The WFNS Neurosurgical Delegation at the World Health Assembly

The WFNS Neurosurgical Delegation at the World Health Assembly

Roxanna Garcia

The 76th World Health Assembly (WHA) – the decision-making body of the World Health Organization (WHO) – will meet in Geneva this coming May. The main functions of the WHA are to determine the priorities and policies of the WHO, supervise financial policies, and review and approve the proposed program budget. Neurosurgical advocates for global surgery/ neurosurgery gathered in May 2022 for the first time following the COVID-19 pandemic at the United Nations (UN) Headquarters. Since the 71st WHA, neurosurgical participation has been contributing to the global dialogues advocating for the neglected neurosurgical patients.1,2 Below we highlight some important highlights from prior years that have led to more global advocacy of the neurosurgical patient, particularly in low- and middle- income countries (LMICs).

Two new global initiatives on surgical patients in the most vulnerable member states were announced last year: the Global Surgery Foundation and the Global Action Plan for Brain Health.3,4 These initiatives continue the dialogue on improving care for the neurologic and surgical patient. Additionally, significant progress toward a neurosurgery-inspired resolution on mandatory folic acid fortification to prevent spina bifida-folate is underway.5 Spina bifida-folate (SB-f) is preventable 92% of the time with adequate amounts of folate in the woman’s body before conception. Globally, less than 80 countries have implemented mandatory flour fortification programs. These programs are estimated to have prevented 65,380 SB-f cases (23%, of all SB-f cases). A statement prepared with collaborators outside of neurosurgery (diplomats, bureaucrats, public health officials, nutritionists, and industry representatives) was presented to the WHO Executive Committee during the 75th WHA. Such statements can be made by non-state actors (NSAs) that have official relations with the WHO. A coalition of NSAs, including the World Federation for Neurosurgical Societies, World Federation of Societies of Anesthesiologists, the International Federation of Surgical Colleges, and the International
Federation of Obstetrics and Gynecology, supported the statement on behalf of the folic acid fortification initiative, read by a G4 Alliance Global fellow, Priyanka Mathur.

These activities garnered support from other international organizations and multiple member states to serve as cosponsors. Simultaneously, the Lancet Global Health released a major publication by Global Alliance for the Prevention of Spina Bifida Folate (GAPSBiF) supporting immediate, mandatory fortification with folic acid to prevent the development of spina bifida and anencephaly.6 This publication makes an urgent call to action for the WHA to pass a universal mandatory folic acid fortification resolution. The Ministry of Health of Colombia has supported this resolution at a national level and ongoing support from other UN member states continues, including Ethiopia.

The WHO-WFNS Neurosurgical Delegation will meet again in Geneva this May to continue to advocate for the neglected neurosurgical patient. Neurosurgeons worldwide are encouraged to participate and support efforts at the global level to minimize the incidence of preventable neurosurgical conditions and raise the standards of neurosurgical care regardless of location and resources. Ongoing efforts to support the most vulnerable populations are upcoming targets as the neurosurgical community continues global efforts to improve access to safe, timely, and affordable neurosurgical care.

1. Rosseau G, Johnson WD, Park KB, Arráez Sánchez M, Servadei F, Vaughan KA. Global
neurosurgery: current and potential impact of neurosurgeons at the World Health Organization
and the World Health Assembly. Executive summary of the World Federation of
Neurosurgical Societies-World Health Organization Liaison Committee at the 71st World
Health Assembly. Neurosurg Focus. 2018 Oct;45(4):E18.

2. Rosseau G, Johnson WD, Park KB, Hutchinson PJ, Lippa L, Andrews R, et al. Global
neurosurgery: continued momentum at the 72nd World Health Assembly. J Neurosurg. 2020
Jan 17;132(4):1256–60.

3. UNITAR. The Global Surgery Foundation [Internet]. [cited 2022 Aug 2]. Available

4. The Lancet Neurology. WHO launches its Global Action Plan for brain health. Lancet Neurol.
2022 Aug;21(8):671.

5. Estevez-Ordonez D, Davis MC, Hopson B, MSHA, Arynchyna A, Rocque BG, et al.
Reducing inequities in preventable neural tube defects: the critical and underutilized role of
neurosurgical advocacy for folate fortification. Neurosurg Focus. 2018 Oct;45(4):E20.

6. Kancherla V, Botto LD, Rowe LA, Shlobin NA, Caceres A, Arynchyna-Smith A, et al.
Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for
universal mandatory food fortification with folic acid. Lancet Glob Health. 2022
December 2023