What We DoIssuesGlobal HealthGlobal Health Resource CenterWorld Health Assembly 78 – What Happened? What’s Next?
Written by Molly Moss & Camden Malone, United Nations Foundation
After an eight-day marathon of meetings, the World Health Assembly (WHA) wrapped up earlier this week. As ever, the annual convening of Member States of the World Health Organization (WHO) offered a forum for strategic global health decision-making during a highly dynamic time for the field. It also showcased the significant political influences at play in health and the growing use of global health policy as a tool of statecraft.
The Member States’ adoption of the Pandemic Agreement was a significant milestone in many respects, demonstrating the World Health Organization’s role as a forum for countries to cooperate on key health issues.
Elsewhere on the agenda, Member States agreed to a reduced budget envelope of $4.2 billion, representing a 21% reduction from the initially proposed $5.3 billion budget. Despite this significant setback, countries agreed to work toward a healthier financial situation for WHO through the approval of a 20% increase in assessed contributions, which will boost the proportion of flexible and predictable funding the Organization receives each year.
Throughout the Assembly, countries debated how WHO can best serve their unique needs, which continue to evolve rapidly in the face of emerging threats, such as climate change and conflict, declining Official Development Assistance, and other macroeconomic forces, as well as emerging opportunities, including the inclusive scale-up of digital technologies and AI.
Alongside public health discussions and administrative deliberations on WHO strategy, countries leveraged the Assembly to demonstrate their position on multiple ongoing geopolitical dramas. They were challenged to reach agreement on the role of WHO and the World Health Assembly on contentious political issues — like the wars in Ukraine and Gaza — which also have significant health consequences.
Traditionally, the Assembly approves decisions by consensus but in recent years, Member States have ramped up the use of voting during the Assembly, which erodes trust and jeopardizes programmatic work on health. This year, delegations voted a whopping 11 times on a range of issues. Political rivalries and alliances are driving states toward voting on technical resolutions, such as the Draft Global Action Plan on Climate Change and Health, as well as clearly political ones, like Raising the flags of non-Member Observer States at the World Health Organization. Apart from duplicating debates in other UN forums, these discussions and voting procedures are also time-consuming amid an already-packed agenda. Although valid global health policy considerations are at the core of these arguments, some votes have become unproductive and contradictory, considering that Member States always cite the need for efficiency and focus during the Assembly.
Countries also used the Assembly to position themselves in other ways. For the first time since WHO was established in 1948, the United States did not send a delegation to WHA. A pre-recorded message from Health and Human Services Secretary Robert F. Kennedy Jr. aired during the proceedings, which promoted global cooperation on health but not necessarily under the aegis of WHO. In contrast to the absence of the U.S., China sent the largest-ever delegation to WHA, with some 180 registered delegates.
Member States’ adoption of the Pandemic Agreement made this year’s WHA historic. Skilled diplomacy, along with encouragement of civil society advocates, helped steer the process away from the edge of defeat and toward the finish line. Despite the persistent challenges of geopolitics and mis- and disinformation, no countries voted against its adoption.
While the Agreement did not pass through the preferred Geneva way of consensus, the unanimous vote in-favor affirms Member States’ approval of the outcome. And against a tough backdrop for multilateral cooperation and for WHO, the fact that countries reached an agreement on a legally binding instrument to address the complex, multisectoral issue of pandemics ignites hope for renewed political buy-in to address our collective threats. With several mandates from the treaty assigned to WHO, the outcome also signals confidence in the Organization’s central role in safeguarding global health security.
But the Pandemic Agreement is a “Christmas tree that needs a lot of decorating,” said former Prime Minister of New Zealand and UNDP Administrator Hellen Clark on the sidelines of WHA. An Intergovernmental Working Group (IGWG) will meet no later than July 15 this year to begin negotiations on the details of the Pathogen Access and Benefit Sharing (PABS) mechanism, which is envisioned as key to operationalizing the vision of equity laid out in the Agreement. Countries will also have to spell out plans for the implementation of other key elements of the Agreement, namely the governance provided by the Conference of Parties, the Global Supply Chain and Logistics Network, and a Coordinating Financial Mechanism. The Assembly has requested the IGWG’s work on PABS to be completed by the next WHA in 2026. This is an extremely ambitious timeline as negotiations will be tedious and contentious, though undergirded by a foundation of agreed upon points already cemented in the Agreement.
Finalizing the PABS mechanism is mission-critical for two main reasons. First, the completed PABS system will be annexed to the whole document, and only then can the treaty be opened for signatures and primed for entry into force. And second, PABS is deemed the lifeblood of manifesting an agreement that, in the face of a pandemic, guides actions rooted in equity and collaboration that the international community failed to summon during the COVID-19 pandemic. While imperfect and unfinished, the Pandemic Agreement restores optimism in diplomacy that could help propel this crucial next phase of work.
After clocking a win early in the Assembly with the adoption of the Pandemic Agreement, Member States turned to difficult discussions about the state of WHO’s financing. The loss of funding from the United States and other donor countries has created a $1.1 billion budget shortfall, which will result in job cuts and significant restructuring of program activities. In the days preceding the Assembly, Director-General Dr. Tedros Adhanom Ghebreyesus announced a new senior management team, which was pruned from 14 leaders down to seven.
In a silver lining to this storm cloud, Member States chose to increase their assessed contributions (membership dues) by 20%. This step is part of an ongoing effort to enhance the quality of financing flowing to WHO, enabling the secretariat to respond more effectively to needs. Member States sought to create budget flexibilities wherever possible, including by allowing the secretariat to temporarily reallocate administrative funds, known as ‘program support costs’, to cover activities other than their initial purpose.
With these major changes underway, Member States are working to understand how their own priorities will be reflected in future work. When discussing how to make the best use of limited resources, a trend emerged showing that high-income countries tend to prioritize ensuring that the Organization focuses on normative guidance and standard setting, while low- and middle-income countries exhibit a preference for greater in-country technical support. Countries’ expectations of the Organization are changing amid new pressures and risks like climate change and health, and the growing burden of mental health conditions.
Throughout the week, discourse in Geneva — both inside and outside the Palais de Nations — reflected how science continues to deliver new vaccines, medicines, and diagnostics that hold the potential to drive health and prosperity for all. More breakthroughs are on the horizon, including the promise of the first effective tuberculosis vaccine in over 100 years.
With these solutions at hand, global health stakeholders from all parts of the ecosystem are asking how WHO, as the guardian of global health governance, can best be positioned to ensure that people everywhere benefit. As the Assembly concluded, it was clear that a greater sense of common purpose is needed to navigate these times of upheaval and uncertainty.
Last updated May 30, 2025
Molly Moss is a Director of Global Health at the United Nations Foundation. Molly leads the Foundation’s work on health in New York, covering policy issues related to global health governance, antimicrobial resistance, and Universal Health Coverage. Prior to the UN Foundation, Molly worked for the Center for Global Health at the University of Colorado, focusing on neonatal survival, immunization, and research ethics. During her time at the University of Colorado, Molly earned her Master of Public Health in community and behavioral health. She also holds a bachelor’s degree in medical anthropology from Hampshire College.
Camden Malone advances the global health agenda through engagement with UN Member States on a wide range of health policy issues, including universal health coverage, antimicrobial resistance, and pandemic preparedness, prevention, and response. Prior to the United Nations Foundation, Camden worked at the Permanent Mission of Costa Rica to the UN, covering intergovernmental negotiations related to health and human rights. Camden holds a master’s degree in International Affairs from the Colin Powell School for Civic and Global Leadership at the City College of New York; and a bachelor’s degree in History and Political Science from the College of Saint Rose.
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