World Health Assembly special edition: A historic loss and a handful of wins

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In a world mired in conflicts, political divisions, and self-interest, can countries agree on a way forward to protect the health of the world’s population?

If the 77th World Health Assembly, the World Health Organization’s ultimate decision-making body, is anything to go by, the answer would be yes and a no. Countries failed to reach a pandemic agreement, did not call for a fossil fuel phase-out in a critical resolution on climate change and health, and took, according to WHO chief Tedros Adhanom Ghebreyesus, a record 10 rounds of voting on various contentious issues, including passing or rejecting resolutions on Ukraine and the occupied Palestinian territory.

On the plus side, they did manage to work through their divisions on a few key points. They agreed to continue negotiations on the pandemic agreement for another year, and in what many deemed a historic move, adopted a package of amendments to the International Health Regulations — a legally binding instrument that defines the rights and obligations of countries during public health emergencies.

But that didn’t happen without reservations. Slovakia expressed its “serious concerns” on the amendments. Costa Rica disassociated itself from extending the work on the treaty, noting that the process has led to polarization affecting vaccination efforts and deteriorating people’s confidence in health systems. Extending the deadline will only worsen the situation, the country said.

And on the last day of WHA, self-proclaimed “freedom lovers” protested against WHO, the treaty, and the IHR amendments outside the U.N.’s headquarters in Geneva.

WHO officials celebrated the wins while also welcoming the debate.

“We should recognize that there are people who … don’t fully trust these processes,” Dr. Michael Ryan, deputy director-general of WHO, said. “That doesn’t mean we should shut down the dialogue. That means we need to intensify our dialogue.”

Catch up on our reporting:

• Countries agree to amend global health security rules

• Will the pandemic treaty get more time, or will it go down the toilet?

• Pandemic Fund eyes $2B funding target to kick-start new strategic plan

• WHO launches first investment round, asking for $11 billion

Background reading: Experts warn about deferring hard parts of pandemic treaty for later  (Pro)

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A seat at the table

Speaking of votes, it was a historic WHA for Palestine, with countries voting to give it rights as an observer state at WHO — but not the right to vote. This is the first time WHA has described Palestine as a state.

The Palestinian Authority can now sit among countries at meetings, speak on issues other than those about Palestine and the Middle East, and submit proposals, among other rights.

“The full participation of the State of Palestine to deliberations of … WHO is essential to enable an effective and inclusive organization where all countries have a seat at the table,” a representative from Brazil said.

There were 101 votes in favor of the proposal, five votes against, and 21 abstentions.

The United States voted against the resolution, with a representative arguing that it was only presented to countries last week, without prior discussion.

“The United States has been clear that sustainable peace in the region can be achieved only through a two-state solution,” according to the U.S. representative. “It remains a view of the United States that unilateral measures like this decision will not advance this goal.”

The vote came amid discussions around the devastating consequences of the Israel-Hamas war in Gaza’s health system and the unprecedented humanitarian crisis, which WHO described as having “soaring levels of civilian mortality and morbidity, forced displacements, destruction of essential infrastructure and targeting of the health care system.”

The assembly approved a decision on the health situation in Palestine — with four amendments. Israel proposed an amendment calling for the release of hostages and condemning the use of health facilities by armed groups while a group of 19 countries in the Middle East and North Africa also proposed amendments including one that “condemns the indiscriminate attacks on medical and humanitarian facilities … by the occupying power.”

CheckUp in Geneva

Last week, the Devex CheckUp team hosted a two-day event on the sidelines of WHA. Catch up on our panels and sign up to our free, weekly global health newsletter CheckUp.

Silent no more?

Antimicrobial resistance is considered a “silent pandemic” with a lack of real coordination happening at the global level. But is that changing?

AMR happens when bacteria, viruses, fungi, and parasites no longer react to medicines. It threatens to turn back the clock on advancements made in modern medicine — creating a world where it’s commonplace that simple infections become impossible to treat and routine medical procedures become too unsafe to perform.

During WHA discussions, this growing global health crisis was given a prominent position. On one hand, countries adopted a resolution to accelerate national and global action toward AMR, with a focus on access to prevention, diagnosis, and treatment of infections.

On the other hand, countries and other health experts prepared for the next steps. There is a high-level meeting on the issue at the United Nations General Assembly in September, where it’s expected a political declaration will be adopted that can serve as a foundation to guide a more coordinated global response. Health experts would like to see several things from the meetings in New York — specifically, the creation of targets on the issue, an independent panel to provide guidance and accountability measures.

“This is, indeed, a very important year for antimicrobial resistance,” Dr. Hanan Balkhy, the regional director for the Eastern Mediterranean at WHO, told the assembly.

Read: Is antimicrobial resistance finally gaining traction? 

ICYMI: Inequality is fueling drug resistance across the African continent

Trauma in crisis

Emergencies such as conflicts, natural disasters, and humanitarian crises are incredibly traumatic for the people caught in the chaos. WHA approved a resolution — led by Ukraine and the Netherlands — calling for countries to ensure people have access to integrated, quality mental health and psychosocial support during humanitarian response. This includes investments in community-based approaches and mental health support for aid workers.

“We know, implicitly, that any of the crises have an impact on mental health,” Dr. Jarno Habicht, WHO representative in Ukraine, told Sara. “But it has not been recognized at such a high level in WHO before.”

He added that due to the war, an estimated 10 million people need mental health services in Ukraine

Habicht said he hopes the resolution inspires governments and nongovernmental organizations to elevate this issue.

Related op-eds:

• In Ukraine, aid workers need mental health support

• To rebuild Syria, addressing the mental health crisis is vital

Urgent action

From severe flooding in Brazil to extreme heat in India, the impact of climate change on health can no longer be ignored — and it wasn’t at WHA.

Countries unanimously adopted a resolution that recognizes the magnitude of the threat climate change poses to health. The resolution, among other things, calls on countries to develop and implement national action plans aimed at decarbonizing and ensuring they have environmentally sustainable health systems, and for them to integrate climate in their data collection systems.

Advocates considered it a “big moment” and an “important step to advance action on climate change and health, setting a clear direction for the global health community.” It comes after the climate talks in Dubai last year, where the first Health Day during a COP took place.

But some are disappointed that there was no mention of a fossil fuel phaseout in the resolution. A recent study found that 5 million people die each year from outdoor air pollution caused by burning fossil fuels.

“It’s not a luxury for the health community or a choice. It is just their moral duty to talk about it if they are really concerned about protecting their patients’ lives,” said Shweta Narayan, an international climate and health campaigner at Health Care Without Harm, during a Devex event on the sidelines of WHA. “The climate crisis is a health crisis.” 

Read: Health workers have a ‘duty’ to demand fossil fuel phaseout, experts say

Opinion: To make health a global priority, move away from fossil fuels