What We DoIssuesGlobal HealthGlobal Health Resource CenterHard-fought Wins for Global Health at WHA77
Written by: Molly Moss, Global Health Policy Officer, United Nations Foundation
Last updated June 3, 2024
As the 77th World Health Assembly (WHA77) ended over the weekend, delegates, dignitaries, and other global health champions walked away feeling relieved that the week-long meeting ultimately delivered a win for multilateralism and pandemic readiness. At the last possible moment, the 194 Member States of the World Health Organization (WHO) agreed on a suite of targeted amendments to the International Health Regulations (2005) after more than two years of negotiation. The Assembly also endorsed the 14th General Programme of Work (GPW14), which serves as WHO’s strategic plan for 2025-2028 and provides a set of priorities and goals for global cooperation on health.
However, these successes were often overshadowed by political debates as deep geopolitical divides and shifting international norms presented serious roadblocks to the work of the Assembly, particularly in relation to conflicts, health emergencies, and gender-related issues. These challenges were also evident in Member States’ inability to meet their self-imposed deadline to adopt the pandemic accord, a new legal agreement envisaged to complement the IHR, at WHA77. Despite this setback, countries have agreed to continue negotiations with the goal of concluding an agreement by the next World Health Assembly in May 2025.
In his welcome remarks to the Assembly, WHO Director-General Dr. Tedros braced delegations for a tough week, saying, “No one said multilateralism is easy, but there is no other way.” In review, WHA77 will ultimately be remembered for hard-won successes for global health and international cooperation.
The high point of WHA77 came mere hours before the Assembly closed as countries made the landmark decision to adopt a package of amendments to the International Health Regulations (2005) or IHR, marking the conclusion of a laborious intergovernmental negotiation process that was mandated in 2021. The amendments aim to enhance the transparency and timeliness of information sharing; increase equitable access to critical health products; and make the global health security architecture stronger while maintaining the sovereignty of individual states. Member States celebrated this eleventh-hour agreement as a milestone in global cooperation, but they also made note that the next step of the IHR process is for domestic governments to evaluate each individual amendment and decide to accept or opt out of these international rules. The accepted amendments will come into force 12 months from the date the Director-General formally notifies countries that the amendments have been adopted, which will likely take place this week.
The pandemic accord was not finalized as planned, however. Despite prolonged negotiations in the weeks leading up to the Assembly, it became apparent that the accord would not be adopted during WHA77. In the current draft, 17 of 34 articles are fully agreed, but “fundamental differences remain on core issues central to the agreement” according to a statement from the delegate from the United States. “These are complex, technical issues that require extensive deliberation and carefully crafted, workable solutions…” The outstanding issues include concrete measures that would help developing countries, like transfer of technology, localized production capacity for medical countermeasures, and a pathogen access and benefit sharing mechanism.
Building on the momentum of the IHR approval, delegations are eager to expand on the foundation the accord process has yielded thus far and tackle the remaining contentious issues. Throughout the Assembly, a group of delegates met behind closed doors to negotiate a plan for the work to continue. In the final hours of the Assembly, Member States agreed to a resolution that extends the negotiating deadline for the accord by one year, to the next World Health Assembly in May 2025. It also includes a provision that allows members of the Intergovernmental Negotiating Body Bureau to rotate, bringing in fresh leadership for the next leg of the negotiations. Delegates expressed urgency in concluding this process, which is at risk of being disrupted by shifting political forces with dozens of national elections occurring in the second half of 2024.
WHA77 hit another high note with Member States’ approval of the 14th General Programme of Work (GPW14), which will contribute to averting 40 million deaths over the next four years. The GPW14 is a significant evolution from its predecessor. The Triple Billion targets, which characterized GPW13, have evolved into absolute targets for global health. Of the projected 8.4 billion people living in the world, 6 billion will be enabled to live healthier lives, 5 billion will be able to access health services without financial hardship, and 7 billion will be protected from health emergencies. The plan’s six strategic priorities emphasize the need to address inequities, health systems strengthening, preventive approaches, and the health impacts of climate change. While the plan is strongly aligned with the principles of universal health coverage, Member States noted that GPW14’s focus on social determinants of health will require a level of multisectoral cooperation that the health agency will be challenged to deliver on. The price tag of the base budget of the new plan is $11.1 billion over four years.
The adoption of the GPW14 provided a timely backdrop for the launch of WHO’s first Investment Round, which is an effort to secure $7.1 billion in unearmarked, up-front commitments. In combination with $4 billion in Member State dues, a successful Investment Round would help fully finance the GPW14 and allow WHO maximum flexibility in resourcing its work. It is important to note that WHO is not asking for more money with the Investment Round, but rather more flexibility in the way voluntary contributions are utilized. Dr. Tedros acknowledged that this ask is coming at a difficult time for the global economy, but the case was made by him and others that the investment is a worthy and modest one, amounting to 24 cents for every $100 spent on cigarettes per annum.
A few Member States made early commitments during the Assembly, including: Singapore (a new donor to broaden the donor base); Ireland (which increased its Member State dues earlier than the planned 2028 deadline), and the European Commission (which committed flexible money up front, for predictability). Several Member State co-hosts and champions of the Investment Round will convene regional fora to socialize this new way of financing ahead of a high-level financing event to be held in Brazil in November as part of the G20 Summit.
While the Assembly clocked some important victories in multilateral cooperation, it also served as a chessboard for geopolitical maneuvering. Throughout the week, the work of this technical public health body was repeatedly logjammed by rounds of voting on issues related to the health conditions in the occupied Palestinian territory and the ongoing health emergency in Ukraine. A small group of countries set in motion another lengthy voting process by objecting to the use of the term “gender-responsive” in the resolution on Strengthening health emergency preparedness for disasters resulting from natural hazards.
The Member States of WHO have historically placed a high value on agreeing by consensus on important global health policies. Voting, which was once a measure of last resort, has become more common in recent years and was on full display at WHA77 with eight rounds of voting consuming many hours of the agenda. The WHO is an organization of states, so it’s inevitable that politics are involved. However, the trend of working without consensus threatens to weaken the acceptability of technical public health resolutions and erodes the foundations on which future policy is made.
WHA77 is now over, but like all World Health Assemblies, the policies agreed will influence global health governance for years to come. This year’s agreement on amending the IHR is especially significant, as the IHR is the premier international legal instrument guiding countries in their response to health emergencies. That countries could agree on these new rules is a testament to their ability to come together in the face of significant headwinds to forge a shared vision for global cooperation on health.
Molly Moss covers policy issues related to global health governance, antimicrobial resistance, and Universal Health Coverage. Molly manages the Foundation’s official relations status with the World Health Organization and also supports engagement on health issues among UN Member States in New York. Prior to the UN Foundation, Molly worked for the Center for Global Health at the University of Colorado, focusing on immunization, pediatric infectious disease research, and research ethics. During her time at the University of Colorado, Molly earned her Master of Public Health in community and behavioral health. She holds a bachelor’s degree in medical anthropology from Hampshire College.
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