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Ebola and reform weigh on WHO assembly

Congo's spreading Ebola outbreak, universal health coverage and questions about spending and reform topped the World Health Assembly's agenda.

GENEVA (AN) — Congo's spreading Ebola outbreak, universal health coverage and questions about spending and reform topped the World Health Assembly's agenda as its eight-day annual meeting got underway on Monday.

Delegates to the World Health Organization's decision-making body were being asked to strengthen the U.N. health agency's response to the outbreak, which has steadily worsened since an expert panel last month advised it did not rise to the level of an international public health emergency.

It is a sensitive topic for WHO, which came under fire for waiting to declare the 2014 Ebola outbreak was an international emergency until after almost 1,000 people died and it crossed borders.

The latest outbreak, announced in August of last year, is close to the borders of Rwanda and Uganda, and South Sudan is not much further away. With more than 1,650 confirmed cases including almost 1,060 deaths due to Ebola as of mid-May, Congo is experiencing the second-deadliest outbreak ever, behind only the West African outbreak from 2014 to 2016 that killed more than 11,300 people.

WHO’s Director General Tedros Adhanom Ghebreyesus said his agency was proud that the outbreak had not yet spread outside two of Congo's provinces, but the risk of that remained very high.

Fighting one of the world's most dangerous viruses, in one of the world's most dangerous places, makes for one of the most complex health emergencies the world ever faced, he said. So far, more than 120,000 people have received a vaccine that is at least 97% effective in preventing Ebola.

"But we are not just fighting a virus. We’re fighting insecurity. We’re fighting violence. We’re fighting misinformation. We’re fighting mistrust. And we’re fighting the politicization of an outbreak," he said in his opening remarks to the assembly, referring to the dozens of serious attacks by unidentified assailants on Congo health facilities that have badly disrupted WHO's operations.

"Unless we unite to end this outbreak, we run the very real risk that it will become more widespread, more expensive and more aggressive," said Tedros. "But of course, Ebola is not the only emergency to which we are responding. Last year, we also responded to the largest recorded cholera outbreak, in Yemen, diphtheria in [Bangladeshi refugee camp] Cox’s Bazar, the ongoing humanitarian crisis in Syria and many others that didn’t make the headlines."

Retooling for 'impact'

The assembly will be asked to approve the addition of video gaming addiction as a mental health disorder and other changes to WHO'S eleventh edition of its International Classification of Diseases.

It represents the first such update to the global manual in nearly three decades. The manual provides international standards for classifying diseases that are the basis of mortality and morbidity statistics. If approved, the changes to the manual would take effect at the start of 2022.

The assembly also is being asked to approve WHO's major restructuring plans that it announced in March to cut red tape and reduce longstanding tensions between headquarters and six field offices.

The plan includes creation of new divisions and positions, reshuffling some deputy director-generals and regional directors and a greater focus on improving life for the world’s 1 billion poorest people.

"There are five components to our transformation: A new strategy; new processes; a new operating model; a new culture; and a new approach to partnerships," Tedros told delegates. He emphasized, however, that the best strategy, management tools, processes and operating model will not deliver results without a healthy work culture and mindset, which is why WHO has new values statements.

"And our new approach to partnerships is helping us move from a risk-averse organization to one that manages risks. This is not just a slogan, it’s already changing," he said. Already, we are engaging much more proactively with civil society organizations and the private sector. But all of these changes are about one thing: impact."

Health spending

Just as the meeting opened, The Associated Press reported that WHO documents showed the agency spent nearly US$192 million on travel expenses last year, which was 4% less than in 2017, but still rife with apparent excessive practices and agency rule-breaking.

Asked about WHO’s travel expenses, U.S. Health and Human Services Secretary Alex Azar said  the United States did not have specific concerns but was “supportive” of Tedros' reform efforts.

In the United States, the newly Democrat-led U.S. House of Representatives this year has focused on the pharmaceutical industry and the high price of prescription drugs. Azar told the World Health Assembly that U.S. President Donald Trump's Republican administration favors cheaper prescription drug prices. Azar is a former executive with U.S. pharmaceutical firm Eli Lilly.

"A top priority of the American people, and therefore a top priority of mine, is the availability of affordable, safe, and effective medicines," he said in his speech. "It is my duty to ensure that American patients have access to cutting-edge cures, and we will protect innovation incentives just as vigorously as ever. But under President Trump, the United States will never be a bystander to abusive drug pricing practices."

As the Trump administration escalates its trade war with China, Azar pointedly told the assembly that Taiwan — which China’s government prevented from attending — should be able to participate.

"We regret that once again Taiwan was not invited to observe at this assembly as they were from 2009 to 2016," he said. "The 23 million people in Taiwan deserve a voice just as much as anyone else does."

Health care for all

Russia's Health Minister Veronika Skvortsova said her nation is aligned with a global push for ways to achieve universal health coverage, or UHC, and quality health care for all. "We're very pleased that today the entire international community is striving in this condition," she told the assembly.

"The health and well-being of all citizens should be a priority of the top leadership of each state," urged Skvortsova, "because without this basic resource it is impossible to achieve success in any of the spheres of the economy and social life, which means it is impossible to achieve any of the ambitious Sustainable Development Goals."

She was referring to the United Nations' 17 Sustainable Development Goals for 2030 that are aimed at ending poverty and building resilience. All 193 of the U.N.'s member nations and the global pharmaceutical industry’s trade group, International Federation of Pharmaceutical Manufacturers & Associations, or IFPMA, support establishing UHC worldwide as part of those goals.

Universal health coverage, or UHC, could sustain health care systems particularly in low to middle income nations. Some 50 million people worldwide deal with what WHO calls “catastrophic spending” on health costs due to user fees and other direct payments.

Half the world’s population lacks full coverage of essential health services, and 100 million people live in extreme poverty — getting by on less than US$2 a day — due to health care costs. About 12%, or 800 million people, spend at least 10% of household income on health care, WHO figures show.