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Health leaders bow to conservative nations

Nations appeased conservatives with a new strategy for HIV, viral hepatitis and sexually transmitted infections that omits a glossary of sexual health terms.

World Health Assembly diplomats meeting in Geneva
World Health Assembly diplomats meeting in Geneva (AN/J. Heilprin)

GENEVA (AN) — After a marathon weeklong session, the World Health Assembly adopted a new strategy for HIV, viral hepatitis and sexually transmitted infections that appeases socially conservative nations by omitting a standard glossary of sexual health terms for discussing treatment and care.

Leaders at the global health talks also approved a U.S.-led process for reforming the legally binding international rules that nations must follow when responding to global health emergencies like the COVID-19 pandemic.

By a vote of 61-2 on late Saturday night, the 194-nation governing body for the World Health Organization agreed to a compromise for updating the strategy for HIV, viral hepatitis and sexually transmitted infections through 2030 by deleting the glossary of terms that are in standard use for HIV treatment and care.

The compromise, crafted by Mexico's delegation, allowed the assembly to duck having to make further concessions to Saudi Arabia and other nations such as Egypt, Nigeria and Syria that had favored imposing even stricter limits on the usage of standard terms in sexual health care. As many as 90 of the 183 delegations that were eligible to vote did not do so. Thirty nations abstained.

U.S. Health and Human Services Assistant Secretary for Global Affairs Loyce Pace, who headed her nation's delegation, said key topics on sex education, gender identity and violence in all types of partnerships were omitted. “The current scientific evidence clearly supports the inclusion of these terms," she said, though the U.S. was satisfied the overall strategy was preserved.

A 'bumpy' ride

Pace also championed a process for updating the International Health Regulations, which govern nations' responses to disease outbreaks, in the face of opposition from some African nations that worried they might not be afforded enough time to consider the changes.

One of the assembly's main committees adopted a resolution by consensus that halves the two-year process for making amendments to the rules down to just one year. Nations will also now get up to 10 months — the previous limit was nine months — to reject or voice reservations over any future amendments. And they will have up to one year, double the previous time allowance, for complying with changes to the rules. A paragraph was also adding urging nations to collaborate on technical cooperation and logistical support.

“The train ride was sometimes bumpy but we arrived at our destination,” Dr. Hiroki Nakatani, a veteran public health specialist and professor at Keio University, said after a week of presiding over one of the assembly's main committees.

Earlier in the week, during its first fully in-person gathering in two years, the assembly voted to condemn Russia's invasion of Ukraine and attacks on its health care facilities. It also re-elected WHO Director-General Tedros Adhanom Ghebreyesus to a second five-year term. Tedros, a former government minister from Ethiopia, ran unopposed after serving as the public face of the global health response to the pandemic. He is the first African and first non-medical doctor to lead WHO.

Tedros pledged to make greater efforts to eliminate sexual exploitation and abuse by staff and contractors after three U.N. special rapporteurs criticized WHO's “inadequate response” to allegations of sexual exploitation and abuses during the Ebola response in Congo from August 2018 to June 2020. An independent commission set up by WHO found 83 emergency responders in that Ebola outbreak, including 21 WHO employees and consultants, had raped nine women and likely abused dozens of women and men, obtaining sex in exchange for promises of jobs.

Nations agreed to increase their regular contributions to WHO to 50% of the U.N. health agency's core budget, up from 16%, by the end of the decade. The rest of the budget, which stood at US$5.8 billion for 2020-21, comes from voluntary contributions.

The U.S. has historically been one of WHO's largest funders of WHO, providing US$200 million to US$600 million a year over the last decade, though Germany became the biggest donor in 2020 when the Trump administration suspended financial support and began to withdraw from the agency. U.S. President Joe Biden reversed that decision upon taking office in January 2021.