This year’s World Health Assembly agenda was jam packed with virtual conversations on how to end the pandemic and prevent future health crises. Still, different health priorities were discussed with over 30 resolutions adopted on topics ranging from local production of medicines to ending violence against children to oral health. Sitting on the terrace of the Graduate Institute, global health expert and co-director of the Global Health Centre professor Suerie Moon shares her thoughts with Geneva Solutions on some of the fundamental discussions that took place during the WHA and what should be done moving forward to address the current Covid-19 pandemic and future health crises.
Covid-19 remained the main topic of discussion, despite ending the pandemic, were there any other meaningful outcomes?
There were a lot of the usual WHA items on the agenda, with Covid featuring high. However, one of the most meaningful outcomes is the political will to support the World Health Organization (WHO), which Covid definitely prompted. Strengthening the WHO is not only about strengthening the organisation for outbreaks, but it took a crisis of this magnitude to focus our minds on addressing the structural weaknesses. I'm a bit more optimistic than I've been in a long time about the political momentum behind addressing the financial question, which we always discuss year after year. This is also ironic to me because technically speaking this area is one of the easiest to fix as governments can give more untied money. It is not terribly complex or difficult but the political willingness to do so has been absent. Right now, more than ever this conversation is gaining momentum, and this makes It the most meaningful outcome for me.
What type of funding is needed?
Of course, for a crisis like Covid there is a surge in funding to meet the required needs but this is less the issue. The biggest issue has long been the nature of the funding rather than the amount of funding. And we have seen over the years that the WHO budget is actually increasing, monotonically for more than 20 years now. It is therefore inaccurate to say WHO is always in a budget crisis. My view is that the budget has become more and more fragile, subject to the control of [private] funders. Due to this WHO has lost autonomy in a significant manner, and this is the bigger problem. The member states have to be willing to solve this problem because we cannot constantly try to pull the purse strings to control the organization like puppet masters.
In the case of Covid, what initiatives should be prioritised to end the pandemic?
Of course vaccine access is important and it is another area where the problem is not about technical solutions. We have excess vaccine doses sitting in different countries. If governments would agree to share them, then we would already be making a big dent in mortality, we could access the most vulnerable groups and protect frontline workers.
At the moment the problem lies with the following: we have the vaccine production capacity that's not being used, we have proposals for an intellectual property waiver and there are lots of solutions that can be adopted quickly to increase vaccine access worldwide, so the problem is not an absence of solutions. Again, the problem is an absence of political agreement, will, momentum, leadership, and courage. As we have the G7 summit in a few days time I hope to see bold acts of political courage and leadership. In the case of vaccines, we have seen evidence from countries that have now immunised 40 to 60 per cent of the populations whose cases are going down, have less hospitalisations and less deaths.
In terms of non-vaccine-related interventions, again we already know what needs to be done. It is not always easy politically or economically to put certain measures in place, for example, lockdowns and social distancing measures. Although these are not popular, they can be very effective. So to your question we know how to end the pandemic but political will and leadership is lacking.
Did this year’s WHA miss the opportunity to create a strategy on how to vaccinate the world?
Yes, it was a missed opportunity but I would say there was already a strategy and that was Covax. That strategy however did not work as it was intended for a lot of reasons, Covax [WHO backed equitable vaccine sharing scheme] has been able to deliver very small numbers of doses in comparison to what it was hoping to do. The power to deliver did not lie with Covax’s sponsors but rather in the hands of the government. The strategy did not fly and perhaps could not fly because the biggest powers did not give it wings. When it comes to the strategy by the powerful countries, there has not been one as these nations have largely been internally focused. In this case then, the WHA could not have solved something that governments themselves did not come to the table ready to solve or were willing to solve.
You mentioned the G7 summit due to take place on Friday, what are your expectations for the event?
From this session, I would again like to see political leadership, which we have not yet seen. For a long time we lived in a G7 world and this shifted. Now one of the things we have seen in this pandemic is fragmentation and an absence of a clear global leader. We have not seen big global solutions and instead we have smaller scale bilateral, national regional models trying to find solutions to global problems and get the pandemic under control.
Still, this does not have to mean less effective, when we think about a lot of countries, lets say for example Malaysia, they have vaccines from different sources and are rolling this out rapidly. They are getting some vaccines through donations, bilateral agreements, Covax, the open market etc. This pattern we have seen over and over again particularly when it comes to vaccine access. I believe the G7 can come together and deliver bold commitments on vaccine sharing. I do not think we will move back into a G7 world where they call the shots but they can and should make major contributions financially, technologically and politically.
Is it time to then give the WHO the power and resources to be that global health leader?
I have been very impressed by the leadership role the WHO has exerted and demonstrated throughout this pandemic. And if there has been a global leader in global health I would say it has been the WHO. But of course, what does it mean to be a global leader, WHO does not have the financial or political authority to provide vaccines, fund Covax, provide debt relief for countries that are undergoing severe economic contractions or the political authority to command countries or companies and tell them what to do. In these ways, it may not be the leader. Where WHO has the resources at its disposal to take the lead is in its normative authority and technical guidance, whilst trying to push for more international cooperation which has been sorely lacking.
The agenda item for the pandemic treaty was shifted to a special session in November after UN General Assembly where it was hoped to be discussed, how will this affect the momentum?
There is understandably a big push to get political momentum and start negotiations immediately and now it has been postponed to give governments enough time to prepare. The biggest risk is a loss of political momentum but at the end of the day the degree of political support was not there to really dive in headfirst as a lot of countries were not ready. I hope in the next five months there will be a continuing buildup of momentum. It is clear there are so many gaps and broken pieces in the global system, with a lot to be fixed, and a treaty offers the potential to fix key parts of that system.
What are some of the '“broken pieces” this pandemic treaty should address?
Information sharing is a key one, and that is all kinds of information. This is an area where the existing regulations are not specific and strong enough. For this we need compliance, enforcement and accountability because we have quite strong commitments in the International Health Regulations, but there is no way to enforce them. Information sharing is critical particularly in the early stages of any outbreak and such a treaty would get countries to really abide by their commitments.
Another area is the access to countermeasures including vaccines, but also diagnostics medicines, personal protective equipment, technologies, the tools you need to get a pandemic under control.
Clearly a high political priority has to be addressed. We do not have anything close to a treaty to address the current situation we see with vaccines. That's going to be tough because if we think about how long it has taken just to get the IP waiver debate to advance, which was officially put on the table in October of last year, we are still fighting over whether we are going to start negotiating.
Human rights protections could be reinforced in a treaty, and so could trade and travel restrictions. Moving into some of the upstream prevention areas, how do we prevent or do the most we can to mitigate the risks of animal to human zoonoses, jumps of pathogens from animals to humans or natural environment to humans, what can we do to reduce environmental degradation and govern human and animal interactions.
So there's a lot, and this will all require kind of poll of government negotiations. So to come back to on your earlier question, what needs to happen in New York [at the UNGA], I agree with what some commentators have said, you need a strong and clear political agreement at the level of the highest levels of government and that will happen General Assembly. The actual negotiation of the treaty, will be about technical and health sector specific questions, which can be done in Geneva but you need a political push from all ministries and not just health ministries which was a fear at the WHA.
What do you think were the biggest achievements of this year's WHA?
The biggest achievement, I think, was the agreement to strengthen WHO. Also, the agreement to consider a treaty and move into reform mode, which I had hoped would start last November at the resumed WHA. We also saw some momentum on vaccines, with a funding push for Covax after the event. Maybe it helped to provide some more momentum on the vaccine issue because access is a major political concern to lots of countries.
For more of the nuts and bolts - many people thought, you cannot do diplomacy and have difficult negotiations in a virtual setting. But the assembly dealt with a long list of the issues, mostly all virtually and it meant a lot more prep work and a lot more negotiation in the weeks leading up to the event. Being virtual did not mean the politics disappeared but it managed to do its work.
Looking ahead, what would you like to see in the 75th WHA session?
I would like it to be in person. In person means the pandemic is under control, everywhere in the world and not just in Geneva. I would like us to be in the thick of the treaty negotiations by then. I would like to see that we have action on the reform of WHO financing.
We have an election coming up, the WHO director general is going up for re-election. It will be interesting to see how the election campaign comes along and it will certainly dominate next year’s assembly.
I also hope that we are still not fighting about vaccines the way we are now and the way that we have been. I would like to see that enough of the world has been reached and the most vulnerable have been vaccinated, cases have been brought down and economies are moving again everywhere in the world. I think that is probably one of the biggest questions for next May, are we going to be there with the world vaccinated and if not this will be a massive failure.