The 72 World Health Assembly (WHA72) brought together delegates from all 192 WHO Member States, along with civil society and other observers to discuss key global health issues. The article below provides a short summary of the discussions for cancer advocates with links through to the recordings of discussions provided for further information.
Key items on the agenda this year were investing in Primary Health Care (PHC); addressing the shortages in human resources for health, especially in low- and middle-income countries (LMICs); the integration of community health workers for PHC; addressing the right to health for women and children; preparations for the upcoming United Nations High-Level Meeting on Universal Health Coverage (UHC); and new commitments to ensure access to medicines, vaccines and health technologies, without which UHC will be very difficult to achieve.
WHA 72 saw the adoption of a landmark resolution on ‘Improving the transparency of markets for medicines, vaccines and health-related technologies.’ Discussions on this agenda item were highly contentious and several Member States made comments on the process leading to the resolution, with reservations expressed about procedural aspects rather than the topic of transparency in itself. This is discussed further below.
The week also witnessed the official launch of two new initiatives; the WHO academy, whose aim is to enhance the technical skills of WHO staff and other health professionals, and EPI-BRAIN (Epidemic Big Data Resource and Analytics Innovation Network) which will promote data sharing in public-private partnerships. The assembly also agreed to establish a special day for patient safety on 17 September each year and designated 2020 as the year of the Nurse and the Midwife. Read on for further information on each of the key resolutions.
The focus of the WHA discussions were on the report (A72/12) and the accompanying resolution EB144.R9. The report describes the ambition to manage current and future health challenges through a primary health care (PHC) approach that recognises and mobilises a range of stakeholders. The report highlights the role of PHC in responding to the health needs of populations and underscores PHC as a platform for health promotion and disease prevention interventions and reiterates the importance of PHC towards delivering UHC.
In the report, the growing burden of NCDs globally is recognised, with many patients living with multiple morbidities. This poses challenges both for individuals to seek care at multiple locations and to health systems as recommendations for the management of complex conditions and co-morbidities are largely absent. Against the backdrop of health emergencies, including climate change, the report recognises the need for PHC to respond to migrating populations that may have unique health challenges.
These documents were initially presented to the 144th Executive Board and the WHO Secretariat was asked to update them for the World Health Assembly to include language on:
The resolution called on Member States to adopt and internalise the Astana Declaration on PHC and for the WHO to develop an operational framework for PHC by WHA 73.
After a lively discussion, Member States noted the report and adopted the resolution which calls for the integration of the Astana Declaration on PHC within national approaches to health planning. The WHO secretariat has also been tasked with developing an operational framework for PHC by WHA 73 in 2020. This agenda item was discussed in the morning session on Wednesday 22 May by Committee A.
The report submitted by WHO (A72/14) provides an overview of the current scale and burden of inequitable access to health and, while WHO continues to support disease-focused approaches, the report notes the need for greater space to respond to ‘additional challenges’ including UHC and health systems strengthening (HSS). It emphasises that UHC is a standalone health goal but also provides a crucial means of implementation for all the health-related SDGs, particularly 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. The resolution notes the importance of strengthening decision-making for health, including the need for improving integrated health information systems in order to promote equitable, affordable and universal health care for all. 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.
Key themes that emerged during the discussions were sexual and reproductive health and rights, the importance of financial protection mechanisms, the need for multistakeholder partnerships and the importance of building PHC around patients to deliver people-centred UHC. Only two Member States, Namibia and the Bahamas, explicitly highlighted the need to invest in dedicated NCD services to tackle the rising burden, while many other Member States emphasised strong health systems to deliver comprehensive preventative and treatment services. Several Member States also articulated the importance of engaging the highest levels of Government in the high-level meeting in September in order to foster greater political commitment.
Following on from the adoption of the resolution the WHO Secretariat is working to develop a report on UHC and will provide reports on the progress of implementation between 2020 and 2030. This agenda item was discussed in the afternoon session on Wednesday 22 May by Committee A.
WHO’s 13th General Programme of Work sets out a clear commitment to addressing global health inequities, structured around three ‘billion targets’ to improve healthier lives, increase UHC coverage and reduce health emergencies. The programme budget provides one of the first concrete examples of how WHO will enact this vision. At the WHO Executive Board 144 session on the proposed budget (A72/4), Member States welcomed the overview but requested that further information be provided on how the current budget and activities will map onto previous workplans, with information on the expected changes in funding by current area of work.
The new impact framework (A72/5) sets out a series of indicators to measure the outcomes of WHO’s work and proposes the development of a scorecard to better capture the different aspects of WHO’s activities. Accompanying the budget is a report on operationalising the proposed programme budget (A72/INF./2). This provides an overview of how WHO has sought to align the outcomes set out in GPW13 with the existing WHO funding and objectives. This report suggests that there will be greater funding for NCDs as a result of synergies with other health areas and provides a rough breakdown as to the expected contribution of each health area to the delivery of the triple billion targets.
This agenda item was discussed in the afternoon session on Tuesday 21 May by Committee A. After discussion among Member States, the Assembly noted the report containing the WHO Impact Framework and adopted the resolution for the Programme Budget 2020-2021.
The report (A72/11 Rev.1) provides an update on progress towards the health-related Sustainable Development Goals and resolution WHA69.11. It is recognised that the burden of NCDs continues to grow and there are upwards global trends in alcohol and tobacco consumption as well as mental health, particularly increasing suicide rates. In the discussion on UHC, the report notes the current shortfalls in investment in health and particularly the 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.
This agenda item was discussed in the afternoon session on Monday 20 May in Committee A. During the Member State statements, several themes emerged including requests to WHO to support Member States to strengthen their health information systems in order to more effectively track and report on progress. PHC was highlighted numerous times as countries shared progress made to date in responding to the health-related SDGs, however there were comparatively few mentions of measures to systematically address cancer and NCD risk factors. It was clear that many Member States are looking to WHO to support their work on the health-related SDGs and the Global Action Plan on SDG3 (currently under development) was largely seen as a supportive tool. The report was noted by the Committee.
After the UN High-level Meeting (HLM) on NCDs last year, the WHA was provided with a report (A72/19) which summarises 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 of dialogues with industry.
Following on from discussions at the 144 Executive Board (EB144), several amendments have been made, including the addition of further evidence on fiscal measures for NCD prevention (Annex 2), updates to the proposed workplan of the GCM, and an analysis of NCD surveillance globally (Annex 7). In addition to this report, Member States were invited to adopt a resolution which extends the period of the Global Action Plan (GAP) on NCDs through to 2030 to align with the Sustainable Development Goals and charges the WHO with updating the Best Buys for NCDs and strengthen monitoring and accountability.
During the statements on this agenda item, Member States recognised the growing burden of NCDs globally and within their own countries. Many shared examples of the work currently being undertaken to address NCD risk factors but echoed the sentiment of the report that not enough is being done to meet the global NCD targets. There were repeated requests for WHO to scale up their technical and policy support to Member States, particularly to support them in implementing the WHO ‘Best Buys’ on NCDs. The shortfall in global funding for NCD responses, particularly among small and low-income countries remains a clear challenge. The statement on behalf of the Africa region emphasised this, alongside the importance of tackling NCDs as a development issue.
Unexpectedly, one of the controversial issues during this agenda item was the proposal from Thailand to develop an expert technical working group to track the implementation of the WHO global strategy to reduce the harmful use of alcohol, which was resolved through negotiations over the course of informal discussions leading to the adoption of the resolution on Friday 24 May in Committee A.
The WHA was 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 research and development (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 EB 144, 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.
Statements from Member States on the roadmap took place in the morning on Monday 27 May in Committee A. Many Member States highlighted that access to quality medicines was crucial in achieving UHC and that high prices remain the main barrier to access in both high-income countries and low- and middle-income countries. A statement by the AFRO region noted the importance of health system strengthening, TRIPS flexibilities and capacity building and applauded the roadmap for including these key issues.
Member States called on WHO to help with the implementation of the roadmap and strengthen member state capacity and increase collaborations with World Intellectual Property Organization (WIPO) and the World Trade Organization (WTO) on issues relating to intellectual property. The importance of good supply chain management, encouraging local production, pooled procurement and pharmacovigilance were also highlighted. Member States gave examples of initiatives in their countries and stressed the need to collaborate with key stakeholders. Challenges faced by small markets were also acknowledged and one Member State asked WHO to consider including measures against vaccinophobia in the roadmap.
Following on from the draft roadmap and the cancer medicines pricing report at the EB 144 (EB144/18) several 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 was still under negotiation leading Member States to hold a series of informal negotiation sessions during the week.
The resolution 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 develop a web tool to share information, including on public investments and subsidies for R&D.
This resolution was the most debated issue at this WHA. After closed door negotiations which carried on throughout the week, Member States finally agreed on text for this resolution and it was adopted on Tuesday 28 May in the morning session by Committee A. Over the course of negotiations a number of key clauses were watered-down, and the major changes included:
After the adoption of the resolution, Germany, the United Kingdom and Hungary took the unusual measure of 'disassociating' themselves from the resolution, citing concerns that Member States did not have enough time to review and reach true consensus on this complicated issue. Several other countries, including Norway, Canada, USA, and New Zealand, shared the view that the process for considering resolutions at the WHA was not followed, however they did not dissociate themselves from the document.
Supporters of the resolution, including Brazil, highlighted that Member States had actively been engaged in the resolution development and had enough time to participate in and provide input into the document. In response to concerns around protocol, Brazil, Spain and Portugal pointed out that agenda item 12.10 on public health implications of the Nagoya Protocol also had not been presented to EB 144 in January 2019 and Member States were still able to arrive at consensus on that topic, which also has far reaching implications. Member States from the AFRO region also highlighted that hosting discussions on the topic during the WHA improved their ability to engage on an equal footing, as they do not have sufficient staff based permanently in Geneva to participate in discussions at other points in the year. In a joint statement, the African Union articulated its full support for theresolution, stressing how important it is to the realisation of UHC and broader SDGs, which are vital for the African continent. It was also recognised that some Member States compromised their positions in order to reach consensus.