For the first time in history, the World Health Assembly was held as a virtual meeting, in response to the COVID-19 pandemic. The main item on the agenda was the passage of a resolution on the global response to the virus.
Concerted advocacy by civil society organisations, and notably by palliative care advocates in Bangladesh and Zambia, meant that palliative care was included in the resolution, despite having been left out of the original draft. The resolution now reads: “OP7.7: Provide access to safe testing, treatment, and palliative care for COVID-19.”
The Worldwide Hospice Palliative Care Alliance (WHPCA) submitted a written statement, noting that palliative care is a vital part of the COVID-19 response by alleviating suffering for people of all ages. The statement reminded delegates that palliative care is an essential part of Universal Health Coverage and that lack of access results in serious health-related suffering.
The WHPCA called for member states to:
- Mainstream palliative care to alleviate suffering now; and build health systems back better.
- Ensure people with palliative care needs are not left behind.
- Support, resource and protect communities to provide compassionate care.
A statement by the International Association for Hospice and Palliative Care noted that 40 million people annually need palliative care, 78% of them in low- and middle-income countries, that worldwide, only about 14% of people who need palliative care currently receive it and that COVID-19 is multiplying those numbers exponentially.
The IAHPC commented on the need for all health systems to:
- Train, equip, and support health care workers to deliver basic palliative care in all settings, including refugee camps, nursing homes, prisons, at home, and in hospitals; and
- Strengthen pharmaceutical supply chains to ensure adequate access to the palliative care medications on the WHO Model List, including immediate release morphine, crucial for managing Acute Respiratory Distress Syndrome (ARDS) and the pain and breathlessness of patients with palliative care needs pre-COVID
The WHO Civil Society Working Group on NCDs released a statement ahead of the meeting, noting that the COVID-19 pandemic has demonstrated the need for more resilient health systems. The statement quotes research showing that people living with NCDs and other chronic conditions are at higher risk of severe illness or death from the virus.
The statement calls on member states to ensure: “The continued delivery of routine chronic care, supplies of essential medicines and technologies, screening and diagnosis, access to resources, and supportive and palliative services for ongoing management of NCDs, mental health, and other chronic conditions.”
WHO staff live streamed the session from WHO headquarters in Geneva, and heads of national delegations gave their interventions via remote audio.
This virtual set up, and a condensed meeting agenda, led to concerns that the voice of civil society was excluded from the meeting.
Civil society organisations were invited to register for the event, and submit written statements, however they were not invited to participate. Thus delegations were registered from both WHPCA and IAHPC, with the Chief Executive of ICPCN being part of the WHPCA delegation. However, there was no allowance for interaction with the delegates, or for verbal interventions by civil society.
Although six civil society organisations, including Help Age international, Alzheimer’s Disease International and UICC, called for palliative care access in their written statements, not one of the member states raised this important issue. Without civil society to raise this issue, people with palliative care needs were left behind.
Prof Julia Downing, Chief Executive of the International Children’s Palliative Care Network (ICPCN), said: “COVID-19 has highlighted the critical importance of the provision of palliative care to those with serious illness throughout the health system and across all ages. It is essential that individuals with COVID-19 can access the palliative care that they need.”