Tom Micklem, Senior Account Executive at Incisive Health, discusses the key takeaways from the WHO Executive Board Meeting 2024, and the extent to which domestic politics may influence progress in a record-breaking election year.
This Saturday, 27 January 2024, saw the conclusion of the 154th session of the World Health Organization’s (WHO) Executive Board (EB) in Geneva, Switzerland. At the start of each year, the WHO EB meets to set the agenda for the World Health Assembly (WHA), the WHOs highest decision-making body that considers the organisation’s policies and priorities. The EB meeting can therefore be considered a bellwether for priority global health policy issues for the year ahead.
The WHO EB meeting ran from 22-27 January, comprising representatives of 34 WHO member states, in which over 40 global health related topics were discussed. There are four areas that are likely to dominate the global health policy agenda in the year ahead: antimicrobial resistance, humanitarian crisis, climate change and the pandemic treaty.
Despite increasing antimicrobial resistance worldwide and a lack of development of novel antimicrobials, the issue of antimicrobial resistance has not consistently been prioritised on the global health policy agenda. It has now been eight years since the UN held its last high-level meeting on the subject, in 2016.
The renewed attention on antimicrobial resistance comes as the WHO’s 10-year Global Action Plan on Antimicrobial Resistance is due to conclude in 2025. This year’s discussions are expected to focus on what should be included in the next iteration of the action plan. A new strategy and targets to tackle the issue are expected to be announced at a high-level meeting at the UN General Assembly, in September.
The ’silent epidemic’ of antimicrobial resistance has already attracted some discussion this year at the World Economic Forum (WEF) in Davos, Switzerland. To spur investment in the development of novel antimicrobials, WEF have advocated for the introduction of subscription payment models, based on fixed payments for the sufficient supply of antimicrobials, which would in turn provide financial security and therefore an incentives to manufacturers for R&D on novel antibiotics. Such an approach is currently being trialled in England and Sweden, with some promising early data on the impact of the policy emerging from the latter.
The EB meeting predictably saw heated debate on conflicts in Ukraine and Gaza, with the WHO Director General Dr Tedros Adhanom Ghebreyesus appealing to ‘choose peace’ and favouring political solutions to ongoing conflicts.
The WHO has increasingly played a greater role in the delivery of humanitarian aid, leading efforts in Gaza, and delivering an estimated $120 million of health supplies to Ukraine since March 2023. The significant number of humanitarian crises threatens to stretch WHO budgets, at a time when the organisation has requested $7.1 billion to fund it’s 14th General Programme of Work until 2028.
Against the backdrop of ongoing global conflicts, the Global Health and Peace Initiative was included on the agenda. The Initiative aims to provide a framework for the delivery of healthcare programmes in the context of conflict settings, while also recognising that peace is necessary for health and vice versa. Currently on its 5th draft, the Initiative is expected to be discussed at the 154th session of the WHA later this year.
Following on from COP 28 last year, which saw it’s very first ‘health day’, climate change remains at the top of the global health agenda. Earlier this month, WEF continued to emphasise the future economic impact of climate change on health, publishing a report -although there was a notable lack of corporate pledges on climate over the course of the annual meeting. Later in January, climate change was recognised as a threat to resilient healthcare systems in a framework adopted at a high-level meeting of the Organisation for Economic Co-operation and Development (OECD).
Climate change also featured in discussions at the EB meeting. For the first time, ‘Transformative action on climate change and health’ was included as one of the six core objectives within the new WHO General Programme of Work, the draft of which garnered considerable support, continuing the momentum from COP 28. The EB meeting also saw the debate of a report brought by the Director General on climate and health, despite some opposition, with the report expected to lay the foundations for a WHA resolution on the subject later this year.
The pandemic treaty
After its initial announcement in 2021 at the height of the COVID-19 pandemic, the treaty for pandemic preparedness and response was taken to the WHO by a group of world leaders, to be debated by an intergovernmental negotiation body. Although not specifically on the WHO EB agenda, an update on the topic was given on the opening day, with the deadline for agreement fast approaching in May this year at the WHA.
Negotiations on the treaty have so far achieved agreement that equity should be a central focus of the treaty, in light of the disproportionate impact of COVID-19 on low- and middle-income countries (LMICs). However, there has been little alignment on how to achieve equity in practice, with disagreement on key issues such as protections of intellectual property rights and technology transfers, both of which are desired by LMICs to enable the local manufacture of necessary medicines in response to a pandemic.
Given the difficulties in reaching a final agreement, with international health experts voicing concerns the treaty was being watered down, the Polish representative at the EB meeting suggested delaying the approval of the treaty past the May deadline. However, opposition from the WHO and several member states, suggests continued preferences for maintaining the political momentum behind the treaty negotiations – and in the case of the USA, a strong desire to come to an agreement before the looming elections in the autumn this year.
But will domestic priorities take precedence?
Most of us would agree that taking action on antimicrobial resistance, the humanitarian crisis, the impact of climate change on health, and pandemic readiness should all be top priorities for global leaders. However, domestic politics will likely distract them over the course of the next year – with more than four billion people across 64 countries and the EU taking to the polls, in what is expected to be the largest election year in history.
The outcomes of these elections could have a dramatic influence over the degree to which countries continue to advance these global health goals. The global health community will have to work together and factor in these four priorities to their policy activity in 2024 to ensure they remain high on the agenda, and that the progress that has been made thus far is sustained.