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This Week in Global Development
What can we expect from the 79th World Health Assembly?
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This week, we look ahead to the key talking points at the 79th World Health Assembly, where the Devex team will be reporting from next week. As the https://www.devex.com/organizations/world-health-organization-who-30562 continues to operate on a...
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Foreign
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My name is Rumbi Chakamba and you're listening to this Week in Global
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Development hosted by myself, Ata Saldinger and David Ainsworth. And I'm joined by our health journalists, Jenny Le Rovello and Andrew Green, who will be giving us a preview of what's to come at this year's World Health Assembly.
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Hi guys.
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And it's so great to have you and it'll be great to see you in person on the ground at wha. I'm going to start off with what's not happening at WHA this year. It's another year of us not having the PUBS agreement. The final negotiations before WHA happened a couple of weeks ago and they did not settle on an agreement. So there'll be new negotiations happening in July. This sounds like it's something that will never ever get done because it keeps being kicked down the line. Is there any update we can give Jennie or. It's just, it's not happening.
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The decision they came up with, I mean, the proposed decision that they're going to be putting forward before the World Health Assemblies to, you know, continue the negotiations. I know, I know, it's kind of, it feels like, you know, we're never going to, you know, see the end of it. But it also illustrates how, I guess difficult the discussions are on this and how member states are really looking at this as a really very critical piece of the pandemic agreement. So, so we'll see again if they end up finding consensus on the full text. We may have a special WHA this year, but if not, as we've seen in the previous agreements when we had the discussion around pabss, it's going to be next year at the World Health Assembly.
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So one interesting thing, a source state about pabss. This was Jamie Love. He says that because people weren't able to ensure there's equity in the rest of the pandemic agreement, PUBS has sort of become this hill that everyone is willing to die on. And you see that from high income countries as well as low income countries and they actually both make really sensible argument about it. And it just seems like it's the one thing that people are not willing to budge on. Andrew, can you just take us through? For those who don't know, what are some of the argument, what are some of the sticking points within the agreement?
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Yeah, definitely. And I think the, the ongoing hantavirus outbreak is a really good example of why the Global south is really pushing for equity in the PABSS agreement. So the argument from the Global south is that they're often called upon to share information with the rest of the world. And in this case the hantavirus outbreak, South Africa played a really key role in identifying the virus and getting critical information out to people. And they're saying that in return for sharing that information, they should then have equitable access to whatever medical countermeasures emerge, whether it's vaccines, whether it's, you know, some kind of test and anything that kind of emerges from the data that they're sharing. The Global north and the pharmaceutical, Pharmaceutical industry that kind of resides in the Global north don't want to make those guarantees. They, you know, the pharmaceutical industry is particularly interested in protecting what it says are the, the money that it needs to generate in order to make, to. To do the work that it's required to do to produce these medical countermeasures. You know, the Global south is saying that this is, that they're leveraging profit off the back of the, the testing and the work that is being done in the Global South. And it does seem like, as Jenny said, they've made very little progress. And you know, as you mentioned, this is something that they, they seem committed to both sides sticking to their guns.
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Yeah.
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So we will wait after wha. To see how this goes on. But one thing that will definitely be on everyone's mind and on the agenda to discuss is who finances. You dug into the financials for 2025 and basically who was operating on a deficit. I think it was 30. Yeah, 39 million last year. And this is, I guess we could probably lay the blame on the US for this one, but. So the US didn't pay their contributions for 2025 and is it 2026? Jenny can take us through the correct numbers for that. So the US hasn't paid their contributions, which kind of left who in a lurch. Can you take us through what the finances look like right now, Jenny?
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Yeah, so we looked at the audited financial statement sending 2025, and you're right. When you look at revenue and expenses, there's higher expense than revenue. And so they ended up with the deficit, although overall their net assets are still positive. But at the same time, what the statement says is who has already. So Remember back in 2025, they asked member states if they can use a portion of their reserves. And in that statement it shows that who has in fact used a portion of their. Of that money, you know, to pay for indemnities and others. And right now what I think there remains a lot of concerns within who. I mean, WHO staff, even former, you know, and current officials, are still worried about looking at that financial situation because WHO has Director General Tedros mentioned earlier in the year they still have over 600 million gap in funding for 2026 and 2027. That's a huge gap. And it's, you know, it's a question where that money's going to come from, you know, to fill that gap, especially now given the declines in foreign aid. And, you know, a lot of health entities are just facing some challenges with their budgets. So there's a concern right now within WHO that we could expect more cuts, more staff cuts, but of course, nothing's clear at the moment.
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Yeah, and as I mentioned, the US Plays a huge role in this. I think one of the things that I said for discussion this year as well, Jenny, and please confirm if I'm correct about this, is the US Exit from who. So there was a discussion around whether they can formally exit without paying their dues that were already owed. And I think there might be a discussion about it, but there's really nothing that one can do because the US has said it has formally exited from WHO and it is now looking to sign bilateral deals with different countries and is looking to sort of circumvent the WHO process. So it looks like there's really no way back. And I think it's time kind of highlights how important US Funding is now because with the US out, the Gates foundation becomes who's biggest donor. So, Andrew, what discussions are you expecting around the US and sort of the role that it's kind of playing in global health right now?
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Yeah, I've seen a lot of people kind of billing this upcoming World Health assembly as the last chance to preserve multilateralism in the global health space. You know, as you mentioned, you've seen the United States striking these bilateral health deals with more than 30 countries at this point. And through those deals, the United States is really pushing what its agenda is, which is, you know, disease surveillance, disease preparedness, thinking about what the biggest risk could be to the United States and not necessarily what the priorities of the countries that it's partnering with are. So against that backdrop, I think that there's a real emphasis both within the, the World Health, the official World Health assembly, and then also within some of the side events to think about how to continue to push a multilateral agenda that reflects the needs of the, you know, the entire global community, but also particularly the Global south, and especially at a time when donor aid is drying up, when The United States is, you know, saying that's going to withdraw a lot of its funding after five years and when governments are being expected to contribute more to their own health budgets. So you're seeing a real discussion bubbling up around the Akrari said, which would set, which is a way for health ministers across Africa to kind of determine their own priorities in collaboration with their governments and finance ministers. And so I think that'll be really interesting to see kind of this fight to see who's going to determine what is at the top of the agenda for the limited global health financing that exists moving forward.
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I'm not sure if I should just say I'm a pessimist, but I feel like funding kind of just defines, kind of decides who sets the priorities. And we're hearing a lot of talk about move, moving to a country led sort of global health architecture where countries sort of define the priorities. But I also think that depends a lot on how much domestic financing can be contributed for countries to be able to actually define that Then also when you speak about funding and sort of defining priorities, it takes me back to WHO and the funding situation. One of the biggest things that Tedro set out to do as dg, and he's coming to the end of his term, is sort of increase the agency's flexible funding. Looking at your recent story, Jen, Jenny, and looking at the finances, is it safe to say that he's failed to do that or should we say it's still a work in progress?
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Well, I guess I would say the numbers speak for themselves. You know, how much they've gone along. I mean, one thing I could say definitely is there's been different efforts led by Tedros to really kind of bring up more flexible funding for the, for the organization, more predictable funding. You've got the investment round, which was the first time it's happened within who you've got. I mean, one of the wins, I suppose is when member states agree to increase their assessed dues up to 50%. It's gradual. So, you know, a lot of that will be realized even after Cedra's tenure. But that's, that's, I guess that's a real win because, you know, you're increasing really flexible funding for the organization. The downside to that is that's pegged on a base that's around, I think was 2022. 2022. So it's not about 50% by the time we reach 2029 and 2030, because you think about inflation and all of these other factors. So there was real effort. And then of course there was WHO foundation was also created to help kind of tap into non traditional sources of funding. And Shannon, you know, a bulk of that fund, of the, of the funds that the foundation is able to raise to who. So there's efforts, but when you look at the finances, it's just that I think, if I remember correctly, there's even an increase in earmarked voluntary contributions to the organization. So I think the numbers that you
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had was out of the 2.5 billion voluntary contributions, 214 million was flexible.
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Yes, correct. And when you look at, I mean, one of the things that we wrote recently is about Saudi Arabia becoming one of the top 10 donors to WHO. But again, when you look at the breakdown of funding coming from Saudi, the number of Jews is actually very small. A big part of it is voluntary contributions, but that's also highly earmarked. And so even though we see maybe some countries and organizations providing funding to who, it's still very much earmarked, including the Gates foundation. If you, if you look at the breakdown of their funding.
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Yeah, and that brings me to the reprioritization process. Because WHO is in this effort to reprioritize, it's kind of been forced to cut a lot of stuff and they're reprioritizing, kind of focusing, kind of changing their focus areas and redefining what they should actually be focusing on. A lot of people say that it should be focused on its normative functions, but when you receive earmarked funding, which is for specific things, and these are things that countries or organizations are probably like championing, you're sort of forced to make. To make those things happen. So is there any way that the organization can actually define what its function is supposed to be without enough flexible funding? And I think this is probably a question for a lot of global health organizations and a lot of countries. Like, how do you define priorities if you don't have like the sort of independence with your finances? Andrew, are you seeing this coming up a lot, like with countries, global health organizations, etc. That's why I keep going back to the money. Like it just depends on who's paying for it.
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Yeah, I think that's right. And I mean, you see around the wha, for instance, there's a lot of, a lot of disease specific conversations that are taking place. A lot of efforts to, you know, get both attention and also draw resources to the kind of niche, not, not projects, but like the niche concerns that people have that have, you know, that it's difficult to draw attention to, especially in a restricted donor setting, donor environment like we're in right now. And so I think everyone's kind of scrambling to see, like what their place is in this new emerging architecture, including the who. And I also, you know, as you said, it's, it's difficult for the WHO to position itself. It's kind of in this constantly moving environment. Right. Because now we're seeing, for instance, in this hantavirus outbreak, there's a call for the WHO to take the lead on this, particularly in a moment when the US cdc, which normally would be playing leadership role, is not. And there's kind of a paucity of research that's being done and because the CDC isn't there. So now there's some suggestion that maybe that's something the WHO should step into at the same moment that, you know, they don't have financing and they're trying to kind of draw down exactly, you know, the, the broad scope of what they do. So I, I think there's going to be a lot of conversation at WHA about global health architecture. I think there's going to be a lot of pushing to make sure that, you know, core key concerns like neglected tropical diseases like NCDS are, don't get left behind, aren't just dropped from the agenda because there's no financing. But as you say, I mean, it's one thing to kind of keep drawing attention to it. It's another thing if there's no money, then what's going to, what's going to be the outcome of, you know, some of the, the meetings and discussions that we have this coming week.
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And Jenny, you've talked a lot to a lot of people about the reprioritization process. And one fear that I know a lot of global health experts is, is that this is kind of going to be shaped by funding cuts basically because we don't have the money we have to cut abcd. Instead of actually thinking of what's the, what's the best place and position for WHO in the global health architecture, is that fear still a reality? And what are people saying about this three prior prioritization process?
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You know, when you look at, you know, WHO came out with a document as well for the who, and I think this will be discussed as well, saying, you know, we've reprioritized, we've shifted things around where things that we think other UN entities or other organizations can lead on. We've stepped back a bit, but we're focusing on our normative work and all of that so there's some details of that. But I think, you know, as you and Andrew have mentioned, that funding still kind of carries things forward. I also think there's a little bit, little transparency in terms of these changes within who. But I, but I do know that, you know, funding continues to kind of, kind of direct what programs it focuses on. For example, there was a road safety, which seems like a varinish, you know, topic. But the euro region, the regional program on road safety and injury prevention in the European region was sunsetted because there's no more funding for it. And my initial question was like, okay, what happens at the global level? Well, I heard Bloomberg, which is a major funder of this initiative, continues to fund this work and that continues at the WHO headquarters level more focused on implementing countries. But because this type of work doesn't really have a country sort of implementing focus in the euro region that's been sunsetted. So, you know, I think one thing that we should also be taking into account is you've got regional offices and they kind of the regional, regional officials are the ones taking note of where, what will be our priorities.
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And which brings me back to something that Andrew, you've been writing a lot about. Like, in addition to everything that's, I guess the main themes that are going to be looked at, the WHO kind of refocused on finances. But a big part of that is what happens to the HIV response, because we're hearing a lot of talk about the future of UN AIDS and what work they'll be able to carry on, what work is supposed to go to WHO with who's financial challenges as well. So we're expecting a lot of discussions around the future of the HIV response. What should we be on the lookout for?
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Yeah, I think that's going to be kind of a big talking, a big issue within certain groups of people at wha. There is a real focus around how domestically governments are going to prioritize HIV and how they're going to both increase funding and then what they're going to increase funding to. So I know there's a, they're drawing in health ministers in these discussions and I think that's important. You want to keep HIV on the agenda. No one wants to see another explosion of infections. But the health ministries have always been on board with this agenda. The question is going to be if the finance ministries are coming on board. And I don't think they're going to be in Geneva for these conversations. So I think that important discussions will probably take place around what it's going to look like for countries to increase domestic ownership of the HIV response and particularly how they're going to continue to fund, prioritize HIV prevention work, which has really been kind of decimated over the past year with US funding cuts to the global HIV response. But at the same time, you know, they can take their expectations and their hopes home to their countries. But it then becomes a question of what domestic resources exist to actually kind of fund whatever plans they come up with. And so I think that will be kind of the sweet spot of these discussions. How to. How to not just develop plans, but develop plans that are actually going to get financed.
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Which reminds me of something that someone said at our last WHA event. They said that there's no use in us coming here discussing all this and leaving the finance ministries out. We need to have the finance ministers in the room. I'm not sure if it's that we're inviting the finance ministers and they're not coming to the table, but that doesn't seem to have happened as yet. Or maybe we're going to see these discussions being carried forward at forums like maybe anga, where we kind of bring more people in besides the global health people. But I'm seeing that a lot of people are saying it's just not enough to talk to each other. We need to actually you talk to people who control the piss strings. Which brings me to our event. We're actually going to be hosting another Devex impact house at WHA still at the InterContinental Hotel for two days of programming. And I know that we've got a really great bang up of speakers. Can you tell me who are you interested? Who are you excited to speak to? Jenny?
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I've got a lot of panels and interviews on stage for sure, but one is I'll be Speaking with welcome CEO Dr. Yonargand. We'll be talking about AI, but also talking about the future of global health. Wellcome is one of those institutions that started this regional dialogues on rethinking the global health architecture. They did that last year. And so now that there's a proposal now before who, for WHO to lead a joint process for aligning all of these discussions around and making recommendations. I think it's very relevant. But I also am very interested in hearing what he'll be saying in terms of how can we move past all these talks to actually change. Because we're hearing so many opinions, so many commentaries about how to change the global health architecture. I think the key question would be how to move from all of those commentaries to Real Action. I'm also interested in speaking with some WHO officials that we have, regional directors, Dr. Hanan Balki, Dr. Barbosa. You know, these people are rumored internal candidates for the WHO position. And while, you know, no one has announced anything, I'm still interested in kind of getting a feel of how the US exit impacted their own visions and how they are evolving and maybe we can get a question there or something or get a sense of, you know, where they are in their ambitions for the DG position.
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Interested in speaking a little bit more about the DG position. But before I jump to that, I was going to say, speaking of the global health architecture, we're actually going to kick off the conversation with Ghana's Minister of Health. And Ghana has sort of been championing the Accra reset, which is the African Union, African continent sort of idea to restructure the global health architecture. So it'll be really great to hear from of him. And then right after that, I get to speak to Donald Kabaruka. I had a conversation with him a few months back also about changing the global health architecture. And he has some strong points and strong opinions on that. So interested to speak to him again. But Andrew, what are you interested in and which conversation are you most looking forward to?
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Yeah, I think one thing that we haven't talked a lot about today, but that's going to also be, you know, on the agenda both at the World Health assembly and beyond, is the role of the private sector is going to play. And so one of the conversations I'm really interested in having is with Amy Weaver. She's the CEO of Direct Relief now and they kind of position medical aid around the world, but she has a background coming from the private sector. And so I think it's interesting to think about not just what private sector financing, but also lessons that the ways that the private sector offers lessons to humanitarian sector, vice versa, and how that you can kind of find a nexus that might result in cost savings, ways to get services to people faster, more efficiently, but also at lower rates than what we're seeing now in the kind of current UN humanitarian model. So I think that'll be an interesting conversation.
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Yeah.
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Speaking of the private sector, we'll also have a conversation with Gilead, who are the manufacturers of Lena Kappa VR, which is going to play such a strong role in the hiv, which is supposed to play such a strong role in the HIV response. I have to cushion that in case we don't get enough doses of Lena Kapovir. But that will also be quite an interesting conversation. But Jenny, you mentioned the DG race, which I think is going to be something really important that we need to look at. You did a story a few months ago, I don't know if you remember this, but it was looking at what kind of leader who needs. And I kind of read through everything that all the experts that she spoke to said. I edited that story. And towards the end of the story, I'm just like, okay, so we're looking for a unicorn. There's a lot that's going to be expected of this next WHO leader. What kind of things are people expecting them to do? And what do you think candidates need to kind of people who are kind of gearing themselves up for this race need to kind of prove and show at this point in time.
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Yeah, I think the unicorn kind of became something that people repeated on social media. It definitely captures what people are expecting from the whodg. Given the funding constraints, given the, you know, misinformation and disinformation currently, you know, happening in the world. The geopolitics people want someone that's, I guess they're looking at someone that can balance between having a vision for the organization, but also have the leadership and the negotiating prowess with member states to be able to lead organization while maintaining good relationships with member states. There's a lot that they are expecting from the dg. Also on funding, of course. How can the next DG resolve this, this outstanding issue of finances of who, especially now that, you know, as with the recent financial statements, they ended up with a deficit. So there's a lot that they're expecting. We don't know yet who exactly will be running. A lot of rumors who said in its process that it will announce all the candidates around the end of October, but we definitely should expect the candidates to, to start coming forward starting this May, if not this May, you know, in the coming months. Because there are WHO regional meetings happening between June and October. And so that's really an opportunity for these candidates to, you know, to come before member states present their platforms, kind of win these member states over. And so we should definitely hear who will be in the running even before the end of the of October.
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And a big question that people have is, is the next DG able to bring the US Back to the table? So I'm also interested to see if we have a candidate that sort of is in alignment with the U.S. what are you expecting around that, Andrew? And what kind of person could be able to bring the US Back to the TABLE I mean, the US Speaks a lot about reforms that it wants from who. And I know Tedros keeps saying the organization is moving in that direction and it's reforming, but what would it actually take to what kind of person would it take to bring the US Back to the table?
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I think that's the million dollar question. I think that's going to be a source of real tension in the coming months because I imagine there are a lot of people, a lot of member states that are perhaps not interested in continuing to cater to the whims of Washington at a time when they've really undercut the kind of global health architecture and maybe, you know, in the push for multilateralism response to the fact that US Is taking a bilateral approach and so saying, well, they're, they're no longer, they can't obviously be extricated from the global response, but, but they're not willing to provide this kind of leadership or this kind of vision. So we're choosing a leader who's going to go in a different direction. At some point when the United States comes to its senses and decides to catch up, then they'll, you know, be welcomed back, but we're not going to, to spend a lot of time, energy and time catering to whatever they want. On the other hand, you know, Jenny just got done talking about the huge deficit that the WHO is facing and that's largely a result of the United States backing out. And so, you know, if this would then kind of be a test, if that's the priority, getting WHO financing back on track, then maybe, maybe it is looking to a leader that's favorable to the Trump administration. And really kind of that then becomes a litmus test for who gets selected.
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Yeah, I think as a big question in global health, can you open afford to say see you later to the US because in a sense I think
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a lot of people would want to
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do that and say when you're ready to catch up, when you're ready to put signs forward, we will be here. But the finances speak a lot and a lot of donors are actually cutting oda. Germany has become the highest provider of oda, but it's also cut funding. So with limited funding available, it's really hard to see if there's any other game in town because besides the US So it'll be interesting to see what candidates come up and what kind of discussions or role bringing the U.S. back. And we should also mention Argentina because I think we also forget that Argentina also left the agency. I guess the funding US Was Providing a lot more funding. So that hits a little bit harder. But Argentina also left the Agency. So that's also something that the next DJ will be also looking to do, bring countries back. Because when Argentina left the Agency, we realized that there is no actual process set out for countries to leave the who because the assumption was no country would ever want to leave. So seeing two countries leaving the WHO in quick succession, I think that's something that the next DG will also have to look at. Make sure no one else is going out the door and how can we bring people back. And I also think this will be a time when people start talking about Tedros legacy. And I'll be interested to see what people have to say about that. Because one of the things that he did set out to do was as provide more flexible funding for the organization. And in a sense he's done that. But it'll probably be realized once he's left the office as dg. So it'll be interesting to see what people have to say about Tedros legacy. Jenny, are you hearing anything around his legacy?
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It's mixed. I think Tedros is one of those global health leaders, has really been very, very popular. You know, he's, he's, he's kind of, some people mention he's like the global health star, you know, always in demand for speaking engagements. You've seen him, you know, on the stage with some of the leaders of the world, really. But at the same time, this past year has really, you know, been a really affected WHO so much. There's been a lot of concern that there was no preparation for what everyone believed was going to happen. You know, the US Exit when Trump won the presidency. And so if you're going to ask people stuff who have been affected, who may be there but still kind of feeling uncertain where their career is going, I don't think we're going to hear much really positives in terms of Tedra's legacy. But again, you know, different folks have different opinions and that's something I really love to do. You know, toward the end of his
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tenure, I feel really bad for the guy. Hey. Because it's so sad that your legacy might end up being defined by this one last year. Because so much upheaval happened in that one last year. But they were kind of like all these years that happened prior to that and a lot of goal setting that happened prior to that. But because of all the upheaval, the focus will sort of be what happens during this upheaval. And I think it'll probably have like a great impact also on who becomes the next DG this particular period in time because you're looking at who would have done things differently. And I think a lot of people will be talking about how they would have responded in this particular situation and it'll be interesting to hear what people would actually say. But yeah, it's harder said. It's easier said than done in that sense. Thank you guys so much for joining me for this conversation. As I mentioned earlier, we'll be on the ground in Geneva next week and we'll have our two days of programming at Devex Impact House. Which also reminds me, we're also supposed to have another Devex Impact House at London Climate Week on 25 June, so look out for that. And if you are going to be in London, please do sign up for that as well. Thank you Andrea and Jenny for joining me and I'm looking forward to seeing you next week in person and doing this. We'll actually have another episode next week in person on stage in Geneva, so it'll be really fun to do that in real life.
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I can't wait to see you guys in Geneva.
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Yeah. And everyone else else tuning into this podcast episode. Hopefully we'll be able to see in person there as well.