The United States is poised to miss this year’s World Health Assembly (WHA) at a pivotal time when global health leaders are expected to finalize a Pandemic Agreement that has been in development for nearly three years.
A provisional list of delegates released by the World Health Organization (WHO) on Sunday indicated that there is no U.S. representation at the assembly, an unprecedented occurrence since the organization’s inception in 1948 if no last-minute decision is made to reverse this absence.
In stark contrast, China is preparing to send more than 180 delegates, reportedly their largest-ever group to the WHA, which takes place from May 19 to May 27.
This delegation comprises senior and mid-level health experts from various government ministries as well as prominent academics from institutions across the country.
Former WHO Legal Counsel Gian Luca Burci highlighted this disparity during a preview session, emphasizing the significance of the U.S. absence and China’s extensive participation.
He stated that the absence of the United States would mark a historical moment for the WHA, which has never occurred before.
In previous years, even amidst controversial U.S. decisions to withdraw from the WHO, a small American delegation has still managed to attend key meetings, albeit with minimal engagement.
Legally, the U.S. withdrawal from WHO is set to take effect in January 2026, but the Trump administration’s failure to pay the $260 million in membership fees for the upcoming years signals unclear intentions moving forward.
The WHA agenda this year packs in about 75 items, encompassing a wide range of political discussions, including ongoing conflicts such as Russia’s war in Ukraine and the Israeli-Palestinian tensions, in addition to key public health proposals.
These agenda items will also address crucial strategies for health programs tackling climate change, air pollution, and diseases, including discussions on mental health advancements.
One of the central items on the agenda is the expected vote to approve the Pandemic Agreement, anticipated on Tuesday, alongside the approval of the 2026-2027 budget which has seen significant reductions following the U.S. financial commitments being called into question.
The total budget for WHO has dropped from approximately $7.4 billion to $6.2 billion, and a further reduction in the base budget from $5.3 billion to $4.2 billion could result in a drastic downsizing of WHO’s workforce by about 20%.
WHO Chief Scientist Jeremy Farrar addressed the challenges posed by these funding cuts, urging the need for global health organizations to adapt and seize the opportunity to emerge stronger in the face of adversity.
Farrar, who now oversees a newly established division focusing on Health Promotion, Disease Prevention, and Control, anticipates a challenging period ahead for the organization but believes reform and evolution are imperative for improving the agency’s effectiveness.
He suggested that consolidating WHO’s existing divisions could alleviate redundancy and promote a more collaborative organizational structure, which he believes will be vital for efficiency.
The human aspect of impending staff reductions cannot be overlooked, Farrar stated, noting that low-income communities worldwide would feel far greater repercussions from the funding cuts than those affected within WHO.
While there is cautious optimism regarding a potential agreement to boost member states’ contributions by 20%, it is crucial that these proposals receive endorsement at the assembly to stabilize WHO’s precarious financial situation.
Germany’s Björn Kümmel emphasized that while support from numerous countries is evident, quiet opposition remains, highlighting the uneven distribution of responsibility among member states in terms of financial contributions.
Emerging economies need to increase their financial commitments to sustain WHO’s future, given the disproportionate reliance on a handful of nations for funding.
Additionally, the Americas region, which includes economically developed nations, has notably not made any voluntary donation commitments to WHO’s investment initiatives.
As discussions surrounding the Pandemic Agreement progress, Burci clarified that, while an agreement may be approved, an annex concerning pathogen access and benefit-sharing remains under negotiation before the instrument can be fully ratified.
This aspect of the agreement seeks to balance the interests of developed countries wanting unimpeded access to pathogen information with the requirements of developing nations for equitable benefits from shared data.
Despite the noted complexities, Farrar insists that the collaboration of 193 member states towards the consensus on a pandemic accord is a significant accomplishment amid global discord and challenges, urging a continued commitment to fostering a collaborative international health environment.
As the WHA assembly unfolds, many look toward the outcome of these discussions and negotiations, particularly regarding funding, international collaboration, and the future of global health governance, all while standing at a crucial crossroad for the health community.
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