8 takeaways from the 70th World Health Assembly

GENEVA, Switzerland – It’s been nearly two weeks of intense debates on global health at the 70th World Health Assembly in Geneva.

The WHA was a whirlwind of activity, marked by fast-paced discussions. Issues were not just confined to the plenary and committee meetings held by the World Health Organization. Attendees, including the most high-level ones such as WHO Director-General Margaret Chan, juggled their schedule, going between the official sessions and the side events taking place within and outside the Palais des Nations.

Several resolutions were adopted by member states, including on cancer diagnosis, treatment and prevention, the integration and prevention of, and care for deafness and hearing loss in government health frameworks, and a global action plan responding to dementia. There were also several discussions on the Coalition for Epidemic Preparedness and Innovation, or CEPI, and noncommunicable diseases.

For those who weren’t able to attend this year’s meetings, which ran from May 22 to 31, here are the main takeaways.

1. WHO director-general election outcome

This year’s annual meeting was particularly eventful, with the historic election of a new director-general. Tedros Adhanom Ghebreyesus will take over the leadership of the United Nations health aid agency in July.

Devex was on the ground to cover the election, which took three rounds and ran for almost five hours. But one could well predict Tedros winning based on the very first round of the election, where he led with a huge margin of 95 votes against rivals David Nabarro (52 votes) and Sania Nishtar (38). The final tally of 133-50 against Nabarro, leaked to the press, established Tedros as the clear choice of an overwhelming majority of 186 member states who were present and voting. It was not entirely surprising however, as almost everyone Devex spoke to days before the vote had little doubt the former Ethiopian health and foreign affairs minister would win the race. He was a clear frontrunner from the start of the campaign, winning over high-profile endorsements and topping the elimination rounds at the executive board meeting in January.

Tedros’s schedule has been packed with bilateral meetings following his victory. He’ll have only a month to transition and hit the ground running when outgoing Director-General Margaret Chan’s term expires at the end of June. Members of the global health community have shared their thoughts and recommendations on where Tedros could and should focus his energy in his first months in office. One of the key things to watch out for is who will make up Tedros’ senior management. Rumor has it that some of his high-profile supporters may be among them.

2. The 3 percent increase in member states contributions

After long and arduous discussions on the budget, Chan was able to convince member states to increase their assessed contributions by 3 percent. This is significantly smaller than the 10 percent increase that she was originally proposing, but WHO Assistant Director-General Hans Troedsson said the organization had to agree on a compromise to accommodate different member states’ views on the budget increase.

The task for the incoming director general is to ensure the budget gets fully funded in the next biennium, so that all WHO programs and offices can continue operations. Tedros has already shared how he plans to boost the organization’s fundraising capacities and potential, such as expanding the size of the organization’s fundraising unit and bringing budget discussions locally and outside formal events such as the World Health Assembly.

3. WHO’s regional office for Africa’s transformation agenda

To address some of the key challenges in many African countries, the WHO’s regional office released a new “transformation agenda” — essentially a set of new programs that will include a focus on adolescent health and the creation of emergency hubs.

WHO will help countries develop strategies and evidence-based solutions to tackle issues related to immunization, substance abuse, mental illness and reproductive and sexual health services, as part of the adolescent-focused program. It will also establish sub-regional emergency hubs in the next two years to help prepare communities in cases of emergency.

In the two years since she took office, Dr. Matshidiso Moeti has initiated wide-ranging reforms at the WHO’s Africa regional office and the country offices in the continent. This included programmatic performance indicators as well as key performance indicators for management.

“The reforms that I instituted were very much aimed at improving WHO’s functioning, effectiveness [and] results focus in the region. [We did so] so that we would be better able to handle not only preparedness for outbreaks and support to outbreak response, but that in general, the work that we do, especially on building health systems in countries, would be more effective at the country level,” she told Devex in an interview which we will be publishing in full in the next few days.

4. Focus on implementation in AMR action plans

Member states took stock of the progress countries made in developing their national action plans in tackling the growing threat of antimicrobial resistance, but for those seeing the effects of AMR on the ground, the challenge will be in implementation.

Devex spoke with Judit Rius Sanjuan, United States manager of Médecins Sans Frontières Access Campaign based in New York, on the sidelines of the annual meetings, to gain insights about how antimicrobial resistance is impacting the medical humanitarian organization’s work in emergencies, and where she thinks discussions on AMR should be focused.

Rius Sanjuan talked about the need for countries to go beyond discussions on stewardship, and how efforts should include better diagnostics, prevention strategies and strengthening health systems, not just on the research and development of new antibiotics, which she emphasized would need to honor the principle of delinking research and development costs with product prices.

In line with AMR, delegates agreed on a resolution on sepsis, a life-threatening condition triggered most commonly by bacterial infections. The resolution asks WHO to develop guidance on sepsis prevention and management, and provide countries support in building and strengthening their capacities and strategies to reduce sepsis cases.

5. Access to medicines

Discussions on AMR are heavily linked to access to medicines and vaccines, which was also a huge topic — albeit quite contentious — at this year’s World Health Assembly.

Several member states, such as the Indian delegation, have long been pushing for the U.N. High Level Panel on Access to Medicines report be discussed and be part of the agenda of the WHA, but reception remains deeply divided. The September 2016 report has yet to be tackled, and discussions on access to medicines at the assembly were largely limited to whether to make it a standing agenda item for discussion, and be tackled at the executive board meeting in January 2018. The report has received strong pushback from powerful nations such as the U.S, United Kingdom and Japan, the latter underscoring the importance of patents to incentivize innovation in the development of medicines.

Proponents of the report were quite disappointed on how the discussions progressed. But during the side event that looked at the impact of the recommendations of the high-level panel on different governments, sponsors invited the audience to support and endorse a joint declaration. That declaration would help push for the adoption of the report’s recommendations by WHO, and the convening of a special session at the U.N. General Assembly for member states to agree on strategies and accountability framework on the issue of access and innovation. The joint declaration also hopes to strengthen south-south cooperation in sharing knowledge and lessons on the innovative ways countries are working toward medicine access.

6. Cross-agency collaboration

Member states agreed on a five-year action plan that will initiate collaboration between WHO, the International Labor Organization and the Organization for Economic Cooperation and Development in tackling shortfalls in global health and social workforce.

Human resources play a huge role in achieving much of the health-related Sustainable Development Goals, including achieving universal health coverage. And yet, the shortage amounts to more than 17 million health workers globally, a figure that includes doctors, nurses and midwives.

7. Global compact for progress towards universal health coverage

 A movement composed of multiple stakeholders — country governments, civil society, philanthropic foundations and multilateral institutions — came together at this year’s WHA to sign a global compact aimed at advancing universal health coverage.

The compact provides the principles to which the stakeholders aim to adhere to as they work toward achieving health for all, which included the commitment of “leaving no one behind.” The group is part of a movement called UHC2030, which launched about a year ago

The signing was only one part of the discussions on UHC throughout the WHA. There were also more concrete discussions on service delivery, financing and governance. Tedros, the incoming director-general, talked at length about the priority he will place on UHC during his tenure, although he said imposing structures or ways of doing will not be his way of working. There are many ways to achieving UHC, he said, but he also mentioned that he will put an end or stop “anything that affects universal health coverage.”

8. Polio

The big challenge facing those working on polio today is how to work on eradicating the final cases, while also planning for a transition away from programs focused on the disease. Country representatives, the Bill & Melinda Gates Foundation and others who have been engaged heavily in the fight to eliminate polio came together to discuss some of the challenges of transition: How to maintain infrastructure, how to ensure that the disease is truly eradicated, even in places that are hard to reach due to geography or violent conflict, and how to support the myriad programs that polio funding has in some way helped bolster, once that money is withdrawn.

WHO has embarked on its own planning work, and at the WHA a polio transition planning document was released, outlining some of the risks — financial, programmatic and to staff — of winding down and eventually ending the Global Polio Eradication Initiative.

GPEI programs are closely integrated with other vaccine programs in a way that could result in serious setbacks to efforts on measles and rubella vaccinations, or diphtheria, tetanus and pertussis, which are often prevalent in key polio transition countries. The African region would be particularly hard hit, as about 90 percent of all immunization staff and infrastructure are funded through the initiative. Disease surveillance programs and laboratory funding could also be impacted, according to the report.

WHO is working at the global, regional and national levels to plan for the transition, and has recognized the threat a mismanaged transition could pose, according to the document.

Adva Saldinger contributed to this report.

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