“Returning to the status quo is not an option,” declared World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus in his closing remarks to the 73rd meeting of the World Health Assembly.
The event, as with many events, looked markedly different this year than it did in years past due to the COVID-19 pandemic. Following an initial de minimis (reduced) meeting between May 18th and 19th, the event resumed on November 9th and is scheduled to close tomorrow. The meeting is an annual affair. As the WHO explains
“The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget.”
The virtual format did not prevent meaningful work being undertaken, Tedros asserted. “Despite the challenges, this Assembly has been very productive,” he said. Among the initiatives taken up, Tedros highlighted “a comprehensive resolution on emergency preparedness; a new roadmap to defeat meningitis by 2030; a new roadmap for neglected tropical diseases; a resolution on scaled-up action on epilepsy and other neurological disorders; and you declared 2021 as the International Year of Health and Care Workers, who deserve our salute.
“Through a written silence procedure you have also adopted the Immunization Agenda 2030; the Global Strategy to Accelerate the Elimination of Cervical Cancer as a public health problem; the Global Strategy for TB Research and Innovation; the Decade of Healthy Ageing; the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property; and resolutions on eye care and food safety.”
Tedros added that “each of these represents an urgent health priority that affects the lives of millions of people, and which increases the demands on, and expectations of, WHO.”
However, celebration was far from the sole theme of Tedros’s remarks. “No country can say it was well-enough prepared for COVID-19, or that it has no lessons to learn,” he said. Going forward, he told member states, “returning to the status quo is not an option.”
In particular, Tedros highlighted to the World Health Assembly that “the COVID-19 pandemic has demonstrated the consequences of chronic under-investment in public health. This health crisis has ignited a socio-economic crisis that has impacted billions of lives and livelihoods and undermined global stability and solidarity…we don’t just need more investment in public health. We must also rethink how we value health.
“The time has come for a new narrative that sees health not as a cost, but an investment that is the foundation of productive, resilient and stable economies.”
For India, this message is apposite. Underinvestment in public health has long beleaguered the country’s health system and, consequently, its communities. Underspending by the Government has fuelled out-of-pocket expenditure on health, which accounts for the majority of India’s total healthcare spend. Budgets of years past have seen only marginal hikes in the Government’s investment in the healthcare sector. Privately-borne healthcare costs, meanwhile, have driven many families into poverty – especially as a result of the country’s rising burden of chronic diseases.
The Director-General’s remarks struck at the truth that is essential to know: that the COVID-19 pandemic has not so much created new issues, as exposed the fault lines that have been there all along. Heeding his message is the only way forward. A return to the status quo, as Tedros rightly said, is not an option.
As Professor Sarang Deo told me of India in an exclusive interview earlier this year, “even without COVID, there were glimmers of hope, where important entities in the country related to the health sector have been thinking in terms of systems. I was part of a few brainstorming sessions and planning sessions around development of a health systems platform consortium in the country. And there is movement.
“I mean, there is now the national National Health Authority, which is the agency that implements the Pradhan Mantri Jan Arogya Yojana (PMJAY). But I am a bit skeptical because everything is so sort of exceptional in this situation. So once you will address a crisis, it is possible that people fall back into old ways. This may be a controversial statement, but we’re not very good at learning lessons from big crises in India. I don’t think we start immediately thinking in terms of systems to prevent such things from happening in the future.
“I would be happy if that happened, but I’m skeptical about it.”