As the World Health Assembly (WHA) opened under the theme of “health for peace”, Dr Tedros Adhanom Ghebreyesus warned member states that achieving ambitious global health goals – from snuffing out Covid-19 to expanding universal health coverage – will be virtually impossible if regional conflicts like ones ongoing in Ukraine, Yemen, and elsewhere continue to smoulder and burn.
War was not far away, however, as the ceremonial session saw leaders such as French President Emmanuel Macron and Croatia’s President Zoran Milanović issue strong denunciations of Russia’s invasion of Ukraine.
“France and the EU stand in full solidarity with Ukraine,” said Macron, one of a number of heads of state to make videotaped remarks. “We condemn in the strongest possible terms the military aggression committed by Russia by the complicity of Belarus."
Even so, a more serious confrontation was avoided after Moscow remained silent over a move by WHO’s European member states to place Armenia, instead of Russia, on the powerful “General Committee” that will decide behind closed doors tonight on the finalised agenda of the week-long WHA meeting.
“War is bad enough, but it’s made worse because it creates the conditions for disease to spread,” said Tedros, who has been WHO’s director-general since 2017 and whose remarks dwelt mostly on the continuing challenges of ending the Covid-19 pandemic – while grappling with a worrisome new outbreak of monkeypox, which continues to spread.
“In war, hunger and disease are old friends... Ultimately the one medicine that’s needed is one that WHO cannot deliver – peace. Peace is a prerequisite for health,” said Tedros, who also spoke movingly of his own experiences growing up in the Tigrayan minority area of conflict-ridden Ethiopia “as a child of war … with the sound of gunfire and shells whistling … tracer bullets in the night sky, the fear, the pain, the loss."
Meeting face to face for the first time since 2020
For the first time since 2020, WHO’s annual meeting of its 194-nation governing body at Geneva’s Palais des Nations was once again a physical gathering, largely reflecting the unprecedented speed of vaccine development since WHO declared Covid-19 a pandemic in March 2020.
Sunday morning, in the streets around the global gathering place, WHO sponsored a “Walk the Talk: Health For All Challenge” event where delegates and others began the day with exercises and ran or walked for several kilometres to emphasise the importance of physical activity and other measures for combating non-communicable diseases that are the cause of two-thirds of premature deaths today globally.
Yet the continuing catastrophic damage to health and economies of the Covid-19 pandemic, and the widening injustices and inequalities it has brought on, along with Russia’s invasion of Ukraine – is expected to dominate debate at the assembly’s seven-day meeting.
WHA Resolutions by both Ukraine and Russia circulating
A resolution denouncing Russia’s aggression on Ukraine, co-sponsored by Ukraine, Canada, the United States and the European Union is expected to take considerable time on the agenda later this week. And Russia was now also said to be circulating its own resolution among member states with its own narrative on the still-raging conflict.
The opening of the WHA also coincided with Israel’s first reported case of monkeypox in a man who returned from overseas, in what apparently was the first case in the Middle East. WHO says it has identified about 80 cases around the world in nations such as Canada, Italy, Portugal, Spain, Sweden, the United Kingdom and the United States.
Until now outbreaks of the virus had been confined largely amongst rural residents of central and western Africa where the virus circulates in rodents, monkeys and other non-human primates, with only isolated cases seen abroad in travellers arriving from endemic countries.
Incremental progress on pandemic reform
While there has been considerable media focus on the prospects for a new and potentially sweeping international pandemic treaty, delegates at this session are only expected to make incremental moves toward that long term goal – likely agreeing, first, to a process for amending the existing binding rules that govern health emergencies: the International Health Regulations (IHR).
A new WHO “White Paper” does, however, outline a vision for strengthening its emergency response with a 10-point plan submitted by Tedros calling for the establishment of a Global Health Emergency Council that would involve heads of state, under WHO’s auspices, as well as a World Bank-hosted Financial Intermediary Fund (FIF) to maintain a standing pool of resources for purchasing treatments and vaccines. The aim is to avoid the kinds of delays and inequities that have occurred with the lagging distribution of Covid-19 vaccines to low- and middle-income countries..
And a draft resolution co-sponsored by the United Kingdom and Argentina calling for greater transparency in clinical trials reporting – with both negative and positive results – was reportedly now finalised after weeks of closed door discussions. Proponents have said that the resolution is critical for ensuring more harmonised reporting of clinical trial results so that there will be a faster uptake of new treatments, particularly during disease outbreaks and health crises.
Along with those big ticket items, the Assembly will debate more than two dozen other issues such as polio eradication, cervical cancer elimination, a roadmap on reducing non-communicable diseases, how to better coordinate research priorities in clinical trials, eradicating polio, and cases of sexual exploitation by WHO staff.
See Friday’s full report on what to expect from the WHA here:
Increasing fixed member state contributions to WHO
In another significant move, delegates are expected to approve a move to gradually increase the proportion of fixed assessments that member states must pay annually towards WHO’s budget.
The assembly’s anticipated new formula for fixed contributions to WHO’s budget – which only covers 17 per cent of its costs – is intended to raise its member nations’ annual “assessed” contributions to as much as 50 per cent of its core budget by 2030.
Most of the agency’s budget now is covered by a handful of wealthy “voluntary” donors: Germany, Japan, the United States, Korea, the European Commission, Australia, the Covid-19 Solidarity Fund, the GAVI Alliance, UN Development Program, the Bill & Melinda Gates Foundation, the United Kingdom and New Zealand.
Tedros and other WHO leaders have repeatedly asked for this move, saying that the agency’s long standing over-reliance on the voluntary funding it receives from countries and charitable donors makes the agency too dependant upon the whims of donors.
A plea to continue fighting Covid
Tedros, who is expected to be re-elected for another term during this WHA session, set the stage for the weeklong discussions by acknowledging that the Covid-19 pandemic has “turned our world upside down” and continues along an unpredictable path still today. “Reported cases are increasing in almost 70 countries in all regions,” Tedros warned. “And this is in a world in which testing rates have plummeted and reported deaths are rising in my continent [African]. The continent with the least vaccination coverage.
“This virus has surprised us at every turn - a storm that has torn through communities again and again. And we still can't predict its path or its intensity. We lower our guard at our peril.”
More than six million Covid-19 deaths have been reported to the WHO. Earlier this month, however, the WHO provided new estimates showing the full death toll associated both directly and indirectly from the continuing pandemic was almost 15 million people in 2020 and 2021 alone. This also is a dramatic illustration of the need for far greater investment in resilient healthcare systems, WHO officials say.
“People have lost their lives, loved ones and livelihoods. Health systems have been strained to breaking point, and in some cases, beyond. Health workers have laboured under extreme circumstances. Some have paid the ultimate price, and we have lost others to stress and depression,” said Tedros.
“Communities have faced great disruptions to their lives, with schools and workplaces closed, and the burden of isolation and anxiety. And you, as governments, have been at the centre of the storm, facing multiple challenges,” Tedros said.
“I know that’s not the message you want to hear, and it’s definitely not the message I want to deliver,” he said. “There’s no question we have made progress, of course we have: 60 per cent of the world’s population is vaccinated, helping to reduce hospitalisations and deaths, allowing health systems to cope, and societies to reopen. But it’s not over anywhere until it’s over everywhere.”
This piece was published in collaboration with Health Policy Watch.