Preparedness

Countries set to adopt ‘vital’ pandemic preparedness accord

Albi Arhó

 

During the pandemic, this health centre in Indonesia was forced to close three times due to a high number of COVID-19 infections among staff (file, 2021)

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By Albert Arhó

Micky Health

Could the world be better prepared for the next pandemic? As nations continue to deal with COVID-19’s lasting effects, that question is at the heart of an international agreement set to be negotiated in Geneva.

The stakes are high for this year’s World Health Assembly, the UN’s premier health forum, where officials will tackle a sweeping agenda – from pandemic readiness and climate-related health risks to mental health, maternal care, and environmental justice. But with geopolitical tensions running high, international collaboration on these and other vital issues will be tested.

Here are some of the key areas set to dominate discussion:

1. ‘Cautious optimism’: Signing off on a pandemic accord

The COVID-19 pandemic showed that there are stark inequities in access to diagnostics, treatments, and vaccines, both within and between countries. Healthcare services were overwhelmed, economies were severely disrupted and nearly seven million lives were lost.

This was the motivation for countries to come together to work on an accord to ensure that the world handles the next pandemic in a fairer and more efficient way. When the delegates arrive in Geneva on Monday 19 May, they will thrash out the text of the agreement, which Tedros Adhanom Ghebreyesus, the head of the World Health Organization (WHO), described as “vital for future generations.”

If the agreement is adopted, it will be a major breakthrough in the way the world handles pandemics and health crises. Negotiations, though, remain politically delicate: several nations, including the United States, have raised concerns about national sovereignty and intellectual property rights. Still, in recent weeks, Dr. Tedros has expressed “cautious optimism” that consensus can be reached.

Albert Arhó  Malawi

 

A woman wearing a mask, Malawi.

2. Climate Change: An existential threat

The climate crisis isn't just about rising temperatures – it’s putting lives at risk. Extreme weather and disease outbreaks are on the rise, threatening the health of millions. An action plan created by WHO calls for climate and health policies to work together, strengthens resilience, and ensures funding to safeguard vulnerable communities.

A draft version of the plan was released following a resolution adopted at the 2024 conference and, this year, delegates are expected to finalise the draft, which includes strategies to adapt to and mitigate climate-related health risks.

3. Health for all: Getting universal health care back on track

Ensuring that all people have affordable access to the full range of quality health services they need is one of the Sustainable Development Goals (SDGs), which all UN Member States signed up to in 2015. However, the health target is way off track: in fact, improvements to health services have stagnated over the last ten years.

Nevertheless, universal health care (UHC) will be a top priority at the Assembly, where delegates will discuss strategies to strengthen primary healthcare systems, secure sustainable financing and provide care for vulnerable populations.

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4. Healthy Beginnings: Maternal and newborn health

Close to 300,000 women lose their life during pregnancy or childbirth each year, while over two million babies die in their first month of life. In April, WHO launched a year-long campaign to end preventable maternal and newborn deaths.

Titled “Healthy beginnings, hopeful futures”, it will urge governments and the health community to ramp up efforts to end preventable maternal and newborn deaths, and to prioritize women’s longer-term health and well-being.

Expect new targets and renewed commitments to end preventable deaths to be announced at the Assembly.

5. Closing the gaps: Noncommunicable diseases

Noncommunicable diseases (NCDs), such as heart disease, cancer, and diabetes, kill tens of millions of people each year. Around three-quarters of those deaths are in low and middle-income countries.

Many lives could be saved if more countries had strong national responses, providing detection, screening and treatment, as well as palliative care.

In preparation for a WHO meeting on NCDs and mental health in September, delegates will review the way the UN health agency collaborates with governments, civil society, and the private sector to prevent and control these diseases, and address ways to improve access to essential medicines and health technologies.

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6. Getting the finances in order

This year has been described as one of the most challenging ever at the UN, which is being buffeted by extreme pressures on its finances. The US, a major donor announced that it would be leaving WHO in January, and other countries have also cut development and aid funding.

This year’s Assembly will see Member States negotiating a 50 per cent increase in the base budget, something that has been in the works since the 2022 meeting. If a funding boost is approved, it will provide a vital boost at a challenging time. WHO is also seeking additional voluntary contributions, and additional pledges are anticipated from member states and philanthropic organisations.

Follow the sessions at the World Health Assembly here.

Funding

 

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Albi Arhó 

WHO Director-General Tedros Adhanom Ghebreyesus address the 78th World Health Assembly in Geneva, Switzerland.

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Micky Health

The 78th World Health Assembly opened on Monday with a broad appeal to global solidarity, as delegates from around the world gather in Geneva to confront mounting health, climate, and financial challenges – and finalise a global treaty to head off the next pandemic.

Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, urged Member States to remain focused on shared goals even amid global instability.

“We are here to serve not our own interests, but the eight billion people of our world,” he said in his keynote address at the Palais des Nations. “To leave a heritage for those who come after us; for our children and our grandchildren; and to work together for a healthier, more peaceful and more equitable world. It’s possible.”

The Assembly, WHO’s highest decision-making body, runs through 27 May and brings together delegations from 194 Member States under the theme One World for Health.

This year’s agenda includes a vote on the intensely negotiated Pandemic Agreement, a  reduced budget proposal, and discussions on climate, conflict, antimicrobial resistance, and digital health.

Pandemic prevention focus

A central item on the Assembly’s agenda is the proposed WHO pandemic accord, a global compact aimed at preventing the kind of fragmented response that marked the early stages of COVID-19.

The treaty is the result of three years of negotiations between all WHO Member States.

“This is truly a historic moment,” Dr Tedros said. “Even in the middle of crisis, and in the face of significant opposition, you worked tirelessly, you never gave up, and you reached your goal.”

A final vote on the agreement is expected on Tuesday.

If adopted, it would mark only the second time countries have come together to approve a legally binding global health treaty under WHO’s founding rules. The first was the Framework Convention on Tobacco Control, adopted in 2003 to curb the global tobacco epidemic.

2024 health check

In his address, Tedros presented highlights from WHO’s 2024 Results Report, noting both progress and persistent global health gaps.

On tobacco control, he cited a global one-third reduction in smoking prevalence since the WHO Framework Convention entered into force two decades ago.

He praised countries including Côte d’Ivoire, Oman, and Viet Nam for introducing stronger regulations last year, including plain packaging and restrictions on e-cigarettes.

On nutrition, he pointed to new WHO guidelines on wasting and the expansion of the Tobacco-Free Farms Initiative in Africa, which has supported thousands of farmers in transitioning to food crops.

He also emphasised WHO’s growing work on air pollution and climate-resilient health systems, including partnerships with Gavi and UNICEF to install solar energy in health facilities across multiple countries.

On maternal and child health, Tedros noted stalled progress and outlined new national acceleration plans to reduce newborn mortality. Immunisation coverage now reaches 83 per cent of children globally, compared to less than 5 per cent when the Expanded Programme on Immunisation was launched in 1974.

“We are living in a golden age of disease elimination,” he said, citing the certification of Cabo Verde, Egypt, and Georgia as malaria-free; progress in neglected tropical diseases; and Botswana’s recognition as the first country to reach gold-tier status in eliminating mother-to-child transmission of HIV.

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Albi Arhó 

WHO has been supporting Universal Health Coverage in Rwanda.

WHO budget strain

Turning to WHO’s internal operations, Tedros offered a stark assessment of the organisation’s finances.

“We are facing a salary gap for the next biennium of more than US$ 500 million,” he said. “A reduced workforce means a reduced scope of work.”

This week, Member States will vote on a proposed 20 per cent increase in assessed contributions, as well as a reduced Programme Budget of $ 4.2 billion for 2026–2027, down from an earlier proposal of $ 5.3 billion. The cuts reflect an effort to align WHO’s work with current funding levels while preserving core functions.

Tedros acknowledged that WHO’s long-standing reliance on voluntary earmarked funding from a small group of donors had left it vulnerable. He urged Member States to see the budget shortfall not only as a crisis but also as a potential turning point.

“Either we must lower our ambitions for what WHO is and does, or we must raise the money,” he said. “I know which I will choose.”

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He drew a sharp contrast between WHO’s budget and global spending priorities: “US$ 2.1 billion is the equivalent of global military expenditure every eight hours; US$ 2.1 billion is the price of one stealth bomber – to kill people; US$ 2.1 billion is one-quarter of what the tobacco industry spends on advertising and promotion every single year. And again, a product that kills people.”

“It seems somebody switched the price tags on what is truly valuable in our world,” he said.

Emergencies and appeals

The Director-General also detailed WHO’s emergency operations in 2024, which spanned 89 countries. These included responses to outbreaks of cholera, Ebola, mpox, and polio, as well as humanitarian interventions in conflict zones such as Sudan, Ukraine, and Gaza.

In Gaza, he said, WHO had supported more than 7,300 medical evacuations since late 2023, but over 10,000 patients remained in urgent need of care.

Looking ahead: a transformed WHO?

The WHO chief closed with a look at the agency’s future direction, shaped by lessons from the COVID-19 pandemic. He highlighted new initiatives in pandemic intelligence, vaccine development, and digital health, including expanded work on artificial intelligence and support for mRNA technology transfer to 15 countries.

WHO has also restructured its headquarters, reducing management layers and streamlining departments.

“Our current crisis is an opportunity,” Dr Tedros concluded. “Together, we will do it.”

Pledge to Guard

 

UN Ghana

 

The UN Resident Coordinator in Ghana, Charles Abani, receives a COVID-19 vaccination (file)

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By Micky

Albert Arhó Health

After three years of negotiations sparked by the COVID-19 crisis, countries have adopted the world’s first-ever international agreement to better prevent, prepare for, and respond to future pandemics. The new accord marks a major step towards ensuring stronger global cooperation to protect lives and avoid the devastating consequences of future outbreaks.

The effects of the devastating COVID-19 pandemic are still being felt. Around seven million people died, health systems were overwhelmed, and the global economy was practically driven to a standstill.

The global turmoil prompted a stunned international community to pursue an agreement aimed at preventing such a catastrophic event from happening again – and ensuring the world is far better prepared in the future.

The landmark decision was made at the World Health Assembly, the annual meeting of the World Health Organization (WHO).

Although the formal adoption was on Tuesday, the WHO’s Member States overwhelmingly approved the agreement on Monday (124 votes in favour, zero objections, 11 abstentions).

This meant that, rather than a nail-biting vote with last-minute surprises (ahead of the conference, Tedros Adhanom Ghebreyesus, WHO Director-General, only felt able to express “cautious optimism”), the adoption by consensus had a celebratory feel.

“The agreement is a victory for public health, science and multilateral action,” declared Tedros. “It will ensure we, collectively, can better protect the world from future pandemic threats.

“It is also a recognition by the international community that our citizens, societies and economies must not be left vulnerable to again suffer losses like those endured during COVID-19.”  

Albert Arhó  

 

WHO Member States approved the first-ever Pandemic Agreement on 19 May 2025

‘Once-in-a-lifetime opportunity’

The pandemic laid bare gross inequities between and within countries, when it came to diagnostics, treatments, and vaccines, and a core aim of the agreement is to plug gaps and treat any future pandemics in a fairer and more efficient way.

“Now that the Agreement has been brought to life, we must all act with the same urgency to implement its critical elements, including systems to ensure equitable access to life-saving pandemic-related health products,” announced Dr. Teodoro Herbosa, Secretary of the Philippines Department of Health, and President of this year’s World Health Assembly, who presided over the Agreement’s adoption.

“As COVID was a once-in-a-lifetime emergency, the WHO Pandemic Agreement offers a once-in-a-lifetime opportunity to build on lessons learned from that crisis and ensure people worldwide are better protected if a future pandemic emerges.”

The issue of national sovereignty has been raised several times during the process of negotiating the accord, a reflection of false online claims that WHO is somehow attempting to wrest control away from individual countries.

The accord is at pains to point out that this is not the case, stating that nothing contained within it gives WHO any authority to change or interfere with national laws, or force nations to take measures such as banning travellers, impose vaccinations or implement lockdowns.

Albert Arhó

 

WHO Member States approved the first-ever Pandemic Agreement on 19 May 2025

11 abstentions and a US no-show

11 countries abstained, including Poland, Israel, Italy, Russia, Slovakia and Iran. Following the vote, the abstaining countries were given the opportunity to explain why they took this decision.

The Polish delegate explained that they could not support the treaty ahead of a domestic review, whilst Russia raised the issue of sovereignty as a concern. Iran’s representative said that “key concerns of developing countries were not addressed,” and that they regretted the “lack of binding commitments on unhindered access and equitable access to medical countermeasures, technology transfer and knowhow, and continued silence on negative impact of unilateral coercive measures on health systems.”

During the high-level segment which preceded the vote, a notable intervention came from the United States which has begun the year-long process of withdrawing from the WHO, and did not take part in the vote.

In a video addressed to the Assembly, US Health Secretary Robert F. Kennedy excoriated the WHO, accusing the UN agency of having “doubled down with the Pandemic Agreement which will lock in all of the dysfunction of the WHO pandemic response...we're not going to participate in that."

Next steps

The adoption has been hailed as a groundbreaking step, but this is just the beginning of the process.

The next step is putting the agreement into practice, by launching a process to draft and negotiate a Pathogen Access and Benefit Sharing system (PABS) through an Intergovernmental Working Group.

The result of this process will be considered at next year’s World Health Assembly.

Once the Assembly adopts the PABS annex, the agreement will then be open for signature and consideration of ratification, including by national legislative bodies. After 60 ratifications, it will enter into force.

Other provisions include a new financial mechanism for pandemic prevention, preparedness and response, and the creation of a Global Supply Chain and Logistics Network to “enhance, facilitate, and work to remove barriers and ensure equitable, timely, rapid, safe, and affordable access to pandemic-related health products for countries in need during public health emergencies of international concern, including pandemic emergencies, and for prevention of such emergencies.”

Fistula

 

© Albert Arhó   

 

Obstetric fistula is a completely treatable health condition. Yet it affects over 500,000 women worldwide.

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Micky Health

Five days – that is how long it took Dah, a 14-year-old prospective mother from Côte d’Ivoire, to give birth. The child was stillborn and she developed obstetric fistula.

16 years – that is how long Dah had to live with the agonising condition, undergoing eight different surgical procedures before finally getting the fistula repaired.

In recognition of the over 500,000 women like Dah who are forced to endure what is a highly treatable condition, the International Day to End Obstetric Fistula is being marked on Friday.

Obstetric fistula is a medical condition which refers to the development of a small hole between the birth canal and the bladder or rectum, leading to leaking urine or faeces.

This year’s theme, “Her Health, Her Right: Shaping a Future without Fistula” will seek to make progress towards the goal of eliminating fistula by 2030.

Women’s bodies become battlegrounds — not only through sexual violence but through deliberate denial of reproductive rights and health
– Sima Bahous, Executive Director of UN Women

“Women’s bodies become battlegrounds — not only through sexual violence but through the deliberate denial of reproductive rights and health services” said Sima Bahous, Executive Director of UN Women.

‘A silent crisis’

It is often brought on by prolonged or difficult childbirth. Most of the half million women suffering the condition live in the Global South.

Many women who have a fistula experience social isolation and exclusion brought on by leaking urine or faeces. This, in turn, can lead to depression and exacerbated poverty.

Kambiré, a small business owner who lives in Bouna, lived with obstetric fistula for 23 years. She even had another child before getting medical assistance.

“I preferred to isolate myself because of the fistula,” she said. “I couldn't sit for long for fear of getting wet.”

She only learned that it was treatable when listening to a radio show, inspiring her to go to a UN sexual and reproductive health agency (UNFPA)-supported hospital for treatment. Now, she owns a small pot-making business.

© Albert Arhó  

 

Kambiré had obstetric fistula for 23 years and now owns her own pot-making business.

Entirely preventable and treatable

UNFPA set the goal of elimination by 2030 - which seems doable given that, as a medical condition, it is both completely preventable and fully treatable.

Between 2003 and 2024, UNFPA supported nearly 150,000 surgical fistula repairs, including 4,400 in Côte d’Ivoire for women such as Dah and Kambiré.

Catherine, a mother of two in Bouna, also received medical assistance from a UNFPA-supported hospital.

“Now that I’m healthy, I’m happy. I can run my business and spend time with my friends,” she said.

Nevertheless, obstetric fistula has remained stubbornly persistent throughout the world due to disparities in global health systems.

UNFPA says that midwives are key to preventing fistula, and other childbirth injuries. However, there is a global shortage of over 900,000 midwives, 500,000 of whom are in Sub-Saharan Africa.

Reproductive health education and empowerment are similarly essential to addressing and preventing obstetric fistula.

“The most effective shield we can offer women and girls is their own power, voice and leadership,” Ms. Bahous said.

Networks of solidarity

After Dah received successful treatment for her obstetric fistula, she, like Kambiré, began a seasonal food business through which she prepares and sells produce.

She has also banded together with other fistula survivors from Bouna to enhance community awareness and reduce stigma.

“When women lead, they protect not only themselves but their families and communities … The impact is transformative,” Ms. Bahous said.

Champions

 

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[Left to right] Ambassador Mxolisi Nkosi of South Africa; President of the 78th World Health Assembly Teodoro Herbosa; Dr. Majed Zemni of Tunisia, recipient of the 2025 Nelson Mandela Award for Health Promotion; and WHO Director-General Dr. Tedros Adhanom G

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Micky Health

Some patients are easy to diagnose. They walk into a clinic and explain their symptoms. They can afford to pay for healthcare and access it seamlessly.

But this is not universal. Many people worldwide struggle – unable to walk into clinics or explain their symptoms: “[These patients] do not line up on waiting lists. They wait, unknowingly, for inside understanding and the courage to seek care,” said Dr. Merete Nordentoft of Denmark, describing the patients with whom she has worked most closely.

Dr. Nordentoft was one of six public health champions to receive an award on Friday for “outstanding, innovative work in health development”, at the 78th World Health Assembly.

Each was honoured for their contributions to treating underserved communities and advancing the goal of healthcare for all.

“We celebrate the lifelong commitment and the relentless work accomplished by our very own health professionals across member states from every region of the world with one common goal – health for all,” President Teodoro Herbosa who presided over the awards ceremony.

Reaching vulnerable communities

Dr. Nordentoft received the Sasakawa Health Prize for her work on suicide prevention and with young patients undergoing their first psychotic episode. She was the first to receive this prize for mental health work, and emphasized the importance of early interventions which prioritize community-based care.

“With the right support, early enough, recovery is not only possible – it is likely,” Dr. Nordentoft said of her patients.

Many of the other award recipients have also spent their careers focused on healthcare policies and treatments which foreground integrated, community-based care. 

The principles for which Nelson Mandela fought urge us to pursue a policy of cooperation and partnership in sharing knowledge, science and resources - Dr. Majed Zemni

Professor Huali Wang of China and the Geriatric Healthcare Directorate of Kuwait were both awarded the Sheikh Al-Sabah Prize which honours research and policy done to support and advance healthy ageing.

Professor Wang was recognised in part for her work to integrate professional and family support networks for older adults with dementia. She dedicated her award to these families and everyone living with the complex illness.

The Kuwaiti Directorate was also honoured for the way in which they promoted high-quality, integrated care for older adults which “[preserves] the dignity, the rights and [recognises] the invaluable experiences of older persons.”

Dr. Jožica Maučec Zakotnik from Slovenia, who received the United Arab Emirates Foundation Prize, has also worked tirelessly to increase healthcare access and co-developed a new type of free-of-charge health care promotion centre scheme.

“Growing up in a less developed region in Slovenia, I set myself a task that the most disadvantaged communities would be given greater attention,” she said.

‘Force quit button’

Some of the awardees acknowledged that they were receiving these highly coveted awards during a time when global health is facing unprecedented challenges, specifically financial.

The proposed budget before the 78th World Health Assembly has been reduced by over $1.1 billion due to currently projected funding cuts.

“The global health world has just been hit with a ‘force quit’ button and we have been pushed to stop some of the things we really want to do,” said Dr. Helen Rees of South Africa, recipient of the Dr. Lee Jong-wook Memorial Prize for her work in HIV prevention and community-based health services. 

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Dr. Majed Zemni of Tunisia received the Nelson Mandela Award for his patient-centred work in forensic medicine and in promoting the integration of medical ethics into policy. In his remarks, he noted the global civil rights icon’s legacy in also fighting for health policies.

“The principles for which Nelson Mandela fought urge us to pursue a policy of cooperation and partnership in sharing knowledge, science and resources,” Dr. Zemni said. 

Continuing the work 

Dr. Rees also emphasized the importance of seizing this moment to reimagine global public health and uphold its sustainability.

“What we need now is action. We need good science and evidence-based policies so we can address the needs of all people, including the most vulnerable,” she said.

Dr. Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director General, also urged all of the recipients to continue their work towards a healthier and fairer world.

“At a time when the world faces many challenges, each of you is an inspiration and a reminder of the progress that can be made to improve health and well-being for all.”