WHO to discuss future of global health as Covid-19 still looms

Countries gather in Geneva for the 151st session of the WHO’s executive board on 30 May 2022. (WHO/Pierre Albouy)

Countries will address issues at a WHO meeting ranging from how to prepare for the next pandemic to how to finance its ever-growing operations.

Health ministers and diplomats will gather in Geneva this week to discuss the future of global health governance as the World Health Organization (WHO) contemplates whether Covid-19 is still a global emergency.

The UN health agency’s executive board – consisting of 34 member states tasked with preparing the agenda for the next World Health Assembly in May – will meet from 30 January to 7 February.

The gathering comes after the WHO’s emergency committee on Covid-19 met Friday to consider whether to recommend that director general Tedros Adhanom Ghebreyesus declare the end of the pandemic.

But the surge in virus infections sweeping over China since December may possibly stall the decision. On Tuesday, Tedros told a press conference  he remained “very concerned” about the ongoing outbreak in China which had killed over 170,000 people in the last eight weeks.

“Do not underestimate this virus. It has and will continue to surprise us,” he said.

“While we're clearly in better shape than three years ago, when this pandemic first hit, the global collective response is once again under strain.”

Media reports suggest that the advisory group may deliver its conclusions on Monday as the executive board meeting kicks off discussions expected to cover a long list of 47 items.

Preparing for the next pandemic

One of the main issues up for debate will be pandemic preparedness and response, meaning how countries can be better equipped to deal with the next global health crisis.

Tedros is due to present ten proposals to strengthen the global “health architecture”. Included in the document published earlier this month, one of the main ones is the creation of a high-level council of heads of states and other leaders tasked with advising the global response to future health emergencies. It remains to be seen where the new entity will be established, and the role the WHO may play in it.

While a high-level body could help raise the profile of health issues and bring attention to gaps, some countries are concerned about any further fragmentation of the health system. An expert panel tasked with examining Covid response and coming up with ways to improve it, made a similar proposal in 2021 for a global health threats council, recommending that the secretariat be hosted in Geneva.

These proposals are meant to help countries apply the future rules of global health currently being hashed out through parallel processes. Countries are already negotiating a new pandemics treaty, with the hopes of striking a deal in 2024. The negotiating body is expected to present a “zero draft” by the end of February for its next session.

The International Health Regulations (IHR) adopted in 1969, which govern how countries respond to global health crises, are also going through a revision, with around 300 amendments proposed so far by countries.

Questions about money

With the WHO’s role in the world poised to grow, countries will have to figure out how to fund its work. Countries reached a landmark decision in 2022 at the last World Health Assembly that should provide a needed boost, agreeing to raise their mandatory contributions up to 50 per cent of the WHO’s core budget by 2028 or 2030. The health organisation, which is grappling with financial constraints, has come to heavily rely on voluntary donations by countries but also private foundations, prompting calls for reform from Tedros, observers and countries.

Member states now have to consider how to implement the decision. But between talks of a recession on the horizon, war raging on in Ukraine and crippling debt weighing on poorer countries, this week’s talks will be underpinned by “a much dire context than when it was decided one year ago”, Nicoletta Dentico, co-chair of the Geneva Global Health Hub, told Geneva Solutions.

A new pandemics fund, housed by the World Bank and advised by the WHO, was launched in November 2022 to “strengthen pandemic prevention, preparedness, and response”. One of Tedros’s 10 proposals is for the pandemics fund to be replenished.

For Dentico, it is “naive” to continue to rely on funding mechanisms that depend on the goodwill of donors rather than strengthening public services. “It will once again replicate all the unpredictability and precariousness of donor-dependent funds,” she said, referring to the Global Fund to Fight Aids, Tuberculosis and Malaria.

“We've seen with Covid how public health systems make a difference in a country, but if we want to create public health systems all over the world, well, it means we also need to rethink the financial agenda,” she said, referring to the need for debt relief for poorer countries.

Ukraine war and other issues

The war in Ukraine will still feature prominently, with states likely to condemn Russia’s ongoing invasion, including its attacks on health facilities. Tedros is due to present a report on the health situation in Ukraine.

Asked if the war would continue to cause geopolitical rifts that would make it hard for countries to come to agreements, Dentico said that it was inevitable. “Global health is not a medical issue, it’s a political issue,” she said.

Other issues due to be raised will be universal health coverage, with Thailand to present a resolution for a high-level conference to be organised in September in New York. Brazil has also announced it will table a resolution on indigenous rights.