The Overlooked Decisions of the 79th World Health Assembly

Egypt, leading the resolution as part of a four-text package that also covered teleradiology, pharmacovigilance and precision medicine, stressed “the urgency of integrated national responses to strengthen prevention, early detection, acute care, rehabilitation, and long-term support, particularly in low and middle-income countries, where the [stroke] burden continues to rise.”

Cold War-era guidelines updated

If stroke waited decades for a resolution, the global system for monitoring whether medicines are killing the people taking them has waited longer.

The Berlin Wall went up and came down, the Soviet Union dissolved, Russia invaded Ukraine twice – and the WHO’s pharmacovigilance architecture stayed where it was.

The architecture prior to WHA dated to resolution WHA16.36, adopted in 1963 in the aftermath of the thalidomide tragedy. The sedative, marketed to pregnant women across 46 countries to treat morning sickness in the early Cold War era, caused an estimated 10,000 to 12,000 babies to be born with severe limb malformations.

The 1963 resolution called for member states to systematically collect reports of serious adverse drug reactions. Pharmacovigilance — the WHO’s term for that surveillance — has not been substantively updated at this level since.

This week’s resolution teleports that framework into the era of COVID-19, real-world data and artificial intelligence. It calls on countries to leverage AI and machine learning “in a safe, transparent and ethical manner to improve safety signal detection and response, while also maintaining public trust.”

The recognition matters because pandemic-era mRNA vaccines and antivirals were rolled out in months, and post-marketing safety signals had to be tracked across populations of billions. The infrastructure built around paper reports and national centres was not designed for the speed or scale of modern global health crises.

“Significant inequities persist in pharmacovigilance capacity, with many developing countries facing capacity and resource constraints and contributing a disproportionately small share of global safety data, resulting in populations being unequally protected against adverse events,” the resolution states.

In other words, drug safety standards around the world are uneven because the quality and scale of surveillance data is uneven.

A similar gap is reflected in the gender divide, where women face a higher rate of adverse reactions due to data over decades of pharmacovigilance trials primarily focusing on men, the resolution says.

Tanzania’s delegation called the updated text “an essential pillar of patient safety, resilient health systems, and public trust.”

WHO will report back on implementation in 2028, 2030 and 2032.

Emergency care gets a nod

An estimated 38 million people die every year from conditions that emergency rooms, operating theatres and intensive care units could treat if patients could reach them in time, according to the new global strategy adopted this week, which notes the same conditions cause 1.3 billion disability-adjusted life years lost annually.

The new Integrated Emergency, Critical and Operative Care Strategy 2026–2035 gives countries a 10-year framework to fix one of the most glaring inequalities in global health: where this care is available, lives are saved; where it is not, the gap is stark.

“Globally, 6% of surgical procedures occur in low-resource countries, despite those being home to over a third of the world’s population,” the International Federation of Medical Students’ Associations told the committee.

Tens of millions of people, most of them in lower-middle-income countries, face catastrophic health expenditure from emergency care every year, the resolution states.

Tens of millions more face catastrophic expenditure from the non-medical costs alone — transport, food, lodging — of trying to reach a hospital with an emergency ward equipped to deal with critical health conditions, from childbirth complications and road traffic injuries to heart attacks, strokes, sepsis, malaria, diarrhoeal disease and pneumonia.

“Ukraine’s experience during Russia’s ongoing aggression shows that critical care must function as a continuum from prehospital response to surgery and rehabilitation,” Ukraine’s delegate told the committee. “We support strengthening workforce capacity, referral systems, and digital tools, especially in conflict-affected settings.”

Burkina Faso, hit by years of militant insurgent violence in the Sahel, described the pressure on its health system “in particular in terms of trauma care, critical care, and emergencies”. Its regional neighbour Chad also pressed the importance of the strategy “for countries facing humanitarian security in health crises, particularly in the Lake Chad Basin affected by terrorist attacks by Boko Haram.”

On the sidelines of the assembly, Ethiopia, Germany and Brazil launched the Global Health Emergency Corps Strategy, aiming to ensure 10% of every country’s health workforce is “organised, trained, exercised and connected to respond to emergencies by 2030.”

WHO will publish an action plan with targets by the end of 2026.

Remote radiology to the rescue

Another resolution on teleradiology, also led by Egypt, aims to make it easier for specialists in one country to read scans from another.

Teleradiology — the secure digital transmission of medical images for remote interpretation — has existed for decades, but its uneven uptake has left many countries with imaging machines and no one trained to read what they produce.

“The absence of trained personnel to interpret the images, or weak referral systems, leads to suboptimal utilisation of the equipment and may limit the effective use of existing imaging capacity,” the resolution notes.

The technology allows expertise to travel where infrastructure cannot. A radiologist in Cairo can read a scan taken in northern Mali. The same arrangement lets a doctor in a safer country read a chest X-ray from a besieged hospital in Khartoum, or a stroke scan from a frontline in eastern Ukraine.

The resolution builds in artificial intelligence as a clinical aid, requiring AI tools to be “developed, validated, safely deployed and governed ethically.”

“These solutions help bridge geographical barriers, strengthen diagnostics across islands, and reduce dependence on overseas referrals,” the Maldives told the committee.

Fiji noted that “digital X-ray systems with embedded artificial intelligence are now being deployed nationwide to improve diagnostic speed, accuracy, and equitable access to healthcare.”

The resolution requests a situation report back to WHA in 2030.

Two decades, missing genomes

The first WHA resolution on precision medicine updates a 22-year-old text on genomics and world health, adopted in 2004 when the human genome had only just been sequenced, and the cost of doing so ran into the millions of dollars per patient.

Today, sequencing giant Illumina says its reagents can sequence a human genome for under $200.

Precision medicine — the use of genomic, molecular and clinical data to tailor prevention, diagnosis and treatment — has delivered measurable gains in cancer survival, faster diagnosis of rare diseases, and safer prescribing, WHO said.

But this miracle of modern medicine is not available to everyone.

“Many populations, particularly women, children and older adults, remain underrepresented in the data and research that underpin precision medicine,” the resolution states, pointing to “developing countries facing limited laboratory infrastructure, underrepresentation in genomic and clinical datasets, shortage of skilled professionals, and inadequate governance mechanisms for ethical data use and sharing.”

A medicine designed using genomes drawn predominantly from people of European ancestry will work less well — sometimes much less well — on populations whose ancestry is not represented.

Without governance, the technology that promised to deliver the right treatment to the right patient at the right time risks delivering it only to the right zip code.

Egypt’s delegation emphasised precision medicine and AI-driven diagnostics “must remain accessible and affordable to all, so that it becomes a tool for equity rather than a source of widening disparities.”

The resolution aligns with last year’s WHA decision on rare diseases, which Egypt also championed. Nearly 80% of rare diseases are genetic, making precision medicine and rare disease policy two halves of the same agenda.

WHO will deliver a global strategy on precision medicine to the 82nd WHA in 2029.

Radiation in a year of nuclear strikes

The assembly’s first-ever comprehensive resolution on radiation and health, sponsored by Armenia, Chile, Egypt, Iraq, Palestine, Qatar, Saudi Arabia, Thailand and Tunisia, was adopted in a year marked by missiles, drones and projectiles striking or landing near nuclear facilities across three continents.

The resolution covers both ionising radiation (from medical imaging, radiotherapy, radon and nuclear sources) and non-ionising radiation (ultraviolet, electromagnetic fields) — a unified framework that previous WHA resolutions had treated seperately.

It acknowledges health risks to children and pregnant women, the increasing use of radiopharmaceuticals in cancer care, and “the non-radiological health impacts of radiation emergencies.”

The resolution explicitly recalls last year’s resolution on the health effects of nuclear war, a text the World Health Assembly fought bitterly over before adopting.

Russia and North Korea opposed it, saying there was nothing left for WHO to study. The Marshall Islands, Micronesia, other Pacific island states, Iraq and Kazakhstan pushed it through, citing decades of documented cancers, birth defects and chronic illness still afflicting populations near former Cold War test sites in the Pacific atolls and the Kazakh steppes generations after the last detonations.

The day before the assembly formally opened, a drone strike sparked a fire on the perimeter of the United Arab Emirates’ Barakah Nuclear Energy Plant, the first nuclear power station on the Arabian Peninsula. The strike drew “grave concern” from International Atomic Energy Agency Director-General Rafael Grossi, and featured as a pivotal part of the debate over a separate WHA resolution adopted this week on the public health consequences of Iranian attacks on civilian infrastructure across Gulf states and Jordan.

Earlier this year, projectiles struck near Iran’s Bushehr nuclear plant twice in eight days, and missiles were fired in the direction of Israel’s Dimona nuclear research centre. Russian forces continue to occupy the Zaporizhzhia nuclear plant in Ukraine, which remains disconnected from the country’s electrical grid and dependent on emergency diesel generators to cool its reactors — a worst-case-scenario configuration the IAEA has repeatedly warned poses ongoing radiological risk.

The resolution requests a global mapping of “relevant actors and initiatives” in radiation and health by 2028.

We have the text, but where’s the money?

The assembly closed by adopting a strategy on the economics of health for all for 2026–2030, building on the work of WHO’s Council on the Economics of Health for All.

The text is ideologically the most ambitious of the week: a “well-being economy” framework calling for governments to use tax, trade, industrial and labour policy as health levers, address “harmful commercial practices,” and confront the “financialization of healthcare delivery.”

It is also the text most exposed to the gap WHO itself now openly calls a “global health financing emergency.”

Global development assistance for health fell 21% between 2024 and 2025, driven almost entirely by a 67% drop in US financing — more than $9 billion — according to data from the Institute for Health Metrics and Evaluation.

But the US is not alone: Germany cut its bilateral health aid by 53%, the UK by 39%, and France by 33%. Total OECD official development assistance fell 23.1% in 2025, the largest single-year contraction on record.

That financing gap is the wall every resolution adopted this week will hit on its way out the door. The World Health Assembly issues guidance; it does not mobilise funds. Unlike UN climate summits, where the headline negotiation each year is over hundreds of billions to trillions of dollars in financing requests from global south countries, the WHA passes rules that national governments must then choose to fund on their own.

As African leaders at the Nairobi World Health Summit last month declared the end of the aid era, a Centre for Global Development audit found that only two African countries proposed new revenue measures to replace lost financing in their 2025 budgets, and none reprioritised spending from other sectors to protect health.

In other words: aid is gone, and the countries it left behind are not — for the most part — yet in a position to replace it.

The crisis framing of the global health funding shortfall stands in stark contrast to the reality that the missing money is, in global terms, comparatively negligible. Year after year, governments choose tanks over hospitals, missiles over medicines, and submarines over the surveillance systems that catch the next pandemic before it spreads.

The $9 billion gap left by US withdrawal is roughly 2.4% of EU defence spending and 0.66% of combined EU-US defence outlays for 2024. EU defence expenditure alone rose to €381 billion in 2025, a 19% increase on the previous year.

Around 200 individuals with net worths above $10 billion hold approximately $5 trillion between them. The combined fortunes of the world’s three richest men — Musk, Google co-founder Larry Page ($257 billion), and Google co-founder Sergey Brin ($237 billion) — could fund the gap for 148 years, until the early 22nd century.

“Every resolution you adopt, every agreement you reach, only has value when it changes what happens in a clinic, in a community, or in a household,” WHO Director-General Tedros Adhanom Ghebreyesus told delegates in his closing remarks on Saturday evening. “When a health worker has what they need to do their job; when a child is vaccinated; when a mother survives childbirth; when an outbreak is contained before it spreads. That is now the task before us.”

The resolutions adopted this week, by any reasonable read, are good policy. Stroke needs a stroke unit. Drug safety needs surveillance. Genomes need to be sequenced from populations they will be used to treat. Health workers cannot be poached without consequence from countries that trained them. Emergencies do not respect borders.

But none of the resolutions are binding. They will sit in the WHO archive unless governments — finance ministries more than health ministries — find the money and the political appetite to implement them.

The history of the World Health Assembly is, among other things, a history of resolutions that did not. Whether any of the new resolutions become more than pages in the archive will not be decided in Geneva.