For the past two weeks, as much of the world went about its business unaware, a critical meeting has been held in Geneva regarding the state of the world’s health – the 68th World Health Assembly. This year’s theme was resilient health systems, which when considering the number of complex disasters, humanitarian crises, conflicts, and health emergencies that are simultaneously occurring around the world, was aptly chosen. As a result, the 68th WHA arguably took on additional meaning this year and several critical topics were debated and, for the most part, agreed, that will have long-lasting implications for the world’s most vulnerable populations for years to come.
On the agenda this year were several pressing issues such as preventing the spread of antimicrobial resistance, global plans to increase the access and affordability of life-saving vaccines, polio eradication, progress in tackling non-communicable diseases, the need to address adolescent health, efforts to the health-related Millennium Development Goals and the inclusion of health targets in the post-2015 sustainable development agenda, implementation of the International Health Regulations, and reform of the World Health Organization itself. While debates at times became heated around specific aspects or proposals, the majority of discussion on the above topics proved comparatively straight-forward with governments declaring their support for the principles under consideration, if not the associated guidelines and recommended measures. As occurs throughout each WHA new pledges of support were announced, resolutions were amended, and eventually passed after being tweaked in drafting groups.
As anticipated, the 2014 Ebola outbreak in West Africa and global health security featured prominently throughout the assembly, serving as a catalysing point for many of the agenda items under consideration. Ebola was, for example, one of the key topics addressed by German Chancellor Angela Merkel in her opening address where she stressed the need to further reform the WHO so that it was capable of reacting more quickly to health emergencies. Consistent with the meeting’s theme of resilient health systems, the Chancellor also announced new commitments to support low-income countries strengthen their capacities and pledged that this would remain a priority throughout Germany’s presidency of the G7. The Ebola outbreak also emerged as a central theme of Dr Margaret Chan’s opening remarks to delegates. In an attempt to circumvent further criticism following the release of the interim report by an independent panel established to review the organization’s handling of the outbreak, the WHO Director-General outlined a series of reforms. These included:
The creation of the global emergency health workforce and emergency fund were discussed at length while government representatives sought to find common ground on a draft resolution on Ebola. Agreement was eventually reached on the proposed scope and operation of these measures, but it is also apparent that the devil remains very much in the detail and many months of work will be required to make these proposals a reality.
Importantly, however, not every topic under discussion gained agreement. One of the more controversial items under discussion had been to raise the level of annual government payments to the WHO, otherwise known as assessed contributions. Since the 1980s governments have declined to increase their assessed contributions, preferring instead to make additional funds available on a voluntary basis only. These voluntary funds frequently come with strings attached that serve, amongst other things, to prevent the WHO from reallocating financial resources when unanticipated events like the Ebola outbreak arise. Given that financial audits revealed that only 20 contributors provide 80% of the World Health Organization’s funds – and that not all these 20 donors were governments – it had been suggested that perhaps 2015 was the year in which the level of assessed contributions would be raised. For many governments, however, this proved too difficult to agree upon and even before the World Health Assembly had commenced the Director-General had brokered a compromise suggestion, advocating instead for an 8% increase of the overall budget. Yet again, even this alternative suggestion proved too much for some, and member states have agreed to temporarily increase the voluntary contributions they make while the level of regular payments remains unchanged.
Arguably one of the most critical elements under consideration at this year’s World Health Assembly that did not secure agreement was the proposed Framework for Engagement with Non-State Actors, or FENSA. Negotiations on the draft framework continued throughout the entire eight days of intergovernmental deliberations, and often late into the evenings after the formal work agenda had ceased. A number of non-governmental organizations, including Medicus Mundi International and the Peoples’ Health Movement, spoke against the risk of commercial and industry interests interfering with the work of the WHO, while industry representatives stressed the need that any agreed principles and practices should be applied equitably across the board without discrimination or distinctions being drawn. At the end of the day, however, member states were not able to arrive at a consensus amongst themselves on several key elements of the framework, and as a result this item has been deferred until the next World Health Assembly in 2016. Amongst those areas that proved especially problematic to resolve were issues around financial resources that the WHO could accept from non-state actors including industry groups; the level and extent of oversight to prevent conflicts of interest arising; the creation of an online register for non-government organisations that would require, for example, the disclosure of assets; and several other aspects. These areas of dispute will be discussed and ideally resolved at an intergovernmental meeting on the FENSA agreement later this year, but if the WHA offers any indication, it may very well be that the only actors happy with the agreement will be the WHO’s member states. Time will, most definitively, tell.