 So there's an odd kind of paradox in the global health situation where some countries have bid farewell to the COVID-19 pandemic. Some countries are still reeling from the after effects of it. And of course, the World Health Assembly was one opportunity for a large number of countries to bring their concerns on board and also to trash out what is being called as a pandemic treaty. We discussed these issues previously during the Executive Board meeting of the World Health Organization and today we're returning to Jyotsna Singh from the People's Health Movement who was actually in Geneva attending all the events and the conferences and she's going to give us an update on what's happening right now. Jyotsna, welcome. Thank you. So Jyotsna, the biggest issue it seems from our discussions which we've had over the last few weeks is that the funding of the World Health Organization and money matters as you said are actually crucial right now, why is that? Absolutely. So the thing is it is about an overall direction in which the global health governance is moving when it comes to talking about where the funding and the resources for any initiative will come from. So I'll begin with the WHO itself. So this is an organization which is a multilateral organization which means that primarily it is the governments which are part of it who form the organization and other people have more of an observer status though they are allowed to speak on the floor of the assembly. But if a voting is concerned and other aspects are concerned it is the governments who do it. However what's happening earlier say till the 1980s most of the money for running WHO used to come from the governments. So there is a ratio according to your population and your per capita income, your GDP, some money is earmarked that every government is supposed to give this much of money to run the organization. Now this is called core funding and all the countries decide together along with the WHO secretariat where will the money be spent. So it was in 1970s that there was this famous conference took place in Almaty which is now in Kazakhstan then in USSR where it was decided that the main focus in the world is going to be and with the leadership of WHO it is going to be primary healthcare because it is an estimate that if people are able to bring their needs early on to the health system then 80% of the ailments can be taken care of and then you go to the higher forms of tertiary care or secondary care only after that. However so but all of this had to happen but then we started to see that the WHO's funding direction shifted. So it started to shift to donors which became majorly the flamethrower capitalist organizations say the Rockefeller Foundation, the Bill and Melinda Gates Foundation has emerged over the years and today when we talk about as much as 83% of WHO's funding comes from these donors and what is the problem? They come with a very project based mentality. They decide where the WHO will spend the money and it is rather than questioning the structural problems they would spend on vertical programs. So I am spending the money only on HIV program or only on polio. Now whether it actually strengthens the public health system or not that is really not there worry in that sense. You can see those words in the documents but what we see happening on the ground is something very different. In fact this this time when I was in Geneva a friend I was talking to and she said that in South Africa and this is her real life experience so a pen was needed in another room and it was present in one of the rooms in one of the wards in the same health facility but it could not be given because it had come under the head of the HIV AIDS program. A simple pen to write with. Yes so you start to decide things so minutely and so the understanding is not comprehensive care at all and it all happens so we do need I mean it is not to say that we did not need these programs to happen but to divorce them from the strengthening of the health systems becomes a problem and with donors the point is that they are very specific about the outcomes so they are giving money for something very specific and they want very specific outcomes within a very narrow schema of things. So this is what is happening in since 90s so now the problem is that WHO actually has very less autonomy in deciding what it would like to do. Alright and when I say WHO I actually mean the WHO secretariat and the countries together because they decide and that is why the world health assemblies are important but then it is all happening at the back door etc etc so this year what happened there was a sustainable financing report which was put forth for discussion by the WHO secretariat the director general and it took two years for a committee to arrive at it. Now the committee itself correctly said that so much of funding earmarked funding coming which is for a specific purposes not giving flexibility to WHO is a problem correct analysis but when he saw the recommendation this time it said that earmarked funding is one form of funding that WHO will take it is really dangerous it is dangerous more dangerous than before because earlier there was this entire move to recognize the problem but now it is institutionalizing earmarked funding now the countries especially the rich countries who some of them something like US who favor earmarked funding they will take back to their parliament and say now WHO approves of earmarked funding and that's what we are going to give that's what Bill and Melinda Gates Foundation will give because US as a country also gives a lot of earmarked funding so that has become the problem and therefore a lot of organizations especially four organizations did a press conference there in Geneva People's Health Movement Society for International Development Third World Network and Public Services International all of them came together because they recognized this is going to be a disaster for WHO. So Jyotsna are there countries which are actually attempting to change the direction which the WHO seems to be headed in and how have what are the crucial issues on which there are differences between the developed world and the poorer countries what are the core issues here? So there was a story which was with Geneva Health files broke right during the WHO and it showed that it was the US the US government which pressurized WHO to bring in earmarked funding they said we will not let it pass the report pass unless you have it so yes this is where the developed world stands right and in our conversations and I will not name the country because they have asked us not to name them but a known representative from an African nation told us that they were not in favor of earmarked funding they actually tried to push for flexible funding because they say that it is the poorer nations who suffer more because the issues of the poorer nations say Ebola in Africa it should be one of the priorities to work on we don't get to work on it and issues like intellectual property etc which have harmed Ebola treatment reaching African nations all of that has happened so but he was very clear that these problems exist and we are not even though we push for not having earmarked funding and flexible funding so that we have an equal say because WHO otherwise works on one country one vote absolutely but then so what is happening is that those very principles on which WHO was formed in the 1950s are being questioned and it is serious WHO should also take it very seriously so you know when we hear a phrase like the pandemic treaty it sounds like the WHO the member countries are actually moving towards solving a very big problem I mean the world was really under covid and it was a very difficult time is that really the case no doesn't so I mean whether it will happen or not is a different question whether it will okay it is going in the direction of solving a problem or not is a different question altogether so pandemic accord as it is called is being discussed and again coming back to the funding part of it yes again the way we are saying the overall direction is something which is becoming a problem because the financial mechanism so there is a pandemic fund that the G20 countries not at the WHO but the group of 20s they have formed which again consists of most of the developed countries and some developing countries like India and all so which is actually based out of World Bank so this is the fund where countries will put the money and they will see how to go about things in future which is such a problem and it is giving a lot of anxiety to continents like Africa I will come back to it again and some of the Latin American countries because they are not in favor of something of this sort because what they are saying is and I think this is going to become one of the points on which some of the developing countries at least or the developing countries blocks are not going to agree and I hope not easily and I hope they will not agree at all not easily for sure they won't which is that you should have a fund of course we need to create a pool of funds for pandemic and it is not only during the pandemics this fund will be used but also to see how to avoid pandemics and if it happens how to have equitable distribution of vaccines medicines and other response the response as they say exactly there should not be travel bans put arbitrarily and all of that so all of that but then the money will should be able to come from this one they they are saying that we can have it should be the WHO which actually decides how much fund and how to use it and even if World Bank because it has as they say experience in using it so these countries some of the south global south countries are saying but the decisions of how to use the fund has to come from the world health assembly kind of a grouping and it cannot be a few countries deciding about it and they also say that it is not enough to have a few nations decide where there is one representation of one country in that group because the developed countries and overpowered them absolutely so it has to be everyone's say when it comes to decide what will be the fund used for and how will the distribution happen so that is one part right yeah and if I can come there are there is another thing on which I know at least the African countries are going to really put their foot down that they will not accept which is access and benefit sharing now ABS in short right which it is called which basically means that if companies and it's mostly companies private companies they make use of a pathogen that has arisen from a particular country and have made treatments or vaccines using that then everybody should have access to the benefit also so the access not only to the pathogens say the virus or the bacteria but also access to the products that come out of using them because some country has actually shared the genetic sequencing and etc using that but then they don't get access to the cures or the remedies no no we saw it in the case of South Africa South Africa was the first one who said about Omicron and they actually shared the genetic genetic sequencing but what did South Africa get a travel ban though the same virus during covid was present in many countries but western countries did not face the travel ban it was such an unequal travel ban that the countries of the global south faced and instead of saying that okay it is good this is what South Africa has done and then the vaccines that now come which will save people from Omicron should reach South Africa and other countries that did not happen and we have seen this in so many cases we have seen this in Ebola we have seen this when Indonesia shared a particular sequencing and Indonesia is not the one which got it in fact Ebola that is what there was this report by MSF they also launched it during the World Health Assembly it clearly shows that so in 2020 two Ebola treatments were approved by the US FDA and we have had outbreaks of Ebola in African nations over the past two years right yes we all know that African nations do not have access to those treatments all the treatments all the treatments are being hooded by the US because the government has bought it they think that if people in their country fall sick then they should get to access those medicines this is what pandemic preparedness and response that is happening all right so so and people are saying that the accord that we want should go absolutely opposite to this right but the WHO already is supposed to have or has a system to deal with health emergencies and you earlier told me that the pandemic treaty or the pandemic accord and the IHR are proceeding in parallel are they replicating the process are they wasting hard-earned funds what is going on there so yeah so there are two things yes initially when the pandemic accord was being discussed and EU was the one which was pushing for it from the beginning and by the way that started even when the COVID was we were in the middle of COVID into 2021 that's right right and that's when they started to discuss about the future pandemic of course then that's where also the inequality comes because the developing world was reeling under COVID worse even that time but well so this civil society organizations and activists said even that time that when we are talking about amending the international health regulations which got kicked in in 2005 after the SARS right COVID that the SARS virus spread that happened so but then there was a lot of push and now we are in a situation where we have two accords being discussed okay so this is where we are but so the thing is again now the problem is the developed countries have more resources you always see more delegates for them from these countries coming in so they talk about two things together all the time they have but with developing countries it becomes difficult to really negotiate on so many fronts at the same time so that is one but again as I'm saying that is happening so on IHR there is in some countries a little less focus there is more focus on pandemic treaty because that has become the famous that's right the word now because of COVID but yes so both are going on and it similar issues are coming up in both because they are quite similar processes whether the intellectual property barriers will be addressed or not whether access and benefit sharing will happen or not and how will we manage the funds so these issues are coming up in both what we have heard is that the developing countries are saying there is a possibility because next year 77th WHA is the one where the pandemic accord is supposed to be finalized but they're saying that what we will say is that we cannot decide one of them first and then leave the second of them to happen later so if pandemic accord is is being discussed then IHR amendments have to be finalized in the same assembly or the other way around because they are saying if they are able to discuss properly in one and get some I mean pushed for their demands and if they are accepted all right they are not confident in the second one that will happen all right and if it doesn't happen then they will be at the losing end all right so either both right or none all right so and but again the point is that this is what they are aiming for and hopefully it will happen in that fashion so I sort of gleaned two things from what you say that the developing world is actually hoping to get what it needs just because the developed countries the wealthy countries are getting what they want you know that's sort of a sad situation but the other thing I sort of understand from what you say is that it is the poorer countries which are more progressive would that be a correct estimate I think it would be yes because as I said that when you talk to the delegates from tsunami bia both swana or the afro block block as a whole you do here because you do you see what happened with Africa during covid like it was the continent which suffered the most and now you have mRNA hub coming up in South Africa but it is just too little too late the mRNA hub would be for the vaccine for the vaccines yes and there was a lot of push that we should have this facility in Africa and throughout covid it didn't happen and now this is happening so hopefully I mean it is it's that's what I'm saying too little too late because maybe some of the new vaccines South Africa will be able to produce but not for the pandemic when it was needed the most so and Africa just none of the countries could achieve a very good level of vaccination so of course their experience and what they are taking very progressive positions because they know their continent can't go through something similar again then we are also seeing good positions coming from some of the Latin American countries and that is because of the change in political dynamics there we have more progressive comments and now with Lula becoming Brazil's premier again and Brazil's famous slogan now is Brazil is back and science is back and a lot a lot of things so you do hear the the slogan in even in these meetings so at WHA we heard that and Brazil has actually so so Brazilian statements if you see there they do take positions which are more progressive and about excellent benefit sharing IP barriers should be removed they do say that they actually brought a resolution which is health for indigenous people so Brazil now does not have only a health ministry they have a vice minister for health for indigenous people so who would focus on that and they were present very actively advocating for indigenous people's rights in the assembly that they did that and in we had interviewed him for people's dispatch and he very clearly said that we want to use the word indigenous people because it has connotations of colonization and it is not just about any community it is about community which communities which got discriminated against or displaced in massive numbers because of the coming of the colonizers so it is actually we are fighting back the colonization so that was good so brazil is doing these things and of course it is easy to talk to them for the civil society and columbia is another country which takes chili as well so we are seeing some of those countries because of their political this thing so yeah so we are hoping that next year when the pandemic accord actually becomes the thing to talk about we will have these progressive positions come out and they do not compromise because otherwise we won't be able to deal with yet another pandemic hopefully it doesn't happen right and it is not only about a pandemic it is also about how do you ensure it does not happen it also gets related to many other health emergencies because IHR is not only about pandemic right it also responds to something like what happened in turkey and earthquake and the earthquake floods in Pakistan Ebola absolutely so it kicks in for all those things so we do need a strong IHR there is no doubt about it now so it's not the IHR like the pandemic accord would work only if the intellectual property rights are relaxed is would that be a correct estimate that's essential to making everything will work only then so because whether you talk about likelihood of that's happening I think those are very different discussions should not be as I said that we would like to see health as treat us as a comprehensive thing and not one by one so whether we talk about non-communicable diseases we have been talking about infectious diseases but non-communicable diseases also the kind of I mean you see and and then I guess you're right this gets reflected in WHO's documents also so if you do not have medicines say for cancers cancer medicines are just so costly medicines for rare diseases are so costly now if WHO wants to put in those recommendations in its documents which would say that you know everyone should have access to these medicines and all and put forth proper policy guidelines right it is difficult to do if your medicines are so costly absolutely and intellectual property is the barrier the problem is it is not only WHO but the TRIPS agreement which actually decides these things which is the trade related aspects of intellectual property that is actually hosted in the World Trade Organization which works very differently than than the WHO it is a very closed body and it is largely the amount of influence transnational corporations and have WHO also has but much less compared to how WTO works so we would like WHO to sort of take more progressive positions and see to it that it does pressure as WTO to behave better when it comes to health it is about lives at the end of the day right Jyotsna thanks so much for joining us with that and as you heard Jyotsna just tell us it's a big fight for the developing countries to get access to basic health care and in fact to push the WHO towards a more progressive public health oriented system for health care thanks very much for watching us