Global health fulfilled the most important mission of its political year with the convening of the 77th World Health Assembly (WHA77) from May 27 to June 1 in Geneva, the headquarters of the World Health Organization (WHO).

A complex agenda was fulfilled by the Ministers of Health of the 194 Member States at their annual meeting in 2024. The main highlights were the approval of the 14th General Programme of Work of the WHO (GPW14), a comprehensive document proposing a pathway for global health to promote, assist, and protect the health of people worldwide over the next four years; approval of the package of amendments to the International Health Regulations; and the extension of the deadline for discussions on the Pandemic Treaty or Agreement. According to the WHO, these critical actions were taken with the expectation of ensuring the development of comprehensive and robust systems in all countries to protect the health and safety of all people everywhere against the risk of future outbreaks and pandemics.

A set of decisions and resolutions were adopted on: Antimicrobial resistance; climate change and health; infection prevention and control; maternal, neonatal, and child health; mental health in emergencies; social participation in primary health care; transplants and others.

An Investment Round for the WHO was launched and there was a significant celebration of the 50th anniversary of the Expanded Programme on Immunization (EPI). In 1974, when the EPI was launched, health systems vaccinated less than 5% of babies worldwide; today, about 84% of the world's children have been vaccinated against diseases like diphtheria, tetanus, and pertussis, for example. Although attacked by irresponsible conservative groups, vaccines are the greatest reason for reductions in child mortality - from 11 million child deaths in 1990 to 4.5 million in 2022.

Strategic Round Tables provided opportunities to address investments in the WHO; health economics for all; artificial intelligence; antimicrobial resistance; and climate change and health.

New directors (all women) from the Southeast Asia region (Saima Wazed, from Bangladesh), Eastern Mediterranean (Hanan Balkhy, from Saudi Arabia), and Western Pacific (Saia Ma'u Piukala, from Tonga) were welcomed.

On May 27, the Assembly was opened with the election of Dr. Edwin Dikoloti (Botswana) as president, and as vice-presidents, Dr. Frank C.S. Anthony (Guyana); Dr. Youngmee Jee (Republic of Korea); Dr. Ala Nemerenco (Republic of Moldova); Dr. Ali Haji Adam Abubakar (Somalia); and Dr. P.G. Maheepala (Sri Lanka). At the opening, the WHO Director-General, Tedros Adhanom, presented the report on the Organization's activities in 2023, which he considered a year of challenges and achievements. Throughout his speech, he raised topics he considered relevant:

1- Healthier populations

• 1.5 billion people will be in better health and well-being by 2025.
• Reduced tobacco use, with 19 million fewer smokers globally.
• Policies to eliminate trans fats in food have been implemented.

2- Universal Health Coverage

• Only 585 million more people will have essential health coverage by 2025, far from the goal of 1 billion.
• WHO is supporting over 120 countries to expand access to essential health services and improve financial protection.

3- Access to medicines

• 120 medicines, vaccines, and diagnostics prequalified.
• Expansion in technology transfer, including new partners in the mRNA Technology Transfer Program.

4- Immunization

• "The Big Catch Up" was launched to recover immunization coverage affected by the pandemic.
• Introduction of new vaccines for dengue, meningitis, and a second malaria vaccine.

5- Noncommunicable diseases

• Expansion of the HEARTS package for hypertension and new initiatives for childhood cancer and cervical cancer.
• WHO's Special Initiative for Mental Health expanded access to mental health services in several countries.

6- Antimicrobial resistance

• Increase in the number of countries reporting data on bacterial infections.
• New national action plans developed to combat antimicrobial resistance.

7- Health emergencies

• 777 million people better protected against health emergencies by 2025.
• Response to 65 health emergencies, including earthquakes, conflicts, and disease outbreaks.
• Continued support to countries and territories, such as Gaza, Sudan, and Ukraine.

8- Other efforts

• Polio eradication with declining case numbers.
• Strengthening emergency response capacities, such as the Pandemic Fund.
• Support for preparation for the Olympic Games in Paris.

9- WHO efficiency

• Publication of over 8,000 new documents and technical products.
• Digital initiatives such as the Global Network of Digital Health Certification and guidance on artificial intelligence for health.

14th. General Programme of Work (GPW 14)

At this AMS, the 14th General Programme of Work (GPW 14) was presented, which sets out a roadmap for global health, seeking to guide the Organization's work in support of Member States and partners over the next four years (2025-2028), according to WHO, "to revitalize actions necessary for Sustainable Development Goals (SDGs) related, while preparing health systems for the post-SDG era."

Recognizing that the world has changed drastically since the adoption of the SDGs, GPW 14 sets an ambitious agenda for global health in the face of challenges and major trends, including climate change, aging, migration, evolving geopolitics, and advances in science and technology. It predicts spending of USD 11.1 billion for global health, to promote, provide, and protect the health and well-being of all people.

GPW 14 was developed through an iterative consultative process of ten months with WHO Member States and a wide range of partners, including UN agencies, international health organizations and funds, civil society, and youth groups, entities in formal relations with WHO, technical networks, and WHO collaborating centers. The document can be consulted in full here.

GPW 14 has six strategic objectives, reflecting the main areas to be focused on in this four-year period:

• responding to the growing health threat posed by climate change;
• addressing the determinants of health and the root causes of health problems in key policies across all sectors;
• promoting primary health care and essential health system capacities for universal health coverage;
• improving health service coverage and financial protection to address overall inequality and gender inequalities;
• preventing, mitigating, and preparing for health risks;
• detecting and sustaining rapid response to health emergencies.

Once adopted by the World Health Assembly (WHA), GPW 14 will be operationalized through the WHO's biennial program budget process. The WHO Investment Round, planned for late 2024, will seek to mobilize resources for financing GPW 14. The Program Budget is a fundamental tool for Member States to define and approve the Organization's priorities, set goals to be achieved, and monitor their implementation.

As part of the funding framework, WHO has launched the "investment case," which outlines the Organization's essential contribution to global health and seeks investment in its 2025-2028 strategy to "save 40 million lives and improve the health of 6 billion people." The 40-page investment case document is rich in data and examples of WHO achievements—from women's health to antimicrobial resistance (AMR) and infectious disease elimination—showing how the Organization amplifies the impact of its work, yielding a return of $35 for every $1 invested, and outlining what can be achieved if WHO is sustainably financed.

WHO's strategy for global health, as approved through GPW 14, calls for deep collaboration with Member States and partners to address health needs in a time of climate change, geopolitical turbulence, mass migration, and other complex issues. With the Investment Round, WHO is not asking for more funds, but rather voluntary contributions, in line with the four-year strategy, to ensure its full implementation, as regular Member State contributions cover only a portion of the costs of activities approved by the WHA; the Investment Round aims to raise funds to cover a $7.1 billion shortfall.

The investment case further details how activities outlined in GPW 14 will potentially save 40 million lives, focusing on health emergencies, AMR, maternal and child health, infectious diseases, non-communicable diseases, vaccination, climate change effects, and risk factors including tobacco, alcohol, physical activity, and diet.

Additionally, it provides examples of activities, including: providing solar electrification to 10,000 health facilities to make them fully functional; supporting 55 countries in training and employing 3.2 million health professionals; increasing the number of vaccines delivered to priority countries; providing access to health services for over 150 million people in humanitarian contexts, in 30 countries; assisting 84 countries in meeting targets for malaria elimination, mother-to-child HIV transmission, and other diseases; enhancing access to timely and reliable health data; and prequalifying 400 health products annually.

Adoption of amendments to the International Health Regulations
After intense two years of negotiations, the 77th WHA successfully approved amendments to the International Health Regulations (IHR). These amendments aim to strengthen global health security by enhancing disease surveillance, information sharing, and response mechanisms. In a world with many questioned weaknesses of multilateralism, agreement on the IHR amendments is truly a victory for global health diplomacy. The consensus for IHR approval assumes even greater significance in a WHA marked by rounds of voting on various issues among the 194 member states.

The set of amendments adopted in the IHR includes recognizing equity as a principle of this instrument for the first time in its history; defining pandemic emergency; including obligations regarding access to health products; establishing a new coordinated financing mechanism; and strengthening transparency and timely disclosure of information, among other elements.

The key results and amendments are:

1. Definition of pandemic emergency

•    A new definition of pandemic emergency—the highest level of alert, which will trigger more effective international collaboration and coordination during disease outbreaks with potential to become pandemics—has been established.

2. Strengthened surveillance and response

•    The amendments aim to improve countries' capacity to detect and respond to future outbreaks by enhancing national capabilities and coordination among countries. This includes better mechanisms for public health surveillance and preparedness.

3. Solidarity and equity

•    The amendments emphasize solidarity and equity, particularly in strengthening access to medical products and funding for developing countries. A coordinated financial mechanism will help equitably address the needs and priorities of these countries in pandemic prevention, preparedness, and response.

4. Committee of the parties

•    A new Committee of the Parties will be established to facilitate effective implementation of the amended regulations. This includes establishing National IHR Focal Points to enhance coordination within and between countries.

5. Commitment to a pandemic agreement

•    The WHA extended the mandate of the Intergovernmental Negotiating Body (INB) to conclude negotiations on a pandemic agreement until the World Health Assembly in 2025, with the possibility of early completion in a special session in 2024.

The adoption of amendments by consensus showed that despite tough negotiations, member states reflected on the need for a comprehensive instrument to better combat pandemics. There is potential to improve detection and containment of health threats before they become international emergencies. For this to happen, urgent investments to implement the Regulation, particularly in low- and middle-income countries, are essential.

There is still a need for further discussion on accountability for implementation and monitoring of commitments made. And although the approved IHR is already an important tool for strengthening the world's response to health emergencies, work towards the Pandemic Agreement must continue, leveraging this momentum towards it.

Approval at the Assembly does not mean immediate adoption of the amendments. It marks the beginning of a national-level process, respecting each country's sovereign right to decide whether to accept or opt out of these international rules, coming into force 12 months from the notification of their adoption. Countries like Slovakia have already stated they would dissociate themselves from these amendments. Others, including Iran, Russia, and Argentina, indicated they would examine the amendments considering national sovereignty and decide whether to reserve the right to implement these obligations.

The adoption of these amendments to the IHR marks a significant step towards strengthening global health security. The focus now shifts to ensuring effective implementation of this Regulation and securing a comprehensive Pandemic Agreement by 2025, which will further strengthen international cooperation and preparedness for future health emergencies.

The successful conclusion of this process will have ramifications not only for the continuation of negotiations on the Pandemic Agreement but also beyond. For stakeholders in global health, who have long suffered after the Covid-19 pandemic, this is the first serious attempt to correct what went wrong during the pandemic. The amendments to the IHR symbolize a first agreement in which developing countries had a say in defining these rules.

Other approved resolutions

Despite this WHA being marked by the approval of PGT14, in addition to IHR and INB, other important resolutions were adopted by the Member States.

Among them is the Resolution on Climate and Health, which acknowledges the intrinsic issues related to the topic and proposes intersectoral actions. The Resolution on Economics and Health for All, resulting especially from the work of economist Mariana Mazzucato and the WHO Council of Economics of Health for All (link here). It is based on four major areas of recommendations, which are: valuing and recognizing health for all, adequate financing, innovation, and strengthening public capacities for performance and monitoring of stipulated measures.

Furthermore, a resolution to accelerate national and global responses to antimicrobial resistance (AMR) was also approved, before the second High-Level Meeting (HLM) of the UN General Assembly on the subject, in September 2024. Under the broad concept of a people-centered approach, the resolution warmly welcomes WHO's strategic and operational priorities for addressing drug-resistant bacterial infections in the human health sector (2025-2035), with the four strategic priorities being: infection prevention; universal access to quality diagnostics at affordable prices and to appropriate treatment for infections; strategic information, science, and innovation; and effective governance and financing of the human health sector's response to AMR.

There was also approval of a new resolution on increasing the availability, ethical access, and oversight of cell, tissue, and organ transplantation. The lack of availability and equitable access to transplants can lead to death or to unethical or illegal practices, such as transplant tourism and organ trafficking. The resolution aims to improve transplant availability, especially in resource-limited countries. It aims to introduce measures to prevent and combat trafficking in persons for organ removal and trafficking in human organs, and to protect the victims and survivors of these crimes through the strengthening of legal norms. WHO is tasked with developing a global strategy on donation and transplantation, to be presented to the Assembly for adoption in 2026.

The WHA also approved texts on 'Mental Health and Psychosocial Support before, during, and after emergencies' (A77/A/CONF./11); the 'Global technical strategy and targets for malaria 2016–2030' (A77/6); and examined 'Health conditions in the occupied Palestinian territory, including East Jerusalem, and in the occupied Syrian Golan: Summary of health support and technical assistance to the Palestinian people in the occupied Palestinian territory, including East Jerusalem, from January 1 to October 7, 2023' (A77/18).

The Assembly also reviewed the 'Report of the Secretariat of the WHO Framework Convention on Tobacco Control' (A77/INF./3) and other items contained in the Director-General's Consolidated Report (A77/4), including: 'Immunization Agenda 2030'; 'Strategy to end TB'; and 'Roadmap for Neglected Tropical Diseases 2021–2030'.

Alarmed by the stagnation of progress in reducing maternal and child mortality, countries today approved a critical resolution committing to specific actions to prevent the deaths of women, babies, and children. Annually, 287,000 women die during pregnancy or childbirth, 4.9 million children die from largely preventable causes before their fifth birthday, and there are 1.9 million stillbirths. Progress in reducing maternal deaths has stagnated since 2016, while gains in newborn and young child survival have slowed.

This new resolution commits to combating the leading causes of maternal and child deaths, especially in the most affected countries, while simultaneously improving access to comprehensive maternal, sexual, and reproductive health services and comprehensive child health services through stronger primary healthcare. It also highlights the need to expand access to emergency services, including urgent obstetric care and neonatal units, essential for managing complications associated with prematurity and other causes of newborn deaths. The resolution underscored that health systems must be able to provide quality, safe, and effective care through well-stocked facilities, well-trained and motivated health professionals, clean water and sanitation, sexual and reproductive health services, including family planning.

With decisive Brazilian participation, through representatives of CNS, Conasems, and Conass, the WHA approved a resolution to implement, strengthen, and maintain regular and meaningful social participation in health decision-making processes. Social participation, as defined in the WHA, means empowering individuals, communities, and civil society through inclusive participation in decision-making processes that affect health, throughout the political cycle and at all levels of the system.

The resolution on social participation recalls and is based on related intergovernmental agreements that affirm the importance of social participation, including: Political Declaration of the High-Level Meeting on Universal Health Coverage (2023); Astana Declaration (2018); SDG Goal 16.7 for responsive, inclusive, participatory, and representative decision-making at all levels (2015); and the Rio Political Declaration on Social Determinants of Health (2011).

The resolution recognizes the fundamental role that social participation can play in promoting mutual respect and trust, while making health systems more responsive, equitable, and resilient. Implementation of the resolution involves convening regular and sustained participatory mechanisms; strengthening the capacities of the public sector and civil society for meaningful engagement; enabling equitable, diversified, and inclusive participation, with special emphasis on promoting the voices of all people in vulnerable or marginalized situations; pursuing political acceptance of recommendations from participatory processes; allocating adequate and sustained resources from the public sector; ensuring supportive public policies and legislative frameworks; and advancing research, monitoring, and evaluation of the implementation and impacts of social participation.

In conclusion, it can be stated that this Assembly satisfactorily fulfilled its role of formulating a work program, with goals to be achieved, strategies for implementation, and seeking financial resources to make it viable.

However, critical voices also arose, warning of certain unrealistic aspects in the goals of PGT14, as well as what concrete results may come from extending another year to the Pandemic Agreement or Treaty given the difficulties in overcoming the divergences between developed and developing countries.

The large intercountry machine begins to move to implement the dozens of agreed resolutions or, satisfied with the roles published in the form of resolutions, will leave them only for the records of another WHO Assembly. This is what we will see throughout this and the next year as Geneva becomes bustling again and the whole cycle begins anew.