Roadmap and process leading up to the World Health Assembly

News item | 06-05-2025 | 11:35

At the WHA, countries adopt resolutions—formal decisions that establish priorities, provide guidance, and articulate the collective will of Member States. While these resolutions are not legally binding, they wield significant political and moral authority in shaping global health policy and advancing international cooperation.

Most resolutions achieve adoption by consensus, which means all countries endorse the text. This approach ensures broad support and maintains unity within the WHO. However, it is increasingly common for sensitive or contentious issues to be resolved by vote, a practice that has historically been avoided in multilateral settings. Voting can polarize nations and compromise the collective integrity of the WHO.

For binding agreements, such as the new Pandemic Agreement or amendments to the International Health Regulations (IHR), the WHA adopts the text, but it is imperative that countries ratify or formally accept these agreements through their national legal processes for them to become legally binding. Each nation must follow its domestic legal procedures to ratify or accept these agreements before they come into effect nationally.

In summary:

• Resolutions = political guidance
• Agreements = legal obligations after national ratification

This distinction is crucial for understanding what unfolds during and after the WHA—and underscores why the positions of influential countries like the United States are of paramount importance this year.

Decision-Making within the WHA

Decision-making within the World Health Organization (WHO) and the broader United Nations framework must be based on consensus, embodying the Spirit of Vienna. This principle ensures that all 194 Member States unite around a decision.

Consensus is non-negotiable in multilateral UN organizations. It cultivates broad international support for agreements, fosters shared responsibility and cooperation, and minimizes political tensions. This focus enables the WHO to concentrate on common global interests such as health, security, and human rights.

Voting within the UN is unusual

As mentioned before, voting at these type of international fora is unusual. Although voting is common practice in national parliaments and other bodies, within the UN and WHO it often has a polarizing effect. In recent years, the number of votes within the WHO and the UN has increased, particularly on sensitive issues such as the situation in Palestine and Ukraine, human rights issues, sanctions and pandemic-related agreements.

Voting in these settings carries certain risks:

• It undermines cooperation and support, especially when major countries vote against or abstain. This is because geopolitical considerations often come into play, with smaller countries feeling pressure to align with larger nations. Some may vote in line with major powers out of fear of political or economic repercussions at the international level, which can further polarize the negotiation process.
• It increases the likelihood that countries will not feel bound by the agreements. When decisions are made through voting, especially on sensitive or contentious issues, countries may feel less committed to the outcome. If a country votes against or abstains, it might not consider itself morally or politically bound by the resulting agreement. This is especially true for countries that feel the decision doesn't align with their national interests. As a result, the agreement risks becoming less effective, as countries might not fully implement or support it.
• It politicizes organizations that are meant to act as neutral, unifying platforms. International organizations like the WHO are intended to be neutral and serve as forums for cooperation on global issues, free from political influence or conflict. When resolutions are put to a vote, it introduces political divisions — especially when powerful countries push their agendas. This can transform a neutral platform into a space where geopolitical interests and power struggles influence decisions, rather than focusing purely on health or humanitarian issues. This undermines the organization's ability to unite countries for common global health goals.

The process leading up to the WHA from the Ministry’s perspective

1. Policy preparation

• Before the WHA, draft resolutions are distributed and reviewed by the various policy teams.
• Through interdepartmental coordination, the Dutch position is determined — for example, on public health, international cooperation, pandemic preparedness, and human rights.

2. Coordination with other Countries

• Through the Health Attachés in permanent missions in Geneva and Brussels positions are coordinated, also aiming to establish a single EU position.
• Bilateral contacts and coordination with like-minded countries outside the EU also take place.

3. Preparatory sessions

• The Spring Health Assembly (PBAC) and the INB negotiations set the stage for the WHA.
• Internally, delegation instructions are drawn up and discussed — including with, for example, the Youth Delegate and civil society organizations.

4. Participation in the WHA

• During the WHA, the Netherlands participates in plenary sessions, committees, side events and negotiations.
• The delegation consists of representatives from the Ministry of Health and Foreign Affairs, the Permanent Representation in Geneva, and the Youth Delegate.

5. After the WHA

• Resolutions and decisions, if ratified nationally, are translated into national policy and international coordination.
• Accountability is provided to the House of Representatives (Tweede Kamer) and civil society partners.
• The lessons and outcomes from the WHA are incorporated into the preparations for upcoming negotiation rounds and international conferences.

This year’s WHA is particularly significant

This year is unique because it marks the conclusion of negotiations on the Pandemic Agreement and the revision of the International Health Regulations (IHR). Both processes are being conducted through a dedicated negotiation track known as the Intergovernmental Negotiating Body (INB). These negotiations are highly significant, as they will determine how countries can better prepare for future pandemics and how international cooperation is structured in this area. While the 78th  WHA in 2025 is expected to be the decisive moment for adopting these agreements, important decisions and preparations nationally have already taken place this year.

Additional sensitiveness

This year, there is heightened sensitivity around the Pandemic Agreement and the revision of the International Health Regulations (IHR). The position of the United States in this is crucial, especially since the Trump administration has withdrawn funding and removed many experts from the WHO. The withdrawal has caused several major challenges. While the US still holds influence within the WHO, because it remains a member, its lack of financial and technical contributions has weakened its engagement and raised concerns about the effectiveness of international health cooperation.

There is uncertainty about whether the US will (actively) participate in the WHA. If they do, there is potential for them to request voting on resolutions, a process that could polarize discussions and complicate consensus-building due to the US's significant influence.

Additionally, the US's withdrawal has created wider problems, among which undermining global solidarity, delaying progress on global health priorities, and creating gaps in pandemic preparedness efforts.

The US’s actions — whether or not they return to active participation in the WHA — will have a critical impact on the unity and effectiveness of global health agreements during this year’s negotiations.