The EB is made up on 34 different WHO Member States and is brought together to guide the work of the organisation, including deciding the agenda for the World Health Assembly. The article below provides an overview of the key cancer-relevant items discussed at the EB in January 2019.
Although appearing dry on the face of it, this is the first budget developed by Dr Tedros’ office. It sets out a vision for how WHO intends to implement the ‘triple billion’ targets contained in the 13 General Programme of Work as part of the organisational shift towards prioritising impacts in countries over outputs. In line with this, the Secretariat have developed several outcomes under each target. Some of the most relevant for cancer are:
This agenda item also includes the WHO’s Impact Framework (EB144/7) which sets out overarching measures for health life expectancy, indices for each of the triple billion targets and a set of programme targets. It is particularly interesting as the UHC index includes coverage indicators for childhood leukaemia, breast, cervical, colorectal and uterine cancers, although there are concerns about the availability of data for these.
The agenda item also includes a short report from the Director General on his plan to improve value for money in the WHO (EB144/6).
This item was discussed on 25th January and many Member States requested further information on the operationalisation of the budget, particularly relating to the shortfall in funding for NCDs, the increased demands for normative and technical guidance and how this will support increased work at country-level. During the discussions the WHO Director General also re-iterated his calls for Member States to give money to the WHO without earmarks.
This agenda item is a biennial report from the WHO Director General, looking at progress made towards Sustainable Development Goal (SDG) 3, including progress in tacking NCDs and rolling out UHC. The second half of the report shares progress on implementing the WHA resolution on health in the 2030 Agenda (WHA69.11), including the development of the Global Action Plan for health lives and well-being for all, which aims to improve coordination between different international agencies and organisation working on global health. We understand that the plan will be open for consultation later this year.
Key points for the cancer community are:
Read UICC’s joint statement on the 2030 Agenda here.
This agenda item includes three documents, the first of which looks at Primary Health Care (PHC) as a mechanism to move towards UHC (EB144/12) and the Astana declaration. From a cancer perspective, some key elements of the report are:
The EB will be asked to note the report and discuss how the Astana Declaration can be used moving forwards, including during preparations for the UN High-Level Meeting (HLM) on UHC. Read UICC’s joint statement on PHC and UHC here.
The second document looks at the opportunities and challenges of community health workers in advancing the development PHC (EB144/13).
The third document up for discussion here is on preparations for the UN HLM on UHC (EB144/14). The first half of the report provides an overview of the role of UHC and current burden of catastrophic spending and impoverishment from health spending, while the second halffocuses on preparations for the meeting. Key points for cancer are:
During the discussions a number of countries recognise the importance of PHC within their current health systems and as a mechanism for helping to deliver UHC. Several countries highlighted the importance of building strong health systems that can detect and diagnose and NCDs early, but the discussion around referral through to treatment and secondary and tertiary facilities was limited. The report was noted.
Many countries also welcomed the Director General’s report on preparations for the High-level Meeting; however the accompanying resolution was subject to intensive negotiations, which reached a consensus on the final day of the EB. These negotiations highlighted key topics for the upcoming negotiations around the Political Declaration on UHC, notably including TRIPs flexibilities and sexual and reproductive health. The report was noted and the resolution was adopted.
This agenda item contains two documents, the first is a report on the draft roadmap for access to medicines, vaccines and other health products (2019-2023) (EB144/17). The report, issued by the Director General, provides an overview of how the roadmap was developed and asks Member States to provide guidance ahead of it being presented to the World Health Assembly in May. The roadmap tackles various barriers to access, including lack of regulatory and health systems capacity, weak supply chains, shortages and affordability, and proposes some approaches.
The second document is a specific report on access to cancer medicines following on from the 2017 cancer resolution (WHA70.12). The report provides an executive summary of the full technical report on the ‘pricing on cancer medicines and its impacts’. It explores the benefits and risks, industry approaches to pricing, relationships across the value chain and their impact on price, availability, affordability and research and development (R&D). As requested, WHO has drawn this together and generated several policy options to improve affordability and availability, contained in Annex 1.
Key messages from the report are:
The discussions on the roadmap to access highlighted the current impact of poor access and welcomed the roadmap as a way forward. Many Member States stressed the importance of the normative work that WHO is undertaking to address this and asked how WHO intends to take the roadmap forwards to implementation, recognising the need for further technical support. The WHO will continue to work on the roadmap ahead of the World Health Assembly in May.
The majority of EB members and other Member States from all regions welcomed the report on cancer medicines, with many representatives focussing on price and cost transparency. While a number of Member States raised objections to the methodology of the report’s preparation and some of the recommendations, many more asked how the WHO intends to operationalise the report as part of stronger international collaboration on the topic. The EB noted the report.
Following on from the HLM on NCDs in September last year, this agenda item (EB144/20) reviews how WHO can support Member States to fulfil commitments made in New York in 2011, 2014 and 2018. It highlights several actions that the WHO will take, including:
The second document under this agenda item contains the workplan for the WHO Global Coordination Mechanism on NCDs (EB144/20 Add.1).
The joint statement from World Cancer Research Fund International supported by UICC, the NCD Alliance and World Health Federation will be available soon here.
In addition to the report put forward by the WHO Director General, EB Member States developed a decision document which aims to help shape follow-up to the meeting over the years to come. Key elements from the decision document includes:
The report (EB144/28) looks at the burden and status of cervical cancer services work to date, and proposes three accelerators for action to facilitate elimination. These are HPV vaccination, screening with HPV DNA test linked to timely treatment, and technical assistance to scale up integrated diagnosis, surgery, radiotherapy, systemic therapy and palliative care.
The report emphasises that elimination is feasible in all countries, however, reaching this elimination goal will need high coverage of services and multi-decade commitments from governments. Therefore we need all countries to consider their response and take action.
A decision (rather than a resolution) at EB in 2019 enables the Secretariat to move more quickly to Member State consultation on the emerging global strategy/action plan, with a view to approval and launch of the strategy at the World Health Assembly in 2020.
Actions that UICC members can take are:
UICC has included the call for a global online consultation to ensure opportunities to input for all civil society organisations. Our key ask, aligned with the focus on universal health coverage in 2019, is for equity in access to cervical cancer prevention and control services with adequate social protection measures. Add your name to our petition to show global support for the call to eliminate cervical cancer.
The agenda item has strong support from 41 countries: Australia, Brazil, Canada, Colombia, Ecuador, the European Union Member States, India, Kenya, Monaco, New Zealand, Republic of Korea, Sri Lanka, Ukraine, United States and Uruguay.