2O23: WHO General’s States at the 76th World Health Assembly

By Ayomide Otitoju

But at the same time, many of us continue to carry grief in our hearts – grief over those we have lost, grief at the terrible toll the pandemic has taken on families, communities, societies and economies, and grief that it didn’t need to be this way. 

As you know, just under three weeks ago I declared an end to COVID-19 as a public health emergency of international concern. It’s encouraging to see life return to normal – to be able to hug a friend, to travel freely, and to meet together. We have been hostages of this virus for some time, so as I said, it’s a relief. 

In particular, the pandemic has taken a heavy toll on mental health, including on many of our own staff, who like so many health workers around the world, have experienced severe stress and burnout. 

The pandemic has confronted us with unprecedented challenges. 

Throughout the pandemic, your WHO has mobilized global expertise to provide technical and logistical tools to support you in your efforts to save lives. 

And through the ACT Accelerator, WHO and our partners delivered nearly two billion doses of COVID-19 vaccine, as well as tests, therapeutics, oxygen, PPE, and other medical supplies. 

The end of COVID-19 as a global health emergency is not the end of COVID-19 as a global health threat. 

Earlier this month, the Secretariat published the fourth edition of the Global Strategic Preparedness and Response Plan for COVID-19, which outlines critical actions for countries in five core areas. 

The threat of another variant emerging that causes new surges of disease and death remains. 

And the threat of another pathogen emerging with even deadlier potential remains. 

And pandemics are far from the only threat we face. In a world of overlapping and converging crises, an effective architecture for health emergency preparedness and response must address emergencies of all kinds. 

This year’s High-Level Meeting on Pandemic Preparedness and Response is a valuable opportunity for leaders to chart a clear path forward towards that future. When the next pandemic comes knocking – and it will – we must be ready to answer decisively, collectively and equitably. 

The COVID-19 pandemic has had significant implications for the health-related targets in the Sustainable Development Goals, and each of the “triple billion” targets. 

More than 1 billion more people are now enjoying better health and well-being since 2018, but progress is insufficient to reach the related targets of the Sustainable Development Goals by 2030. 

On universal health coverage, we have made progress and closed gaps, and since 2018, 477 million more people are enjoying the benefits of universal health coverage. 

But on current trends, fewer than half the world’s population will be covered by the end of the SDG era in 2030, meaning we must at least double the pace. 

And on emergencies, the COVID-19 pandemic has shown that it’s not 1 billion people but 8 billion people who need to be better protected. 

The pandemic has blown us off course, but it has shown us why the SDGs must remain our north star, and why we must pursue them with the same urgency and determination with which we countered the pandemic.  

It’s impossible to do justice to the huge range of accomplishments in 2022, but the Results Report highlights key achievements that are symbolic of our work in all its diversity. 

I would like to highlight a few, according to each of the “five Ps” that I outlined at last year’s Health Assembly: promoting, providing, protecting, powering and performing for health. 

The first set of highlights relate to the first P, promoting health, by preventing disease and addressing its root causes. 

One of the key ways countries are doing that is through the use of health taxes in the fight against no communicable diseases. 

Between 2017 and 2022, 133 Member States increased or introduced a new health tax on products that harm health, including tobacco and sugary drinks. 

For example, with advocacy and technical support from WHO, Timor Leste last year increased its tax on tobacco from US$19 a kilogram to US$50 a kilogram, and already this year has increased it again to US$100 a kilogram – one of the largest tobacco tax increases achieved anywhere. 

Elsewhere, Mauritius and Finland introduced plain packaging, Oman will do so this year, and Tunisia increased health warnings to 70% of the front and back of tobacco packaging. 

Sierra Leone introduced some of the toughest tobacco controls in the world, Ukraine expanded its smoke free laws to ban the use of e-cigarettes and heated tobacco products in public places, and Kazakhstan introduced a new tax policy on heated tobacco products. 

We also see encouraging progress in eliminating industrially-produced trans fat from the global food supply. 

Since we launched our REPLACE initiative in 2018, we have seen a six-fold increase in the number of people protected by WHO-recommended policies on the use of industrially produced trans-fat, from 550 million people to more than 3.7 billion. 

Just in the past six months, Bangladesh and Nigeria and the United Arab Emirates have implemented trans fat policies, and Argentina, Egypt, Mexico, Paraguay, Philippines and Ukraine are all preparing to introduce their own policies in the next two years. 

Many countries have also made impressive progress in reducing salt intake, a leading risk factor for cardiovascular disease. 

For example, over the past 10 years, Sri Lanka has reduced average salt consumption per capita by almost 20%, with support from the WHO country office. 

On climate change, at COP-27 last year, we Launched the Alliance on Transformative Action on Climate Change and Health, which is supporting 65 countries to build climate resilient and climate-friendly health systems. 

For example, with support from WHO, Guinea has begun assessing emissions from its health sector and is developing a plan to reduce them. 

In addition to all of this work, we continue to support countries to build healthier populations by increasing physical activity, improving road safety, fostering healthy ageing, and so much more.

Now to the second set of highlights, which relate to the second P, providing health, by reorienting health systems towards primary health care as the foundation of universal health coverage. 

The High-Level Meeting on UHC at the UN General Assembly in 2019 was a historic commitment by world leaders to realise the vision of health for all. 

Little did we know then that COVID-19 was just around the corner. 

The Second High-Level Meeting on Universal Health Coverage at this year’s UN General Assembly is therefore a vital opportunity to refocus political attention and financial investments on accelerating progress. 

Strong primary health care is especially vital for delivering life-saving services for maternal and child health, including routine immunization. 

Between 2019 and 2021, an estimated 67 million children missed out on at least one essential vaccine, including 48 million children who missed out entirely. 

In response, WHO and our partners have launched “The Big Catch-up”, a global effort to increase vaccination levels in children to at least pre-pandemic levels by the end of this year, and to protect those who missed out. 

Despite the setbacks of the pandemic, many countries have continued to make progress in maternal and child health. 

DPR Korea, Indonesia, Maldives, Sri Lanka and Thailand have all achieved SDG targets in reducing neonatal mortality, under-five mortality, and the same five countries, plus Bhutan, also achieved the 2030 target on stillbirths. 

We are also proud to note the impressive progress countries have made in the promotion, protection and support of breastfeeding. 

In 2022, 48% of children below 6 months were exclusively breastfed, getting close to the target of 50% set by the World Health Assembly. 

And we continue to support research to improve care for pregnant women. Last year, WHO reviewed evidence from trials in 20 countries that showed for the first time that immediate skin-to-skin care, or kangaroo mother care, can save almost one third of children born preterm. 

And a WHO-led study showed that implementing a set of interventions at the same time, instead of consecutively, was able to reduce severe post-partum hemorrhage by 60 percent, and reduce the chance of death. 

The new WHO compendium – “Promoting the health of refugees and migrants: experiences from around the world” –  showcases dozens of country case examples from 44 Member States that demonstrate real progress in addressing the unmet health needs of refugees. 

Over the longer-term, it is a priority to mainstream care for refugees and migrants into broader national plans, supported by partnerships within countries and internationally. 

One of the most important investments in primary health care and universal health coverage is investments in health workers. 

Five years ago, WHO projected a shortfall of 18 million health workers globally by 2030. That projected shortfall has now reduced to 10 million, but the African and Eastern Mediterranean regions bear an increased share of the shortage. 

If we are to get anywhere near the SDG target of universal health coverage by 2030, we must close that gap, by supporting all countries to build the health workforce they need. 

This is not something that each country does on its own; it’s something countries must do together. 

We call on all countries to respect the Global Code of Practice on the International Recruitment of Health Personnel, and in particular to protect the 55 countries on the recently-updated Support and Safeguards list against international recruitment, which is draining those countries. 

We’re also working hard to support countries to deliver lifelong training to continuously improve health worker competencies and quality of care. 

Just last month we launched the Global 25 x 25 x25 Campaign, which aims to provide access to basic emergency care training for 25% of nurses and midwives from 25 countries by the end of 2025. 

And with the strong support of France, we continue to achieve key milestones on the establishment of the WHO Academy, with our new building scheduled to be completed in seven months, and the first release of learning programmes scheduled for later this year. This will have a significant contribution to building country capacity. 

One of the other most important elements of UHC is access to essential medical products, and 2022 saw the introduction and rollout of several important new tools. 

For tuberculosis, we launched new WHO guidelines recommending the first all-oral treatment regimens for multidrug-resistant TB, reducing treatment time from 18 months to 6 months. 

So far, 109 countries have started using these new regimens, based on WHO guidelines. 

But recognizing that we can only end TB with effective vaccines, earlier this year we also established a ministerial-level TB Vaccine Acceleration Council, to bring new vaccines to market as quickly as possible. If there is a will, there is a way. It was done for COVID; it can be done for TB. 

As we approach the high-level meeting on TB at this year’s UN General Assembly, we are asking leaders to commit to concrete targets over the next five years, on diagnosis, treatment, vaccine development, social protection, financing and research and innovation. 

Last year we also published new guidelines on the use of long-acting injectables for preventing HIV – a potential game-changer for those most at risk. 

So far, based on WHO guidelines, six countries have approved the use of long-acting injectables – Australia, Botswana, Malawi, South Africa, the United States and Zimbabwe – and approval is underway in another 12 countries, plus the European Union.  

And following WHO’s recommendation for widespread use of the RTS,S malaria vaccine in 2021, more than 1.5 million children have now received it in Ghana, Kenya and Malawi. 

Among those vaccinated, we see a 30% reduction in severe malaria, and a 10% drop in child deaths. We estimate that one death is prevented for every 200 children vaccinated. 

Put simply, this vaccine is changing the course of malaria, and as a malariologist, I’m really happy. 

At least 28 more countries in Africa are planning to introduce it, starting this year. 

A second vaccine is under review by WHO, and if recommended for use, could help to close the gap between demand and supply, and reduce costs – so more accessible than the one we have. 

As I said yesterday, vaccines are among the most powerful innovations in history. 

Vaccines have extinguished smallpox, pushed polio to near eradication, and tamed multiple other diseases. 

And vaccines are bringing the dream of eliminating cervical cancer within reach. 

Since WHO’s Call to Action to eliminate cervical cancer in 2018, nearly fifty more countries introduced the HPV vaccine into their national immunization programs, including 41 lower-middle income countries.  

We continue urging all countries to scale up services to meet the 90-70-90 targets by 2030. 

Even as we work to expand access to essential medicines and vaccines around the world, we are also continuing our work to protect precious medicines against the threat of antimicrobial resistance. 

For the first time, Ministers of Health and Ministers of Agriculture from around the world came together in Oman last year to agree on a target to reduce the use of antimicrobials in the agri-food system by 30% by 2030. 

Next year’s High-Level Meeting on AMR will be crucial for mobilizing political and financial commitment to meet those and other targets. I would like to use this opportunity to thank the Prime Minister of Barbados for her leadership of the Global Leaders Group, and also Deputy Prime Minister Chris Fearne of Malta. 

Finally, as I mentioned earlier, the pandemic has exposed the huge burden of mental health. 

The WHO Special Initiative for Mental Health has supported nine countries to increase access to mental health services for over 5.2 million people who previously were not able to access them. 

The third set of highlights relate to the third P, protecting health by strengthening the global architecture for health emergency preparedness and response. 

In addition to COVID-19 and mpox, last year WHO responded to 70 graded health emergencies from floods in Pakistan, to Ebola in Uganda, the war in Ukraine, cholera outbreaks in more than 30 countries and complex emergencies in the greater Horn of Africa, Northern Ethiopia and the Sahel. 

A crucial enabler of our response was the Contingency Fund for Emergencies, which was established following the West African Ebola outbreak in 2014 and 2015.                                            

Last year, the CFE released almost US$90 million in as little as 24 hours to support the rapid response to emergencies. 

Already this year we have allocated more than US$37 million to fund our response to the earthquakes in the Syrian Arab Republic and Türkiye, the conflict in Sudan and more. 

And our Dubai Logistics Hub in the United Arab Emirates processed almost 600 shipments to 90 countries, and I would like to use this opportunity to thank the UAE for its support, starting with His Highness the President. 

Last year we also launched the first consolidated WHO Global Health Emergency Appeal, and in January we launched this year’s appeal, for US$2.5 billion. 

Just as we continue to respond to emergencies around the world, so we are continuing to work with Member States and partners to strengthen the global architecture for health emergency preparedness and response. 

One of last year’s key achievements in this regard was the establishment in November of the Pandemic Fund at the World Bank, with technical leadership from WHO. 

The Fund has an initial budget of US$1.6 billion, and has already approved US$300 million for the first round of funding, to support catalytic and gap-filling financing for pandemic preparedness and response around the world. 

The Pandemic Fund is just one of many initiatives that WHO and Member States are undertaking to make our world safer against health emergencies: 

For enhanced accountability, the Universal Health and Preparedness Review; 

For enhanced surveillance, the WHO Hub for Pandemic and Epidemic Intelligence, and the newly-launched International Pathogen Surveillance Network; 

For an enhanced emergency response workforce, the Global Health Emergency Corps, launched just last night with my good friend Minister Lauterbach and Chris Elias from the Gates Foundation. 

For enhanced governance, amendments to the International Health Regulations; 

And for enhanced international cooperation, the pandemic accord – a generational commitment that we will not go back to the old cycle of panic and neglect that left our world vulnerable, but move forward with a shared commitment to meet shared threats with a shared response. 

That’s why we say the pandemic is a generational commitment: a commitment from this generation is important because this generation experienced how awful a small virus could be. The end of COVID-19 and mpox as public health emergencies of international concern means polio remains the only official global health emergency. 

After an all-time low of 5 wild poliovirus cases in 2021, we saw an increase last year, with 20 cases in Pakistan, two in Afghanistan and eight in Mozambique. 

So far this year, there have been three reported cases of wild polio virus, including one from Pakistan and two from Afghanistan just last week. 

WHO and our partners remain steadfastly committed to finishing the job of consigning polio to history. 

Last year, 3 million children previously inaccessible in Afghanistan received polio vaccines for the first time. And in October, donors pledged US$2.6 billion to support the push for eradication. 

At the same time, as part of the polio transition, more than 50 countries have integrated polio assets to support immunization, disease detection and emergency response. 

We must make sure that the significant investments in polio eradication do not die with polio, but are used to build the health systems to deliver the services that these communities so badly need. 

After all, we haven’t truly helped a child if we protect her from polio but she dies from measles. The fourth set of highlights relate to the fourth P, powering health, by harnessing the power of science, research, innovation, data, and partnerships to deliver impact. 

The mRNA Hub in South Africa is a perfect example, as part of our commitment to strengthen local production and enhance pandemic preparedness and response globally. 

I visited the mRNA Hub in 2021, shortly after it was created, and had the opportunity to return for the official launch just one month ago. The progress is remarkable. 

The Hub has now started transferring technology to manufacturers in 15 countries, supported by the biomanufacturing training hub in the Republic of Korea, which has trained 300 staff in low- and middle-income countries. 

The mRNA Technology Transfer Programme holds huge promise, not just for vaccines against COVID-19, but also for other diseases including HIV, tuberculosis, malaria and more. 

Central to our efforts to track progress towards the health-related SDGs is our work to strengthen health information systems in countries, to generate and analyse reliable data to inform the best health policies and programmes. 

One of last year’s key data products was our estimate of excess mortality from COVID-19. Based on consultations with Member States, and working with partners across the United Nations and scientists around the world, we estimated 14.9 million excess deaths in 2020 and 2021. 

Last year we completed the beta version of the World Health Data Hub, providing a single source for publishing health data – the first time in our history. 

And during this Assembly we will be launching DataDot, the public-facing portal of the World Health Data Hub.

The final set of highlights relates to the fifth P, performing for health, by building a stronger and sustainably financed WHO. 

Your decision last year to transform WHO’s financing model was a landmark towards strengthening and empowering WHO to fulfil its role as the leading and directing authority on global health. 

Thank you so much for that truly historic decision, which will bring a huge return to saving lives. 

In return, you asked the Secretariat to implement reforms on budgetary, programmatic, finance and governance processes, and accountability. 

Working with you, we developed the Secretariat Implementation Plan, with 96 actions, which the Executive Board endorsed in January. 

So far, we have implemented 42 actions, and 54 are ongoing, and I assure you of my commitment to be more aggressive in implementing the remaining actions. 

We are also continuing in our efforts to transform the way this organization prevents and responds to sexual misconduct, and to achieve gender equality. 

For the first time in WHO’s history, we have reached overall gender parity for staff across all appointment types and categories of positions. 

At the end of last year, we held a Global Management Meeting involving all our country representatives, Regional Directors and headquarters leadership. 

The main outcome was the establishment of an Action Results Group, led by country representatives, which has developed an ambitious 100-day plan with 100 actions, in seven critical areas, including a core country presence, delegation of authority, and adequate financial and human resources, including through mobility. 

To support these efforts, I have squeezed US$100 million from our budget to allocate to country offices. 

But in order to sustain this commitment, we look to Member States to approve the 20% increase in assessed contributions at this Health Assembly. Now, we ask you to honour your commitment to increase assessed contributions, to enable us to deliver the long-term predictable programming in countries that will deliver the results we all want to see. Many of my colleagues will be disappointed that I was not able to mention their area of work. 

The highlights I have given you, though extensive, barely scratch the surface of everything we have achieved across the world in the past year, or everything that we’re doing. Some of it attracts the attention of donors; and some of it doesn’t. 

But in so many ways and in so many places, your WHO is working to promote, provide, protect, power and perform for health – the five Ps. First, I urge every Member State to work with the Secretariat to identify concrete ways to pick up the pace of progress on the triple billion targets and health related SDGs. 

Second, I urge every Member State to engage constructively and urgently in negotiations on the pandemic accord and the International Health Regulations, so the world will never again have to face the devastation of a pandemic like COVID-19. 


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