3 key issues to watch at the 76th World Health Assembly

The World Health Organization declared the COVID-19 and mpox global emergencies over in a span of two weeks. But there are still over 50 health emergencies taking place globally, and the threat of another one emerging at any time. There’s the conflict in Sudan disrupting health care services, Russia’s war in Ukraine that has sparked a mental health crisis, and multicountry cholera and measles outbreaks, just to name a few. Many of these crises provide the backdrop for this year’s World Health Assembly, where health emergencies including how the world can better prepare for future ones will continue to dominate discussions. But after three years of the COVID-19 pandemic, experts said countries and WHO must also shift their attention back to long-neglected issues, such as universal health coverage, noncommunicable diseases, and the different drivers affecting people’s health and well-being. All these will require money, and WHO’s quest for sustainable financing will continue at this year’s WHA. Sustainable funding After agreeing last year to provide WHO with more flexible funding, the WHA will decide whether they’re ready to put that into action. At last year’s assembly, member states agreed to gradually increase their assessed contributions to reach $2.18 billion by 2029. The first increase of 20% is expected this year as they approve WHO’s 2024-2025 budget. Even if it’s not a firm obligation, there are expectations for member states to follow through. “At stake is the very future of WHO as the world's leading global health organization. A major increase in assessed dues would also send a vital political signal about the centrality of WHO as the world’s coordinating authority for health,” Lawrence Gostin, a professor at Georgetown University and founding O'Neill chair in global health law, wrote to Devex. But it’s not the only money question on the agenda. Member states will also decide next week whether to allow WHO to fundraise via a replenishment, which some experts say may be the “most consequential decision” in this year’s WHA. If they agree, WHO’s proposal is for a replenishment mechanism called “investment rounds,” with the first pledging event taking place in the second half of 2024. This is so as not to compete with other organizations that are planning to hold their own replenishment events in 2025. “One of the six principles we're given … is like the six commandments — thou shalt not interfere with your friends’ replenishment campaigns, so we need to go earlier,” Dr. Bruce Aylward, who is now WHO assistant director-general on universal health coverage, life course division, told Devex. The target is to raise resources for WHO’s work from 2025-2028. WHO plans to engage sovereign donors, NGOs, philanthropic foundations, and academic institutions for the replenishment, but also the private sector through the WHO Foundation. Part of the proposal is also for WHO to hold an investors forum to “build support” for its replenishment. The idea of replenishment for WHO has been proposed before, including by the Independent Panel for Pandemic Preparedness and Response. Suerie Moon, a global health expert who serves as co-director at the global health center at the Geneva Graduate Institute, said this should supplement and not replace other contributions to WHO. Funders also need to understand the distinction between WHO and other global health entities. “In a better world, Member States would fully fund WHO every year based on assessed contributions, but that's not the world we live in,” she wrote to Devex. Preparing for emergencies Increasing WHO’s predictable and flexible resources could help it in responding to health emergencies, including having the means to allocate immediate funding for new ones and those that don’t receive a lot of donor attention. When WHO announced that mpox is no longer a public health emergency of international concern, Dr. Michael Ryan, the agency’s executive director for health emergencies, said he was “stunned” that WHO could not get any funding for it, despite it spreading globally, leaving WHO to rely mainly on its contingency fund for emergencies that has also struggled to raise money. So far this year, WHO has allocated over $37 million for a whole range of outbreaks and health emergencies, including in response to the health consequences of the deadly earthquakes in Syria and Turkey. However, it only received contributions of over $13 million as of April — the bulk of it in the form of commitments — for its contingency fund for emergencies. Under Director-General Tedros Adhanom Ghebreyesus’ 10-point proposal to strengthen the global architecture for health emergency preparedness and response, which is on the WHA agenda, he suggests an expansion in the size and scope of the fund to allow it to directly finance national and international partners in the initial health emergency response. Meanwhile, there have been ongoing discussions taking place on an “interim” countermeasures platform based on consultations led by WHO, and there will be a meeting led by Norway and South Africa on where things stand during WHA, Aylward said. The issue of countermeasures — essentially access to lifesaving medical products to protect people’s health — may also come up when the Intergovernmental Negotiating Body tasked to draft and negotiate a pandemic accord gives member states an update on its work. But there won’t be any decisions yet on an accord at this year’s WHA. There’s been debate over what the next countermeasures platform for health emergencies like COVID-19 should look like. WHO has launched a process and has been meeting with different groups, including member states, multilateral agencies, civil society representatives, and regional entities such as the Africa Centres for Disease Control and Prevention, Pan American Health Organization, and the European Commission’s Health Emergency Preparedness and Response Authority, to gather inputs, with the goal of working toward an “interim platform” or “minimum viable product” that can be adjusted later on, but is readily available in case another global emergency like COVID-19 emerges in the near-term. But some experts have concerns that discussions on countermeasures may focus mostly on distribution. The goal, they said, should be an end-to-end ecosystem designed to specifically improve health outcomes. Els Torreele, an independent consultant and visiting policy fellow at the University College London Institute for Innovation and Public Purpose, said this means requiring equity from the early stages of research and development all the way to manufacturing and a product’s usage. The WHO executive board, during its meeting in early February, also recommended the WHA adopt resolutions linked to UHC, but also as part of health emergency preparedness. These include increasing countries' access to medical oxygen; strengthening their diagnostics capacity; adopting a global strategy for infection, prevention and control; and integrating emergency, critical and operative care for UHC and to protect people from health emergencies – areas where many countries struggled with COVID-19. Long neglected How the world can better prepare and respond to future health emergencies is important, but experts said it’s time for the World Health Assembly to also pay attention to other neglected issues, such as universal health coverage and NCDs, and how to tackle the different drivers affecting health outcomes, such as education, economic status, gender, and race. Before COVID-19, the world was already off track in reaching the Sustainable Development Goal target of achieving universal health coverage, and emerging data for 2023 “is likely to articulate a major erosion of progress,” according to WHO. No country is also on track to achieve the voluntary global targets on NCDs that the WHA set for itself by 2025. The WHA is expected to adopt a resolution on universal health coverage and primary health care, in the lead-up to the United Nations high-level meeting on UHC in September. “Ever since the Alma Ata declaration on primary health care in 1978, WHO has promised to deliver on its goal of health for all. Yet, here we are decades later and we are no closer to that goal,” Gostin said. “[T]he Assembly will have to keep the political pressure on for the UN High Level Meeting in September and push for a robust political declaration, with the pledge of funding. Most importantly, high income countries will have to put major funding into building health systems in lower income countries,” he added. Aylward said the WHA will also be considering a draft global framework for integrating well-being into public health. They will also be looking at an operational framework for monitoring social determinants of health — which can be a “game changer” to effectively address health inequities and NCDs and their risk factors, according to Liz Arnanz Daugan, policy and advocacy manager for NCD prevention at the NCD Alliance. The WHA is also expected to endorse an updated menu of cost-effective interventions to address NCDs, which are the top killers globally but don’t get enough attention and funding. These include an intervention on the prevention of tobacco use and harmful use of alcohol, promotion of healthy diets, and prevention and early detection of different kinds of cancer. The board also recommended the WHA adopt a resolution to strengthen their rehabilitation services to meet increasing needs of people suffering from NCDs and those affected by COVID-19. In 2021, an estimated 144.7 million individuals had post-COVID-19 conditions for which rehabilitation can help alleviate symptoms, according to WHO. “One person under age 70 dies every two seconds from a noncommunicable disease. So that's a pretty clear indicator that they're top killers. And yet they're very underappreciated and underfunded,” said Dr. Kelly Henning, who leads the public health program at Bloomberg Philanthropies. Devex is hosting a two-day event during the World Health Assembly. Make sure to sign up here to participate in person or online. Update, May 19, 2023: This story has been updated with details of other resolutions for adoption at WHA.