A selection of leading global health experts answers questions from Ilona Kickbusch on global health challenges.
Dame Sally Davies
Chief Medical Officer and Chief Scientific Adviser, Department of Health, United Kingdom
The Director General was right to call WHA 68 a landmark World Health Assembly (WHA). The Ebola outbreak in West Africa demonstrated there was a need for fundamental reform of the World Health Organization (WHO), and at WHA many of the key measures that will allow the WHO to respond more effectively to future health emergencies were agreed.
In particular, I would highlight the development of a Health Emergency Contingency Fund, that will ensure money is in place to fund the WHO’s initial response to health emergencies, as well as the development of a Global Health Emergency Workforce, that will allow for staff to quickly be deployed.
I also pay tribute to the WHA for approving the Global Action Plan on Anti-Microbial Resistance (AMR). AMR is one of the greatest threats to global health, and we know it already has a substantial impact around the world. I look forward to working with colleagues in Geneva and internationally to drive forward the work on AMR, including with the development of National Action Plans.
Thomas Fitschen
Ambassador and Deputy Permanent Representative, Permanent Mission of the Federal Republic of Germany to the United Nations Office and other international organizations in Geneva
After the Ebola crisis and the special session of the Executive Board earlier this year it was pretty clear that this year’s WHA would be a decisive moment for the Organisation. Would the WHO be able to prove that it has learned its lessons and is ready to reform its ways of doing business in times of global health threats? And would the member states be ready to take the necessary decisions to enable the Organization to put into practice what they themselves expected it to do? I think that the WHA has indeed met the expectations. As Federal Chancellor Merkel had underlined in her opening speech: “WHO is the only international organisation that enjoys universal political legitimacy on global health matters.” Based on the valuable input provided by the Ebola Interim Assessment Panel a number of very important decisions have been taken: the establishment of a Contingency Fund and the first steps towards setting up a real Global Health Emergency Workforce show that the WHO is up to the challenge. It took very arduous negotiations to get there, and many details still need to be fleshed out. However, anyone in the room could feel that the political will was there. Other milestones were the adoption of the Global Action Plan on AMR and the resolution on air pollution and health that were agreed after difficult negotiations. But let us not forget that some other pending issues remain unsolved. WHO is still in desperate need for stable financing mechanisms. The slight increase that was agreed in the field of voluntary contributions is of course welcome, but it does not do away with the WHO’s dependence on donors and increases its overall financial vulnerability. Likewise, the future role of non-state actors such as private enterprises, non-governmental organisations (NGOs) or scientific institutions in the work of WHO, and the potential for partnerships among them, remain contentious. Germany for its part will continue to push for strong reforms to make WHO fit for purpose.
Martin Leschhorn Strebel
Director, Network Medicus Mundi Switzerland
Ebola casts its shadow over the World Health Assembly
Once again, another WHO World Health Assembly has passed into history. It is tempting to talk about an annual ritual with the same annual tittle-tattle. But this would not do justice to the significance of WHO as the only democratically mandated standard-setting body for global health policy. Parliamentary processes are always tedious, regardless of whether they take place at local, national or even international level. However, they represent the path to finding tolerably sustainable solutions to the challenges we face.
"Things are different this year," said a civil society representative who has been travelling to Geneva for several years now. "Ebola has changed the debates at the WHA." Delegates are stricken by the fear of an epidemic that is capable of becoming an international threat by bringing healthcare systems to their knees. And suddenly there is no longer any doubt that situations like these require an institution like WHO to respond quickly and appropriately. Just as deep-rooted is the feeling of despair that WHO has failed in precisely this role.
An expert panel commissioned by WHO draws clear conclusions from WHO's inability to deal with the epidemic: "Now is the historic political moment for world leaders to give WHO new relevance and empower it to lead in global health." (Ebola Interim Assessment Panel: Report by the Secretariat). We can only hope that this assessment is widely supported in practice.
Members had an initial opportunity to strengthen WHO during the budget discussion. WHO had requested an increase in freely available resources. This is crucial in enabling the organization to respond flexibly and quickly to future health crises. While delegates approved the request, these untied funds are still too small to do anything significant to resolve the issue.
To be able to function correctly, WHO needs to be free of economic interests. However, a scheme to strengthen cooperation between key stakeholders such as NGOs, science and industry attracted harsh criticism, particularly from the representatives of civil society. Our network, Medicus Mundi International, played a key role here. The scheme is still so unclear in some paragraphs that there are strong grounds to fear that the tobacco and food industries might ultimately be able to directly influence decision-making processes. Member countries were at least sufficiently in agreement on the fact that the scheme still requires quite a lot of improvement, which is why it can now only be approved in a year's time.
So let us see that WHO emerges from these crises and debates strengthened. This calls for it to follow a clear vision under which the international community can only improve health for all worldwide by working together. It also means that it will only be able to achieve this vision if it has transparent and sustainably financed structures.
Robert Marten
Senior Program Associate, The Rockefeller Foundation
Yes, I do agree: this year’s 68th Assembly was a landmark WHA. This meeting occurred while the world’s largest and most complicated Ebola outbreak continues in West Africa. In the last 18 months, more than 11,000 people lost their lives to Ebola, and the total number of reported cases is close to 30,000. The challenge of both containing Ebola and getting to zero new cases has captivated the global health community. It is a defining moment for WHO. As German Chancellor Merkel noted, “the WHO is the only international organisation that enjoys universal political legitimacy on global health matters.” Accordingly, the Assembly provided a platform to discuss many important questions which were raised in the WHO-mandated Ebola Interim Assessment Panel’s first report: Why and how were early warnings, particularly between July and August 2014, ignored? What sort of reform, accountability and leadership are now required? These questions were asked during this landmark Assembly.
Suerie Moon
Research Director and Co-Chair, Forum on Global Governance for Health, Harvard Global Health Institute; Lecturer, Department of Global Health and Population, Harvard School of Public Health
The 2015 WHA had the potential to be a watershed moment for global health. Coming on the heels of the devastating Ebola outbreak in West Africa and the widely-discussed failures of WHO in recognizing the emerging crisis and mobilizing international action to respond, many had anticipated that this would be the year when the WHO leadership and member states seized the window of opportunity to make major and long-needed reforms to the organization. Instead, cloudy thinking, rhetoric and meek proposals prevailed. While nearly everyone agreed on the need to “strengthen” WHO, no one seemed to agree on how to do it – or more importantly – what to strengthen WHO for. That is, what are the most important core functions that WHO is uniquely-suited to carry out, and therefore must be able to perform well? Surely one of the answers must be to sound the alarm regarding infectious disease outbreaks that pose international risks, based on the best evidence and technical expertise, driven fundamentally by public health concerns rather than political or economic considerations. And yet proposals to ensure the organisation would have the leadership, financial independence and member state political support required to carry out this function were barely discussed. In short, there was a collective failure to seize the opportunity to make WHA 68 a “landmark” gathering; whether the window of opportunity for significant reform of WHO has already closed remains to be seen.