The World Health Assembly, the governing body of the World Health Organization (WHO) is meeting this week in Geneva for the 69^th time, with a thematic focus on the Sustainable Development Goals and the 2030 agenda. Over 3500 delegates from WHO’s 194 member countries are there. In addition to a large proportion of the world’s ministers of health, many representatives from other agencies, foundation and non-state actors are attending – even Jamie Oliver is in Geneva this year, helping to draw attention to how unhealthy diets are driving a global epidemic of obesity among children.

The battle for accreditation

I decided to go too, to conduct participant observation for my ethnographic research into civil society engagement in global health governance. As a researcher without ties to an official delegation, I headed to the WHO’s headquarters on Monday morning, where, I had heard, it was possibly to apply for accreditation as a public observer. I met a queue of disappointed people who had just been told that the last of 68 dedicated public passes had just been distributed.  A Frenchman wearing a cannabis leaf-patterned baseball cap who had come to lobby for more “humane” drug policy quipped that it would have been decent to extend this number to 69, in keeping with this being the 69^th World Health Assembly. The guard pointed to a lack of space, even though the assembly is held in the UN’s European headquarters, reportedly the second largest building complex in Europe after Versailles. On twitter, a journalist asked why it was so difficult for journalists to get press accreditation to the WHA69, and reported that a WHO official had told him that it was because the WHO didn’t want to hear what they have to say. That day I had to settle for watching the proceedings from an overflow room in the WHO building.  But the following morning, like a die-hard fan preparing to camp out for tickets to hear my favorite band play, I made my way back to the WHO HQ, arriving before seven. Half an hour later, I had filled out the required paperwork, showed my passport and was handed an entry badge, along with a written warning in six languages specifying that advocacy materials and megaphones should not be brought into the Assembly Hall.

Into the marble palace

I felt awestruck when I, following an airport-style security check, was permitted into the magnificent marble building that is the Palais des Nations, surrounded by idyllic parkland with an amazing view of Lake Geneva and the Alps. Along with the other “public” observers – researchers like me, activists without formal NGO accreditation and industry lobby groups – I was directed to a public gallery on the 6^th floor, with an immense view of the delegates far below in the Assembly Hall, seated in tidy rows arranged alphabetically by country names. Everything being said was relayed through earphones, with a choice of simultaneous translation in any of the six official UN languages. There was spontaneous applause when the Director General made her addresses, but on the whole I was surprised by how formal the proceedings were. Delegates wishing to speak followed a strict protocol, and read pre-submitted written statements, while a traffic light system signaled when their five minutes were up. All delegates formally addressed the Assembly’s president and commended the WHO for its work. While some country delegates emphasized their country’s achievements, others emphasized WHO’s responsibility for helping member states strengthen their health systems to deal with health emergencies and emerging threats like antimicrobial resistance. Others still talked about the importance of health workers, or the imperative to approach health and sustainable development as indivisible goals.

Committee meetings are held in parallel to the plenary to address the specific agenda items, including questions of an administrative and operational manner, including the importance of achieving more flexible core funding for the WHO’s budget. I had been particularly interested to follow the discussion on the proposed Framework for engagement with non-state actors (FENSA), but was disappointed when it was struck from Tuesday’s agenda after it was decided that a drafting group should meet to deliberate on the final framework for how the WHO should manage its relationship with actors from civil society, academia, foundations and private sectors to avoid conflict of interest and undue influence. Unfortunately, the drafting group’s deliberations were not open to the public.

WHO – no longer the undisputed king of global health

Anyone can follow the World Health Assembly online and on twitter (#WHA69) and other social media, a result of the WHO’s commitment to transparency, so I asked myself whether it was worth making the trip to Geneva. The answer is, without a doubt, yes, because what you don’t get through a live stream or social media is the reverent and excited atmosphere, and, not least, the many discussions that take place outside of the formal meetings, in multiple side events inside and outside the UN complex, but also in the hallways and in the coffee shop. Although civil society actors in “official relations” with the WHO can submit statements to the Assembly, it is in these informal settings that the hard work done in preparation for the meeting is put into life, as networks are forged and positions negotiated. I was intrigued to learn, for instance, about how one activist network works strategically to help country delegations from the poorest countries analyze draft resolutions and draft statements to advance their own interests. Civil society influence within the WHO is growing, suggested one activist I spoke with, but he also pointed out that this influence is restricted to an organization that has itself lost much of its influence within today’s global health governance structure dominated by donors, partnerships and multi-stakeholder consultations. If I really want to understand who has the power to set the global health agenda, my next fieldwork trip will have to go to Washington D.C and Seattle, I guess.