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On being resilient at the World Health Assembly

By Kristof Decoster
on May 21, 2015

I’m about to leave Geneva, after my first  ever “immersion” in the World Health Assembly.  The assembly is not even halfway, and so I have absolutely no intention of giving key messages so far. But the main reason for being cautious is this one: I agree wholeheartedly with the assessment given to me by a senior Swiss lady who has been following the WHA, in different roles, for over 20 years. It takes a while to understand what’s really going on here, mentorship seems key (I was lucky to have Remco van de Pas, a seasoned WHO watcher, around) and so you probably first have to be here for the full duration of a World Health Assembly before you can hope to be “effective” the year after.  (I also went to a briefing for new delegates before the WHA, on Sunday, at the (well-resourced) Graduate Institute, which was helpful as well.)

So here are some of my own impressions so far, based on very fragmentary information. I’m sure that the many global health aficionados, passionate  IFMSA participants, career global health people,  and the more seasoned WHO watchers over here have plenty of other insights. Or just follow Laurie Garrett, Pam Das, and many others on Twitter, if you find the time.

* Mrs Merkel’s visit to the Assembly on Monday (she was the main invited speaker) was short and a bit disappointing, even if she discussed the Ebola response, needed WHO reforms and the upcoming G7 global health agenda. Nevertheless, and in spite of the heavy security, she was an excellent choice. If WHO is partially responsible for the fact that the Ebola crisis became a pandemic, Merkel is no doubt also partially responsible for the current mess in Greece. So let’s hope she can empathize a bit with the WHO people in these difficult days.  (I suggest that next year, when the WHA might discuss the outcome of Paris (who knows?), we invite Vladimir Putin.)

* Margaret Chan’s address in the afternoon was a lot better. I’m a big fan of Margaret, I have to say. For one, she looks very ‘resilient’ – and thus a perfect match for this WHA’s theme: “building resilient health systems”. As other people have noted, she also has the gift to come up with quotes that can loosen up audiences. My favourite Chan quote of this WHA: “If a problem is complex, leave it to a woman.”  (makes you wonder what she has in mind for men – she probably thinks that our minds are all focused on the many ‘hot legs’ on offer over here)

* Speaking of resilience, you can’t escape the feeling that the focus lies here on the ability to cope with and recover from shocks, rather than on the ability to prevent shocks. The latter gets some emphasis too, but less than the first.

* If anything, trying to keep up with all that’s going on at the WHA is a complex venture, and that’s just for all the things happening in the open, in sessions, General Assembly meetings, or on social media. You have to be some combination of a multi-tasking bright woman, a steeled man in perfect physical condition as well as a Bill Clinton-style networking schmoozer to survive here, in short, to be a ‘resilient’ WHA participant. I’m afraid I don’t fit the bill. Just following Adam Kamradt-Scott’s tweets on the WHA is already almost a full-time job! (great resource, by the way, his tweets) WHO now also offers live webcasts and in general has improved its communication on the WHA.  In the evenings, it really gets hectic when there are at least three or four events you’d like to attend. Following the twitter feed can also make you dizzy, the hashtag #wha68  was even ‘trending’, at some point.

* The president of this WHA, Shri Jagat Prakash Nadda from India seemed quite eager to promote International Yoga Day in his opening speech, so Mr Modi might be another option for next year’s invited speaker. By the way, for some reason, it feels natural to have an Indian president for this sort of Assembly, with so many ‘distinguished guests’, ‘honorable speakers’, ‘esteemed colleagues’, … around here.

* The technical briefings at lunch time tend to be ‘value for money’ (even if they really have to do something about the sometimes suffocatingly hot meeting rooms (with the SDG technical briefing as a sad case in point, as if to prove something in terms of the climate urgency)). They do give a good update on key global health issues, and also on dealings with other UN institutions, in order to find synergies.

* ‘Value for money’, investment cases, Grand Convergences, the Copenhagen consensus … are less prominent here than at some other global health gatherings. No doubt a good thing.

* Speaking of value for money, we should do something about the (fortunately) short but often very woolly speeches by ministers in the General Assembly. After listening for an hour or so, on Tuesday afternoon, I had more than enough of all these utterings on the need for resilient, robust, responsive … health systems. Easy talk. No, then some of the Committee A meetings are far more fun. When the delegates discussed the programme budget, for example, I even heard a whiff of Margaret Thatcher from the UK representative, lecturing Chan et al in a way only British people feel entitled to. Money always makes people focused. Especially the Brits in the Cameron era.

*As for the key themes of this Assembly, so far, in addition to, obviously, the Ebola response and the related WHO reform, global health security in general is predominant here, with among others the urgency of AMR becoming clearer day by day (the next step is to go from increased global awareness to action, it was emphasized). But also SDGs & health, climate change and health, and pretty much any other global health agenda item that merits attention in our increasingly dangerous world gets attention here. As I tweeted, we seem to need an ‘SDG tree’ just for health alone. The only exception, perhaps, and I agree with David Legge here, is that trade and investment agreements don’t get much emphasis. In general, even if Bill Gates is not around, at least not in person, there’s not much mention of the transnational capitalist class (even if we acknowledge the fragmentation within the global elite, and thus the difficulty of using this lens).

* As for that other evergreen, the relationship with non-state actors, much happens behind the scenes, as you might expect. The briefing in the Graduate institute, by some slick Swiss WHO staff member (you probably have to be slick for this sort of negotiation), on this particular topic, was also illuminating. And then there’s of course the messages that countries like the US try to get out via some of their ‘friends’.  Quite a theatre.

* In spite of the pristine setting here in Geneva, there is definitely a ‘sense of urgency’ on the world’s multiple threats. That was clear for example in the AMR related session, or in a presentation by Anthony Costello (another one of my global health heroes) on the forthcoming report on policy advice on climate & health which will offer 10 recommendations, the key message in the same session that the CoP treaty in Paris also needs to be a public health treaty (“let’s turn climate change into the greatest global health opportunity of the 21st century”), or the SDG related technical briefing (although that one was moderated by Richard Horton, which always helps to focus minds on the planet’s dire situation). Chan also didn’t mince words in her opening speech, of course. And of course, we hear over and over that there is no planet B.

* As for the budget, it appears WHO gets a bit more budget space for ’16-‘17. Whether that will also materialize in more money will depend on the Financing Dialogue. There was definitely no room for a 5 % increase in assessed contributions, no surprises there. Maybe, as a seasoned WHO watcher said, because this might open a ‘can of worms’ for diplomats and set a precedent for other UN institutions? I suggest that from now on, we open every WHA with Madonna’s ‘Frozen’.

* Anyhow, at the very least, if we agree that the Ebola crisis was not the ‘finest/proudest hour’ for the global health emergency response, it appears that the global community is not exactly seizing the ‘cosmopolitan moment’, the ‘defining moment’ for global health, or whatever you may call it.

* On Wednesday, I attended a very nice breakfast meeting on PEF (or is it PEFF), the Pandemic Emergency Facility that the World Bank is working out, in close collaboration with, among others, WHO. Tim Evans and Bruce Aylward get along fine, these days, which is probably a good thing. For some, this might prove that WHO has gotten closer to the World Bank, but I think it’s also true the other way around. Anyhow, If you do decide to work ‘within the system’ as it is, it doesn’t sound like a bad idea (but perhaps the VIP breakfast and gorgeous setting (8th floor, looking over the lake) had pampered me a bit too much – quite a change from John Knox where I’m staying). It’s clear a lot of nuts and bolts still have to be worked out – and I could see that typical ‘bottomline’ look in the eyes of the Re Munich panel participant (I’m afraid we’re going to see a lot more private companies trying to make profit in the coming age of ‘catastrophe capitalism’), but for example the division of labour with WHO’s new Contingency fund sounds like a sensible idea. We would need, of course, ‘universal coverage’ of LMICs… (not exactly the private sector’s strong point, as you know).


In sum, as you can see, although fascinating, this event requires more resilience than the run-of-the-mill scientific conference. Just ask the WHO watchers, for example, who are doing a great job over here.

Resilience for all !

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