75 Years of WHO: The World Health Assembly Considers What’s Next for the Global Health Agency

When the World Health Organization (WHO) was established 75 years ago, the global health picture looked markedly different than it does today.

Smallpox was still spreading around the globe. Between an estimated 300 million and 500 million people worldwide died from the disease in the 20th century alone.

No coordinated global system existed to track the spread of disease, making it hard to control and contain outbreaks, especially those that spread across international borders.

And countries had very little information on how to use a newly discovered class of drugs with tremendous potential: antibiotics.

The newly founded WHO took on each of these challenges: working with partners and countries to eradicate smallpox, establishing the first-ever disease tracking service, and providing guidance for countries on how to properly use antibiotics and other health products.

Today, WHO continues to defend everyone’s right to health. However, its work is complicated by increasingly complex global challenges, from geopolitical tensions to economic fragility, intensifying climate impacts, and disruptive mis- and disinformation trends. At the 76th World Health Assembly from May 21 to 30 in Geneva, WHO’s 194 Member States and other stakeholders will apply lessons learned from the COVID-19 pandemic to strengthen WHO and build health systems that are fit to respond to modern challenges.

Reforming the Preparedness and Response Architecture for Health Emergencies

With the tremendous toll and trauma that the pandemic inflicted worldwide still fresh, global readiness for future pandemic threats remains a top concern. Countries around the world are deep into negotiating two intergovernmental legal agreements to improve global preparedness and response to health emergencies. One process is being led by Member States through the Intergovernmental Negotiating Body (INB) to draft and negotiate a new pandemic accord. Another negotiation process, also led by Member States, will update the International Health Regulations (IHR), which were first agreed by participating countries in 1969 and last revised in 2005.

These two negotiations are now well underway, and their outcomes have the potential to significantly strengthen the rules-based international system for how countries respond to and work together to manage health emergencies. Member States anticipate that the final outcomes of these processes, which will not be determined until the World Health Assembly in 2024 at the earliest, will enable the world to respond more rapidly, effectively, and equitably to the next health crisis. Through negotiations this year, Member States will strive to balance high ambition with political feasibility on tricky issues like enhancing equitable access to countermeasures like vaccines and treatments. Member States’ policy positions are predictably far apart on issues such as intellectual property and technology transfer. Progress reports from the INB and the IHR processes will be presented at this Assembly, and there will be plenty of unofficial discussions on this topic on the way to 2024.

The World Health Assembly will also review WHO’s work on a range of other health emergencies, given that the organization is responding to 56 graded health emergencies. These include nine acute emergencies, such as the cholera outbreak affecting countries across Africa and the Middle East, the aftermath of the February 6 Türkiye-Syria earthquake, and the ongoing war in Ukraine. Because 70% of disease outbreaks that WHO responds to take place in fragile, conflict-affected, and vulnerable settings, WHO leadership will update Member States about its Global Health for Peace Initiative. The Assembly will consider a draft strategy for the initiative, which focuses on addressing drivers of critical health needs in crisis settings and reinforcing the role of health as a core element of peace and sustainable development.

Growing Momentum for Universal Health Coverage & Primary Health Care

As the world adapts to the reality that COVID-19 is here to stay, the urgency to make progress on universal health coverage is higher than ever. The core principle of UHC — that all people have access to the health services they need, when and where they need them, without financial hardship — is key to making progress on the Sustainable Development Goals (SDGs) and is explicitly stated under SDG3: Good Health and Well-Being.

In 2022, Director-General Tedros Adhanom Ghebreyesus made it one of WHO’s five priorities to help countries reorient their health systems from vertical programs and specialized care toward primary health care. WHO estimates that up to 90% of essential health services can be delivered through primary health care and that investing in primary care could increase global life expectancy by as much as 6.7 years by 2030.

Political momentum for strengthening primary health care is growing, which is one of the reasons why Member States have agreed to hold a high-level meeting for universal health coverage during the UN General Assembly in New York in September. At WHA in May, Member States are expected to adopt a resolution to keep primary health care as a central focus for the high-level meeting and its corresponding political declaration. UHC is a political choice, and this broad commitment to UHC in Geneva and New York sends an important message that countries are serious about getting progress toward universal health care back on track.

Getting it Done: Sustainable Financing for WHO

One of the primary functions of the WHA is to provide Member States with an official pathway for creating new mandates, for the WHO secretariat to execute, such as providing technical support to countries or organizing consultations. Each new workstream that is assigned to WHO through this process has one thing in common: They all require financing. WHO has dealt with insufficient and unpredictable funding for most of its 75-year history, and currently less than 20% of WHO’s budget is covered by predictable, fully flexible financing. Recognizing the eroded quality of its financing, a Member State working group recommended a series of measures in 2021 to improve funding for WHO.

During the WHA in May 2022, Member States decided to increase membership dues to WHO, officially called “assessed contributions,” over the next six years. This year, Member States will have to uphold that commitment in practice by approving the biennial program budget for 2024–2025, which will reflect the new dues scale. Such approval would not only enable WHO to more effectively deliver its mandate but it also would send an important political signal about the centrality of WHO as the world’s coordinating authority for health.

While the discussion of increasing assessed contributions is well advanced, Member States will also actively consider other recommendations from the Member State working group regarding ways to enhance the predictability and flexibility of voluntary financing for WHO. The vast majority of WHO’s budget relies on voluntary funds, which often are earmarked to address specific priorities and can be withheld at any time. This inflexibility has prevented the organization from addressing areas of its work that are chronically underfunded.

New Health Challenges Ahead

Even as Member States and WHO grapple with how to make best use of finite resources through the budgeting process, new and complex health challenges loom that will require WHO to continue to evolve, adapt, and potentially expand its scope of work. Challenges such as mental health disorders and health impacts of environmental and social factors are increasingly understood as significant threats to health and well-being that demand multisectoral solutions.

Earlier this year, WHO Member States welcomed a new draft global framework for addressing some of these worsening trends, and the strategy will be reviewed again at WHA76. As the organization looks ahead to its next 75 years, these issues are likely to be significant drivers of disease and serious impediments to global wellness and prosperity. WHA presents a platform for Member States to demonstrate their commitment to ensuring that WHO has the resources it needs to work in new ways and with new partners to achieve a world in which everyone can live healthy, productive lives regardless of who they are or where they live.