At a time when global public health is more visible than ever, the World Health Organization held its 74th World Health Assembly with a theme to “Build Back Better” and a message of restoring trust across the global health community.
Grappling with the COVID-19 pandemic that is still raging in many parts of the world, country representatives in the virtual meeting wrestled with a slew of related issues including vaccine equity and hesitancy, misinformation, mental health, battered health systems, glaring inequalities, protecting health care workers, and a lack of trust and transparency in the private sector. The assembly also highlighted the significance of social determinants of health, underscoring that where people live, work, and age is critical to their health outcomes.
Here are five takeaways from the event
Global Pandemic Treaty Delayed
To address shortfalls in pandemic preparedness and response, the European Union, France, Germany, South Africa, the United Kingdom and others sponsored a proposal for a global pandemic treaty. If adopted, it would be only the second public health global treaty, after the WHO Framework Convention on Tobacco Control. However, the proposal was tabled until November 2021, with some countries arguing that a treaty could not be effectively advanced during the pandemic and that more sustainable and long-term fiscal and accountability measures need to be considered first. The concept of a treaty is attractive, but many agree only if it can strengthen preparedness now – without delay – given the urgency of the pandemic.
For our take, read: “Will a global public health treaty help or hinder pandemic preparedness?” in BMJ Global Health, by Dr. Tom Frieden and Marine Buissonnière of Vital’s Resolve to Save Lives initiative.
WHO’s Role in Global Health Emergencies
Recognizing the concerns raised by stakeholders across the globe, WHO focused much of the assembly on promoting its recent efforts to strengthen and expand its role in global health emergencies.
A common thread throughout the sessions was WHO reform and the effective and timely implementation of the International Health Regulations, which task the WHO with acting as the main global health emergency surveillance system. Former Liberian President Ellen Johnson Sirleaf and former Prime Minister of New Zealand Helen Clark presented their findings as co-chairs of the Independent Panel for Pandemic Preparedness and Response, which was assigned the crucial role of promoting transparency and making sure WHO, its member states, and global institutions effectively address health threats. Their recommendations further highlighted skepticism about WHO’s efforts to mitigate the pandemic and bolstered the idea that WHO did not garner the political will it needed to function at the high levels necessary to address the crisis.
While acknowledging the concerns raised, Director-General Dr. Tedros Adhanom Ghebreyesus offered examples throughout the assembly of the global solidarity and trust WHO has built with its partners in recent months in creating two tools to advance vaccine equity: the COVAX (COVID-19 Vaccines Global Access) facility and ACT (Access to COVID-19 Tools) accelerator. A resolution adopted at the assembly reaffirmed WHO’s role as the chief global coordinating body during health emergencies.
But a last-minute call from the United States and others to investigate the origin of COVID-19 and to advance a WHO investigation in China into the origin suggests that there is still lingering mistrust.
Disturbing takeaway: The entire continent of Africa is receiving under 2% of the world’s vaccines. This may explain why some countries are less sanguine about WHO’s capacity to address this urgent health need equitably.
A Diabetes Resolution
A resolution on diabetes advanced by the Russian Federation urged countries to focus on the management of risk factors, such as obesity, by promoting healthy diets. WHO estimates that some 1.5 million deaths occur annually due to diabetes-related complications. The resolution includes key recommendations for physical activity and avoiding tobacco use to help prevent diabetes.
Some participants noted that while the world is commemorating the centenary of the discovery of insulin, many developing countries do not have the resources in place to pay for it due to price gouging and a lack of availability. This affects a huge number of the more than 420 million people worldwide who live with diabetes, and prevalence is rising rapidly in low- and middle-income countries.
In addition to emphasizing the importance of prevention, the resolution urges more regulation of markets. Corporate maneuvering, high costs, access issues contribute to a lack of equity and transparency in providing medicine and supplies.
For our take read: Vital Strategies is glad to see a focus on prevention but urges more of a push on equity in the distribution of essential medicines and more of a focus on public policy and structural change rather than calls for individual actions. The diabetes resolution is also aligned with Vital Strategies’ global policy priorities on healthy food. For further information on our food policy work, please visit our website.
Strengthening Commitments to NCD Prevention
Recognizing that COVID-19 has further stalled progress on noncommunicable diseases (NCDs), the assembly worked to advance an NCD agenda with support for prevention and control and a focus on Sustainable Development Goal 3—specifically Target 3.4 on reducing premature mortality from NCD’s by one-third by 2030 and the target related to tobacco control.
A staggering 1.3 billion people worldwide use tobacco products. Tobacco use contributes to all of the most common and deadly NCDs and makes COVID-19 cases more severe. The WHO hopes to encourage more countries to increase tobacco excise taxes, pass comprehensive tobacco control laws and ban smoking in public places.
The assembly also passed a resolution on improving oral health. Member states noted links between poor oral health and NCD risk factors such as the use of sugar, tobacco, and alcohol. More than 3.5 billion people suffer from oral diseases ranging from dental caries to oral cancers.
For our take, watch: Notable World Health Assembly side events focused on NCD prevention including one organized by Vital Strategies and the NCD Alliance, Investing in Health: NCD Prevention and COVID-19 recovery, and an event in partnership with the Pan American Health Organization entitled: New Decade of Action: Making Our Streets #StreetsForLife to commemorate UN Global Road Safety week in Latin America and to advance the New Decade of Action for Road Safety (2021-2030).
Limited Engagement with Civil Society
As has happened over the last several meetings, it is again worth noting that civil society organizations, known at WHO as non-state actors expressed concerns about WHO’s lack of engagement with stakeholder organizations in the lead-up to the assembly and during the sessions. Constituency statements had to be pooled together in a very short time frame with little feedback. A parallel WHO session for civil society in April was offered to provide these organizations with a voice, but made some organizations feel more outside the process than ever.
International civil society organizations reinforced their role as effective conveners to enable stronger partnerships and providers of much needed technical assistance. It seems clear that there are gaps in knowledge and capacity building initiatives that non-state actors could be called on to fill.
For our take, read: Vital Strategies believes civil society and other non-state actors’ engagement is critical. Further information on Vital Strategies’ position on non-state actor participation with the WHO can be found here.
About Vital Strategies
Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. We work with governments and civil society in 73 countries to design and implement evidence-based strategies that tackle their most pressing public health problems. Our goal is to see governments adopt promising interventions at scale as rapidly as possible. To find out more, please visit www.vitalstrategies.org or Twitter @VitalStrat.