Health Sovereignty and Reform at WHO’s 158th Executive Board

Alongside escalating humanitarian crises, steep funding cuts, and a visible retreat from multilateralism, the most recent meeting of the World Health Organization’s (WHO) Executive Board was, unsurprisingly, deeply political. Against this backdrop, the WHO Board pushed ahead with timely debates and decisions that underscored countries’ dual focus on national sovereignty and collaboration against health threats that do not respect borders.

Meeting February 2–7 in Geneva, Switzerland, Member States deliberated on pragmatic ways to adapt and optimize WHO’s role in preventing and responding to pressing global health challenges. Agreement on, and implementation of, reforms will shape the global health system’s ability to best serve and protect communities.

Reforming WHO governance and finance

The Board’s gathering followed a period of flux in global health finance and a reshuffling of WHO priorities that dealt significant blows to capacity and morale across the organization. The news that WHO managed to secure 85% of its core budget for 2026-2027 created room for optimism, though the remaining gap will be difficult to cover. Extensive budget cuts of about $1 billion, as well as steady increases in assessed contributions or membership dues, allowed WHO to achieve relatively stable financial footing. This fully flexible source of funding, which represented a mere 16% of the core budget five years ago, is approaching 50% of the total budget by the 2030-2031 cycle. Sustained progress against this outcome is essential for the agency to tackle its evolving mandate with agility and impartiality.

To make every dollar and second count, the Executive Board adopted several efficiency measures to reduce the overload of draft decisions and mandates. These resolutions, which were proposed by Member States, now require more diverse geographic backing to be eligible for consideration and will be carefully assessed by the secretariat to ensure alignment with strategic plans and the budget. While these reforms were hard-won, they reflect renewed consensus that WHO and its Member States must work together to improve efficiency in preparing for and responding to global health challenges.

WHO’s role in a complex global health landscape

The Executive Board reflected on WHO’s work over the past year as the global health landscape shifted dramatically. WHO assessed and verified around 500 health threats and worked with countries to respond to 450 of those events. The International Pathogen Surveillance Network, the Global Outbreak Alert and Response Network, and other networks translated public health intelligence into coordinated action. And in the Gaza Strip, WHO helped to vaccinate around 600,000 children to control the Strip’s first recorded polio outbreak in 25 years.

Central to WHO’s work are steps to promote trust and transparency, and WHO continues to serve as a guarantor of scientific norms and standards. Through its prequalification program and Essential Medicines list, critical treatments reached the market faster in the past year and expanded access for patients around the world, including new medicines for cancer and diabetes in people with obesity. To address continuing concerns about vaccine safety, WHO analyzed 31 independent studies in multiple countries over 15 years, which confirmed that vaccines do not cause autism.

These combined efforts have prevented the spread of disease and saved lives. Outbreaks of avian influenza (H5N1), Ebola, and most recently Nipah, as well as the resurgence of measles and other vaccine-preventable diseases are stark reminders of why the world needs WHO as a forum to collaborate on how to best keep people safe.

The future of the global health architecture

The Executive Board directed the WHO secretariat to design a process to harmonize recent initiatives on reforming global health architecture (GHA), or the ecosystem of global health actors and institutions, and the principles that drive them to enhance health outcomes in all settings. The GHA process mandated by the Executive Board seeks to align reform discussions that have emerged in the Lusaka Agenda, Accra Reset, and other forums. The joint discussion under WHO is also an opportunity to bridge GHA reforms with broader renovation of the UN system through the UN80 Initiative.

Between now and the 79th World Health Assembly (WHA79) in May, the secretariat will produce a technical report on the best way forward to facilitate inclusive and constructive dialogue on the future of GHA. Member States were clear about wanting to avoid more cumbersome negotiations and agreed that any joint process hosted by WHO would have to be agile and resource efficient.

At a time when nothing in the global health sector is guaranteed, Member States’ endorsement of WHO as a global convenor solidified its standing as the most inclusive setting for establishing shared values and principles in health cooperation.

Navigating geopolitical tensions and the path forward

The growing politicization of the WHO governing bodies’ work has counteracted some efficiency gains. Several of the Board’s technical priorities became subjects of political debate, including the Global Action Plan for Antimicrobial Resistance, whose progress stalled due to an intellectual property dispute. Tensions also surfaced regarding countries’ withdrawal from WHO. While most countries respect the sovereign right of every country to interpret, enter, and exit international treaties, the greatest concern is the public health ramifications of an à la carte approach to multilateralism.

After a busy week in Geneva, many officials returned to capitals to weave global policies into national strategies. It was a shorter turnaround for other diplomats who resumed negotiations of the Intergovernmental Working Group on the WHO Pandemic Agreement. Their mission is to finalize a Pathogen Access and Benefit-Sharing system in time for consideration at WHA79.

While WHO’s footprint is changing, new ideas will take hold for what the future of the organization, its membership, and its leadership should look like. As global health governance enters an age of self-determination, WHO still stands as the preeminent forum for developing a shared understanding of vital global cooperation. However, this Executive Board meeting affirmed high expectations for the agency to leverage its comparative advantages further.