What to watch at the WHO’s World Health Assembly

The World Health Organization’s annual ministerial meeting opens on 22 May with the prospect of diplomatic fireworks over Russia’s invasion of Ukraine, and with critics slamming the pace of reforms to strengthen the health agency’s response to pandemics as too slow.

The World Health Assembly, which runs from 22-28 May in Geneva, is where the WHO’s 194 member states set a global health agenda for the coming year, reviewing the agency’s budget, priorities, and plans.

The past two WHAs – held virtually during the pandemic – both saw demands for reforms at the top, tension over the WHO’s investigation into the origin of COVID-19, calls for better emergency and pandemic preparedness, and pleas for more funding to address widening health inequalities. 

While the emergency in Ukraine is an understandable point of focus this year, there are worries that other urgent issues risk being sidelined – including health crises in places like Tigray and Afghanistan, plans to reduce deaths from non-communicable diseases, and the push to speed up pandemic response.

Here are some of the issues we’re watching:

Finances: More reliable funding

First, the positive news: A member-state agreement to bolster the WHO’s financial stability is expected to win approval after months of closed-door negotiations. 

The new formula involves a commitment to raise member state annual “assessed” contributions to 50 percent of the WHO’s core budget by around 2029. 

Currently, such fixed contributions only comprise about 17 percent of the WHO’s budget. Voluntary funding from a few rich countries, as well as from big philanthropic donors like the Bill and Melinda Gates Foundation, covers an outsized portion of the budget – and has a large influence on priorities.

Pandemic preparedness: A closing window for change

The assembly opens with a warning, however.

In a stiffly worded report released ahead of the meeting, the former co-chairs of an independent panel set up to examine the international response to the pandemic said the world is little more prepared to cope with a pandemic threat today than it was when the COVID-19 crisis began.

“Should a new health threat arise this year, the world would largely have to draw on the same tools it had at the end of 2019,” Helen Clark, former prime minister of New Zealand and co-chair of the Independent Panel for Pandemic Preparedness and Response, told a pre-assembly press briefing. 

Their scathing original report, released at last year’s WHA, levelled criticism throughout, from an “under-powered” WHO to “absent” global political leadership.

“Should a new health threat arise this year, the world would largely have to draw on the same tools it had at the end of 2019.”

“The weak links that we identified then still exist today, and without more concrete efforts to fix them, we could find ourselves once again scrambling to protect people from a new pandemic threat,” added Clark, who co-authored the report with Ellen Johnson Sirleaf, former president of Liberia.   

Timing: Reforms could take years

The inherently slow and conservative nature of WHA assemblies – along with the still-evolving humanitarian emergency in Ukraine – will make faster action by WHO member states highly unlikely.

Well ahead of the pack, the United States in January submitted a draft WHA proposal for a series of pinpoint amendments to the existing International Health Regulations, which govern the WHO’s emergency powers. Key among those was a tight 48-hour timetable for countries to report emerging threats, and another 48 hours for the WHO to respond – something that can take weeks or months now.  

But final agreement on IHR amendments is now likely to be punted down the field to 2024, confirmed Switzerland’s ambassador for global health, Nora Kronig Romero, in a media briefing on 18 May.  

At the current pace, processes likely to be initiated by the World Health Assembly this session “could take many years”, Clark and Sirleaf warned. Along the way, “critical issues, including [the] WHO’s authority to report, and investigate health threats based on the precautionary principle, may be lost in negotiation”.

Leadership: Status quo at the top, and a reshuffle just below

WHO Director-General Tedros Adhanom Ghebreyesus is expected to be re-elected for another five-year term during the assembly. 

There could be changes elsewhere in senior leadership, in an effort to show major donors like the United States that the WHO is intent on becoming more “fit-for-purpose”, even in the absence of a major new mandate on emergencies, diplomatic sources told Health Policy Watch. A reshuffle is likely to include the departure of Mike Ryan, who has led the agency’s pandemic response through two years. 

While the official rationale for the departure of Ryan, a seasoned health emergencies professional, will be for family reasons, sources said it also reflects Washington’s desire to see new leadership in the WHO’s emergencies operations. 

While supporters see Ryan as a dedicated professional, critics also say he has been unduly slow and cautious at key moments, as a loyal footsoldier to Tedros.

This includes criticism both that it took too long for the WHO to declare a public health emergency for COVID-19, and over the agency’s months-long resistance to acknowledging that the virus is “airborne” and warranted the public use of face masks.

Non-communicable diseases and more: The health crises that don’t make headlines

Topline issues like the COVID-19 pandemic and Ukraine may occupy the limelight, but there are more than two dozen other core health issues before the assembly, in what may be the heaviest agenda yet seen by the global health body.

These range from progress reports on cervical cancer elimination, polio eradication, and maternal and child health, to neglected tropical diseases and ways to advance new “One Health” approaches to reducing outbreak risks and controlling antimicrobial resistance.

One example: The WHA will discuss a draft WHO roadmap for reducing deaths from non-communicable diseases (NCDs) by one third by 2030. Non-communicable diseases kill about 41 million people each year – equivalent to about 7 in 10 global deaths, according to the WHO.

The Sustainable Development Goal target for reducing NCDs is already wildly ambitious in light of the world’s increasing taste for ultra-processed foods and unhealthy diets, sedentary lifestyles, as well as toxic chemical and air pollution exposure. But the roadmap, however detailed on traditional health issues like smoking cessation and screening, barely touches these other problems – mentioning air pollution, which kills 7 million people every year from NCDs, only in passing. 

There is also diminishing support from donor countries for initiatives to combat NCDs in low- and middle-income countries, where the highest proportion of deaths now occur – due to the huge drain on resources created by the Ukraine war. 

DRC sexual abuse: New details

The WHA will also hear a report from the WHO about the measures it has taken to respond to the sexual exploitation and abuse scandal involving WHO staff and consultants in the Democratic Republic of Congo, which was first reported in September 2020 by The New Humanitarian and the Thomson Reuters Foundation.

An update from Director-General Tedros also contains a few new details of the WHO’s pledges to overhaul its culture and operations:

• The WHO has funded support for 92 victims and survivors, and the children born as a result of abuse.
• The WHO intends to enlist a women-led legal aid NGO to provide “full legal aid to up to 25 victims and survivors” in 2022.
• As of February, some 13,000 staff and non-staff worldwide had completed a new, mandatory training programme on preventing sexual exploitation and abuse. 
• There’s a new, global team of 15 people who are experts in conducting sexual misconduct investigations. About 70 percent of them are women.

The politics of procedure: Ukraine and Russia

Before delegates even get to the core issues at stake at the WHA, however, they will have to get past the contentious issue of Russia’s invasion of Ukraine. 

That could rear its head on the ceremonial opening day, 22 May, when member states must approve the WHA’s “General Committee” that oversees the week’s proceedings. 

That committee was originally supposed to include Russia. But the WHO’s European member states, most of which staunchly back Ukraine, substituted Russia for Armenia at the last minute.  

Meanwhile, the General Committee will then be in charge of approving the agenda, likely to include a resolution being circulated by Ukraine, Canada, the United States, and the EU condemning the Russian invasion and calling for more WHO measures to address the health impacts. 

So if Russia objects to being excluded from the powerful committee, the assembly will face a very long roll call vote by all 194 WHA members – with African, Asian, and Latin American states forced to take sides over the geopolitical conflict on the opening day of the gathering. 

Edited by Irwin Loy.

Adapted from reporting by Health Policy Watch.