Devex CheckUp: The big win at WHA — flexible financing for WHO

It’s a busy week in Geneva for the 75th World Health Assembly and a big week for WHO. As expected, Tedros Adhanom Ghebreyesus was reelected for a second term as WHO’s director-general — he was the only candidate. And member states gave him a present of sorts by agreeing to the recommendations of a WHO working group to improve the agency’s financing, including a gradual increase in their “assessed contributions” — or membership dues — which are entirely flexible.

Why it matters: WHO and several experts who’ve called for overhauling the agency’s financing called the decision “historic.” Its budget has long relied on funding earmarked for particular programs, such as polio eradication. That means WHO has often been unable to move money to programs receiving less funding, such as noncommunicable diseases. But increasing flexible funding can give WHO more room to make budget allocations as it sees fit.

The change would also provide the agency — which typically relies on staffers with short-term contracts — with more stability. But the funding increase is coupled with heightened expectations from member states for reforms at WHO, including on governance, transparency, accountability, and effectiveness.

The devil in the details: Currently, WHO’s assessed contributions are set to total $956.9 million for 2022-2023, or just 22% of its base budget of $4.4 billion approved last year — the rest of the budget is funded by voluntary contributions often earmarked for specific projects. Per the recommendations adopted this week, that figure would potentially increase by 20% in 2024-2025 and ultimately double by 2028-2029, reaching $2.2 billion.

But these funding hikes won’t cover even 50% of WHO’s current base budget until nearly 2030. And it’s even possible that member states won’t agree to make these increases by the time they have to approve WHO’s next budget proposal for 2024-2025 at next year’s WHA — although Björn Kümmel, chair of the working group on sustainable financing that made the recommendations, believes it’ll happen.

“The cynic would say [the uncertainty of  the increase] makes it precarious. The optimist would say we've got a blueprint and a way to ensure mutual accountability among member states that … signed up to this … and outside actors, civil society actors will hold them to account too because they signed up to this blueprint,” says Kate Dodson, vice president for global health at U.N. Foundation. “I am one of the optimists who see this as historic.”

Deep dive: Countries agreed to sustainable financing for WHO. What's next?

More WHA developments

• WHA took one step forward in global efforts to create a new instrument on pandemic preparedness and response by approving a report that will serve as a road map.

• Delegates identified primary health care as key in a new global action plan that aims to reduce premature mortality from NCDs by 25% in the next few years.

• A resolution to strengthen clinical trials was adopted, although some NGOs say it has shortcomings.

Paxlovid for all

At Davos, Pfizer committed to making patented medicines and vaccines, currently available in the United States and Europe, accessible to 45 lower-income countries at a not-for-profit price.

This includes not just its COVID-19 treatment Paxlovid, but nearly two dozen other medicines and vaccines for infectious diseases, some cancers, and rare and inflammatory diseases, as well as future products. However, some critics say the company hasn’t gone far enough and should support generics manufacturing too.

Read: Behind Pfizer's new not-for-profit deal on patented vaccines and drugs

Shifting priorities

A $45 million health project in Ukraine was originally designed to strengthen the country’s national health security amid the COVID-19 pandemic. But following the Russian invasion, USAID pivoted the program's focus to the health system fallout from the war, which has included widespread targeting and destruction of health care facilities.

Read: USAID pivots Ukraine health project from COVID-19 to war (Pro)

+ Join us on June 9 for a Devex Pro Live event on USAID’s largest-ever suite of contracts Beyond NextGen: Solving the challenges of health supply chains. Pro subscribers can register here. If you’re not a Pro subscriber yet, you can sign up for a free trial to join. 

No justice in DRC

A team of United Nations rapporteurs says that WHO had an “inadequate response” to allegations of sexual exploitation and abuse during an Ebola outbreak from 2018 to 2020 in the Democratic Republic of Congo, which may have “prevented a fair and thorough investigation.” Among other criticisms, they reported a failure to support criminal investigations in DRC, provide reparations to victims, and properly protect the confidentiality of victims.

Read: UN rapporteurs say WHO failed DRC sexual abuse victims

The room where it happens

This week, Devex reporters have been on the ground at WHA and Davos. This is some of what they’ve been hearing:

• “I believe that an African body is made in the same structure is other bodies elsewhere. It follows therefore that an African health specialist must be as good as any specialist anywhere on Earth,” Kenyan Health Cabinet Secretary Mutahi Kagwe said during a WHA side event on the health workforce in Africa, drawing attention to the severe shortfall of trained health personnel on the continent.

• A proposal to temporarily waive patent protections on COVID-19 vaccines is not "the text of what our government basically negotiated or agreed to even informally in Geneva," said Fatima Hassan, director of the South Africa-based Health Justice Initiative, during a Devex side event held during WHA.

• At Davos, Moderna CEO Stéphane Bancel said sharing COVID-19 vaccine technologies with WHO’s so-called technology transfer hub for messenger RNA vaccines is not a “priority” for the company.

+ For more tidbits from our Davos reporting, check out our new podcast series Davos Dispatch. In its latest episode, Peter Sands shares what’s ahead for the Global Fund’s replenishment in September and reflects on how ACT-A could have more effectively responded to the pandemic.

What we’re reading

Doctors in Africa have pointed out a double standard around monkeypox. [The Washington Post]

WHO “certainly don't have enough money” for health emergencies program. [Devex]

Ghana startup strives for greater African representation in cancer research. [Reuters]