How committed is the world to a stronger WHO?

The World Health Assembly (WHA), the top decision-making body of the world’s top global health agency, the World Health Organization (WHO), is meeting in person from May 22nd in Geneva. It has one week to better prepare the world for the next pandemic.

This content was published on May 22, 2022 – 10:00

“If there were a new pandemic threat this year, next year, or the year after, we would be largely in the same place as we were in December 2019,” Helen Clark, former co-chair of the Independent Panel for Pandemic Preparedness and Response (IPPPR), said at a press briefing earlier this month.

The IPPPR was established in 2020 to draw lessons from the pandemic and to suggest reforms to the WHO that would allow it to better address future health threats. Its former co-chairs published a report this month to assess the progress made.

“In terms of reforms, there have been some small steps, but to us, they remain very insufficient,” says Michel Kazatchkine, a former member of the IPPPR.

The pandemic has shone a spotlight on the WHO’s role as a scientific guide on health-related issues. It has also laid bare the discrepancy between the world’s sky-high expectations towards the WHO and its underfunded budget.

The WHA is expected to approve a reform of the WHO’s funding. It will also try to move ahead on a much-awaited pandemic treaty. How far they will get though, will depend on how much the 194 members can align their sometimes conflicting priorities.

More money

One of the main lessons of the pandemic was the inadequate level of funding for the WHO.

Currently, assessed contributions – the membership fees of the WHO’s member states – only cover about 16% of the organisation’s budget. The rest is financed through so-called voluntary contributions from countries, other international organisations, and private actors that are largely tied to specific programmes.

These contributions are unpredictable and, some argue, compromise the WHO’s independence, because it has to rely on a small number of influential donors. The Bill and Melinda Gates Foundation, for example, is the second largest contributor to the WHO after Germany and ahead of the United States. But its funding is mostly funnelled towards polio eradication.

“The world will not be safe until we have a better financed WHO,” says Björn Kümmel, deputy head of the global health division at Germany’s Federal Ministry of Health, and chair of the WHO’s Working Group on Sustainable Financing. Especially, he believes, because investments to prevent health crises from happening have repeatedly been neglected in the past.

The Working Group on Sustainable Financing was established in 2021 by the Executive Board of the WHO to find solutions to the organisation’s financial problems. But until recently, member states could not agree to increase their contributions.

The group has now produced a draft resolution – that still needs to be adopted by the WHA – to gradually increase their mandatory fees to cover 50% of the WHO’s budget by 2030-2031. Experts say such an agreement would be historic, but the timeline remains an issue. Financial uncertainty will remain the norm for years to come.

“We’re discussing a huge increase in percentage, but we are not asking for a huge increase in absolute terms,” says Kümmel, who adds that the increase will amount to $1.2 billion (CHF1.17 billion) over eight years. The bill will be split between 194 member states, with larger and richer countries such as the US, China, Japan, and Germany supporting most of the increase.

A small investment when compared to the price countries have had to pay to respond to the pandemic, Kümmel points out.

Binding rules

Another big step to better prepare the world for a future global outbreak was the WHA’s decision last year to start negotiating what could become a pandemic treaty. But this too has been a slow process.

“The treaty is moving at a snail’s pace,” says Kazatchkine. “Negotiations are not progressing at the same pace as the virus is or the next epidemic will.”

Drawing up an international agreement is a notoriously complex and time-consuming process. The current Intergovernmental Negotiating Body will not produce a draft text for another two years. At the earliest, an agreement could be reached at the WHA in May 2024. But more time is likely be needed until it comes into force.

To this day, countries have only agreed to establish a legally binding WHO treaty once. That is the 2003 Framework Convention on Tobacco Control (FCTC), which oversees the global sale and marketing of tobacco products.

Details about what a pandemic treaty would cover remain unknown. Experts have recommended that it gives the WHO the power to send experts to investigate new outbreaks without having to ask for countries’ permission. But some fear that the current process is not the right approach.

“I don’t think at this stage that there is enough evidence that we need a new pandemic treaty,” Nicoletta Dentico, head of the global health programme at the Society for International Development (SID), told the Inside Geneva podcast.

According to her, updating the current International Health Regulations (IHR) – a set of legally-binding rules that address health emergencies – would be a more productive approach.

This view is shared by countries that have proposed amendments to the IHR, but some experts fear that these are attempts to avoid giving more power to the WHO through a pandemic treaty.

The US has put forward a draft amendment that the WHA will consider. It proposes to shorten the amendment process, which currently takes two years, so that future revisions can come into force more quickly. But the revisions themselves are not currently on the agenda.

Time is running out

More than 2.7 billion people in the world are still waiting for their first vaccine dose. In low-income countries, less than 15% of the population has been fully vaccinated. This failure to vaccinate the world is a “collective moral stain on our history,” says Joanne Liu, a former IPPPR panel member.

Some experts argue that a pandemic treaty should also consider the fair distribution of vaccines and other medical supplies. But this too is going to be difficult. At the World Trade Organization (WTO), member states have been haggling over a waiver on intellectual property rights for Covid-related technologies for almost two years, but have not been able to reach an agreement.

“And that’s just for one waiver for one disease. […] You can imagine, trying to get an agreement on the types of difficult issues like intellectual property that we have to address in a broader pandemic treaty, that’s going to be tough,” says Suerie Moon, co-director of the Global Health Centre at the Geneva Graduate Institute.

Vaccines were developed in record time but were not all well suited for lower income countries as mRNA vaccines had to be stored at very low temperatures. Meanwhile, the COVAX mechanism, which aimed to ensure a fair and equitable access to vaccines for every country, showed its limitations. Richer countries used it to dispose of surplus doses – it was too little too late.

“When we start researching and developing vaccines, we must already think about access for everyone and not about access for the richest people and then subsequently look for mechanisms so that it also goes to the poorest,” says Kazatchkine.

The WHA will take place at a time when many countries consider the pandemic to be behind them. The war in Ukraine has polarized the world and made international cooperation harder. Health experts urge WHA member states to not give up on the fight against Covid.

“The clock is ticking. As high-income countries pull themselves out of this pandemic, it becomes invisible. And when it becomes invisible to the high-income countries, it means it doesn’t exist anymore, even if low-income countries are still fighting it,” says Liu.

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