Remco van de Pas (ITM)                   remco-300x300

The 67th World Health Assembly (WHA) closed last week, after long-working days, and adopting many resolutions on public health issues of global importance. In fact, this WHA broke many records, with the most resolutions and decisions (41) ever, as well as the most words translated for a five-day Assembly (1,300,000), and the most meetings (290). Happy I survived.

Let me provide some highlights and important developments for health policies.

This has been an intense Assembly, with a record-breaking number of agenda items and documents, and nearly 3,500 registered delegates. This is a reflection of the growing number and complexity of health issues, and your deep interest in addressing them.” WHO director general Margaret Chan, in her closing remarks to the assembly, obviously also felt happy she survived this 67th WHA.

But she also mentioned that the assembly was big in a second sense. “From the very first day, it was clear that Member States are deeply concerned about two big trends with major consequences for health: climate change and the rise of antimicrobial resistance (known under its abbreviation AMR)”.

WHO released its  Antimicrobial Resistance: Global Report on Surveillance in April 2014.   “The report clearly documents that multidrug resistant bacteria are now transmitted from the environment to people – not only in hospital but in communities as well, and from contaminated water, whenever there is improper waste sewer systems or surveillance ” as can be read in a statement provided by Mrs Garance Upham on behalf of Medicus Mundi International. The WHO report mainly recommends to strengthen (global) surveillance networks and cross-sectional action, and WHO in consultation with its member states and others will work towards a global action plan on antimicrobial resistance.  The assembly also adopted a resolution, which requests the Director-General  to strengthen the tripartite collaboration between WHO, the FAO and the World Organization for Animal Health (OIE) for combatting AMR in the spirit of the “One Health” approach. An intersectoral civil society Antibiotic Resistance Coalition is also providing analysis and policy suggestions for global action. This is a highly relevant initiative that needs to be followed closely in the coming years.

 

Climate change and Health

Climate change then. This issue was addressed via a progress report (see page 16). WHO has over the last years increased its work on climate change and health, for obvious reasons. Amongst others it has produced an atlas on Health and Climate. WHO leads the health component of the UN response to climate change through the negotiating process of the UN Framework Convention on Climate Change. The organization also contributed to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC).  Member States become more aware that resilient health systems can be an important asset (and thus requirement) in the adaptation to climate change. They hence also agreed on a resolution to ensure that health remains central to the post-2015 development agenda, and requested WHO to actively engage in ongoing discussions.  The resolution also referred to the UN General Assembly resolution 66/288 “The future we want” , which recognizes that health is a precondition for and an outcome and indicator of all dimensions of sustainable development. When reading about all these nice policy recommendations one might think that health is of major concern in the post-2015 and Sustainable Development Goals (SDG) negotiations, but many observers wonder whether this is the case. There is fierce competition from other urgent concerns such as environmental and biomedical degradation or food and energy security. In contrast to what Margaret Chan mentioned in her opening speech and closing remarks, there has not been an extensive debate between member states during this WHA on climate change and health, including in a draft resolution on health in the Post-2015 Development agenda.

 

WHO Reform: Engagement with Non-State Actors

At this Assembly, one of the most debated and contested issues was – again – the ongoing reform, more precisely the framework on engagement with non-state actors. This unresolved policy debate and consultations are already taking place for several years, and the end is not yet in sight, as far as we can tell ( See also a recent blog post on this debate here).

During the WHA, a drafting group was established. This drafting group focused mainly on potential conflicts of interest that could arise from non-governmental actors (whether profit or non-profit) engaging with WHO. The drafting group eventually produced this decision document, requesting the secretariat to further address questions on potential conflicts of interest that might arise from interaction with the private sector, and calling for continued consultations on this framework during the regional meetings. Further decisions will need to be made at the Executive Board meeting in January 2015.  A number of countries, spearheaded by Brazil, wanted to have further guarantees to prevent potential conflicts of interest. This position has frustrated the EU, US, Australia and others that want to finalize this framework and move on. See for more info this IP Watch article.

The policy framework on engagement with other actors than member states is a very contentious policy debate within WHO – the word ‘hot potato’ comes to my mind – and deserves to be followed with great attention. It provides insight in a key controversy in global governance for health: multi-stakeholder platform mechanisms, as for instance discussed in the recent Lancet- University of Oslo commission report on Global Governance for Health. 

 

and more policy debates on pressing health issues.

Obviously, many more issues were addressed at the Assembly. This includes debates and decisions on essential medicines, traditional medicine , Regulatory Systems Strengthening for medical products and follow-up of the report of the Consultative Expert Working Group on Research and Development.  Again, IP Watch is a very useful portal for detailed info on these WHO policies. The WHA also agreed on a resolution developing a global strategy on human resources for health, and discussed how to move forward with the Health in All Policies Approach. 

Member States agreed upon a Global Coordination Mechanism for NCDs, although there is no mention how this mechanism will deal with the controversial effects of Free Trade Agreements that are currently under negation.  This despite sharp remarks made during Margaret Chan’s opening speech, a lively debate during a side-event at the WHA and even, believe it or not,  concerns expressed by the Bill & Melinda Gates Foundation! Anyway, the policy debate on the nexus between trade and health, and WHO’s role in it, deserves careful attention.

Many thanks go to the hard work of the WHO-Watchers, organized by the People’s Health Movement. Just like the many delegates, these people made very long hours throughout the week – while their salaries are no doubt far lower than the ones of most delegates! So via this means, a big virtual applause for their contribution. The WHO Watch commentaries and reports are a very useful source to keep track of a range of global health policies.  All statements made by NGO networks on the numerous agenda items remain available.

Let me end with this reflection. After this record breaking WHA, the WHO and member states really have to consider how to manage these governance meetings in the future. Prioritization of themes is needed, and we do also note that more and more of the diplomatic consultations take place before the assembly and board. Unfortunately, these negotiations are for the moment closed to outsiders. This might undermine trust in the formal World Health Assembly itself.  The actual role of WHO in the global health system remains ambivalent… perhaps there is a need for more regional and decentralized governance approaches, while maintaining the universal scope of the mandated global health authority?

Anyway, the annual ‘World Health Theatre’ has lived up to its reputation once again. Can’t wait to go back to Geneva next year. Mind you, I’m already humming ‘Eye of the Tiger’  from Survivor!

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