72nd World Health Assembly: what to watch out for

16 May 2019

This year’s World Health Assembly (WHA) has a packed agenda and will bring together delegates from around the world to discuss issues spanning the breath of global health. This article aims to provide UICC members with a digest of key agenda items and why they are relevant for the cancer community, alongside a snapshot of cancer-relevant side events taking place. 

Anticipated key topics at this year’s WHA are:

  • Access to medicines (particularly in light of a proposed resolution on price transparency)
  • Improving the response to health emergencies
  • Building sustainable universal health coverage (UHC) including preparations for the UHC high-level meeting
  • Approval of the budget for WHO’s 13th General Programme of Work.

Throughout the discussion documents and side events, the UICC team has identified three key drivers for the discussions which we think will be influential in 2019. We have used these to help shape and priorities our statements and advocacy messages, and would welcome your thoughts and feedback to advocacy@uicc.org.

Once again, the UICC team will work throughout the week to raise the profile of cancer control in official and unofficial discussions and we are delighted that seven different UICC members will be travelling to Geneva to join the delegation and help up champion global cancer control on the international stage.

You can watch the livestream of the discussions, or catch up on previous conversations in the committees, here

WHA 72 Building strong health systems to deliver UHC

Agenda item 11.5: Primary health care towards universal health coverage

The documents up for discussion and adoption are report A72/12 and resolution EB144.R9. The initial report and resolution were presented at the 144th Executive Board, and following on from the discussions, the WHO team updated the report to include language on:

  • The importance of adapting national UHC packages to respond to local health needs – this will be important for cancer, particularly in low- and middle-income countries where interventions for cancer may not yet have been integrated into PHC packages.
  • The role of primary health care (PHC) facilities in coordinating and supporting patients to access more specialised care and ensuring the transition of patient information along these referral pathways to ensure appropriate treatment. So far, many of the discussions on UHC have not included the need for referrals through to secondary and tertiary care facilities and so it is great to see its inclusion in the report as referral is essential for the effective treatment of cancers. We also welcome the language on the need to better coordinate and support patients through referrals.
  • The importance of developing multidisciplinary teams for effective PHC – again this will be essential to deliver comprehensive cancer control, and the report also goes on to mention the importance of staff development plans to improve skill sets and retention of PHC staff in all countries.

The resolution calls on Member States to adopt and internalise the Astana Declaration on PHC, and for the WHO to develop an operational framework for PHC by the 73rd WHA.

Key points from an advocacy perspective are:

  • To encourage the adoption of the resolution
  • To urge member states to implement a PHC-approach to the upcoming discussions on UHC ahead of the high-level meeting, recognising the important role of PHC as an entry point to health systems and the essential role that PHC needs to play in coordinating referrals through to more specialised care at secondary and tertiary facilities for cancer and other NCDs.

Agenda item 11.5: Preparation for the high-level meeting of the General Assembly on universal health coverage

Agenda 11.5 is a blockbuster and the second part which will be important for the cancer community is the discussion on preparations for the high-level meeting (HLM) on UHC, report A72/14 and resolution EB144.R10.

The report provides an overview of the current scale and burden of inequitable access to health and, while WHO continues to support a disease-focused approach, the report notes need for space for ‘additional challenges’ including the need to strengthen health systems to successfully deliver UHC. The report also highlights that UHC is both a goal itself and a means of implementation for the a suite of the Sustainable Development Goals (SDG) 3.

The resolution associated with the report calls on member states to attend the HLM on UHC at the highest level of government and to work towards a concise, action oriented political declaration. Within this, the resolution notes the importance of strengthening decision making, including the need for improvements in integrated health information systems in order to promote equitable, affordable and universal health. The resolution also tasks WHO with developing a report on UHC as an input to the meeting, and to submit biennial reports on progress in implementing the resolution between 2020 and 2030.

Find out more about UICC’s engagement in the UHC discussions here.

WHA 72 Addressing global health inequities

Agenda Item 11.1: WHO Proposed programme budget 2020–2021

At its core, WHO is committed to addressing global health inequities, and this has come out very strongly in Dr Tedros’ 13th General Programme of Work. After initial discussions at the 144th EB on proposed budget (A72/4) and the impact framework (A72/5), the WHO has refined the indicators and is proposing the introduction a scorecard to better capture the outcomes of its work. Alongside this, the WHO has also developed information note A71/INF./2 which helps map out how current funding will be re-allocated under the GPW13 targets.

Key points from an advocacy perspective are:

  • To welcome the move from a disease-siloed approach towards one which focuses on people-centred care.
  • To urge WHO to ensure the smooth coordination between prevention and treatment and care activities which are now divided across the triple-billion targets and, in this manner, to identify and maximise the opportunities for integration between previous siloes to achieve the overall objective of stronger health systems which are capable of delivering people-centred care across the lifecourse.
  • To urge Member States to ensure budgetary allocations for NCDs are sufficient to meet the growing demands for technical assistance.
  • To urge Member States to explore the results framework and indicators provided and to adopt and utilise these, based on national priorities, recognising that these targets should be considered indicators of progress, not goals to be achieved in new siloes. We wish to underscore the importance of a health systems approach which can deliver the tracer targets identified but overall better equip the health system to respond to the needs of whole populations.

Agenda item 11.4: Implementation of the 2030 Agenda for Sustainable Development

The report (A72/11) provides an update on progress towards the health-related Sustainable Development Goals and resolution WHA69.11. The discussion on NCDs recognises that the burden of NCDs continues to grow and discusses the global trends in alcohol and tobacco consumption as well as mental health, focusing particularly on suicides. In the discussion on UHC, the report notes the current status of spending on health and coverage of essential health services, including access to essential medicines for palliative care and pain management.

The update on resolution WHA69.11 details actions taken by WHO to further the 2030 agenda, including the establishment of the Regional Healthy City Network, the development of the Global Action Plan on SDG3+, regional plans on UHC, the development of the SCORE package and collaborations beyond health.

Key advocacy points:

  • To welcome progress to date and the general movement to see UHC as both an outcome and indicator of progress on health under the SDG agenda, we urge further investment in health systems to deliver core interventions for cancer and NCDs including early detection, diagnosis, timely treatment and palliative care.
  • To call on all stakeholders to strengthen collaborations across health and with actors outside of the health system and promote recognition of the impact of non-health actors on health
  • To urge Member States to strengthen health information systems to improve evidence-based policy making, and particularly prioritisation for UHC, and to increase transparency and accountability and more effective stakeholder engagement to implement plans to deliver against the SDGs.

Agenda item 11.8: Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues - prevention and control of noncommunicable diseases

Not all the documents for this agenda item are currently available, but discussions will build on report A72/19 which provides a summary of the current burden of NCDs, the lack of progress at national level, and the outcomes from the 2018 HLM on NCDs. It highlights the limited data to track progress against the nine voluntary NCD targets and identifies follow-up actions including commitments by WHO to strengthen technical support, such as identifying a subset of NCD accelerators from the ‘best buys’, promotion of special initiatives (including cervical cancer elimination), the promotion of fiscal measures to address risk factors and the development industry dialogues.

Following on from discussions at the 144 Executive Board a number of amendments have been made, including the addition of further evidence on fiscal measures for NCD prevention (Annex 2), update to the proposed workplan of the GCM, and an analysis of NCD surveillance globally (Annex 7). In addition to this report, Member States will be invited to adopt resolution EB144.R10 which proposes to extend the Global Action Plan (GAP) on NCDs through to 2030 to align with the Sustainable Development Goals, charges WHO with updating the Best Buys for NCDs and strengthen monitoring and accountability.    

Key points from an advocacy perspective are:

  • To support the extension of the GAP through to 2030
  • To support the proposal to update and expand the current set of Best Buys and other recommended interventions, but caution against identifying a subset of ‘NCD accelerators’ as this runs the risk of side-lining those measures which may be less politically supported in the face of industry lobbying.
  • To support a strong focus on data and the need to improve both data surveillance systems in countries, and its uptake and use in policy making. In particular, we would urge countries to take up the technical support and resources provided by GICR.
  • To urge member states and WHO to work to secure sustainable financing for the NCD technical support programme in order to meet current Member State demands and facilitate the growth and development of these packages to respond to the evolution of Member State needs through to 2030 and beyond. 

WHA 72 Improving access to medicines, technologies and vaccines

Agenda item 7: Access to medicines and vaccines

The WHA is invited to note the draft road map (A72/17) which has a dual focus: to ensure the quality, safety and efficacy of medicines and vaccines via regulatory system strengthening, assessment, market surveillance and to improve equitable access by matching R&D to public health needs, affordability and pricing and reducing waste, procurement and supply chain management, appropriate prescribing and rational use.

Following on from discussions at the 144th Executive Board, the draft roadmap has been revised with the addition of Appendix 2 to show linkages between the GPW13 and roadmap activities, actions, deliverables and milestones, and to reflect the global goods planning process. The report recognises the high percentage of health spending on medicines (up to 20-60% in some LMICs) as a barrier to UHC. Recognising the growing burden of NCDs, and the knock-on impacts for medicines and vaccine spending, the WHO is working to develop a list of agreed indicators to improve access to quality health products, which will contribute to the SDG indicator for access to medicines under development.

Key points from an advocacy perspective are:

  • To ensure the affordability and availability of safe, effective and quality medicines using the WHO Model list of essential medicines, and with a focus on building effective regulatory systems, procurement strategies and policies for fair pricing.
  • To build capacities for the proper implementation of intellectual property laws in line with TRIPS and that make use of its flexibilities to improve access.
  • To address the training needs of the health workforce to strengthen supply chain management and improve data management systems nationally.

Draft Resolution on improving the transparency of markets for medicines, vaccines and health-related technologies

Following on from the cancer medicines price report at the 144th Executive Board (EB144/18) a number of member states have called for a specific resolution on the transparency of prices for medicines, vaccines and health-related technologies. Going into the WHA week, this resolution is still under negotiation, but we understand that it urges member states to share information to increase transparency of prices of medicines, vaccines and health technologies. It calls on governments to require information on R&D costs and sources of funding and results of clinical trials to be made publicly available. It asks the WHO to support governments in collecting information on prices, reimbursement, clinical trials outcomes and a webtool to share information, including on public investments and subsidies for R&D.

Key points from an advocacy perspective are:

  • To recognise that transparency is an important issue, but that it is one amongst many which impact both the availability and price of essential cancer medicines.
  • To urge Member States to review and implement the policy options identified in the cancer medicines pricing report, based on national challenges and priorities, to improve access to essential cancer medicines, vaccines and technologies.
Last update: 
Friday 7 June 2019