General Assembly Pledges Improved Response to Global Health Challenges, Adopting Declarations on Pandemic Prevention, Universal Coverage, Fighting Tuberculosis
The General Assembly today committed to tackle several major global health challenges, adopting three declarations that laid out measures to better prepare for and respond to pandemics, give everyone access to health coverage and care for people suffering from tuberculosis.
Several delegates said the wide-ranging declarations — the outcome of a series of high-level meetings at UN Headquarters from 20‑22 September — disregard the effects of unilateral coercive measures on global health, while others expressed their disappointment that the language on sexual and reproductive rights was not stronger.
In the declaration on pandemic prevention, preparedness and response, the Assembly committed to scaling up efforts to strengthen regional and international cooperation at the highest political levels, and committed to work to make access to pandemic-related products — such as vaccines, diagnostics and therapeutics — timely, sustainable and equitable.
Through a declaration on universal health coverage, the 193‑member body pledged to bolster efforts to achieve the health-related Sustainable Development Goals and to expedite the achievement of universal health coverage by 2030. To do so, the Assembly resolved to address the global shortfall of 523 million people without access to quality health care, medicines and services, and to reverse the trend of rising catastrophic out-of-pocket health expenditure by 2030.
A third declaration, on tuberculosis, laid out commitments to increase international cooperation to advance research and innovation; to strengthen financial and social protections for people affected by the disease and to alleviate the health-related financial burden experienced by those affected and their families. The Assembly also promised to mobilize financing for tuberculosis research with an aim of reaching $5 billion a year by 2027.
More than 25 speakers today expressed their position before and after the adoption by consensus of today’s resolutions, through which they endorsed the political declarations. While hailing the declarations as a show of international solidarity to achieve the third Sustainable Development Goal on good health and well-being, many delegates said that while they joined the consensus, they also disagreed with several parts of the texts.
The representative of Cuba, speaking for the Group of 77 and China, said the take-it-or-leave-it attitude of the negotiations doesn’t reflect a spirit of multilateralism, describing it as unacceptable and discriminatory that language on tuberculosis was weakened to accommodate one delegation over the concerns of the largest group in the United Nations. The aspiration and concerns of developing countries should not be ignored, he said.
The United States’ delegate expressed regret that language on sexual and reproductive health rights was not strengthened — a point echoed by the speaker for the United Kingdom — and further expressed concern with references in that text relating to trade and technology transfer and terminology on equal pay for equal work.
The Syrian representative said some Western countries politicized the process and that the concerns of several delegations weren’t considered. “We cannot consider these declarations consensual if they leave a large part of our populations behind,” he said, and noted that because of unilateral coercive measures, many Syrian facilities are not operational and the provision of vaccinations and medicines has been hampered, especially after the earthquake.
The representative of Algeria said there were gaps between the views of countries in the North and the South and that the negotiations placed pressure on developing countries. He regretted that certain language on the role of the family was not included in the declaration on tuberculosis, and that the three adopted texts lacked language on the impact of unilateral coercive measures.
Nicaragua’s delegate said that less than a week ago the Assembly witnessed a similar situation: the proposals of the affected countries of the Global South were once again ignored. These three declarations are incomplete and exclude millions of people who are shut out from their right to development, he said, adding: How can those countries imposing unilateral coercive measures say they care about “leaving no one behind”.
The speaker for Belarus added that the World Health Organization (WHO) should play a stronger role in the global health infrastructure and consider the impact of these measures.
Also today, the Assembly adopted a resolution, recommended by its Fifth Committee, by which it agreed that the failure of Comoros, Sao Tome and Principe and Somalia to pay the full minimum amount of their budgetary assessments — necessary to avoid the application of Article 19 of the Charter — was due to conditions beyond their control. The Assembly decided to permit those three States to vote until the end of its seventy-eighth session.
Scale of assessments for Apportionment of United Nations Expenses
The General Assembly first took up the report of the Fifth Committee (Administrative & Budgetary) titled, “Scale of assessments for the apportionment of the expenses of the United Nations” (document A/78/383).
The representative of the Russian Federation disassociated himself from paragraphs 108, 113 and 122 of the report. In those paragraphs the war in Ukraine is mentioned as a factor in the abilities of the countries currently in arrears to pay their dues. The economic nature of the concerned countries appeared long before the special military operation in Ukraine, he said.
The Assembly then adopted without a vote the resolution titled “Scale of assessments for the apportionment of the expenses of the United Nations: requests under Article 19 of the Charter”, recommended by the Fifth Committee in its report.
By that text’s terms, the Assembly, reaffirming its role in accordance with the provisions of Article 19 and the advisory role of the Committee on Contributions in accordance with rule 160 of the Assembly’s rules of procedure, agreed that the failure of Comoros, Sao Tome and Principe and Somalia to pay the full minimum amount of their assessments necessary to avoid the application of Article 19 of the Charter was due to conditions beyond their control. It decided that those three Member States shall be permitted to vote in the Assembly until the end of its seventy‑eighth session.
Joint debate on Several Agenda Items
The Assembly then in a joint debate took up several agenda items, including “Integrated and coordinated implementation of and follow-up to the outcomes of the major United Nations conferences and summits in the economic, social and related fields”; “Follow-up to the outcome of the Millennium Summit”; “Strengthening of the United Nations system” and “United Nations reform: measures and proposals”.
Under the agenda item on “Integrated and coordinated implementation of and follow-up to the outcomes of the major United Nations conferences and summits in the economic, social and related fields”, the Assembly had before it a note by the Secretary-General (document A/78/258).
The Assembly then continued its consideration of agenda item entitled “Follow-up to the outcome of the Millennium Summit” to hold a specific meeting focused on development, in accordance with its resolution 60/265 of 30 June 2006.
There were no speakers on the above-mentioned agenda items.
Global Health and Foreign Policy
The Assembly then turned to its agenda item on “Global health and foreign policy”, taking up three draft resolutions: Political Declaration of the United Nations General Assembly High-Level Meeting on Pandemic Prevention, Preparedness and Response (document A/78/L.2); Political Declaration of the High-Level Meeting on Universal Health Coverage (document A/78/L.3) and the Political Declaration on the High-Level Meeting on the Fight Against Tuberculosis (document A/78/L.4).
In explanation of vote before the vote, the representative of Bolivia said these three resolutions disregard the effect of unilateral coercive measures on global health. Taking up these texts shows that the Assembly does not consider the impact of United Nations decisions on people’s daily lives. “The question of unilateral coercive measures cannot be swept under the carpet,” he said. There is a growing trend and ever-increasing expansion of so-called sanctions, which affect the targeted nations, the global economy and supply chains. The Assembly has learned nothing from the disruption caused by the COVID‑19 pandemic. There was an attempt to apply a type of veto on unilateral coercive measures during the discussions. “This is not a way to carry out intergovernmental relations in this Organization,” he said, adding that the text lacks critical elements. He called urgently for the immediate elimination of these measures.
The representative of Cuba, speaking on behalf of the Group of 77 and China, explained the position on the adoption of the document by saying the Group had showed great willingness to compromise but unfortunately had to break its silence twice due to the take-it-or-leave-it attitude of the negotiations which doesn’t reflect the spirit of multilateralism and cooperation. It is unacceptable and discriminatory that the co-facilitators decided to weaken the agreed language on tuberculosis to accommodate one single delegation and decided to ignore the concerns of the largest group in the United Nations. The aspiration and concerns of developing countries should not be ignored, he said, adding the Group wanted to put on record its dissatisfaction with the shortcomings of the negations and outcome of the 2023 political declaration on the fight against tuberculosis. This process was not conducted in a balanced and fair manner, he said.
The representative of Zimbabwe, associating himself with the Group of 77 and China and the Group of Friends in Defense of the Charter of the United Nations, said that unilateral coercive measures cause immense economic hardship and deprive vulnerable populations of critical medical care. These measures also undermine the abilities of countries and governments to respond to pandemics, achieve universal health care and make progress on sustainable development. The principle to “leave no one behind” will be relegated to history if people do not have a fair shot at sustainable development. “Unilateral coercive measures are meant to cripple targeted governments,” he said. Pandemics respect no boundaries. “No one is safe until everyone is safe,” he added.
The representative of Iran said the United Nations is based on the views and priorities of all Member States yet the fundamental positions of many delegations were disregarded in the negotiations of these resolutions. Language was altered for the benefit of a few and did not demonstrate neutrality, transparency and good faith, he said, adding that negotiations should be an inclusive and fair process. Unilateral coercive measures have a detrimental effect on innocent people, cutting off people’s access to medicines, vaccines and medical equipment. Such measures violate people’s social, economic and educational rights to development, which cause suffering and are inhumane. She stressed the need for countries to have national ownership.
The representative of Syria, aligning himself with the Group of 77 and China and the Group of Friends in Defense of the Charter of the United Nations, approved the high-level meeting on health, which he called timely, given the emerging challenges. However, some Western countries politicized the process and the concerns of several delegations weren’t considered, he said, adding that some demands were ignored. “We cannot consider these declarations consensual if they leave a large part of our populations behind,” he said. Many Syrian facilities are not operational because of unilateral coercive measures, preventing the provision of vaccinations and medicines, especially after the earthquake. Because of sanctions, Western companies cannot export the medical devices to treat children and a lack of electricity also affects the health sector, he said, adding that his delegation wanted to add language to one of the three political declarations but that unfortunately the facilitator did not take that into account.
The representative of Nicaragua, associating himself with the Group of 77 and China and the Group of Friends in Defense of the Charter of the United Nations, said that less than a week ago the Assembly witnessed a similar situation: the proposals of the affected countries of the Global South were once again ignored. These three declarations are incomplete and exclude millions of people who are shut out from their right to development. How can those countries imposing unilateral coercive measures say they care about “leaving no one behind”, he asked. Millions upon millions of people could not access critical medications during the COVID‑19 pandemic due to such measures. Everyone has a right to health, he stressed.
The representative of Belarus said universal health coverage is a foundation for the achievement of all the Sustainable Development Goals (SDGs) and all people’s need for a healthy life. Developing countries regret that these political declarations do not reflect the negative impact of sanctions on their countries. These measures create a lack of access to medicines and medical equipment necessary to treat illnesses, including tuberculosis — tools that are necessary to extend quality care to their people. He condemned the use of such measures and requested their removal. The World Health Organization (WHO) should play a stronger role in the global health infrastructure and consider the impact of these measures, he said.
The representative of China aligned himself with the Group of 77 and the Group of Friends in Defense of the Charter of the United Nations and joined the consensus in support of the adoption of the resolutions. COVID‑19 once again demonstrated the importance of strengthening global health measures, he said, adding that during the negotiation process, China and others tried to bring attention to the issue of universal coercive measures which are in contravention of international law and the purposes and principles of the Charter. Such measures severely undermine public health and have a serious negative impact on the populations in the countries sanctioned. He regretted that the outcome document did not reflect that concern and said that China will continue to work with like-minded countries to highlight the serious harm of such measures.
The representative of the Russian Federation said that he joined in on consensus on the texts, underscoring that they contain many important elements for humanity’s common future. During consultations, however, many Member States showed very clearly that they did not wish to be involved in attempts to politicize negotiations and serve the interests of the West. Some countries attempted to bring the issue of Ukraine into negotiations. He associated himself with the Group of Friends in Defense of the Charter of the United Nations and expressed disappointment that the documents were to be adopted without an appeal to remove unilateral coercive sanctions against millions of people. It is obvious that the development of countries is being blocked by unilateral coercive measures. He also expressed concern that the declaration on tuberculosis saw a whole paragraph removed. The language was important as it considered the vulnerable situation of children with tuberculosis.
The Assembly then adopted the three drafts resolutions — “L.2”, “L.3” and “L.4” without a vote.
In explanation of vote after the vote, the representative of Spain, speaking on behalf of the European Union, said she was delighted to approve the three political declarations and commended the co-facilitators that brought the Assembly together to reaffirm its commitment to improve global health. When it comes to pandemic preparedness, prevention and response, she underlined the power of collaboration to address global inequity and said the European Union is “walking the talk” by taking concrete action that makes everyone safer. In terms of universal health coverage, a top priority, she highlighted the importance of primary health care as well as sexual and reproductive health, and the centrality of an effective health care workforce. She wanted the record to reflect the bloc’s disassociation with two points: The paragraph continuing non-consensual references to the right to development and that the transfer of technology must be voluntary and on mutually agreed terms.
The representative of Australia, also speaking on behalf of Canada and New Zealand, said that the three declarations aim to ensure “our health systems are equitable” and better positioned to respond to a future global pandemic. All people must be able to access equitable health services consistent with their human rights. The COVID‑19 pandemic has had devastating health, economic and political effects on all Member States. Climate change is also impacting the delivery of health services. Non-communicable diseases are rising globally. He also expressed disappointment that stronger language on sexual and reproductive health was not included in the declarations.
The representative of Oman, speaking on behalf of the Gulf Cooperation Council, said his delegation appreciated the negotiations that led to the Political Declaration on pandemics. It shows how pandemics affect countries’ ability to move forward on economic development and recognizes the value of multilateralism in combatting pandemics. It helps the international community build on the lessons and best practices learned and recognizes the need to support developing countries and build their national and regional capacities, he said. It ensures their timely access to medical equipment and tools. The Declaration also commends the important role of health care workers in preventing pandemics. Turning to paragraph 52 of the text and its terms to sexual and reproductive health care services and rights, he said Oman will interpret this paragraph based on the traditions of its community and its national laws.
The representative of Namibia said the political declarations represent an opportunity for the international community to recommit to the prevention of, preparation for and more rapid responses to future pandemics. “Unfortunately, we have fallen short of the goal,” she said, adding that no consensus was reached on important language that speaks to ensuring equitable access to health care, technology transfer and the removal of intellectual property barriers as well as the investment in manufacturing to enable production in the Global South. She said that the promulgation of the punitiveness of unilateral coercive sanctions constitutes one of the greatest obstacles to the realization of the 2030 Agenda, emphasizing that what was adopted today was a minimum.
The representative of the United States said that promoting and protecting the human rights of all persons is fundamental, and that includes implementing laws and policies that eliminate stigma and marginalization. The voices of all persons must be included in building a more resilient world in the face of climate change and future pandemics. Preventing, preparing for and responding to future pandemics is key as is restoring essential health services to levels seen prior to the pandemic, and preferably before 2025. The world has been profoundly impacted by the COVID‑19 pandemic with nearly seven million lives lost. “We need to address the gaps exposed by COVID‑19 and prepare for the future,” she said. Turning to the declaration on tuberculosis, she expressed regret that language on sexual and reproductive health rights was not strengthened. She further expressed concern with references in the text relating to trade and technology transfer and terminology on equal pay for equal work.
The representative of South Africa said good health and access to health care is a human right. He reaffirmed the importance of health to the achievement of the SDGs and the promotion and protection of human rights. The Assembly’s three high-level meetings on health were important and showed the need to address health emergencies on a global basis. The pandemic showed that global health is unequal and developing countries need unhindered access to vaccines. It is regrettable that the three political declarations ignored the views of developing countries on the impact of unilateral coercive measures, she said, adding that a compromise could have been achieved.
The representative of Egypt welcomed the adoption of the three political declarations which reflect international solidarity in the effort to achieve the third SDG and said he remain committed to the international efforts to promote the right to universal health coverage and overcome the gaps created and exacerbated by COVID‑19 pandemic. Egypt’s national efforts in this regard will continue, he said. Developing countries were looking forward to seeing in the three political declarations a commitment to overcoming challenges and ensuring equal and unhindered access to medical tools, equipment and technologies, he said, adding he believed the adoption of the resolutions represents an international commitment to supporting developing States in the promotion of their national health systems.
The representative of Hungary said that pandemic prevention and response should be based on professional experience. “Saving lives cannot be a choice of politics or ideology,” he added. Welcoming the text’s “explicit reference” to the primary responsibility of all Governments to achieve goals set out in the declarations, he said that Hungary reserves the right to apply the provisions of the documents in line with its national laws. “We believe that national health care policies and priorities must remain a matter for Member States’ government to set and regulate,” he emphasized. No provisions of these declarations should be read as originating any newly recognized rights in this regard.
The representative of Guatemala said her country is committed to achieving universal health care coverage. Yet her delegation dissociates itself from paragraph 52 of the pandemic declaration and paragraph 62 of the health care coverage declaration as these portions contravene national legislation and Government policy to protect life and the family. Her Government protects the human rights of all its citizens. The country has reservations on the application of terms, conditions and provisions that explicitly or implicitly contradict its political Constitution and judicial order, she said. For Guatemala, the terms related to sexual and reproductive rights should not be interpreted to include abortion, she said, adding that there is no international consensus on the interpretation of reproductive rights.
The representative of the United Kingdom said that he was pleased about the adoption of the resolution, adding that his Government has committed 500 million pounds in support of global health. He welcomed the increased focus on scaling up investment in primary health care and combatting tuberculosis, and he highlighted the necessity of reforming the international financial system to release more finance for health systems and pandemic preparedness in developing countries, including through greater investment in the pandemic fund. However, domestic public resources must be the primary source for stronger health systems, he said. In terms of tuberculosis, he welcomed efforts to end the disease by 2030 but said he was frustrated that the declarations did not move the United Nations forward on the key issues of gender equality and sexual and reproductive health and rights.
The representative of Japan said that reaching consensus at the international level on how to deal with global challenges, including health, have become increasingly complex. “It is during these challenging moments that we should return to our core principle,” he added. “Leaving no one behind” is the guiding light that the international community must follow. Japan remains resolute to the concept of human security and will aim to redouble its efforts toward achieving the SDGs. The principles of dignity and solidarity must guide all Member States toward a future where all people can have access to quality health services, he added.
The representative of Argentina said his delegation supported the adoption of the pandemic declaration as it shows progress on global efforts to prepare and respond to pandemics. Equity and solidarity are guiding principles that enable the international community to prepare for other health emergencies. Argentina has worked with regional organizations to help expand middle‑ and low-income countries’ access to medicines, vaccines and medical technology. These are global public goods and the principle of transparency must be followed to contribute to universal access and the equitable distribution of these goods, he added. Funding to developing countries must be strengthened to build their capacity.
The representative of Indonesia applauded the consensual adoption of the three political declarations. He also commended the facilitators for their work during the negotiation process in navigating and leading the deliberations. For a country of more than 275 million people, spread across more than 70,000 islands, the three declarations play an important role in boosting the implementation of sustainable development in the health sector. While each of the three specific topics are important, the political declarations are also key, and interlinked one with another, he added, expressing his support for them at all levels, including within the United Nations environment.
The representative of Switzerland attached great importance to the political declarations as they symbolize an important step toward the shared vision of achieving the SDGs. “The declarations are not perfect,” she said, adding that nevertheless her delegation still supports the current consensus. She attached great importance to the overall objective of succeeding in formally adopting these declarations. “We regret that this objective was not achieved before the high-level week,” she stressed. Attempts to modify texts after they had been approved by Heads of States and Government are “very worrying”. She expressed concern over this process and urged Member States not to allow this situation to set a new precedent.
The representative of Algeria said that despite the consensus in the adoptions there were gaps between the views of countries in the North and the South. Health is very important to build sound societies and it is necessary for the international community to live up to its commitments and achieve universal health coverage. The negotiations placed pressure on developing countries, he said, calling for enhanced cooperation in all areas. He regretted that certain language on the role of the family was not included in the declaration on tuberculosis, and that the three adopted texts lacked language on the impact of unilateral coercive measures. He hoped the resolutions would form a basis for future negotiations so countries can enjoy high-level health care.
The representative of the Dominican Republic voiced her gratitude to the co-facilitators, Morocco and Israel, for their leadership and their unwavering commitment to the successful outcome of the four-month negotiations. Given the novelty of the themes for negotiation, there were many challenges, but the document largely reflects the interests of all members, she said, adding that it is imperative to highlight the challenges of this process, especially when it comes to agreement on language, and improved coordination in the future. She had hoped for a better balance being struck, especially in terms of priorities, but wholeheartedly supported the declarations. The texts provide recommendations to improve a holistic, cross-country approach that will strengthen health systems, she said.