World Health Assembly ends amid aid cuts and political divisions

An annual gathering of the World Health Organization (WHO) drew to a close on May 27 after countries approved a historic pandemic agreement, increased core funding to the embattled United Nations (UN) agency, and reached a slew of decisions addressing critical health issues, including the use of traditional medicine and addressing the medical impacts of climate change.

Delegates from all 194 member states, minus the US, gathered in Geneva from May 19 for the World Health Assembly (WHA) as global health faces threats from aid funding cuts, shifting geopolitics, and health emergencies.

At the closing plenary, WHO director-general Tedros Adhanom Ghebreyesus hailed the defense of equity, hope, and multilateral cooperation at the assembly: “You expressed the collective will of the nations of the world—the United Nations—to work together on a shared approach to shared problems.”

It was the first time since 1948 that the US, until recently WHO’s largest contributor, was absent from the meeting, following Donald J. Trump’s executive order in January to withdraw the US from the organization and stop funding it. Argentina also chose not to attend after President Javier Milei, a Trump ally, announced in early February that Argentina would also withdraw from the WHO.

Pandemic agreement

During the assembly, countries adopted a much anticipated agreement to better prepare for and tackle future global health emergencies, 3½ years after the idea was first proposed at the height of the COVID-19 pandemic. Agreements are approved by states before they sign and ratify the completed pact, which binds countries to them.

The agreement, adopted by consensus, now awaits a yet-to-be-agreed annex on the contentious issue of pathogen access and benefit sharing (PABS). That annex, which observers expect will be adopted by next year’s assembly, must be approved before the agreement can move forward for signature and ratification.

“You want to finish this because there are 34 other articles in the agreement which are important,” Precious Matsoso, cochair of the pandemic agreement’s Intergovernmental Negotiating Body, tells C&EN. The other items include countries’ requirements to invest domestically in pandemic preparedness and protect its health-care workers. A new working group appointed to iron out details on PABS is set to begin talks on July 15.

Money matters

The US aid freeze provided a backdrop as countries approved a plan that was proposed in 2022 to increase their membership dues by 20% with the aim to put dues at an equal footing with voluntary contributions from member states and other partners, including philanthropies. The WHO budget for 2026–27 was also approved, after donor cuts forced the organization to reduce it from an initially proposed $5.3 billion to $4.2 billion. A week before the start of the assembly, Tedros announced that the top management team would be sliced from 10 to 4 people to cut costs. 

Meanwhile, China, which sent 180-plus delegates to the assembly, announced a $500 million 5-year pledge to the WHO, which is expected to set the country as the organization’s biggest funder. A senior Chinese government official declared that the contribution was to oppose “unilateralism,” referring to the US withdrawal from multilateralism. 

Political and technical decisions

In total, 75 agenda items were discussed at the WHA. Among the more political were the adoption of two resolutions on the situation in the Palestinian territories, as Israeli military operations intensified in Gaza, including reiterating a condemnation of the impacts of the war on civilian populations. Member states also voted to continue to support Ukraine in restoring and strengthening its health-care system, rejecting Russian amendments to the decision.

A new strategy calling for increased investment to help integrate traditional medicine in modern health-care systems was approved, and on the final day of discussions, a climate change and health action plan was adopted, defeating oil-producing states that tried to oppose it. Other decisions that were adopted include a target to strengthen regulations for digital marketing of baby formula and one that would make rare diseases a global health priority.

On rare diseases, the resolution adopted at the meeting calls on countries to integrate them "into national health planning, improve diagnosis and care through universal health coverage, promote inclusive policies, and accelerate innovation, research, and access to affordable treatment. Importantly, the Resolution mandates WHO to develop a comprehensive 10-year global action plan on rare diseases, with measurable targets to guide progress toward equity, inclusion, and access to care for all affected individuals,” the WHO says in a May 24 news update.