With a united voice, World Health Organization Board members agreed last week on a draft resolution for the preparation of a United Nations General Assembly high-level meeting on universal health coverage in the fall, following intensive closed consultations. The United States, however, dissociated itself from language it thought gave a permissive view of abortion.

The resolution, cosponsored by a large number of countries and adopted by the WHO Executive Board on 1 February, underlines the slow progress in achieving universal health coverage in many countries, and calls for WHO members to promote access to affordable, safe, effective, and quality medicines, vaccines, diagnostics and other technologies.

The resolution also asks member states to support research and development on medicines and vaccines for communicable and non-communicable diseases, including neglected tropical diseases, “particularly those that primarily affect developing countries.” It further calls for “needs driven, evidence-based, guided by the core principles of affordability, effectiveness, efficiency and equity, and considered a shared responsibility.”

According to the WHO, universal health coverage means “ensuring that everyone, everywhere can access essential quality health services without facing financial hardship.”

The resolution, still a Conference paper [pdf], was adopted by the Executive Board, which met from 24 January to 1 February. It has to be adopted by the World Health Assembly, taking place from 20-28 May.

The resolution was originally proposed by Japan and Thailand: After extensive informal consultations spanning the length of the Board meeting, the agreed upon version of 1 February was cosponsored by Bangladesh, Botswana, Canada, China, Finland, Georgia, Indonesia, Japan, Malta, Russia, Sri Lanka, Switzerland, Thailand and Uruguay.

Other countries joined at the close of the Board meeting, including Mexico, Brazil, China, the Netherlands, France, Kenya, Benin, Norway, Portugal, Belgium, the United Kingdom, Ireland, Spain, India, and Moldova.

The WHO was requested by the UN General Assembly “to work in close collaboration, in consultation with Member States, to prepare for the meeting with a view to ensuring the most effective and efficient outcomes, including potential deliverables,” according to the report [pdf] of the WHO director general on universal health coverage.

Reproductive Health: US Blasts Abortion

One of the difficult issues of the informal discussions was the issue of reproductive health, according to sources. On 1 February, The United States, although joining the consensus, said it wished to be dissociated from paragraph “PP6,” dealing with sexual and reproductive health. The paragraph reads:

“Recognizing also that Heads of State and Government committed to ensuring, by 2030, universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.”

The US “takes exception on reproductive health terminology” in paragraph PP6, the delegate said, “because the meaning of the paragraph has evolved to include abortion, encouraging countries to change their laws on abortion, leaving the normalisation of sexual activities as an expectation for teenagers.”

Defending the US interest in health care for women, the delegate said women should have equal access to health care and “our investment in women’s health and family planning which far exceeds any other country, speaks for itself.”

The US fully supports the principle of voluntary choice regarding maternal, child health and family planning but “we have never recognised abortion as a method of family planning and we do not support abortion in our global health assistance,” the delegate said.

IP & Trade Flexibilities 

According to sources, mention of the use of flexibilities in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to facilitate access in an operative paragraph was the other major source of disagreement during informal sessions.

In an earlier leaked draft [pdf], India, Ecuador, Egypt, and Peru introduced TRIPS flexibilities as a way to promote better access to medicines (IPW, WHO, 28 January 2019).

The mention of TRIPS flexibilities no longer appears in the resolution as something member states should be encouraging, but an introductory paragraph (PP14) does mentions the TRIPS flexibilities and the 2011 Doha Declaration on the TRIPS Agreement and Public Health “which recognizes that intellectual property rights should be interpreted and implemented in a manner supportive of the right of Member States to protect public health and, in particular, to promote access to medicines for all, and notes the need for appropriate incentives in the development of new health products;”

WHO Member States Urged to Be Inclusive

The resolution calls on WHO member states to accelerate progress towards achieving target 3.8 of the UN Sustainable Development Goals. Target 3.8 states: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”

No one should be left behind, in particular the poor, vulnerable, and marginalised population, the resolution states.

Image Credits: World Health Organization.