World Health Assembly
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The World Health Assembly (WHA) is the forum through which the World Health Organization (WHO) is governed by its 194 member states. It is the world's highest health policy setting body and is composed of health ministers from member states.
The members of the WHA generally meet every year in May in Geneva at the Palace of Nations, the location of WHO Headquarters. The main tasks of the WHA are to decide major policy questions, as well as to approve the WHO work programme and budget and elect its Director-General (every fifth year) and annually to elect ten members to renew part of its Executive Board. Its main functions are to determine the policies of the Organization, supervise financial policies, and review and approve the proposed programme budget.
Members, observers and rules
In addition, six agencies have observer status at the WHA – the Vatican, the Palestinian Authority, the Sovereign Military Order of Malta, the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies, the South Centre organization, and the Inter-Parliamentary Union.
The Assembly is governed by Rules of Procedure of the World Health Assembly; agenda items are set by the General Committee of the Assembly, a group of 25 individuals that includes the President and subcommittee chairs, and a number of delegates elected by the Assembly previous.
The Department of Health of the Republic of China, commonly known as Taiwan, was invited on 28 April 2009 to participate in the WHA 2009 as an observer for the first time since losing its China seat in United Nations to People's Republic of China in 1971. The invitation was extended to "the Department of Health, Chinese Taipei." Since 2017, it has been completely excluded from the WHA.
Each year, the WHA elects members from among its ranks to renew the Executive Board (EB). This body is governed in Chapter VI, Articles 24 through 29, of the Constitution of the WHO. The EB must have an equitable geographic distribution, and "shall be elected for three years and may be re-elected... The Board shall meet at least twice a year and shall determine the place of each meeting." This is invariably chosen (by consensus) to be Geneva. A current list of members on the Executive Board can be derived through consultation of the WHA #Annual Assemblies summaries which are posted below.
The main international policy frameworks adopted through WHA resolutions include:
- International Health Regulations
- International Code of Marketing of Breast-milk Substitutes, adopted in 1981
- Framework Convention on Tobacco Control, adopted in 2003
- Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010
In addition, the WHA has endorsed through resolutions a number of WHO action plans dealing with different areas to improve health around the world, such as:
- Worldwide eradication of smallpox, first endorsed in 1959, and then declared to have been won in 1980
- Worldwide eradication of polio, first endorsed in 1988, recently re-affirmed in 2011
- Control of human hookworm infection through regular deworming of at-risk school children, endorsed in 2001
- WHO global action plan for workers' health, endorsed in 2007
- Control of harmful use of alcohol, endorsed in 2010
- Enhanced global actions for the prevention and control of non-communicable diseases, endorsed in 2011
The WHA is also responsible for the endorsement of the WHO Family of International Classifications, a series of internationally standardized medical classifications, including the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF).
2008: Sixty-first WHA
The focus of the 61st WHA was public health. Participants from 190 countries attended, with a record 2704 delegates. Important briefings and resolutions involved intellectual property barriers in research and development; combatting non-communicable diseases and female genital mutilation; campaigns to support breastfeeding and to decrease abuse of alcohol and tobacco; immunization practices, including adoption of the term "pharma fraud"; and health issues facing migrants.
2009: Sixty-second WHA
In her role as global patron of The White Ribbon Alliance for Safe Motherhood, and chair of the Maternal Mortality Campaign, Sarah Brown gave the keynote speech at the World Health Organization's 62nd WHA, alongside United Nations Secretary-General Ban Ki-moon, asking "Where is the M in MCH?’ [maternal and child health]" in an echo of Allan Rosenfield's landmark Lancet article of 1985 – and highlighting that the numbers of women dying in pregnancy and childbirth were still the same 14 years later.
2012: Sixty-fifth WHA
Among other actions, the 65th Assembly endorsed the Rio Political Declaration to address the social determinants of health, intended to spearhead support for all countries to adopt inclusive ‘Health For All’ approaches to health promotion. It also endorsed the first World Immunization Week.
2013: Sixty-sixth WHA
In her address to the 66th WHA in May 2013, DGWHO Margaret Chan traced a brief history of revisions to the International Health Regulations following the SARS outbreak in 2002-3, the "first severe new disease of the 21st century." She observed that the two new diseases WHO is dealing with in 2013 are the novel coronavirus (MERS), from the same family as SARS, detected in 2012 in Saudi Arabia, and the first-ever human infections with the H7N9 avian influenza virus reported in China in 2013. She attributed the positive report by the World Health Statistics (May 2013) on dramatic improvement in health in the world's poorest countries from 1993–2013, to the emphasis placed on poverty alleviation by the Millennium Development Goals. She announced the emergence of global action plans for noncommunicable diseases, mental health, and the prevention of avoidable blindness and visual impairment calling for a life course approach which includes "equity through universal health coverage," preventive strategies and "integrated service delivery."
Chan declared at the assembly that intellectual property, or patents on strains of new virus, should not impede nations from protecting their citizens by limiting scientific investigations. Following the 2012 MERS outbreak, Saudi Arabia Deputy Minister of Health Ziad Memish raised concerns that scientists who applied for a patent would not allow the MERS-Coronavirus to be used for investigations by other scientists and were, therefore, delaying the development of diagnostic tests. Ten of the 22 people who died and 22 of 44 cases reported were in Saudi Arabia. Saudi Arabia–based microbiologist Ali Mohamed Zaki reported the first known case, a 60-year-old Saudi man who got sick in June, 2012 on ProMed-mail, a public health on-line forum then published more details including the virus’s genetic makeup and closest relatives. The Erasmus Medical Center "tested, sequenced and identified" a sample provided by Ali Mohamed Zaki. Erasmus MC and Dr. Zaki strongly refuted all allegations concerning a presumed lack of willingness to cooperate in research into the new MERS coronavirus, making diagnostic tests and virus specimens freely available to all research institutions around the globe.
2014: Sixty-seventh WHA
The 67th WHA took place in Geneva on 19–24 May 2014. Among the more than 20 resolutions adopted by the Assembly included ones concerning strengthening of national drug management systems to address antimicrobial resistance; implementation of the Minamata Convention to protect human health and the environment from effects of exposure to mercury and mercury compounds; and improving access to essential medicines worldwide. Also endorsed was a global monitoring framework for maternal, infant and child nutrition.
Following the 67th WHA, DGWHO Chan was criticized by the Association of Correspondents Accredited to the United Nations (ACANU) for not having spoken directly to the media during the course of the Assembly.
2015: Sixty-eighth WHA
During the assembly the WHA agreed to the Global Malaria Strategy and Programme Budget for 2016–2017, polio, International Health Regulations, strengthening surgical care, WHO's reform of its emergency and response programme, antimicrobial resistance, immunization gaps, malnutrition, air pollution, and epilepsy. Annual health awards were given by the DGWHO and the President of WHA.
2016: Sixty-ninth WHA
The 69th World Health Assembly took place 23–28 May 2016, and agreed to pursue the health-related Sustainable Development Goals (SDGs) through a comprehensive set of foundational steps, prioritizing universal health coverage, working with actors outside the health sector to address the social, economic and environmental root causes of antimicrobial resistance and other human health problems, to continue expanding efforts to address poor maternal and child health and infectious diseases in developing countries, and to focus upon equity within and between countries. Delegates decided to invite the WHO Framework Convention on Tobacco Control’s (WHO FCTC) Conference of the Parties (COP) to provide information on outcomes of this biennial event to future World Health Assembly meetings.
2017: Seventieth WHA
The 70th World Health Assembly took place 22–31 May 2017.
For the first time since 2009, Chinese Taipei was completely excluded from the WHA, following the election of Tsai Ing-wen and subsequent political pressure from the People's Republic of China (PRC). Mainland China stated that the role of Chinese Taipei as an observer to attend WHA between 2008 and 2016 was based on a consensus between the Ma Ying-jeou Administration and Mainland China, as well as resolution WHA25.1 "Representation of China in the World Health Organization" (1972). As the Tsai Ing-wen Administration did not recognize the "1992 Consensus" as the Ma Ying-jeou Administration did, the People's Republic of China had withdrawn its endorsement of Chinese Taipei to attend WHA as an observer.
2018: Seventy-first WHA
The 71st World Health Assembly took place 21–26 May 2018.
2019: Seventy-second WHA
The 72nd World Health Assembly took place 20–28 May 2019. Argentina, Austria, Bangladesh, Burkina Faso, Grenada, Guyana, Kenya, Singapore, Tajikistan, Tonga, Tunisia, United Arab Emirates were elected to the Executive Board. The President of WHA72 was Dr Bounkong Syhavong of the Lao People’s Democratic Republic.
2020: Seventy-third WHA
The 73rd World Health Assembly took place virtually, through electronic media, 18 and 19 May 2020. One problem was the fact that, in the interval of one year between the WHA72 declaration of Geneva as the location of the WHA73 and the occurrence, the airlines of the world had been collapsed by the coronavirus and so few people could physically be in Geneva on the prescribed dates of WHA73. The Special Procedures document was suggested by the Executive Board to allow a virtual de minimis WHA73, and contained as Annex the Special Procedures guideline, in order that it might be passed at the earliest possible juncture during WHA73. As there was to be in operation only the Plenary session, all decisions would be taken there. In practice, this meant a) that the decisions were reduced to one vote, on the adoption of the seven-page motion (discussed below) and b) that the heavy lifting and consensus building was done offline and before 18 May, in order for a meaningful vote to be obtained on 19 May with what turned out to be the seven-page consensus motion.
Because of the aforementioned travel restrictions, Bahamian civil servant Keva Bain was selected President of WHA73 from amongst the Permanent Representatives of member governments to the WHO.
On Monday 18 May, Australia and the EU tabled a seven-page motion which was supported by over 120 delegations. The Australian delegation hardened the tone of the original European text, to include the qualifiers "impartial, independent and comprehensive evaluation", to the text of OP9.10 "as appropriate, to review experience gained and lessons learned from the WHO-coordinated international health response to COVID-19", "using existing mechanisms (including an IHR Review Committee and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme)". The Aus-EU motion passed with unanimity. The final motion calls for the review to be coordinated by the WHO itself. The proposal for a supplementary agenda item, "Inviting Taiwan to participate in the World Health Assembly as an observer", did not receive consideration although it was tendered by 14 independent states.
The WHA73 was largely composed of two-minute statements by each world leader; in fact these statements overflowed into day two. At the virtual opening, President Xi Jinping of China pledged that the People's Republic of China will: 1) make its COVID-19 vaccine development and deployment a global public good once available, and contribute to ensuring vaccine accessibility and affordability in developing countries; 2) provide $2 billion USD over two years to help with COVID-19 response, especially in developing countries; 3) establish a cooperation mechanism for its hospitals to pair up with 30 African hospitals and accelerate the building of the Africa CDC headquarters to help the continent ramp up its disease preparedness and control capacity. The position that the Republic of China be admitted to the WHA as an observer earned strong verbal support from the United States, Paraguay, Haiti, Marshall Islands, Nauru, Belize, Saint Lucia, Palau, St Kitts and Nevis and Tuvalu. The Russian delegation, which was elected on day two to the Executive Board of the WHO over the misgivings of an unknown delegation, objected strenuously to the Ukrainian delegation's remark on the degraded health in the TOTU population owing, felt the Ukrainians, to unwanted territorial expansion by Russia. The Russian delegation disclaimed involvement in the TOTU, including the Republic of Crimea which has been a member of the Russian Federation for over five years but is unrecognized by the international community of which the WHA forms part.
Ten members of the Executive Board were elected on day two, from Botswana, Colombia, Ghana, Guinea-Bissau, India, Madagascar, Oman, Republic of Korea, Russian Federation, United Kingdom of Great Britain and Northern Ireland.
The Republic of China was invited under the name Chinese Taipei as an observer to the WHA for 8 years between 2008 and 2016, based on "a consensus between the two sides of the Taiwan Strait" (namely, the Ma Ying-jeou Administration and Mainland China) and resolution WHA25.1 "Representation of China in the World Health Organization" in 1972. However, since the 70th WHA in 2017, the People's Republic of China has continued to block the participation of the Republic of China in the WHA as an observer. United States Secretary of Health and Human Services Alex Azar has voiced support for the Republic of China's inclusion in WHA as an observer. WHO Principal Legal Officer Steven Solomon had in early May 2020 on this subject a press conference, wherein he describes the issues and gives interesting answers when pressed about the similarity of this subject to the invitation of Palestine. Solomon pointed to Article 18(h) of the Constitution, which states that the Assembly has power: "to invite any organization, international or national, governmental or non-governmental... but in the case of national organizations, invitations shall be issued only with the consent of the Government concerned." Palestine has been invited to attend as an observer "based on, and with reference to, resolution WHA27.37, as further clarified by resolution WHA53.13 ".
Notes and references
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