May 19, 2020
The big news this week in International Geneva and around the world, was of course WHO’s World Health Assembly (WHA). Several hours ago, the WHA adopted by consensus an EU-led resolution with more than 144 co-sponsors on the global response to Covid-19, although the US did dissociate itself from several key paragraphs.
At a time when the US’ erratic behaviour threatened to disrupt the virtual gathering, the resolution itself is a success for the WHO and the diplomatic efforts behind the scenes. Greeted by whoops and clapping in the almost empty Executive Boardroom at WHO’s Geneva headquarters, the question remains whether it is a successful response or whether it represents a lowest common denominator agreement.
While the US-China row did flare up, the Assembly was a global show of solidarity and support for WHO’s leadership role. The latest instalment of the “scold war”, as The Economist coined it, began at WHA in a form more in accordance with diplomatic niceties. President Xi Jinping got things going, telling the virtually assembled that, “all along”, China had reacted “with openness, transparency and responsibility”, providing “information to WHO and relevant countries in the most timely fashion”.
For the US, Health Secretary Alex Azar riposted later in the afternoon by saying “we must be frank” (strong diplomatic language, indeed), and called out the unnamed (but no prizes for guessing) “one member state” that had “made a mockery of their transparency obligations, with tremendous cost to the entire world”. Much to Chinese fury, Azar also brought up the Taiwan issue despite a pre-agreed convention among member states not to mention it.
It seems that, after a failed attempt to oust Dr Tedros and a failed attempt to water down the language of the resolution on COVID-19, President Trump had had enough. He waded in on Monday (Tuesday night in Geneva), revealing on twitter a letter he had sent to WHO, accusing it of repeatedly making inaccurate and misleading statements on the Chinese situation, making a number of accusations against China, and threatening that "If the WHO does not commit to major substantive improvements within the next 30 days, I will make my temporary freeze of United States funding to the WHO permanent and reconsider our membership.”
The resolution adopted by Member States reaffirms WHO’s directing and coordinating role. It further requests WHO initiate an independent, external review of the WHO-coordinated response to COVID-19.
Against, and perhaps despite, this backdrop, a succession of world leaders nevertheless reiterated their support for the embattled organisation and their conviction that it should in fact be strengthened rather than weakened (including financially).
The resolution adopted by Member States reaffirms WHO’s directing and coordinating role. It further requests WHO initiate an independent, external review of the WHO-coordinated response to COVID-19. As ever with such agreements, the devil will be in the operationalising details. While there is agreement that the review must be “comprehensive” and conducted at the “earliest appropriate moment”, there will be disagreement over what those terms mean in practice.
Incidentally, WHO Health Emergencies Programmes’ Independent Oversight Committee decided it was an appropriate time to publish its interim report on Monday (18th May). Overall, the report is broadly favourable to WHO’s response though it does raise some key questions. Specifically, that WHO is underfunded and its resources are stretched in key areas of its emergency response; that while WHO’s secretariat’s response was faster than either for MERS or SARS, it did not prompt a similarly rapid response by all Member states; and connected to this, whether the WHO’s system for ringing the alarm bell (the Public Health Emergency of International Concern under the International Health Regulations) is too broad a designation and is thus not taken seriously enough by Member States.
On ensuring access to future vaccines and other equipment, the situation remains rather muddy. That’s not surprising as the question has enormous economic and political implications. Before the event, many leaders signed up to the People’s Vaccine Initiative. Still others threw around the phrase ‘Global Public Good’ during the Assembly like it was the ‘90s—the last time the term was in fashion. Although it may have its uses as a rhetorical tool in consolidating support around the idea that a vaccine should be available to all, it is actually legally meaningless.
The resolution, for its part, states that technologies should be available through existing mechanisms (like voluntary patent pooling or the public health flexibilities contained within the TRIPS agreement). This isn’t a loss for global access advocates, but it is a far cry from the mandatory mechanism some had hoped for. Despite this, Washington still considered that it went too far. Although it allowed the resolution to pass without a vote, the US mission in Geneva immediately released a statement dissociating itself from the language on patents (as well as on reproductive healthcare), saying that it “sent the wrong message to innovators”.
As the world moves on from the WHA, it will be interesting to see which—between the US-China dispute and the global meeting that adopted a resolution on the largest challenge confronting the world today—was the side show and which was the main event.
For its part, the WHA’s session is only temporarily suspended and it’s expected to resume later this year. As global health emergencies can become black holes, sucking up money and attention towards one issue and detracting from all others, part of WHO’s role when the WHA resumes will be ensuring the world’s attention is not only on COVID-19.