With an agenda that is more packed than ever – and razor sharp political crises from Gaza to Taiwan to Myanmar also coming to the fore – will the upcoming World Health Assembly prove to be the decisive moment that it should be for global health? 

Now, more than ever perhaps, huge tensions and inequalities plague the global health scene – with new COVID cases in high-income countries slowly declining, and international borders reopening, while India as well as other low-income countries in South East Asia and the Americas battle continue to battle huge case counts and death tolls. 

Against that landscape, however, some far-reaching recommendations for reform that will be on the table this year could make a big difference, said a group of high-level global health voices at an “Introduction to WHA 74 session,” sponsored by the Global Health Centre of the Geneva Graduate Institute.  

They referred to proposals by The Independent Panel for a Pandemic Treaty; limiting the Director General’s term to one five-seven year stint to remove the position from political influences; and the granting of stronger investigative powers to visit countries and publish data on outbreak threats, said Julio Frenk, former minister of health for Mexico and president of the University of Miami, speaking at the event.  

”The main problem until now has been that the member states by design or by behaviour have weakened the operation of their own organisation,” said Frenk at the session, which also featured Ellen Johnson Sirleaf, co-chair of The Independent Panel on Pandemic Preparedness and Response, Gro Harlem Brundtland, former Prime Minister of Norway as well as WHO director general Tedros Adhanom Ghebreyesus, and Joy Phumaphi, of the UN Secretary General’s Every Woman, Every Child Accountability Panel.  

Limiting the director-general’s tenure to just one term in office would be a “major step” towards a more independent and depoliticized WHO – “so as not to have a director who is also campaigning for re-election,” Frenk asserted. 

Added Brundtland, who gained worldwide acclaim for key health reforms that she instituted at WHO during her 1998-2003 tenure, “A seven year term is a better choice. Because then, no leader of WHO, in the future will be in the situation to be lobbying to be reelected.”

But the inequalities in access to vital COVID-19 vaccines and other health products, is the bigger pandemic picture that must urgently be addressed, she said.

“The world again was taken unprepared. The vaccine situation is an illustration that a whole-of-government approach, whole-world approach at the highest level is not there.”

“I was shocked when we realized that not only with regard to vaccine distribution, but also PPE, therapeutics, nothing could be done, frankly, by our financial institutions who serve the developing countries, because they have no mechanism for supporting global public goods.  This illustrates how important it is that we pursue these kinds of recommendations – broadly speaking, to be prepared.” 

Reforms that stimulate more equitable access could be stimulated by the creation of a high-level Global Health Threats Council – annother recommendation emerging out of the Independent Panel: 

“A Global Health Threats Council is something I think needs to be institutionalized – with a financing mechanism that is not based on ODA [donor aid] and the idea of giving gifts to countries – but rather a responsibility of all countries, based on ability to pay,” Brundtland said.

Intellectual Property Waiver – A Novel Suggestion

As for the debate over current proposals by WHO and many other global health advocates to implement a World Trade Organization waiver on intellectual property (IP) rights for COVID health products, for the duration of the pandemic, Johnson-Sirleaf  suggested a novel proposal.  She said that high-income countries flush in vaccines should commit to turning over at least 1 billion doses to the COVAX global vaccine facility by 1 September – and two billion doses by 2022, supported by more agreements for voluntary licensing by big pharma of manufacturing in the global south, and tech transfer agreements. And in the absence of such commitments, then WTO members should rally around the proposed agreement to waiver IP rights set out in the WTO TRIPS Agreement altogether.

“We feel if that doesn’t happen, there should be a waiver of TRIPS,” she declared. ” So that, that can come into force with immediate effect. What this will require is that the major vaccine producing have the power to make that happen.”

Sirleaf said she was looking to Friday’s G-20 Global Health Summit, hosted by Italy and the European Commission, for clear responses.

“The Independent Panel’s impact is a moral force and setting the expectations, but we have very little leverage. It is the inter-governmental forces such as the G-20 and the G-7 that are the useful institutions to create the peer pressure, and to promote a sense of momentum. The key message from us the the scale of vaccine distribution needed.  With 1 billion doses by September. Not 10 million. Not 100 million… we need 1 billion by that date. Anything short of this, will simply not be enough to start slowing the pandemic, towards eradication.”

Increasing Annual Contributions to WHO 

Another key reform with meaning would be increasing the regular annual contributions to WHO from member states, beginning with a gesture by the United States to reverse the 1999-era  Helms/Biden Act – which froze it’s regular WHO contributions in time, emphasized Frenk.   

“We’ve got to change the funding, there’s no national health agency that could function, if 80% of its funding came from voluntary contributions.  

“If this is really the organisation of member states, then member states need to pay for their organisation,” declared Frenk at the session. “Therefore, the increase to two-thirds of the budget coming from assessed contributions with an equitable formula. That has to happen, and the United States needs to lead the way. 

“Because the process that led us to the current situation was an amendment to a law that bears the name of the current president, President Biden, it’s called the Helms/Biden Act, and it froze the nominal amount of assessed contributions. And since then, the proportion that’s covered by those assessed contributions has been coming down to be now, very very insufficient.” 

In RealPolitik Prospects for Key Reforms are Dim 

However, in the realpolitik of WHA negotiations, the changes that key reform measures might receive the consensus vote they need for approval remains dim to doubtful, people close to the organisation told Health Policy Watch. 

“On the single term DG issue, there’s not a chance that it can be considered in operational terms at this World Health Assembly because formally it does not fall within the scope of the existing items on health security. It requires reopening the issue of DG elections,” said one diplomatic observer, adding, “and I doubt that that reform – as objectively desirable as it can be – will ever pass because it would deprive key countries of influence and control over the DG if he/she cannot run for re-election.” 

Prospects for a Pandemic Treaty – most likely to take shape as a Pandemic Framework Convention supervised by the WHO if it happens at all – appear to be equally troubled by opposition from major countries such as the United States, Russia and Brazil.  The unusual set of allies have argued that negotiations over a treaty would be too time-consuming to conduct right now, as the world remains in the midst of battle with COVID-19. 

This is despite support the pandemic treaty concept has received from some two dozen other G-20 countries, as well as the WHO.  

That ambivalence has led to the circulation of two versions of a draft WHA resolution on follow-up to the Independent Panel’s recommendations. According to one version, WHA member states would explicitly agree to begin negotiations towards a legal treaty or convention. But the other version would merely agree upon the creation of a working group to take forward the recommendations of the Independent Panel as well as those of two other investigative committees, exploring gaps that emerged during the pandemic in the existing International Health Regulations as well as WHO’s own emergency response 

“I understand that there are negotiations going on now on whether and how to combine them –  given the fact that the US, Russia, Brazil and some other big countries are against starting negotiations now and want to kick that issue down the road,” said one observer. 

Geopolitical Rifts Also Threaten Unity 

Along with the burning global health issues that need to be faced, some serious geopolitical rifts are likely to disturb the proceedings of the WHA – already from the first day of the Assembly. 

That will be when member states debate a proposal to admit Taiwan as an observer to the WHA – after freezing it out since 2016.  The controversial proposal is now supported by 13 leading member states, including G-7 countries. 

There will also be an equally heated debate on which government should represent Myanmar. Since the military coup – two claim that role – the junta now in power and a shadow, opposition government. 

Finally, the thorny issue of the Palestinian humanitarian situation in Gaza will also be debated – after being front and center in the news over the past 10 days, following intense exchanges of missles and fire power between the Hamas-controlled Gaza strip and Israel. 

”There will be political issues and issues of  participation,” said Gian Luca Burci, a professor of international law at The Graduate Institute and a former WHO legal counsel.  He noted that politically-laden procedural hurdles that will  have to be navigated in addressing all three issues. 

“Thirteen states have  again made invitation for Taiwan to attend the Health Assembly as an observer, ” he said. “There will certainly be a very difficult, very controversial debate and vote on the draft resolution on assistance to Palestinian population in the occupied Palestinian territory in view of the current circumstances. There will be two governments that would like to represent Myanmar. One is a military government that has taken power in the coup in February, and the other is the civilian government deposed. Both presented credentials, and these will need to be considered in the credential committee. 

“On the positive side, the WHA will invite the Holy See, which has already been observing the Health Assembly for many years at the invitation of the director general, to be formally invited to participate as a non member observer state.” 

Big Agenda – Modest Expectations  

“This year’s Health Assembly is arguably one of the most important in the history of WHO, and the COVID 19 pandemic means we will once again gather, virtually – but that has not limited the scope or importance of the discussions,” said WHO Director General Dr Tedros, in a video-cast message at the opening of the Global Health Centre panel discussion. 

“In fact, this year, We have one of the heaviest agendas on record.”

Actions taken in response to the recommendations of the Independent Panel and two other investigative panels, which have reviewed WHO’s own internal emergencies response and the International Health Regulations, “ will have far reaching ramifications for the Global Health architecture of the future, “ he noted. 

Items on “the global health workforce, and accountability issues around the prevention of sexual exploitation and abuse,” are other issues of particular note, Tedros added. 

Despite the big agenda, Burci has modest expectations.

“This crisis is quite different from Ebola and so on.  There’s (as of now) hardly any agreement on anything except at a high level of generality.  Besides advocating for big changes and criticizing states’  short-sightedness, there should be some serious analysis why this is the case – because it may show more systemic changes in the world that we need to understand.

“The upside is probably that the WHA will set up an intergovernmental process to at least discuss the various reviews and sketch some ways forward.  It sounds like a talk shop, but states need to be brought back to the centre of the policy debate within WHO rather than through the usual G7/G20 clubs.  

Memories Are Short 

Along with being a milestone moment, this year’s WHA also has one of the largest agendas ever on record, noted Suerie Moon, co-director of the Global Health Center at the Geneva Graduate Institute, who moderated the panel. 

“There are about 70 agenda items on the WHA agenda, beyond COVID-19 – and this is a timely reminder that who is more important for the health of all of us, than it’s ever been.” 

“Clearly there’s no shortage of challenges, nor potential solutions to address some of these weaknesses, but there’s also no guarantee that we will seize this moment, and that we will seize this moment to strengthen the WHO.” 

 “This pandemic is not yet over, and yet we know that memories are short. Opportunities are limited to fix the global system that COVID has shown is deeply inadequate,” said Moon.  

“And whether or not COVID becomes a game changer will depend on at least four things. I would say political leadership, political courage, political wisdom and political mobilization.”

Editor’s Note- Health Policy Watch is a media partner in the Geneva Health Centre’s series of WHA week events. 

Image Credits: Global Health Center.