“Solidarity is not fairness”

The World Health Assembly draws all member states of World Health Organization to discuss health challenges, review actions, debate proposals and set future goals. It entrusts the secretariat to consult and engage with countries and other actors to coordinate vast areas of global health policy. This complex mechanism, some say, is now under threat. In this story, we will see why process matters and how it eventually impacts member states participation during the worst health emergency in a century.

In addition, concomitant developments this week, dominated global health agenda. This crowded out the Assembly. Events that unfolded outside of the multilateral governance framework are likely to have lasting ramifications on the future of global health governance.

This week, the Paris Peace Forum not only raised funds for the global pandemic response, it was significant in solidifying the roles of key donors of the ACT Accelerator and appeared to be a de facto declaration of formalizing this mechanism.

In addition, this week also saw the first steps towards the European Health Union which envisions among others, “declaration of an EU emergency situation”.  It problematically raises questions on the trust that WHO commands in the midst of the pandemic.  


The resumed session of the 73rd World Health Assembly is underway. Notwithstanding the virtual nature of the meeting, that has undoubtedly contributed to inadequate transparency and engagement, there are more fundamental issues at stake than merely the process of consultation.

Last month members of the Executive Board lamented the lack of a global multilateral mechanisms to guide the response to the pandemic. This was reiterated by Austria’s Clemens Martin Auer at a recent event. This week member states continued to push for the need for more multilateral engagement. But some observers point out, that without a specific framework for consultations, this is not useful.

To understand the significance of this assembly in the context of the flux of changes in global health, Geneva Health Files spoke to an experienced observer who has long worked with a range of countries on health matters. The expert chose to be anonymous.

“It not merely consulting member states, or informing countries about decisions on the response to the pandemic. But the secretariat has to essentially seek approval from member states on many of these matters,” a source who works closely with many health missions in Geneva said. Increasingly, there is insufficient time for more strategic thinking and preparation for key meetings, some countries are understood to have said.

In the context of the response to the pandemic, there is a perception that while they are being consulted to an extent, some of their questions and demands do not find representation in forums outside of WHO, including at Gavi’s vaccines initiatives for the pandemic – the COVAX facility, for example. A lot of the decisions are made outside of WHO and then it is a “fait accompli”, countries have to take it or leave it, the source said.

“Consultation with countries should go beyond moral rhetorical support”, the source said.

Given the prolonged nature of the pandemic, consultations on key issues have been inadequate. Countries have to be alerted on many matters, that they would otherwise have been involved with, if it were not for the crisis.

“The Assembly now risks being reduced to a ‘rubber-stamp’ simply endorsing whatever is brought to it. Ideally, countries must take charge and instruct WHO,” the source who did not wish to be named said.

Given the urgency of the pandemic, no country wishes to be seen as being too critical of WHO efforts, or risk being seen as too “obstructionist” and hence reserve their discomfort with the ACT Accelerator mechanisms. (To be sure, at the Assembly, a number of countries expressed support to ACT Accelerator mechanisms while pushing for more involvement in the decisions. Some say, many low and middle income countries have no choice. The ACT Accelerator was given a carte blanche but it has not yet delivered as per expectations, not the least because of acute financing shortfalls.)


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