EB 154: WHO rejects Thailand’s proposal on trade and health policy coherence to support universal health coverage and health security

The 154th session of the World Health Organization’s (WHO) Executive Board will take place from 22 January 2024 to 27 January 2024 in Geneva, Switzerland.

Rule 8 of the Rules of Procedure of the Executive Board of the World Health Organization dictate the following:

    The Director-General shall draw up a draft provisional agenda for each session of the Board, which shall be circulated to Member States and Associate Members within four weeks after the closure of its previous session.

    Any proposal for the inclusion on the agenda of any item under (c), (d) and (e) of Rule 9 shall reach the Director-General not later than 12 weeks after circulation of the draft provisional agenda or 10 weeks before commencement of the session, whichever is earlier.

    The provisional agenda of each session shall be drawn up by the Director-General in consultation with the Officers of the Board, on the basis of the draft provisional agenda and any proposals received under the second paragraph of this Rule.

    Where the Director-General and the Officers find it necessary to recommend the deferral or exclusion of proposals received under the second paragraph of this Rule, the provisional agenda shall contain an explanation for such recommendation.

    An annotated provisional agenda, together with any recommendations referred to in the fourth paragraph of this Rule shall be dispatched with the notice of convocation to be sent in accordance with Rule 5 or Rule 6, as the case may be.

Pursuant to Rule 8, WHO convened a meeting on 6 October 2023 between the WHO Director-General and the Officers of the Board. Participants included the Director-General (Tedros Adhanom Ghebreyesus), Dr Hanan Mohamed Al Kuwari (Qatar), Chair, Dr Sabin Nsanzimana (Rwanda), Vice-Chair and Dr Kerstin Vesna Petrič (Slovenia), Rapporteur.

Observers included:

Mr Andrej Vujkovac (Slovenia), First Secretary, Permanent Mission, Geneva
Dr Eiji Hinoshita (Japan), Assistant Minister for Global Health and Welfare, Ministry of Health, Labour and
Welfare
Dr Theophile Dushime (Rwanda), Chief Technical Advisor, Ministry of Health
Dr A.G. Guntie (Ethiopia), Regional Coordinator for the African Region
Mr A.R. Rubio (Mexico), Regional Coordinator for the Region of the Americas
Mr Sukpuck Barnett (Thailand), Regional Coordinator for the South-East Asia Region

The members of the Secretariat who participated included:

Dr Catharina Boehme, Chef de Cabinet
Dr Timothy Armstrong, Director, Department of Governing Bodies (GBS)
Mr Derek Walton, Legal Counsel
Dr Egle Granziera, Senior Legal Officer
Mr Jude Osei, Head of Unit, Protocol, GBS
Dr Carmen Savelli, Head of Unit a.i., Governance, GBS
Mrs Paidamoyo Takaenzana, External Relations Officer, Governance, GBS
Ms Diana Graf, Assistant to Director, GBS
Mr Nicolas Ashforth, Senior Editor, GBS
Ms Laurence Vercammen, Protocol Assistant, GBS

The purpose of this meeting was to “review the existing draft Provisional agenda of the 154th session of the Board, to be held in January 2024 together with proposals received for additional items, in order to prepare the Provisional agenda” in accordance with in accordance with Rule 8 of the Rules of Procedure of the Executive Board. The five page Note for the Record 2023 is a comprehensive record of this meeting; prior to Dr. Tedros’s tenure as Director-General, the WHO secretariat did not circulate Notes for the Record to the general public.

In terms of participation, the note for the record states that the “meeting was organized using a hybrid format, with some participants physically present in Geneva and
others attending virtually by means of video conference technology. The Vice-Chairs from Japan, Timor-Leste and Paraguay were unable to attend.”

The deadline for the submission of new agenda item requests was 20 September 2023; 20 proposals were received by the deadline.

In terms of the selection of proposed new itmes, the Chair, Dr Hanan Mohamed Al Kuwari (Qatar), reminded Officers of the template, requested by the Executive Board at its144th session, which invited the Officers to consider several elements, including whether the proposed items addressed a global public health issue, a new subject within the scope of WHO, or an issuerepresenting a significant public health burden.”

The Chair employed the following method of work:

8. The Chair proposed that, following their review, the Officers should decide between five options:
Option 1: accept the proposal as a new agenda item
Option 2: combine the proposed item with an existing item
Option 3: defer the proposed item to a later session
Option 4: refer the proposal to another governing body, such as the regional committees or the Programme, Budget and Administration Committee of the Executive Board
Option 5: exclude the proposal.

In relation to Thailand’s request on antimicrobial resistance, the officers of the Board decided that “the item proposed by the Government of the Kingdom of Thailand on behalf of a group of Member States – entitled “Antimicrobial Resistance: accelerating national and global responses” – should be accepted onto the provisional agenda of the 154th session of the Board in view of the fact that efforts in that area were lagging behind”.

However, in relation to Thailand’s request to an agenda item on “Trade and health policy coherence to support universal health coverage and health security”, the officers of the Board rejected the proposal noting that “the item proposed by the Government of the Kingdom of Thailand – entitled “Trade and health policy coherence to support universal health coverage and health security” – should be excluded as a broader mandate for action already existed through the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, the timeframe of which had been extended from 2022 to 2030 through resolution WHA75.14 (2022)”. Consequently, the GSPOA was used as a justification to reject Thailand’s proposal.

At the same time as the WHO Executive Board, the Prince Mahidol Award Conference (PMAC) will convene from 24 January 2024 to 27 January 2024; its theme is: Geopolitics, Human Security and Health Equity in an Era of Polycrisises. Perhaps the WHO’s rejection of the discussion of trade and health policy coherence to support universal health coverage and health security will be raised at the PMAC session entitled, “Can Geopolitics Help Health Systems and the World Prepare for Future Pandemics?”

Dr. Suerie Moon, Co-Director, Global Health Centre, Graduate Institute provided the following reaction.

That is a pity. Trade and health is about so much more than IP or health products. Trade rules have implications for tobacco control, growing consumption of unhealthy processed foods, potential brain drain linked to medical tourism, mental health effects from increased economic insecurity for displaced workers, one could go on and on. All of this has implications for WHO’s priorities regarding UHC, NCDs, mental health and health systems strengthening, which I hope would be a priority for the EB, and later, the WHA.

Finland’s proposal on “Economics and health for all” was accepted. The officers of the Board decided:

that the item proposed by the Government of the Republic of Finland on behalf of a group ofMember States – entitled “Economics and health for all” – should be accepted onto the provisional agenda of the 154th session of the Board as no specific mandate existed for action in that area and discussion by the governing bodies of this matter could open doors for greater cross-government involvement in health, with the Officers stressing the challenges to health financing in respect of current pandemics and the importance of WHO showing leadership on the matter;

The officer’s of the Board accepted the Chair’s porposal on universal health coverage. The officers of the Board decided:

that an item proposed by the Chair on universal health coverage should be accepted onto the provisional agenda of the 154th session of the Board as efforts to achieve SustainableDevelopment Goal target 3.8 (Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all) were not on track and there was currently no opportunity for Member States to have a broad discussion of universal health coverage; moreover, the subjects covered by certain proposals excluded from the agenda were linked to universal health coverage, meaning that any related draft resolutions could be tabled and therefore could also be raised under a dedicated item on that subject;