World Health Organization member states gather for their annual meeting in Geneva Monday amid concern over deadly hantavirus and Ebola outbreaks and uncertainty over announced US and Argentinian withdrawals.
While the rare hantavirus outbreak on a cruise ship that has gripped global attention is not officially on the agenda, it is expected to feature prominently in the discussions, as is the fresh Ebola outbreak in the Democratic Republic of Congo.
A diplomatic source, who asked not to be identified, said it would be interesting to see how such outbreaks are used by WHO "to promote other things", including "to pressure (the United States and Argentina) not to go".
The meeting of the WHO's annual decision-making assembly, which runs through Saturday, comes after a difficult year for the organisation. It has been weakened by the announced US withdrawal and by funding cuts that have forced it to slash its budget and staff numbers.
"We are stable now and moving forward," WHO chief Tedros Adhanom Ghebreyesus insisted at the end of April.
Diplomats and observers agreed.
The situation is "still fragile, but they've been successful in mobilising most of the funds" required for the next two years, Surie Moon, co-director of the Global Health Centre at the Geneva Graduate Institute, told AFP.
And the hantavirus crisis provided "a clear illustration of why the world needs an effective, trusted, impartial, reliably-funded WHO", she added.
But significant divisions persist.
Continued disagreement between wealthy and developing nations has for instance blocked progress on the key missing piece of the WHO's landmark 2025 pandemic treaty, with negotiations now expected to be extended for another year.
It also remains unclear what, if anything, would be decided on the US and Argentinian announced withdrawals.
US President Donald Trump, on his first day back in office in January 2025, handed the WHO his country's one-year withdrawal notice, with Argentina soon following suit.
The WHO, whose constitution does not include a withdrawal clause, has not confirmed either withdrawal.
The United States reserved the right to withdraw when it joined the WHO in 1948 -- on condition of giving one year's notice and meeting its financial obligations in full for that fiscal year.
While the notice period has expired, Washington has still not paid its 2024 or 2025 dues, owing around $260 million.
When WHO's executive board met in January, Israel submitted a resolution to approve Argentina's withdrawal -- something countries are expected to discuss during the assembly -- but not a word was said about the US leaving.
Diplomats and observers indicated there was broad agreement that it would be better to maintain a grey zone around whether the US was effectively out.
"We hope that it will go past quietly on the US," a European diplomat said on condition of anonymity.
The assembly will take place as the process towards next year's election of a new WHO chief heats up.
No one has yet declared their candidacy, but announcements are possible this week ahead of the nomination deadline of September 24.
A number of sensitive resolutions are also on the table, including on Ukraine, the Palestinian territories and Iran, which could spark heated debate.
Much of this week's discussions will centre on whether to launch a formal reform process for the so-called "global health architecture" -- a mishmash of organisations that do not always work together and often overlap.
"Among the issues to be explored are what is best done at the global and regional levels... and what is a national responsibility?" Helen Clark, co-chair of The Independent Panel for Pandemic Preparedness and Response and a former New Zealand prime minister, told AFP.
Canadian Health Minister Marjorie Michel told AFP that "this current crisis, with the departure of key players, also allows ... the WHO to re-examine its strategy with its members".
A key focus will be to ensure the process does not see "controversial" issues, such as climate and sexual and reproductive health rights, sacrificed in the context of dwindling international aid funding.
"The objective is to ensure better coordination among health actors, so that no activities or populations are left behind," said a diplomatic source, who asked not to be named.
But Thiru Balasubramaniam of the Knowledge Ecology International NGO, told AFP the WHO had already "scaled down some of their activities, including in terms of sexual and reproductive health".
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