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Reforming WHO, Health as Security, NCDs and Vaccines: Four Issues COVID has Impacted at the World Health Assembly

By Ayushi Parvathaneni Pathipati, Policy and Advocacy Consultant at Vital Strategies

The world is seeing a sharp resurgence of COVID-19 cases, and Geneva, Switzerland where the World Health Assembly traditionally is held is in lock down, but the 73rd World Health Assembly (WHA73) resumed for a fully virtual second session earlier this month—picking up from where they left off in May—with a packed agenda.  

The meeting was different than the initial May convening, which was a one-day virtual meeting dedicated solely to the COVID-19 response. This time, global leaders included robust discussion of the importance of not neglecting people living with noncommunicable disease and other chronic health conditions. Also, in response to criticism that May’s meeting excluded the voice of civil society experts, this meeting included venues for civil society stakeholders to make statements.  

There was a palpable sense of relief due to the election of Joseph R. Biden Jr., President-Elect of the United States, as his administration will likely reverse many of the decisions made under President Trump that weakened global cooperation on health. Biden has indicated that he will prioritize Covid-19 control, public health, and recommit to the World Health Organization (WHO) and The Paris Agreement on climate change. And in much needed acknowledgement to those who have worked tirelessly fighting Covid-19 this year, member states designated 2021 as the “International Year of Health and Care Workers.”

Like the growing pains of many virtual summits this year, WHA saw its fair share of fitful internet connectivity, unmuted interjections, and featured canine barking. Despite these challenges, issues ranging from WHO reform and funding, to deteriorating health conditions in the Palestinian territories were discussed. They also tackled maternal, infant and young child nutrition, digital health, and the international recruitment of health workers.

Here are our key takeaways from the reconvened WHA session:  

Reforming and Strengthening WHO  

After much discussion, The European Union (EU) took the mantle of much-discussed WHO reform by working on a WHO reform document, drafted by the German government. The EU draft document seeks to strengthen UN and WHO responses to future health crises and also urges Member States to support country assessments through independent experts in high-risk areas during health crises. German Health Minister Jens Spahn emphasized and encouraged member states to share more information and resources.

Low and middle-income countries (LMICs) expanded on the idea of reform and stressed the urgent need for investments, equipment and technological tools to support emergency response. LMICs stressed the need for predictable and stable funding and keeping costs low. 

While the world wasn’t prepared for this pandemic – it could, and should be. On 10 November, WHA approved a resolution focused on strengthening WHO and global preparedness for health emergencies. In particular, the resolution calls on WHO and nations to restore emergency preparedness processes, response, investments and compliance with International Health Regulations that had not been updated since 2005.

Emergency Health Preparedness Pivoting from Public Health to International Security

“Our Annual Budget is equivalent to what the world spends on tobacco products every single day. If the world can send that much money up in smoke every day on products that maim and kill, surely it can find the funds and the political will to invest in promoting and protecting the health of the world’s people.”

– Dr Tedros Adhanom Ghebreyesus, WHO Director-General

The pandemic has dramatically shifted global health from a development issue to a security issue. Nations now realize that to protect their citizens, global governance of health requires significant improvement. Today, public health is as great a security issue as national conflict, and a weak health system makes it virtually impossible to effectively govern.  

Minister Jens Spahn, the German health minister, spoke on behalf of the European Union and highlighted that there is a gap between WHO’s 194 member states’ expectations of WHO and its capacity to fulfill them. Nations will have to step up with the funds to fill this gap, he warned.

There are significant barriers: Some countries, including influential  Russia and China,  agreed that additional funds were necessary but were opposed to wide-ranging reforms citing concerns around country sovereignty.

Ramping up Efforts to Address Noncommunicable Diseases – An Epidemic Exacerbated by a Pandemic.

Also addressed at the WHA was the way forward for noncommunicable diseases (NCDs) and an acknowledgement of the disruption of care for people living with NCDs and other chronic conditions. The pandemic has put NCDs in the spotlight as people living with cancers, diabetes, heart and lung diseases are at a greater risk of developing serious complications and dying from COVID-19.  

Even before the pandemic, NCDs were the leading cause of death and accounting for 71% of global deaths. Due to public health and social measures such as lockdowns many countries put in place to prevent the spread of the virus, many communities have seen an increase in consumption of unhealthy food, sugary drinks, alcohol and tobacco. Unhealthy commodities industries in turn have created corporate social responsibility campaigns that offer free products as aid. The COVID-19 pandemic has already laid bare the fault lines in global health, but as countries prepare their national health strategies for the future, it is critical to address the behavior of corporations selling unhealthy products.

  • Tobacco consumption is linked to the onset of the four most common NCDs- lung disease, cancer, heart disease and diabetes. At Vital Strategies, we support 11 LMICs countries with high tobacco consumption by encouraging policies that limit tobacco use, including smoke-free environments and tobacco taxation. STOP a global tobacco industry watchdog, in which Vital Strategies is a partner monitors and challenges industry interference in policy making.
  • Vital Strategies recently published “What’s in Our Food?,” a guidebook introducing effective front-of-package nutrient labeling to governments and public health leaders. Food labels that indicate the presence of harmful ingredients can empower consumers to make healthier choices and prevent early onset of NCDs.

A Vaccine for All: How will Nations Address Vaccine Hesitancy and Inequity?  

With COVID-19 vaccines finally on the horizon, countries actively debated vaccine development, distribution and what intellectual property means in the age of a pandemic. This week, biotech firm Moderna announced that its COVID-19 vaccine candidate has 94.5% effectiveness in protecting against COVID-19. Moderna joins Pfizer in developing a vaccine that is over 90% effective which show no significant side effects. 

With recent progress, there is hope that the COVID-19 pandemic can be controlled.  That said, challenges remain.  Beyond vaccine disbursement, two significant issues loom –

  • How to allocate a limited supply of vaccines.
  • How to allay fears around safety and efficacy of the vaccine.

Thus far, WHO and other experts have encouraged a framework to prioritize health care workers and high-risk adults (those over 65 with underlying conditions).  

Even if countries such as the U.S. manage to secure doses for the population of 300 million Americans, polls suggest that only 50% would be willing to be inoculated. Also, vaccine hesitancy isn’t just an American problem, countries across the globe are grappling with similar challenges: 

  • In South Africa and India, opposition to vaccines is 21% and 19% respectively.
  • In Spain and Brazil, 48% of people have fears around the rush of clinical trials.

To bring this pandemic under control nations have their work cut out, and must continue educating communities about the safety of science-based interventions. 

As COVID-19 continues to spread across the world, the World Health Assembly served as a critical moment to reimagine the importance of public health, and to reinforce cooperation and community as we build a world that meets the need of those effected by COVID-19, food insecurity, NCDs and beyond.