Reflecting on WHA78: Progress, gaps, and the path forward for antibiotic resistance and global health governance

2025-05-28

The 78th World Health Assembly (WHA78), held in Geneva in May 2025, marked a special moment in global health diplomacy. As the world grapples to prepare for and address overlapping crises—pandemics, climate change, and the health impacts of protracted conflicts—this year’s assembly presented both reasons for hope and critical areas requiring sustained attention and action.

A historic pandemic agreement – but how enforceable?

After more than three years of negotiations, countries around the world adopted a long-awaited global pandemic agreement on May 20, 2025. With 124 countries voting in favor and none against, the consensus marked what WHO Director-General Dr. Tedros Adhanom Ghebreyesus called a “truly historic moment.”

Importantly, the agreement includes recognition of AMR under Chapter II, Article 4 (Pandemic Prevention and Surveillance). This means that AMR is now recognised as a growing threat within this framework, and that Member States commit to addressing it through surveillance and facilitating affordable and equitable access to antimicrobials, as well as their responsible use across sectors.

Yet, key questions remain about the legal enforceability of the agreement. It still remains unclear which mechanisms can ensure accountability and timely implementation by member states? These ambiguities may challenge the agreement’s transformative potential.

WHO budget: A changing funding landscape

WHA78 approved WHO’s base program budget of US$ 4.2 billion for 2026–2027 — a 22% decrease from the initial US$ 5.3 billion proposed in February. This reflects ongoing challenges in global health financing, particularly amid shifting geopolitical dynamics.

China emerged as the top voluntary contributor with a US$ 520 million pledge — more than double the U.S. assessed contribution. China also sent the largest WHA delegation on record (180+ delegates), showcasing its growing influence. Meanwhile, the U.S. had no registered delegation despite its WHO withdrawal only becoming effective in January 2026.

Additionally, the Novo Nordisk Foundation climbed in the top pledgers’ ranking. Given that the Foundation owns the pharmaceutical company Novo Nordisk, the manufacturer of Ozempic, through its holding company, Novo Holdings A/S, its growing financial support for the WHO does raise questions about the role of private actors in global health governance and institutions.

While the full implications of the WHO budget cuts remain to be fully analyzed, its a concern if reduced funding would disproportionately impact low- and middle-income countries, where gaps in infrastructure and implementation of actions to address antibiotic resistance are already most acute.

Independent Panel on Evidence for Action on AMR

Following last year’s UN Political Declaration on AMR, the Quadripartite (WHO, FAO, WOAH, UNEP) has been tasked with establishing an Independent Panel on Evidence for Action on AMR by the end of 2025. This is an important mechanism to ensure that global policy is evidence-informed and truly global.

To be effective and legitimate, it should be inclusive, context-sensitive, and independent — with equitable representation from low- and middle-income countries. Evidence should be actionable and accessible with communication strategies that resonate with policymakers and the public alike. Its success will depend on impact, not just intent.

AMR in the upcoming NCD Political Declaration

A Zero Draft of the upcoming UN High-Level Meeting (HLM) on Noncommunicable Diseases (NCDs), set for September 2025, includes an AMR reference:
“Recognize the threat of antimicrobial resistance, especially in the treatment of noncommunicable diseases such as cancer…”

While this is a welcome acknowledgment of the AMR-NCD nexus, the language remains vague and lacks concrete commitments. Civil society now has an important opportunity to strengthen the draft by calling for clear actions — including ensuring equitable access to antibiotics for cancer patients, especially in low- and middle-income countries, and aligning the declaration with existing AMR targets from the 2024 UN HLM. Let’s not forget: the 2024 political Declaration calls for all countries to have multi-sectoral national action plans with measurable targets in place by 2030, and for the Global Action Plan on AMR to be updated by 2026.

Highlight: FIP Side Event – ReAct at the forefront

As part of WHA78, ReAct’s Andrea Caputo Svensson was honored to serve as keynote speaker at a side event hosted by the International Pharmaceutical Federation (FIP) and the International Federation of Red Cross and Red Crescent Societies. The keynote had the theme “Addressing Antimicrobial Resistance Through Policy, Stewardship, and the One Health Approach”, offered reflections from ReAct’s 20 years of global engagement.

Key messages included:

Antibiotic resistance is still a major global health crisis. In 2021, 1.4 million deaths were attributable to antibiotic resistance. If left unchecked, it may reduce global life expectancy by 1.8 years by 2035. The financial cost is immense — US$ 66 billion per year in direct health expenditures and more than US$ 1 trillion in annual GDP shortfalls post-2023.

Insufficient sustainable financing for antibiotic resistance. While recent UN declarations mark important milestones, the momentum has not translated into sufficient, sustainable funding. Implementation lags behind political commitments, and the resources needed to operationalize national action plans — especially in low- and middle-income countries — remain scarce. This chronic underfunding undermines the potential for meaningful action and leaves civil society, communities, and front-line responders struggling to engage effectively. Turning words into action means that financing should be prioritized and made more predictable across all levels.

Community voices matter. More than 800 stakeholders signed on to the “From People to Leaders: Act on AMR NOW!” campaign, in the lead up to the 2024 UN HLM on AMR, demonstrating how inclusive community engagement—particularly in fragile and crisis-affected settings — is critical to progress. One example is Ukraine, where ReAct is supporting the implementation of the 2024 One Health AMR National Action Plan in collaboration with Sweden and Uppsala University.

Stewardship is critical. The inappropriate use of antibiotics accelerates resistance. Without stewardship, even new antibiotics won’t last long. Pharmacists play a key role in optimizing antibiotic use through patient education and prescribing oversight. ReAct is working on stewardship initiatives in Kenya (ASPIRE )– with plans to expand to Zambia – and in India.

Sustainable antibiotic manufacturing. From sustainable antibiotic manufacturing to cross-sectoral regulations, AMR must be addressed across human, animal, and environmental health. This includes addressing fragmented regulations, improving wastewater treatment, and ensuring transparency in pharmaceutical supply chains.

Promising momentum

The 78th World Health Assembly marked both progress and uncertainty. The adoption of the pandemic agreement and the momentum it provides for global collective action is welcome, yet concerns remain — especially around funding cuts, power imbalances, and unclear enforceability and accountability.

Addressing antibiotic resistance demands urgent, inclusive, and well-funded action across sectors. As the global health landscape shifts, there is a growing need to ensure that important voices and perspectives are not sidelined in decision-making. Without inclusive governance and sustained investment, progress will remain uneven. We must act now to protect effective antibiotics, particularly for the most vulnerable populations.