144th session of the WHO’s Executive Board, January 2019. © Lucy Westerman / NCDA Alliance

Packed WHO Executive Board meeting sets next steps on NCDs, looks ahead to UHC HLM

11th February 2019

The 144th session of the WHO’s Executive Board (EB) took please from 24 January – 1 February 2019 with an exceptionally full agenda. The extended meeting of the Executive Board of WHO sought agreement on a wide range of issues to set the agenda for this year’s World Health Assembly (WHA72) in May. Many NCDA priorities were well reflected in the discussions between Member States. Here is our pick of most relevant discussions for NCDs.

Follow up to the UN HLM on prevention and control of NCDs

A Decision, co-sponsored by a large group of Member States, was adopted by the EB, setting a course to follow up on the political declaration of the High Level Meeting on NCDs agreed by Heads of State and Government during the UN General Assembly in September 2018. The Decision – proposed to WHA72 for adoption in May – would extend the period of the current WHO Global Action Plans on NCDs and Mental Health from 2020 to 2030, to align them with the SDG 2030 agenda.

It would also request the Director-General to propose updates to the appendices of both action plans, in consultation with Member States and stakeholders, in order to meet previously agreed targets to reduce NCDs by 2025 and 2030, and specifically to prepare a menu of effective policy interventions to promote mental health and wellbeing and reduce premature deaths from air pollution. The Decision would also require the WHO to report in 2020 on progress on the global strategy to reduce the harmful use of alcohol and outline a way forward.

The Decision requests guidance from WHO for Member States on health literacy, education programmes and social media. It asks for a report to the WHA in 2021 on positive examples of multisectoral action to tackle NCDs, including measures addressing social, economic and environmental determinants, and on best practices to tackle childhood malnutrition in all forms.

Importantly, the EB Decision requests the WHO to provide more technical support to Member States in integrating prevention and control of NCDs and promotion of mental health into primary care services and in improving NCD surveillance, as well as to make more human and financial resources available to meet increasing demand for technical support for national NCD responses. Member States have also requested the WHO to identify innovative funding mechanisms, such as a multi-donor trust fund.

In marked contrast to their regular calls to demonstrate that the WHO NCD reduction “Best Buys” are evidence-based, representatives from Italy and the US objected to an annex to the WHO’s report which presents a synthesis of evidence following implementation of taxes on sugar sweetened beverages in Mexico, Chile and in some US states and cities.

Decision on cervical cancer elimination strategy

The EB has requested the Director-General to draft a global strategy to accelerate cervical cancer elimination, for the period 2020-2030, for consideration at WHA73 in 2020. The EB notes the urgent need for action to scale up implementation of proven, cost-effective measures including HPV vaccination, screening and treatment of pre-cancer, early detection, prompt treatment, and palliative care, noting the need to develop strategies to mobilise resources.

Health, environment and climate change

The recognition at the NCD HLM of air pollution as a major NCD risk factor and the conclusions of the WHO’s First Global Conference on Air Pollution in October 2018 have fed into a draft WHO global strategy on health environment and climate change and a draft action plan on small island developing states in view of vulnerability to climate change and its health impacts. The drafts were widely welcomed by EB members and Member States. Concerns over the WHO’s remit however were voice by the US and Brazil.

The reports touch on other environmental determinants of health beyond air pollution, greenhouse gases and climate change, mentioning waste, plastics and chemicals. The draft strategy outlines targets for 2023, calls for a transformational approach with increased resources, and recommends routine implementation of health impact assessment in different policy areas to ensure policy coherence. The report also echoes calls, for example from recent Lancet commissions on food systems and the obesity-malnutrition-climate breakdown syndemic, to shift to more sustainable and healthy diets.

Access to medicines and vaccines, WHO report on cancer medicines

The Director-General presented two milestone reports intended to further the discussion around access to medicines and health products worldwide. The WHO presented a draft roadmap on access to medicines, vaccines and other health products for 2019-2023. The roadmap tackles various barriers to access, including lack of regulatory and health systems capacity, weak supply chains, shortages and affordability, and proposes some approaches.

The WHO Director-General asserted the WHO’s mandate to work on intellectual property issues, together with WTO and WIPO, in response to a challenge from the US. Italy (EB member) called for a resolution at WHA72. The draft is expected to be updated on the basis of many comments and questions raised during the EB, ahead of the WHA.

A second report focused on access to cancer drugs, and particularly issues posed by increasing prices worldwide. The report was requested by the Cancer Resolution adopted at the WHA in 2017 and reviews pricing trends and strategies observed in different regions. The report recommends various policy options for consideration at national and regional levels to improve accessibility and affordability. The majority of EB members and Member States from all regions welcomed the report, with many representatives focussing on price and cost transparency. The US raised objections to the methodology of the report’s preparation and some of the recommendations. The EB noted the report which will be further considered at WHA72 in May.

Preparation for UN HLM on Universal Health Coverage, September 2019

After intensive closed-door negotiations between Member States, agreement was reached on the final day of the EB meeting on a draft resolution preparing this year’s UN General Assembly High Level Meeting on UHC. The negotiations over the resolution, to be adopted at the WHA in May, offer a glimpse of likely sticking points for the political declaration on UHC.

Notably, the US disassociated from a paragraph on sexual and reproductive health. Compromise wording was reached mentioning use of TRIPS flexibilities, recalling the agreed language from the NCD HLM political declaration. The text includes a specific call to development cooperation partners to enhance their support to help countries achieve UHC and the health SDG more broadly.