Monday marks the beginning of the 74th World Health Assembly, where delegations from the World Health Organization’s (WHO) 194 member states will gather to set the agency’s policies. The Assembly will consider 74 agenda items, but among the most highly anticipated discussions is the possibility of a pandemic treaty. Here are three big topics that will be addressed at the Assembly this week:

 

An international pandemic treaty

The Assembly primarily makes recommendations to set policy. A couple of times, it has adopted regulations, and only once has it ever made a legally binding treaty – The WHO Framework Convention on Tobacco Control. But next week, the Assembly will discuss whether to create a pandemic treaty. Of course, that process would likely take months, even years, but many health experts are hoping that member states will endorse a resolution to form an intergovernmental task force to draft and negotiate a treaty.

On March 30, 26 heads of state, the president of the European Council and Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, published a joint commentary calling for a new international treaty for pandemic preparedness and response. “The main goal of this treaty would be to foster an all-of-government and all-of-society approach, strengthening national, regional and global capacities and resilience to future pandemics,” said the commentary. It would likely include requirements for equitable distribution of health products, data-sharing and accountability.

The commentary was signed by countries including the UK, Germany, Italy, South Africa, Kenya, Rwanda, Thailand, Indonesia, South Korea and others. However, the U.S., Russia, Brazil and others are said to be resistant to such a treaty. While some countries have expressed that such a treaty just doesn’t seem necessary, others say their primary concern is that many countries do not have the resources or time to participate in lengthy negotiations while they’re still battling the pandemic. Instead, the U.S. would like to set up a working group of member countries to look at recommendations, a senior U.S. health official said, according to Politico.

“What’s so interesting about this upcoming Health Assembly is that all three tools [recommendations, regulations and a treaty] will be considered by the Health Assembly for possible use in response to the pandemic,” said Steve Solomon, WHO principal legal officer in a media briefing ahead of the gathering.

Commitments to vaccine equity

COVAX, the international facility set up to ensure that low- and middle-income countries have equitable access to COVID-19 vaccines, hoped to deliver 2 billion doses this year. So far, it has delivered 65 million doses to more than 100 countries, but that’s only 3.4 percent of the way to its goal. And the Access to COVID-19 Tools (ACT) Accelerator, which COVAX is a part of, is facing a $19 billion shortfall.

“COVAX works,” said Peter Singer, Special Advisor to the Director General of the WHO, at the UN Foundation’s media briefing. “It’s an effective mechanism for distributing vaccines worldwide. …But you can’t distribute the vaccines that you don’t have.”

The problem lies with insufficient funding, dose-sharing, and manufacturing. But those are all issues that experts hope will be addressed at the Assembly with some much-needed commitments to fund the ACT accelerator, share vaccine doses through COVAX and facilitate more manufacturing, including through loosening intellectual property rights.

Recently, the Biden Administration’s commitment to share 80 million doses with COVAX was welcomed by the WHO. It is also working with the World Trade Organization to negotiate a deal to suspend intellectual property rights associated with COVID-19 vaccines. The EU also announced on Friday that it will donate 1.3 billion vaccine doses to low- and middle-income countries. Many of those doses will be distributed through COVAX. 

“This is the world’s ‘Mandela moment,’” said Singer. “COVID has brought the world to its knees, and it’s time for the world to rise up. As Dr. Tedros said the other day, this can’t become a tale of two pandemics, where it seems to be ending in rich countries, and it’s raging in low- and middle-income countries, because that’s going to come back to bite us all.”

 

Progress and backsliding on global health targets

The WHO’s annual results report will be presented at the Assembly looking at progress toward (and backsliding on) the WHO’s Triple Billion Targets and the UN’s Sustainable Development Goals. The Triple Billion Targets were endorsed in 2018 and aim to help 1 billion more people achieve healthier lives (with clean air, water, etc.), 1 billion more people be better protected from health emergencies and 1 billion more people have access to universal health coverage by 2023. 

Without accounting for the effects of COVID, the world is on track to help 900 million more people healthier lives – a shortfall of only 100 million. However, most of those 900 million are not in the lowest income countries. On health emergencies, 920 million people are projected to be better protected by 2023, but according to Singer, the pandemic has revealed that measurements of success will likely need to be adjusted.

The forecast for universal health coverage is far less rosy. Only 290 million more people are expected to have access to universal health coverage. That’s a shortfall of 710 million people, and COVID certainly has made things worse. A recent global pulse survey found that 90 percent of countries are still experiencing health service disruptions as a result of the pandemic. That includes immunization campaigns that have been suspended and could put 228 million people, primarily children, at risk of death and diseases.

To that end, the Assembly will be discussing next steps in the effort to eradicate polio and will likely adopt the Immunization Agenda 2030, a new 10-year roadmap to try to accelerate progress on access to immunization and strengthen immunization systems as a backbone of primary care.

“There’s the potential to save 50 million lives in this decade if the Immunization Agenda is fully realized,” said Kate Dodson, Vice President of Global Health at the UN Foundation. “Seventy-five precent of those gains will be in low and middle income countries.”

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