World Health Assembly 2023: Moving forward with lessons from COVID-19

With the theme "Saving lives, driving health for all," the 76th World Health Assembly (WHA) held May 21-30, 2023, paid tribute to the past as it looked to make progress on health issues that have been overshadowed by the COVID-19 pandemic. The meeting in Geneva marked 75 years since the establishment of the World Health Organization (WHO) and the accomplishments the world has seen in that time, including the eradication of smallpox, a massive jump in life expectancy, and widespread access to vaccines.

But eyes were set firmly ahead, as the Assembly, WHO's decision-making body, took steps that contribute to the "triple billion targets" defined by WHO in 2019 with the goal of achieving universal health coverage, health emergencies protection, and better health for an additional one billion people by 2025.

“The end of COVID-19 as a global health emergency is not just the end of a bad dream from which we have woken. We cannot simply carry on as we did before," said WHO Director-General Dr. Tedros Adhanom Ghebreyesus in his opening remarks. "This is a moment to look behind us and remember the darkness of the tunnel, and then to look forward, and to move forward in the light of the many painful lessons it has taught us.

Over the course of the 10-day meeting, member states aimed to lay that path forward by adopting resolutions and making commitments on a sweeping range of issues, from pandemic prevention to polio, and universal health coverage to infection control.

To prepare for the next pandemic, leaders noted, we must be clear about our failings during the COVID pandemic. By the time WHO declared an end to the COVID-19 global health emergency in May 2023, the pandemic had claimed more than 7 million lives. This year's WHA was determined the world would not be caught off-guard again.

Dr. Tedros warned that the emergence of an even deadlier pathogen is an ever-present threat. “When the next pandemic comes knocking – and it will – we must be ready to answer decisively, collectively, and equitably,” he said.

With that aim, he called for urgent progress on the proposed new global pandemic accord. The accord is a legally binding set of rules on how the WHO's 194 member countries should prevent and respond to pandemics. Dr. Tedros also called on amendments to strengthen the International Health Regulations, adopted in 2005 in an effort to stop the spread of communicable diseases and guarantee an equitable response to public health emergencies.

The related issue of immunization was also in focus at the meeting, highlighted as a priority program for WHO and one that is vital to protecting communities against the next pandemic. Delegates discussed challenges around COVID-19 vaccine rollouts and stressed the role of frontline and community health workers in reaching zero-dose children, those who have not received a single dose of the diphtheria-tetanus-pertussis vaccine. In 2021, there were an estimated 18 million zero dose children. That number is thought to have increased by five million each year since 2019. Over the past three years, 67 million children around the world have missed at least one essential vaccine.

Member states also passed a resolution to strengthen diagnostic testing capacity, which will enable countries to focus on improving systems and resources to make sure everyone can get affordable testing whenever they need it. The resolution recognized that diagnostic data is key to preventing, tracking, diagnosing, managing, and treating a whole host of health conditions, including communicable and noncommunicable diseases, injuries and disabilities, pandemic prevention and preparedness, and antimicrobial resistance. It covers “in vitro” laboratory tests, such as rapid diagnostic tests and polymerase chain reaction, and “non in vitro” diagnostics, including imaging or blood pressure measurement devices, plus at-home tests.

The implementation of the resolution will build and expand on work that WHO has done and is doing to help countries improve access to diagnostic services, with a progress report expected in 2025. According to Médecins Sans Frontières/Doctors Without Borders, almost half of the global population currently has little or no access to testing.

The Assembly also pushed for progress on women's health. Delegates reiterated their commitment to the Global Strategy for Women’s, Children’s, and Adolescent Health, adopted in 2016 as an ambitious plan for ending all preventable maternal, child, and newborn deaths – including stillbirths – by 2030, while also improving overall health and well-being.

Discussions revolved around the Secretary-General's April 2023 report on the Strategy, which notes that some progress has been made, such as a drop in the global under-five mortality rate and in adolescent pregnancy. But women are being left behind. The report opens with the fact that the global maternal mortality rate has stagnated since 2016 at around 223 maternal deaths per 100,000 live births. Southeast Asia is the only WHO region that has recorded a significant decline in maternal mortality since 2016 – all the others have recorded either a stagnation or an increase.

Delegates also noted that levels of violence against women and girls are still "alarmingly high." An average of 736 million (almost one in three) women who were aged 15 years or older in the year 2018 have experienced physical and/or sexual violence by an intimate partner and/or sexual violence by a non-partner at least once in their lifetime.

The group stressed the need for an integrated approach to improving outcomes over the entire course of women and children's lives, including access to sexual and reproductive health services. They also called for more focus and investment in tackling the problem in the world's poorest and conflict-affected countries.

Member states further committed to doing more to end "hidden hunger" and decrease micronutrient deficiency around the world with the adoption of a resolution to fight the problem through food fortification.

Even in populations that have enough food to meet their energy needs – so, are not technically considered "hungry" – people's diets can be missing one or more micronutrients that are vital to good health. This "hidden hunger" – the lack of vitamins and minerals such as folate, iron, vitamin A, and zinc – affects half of all preschool aged children and 67% of all women of reproductive age worldwide. Micronutrient deficiencies can lead to spina bifida and other neural tube defects, blindness, fragile immune systems, premature birth, low birth weight, impaired brain development, and a slew of other health consequences.

The resolution points to large-scale food fortification as part of the solution. It urges member states to add essential vitamins and minerals to staple foods and condiments, such as wheat and maize flours, rice, cooking oil, and salt to correct current and prevent further micronutrient deficiency and notes the importance of improving financing and monitoring mechanisms for long-term success.

Other notable progress made at the WHA this year includes:

• Member states agreed on a resolution that supports preparations for the United Nations High-Level Meeting on universal health coverage in September 2023, which aims to ensure that all people have access to the full range of quality health services they need, when and where they need them, without causing financial pain. At the same time, delegates committed to expanding and strengthening primary health care access in their countries as a way to bring affordable health services to all.

• The WHA approved WHO's expanded list of "NCD Best Buys," interventions for combating noncommunicable diseases that are both effective and cost efficient. This list guides countries of every income level to identify and implement critical lifesaving policies to prevent and treat a group of diseases that last year overtook infectious diseases as the world's biggest killers. The list includes taxes and bans on advertising for tobacco and alcohol; policies to make food and drinks healthier for consumers; support for breastfeeding; asthma treatment; and early diagnosis and treatment of various types of cancer.

• Delegates recognized the unique opportunity to eradicate wild poliovirus, which is now only endemic in certain areas of Pakistan and Afghanistan, the smallest geographic footprint for the disease ever recorded. The Assembly said the key to achieving eradication is for countries to devote funding and political will to reaching the remaining un- or under-immunized children in the identified areas and minimizing the potential spread of the disease to polio-free areas.

• Looking ahead to the upcoming UN High-Level Meeting on Tuberculosis (TB) in September, delegates supported keeping up the political momentum to end TB by 2035 and discussed the challenges to reach that goal, including the increasing threat of antimicrobial resistance.

• The Assembly agreed on the first-ever global strategy on infection prevention and control (IPC) to reduce the risk of infections associated with healthcare, setting out three specific goals it wants the world to reach by 2030: prevent infection in health care, act to ensure IPC programs are in place and implemented, and coordinate IPC activities with other areas and sectors.

• The Africa Centres for Disease Control and Prevention (Africa CDC) and WHO launched a Joint Emergency Preparedness and Response Action Plan (JEAP) to help address the over 100 disease outbreaks that take place across Africa each year. The five-year collaboration aims to enhance the continent’s capacity to detect, monitor, and respond swiftly to health emergencies. This includes strengthening surveillance intelligence and genomic sequencing for quicker detection; stockpiling emergency supplies at newly established sub-regional hubs to improve emergency response operations; and deploying first responders within 24-48 hours of a disease outbreak.

In his closing remarks on Tuesday, Dr. Tedros returned to the idea that future progress owes a lot to the mistakes and successes of the past. "This is a generational opportunity that we must seize," he said. "We are the generation that lived through the COVID-19 pandemic, so we must be the generation that learns the lessons it taught us and makes the changes to keep future generations safer."