest accomplishment from this year’s historic World Health Assembly.”

“The stakes were high to pass something, and it was extremely encouraging to see both a practical and cooperative resolution emerge from the week-long gathering,” she said, adding that the resolution signifies support for multilateralism and WHO “to remain at the center of the global health architecture.”

“It is hard to imagine that something like this would have passed a year ago when early pandemic responses caused a fracturing of support for multilateral solutions and global cooperation,” Dodson said.

The US is back

While the United States participated in a special session of the assembly in November, experts welcomed the renewed U.S. engagement at the 74th WHA, the first assembly after President Joe Biden’s inauguration in January 2021.

“It was great to see the U.S. providing positive leadership at WHA after initiating a pullout from WHO a year ago,” Reynolds said.

Thomas Schwartz, executive secretary of Medicus Mundi International, said with the U.S. “back at the table, the assembly has not been distorted as much as in previous sessions by geopolitics, but remained focused on the deliberations on a variety of “technical” (as in fact still political) issues.”

However, he said, the WHA still could not overcome business as usual. While the assembly adopted some important resolutions, member states “have not adequately addressed some of the urgent and politically sensitive issues related to COVID-19 … such as the grave human rights abuses in the COVID-19 response or vaccine equity.”

“Unfortunately, the WHA is still not [a] place for member state[s] to be challenged, and the full transparency, with all sessions being live webcast, does not provide the setup for critical self-reflection,” he added.

A big win for health care workers and NCDs

The plight of health and care workers responding to COVID-19 was championed by Tedros in his opening address to the assembly, citing WHO estimates that 115,000 have lost their lives fighting the pandemic. Dhatt said the adoption of two resolutions advocating for government support for the Gender Equal Health and Care Workforce Initiative to address gender inequities in the health and care workforce was, for her, the WHA’s “biggest success.”

The first resolution, on protecting, safeguarding, and investing in the health and care workforce, was backed by Ethiopia and Senegal, indicating strong buy-in from two of the continent’s heavyweights.

The second, on strengthening nursing and midwifery, included calls for action by member states on 19 points, such as increasing “access to health services by sustainably creating nursing and midwifery jobs with fair remuneration, effectively recruiting and retaining nurses and midwives where they are needed most, and ethically managing international mobility and migration.”

“Women in Global Health believe a new social contract is needed for women working in health and social care as the essential foundation for strong future health systems, global health security, and achieving universal health coverage,” Dhatt said.

The adoption of a diabetes-specific resolution after lengthy negotiations — and other resolutions on oral and eye health, and decisions on NCDs — was also welcomed by NCD advocates.

Advocates expect more momentum on the issues over the next year, as different proposals reach WHO governing bodies for consideration. There are plans to prepare a compact with technical guidance on how to protect health and care workers, safeguard their rights, and promote and ensure decent and safe work. 

On NCDs, WHO is developing a proposal for a global action plan to reduce harm from alcohol consumption. The member state working group that would be in charge of looking into recommendations to strengthen WHO is expected to submit a report with proposed actions for WHO, member states, and nonstate actors at next year’s meeting of the WHO executive board, for consideration at the 75th World Health Assembly.

A member state working group tasked to identify solutions to address WHO’s unsustainable financing — which would be critical as WHO takes on additional tasks given by the WHA — is also submitting its final report to the WHO executive board in January 2022.

“The reality of our funding model is that many of these [WHO] expert colleagues are on short-term contracts. And even if they are not, their programs have to be planned in a debilitating cycle of financial ebb and flow,” Tedros said in his closing remarks at the WHA, adding, “WHO cannot grow stronger without sustainable financing.”