Breakthroughs Blog: United Nations

As is tradition, the World Health Organization (WHO) Executive Board (EB) kicked off what promises to be another packed multilateral calendar. While much has remained the same, this year’s forum also ushered in noteworthy shifts in deliberations, dynamics, and dialogue that advocates should be aware of. Here are GHTC’s top takeaways from the week: 1. EB shrinks space for civil society engagement. As civil society delegates entered the halls of WHO for the EB for the first time since 2020, they were confronted with a harsh reality: The ability for non-state actors to meaningfully participate in these meetings is at an all-time low. New protocols had been introduced limiting delegation size and physical and structural changes put in place that left civil society literally on the outside looking in. Gone are the days when civil society could be physically present in the assembly room to follow the proceedings. Instead, advocates were relegated to a small, hot, and stuffy overflow room, more akin to a small press room, located far away from the official proceedings, hampering their ability to connect with officials and country delegates, which is often the most valuable part of the week. As EB participation and the number of agenda items have ballooned, WHO has also imposed new constraints on civil society statements, which have hit non-state actors particularly hard. WHO has tried to force civil society organizations to come together and develop single constituency statements for certain agenda items, a challenge that often further dilutes specific technical feedback from a diverse set of voices as various WHO-accredited institutions try to reconcile diverging views into a single, cohesive communication. Individual interventions are now reduced to just one minute, and they must be uploaded to a WHO database prior to the start of that agenda item. Apart from the challenge of distilling feedback and technical input down to around 100 words, the requirement to upload in advance prohibits advocates from rebutting issues that arise during debate or meaningfully influencing the decision making in real time. Other United Nations (UN) agencies, such as the World Trade Organization and the World Intellectual Property Organization have far more robust and meaningful civil society engagement processes that could serve as better models for WHO to emulate. 2. Debate on WHO’s work in health emergencies goes into the next round. Global politics tend to spill over into the parliamentary debates at EB, and this year was no different with the war in Ukraine creating serious tension between western allies and Russia. Much of the debate surrounding WHO’s role in health emergencies was derailed by several testy back-and-forths between delegations, leading to disruptions and little progress on key agenda items. A new ten-point proposal from WHO Director-General Dr. Tedros Adhanom Ghebreyesus to improve preparedness and response to health emergencies also received mixed reviews from WHO member states, with many warning the WHO secretariat not to move ahead of member states and the already ongoing processes to amend the International Health Regulations and negotiate a pandemic accord.  The latter did make waves at this EB, as the WHO Intergovernmental Negotiating Body (INB) published a “zero-draft,” that included a few surprises. The draft features some strong, equity-focused language, as well as calls for building and strengthening country regulatory, manufacturing, and innovative research and development (R&D) capacities for pandemic-related products. Surprisingly, it also features numerous callouts and provisions focused on intellectual property, including incentivizing relevant transfers of technology and know-how, forcing manufacturers that receive public funding to disclose prices for pandemic-related products, and time-bound waivers on medical countermeasures that can accelerate or scale up manufacturing, signaling the key battlegrounds for upcoming negotiations.  The biggest stunner, though, is a brand-new section focused on creating a new WHO Pathogen Access and Benefit-Sharing System (the “PABS System”) that would collect and equitably distribute a portion of all globally produced vaccines and other medical products during pandemics. According to the draft, 10 percent of total global production of pandemic products would be allocated to WHO, with half donated and half bought at an “accessible” price. Now, deliberations on the specific provisions will begin in earnest ahead of the World Health Assembly (WHA) in May, with the INB hosting two meetings in the next few months to debate individual chapters of the draft.  3. Implementation of the clinical trials resolution enters its next phase as member states argue about scope. Member states also debated the implementation of last year’s clinical trials resolution during the session on global health emergencies. Delegates noted the progress WHO had made over the past year in leading consultations and mapping the current clinical trial networks landscape. A few countries underscored the importance of inclusiveness and equity and called for greater technical support from WHO. On the contrary, in response to a WHO proposal to develop a complementary self-assessment tool to measure the maturity of the clinical trial ecosystem at national and international levels, the United States and United Kingdom instead urged the WHO secretariat to keep its focus limited to the scope of the actual resolution until more progress is achieved. The WHO is now set to move forward with a process to develop draft guidelines for clinical trials, with the help of experts and member states, that is expected to be in place by WHA. 4. Universal health coverage (UHC) reemerges as a priority from COVID-19 slumber. In 2019, UHC was the “it” topic of global health. It featured prominently on the agenda of WHO meetings and the UN held a high-level meeting on the subject to advance a new framework to achieve the Sustainable Development Goals. Then came the pandemic, and focus and attention on the topic slipped. This year, UHC is back on the map, having featured heavily at this year's EB.  During the broader discussion on UHC, WHO member states highlighted the importance of primary health care and health system strengthening, as well as considered and ultimately passed a resolution on strengthening diagnostics capacity. The resolution urges member states to address a range of diagnostic issues, including increasing local production, streamlining regulatory approaches, and addressing access barriers. It also calls for greater investment in diagnostic R&D and more systemic funding of capacity-building infrastructure for diagnostics, as well as urges WHO to enact specific technical changes to facilitate and catalyze diagnostic development.  The next couple of months will continue to deliver multilateral developments at a breakneck pace, and given the interlinkages between the many multilateral processes underway, it will be vital for advocates to understand the full landscape of possible changes to the global health architecture. While the dynamics may be shifting, it is encouraging to see that the research agenda is present throughout these different dialogues, both in Geneva and beyond. 

The annual opening of the United Nations General Assembly (UNGA) is always a key moment on the diplomatic calendar. For the first time since the COVID-19 pandemic began, UNGA was held in person. This provided opportunities to renew relationships, forge new partnerships, and debate in-depth in ways that are difficult in the Zoom world. And while many want to say that the pandemic is behind us, as President Joe Biden pronounced on his recent 60 Minutes appearance, COVID-19 and the possibility of future health threats still loomed large during the first half of UNGA discussions.Concurrently, leaders gathered for the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and to contend with the erosion of progress in other global health areas as a result of resources being diverted to COVID-19. Chief among the backslides are three of the world’s leading infectious killers: HIV, tuberculosis, and malaria, which all suffered setbacks during the pandemic with a reduction in access to testing and treatment coupled with a troubling rise in cases. If that were not enough, the rising threat of antimicrobial resistance was also top of mind for many leaders.Below are some of the key highlights from the first half of UNGA.Major focus on pandemic preparedness and global health architectureWhile some major speeches at UNGA, such as those by German Chancellor Olaf Scholz or US President Joe Biden, barely acknowledged the pandemic, plenty of events and meetings throughout the the first half of UNGA highlighted a sustained and strong focus on current and future health crises.Underscoring the need for a robust discussion on reforms to global political structures and recommendations put forth over the last two years by the Independent Panel for Pandemic Preparedness and Response and the Global Preparedness Monitoring Board, the UNGA overwhelmingly adopted a resolution to hold a high-level meeting at the heads-of-state- and government-level on pandemic preparedness and response no later than the 78th session of UNGA in September 2023. The agreement—co-sponsored by more than 100 countries—instructs the next General Assembly's president to organize the meeting in collaboration with the World Health Organization (WHO) and to “adopt a succinct political declaration aimed at, inter alia, mobilizing political will at the national, regional and international levels for pandemic prevention, preparedness and response.”Discussions were also centered on the future of the Access to COVID-19 Tools Accelerator. Civil society and other global health stakeholders questioned whether Accelerator is winding down, but stakeholders like WHO Special Envoy Dr. Ayoade Alakija assured the community that the framework is simply moving into a new phase. Questions remain on what the initiative will look like post-COVID-19, yet it is clear that there is a desire to retain some of the coordination functions of the framework, even as advocates continue to highlight the stark inequities and the sometimes-mismatched priorities that the framework created, highlighted by the lack of focus and resources for testing in LMICs.Bolstering local manufacturing capacity The COVID-19 pandemic laid bare what stakeholders across the Global South have long known: severe shortages in lifesaving medical products result when low-income countries are left to rely on the Global North and Asia as primary suppliers. The lack of local manufacturing capacity has been a driver of extreme global disparities in access to lifesaving COVID-19 vaccines, diagnostics, drugs, and devices. More than two years into the pandemic, it has become increasingly clear that strengthening health security in low- and middle-income countries (LMICs) will require long-term investments to fortify local capacity.This realization was echoed throughout discussions. Multiple stakeholders and events focused on the need to bolster manufacturing capacity in LMICs. PATH, in partnership with Foreign Policy, explored the investments, partnerships, and models that can inform a strategy for fostering a sustainable African manufacturing industry and distribution networks across the continent, addressing chronic inequities, and strengthening regional health security. At the Clinton Global Initiative, PATH committed to partnering with the African Union to develop principles for drug, vaccine, and diagnostic manufacturing on the African continent. We also witnessed firsthand commitments being made to strengthen this capacity, including by the Distributed Vaccine Manufacturing Collaborative. The Collaborative is co-chaired by Dr. Richard Hatchett from the Coalition for Epidemic Preparedness Innovations and Dr. Victor Dzau from the US National Academy of Medicine in partnership with the World Trade Organization; Gavi; WHO; the Wellcome Trust; Africa Centres for Disease Control and Prevention; the Oswaldo Cruz Foundation, or Fiocruz; and various governments and industry partners. The goal of the Collaborative is to increase vaccine access in LMICs through the establishment of a versatile global vaccine manufacturing network capable of producing vaccines during pandemic and non-pandemic times. Sustainable financing for pandemic preparedness Another focal point of the first half of UNGA was the need for incremental and sustained financing. While the elephant in the room was clearly the Global Fund replenishment, which raised a record-breaking US$14.25 billion, despite falling short of the ultimate target of $18 billion, broader conversations on financing for pandemic preparedness also attracted plenty of attention. COVID-19 has highlighted that the world has consistently underinvested in preparedness and specifically in the frontline health workforce, resilient supply chains, and research and development for new countermeasures including novel vaccines, therapeutics, and other platforms and technologies that can be deployed during a pandemic.Many dialogues prioritized equity, and the idea that regardless of location or income level, all people must be able to access the science, tools, and resources they need to both better prepare for and respond to health crises. Cross-sector leaders, including the World Trade Organization Director-General Ngozi Okonjo-Iweala, came together for a frank conversation about pandemic preparedness, prevention, and response financing needs, and how we can sustainably mobilize resources for the full range of needs.Much of the attention and debate zeroed in on the newly created financial intermediary fund. This fund is meant to provide a dedicated stream of additional, long-term financing to strengthen pandemic prevention, preparedness, and response capabilities and address critical gaps in LMICs through investments and technical support at the national, regional, and global levels. Yet at UNGA, with the backdrop of the recent disparities in the COVID-19 response still fresh, conversations swirled around how the Fund would ensure a broad set of voices were represented, its ability to achieve its full scope given limited catalytic funding, and how it connects to the broader health security architecture.  This year’s formal UNGA agenda did not feature health as prominently as in the past, perhaps a signal that the outsized attention our community has received due to COVID-19 is waning, as concerns about climate change, a global food crisis, and ongoing global conflicts rise on the list of the world’s most pressing challenges. In the coming months, advocates must pivot to ensure that pandemic needs are not forgotten, and that we start to build the fit-for-purpose architecture of the future, while also recommitting to non-COVID-19 health priorities and addressing the backslides we have seen since the onset of the pandemic.

President Joe Biden has made clear that addressing climate change is a top priority for his administration. Since January, the president has issued executive actions in pursuit of tackling the climate crisis; opened a new federal office for climate change, health, and equity; and convened two meetings of the Major Economies Forum on Energy and Climate, one of which was part of a larger leaders summit intended to rally world leaders to strengthen climate ambition in the lead-up to the 26th United Nations Climate Change Conference of the Parties (COP26) in early November, during which countries hope to negotiate shared climate commitments.Amid these ongoing and vital conversations, GHTC is taking stock of how global health and climate are intertwined and how innovation can address these twin issues and mitigate the impact of climate change on human health. As the Unites States prepares to engage in COP26, we hope to see continued commitments and concrete actions to combat the climate crisis, including climate-related global health challenges.Climate-related global health risksClimate and global health are inextricably linked: Climate change could put billions more people worldwide at risk of vector-borne and zoonotic diseases like malaria and dengue. Changing temperatures have been described as a “threat multiplier” of antimicrobial resistance, due to warm conditions being more favorable for bacterial reproduction. The climate crisis exacerbates food instability and malnutrition as a result of droughts and other extreme weather events—circumstances which also prove opportune for disease outbreaks. The threat of a “Disease X” outbreak occurring, and spreading globally, is greater than ever before due to deforestation and other climate-related risk factors.These risks will not be felt equally around the world. Children are among the most vulnerable—and will be exposed for the longest—to health risks resulting from climate change, given their physical and cognitive immaturity. Health effects are also expected to be worse for people who are older, have preexisting medical conditions, or are living in poverty or in low- and middle-income countries. These populations are less able to insulate themselves through technology, housing, social networks, health services, and other infrastructure. Food insecurity is likely to particularly affect Indigenous communities, many of which rely on local food sources, such as fish. Women and girls, too, are often underprioritized in responses to climate-induced disasters, which can inhibit their agency and access to sexual and reproductive health services, from contraception to HIV prevention and treatment.Existing efforts by US agenciesThe US government is beginning to recognize and take on the interconnected fight against climate change and global health crises through programs at the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and US Agency for International Development (USAID).For example, CDC’s Climate and Health Program assists states, cities, territories, and tribes in the United States with protecting human health from a changing climate by providing data, tools, and technical guidance to reduce vulnerability and increase resilience.NIH has launched a Working Group on Climate Change and Health aimed at addressing climate change and its health effects through research and innovation, and its National Institute of Environmental Health Services Climate Change and Human Health Program funds research aimed at understanding the health effects of climate change.USAID conducts a breadth of climate-related work, playing a crucial role in mitigating climate change and supporting resilience against its global impact—including by strengthening resilient food systems. USAID-supported programs have worked to develop and distribute disease-, heat-, and drought-tolerant seeds as well as nutrient-dense foods. For example, to support response to climate change–induced droughts and dry climates, USAID has invested in a public-private partnership to develop a variety of drought-tolerant maize, which was used by 6 million farmers in 2016 when the El Niño drought hit Southern and Eastern Africa.Looking ahead: What more should the US government do?In line with its expressed priorities, the US administration should continue to sustain and expand investment in climate change innovation—embracing a comprehensive agenda that recognizes the need to not only directly improve climate health, but also mitigate its impact on human health. While US health agencies have demonstrated some capacity to take on climate action for health, there is much more to be done.US agencies addressing climate change should consistently consider its ripple effect on global health and integrate a broad range of health-related climate innovation into their work—for instance, through emerging infectious disease surveillance, health and environmental systems capacity strengthening, or research to further understand both threats and the ways they interact.We will never achieve global health goals without also protecting our environment, and we won’t succeed in preventing the climate crisis’s worst impacts without bolstering investments in global health. GHTC looks forward to seeing continued commitment and global leadership from the US government to advance innovation to address these deeply intertwined challenges.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email.  According to a report by the AMR Industry Alliance, a private sector coalition, there is a “concerning shortfall” in investment in late-stage research and development (R&D) to battle antimicrobial resistance (AMR). Though in 2018 the Alliance’s members invested US$1.6 billion in R&D for antibiotics, vaccines, and disease diagnostics needed to tackle AMR,—a figure which dropped by one-third between 2016 and 2018—the report cited this investment as likely insufficient to deliver the tools needed to address growing AMR. It also cited a lack of access to quality and responsibly manufactured antibiotics as a significant challenge in low- and middle-income countries. The report calls on the public sector to provide greater R&D investment, particularly for later-stage research, and advance policy solutions like incentives to spur greater R&D investment and improve access. According to the United Nations, AMR is estimated to result in 700,000 deaths annually, a figure that is forecast to increase to 10 million by 2050. German researchers have developed the first diagnostic test for a new coronavirus that has emerged in central China. The virus was first detected in the city of Wuhan last year and has since sickened dozens of people with recent cases reported in Japan and Thailand. The diagnostic test developed at the Institute for Virology at Berlin’s Charite hospital will allow labs to reliably diagnose the new coronavirus “in a very short period of time,” according to its developers. The test protocol is being made available by the World Health Organization (WHO), and laboratories will be able to order a molecule from the German team to compare patient samples with a positive control. Until now, doctors have only been able to perform a general virus test and then had to sequence and interpret the genome—a difficult task for smaller labs, for facilities in countries where it’s not easy to transport samples or staff aren’t trained thoroughly, or those handling a large number of patients who need to be tested. Last week, WHO published its list of urgent global health challenges facing the next decade, which included climate change, infectious diseases, anti-vaxxers, and AMR, among other challenges. The list was developed with input from experts around the world and “reflects a deep concern that leaders are not investing enough resources in core health priorities & systems, putting lives & economies in jeopardy," according to a tweet by WHO Director-General Dr. Tedros Adhanom Ghebreyesus. Last year, WHO published a list of ten global health threats for the year 2019 which also included climate change, AMR, weak primary health care, and vaccine hesitancy. WHO noted that these challenges demand a response from the health sector, governments, communities, and international organizations.