Breakthroughs Blog

The World Health Organization (WHO) has faced tumultuous times over the past few years, and this year’s Executive Board (EB) meeting seemed to bring a chaotic new chapter. Major tectonic political shifts worldwide have plunged the global health organization into serious talks about its long-term funding, sustainability, scope, and ability to deliver on its core mandate.   The EB was anything but business as usual, though member states did their level best to address the political tensions du jour while trying to move through a regular agenda that spanned issues from noncommunicable diseases and maternal and child health to global health security and climate and health. Here are some reflections from a hectic week in Geneva: “We do expect things to change...”  - Assistant Director-General for Business Operations Raul Thomas1. Member states agree to reduce the WHO budget and mostly commit to a 20 percent increase in assessed contributions.In his opening remarks before the WHO EB, Director-General Dr. Tedros Adhanom Ghebreyesus noted that even before the United States and Argentina’s withdrawal announcements, WHO was planning to shrink spending because of a shortfall caused by economic difficulties in many donor countries.  WHO’s budgetary shortfalls overshadowed the first several sessions of the EB, with many member states expressing concern over the sustainability of WHO’s financing in the next biennial budget. Ultimately, a decision was made to lower the program budget to $4.9 billion (from $5.3 billion). Assistant Director-General for Business Operations Raul Thomas captured the general sentiment of EB funding conversations, conveying that WHO’s cash flow is secure for now, but WHO leadership “expects things to change” regarding the viability of the organization’s budget.   However, member states harped over what should change. Many supported a 20 percent increase in assessed contributions—something that members had agreed to at the World Health Assembly (WHA) two years ago—that would reduce the organization’s reliance on voluntary contributions from member states, while others, specifically Russia and China, showed opposition to this plan.   Several member states emphasized the importance of continuing down a path toward sustainable financing through the WHO investment round and developing alternative short- and long-term resource mobilization plans. Member states also urged WHO to distribute information about what the 20 percent increase in assessed contributions would mean for each country. Given the reduced budget, countries insisted on costing all 2025 draft resolutions and decisions prior to any vote during this year’s session.   “It’s back to basics...” - WHO Regional Director for Europe Dr. Hans Kluge2. WHO leadership and member states stress progress and continued need for reform.In the wake of the larger discussions held during the EB about prioritization due to the cash crunch the WHO is facing, there was also a strong focus on the continued need to streamline and reform the organization. WHO Regional Director for Europe Dr. Hans Kluge called for the organization to go “back to basics.” Dr. Kluge emphasized the importance of remaining steadfast to WHO’s organizational mission while being adaptive to emerging threats like antimicrobial resistance (AMR).  Director-General Dr. Tedros also referenced WHO reforms in his opening remarks, acknowledging the significant improvements the organization has made over the last five years, including the newly introduced prequalification framework for novel products. At the same time, Dr. Tedros emphasized the need for continued reform and underscored the importance of engaging in constructive dialogue with member states moving forward.  During the final two days of the EB, member states agreed to several internal improvements and left the door open for further reform discussions at WHA. Citing concerns over its unclear mandate and overlap with other divisions, member states decided to extend by one year the operations of the Standing Committee on Health Emergency Prevention, Preparedness, and Response—which was first established in 2022 to provide guidance and recommendations to the EB and the Director-General on WHO’s emergency response—through May of next year to further evaluate the role of the committee and other similar bodies in health emergencies.  3. Global health security, maternal and child health, and the nexus of climate and health remain key topics.Member states did manage to untangle themselves from WHO’s structural dialogues to fully engage with the more than 47 agenda items on the docket this year.  WHO’s work in health emergencies featured prominently on the agenda once more, though much of the discussion centered around the need to adjust the scope of WHO’s activities. A few member states, including the European Union, Australia, Ethiopia, Finland, and the Republic of Korea, reaffirmed their commitment to the Pandemic Accord, including the then-upcoming negotiations that took place last week, as critical to advancing the prevention, preparedness, and response agenda, including access to medical countermeasures.Dozens of member states shared their appreciation of WHO’s report and draft action plan on women’s, children’s, and adolescents’ health and emphasized their commitment to advancing this agenda item, though Dr. Tedros highlighted that despite progress, “we still have a long way to go.” Equity and access were primary topics of concern for many countries. Several countries also advocated for greater urgency in accelerating efforts for maternal and child health and stressed the importance of intersectoral policies for vulnerable populations. Mentions of research and development were notably absent from the discussion, despite its critical role in addressing gaps in maternal, newborn, and child health, particularly in low-resource settings.  Countries also deliberated the draft global action plan on climate change and health. The plan, which includes some strong R&D provisions, outlines strategic frameworks for building climate-resilient health systems. However, it was surprising to note the absence of the threat of AMR, which is mentioned only once in the document. AMR is poised to cause 10 million annual deaths by 2050 and likely more with the growing influence of rising temperatures and evolving zoonotic diseases. Concerns over cost also dominated the discussion on this agenda item, and several member states, including Malaysia, Bangladesh, and representatives from the Africa Group, highlighted the need to include common but differentiated responsibilities—a longstanding equity principle in climate negotiations that holds historical emitters to a higher bar of responsibility for climate action.4. Civil society engagement continues to be a challenge at the EB.At the tail end of the EB, member states zeroed in on the role of civil society in these debates. While there seemed to be general agreement on the overall usefulness of non-state actor (NSA) statements in WHO proceedings, we did see the continued trend of politicizing otherwise straightforward processes governing NSA access and status with WHO. Member states held a fervent debate over WHO’s Framework on Engagement with non-State Actors (FENSA), which outlines clear criteria and principles for attaining status with the WHO. During the debate, some member states questioned the framework, with representatives from the Eastern Mediterranean and African Regions, as well as China and Russia, all expressing concern over the Centre for Reproductive Rights and Women Deliver receiving status from WHO. The delegate from Egypt captured this sentiment best: “Our reading of FENSA is that it is the foundation and main criteria that we use to accept or reject NSAs — it’s the foundation, but it is not obligatory for member states to accept only on this criteria.”  While on the surface, this debate may appear like an outlier, it marks a broader shift in how some member states are approaching the global health agency, as it has become more commonplace in the last few years to overturn or question established frameworks, rules, and processes at WHO based on national politics. This is especially concerning for civil society, which has seen its ability to meaningfully engage in these forums curtailed over the years.Dr. Tedros concluded the EB by acknowledging the endurance of countries in getting through such a substantial agenda this year and the significance of WHA later this May. While we often talk about the importance of these forums for combatting specific health threats, this year feels like a bigger moment and pivot point for the global health architecture as a whole. Will WHO be able to shoulder the financial blow, make the necessary reforms, and find a way to become more sustainable in its operations? Or will the global health community look back at this moment as the start of the unraveling of the global health ecosystem? Only time will tell.