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The World Health Organization (WHO) has faced tumultuous times over the past few years, and this year’s Executive Board (EB) meeting seemed to bring a chaotic new chapter. Major tectonic political shifts worldwide have plunged the global health organization into serious talks about its long-term funding, sustainability, scope, and ability to deliver on its core mandate.   The EB was anything but business as usual, though member states did their level best to address the political tensions du jour while trying to move through a regular agenda that spanned issues from noncommunicable diseases and maternal and child health to global health security and climate and health. Here are some reflections from a hectic week in Geneva: “We do expect things to change...”  - Assistant Director-General for Business Operations Raul Thomas1. Member states agree to reduce the WHO budget and mostly commit to a 20 percent increase in assessed contributions.In his opening remarks before the WHO EB, Director-General Dr. Tedros Adhanom Ghebreyesus noted that even before the United States and Argentina’s withdrawal announcements, WHO was planning to shrink spending because of a shortfall caused by economic difficulties in many donor countries.  WHO’s budgetary shortfalls overshadowed the first several sessions of the EB, with many member states expressing concern over the sustainability of WHO’s financing in the next biennial budget. Ultimately, a decision was made to lower the program budget to $4.9 billion (from $5.3 billion). Assistant Director-General for Business Operations Raul Thomas captured the general sentiment of EB funding conversations, conveying that WHO’s cash flow is secure for now, but WHO leadership “expects things to change” regarding the viability of the organization’s budget.   However, member states harped over what should change. Many supported a 20 percent increase in assessed contributions—something that members had agreed to at the World Health Assembly (WHA) two years ago—that would reduce the organization’s reliance on voluntary contributions from member states, while others, specifically Russia and China, showed opposition to this plan.   Several member states emphasized the importance of continuing down a path toward sustainable financing through the WHO investment round and developing alternative short- and long-term resource mobilization plans. Member states also urged WHO to distribute information about what the 20 percent increase in assessed contributions would mean for each country. Given the reduced budget, countries insisted on costing all 2025 draft resolutions and decisions prior to any vote during this year’s session.   “It’s back to basics...” - WHO Regional Director for Europe Dr. Hans Kluge2. WHO leadership and member states stress progress and continued need for reform.In the wake of the larger discussions held during the EB about prioritization due to the cash crunch the WHO is facing, there was also a strong focus on the continued need to streamline and reform the organization. WHO Regional Director for Europe Dr. Hans Kluge called for the organization to go “back to basics.” Dr. Kluge emphasized the importance of remaining steadfast to WHO’s organizational mission while being adaptive to emerging threats like antimicrobial resistance (AMR).  Director-General Dr. Tedros also referenced WHO reforms in his opening remarks, acknowledging the significant improvements the organization has made over the last five years, including the newly introduced prequalification framework for novel products. At the same time, Dr. Tedros emphasized the need for continued reform and underscored the importance of engaging in constructive dialogue with member states moving forward.  During the final two days of the EB, member states agreed to several internal improvements and left the door open for further reform discussions at WHA. Citing concerns over its unclear mandate and overlap with other divisions, member states decided to extend by one year the operations of the Standing Committee on Health Emergency Prevention, Preparedness, and Response—which was first established in 2022 to provide guidance and recommendations to the EB and the Director-General on WHO’s emergency response—through May of next year to further evaluate the role of the committee and other similar bodies in health emergencies.  3. Global health security, maternal and child health, and the nexus of climate and health remain key topics.Member states did manage to untangle themselves from WHO’s structural dialogues to fully engage with the more than 47 agenda items on the docket this year.  WHO’s work in health emergencies featured prominently on the agenda once more, though much of the discussion centered around the need to adjust the scope of WHO’s activities. A few member states, including the European Union, Australia, Ethiopia, Finland, and the Republic of Korea, reaffirmed their commitment to the Pandemic Accord, including the then-upcoming negotiations that took place last week, as critical to advancing the prevention, preparedness, and response agenda, including access to medical countermeasures.Dozens of member states shared their appreciation of WHO’s report and draft action plan on women’s, children’s, and adolescents’ health and emphasized their commitment to advancing this agenda item, though Dr. Tedros highlighted that despite progress, “we still have a long way to go.” Equity and access were primary topics of concern for many countries. Several countries also advocated for greater urgency in accelerating efforts for maternal and child health and stressed the importance of intersectoral policies for vulnerable populations. Mentions of research and development were notably absent from the discussion, despite its critical role in addressing gaps in maternal, newborn, and child health, particularly in low-resource settings.  Countries also deliberated the draft global action plan on climate change and health. The plan, which includes some strong R&D provisions, outlines strategic frameworks for building climate-resilient health systems. However, it was surprising to note the absence of the threat of AMR, which is mentioned only once in the document. AMR is poised to cause 10 million annual deaths by 2050 and likely more with the growing influence of rising temperatures and evolving zoonotic diseases. Concerns over cost also dominated the discussion on this agenda item, and several member states, including Malaysia, Bangladesh, and representatives from the Africa Group, highlighted the need to include common but differentiated responsibilities—a longstanding equity principle in climate negotiations that holds historical emitters to a higher bar of responsibility for climate action.4. Civil society engagement continues to be a challenge at the EB.At the tail end of the EB, member states zeroed in on the role of civil society in these debates. While there seemed to be general agreement on the overall usefulness of non-state actor (NSA) statements in WHO proceedings, we did see the continued trend of politicizing otherwise straightforward processes governing NSA access and status with WHO. Member states held a fervent debate over WHO’s Framework on Engagement with non-State Actors (FENSA), which outlines clear criteria and principles for attaining status with the WHO. During the debate, some member states questioned the framework, with representatives from the Eastern Mediterranean and African Regions, as well as China and Russia, all expressing concern over the Centre for Reproductive Rights and Women Deliver receiving status from WHO. The delegate from Egypt captured this sentiment best: “Our reading of FENSA is that it is the foundation and main criteria that we use to accept or reject NSAs — it’s the foundation, but it is not obligatory for member states to accept only on this criteria.”  While on the surface, this debate may appear like an outlier, it marks a broader shift in how some member states are approaching the global health agency, as it has become more commonplace in the last few years to overturn or question established frameworks, rules, and processes at WHO based on national politics. This is especially concerning for civil society, which has seen its ability to meaningfully engage in these forums curtailed over the years.Dr. Tedros concluded the EB by acknowledging the endurance of countries in getting through such a substantial agenda this year and the significance of WHA later this May. While we often talk about the importance of these forums for combatting specific health threats, this year feels like a bigger moment and pivot point for the global health architecture as a whole. Will WHO be able to shoulder the financial blow, make the necessary reforms, and find a way to become more sustainable in its operations? Or will the global health community look back at this moment as the start of the unraveling of the global health ecosystem? Only time will tell.

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. A prospective cohort study of patients with drug-resistant tuberculosis (TB) found that the six-month, all-oral BPaL (bedaquiline, pretomanid, and linezolid)-based regimens recommended by the World Health Organization were safe and highly effective, providing critical data from real-world settings with a high burden of drug-resistant TB to support global guidelines recommending their use. The results were comparable to previous Phase 3 clinical trials testing the regimens. Further research is needed to test the regimens among other key populations, including children and people with severe forms of extrapulmonary TB.A recently published analysis found that the 2023 global supply of seasonal influenza vaccines has been stable since 2019, suggesting that production capacity was sustained through the COVID-19 pandemic. Monitoring seasonal vaccine production capacity is important for estimating the capacity to manufacture vaccines in the case of an outbreak of pandemic influenza because pandemic influenza vaccines are produced primarily by the same or similar manufacturers, technology, and facilities as seasonal flu vaccines. The analysis found drastic disparities in production capacity between high-income and low- and middle-income countries and found that the majority of pandemic vaccines, in the case of a novel flu pandemic in the near future, would be egg-based. The author noted that advancing novel influenza vaccines, including mRNA vaccines, could greatly improve global production capacity and pandemic preparedness in the face of pandemic influenza, given they would be faster to produce than egg-based vaccines.A team of researchers has engineered an improved paper-based device for collecting and transporting blood samples of HIV patients. In low-resource settings with limited clinical and laboratory facilities, paper-based devices have become one way that HIV patients can collect their blood to be shipped and analyzed in distant laboratories. The new device has wax-printed patterns that create precise channels and collection spots, ensuring that it consistently collects the same volume of blood and thereby reducing the chances of inaccurate readings. A clinical pilot found that the device more accurately measured the extent of HIV infection compared to the industry gold standard and was also better at detecting drug-resistant viral mutations, enabling physicians to make better care decisions.

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. Last week, the Gates Foundation, the Novo Nordisk Foundation, and Wellcome announced the launch of the Gram-Negative Antibiotic Discovery Innovator, a new $50 million effort to boost the discovery of new antibiotics for gram-negative bacteria as the global threat of antimicrobial resistance continues to rise and there remains a lacking pipeline of novel antibiotics. The effort will function as a consortium, where multiple funders, research institutions, and industry partners share data and work collectively. Specifically, the project will focus on the discovery of direct-acting small-molecule antibiotics with broad-spectrum activity against Enterobacteriaceae, with Klebsiella species selected as the pathogen to be used in all proposed projects.An innovative, one-dose vaccine designed to offer high-level protection against malaria could transform global malaria efforts if proven effective in further studies. The Sanaria® PfSPZ-LARC2 Vaccine, designed by Sanaria and the Seattle Children’s Research Institute’s Center for Global Infectious Disease Research, uses advanced genetic engineering to delete two critical genes from the malaria parasite, ensuring that the parasite cannot advance to the blood stage and that the vaccine cannot cause or transmit disease. A pivotal study published last month demonstrated the remarkable potential of this approach, and clinical trials are scheduled for later this year.Last week, the Coalition for Epidemic Preparedness Innovations (CEPI) announced $5 million in funding to Ethris to support proof-of-concept research of spray-dried RNA vaccines that remain stable at room temperature and are suitable for mucosal delivery, an approach that could make these vaccines more accessible in low-resource settings and faster to roll out during outbreaks. The spray-drying technique is widely used for other health technologies and applying it to RNA vaccines helps minimize dependence on cold storage and complex delivery systems, especially in low-resource settings. Nasal delivery medicines are also well-established but used with RNA vaccines, this approach could also support their ability to remain stable and could help to offer mucosal immunity, which scientists believe can help reduce virus transmission.

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. A new study explores the novel use of artificial intelligence (AI) to screen for antimicrobial compound candidates that could be developed into new tuberculosis (TB) drug treatments, as the rise of drug-resistant strains of TB underscores the urgent need for new drug candidates. While discovering new TB drug candidates through traditional laboratory methods is laborious and time-consuming, sensitive machine learning is better and faster at helping interpret complicated images of the Mycobacterium tuberculosis bacterium, accelerating TB research capabilities and helping identify optimal candidate compounds for drug development.A COVID-19 nasal vaccine will enter a Phase 1 clinical trial conducted by the National Institute of Allergy and Infectious Diseases in the United States this spring. While COVID-19 cases have fallen dramatically since the height of the pandemic, the virus continues to circulate and cause severe illness and death. The nasal vaccine is designed to induce strong immunity in the nose and upper respiratory tract where the virus enters the body, aiming to not only reduce serious illness and death but also to stop transmission in the first place, which cannot be achieved through COVID-19 vaccines that are injected into the body. If proven successful, the technology could also be adopted for other common respiratory viruses, including seasonal influenza, avian flu, and respiratory syncytial virus.Uganda recently launched a trial of IAVI’s experimental vaccine targeting the Sudan virus, which causes Ebola disease, following the identification of an outbreak in the country that has, so far, killed one person and infected two others. There are no currently approved vaccines for Sudan virus, although there is a vaccine for the Zaire strain of Ebola, highlighting the urgent need to generate data about vaccine candidates in the pipeline when outbreaks arise. Ugandan health authorities and research teams have rapidly jumped into action to prepare for the trial—2,160 doses of the trial vaccine and treatments arrived in Uganda’s capital, Kampala, over the weekend.