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The 75th World Health Assembly (WHA) concluded on Saturday after seven intense days of debate and decision-making. While the Assembly took key actions to shape the leadership and financial future of the World Health Organization (WHO) and to strengthen coordinated regionally distributed clinical research, efforts to advance immediate substantive reforms to the world’s health preparedness framework sputtered, laying the grounds for a prolonged policy process ahead to make the world better prepared for future health threats.Here are our top takeaways from this year’s Assembly:1. WHA adopts landmark decision on sustainable financingIn a move many had anticipated leading into this year’s Assembly, member states adopted a landmark decision to gradually increase their assessed contributions, or membership dues, to WHO to reach 50 percent of the organization’s base budget by 2030. Today, assessed contributions represent just 16 percent of WHO’s budget, with the remainder of its funding derived from voluntary contributions that are often earmarked and unpredictable—a situation that has challenged the agency’s ability to plan strategically and respond effectively during crises. This decision means WHO will eventually receive a boost of roughly $600 million a year of predictable funds to its base budget, which in the words of its director-general will empower the agency to meet “expectations and truly fulfill our mandate as the world’s leading global health authority.” 2. WHO Director-General Dr. Tedros is reelected for second termWHA followed the old adage “don’t change horses in midstream,” voting to reelect Dr. Tedros Adhanom Ghebreyesus to serve another five-year term as WHO director-general. The former Ethiopian minister of health and foreign affairs, who has helmed the agency since July 2017, received the Assembly’s overwhelming endorsement, running unopposed. WHO director-generals can be reappointed only once, so Dr. Tedros should hold the position until August 2027, at which point the Assembly will need to choose a new agency leader. Under his leadership, WHO reshuffled the agency’s organizational structure, creating the Science Division, and GHTC will closely watch what other strategic shifts the director-general will make in his second term that could have implications on research and development (R&D).3. WHA fails to adopt immediate substantive reforms to preparedness framework, but establishes long-term processIn the meatiest of agenda items at this year’s Assembly, member states considered approaches to strengthen WHO and the world’s preparedness for health emergencies, including via potential changes to the International Health Regulations (IHR)—the current legal framework governing how countries are expected to respond to health threats. While going into the Assembly, a WHO working group had recommended that this year WHA establish a longer-term process for amending the IHR, while also immediately considering any proposed IHR amendments that were already tabled—and the United States came ready with a series of proposed IHR amendments that among other items would change requirements around countries notifying WHO of incidents—in the end, the Assembly decided not to adopt any immediate substantive changes to the IHR. Instead, it set in motion a long-term process, tasking the WHO working group with driving a two-year consultation and reform negotiation with member states, with the intent of having amendments voted upon at the 77th WHA in May 2024. Additionally, WHA also passed a companion resolution that halved from two years to one the time period for countries to implement IHR amendments, meaning if amendments are adopted in May 2024, then should be in force by May 2025. A separate but related process for countries to negotiate a new potential pandemic accord or instrument was not formally part of this year’s agenda but will continue via an Intergovernmental Negotiating Body, which will meet again next month.4. WHA passes resolution on strengthening clinical trialsMember states passed an important resolution, introduced by the United Kingdom and Argentina, to strengthen clinical trial research. The resolution urges countries to introduce grant conditions to encourage the use of standardized data protocols and mandate registration of trials via a WHO trial platform or other registry meeting its international standards. It also encourages measures to improve reporting of results, including negative results; promote sharing of prepublication results with regulatory bodies for rapid decision-making during health emergencies; and strengthen global coordination and clinical trial capacity in low- and middle-income countries. While it calls on individual member states to actually adopt the above changes at a local and regional level, it also requests that WHO convene stakeholders and provide guidance to facilitate implementation of the resolution principles.5. WHO takes small steps on other health issuesWhile much of the energy in Geneva was focused on WHO financing, IHR reforms, and pandemic preparedness, each year the Assembly addresses a huge range of agenda items from drug and alcohol abuse to nutrition, to progress on individual diseases and health conditions, and more. This year was no different. In addition to the headline-grabbing news, WHA also took other smaller actions of note and important to health R&D. It extended into 2030 its global strategy and plan of action on public health, innovation and intellectual property, a framework particularly relevant in the wake of COVID-19 that is intended to promote innovation and improve access to health technologies. In addition, it also heard progress reports on the global strategy for tuberculosis research and innovation, the road map on neglected tropical diseases, and implementation of the Immunization Agenda 2030 to improve global immunization coverage—all areas that, as GHTC emphasized in statements going into the Assembly, require enhanced investment in R&D. Unfortunately, these items did not come up until late in the Assembly, highlighting their lower priority in this year’s forum.

The following statement—from Global Health Council, supported by the Global Health Technologies Coalition—was delivered at the 75th World Health Assembly on agenda items 14.5: Immunization Agenda 2030; 14.6 Infection prevention and control; and 14.7 Global road map on defeating meningitis by 2030.The COVID-19 pandemic has overwhelmed immunization infrastructure and workforce, impacted the global supply chain, increased the incidence of antimicrobial resistance (AMR), and derailed gains made in immunization campaigns around the world.We therefore call on WHO and member states to:Focus on the full spectrum of innovations that support immunization programs. Support implementation research and the development of formal feedback loops to monitor follow-up of recommendations made by groups such as the WHO Strategic Advisory Group of Experts on Immunization. Strengthen manufacturing capacities in low-and-middle-income countries.Invest in scaling up access to WASH in healthcare facilities as an essential part of infection prevention and control and combating AMR.

GHTC welcomes the G7 Health Ministers’ Communique, particularly the commitments leaders made to bolster the global health architecture and ensure that the world can respond to future pandemics in a more coordinated and equitable manner.The G7 expressed support for the proposal from the World Health Organization (WHO) Working Group on Sustainable Financing that would raise assessed contributions to WHO to 50 percent of its base budget by 2030–2031 to strengthen the organization’s global leadership role, something that GHTC and its partners have broadly supported.GHTC was encouraged to see that the communique also stresses the need to scale up local and regional research, development, and manufacturing capacities, along with more sustainable supply and distribution mechanisms to support faster, equitable global access to safe and effective medical countermeasures.Commitments were also made to tackle the silent pandemic of antimicrobial resistance (AMR)—including by exploring a range of market incentive options to encourage pharmaceutical companies and others to fund research and trials for new antibiotics. This included specific calls to support initiatives such as the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator, or CARB-X, and the Global Antibiotic Research and Development Partnership (GARDP). Furthermore, the G7 underlined the importance of closing GARDP’s funding gap to facilitate its “5 by 25” initiative for the delivery of five new treatments by 2025.Lastly, GHTC supports the new G7 framework, the Pact for Pandemic Readiness, which will see the United Kingdom, United States, Japan, Canada, France, Germany, and Italy coordinate more closely together—and with relevant multilateral organizations like WHO—by building upon the best of their COVID-19-inspired initiatives, including those on surveillance and rapid response.While it was encouraging to see such a strong consensus-driven agenda around global health security, it was disappointing to see that the communique makes no mention of several health priorities that have been neglected during the pandemic, including tuberculosis, malaria, HIV/AIDS, and neglected tropical diseases. It is vital that leaders continue to break down silos and ensure that investments to strengthen surveillance, laboratory, manufacturing, and clinical trial capacity for health security can be leveraged across disease areas. It was also disappointing to not see additional financial commitments made to support the launch of the financial intermediary fund or to bolster manufacturing hubs and laboratory infrastructure in low- and middle-income countries.Leaders must refocus their attention on a broader range of enduring and emerging health threats and make immediate long-term investments to put the world back on track to meet the sustainable development goals.

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. IAVI and Moderna are preparing to launch the first in-Africa trial for an mRNA HIV vaccine candidate, the organizations announced last week. The phase 1 vaccine trial will take place at the Center for Family Health Research in Kigali, Rwanda, and The Aurum Institute in Tembisa, South Africa. The vaccine candidate, mRNA-1644, uses Moderna’s mRNA technology to deliver a specific class of B cells needed to develop broadly neutralizing antibodies to fight HIV infection. mRNA technology could accelerate the development of a safe, effective, affordable, and durable HIV vaccine, according to IAVI, and the trial will build on progress in HIV vaccine research using the combination of Moderna's proven mRNA vaccine technology and a novel HIV vaccine approach developed by IAVI and Scripps Research, and draw on more than two decades of collaboration with scientific centers of excellence in sub-Saharan Africa, supported by the US Agency for International Development.A US Centers for Disease Control and Prevention (CDC) advisory panel on Thursday voted to recommend children between the age of 5 and 11 should be offered a third dose of the Pfizer-BioNTech COVID-19 vaccine at least five months after receiving their second dose. CDC Director Dr. Rochelle Walensky then endorsed the panel’s recommendation, which followed authorization by the Food and Drug Administration earlier that week. In making their decision, the CDC advisors reviewed data indicating a third dose increases the antibody response from the vaccine, which should protect recipients better, at least temporarily. CDC also now recommends those who are 12 and older and immunocompromised and all people over the age of 50 should receive a second booster, at least four months after their first dose.Clinical research in the United States faces a “critical shortcoming” when it comes to diversity, a new report from the National Academies of Science, Engineering, and Medicine stresses. While diversity has become an increasingly important priority, racial and ethnic minority populations continue to be left behind in research, leaving a large portion of the US population—and those that often face the greatest health challenges—less able to benefit from discoveries, because they are not adequately represented in clinical studies. Members of the LGBTQIA+ community, older adults, pregnant and lactating individuals, and people with disabilities are also among the populations frequently left out. The report offers recommendations to increase the inclusion of these groups in order to advance equitable research—described as a clinical trial population that matches the demographics of the disease being studied.