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WHO Director-General’s High-Level Welcome at the Seventy-Sixth World Health Assembly – 21 May 2023
21 May 2023
Your Excellency Ahmed Robleh Abdilleh, President of the 75th World Health Assembly,
Your Excellency Alain Berset, President of the Swiss Confederation,
Your Excellency Filipe Nyusi, President of Mozambique,
The Right Honourable Jacinda Ardern, former Prime Minister of New Zealand – between jobs,
Gianni Infantino, President of FIFA,
Renée Fleming our brand new Goodwill Ambassador for Arts and Health. She’s joined by Pretty Yende from South Africa.
Members of the Global Scrub Choir,
Excellencies, Ministers, heads of delegation, dear colleagues and friends,
First, let me begin by thanking Your Excellency President Berset for your personal support and partnership, and for Switzerland’s continued support and partnership for WHO and global health.
My thanks also to Your Excellency President Nyusi, for being with us today, and for your commitment to health, including your championship on malaria and your country’s journey towards universal health coverage.
My thanks to Your Excellency former Prime Minister Ardern, for your leadership in global health, and especially for your humble leadership. That’s what we want from all our leaders – humble leadership. Thank you so much for being the model of that.
Thank you, Your Excellency Minister Abdilleh, for your leadership of the 75th World Health Assembly, which is very historic.
Thank you, Mr Infantino, for your partnership in harnessing the power of the beautiful game for health, any my congratulations on FIFA’s 119th birthday today. Happy birthday FIFA.
And my thanks to Renée Fleming and the Scrub Choir for inspiring, moving and entertaining us, through the powerful medium of music.
Thank you all for being with us today, for this historic World Health Assembly in WHO’s 75th year.
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Excellencies, dear colleagues and friends,
In 1977, Ali Maow Maalin was a 23-year-old working as a hospital cook in the port of Merca, Somalia.
In addition to his duties in the kitchen, Maalin had worked as a vaccinator in WHO’s smallpox eradication programme, which had hunted down the last remaining cases of smallpox among groups of nomads along Somalia’s border with my country Ethiopia.
In October of that year, two children with smallpox from a nomadic group, or pastoralists group, were sent to an isolation camp near Merca. The driver who was transporting them stopped at the hospital where Maalin worked to ask for directions.
Maalin offered to accompany them, and the driver asked if he was vaccinated. Maalin said, “Don’t worry about that, let’s go.” He wasn’t vaccinated.
Maalin was in contact with the infected children for 15 minutes. But that was enough.
Nine days later he started to feel sick and developed a rash. He was diagnosed with chickenpox and sent home. But Maalin knew it wasn’t chickenpox.
He was too scared to go to the isolation camp, but a hospital nurse reported that he was sick.
The hospital stopped taking patients while everyone inside was vaccinated and put in quarantine.
Meanwhile, a team started vaccinating everyone surrounding Maalin’s home – more than 50 000 people in two weeks.
Ali Maow Maalin was the last recorded case of naturally occurring smallpox. He went on to work with WHO in the polio eradication campaign in Somalia. He used to say that Somalia was the last country to get rid of smallpox, and he wanted to make sure it wasn’t the last to get rid of polio, and he was right.
In 2013, during a campaign to counter a flare-up of polio, he contracted malaria and died a few days later, aged 59.
The campaign to eradicate smallpox was launched in 1959 by WHO Director-General Dr Marcolino Candau, and ended officially in 1980 with the World Health Assembly’s declaration “that the world and all its people have won freedom from smallpox”.
Dr Candau is from Brazil, by the way, and today I wanted to use my speech to recognize all our former Director-Generals. Dr Gro Harlem Brundtland, and I will talk about her later.
It remains the greatest achievement in the history of public health, and the only human disease to have been eradicated to date.
But today we stand on the threshold of eradicating two more diseases: polio and Guinea worm.
When the Global Polio Eradication Programme was launched in 1988 under Director-General Hiroshi Nakajima of Japan, there were an estimated 350 000 cases a year. So far this year there have been just three cases.
And when the Guinea Worm Eradication Program began in 1986, there were an estimated 3.5 million human cases in 21 countries. Last year, just 13 cases were reported from four countries.
We will finish the job. We must. But our work will not be done.
I grew up next door to Maalin, in Ethiopia. In Africa, we are all neighbours.
One of my earliest memories is walking with my mother through the streets of Asmara – then Ethiopia, now Eritrea – and seeing posters about a disease called smallpox and an organization that was eradicating it from our communities.
I had never heard of smallpox before. I had never heard of the World Health Organization. I couldn’t have pointed to Geneva on a map.
But I knew that sometimes, diseases could sneak up on children and snatch them away.
I knew, because that’s what happened to one of my brothers, my younger brother.
I don’t know what disease took him. Maybe measles.
But most probably he was taken by a disease that could have been prevented with a vaccine.
Vaccines drove smallpox into oblivion. But millions of children across Africa and around the world – children just like my brother – continued to be snatched away by diseases for which children in other countries were immunized.
That’s why, in 1974, WHO launched the Expanded Programme on Immunization, to ensure all children, in all countries, benefited from the life-saving power of vaccines, initially for six major diseases: diphtheria, pertussis, tetanus, polio, measles and tuberculosis.
At the time, only about 10% of the world’s children received three doses of DTP vaccine. Thanks to the Expanded Programme on Immunization, or EPI, it reached 86% in 2019, but has slipped since then owing to the disruptions of the COVID-19 pandemic, and the very big campaign of anti-vaxxers.
Today, more than 30 diseases are vaccine-preventable, and EPI recommends 12 as essential for every country. Through WHO’s support for countries to ensure access to vaccines for all children, we are helping to avert more than 4 million deaths every year.
Vaccines are among the most powerful innovations in human history.
Thanks to vaccines, once-feared diseases like diphtheria, tetanus, measles and meningitis can now be easily prevented.
Vaccines now give us hope of eliminating cervical cancer;
Vaccines are helping us to snuff out Ebola outbreaks faster;
For the first time, we can say that malaria is a vaccine-preventable disease;
Vaccines were critical in ending COVID-19 as a global health emergency;
And vaccines have brought us to the threshold of eradicating polio.
For more than 20 years, millions of children around the world have enjoyed the benefits of vaccines thanks to the work of Gavi, the Vaccine Alliance.
And for the past 12 years, that work has been led by my friend and brother Seth Berkley, who is stepping down in August.
Under his leadership, Gavi introduced new vaccines against cervical cancer, malaria, pneumonia, meningitis, polio, and reached the incredible milestone of immunizing 1 billion children.
During the pandemic, Seth was a champion of vaccine equity through Gavi’s partnership in COVAX, which supplied nearly 2 billion vaccine doses to 147 countries.
I offer Seth my deep gratitude for his leadership and partnership, and I look forward to working with his successor, Dr Muhammad Pate, to realise the power of vaccines for even more children. So I would like to say welcome to my brother Muhammad Pate.
The demise of smallpox coincided with the realization that achieving the founding vision of WHO for the highest attainable standard of health for all people could not be achieved one disease at a time.
It would require a holistic approach that delivered the health services people need, where and when they need them, but that also improved health literacy, nutrition, water and sanitation and other drivers of disease.
It was an approach we now know as primary health care, and its chief architect and advocate was WHO’s third Director-General, Dr Halfdan Mahler. By the way, he has a T in the middle, which stands for Theodore, so we share the same name.
Under Dr Mahler’s leadership, the term “Health for All” was first coined as the theme of the World Health Assembly in 1977.
And under Dr Mahler’s leadership, the Declaration of Alma-Ata was negotiated and adopted in 1978 – a landmark commitment to primary health care as the platform for achieving a bold vision: Health for All by the year 2000.
It was a milestone in public health that changed the way countries thought about, designed and delivered health services – and continues to do so.
Although the vision of Health for All by 2000 was not realised, its spirit and ambition persisted, and today the concept of primary health care remains the bedrock of our shared commitment to universal health coverage.
Five years ago, I had the honour to join our colleagues from UNICEF and Ministers of Health from around the world in Kazakhstan, the birthplace of the Declaration of Alma-Ata, to renew our commitment to its vision in the Declaration of Astana.
Dr Mahler later described the adoption of the Declaration of Alma-Ata as a “sacred moment” and a “sublime consensus”.
But in 1981, just three years after Alma-Ata, and just one year after the World Health Assembly declared smallpox eradicated, a new threat emerged, the likes of which the world had never seen before.
In the United States, the first cases were reported of a mysterious new illness – an illness that appeared first in gay men, and within months was reported around the world, affecting people of all ages and sexualities.
It was not for another two years that the cause of this new disease was identified – a retrovirus we now know as HIV.
HIV presented a new challenge for WHO; a challenge it did not always meet successfully.
It highlighted the fact that a global health challenge of this scale and speed could not be met by one agency alone, but required WHO to work with partners across the UN system and beyond.
It also highlighted in a new and stark way the vast inequities in global health. When the first antiretroviral treatments became available in 1987, only high-income countries could afford them.
By the turn of the century, the severity of the global HIV epidemic prompted the United Nations Security Council to adopt a resolution on HIV, the first time it considered a health issue as a threat to global security.
But the inequities continued. By 2003, only 400 000 people were receiving ARVs in low- and middle-income countries.
Since the smallpox eradication campaign, WHO had developed proven know-how in getting essential medicines to people who needed them, wherever they were.
And so, under the leadership of then Director-General Dr J.W. Lee, from the Republic of Korea, WHO launched the “3 by 5” initiative – to get ARVs to 3 million people by 2005.
It took an extra two years to reach the target, but “3 by 5” laid the platform for the dramatic expansion in access to ARVs that has turned the tide on HIV.
Sadly, Dr Lee did not live to see the accomplishment of his vision. Tomorrow marks the anniversary of his passing, in May 2006.
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For most of the first 50 years of its history, WHO’s work was focused mainly on infectious diseases afflicting low-income countries.
But throughout those decades, a new pandemic was spreading almost unchecked, fuelled by the deadliest non-infectious agent in history – tobacco.
The link between smoking and lung cancer was proved by the British researcher Richard Doll in 1952, shortly after WHO was founded, but smoking prevalence continued to climb for decades.
Indeed, some of the photos from WHO’s early years show men in offices – and yes, they were mostly men – sitting at their desks, smoking.
It was not until 1988 that Dr Mahler banned smoking inside WHO buildings. He smashed his own ashtray with a hammer in the WHO lobby, and pledged to stop smoking.
And it was only in 2013 that our entire headquarters campus became smoke-free. The manager of the Tobacco Free Initiative at the time, Dr Armando Peruga, was even roughed up a couple of times by WHO staff for telling them not to smoke on campus.
Some countries made their own efforts to curb the harms of tobacco, but it became clear that unlike localised disease outbreaks, tobacco was a global threat that demanded a global response.
WHO’s founders had foreseen this need in Article 19 of our Constitution, which enabled Member States to adopt conventions or agreements on any health threat.
But it was a provision that lay dormant until the mid-1990s, when an American lawyer, Dr Ruth Roemer, first proposed the idea of an international treaty on tobacco control.
Dr Roemer had herself been a heavy smoker, and for a short time her husband had worked for WHO.
Dr Roemer proposed her idea to Neil Collishaw, who was then the head of WHO’s tobacco control unit.
Collishaw was supportive, but skeptical. Adopting a convention would require a two-thirds majority of Member States, and at the time, only about 10 countries had strong tobacco control policies.
But Dr Roemer wouldn’t take no for an answer. That’s how many of the best ideas in global health happen, and there’s often a woman behind them.
Bit by bit, the idea gained traction, and in 1996, the World Health Assembly adopted a resolution calling for an international framework convention on tobacco control.
However, like too many resolutions, it was slow to become a reality.
It was another two years before the idea began to move forward, driven by a new Director-General with a strong commitment to the fight against tobacco, and political experience as Norway’s Prime Minister – Dr Gro Harlem Brundtland.
No sooner had Dr Brundtland taken office than she established the Tobacco Free Initiative and began advocating relentlessly for the framework convention.
But she was up against a wily and well-resourced enemy. You know what I’m saying.
In 1999, it emerged that for many years tobacco companies had been infiltrating WHO by paying consultants to undermine WHO’s work. Staff at the Tobacco Free Initiative even began checking for wire taps.
The tactics were unnerving, but they did not work.
Negotiations on the framework convention began in 2000 and went on for two-and-a-half years.
Finally, twenty years ago today, on the 21st of May 2003, and almost 30 years after Dr Roemer first proposed the idea, the 56th World Health Assembly adopted the WHO Framework Convention on Tobacco Control.
In the 20 years since then, thanks to the WHO FCTC and the MPOWER technical package that supports it, smoking prevalence has dropped by one third globally.
Two thirds of the world’s population is now protected by at least one MPOWER measure.
The WHO FCTC is living proof of the power of global agreements to drive a paradigm shift in global health.
Dr Brundtland is with us today, and I would like you to join me in thanking her for leadership, and the legacy she has left.
[APPLAUSE]
Thank you Gro, tusen tak.
The adoption of the WHO FCTC coincided with the first of a series of outbreaks, epidemics and pandemics that have marked the first two decades of the 21st century, and that have been significant in shaping the WHO of today.
In February 2003, the first cases were reported of a strange new respiratory disease caused by an unknown pathogen that later proved to be a coronavirus. Sound familiar? It was the SARS outbreak.
Around the same time, the first human cases of H5N1 avian influenza were reported, sparking fears of an influenza pandemic caused by a virus that killed 6 in 10 it infected.
Although SARS and H5N1 both caused global panic, neither caused a global pandemic, thanks in no small part to Dr Brundtland’s strong leadership.
Her leadership was also instrumental in the major revision of the International Health Regulations that followed, which included the provision for a Director-General to declare a public health emergency of international concern.
Although she never needed to use that provision herself, her successor did, four years later, by Director-General Dr Margaret Chan, from China, when a new influenza virus sparked the first pandemic of the 21st Century: H1N1.
While H5N1 was highly pathogenic but not highly transmissible, H1N1 was the other way round. Although it spread rapidly around the world, it caused largely mild disease and, for a pandemic, relatively few deaths.
Nevertheless, H1N1 exposed a dangerous breach in the world’s defences against pandemics.
Vaccines were developed rapidly, but by the time the world’s poor got access, the pandemic was over.
That experience led to the development, under the leadership of Dr Chan, of the Pandemic Influenza Preparedness Framework, a historic commitment between Member States to work together in the face of a flu pandemic to share virus samples and vaccines.
But the ink was barely dry on the PIP Framework when a new and deadly epidemic erupted, caused not by influenza, but by one of the most feared viruses on earth – Ebola.
For more than two years, the world watched in horror as Ebola laid siege to West Africa.
And although it never became a global pandemic, the West African Ebola outbreak highlighted the need for substantial reforms of WHO’s work to prepare for and respond to emergencies.
That led, in 2015, once again under the leadership of Dr Chan, to the creation of the WHO Health Emergencies Programme, and the Contingency Fund for Emergencies – a flexible financing instrument that has enabled WHO to release more than 350 million dollars to respond rapidly to hundreds of emergencies over the past eight years.
Each of these outbreaks, epidemics and pandemics taught the world new lessons and resulted in new agreements and new tools to keep the world safer.
But even so, the world was taken by surprise and found unprepared for the COVID-19 pandemic, the most severe health crisis in a century.
Over the past three years, COVID-19 has turned our world upside down.
Almost 7 million deaths have been reported, but we know the toll is several times higher – at least 20 million.
The pandemic has caused severe disruption to health systems, and severe economic, social and political upheaval.
COVID-19 has changed our world, and it must.
In 2020, I described COVID-19 as a long, dark tunnel.
We have now come out the end of that tunnel.
To be clear, COVID-19 is still with us, it still kills, it’s still changing, and it still demands our attention, but it no longer represents a public health emergency of international concern.
The end of COVID-19 as a global health emergency is not just the end of a bad dream from which we have woken. We cannot simply carry on as we did before.
This is a moment to look behind us and remember the darkness of the tunnel, and then to look forward, and to move forward in the light of the many painful lessons it has taught us.
Chief among those lessons is that we can only face shared threats with a shared response.
Like the WHO Framework Convention on Tobacco Control, the pandemic accord that Member States are now negotiating must be a historic agreement to make a paradigm shift in global health security, recognising that our fates are interwoven.
This is the moment for us to write a new chapter in global health history, together;
To chart a new path forward, together;
To make the world safer for our children and grandchildren, together.
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Excellencies,
In the three quarters of a century since WHO was founded, the world has seen major improvements in health.
Life expectancy globally has increased from 46 to 73 years, with the biggest gains in the poorest countries.
Forty-two countries have eliminated malaria, we have pushed back the epidemics of HIV and TB, driven polio and Guinea worm to the brink of eradication and expanded access to curative treatment for hepatitis C.
I would like to use this opportunity actually to thank President Carter for his leadership and commitment to eradicating Guinea worm, which is very close.
In the past 20 years alone, maternal mortality has fallen by a third and child mortality has halved.
In just the past five years, new vaccines for Ebola and malaria have been approved and are now saving lives.
Of course, WHO can’t claim sole credit for these successes—the very nature of what we do involves working with partners to support innovation and countries as they implement policies and programmes that drive change.
But it’s difficult to imagine the world would have seen the same improvements had WHO not existed.
The challenges of today are very different from those we faced in 1948.
Noncommunicable diseases now account for 70 percent of all deaths globally;
Tobacco still kills 8.7 million people every year;
Obesity rates have skyrocketed;
The COVID-19 pandemic highlighted the huge burden of mental health disorders and the weakness of health services;
Antimicrobial resistance threatens to unwind a century of medical progress;
Vast disparities persist in access to health services, between and within countries and communities;
And the existential threat of climate change is jeopardizing the very habitability of our planet. A climate crisis is a health crisis.
WHO also faces its own institutional challenges. Over the past 20 years the world’s expectations of WHO have grown enormously, but our resources have not.
Then there is the challenge of being a technical, scientific organization in a political—and increasingly politicized—environment.
These are daunting and complex challenges. We will not solve them at this World Health Assembly, and we may not solve them in our lifetimes.
But bit by bit, we are building a road that our children and grandchildren will walk down, and which they will continue to build.
Sometimes the building is slow. Sometimes the road is meandering and rough.
But the destination is sure, and is closer now than when our forebears began in 1948.
It is the destination envisioned by WHO’s first Director-General, Dr Brock Chisholm from Canada, one of the fathers of the WHO Constitution: the highest possible level of health for all people.
I thank you.
