What came out of WHO’s World Health Assembly last week?

Suerie Moon (here at a talk at Maison de la paix, on 23rd March 2020) is co-director of the Graduate Institute’s Global Health Center, in Geneva. | Graduate Institute, courtesy

The 73rd WHO’s World Health Assembly (WHA) took place in Geneva on 18th and 19th May 2020. Suerie Moon, co-director of the Graduate Institute’s Global Health Center, followed carefully this very first assembly to take place in the middle of a pandemic. We asked her to break down for us the highlights and outcomes of the event. For this leading expert, the biggest story is not about US-China rivalry, but how other countries, including China, agreed to commit on a stronger international cooperation.

The World Health Assembly (WHA) is usually a huge summit here in Geneva. But due to pandemic concerns, this year’s session was abridged and only virtual. How did it go for you?

Suerie Moon – Of course it is unprecedented that it was condensed in two days instead of the usual 14 days nonstop from morning to evening, meeting people, having debates and negotiations. But it’s not an exaggeration to say this was one of the most important WHA ever. It was coming in the middle of a pandemic and at a time where the World Health Organization (WHO) has been under scrutiny as never before. It was a critical moment politically, to see whether international collaboration would be strengthened or weakened through the process of the assembly.

How did it turn out?

If you look at the list of speakers: the president of China, president of France, chancellor of Germany, the president European Commission, Italian Prime minister, it is really not “normal” to have so many high level political figures speak at the assembly. It really shows a tremendous political support for WHO as an organization and a very powerful call for international cooperation. The message that came through over and over again, with pretty much every political leader that spoke, was that we had to work together in order to get the pandemic in control. This is quite an encouraging message and this was not a given prior to the assembly!

What do you think are the most important topics in the EU-led resolution that was adopted by consensus, by more than 140 countries?

The first was the language about making treatments and vaccines available quickly and in a fair way to all countries. This is a very sensitive issue, which touches on national security, commercial and industrial interests. For many politicians, it’s very difficult to say: “yes, I’ll allow another countries to get vaccines before everyone in my own country got it”. Yet, they committed to that. Of course the devil is in the details.  But it’s noticeable that this high-level political message came from countries with strong pharmaceutical industry such as Germany France, Japan, UK… [Ed. note: Switzerland did not co-sponsor the resolution, nor did the USA.] Even China, which is probably in the lead in the global vaccine race, supported it. When the Chinese president said that the vaccine would have to be available to all countries, I think this is a first in history.

The Member States also agreed to conduct an impartial, independent and comprehensive review of WHO.

There were two paragraphs about trying to review how the WHO, but also governments, responded to the epidemic. There is of course a number of questions about what happened in China in the earliest days. When did the Chinese first begin to understand what was happening and how long did it take them to share information? These are very sensitive questions and the fact that there is a call for investigation in the resolution, and that the Chinese ended up being a co-sponsor anyway, is a very important political shift. I wasn’t certainly not expecting that.

There was also an agreement for an independent stepwise review of WHO. I think this is most acceptable than the US proposal for an “immediate review” only focused on WHO. But this kind of language appropriately asks everybody to look at what they’ve been doing and what lessons can already be learned.

When exactly such a comprehensive in-depth review should take place remains open to debate. It’s quite important that for example Ursula von der Leyen [Ed. note: European Commission president] said in her closing remarks very clearly to the assembly “we don’t’ think the time is now”, and that they had to wait for the dust to settle. said in her closing remarks very clearly to the assembly “we don’t’ think the time is now”, we have to wait for the dust to settle. I personally agree that any in-depth review now would be a destruction, as WHO is already being stretched very thin to try to coordinate the global response. And we are nowhere near the end of this pandemic. You have to get the virus under control as a first priority rather than taking the risk of destructing WHO leadership.

Are there already lessons to be learned about WHO’s response?

There was an important report released on the first day by IOAC, a WHO-independent evaluation committee. They observed that the emergency declaration process should be made more transparent and they also argued that governments have not taken it as seriously as they should have. Is there way to improve the process in order to make governments pay more attention in the future, and also to protect WHO from accusations of being biased? They don’t know how to do that yet but at least it’s a very honest critic.

There was another recommendation on the way WHO managed advice on travel restrictions. WHO’s main competence is about epidemic response, but they need more competence about how to manage travel restrictions and their impacts on industry and tourism. These are important issues on which the committee wished there would be more involvement with travel authorities, which have more expertise around travel restrictions.

The third point is about guidelines. The organization has already issued 50 guidelines for countries, companies, or individual, on how to protect healthcare facility, treat patients, disinfect cargos, so on and so forth. The range is really incredible: usually one single guideline takes a year! But the committee said they needed to move even faster. Governments needed guidelines for example on how to lockdown or how to lift lockdown while minimizing the social and economic harm. This is demanding a lot but it shows this committee was quite critical in its assessment, and it’s healthy.

Let’s get to the hot topic: the United States’ attitude at this WHA...

Trump issued a 4-page letter on Monday night, right in the middle of the assembly, and repeated his threat to cut off funding permanently to WHO and to withdraw as a member of the organization. It’s the first time he made the second thread. He issued a very open-handed ultimatum: if WHO doesn’t commit to “major substantive improvements” within 30 days, this is what will happen. The fact that the letter did not specified what reforms they were talking about and that this is an impossible timeline –any substantive reform need to be agreed among Member States– signals to me that the purpose of the administration is not to reform WHO.

It’s interesting to notice that the political messages of support didn’t change once this explosive letter was released, from Spain, Italy, European Commission, or smaller countries as Tuvalu, Vietnam, Bhutan. They didn’t change their message. Almost every speaking country issued a very strong level of support for multilateralism, WHO, and often the director general himself.  It reflects the fact that the US is quite isolated diplomatically. The style of the letter, which was very accusatory and left no room for maneuver, really undermines the ability of the US to actually secure a reform of the WHO. In a diplomatic town like Geneva, this letter was completely devoid of diplomacy…

I don’t mean to say the letter didn’t raise concerns that other governments, in Europe or Switzerland, have raised, for example about the transparency of information in the early days of the outbreak. Now the focus is on China but pretty much every government that I heard of had an initial reaction to downplay the epidemic, to try to reassure and control any kind of panic reaction. That’s because we know that the economic harm from outbreak is extremely high and the economic contagion is sometimes much worse than the health effect. It is a big problem across all countries, including China, so it’s difficult to get information in the early days of an outbreak.

Would WHO be able to politically survive in case the USA withdraw from membership?

WHO would survive, I’m not worried about that. Of course there would be a major decrease of budget almost overnight. The question whether other governments would step up to fill this gap is still open, but money at the end of the day is replaceable. The technical collaborations are more of a concern. For example, the NIH are the world single largest founder in biomedical research and have a huge expertise. If the US were to drop out, it’s not clear whether the gouvernement would try to lock that kind of scientific collaboration. The same thing goes for the CDC, which was widely considered one of the best public health agencies in the world until recently and whose collaboration with WHO is very important. There is also a lot of American staff embedded within WHO agency. These are the kind of benefits that are hard to replace.