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After what was described as the biggest World Health Assembly ever, with the highest number of agenda items and the highest attendance, it seemed that all’s well that ends well at the closing ceremony earlier today. A notable fact during this assembly has been the rising volume of voices from developing countries, joined by developed countries on issues related to access to affordable, safe, and efficacious medicines. Resolutions and decisions were adopted, many with hopes of better addressing challenges such as antimicrobial resistance, cancer, substandard and falsified medical products, medicines access and shortages and more.

The annual World Health Assembly took place from 22-31 May.

Margaret Chan, the outgoing director-general of the World Health Organization, gave her final speech at a WHA during the closing plenary session today.

Chan said that it was an “unprecedented record-breaking Assembly” in many ways. The 70th WHA had “the largest ever number of agenda items, documents, delegates and record numbers of interventions,” she said. “More than 80 delegations took the floor to speak about health emergencies, and nearly as many spoke during the item on polio eradication.” Delegations got through an agenda which “looked like an impossibly heavy agenda, almost impossible to finish,” she said.

“In the spirit of consensus that has always warmed my heart, you approved the programme budget for 2018–2019,” Chan said. “Equally unprecedented in recent years, you agreed to a 3% increase in assessed contributions” (which are paid by governments).

Delegates approved the WHO’s proposed programme budget of US$ 4421.5 million for the biennium, which includes a 3% (or US$28 million) increase in Member State assessed contributions for 2018-2019, according to WHO. The proposed budget sets out the UN health agency’s priorities in line with the UN Sustainable Development Goals. It includes increased investments in the new WHO Health Emergencies Programme (US$ 69.1 million) and combating antimicrobial resistance (US$ 23.2 million), it said.

Chan also thanked the staff members for their work during the WHA.

“The world is hungry for success stories,” Chan concluded. “WHO is well positioned to deliver them. Under the leadership of Dr Tedros, I have every confidence that WHO will do so.”

On the second day of the Assembly, Tedros Adhanom Ghebreyesus of Ethiopia was elected next director general of WHO, starting on 1 July (IPW, WHO, 24 May 2017).

Below are highlights of some key actions taken during the Assembly.

Antimicrobial Resistance (AMR)

Affordability and accessibility to new medicines are part of a resolution approved last week to improve the prevention, diagnosis, and management of sepsis, a life-threatening blood stream infection for which there is growing bacteria resistance. Sepsis is one of the issues of the broader antimicrobial resistance problem.

The resolution calls for the WHO to collaborate with other United Nations organisations, and the need to enhance access to quality, safe, efficacious and affordable treatments.

During the discussion on a secretariat report on the implementation of the global action plan on antimicrobial resistance, some member states, such as Brazil and India, remarked on the absence of reference to either the concept of delinking the cost of R&D and the prices of medicines, nor the need for affordability and access to new and existing antibiotics and vaccines (IPW, WHO, 26 May 2017).

Cancer Resolution, Delinkage Out but SmoothAdoption

After inconclusive discussions at the WHO Executive Board in January on a draft cancer resolution, mainly over intellectual property-related elements, and three informal meetings since then to agree on a text just days before the opening of the WHA, a resolution on cancer prevention and control was easily adopted yesterday.

The last contentious issue in the text, which was removed, was a reference to delinking. This has been a keyword for civil society for many years, and was heard routinely from some delegations, mainly from developing countries, in this WHA.

The resolution lists actions to be taken by governments and the WHO. These include implementation of national plans for prevention and control of cancer, and the promotion of research and equitable, affordable access to cancer care, for governments. WHO is requested to work with outside actors to foster the development of effective and affordable new cancer medicines.

Substandard and Falsified Medicines

The WHA agreed to replace the term “substandard/spurious/falsely-labelled/falsified/counterfeit medical products” (SSFFC medical products) with “substandard and falsified medical products.” Key to this decision is that protection of intellectual property rights is not a competence of the WHO and that it approaches substandard and falsified medicines from a public health perspective (IPW, WHO, 30 May 2017).

In announcing the change to a shorter, more pronounceable term, the committee chair told the closing plenary that not having to say the longer term could save future Assemblies “hundreds of hours,” which was met with laughter and applause. The longer term was a product of a past disagreement among governments over how to handle the issue.

Global Strategy on Innovation and IP, Help on TRIPS Flexibilities Needed

The WHA also noted an independent review [pdf] by an external consultant on the WHO Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA). The review looks at the implementation of the GSPOA at country level and provides key findings, achievements, and gaps and challenges identified for the eight elements of the GSPOA.

In general, countries welcomed the report and expressed satisfaction. A number of developing countries underlined the importance of affordability and accessibility to medicines. Many called for support in the implementation of the flexibilities included in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), as a way to facilitate access to medicines, through generic production of medicines.

NGOs Knowledge Ecology International, and Médecins Sans Frontières (MSF – Doctors Without Borders) criticised the report. The former because the review does not include mention of delinkage, the latter because the conclusion of the review is at best vague, and at worst deliberately obscure (IPW, WHO, 28 May 2017).

Access to Medicines: Discussions to Stay

India and the United States, in an unlikely alliance, suggested that the topic of access to medicines be further discussed, which was supported by a number of other countries. The WHA decided to keep access to medicines on the agenda of the WHO Executive Board (EB) meeting in January 2018.

The issue of access to medicines had been lumped together with shortages of medicines, after some developing countries pressed for the access to medicines, and in particular the recommendations of the United Nations Secretary General’s High-Level Panel on Access to Medicines to be discussed at the WHA.

All countries, in proportionate terms, said they are suffering from unaffordable new medicines. In the past, pricing of medicines was mostly an issue met by developing and least-developed countries, but developed economies have been feeling the bite of medicines shortages and prices, which is being judged as unacceptable.

Last week, some European countries took the floor to voice their concern over prices and to detail the actions they are taking (IPW, WHO, 28 May 2017).

R&D for Diseases Affecting the Poor: Chronic Underfunding

WHA members had to hear the hard truth: the WHO strategic work plan on research and development for diseases primarily affecting poor countries and vulnerable populations is underfunded. Not that they did not know about it, as the situation is chronic.

As a result, the report, which was noted by WHO members, out of the estimated total financial requirement over the period 2014-2017 for the implementation of R&D demonstration projects and the establishment of the newly established Global Observatory, of US$85 million, as of January 2017, only US$2.5 million was founded for the observatory, and US$10.45 million for the demonstration projects.

This chronic underfunding made its first victim: last week, the WHO announced that the 6^th demonstration project on a single-dose malaria cure had to be cut short (IPW, 29 May 2017).

Pandemic Flu Preparedness Review: Wait a Minute

A decision was adopted on 25 May on the WHO Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits. Following the review of the framework in 2016, and the recommendations suggested by the review group. WHO member states agreed on the need to carry more in-depth analysis on some of them.

It was decided that a closer look is needed on how to handle pandemic flu viruses under the framework, whether the framework should cover seasonal influenza, and whether it should become a specialised international instrument on access and benefit-sharing under the Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the UN Convention on Biological Diversity (IPW, WHO, 26 May 2017).

 

William New contributed to this report.