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World Health Organization member states’ first reactions to the secretariat-proposed draft work programme for the next five years were mixed this morning. Although many praised the effort and the vision of the programme of work, in particular its alignment with the United Nations Sustainable Development Goals, a number of countries found the programme ambitious without the needed financial backing, and sometimes straying from the core function of the organisation.

On 22-23 November, a special session of the WHO Executive Board (EB) is looking at the draft 13^th General Programme of Work (GPW13 [pdf]) for 2019-2023.

According to Board Chairman Assad Hafeez of Pakistan, the special session of the EB was organised after the joint request of ten or more Board members asking for it, following the rules of procedures of the EB.

Countries requesting that special session were: Brazil, Burundi, Fiji, France, Italy, Japan, Kazakhstan, Malta, the Netherlands, New Zealand, Pakistan, Sweden, and Thailand, according to a WHO spokesperson. The Executive Board includes a rotating 34 WHO member states out of its 194 members.

The list of participants at this week’s special session of the Board is well beyond the Board membership. The participant list is available here [pdf].

DG Setting Up New Councils, Intensifying Partnerships

In his opening speech, WHO Director General Tedros Adhanom Ghebreyesus (Tedros) said the WHO is at a turning point, and provided ten highlights of work done since taking office at the head of the organisation.

He underlined the response to health emergencies, such as the plague in Madagascar, oral cholera vaccination in Bangladesh, an outbreak of the Marburg virus in Uganda, and the establishment of the WHO Health Security Council, a fortnightly meeting on emergencies.

Tedros also mentioned the establishment of a new High-Level Commission on Non-Communicable Diseases (NCDs) to be chaired by President Tabaré Vazquez of Uruguay and Sania Nishtar of Pakistan, who ran unsuccessfully against Tedros to head the WHO.

WHO, he said, has intensified work with several partners, including the World Bank, UNICEF, the UN Development Programme, Gavi the vaccine alliance, the Global Fund for AIDS, Tuberculosis and Malaria, and the International Telecommunication Union.

The WHO is currently responding to 44 health emergencies, he said, while the burden of NCDs continues to grow “as multinational companies market products that are harmful to health with little or no regulation.”

Tedros also underlined the threat of antimicrobial resistance and climate change, especially for people living in small island developing states.

In a couple of weeks, he said, the WHO will publish new data “that reveals the true extent to which people around the world lack access to essential health services, and are exposed to catastrophic health spending.”

Disparities are still rampant, he said, calling for a paradigm shift, “a radical change in approach.”

The GPW13 clarifies WHO’s mission, he said, and outlines the strategic shifts that have to happen so that WHO can achieve its mission. One of the solutions, according to Tedros, is to become more focused on impact and outcomes.

He explained that the GPW13 proposes the “3 billion targets”. These are: 1 billion more people with health coverage, 1 billion people made safer, and 1 billion lives improved.

WHO must become “much more vocal and visible as a global health leader by advocating for health at the highest possible level,” he said, adding that WHO also must become more operational and relevant in all 194 countries, and that WHO must put countries at the centre of everything it does.

No discussion on the financial implications of the GPW13 should be held yet, he said, as this should only happen once member states agree on the vision and ambition of the programme of work. Comments by member states later show they do not seem to see matters in this light.

EB Members: Where is the Money?

EB members delivered general statements today and voiced praise, questions, and some concerns.

Despite Tedros’s suggestion that they wait, they asked for more information on how the GPW13 would be financed. The European Union asked that the GPW13 investment case be delivered at the same time as the updated version of the GPW13 for discussion during the next session of the EB in January. Canada, Japan, Vietnam, France, and Sri Lanka also asked for greater financing details.

Some members also stressed the importance of access to health services and medicines, such as those in the EU, the African region, and Georgia which said countries cannot be held hostage to high prices of medicines.

Algeria for the African region said the continent needs to be supported so it can produce medicines at the local level, making full use of the flexibilities included in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), and the Doha Declaration on the TRIPS Agreement and Public Health.

Algeria also said among the strategic priorities, health emergencies and universal health coverage (UHC) need to be fleshed out, and more information is needed on subjects such as research and development (R&D) strategy, and funding.

Colombia remarked that the GPW13 focuses on low income countries and said middle-income countries also have their share of health challenges. The representative also asked to have some technical background on how the 3 billion goal targets were defined and how these targets will translate at the regional level.

GPW13 a Political Document, Some Say

Japan said the GPW13 appears “quite different” from GPW12, which the delegate said was less political and more pragmatic. Sweden said the six core functions of the WHO, as defined in GPW11 and GPW12, are still relevant and should be included in GPW13. France said the redefinition of the WHO’s role should not compromise its key functions.

Turkey voiced concerns over the ambition of GPW13, which he said is “much more of a political document prepared by a group of … consultants of an ambitious politician than a technical paper.” It needs more emphasis and clues about its implementation, the delegate said, adding that Turkey would still support the “intentions and dreams” of GPW13.

Some members also underlined the need for WHO to maintain its normative and leadership functions on the forefront, such as Malta on the behalf of the European Union, and Brazil.

Fiji said it is concerning that the draft GPW13 seems to “shy away” from saying what WHO will cease doing or do less. Like Malta for the EU, Fiji said an analysis of the global health environment and its actors would be important.