Speech by the President of the Government of Spain, Pedro Sánchez, at the 79th World Health Assembly of the WHO

Palace of Nations, Geneva (Switzerland)

SPEECH BY THE PRESIDENT OF THE GOVERNMENT OF SPAIN, PEDRO SÁNCHEZ

Dear President, dear Director-General of the World Health Organisation, Excellencies, ladies and gentlemen.

Let me begin this address with a question: What is the first sign of civilisation?

It wasn't the wheel, it wasn't fire, it wasn't writing. Some say the answer lies in a bone. A human femur found in an excavation thousands of years ago had something particularly extraordinary about it-it had been broken and then healed.

That healed bone is the first trace of civilisation, because civilisation does not start with a tool. It starts with an outstretched hand.

And it is there, precisely there, that global health also begins. In the awareness that all of us, sooner or later, are that broken femur. In the conviction that caring for those who cannot care for themselves is not an act of charity, but the very essence of what makes us human beings.

Therefore, no society deserves to call itself civilised if it abandons its own when they fall That is why, in the face of those who today invoke "national priorities" to exclude, many of us understood a long time ago that the real priority of every country, of every State is to protect the health of its citizens, without exceptions or conditions. For those who divide society into first and second class citizens are not strengthening their country, but weakening it.

Forty years ago, when Spain began its transition to democracy, Spain opted for free, universal, public healthcare once democracy had been consolidated. Ultimately, making health a right is what transformed our country.

In barely a generation, infant mortality has plummeted, we have gained more than a decade in life expectancy, Spain now leads the EU in longevity along with countries such as Italy and Sweden, and for the first time in its history, we have exceeded 84 years of life expectancy.

Such progress never happens by inertia. It requires political will. It certainly requires financial resources. It requires a committed, demanding citizenry that does not allow backtracking. In short, an extraordinary citizenry that demonstrates humanity whenever it can.

For example, on 24 March, Spain broke the record for organ donation in 48 hours: 39 people - including 34 deceased people whose families gave their consent - saved the lives of 75 human beings. In just 48 hours.

Such is the country over which I am honoured to preside.

And the government over which I preside has a moral duty to live up to that civic spirit. That is why, in recent years, Excellencies, we have increased the health budget by 43%. In 2024, public health spending exceeded no less than 100 billion euros, or 6.4% of Spain's GDP. We have restored universal access to health care, regardless of the patient's background or financial situation.

And we have also expanded the portfolio of public services, in line with the recommendations made by this organisation, the World Health Organisation, with new neonatal screenings and improved oral health coverage for the over-65s.

In any case, I know that this is not enough because despite the strength of the system, it is also true that our health system faces a threat shared with many other countries and that is the pressure from those who want to turn health into a business.

Leaders who come to power divert millions of euros of public money to large private companies, consequently weakening the common good to enrich a select few

Those who turn health into a privilege and subordinate it to the dictates of money break the most basic social contract of any democratic system, and the consequences of this model are simply devastating: in 2022 alone, 1.6 billion people-I repeat, 1.6 billion people-faced financial ruin trying to meet healthcare cost. 1.6 billion people, and a quarter of the world's population faced financial hardship for their healthcare costs. One in four people in the world, forced to choose between healing and eating.

And this is happening at a time of enormous global challenges. We live in a world where misinformation erodes trust in science and thus puts many lives at risk. An increasingly ageing world with care needs. A deeply interconnected world, where a health threat, as we are seeing again today with Ebola, anywhere in the world can become a global crisis in a matter of days.

And a world that has yet to fulfil the fundamental commitments of the 2030 Agenda: guaranteeing healthy lives, reducing inequalities, ensuring scientific and health progress that reaches all people, wherever they live.

I believe that the COVID-19 pandemic taught us a lesson that is impossible to ignore and certainly impossible to forget, and that is that we cannot protect health within our borders if we are not able to protect it outside our borders as well. Because, evidently, viruses do not understand borders, flags or passports.

Therefore, no country is safe alone, no country is safe alone, and protecting others is the best way to protect our own societies.

We experienced it 12 years ago with Ebola, unfortunately we are experiencing it again. We experienced it a few years ago, six years ago, with much greater severity during the COVID-19 pandemic. And that same fear, on a smaller scale, resurfaced just a few days ago with the hantavirus outbreak on the MV Hondius ship.

Therefore, investing in global health is investing in security for our countries and our fellow citizens, but I would also like to say that it is not only a matter of security, it is a matter of justice because, clearly, neither you nor I want to live in a world where twelve people-twelve people-hold more wealth than half the world's population, while a mother doesn't know if she will be able to feed her children.

I, like all of you, am convinced that we do not want to live on a planet where, for millions of women, giving birth means more fear than hope.

To accept such a thing is to assume that the lives of millions of people are worth less simply because of where they were born, and therefore I am convinced that no one here is willing to accept it, and I believe that no one should.

Because this situation is simply not inevitable. It is not a historical inevitability. It is the result of political decisions. Political decisions taken by a few, and blessed, unfortunately, by the silence of many.

In the last two years alone, to give us an idea of the scale, of the magnitude of the crisis that the multilateral system is suffering, international funding for global health has been reduced by around 30%. In the last two years, 30%.

And the consequences are already here.

Reduction in infant mortality stagnates for the first time in decades. Measles, a disease we thought was under control, is spreading again. And if we don't act, 14 million people could die before 2030 from preventable causes, including 4.5 million children under the age of five.

Fourteen million lives. Not because we don't know how to save them, which we do, but because some have decided not to.

The greatest risk to global health is no longer a lack of science, but a lack of conscience.

In just a few months, the same country that has cut some $18 billion in global health and development aid has spent more than $29 billion on a war whose humanitarian and geopolitical consequences will also be devastating.

And, faced with this situation, the position of Spain, of my government, is limited to defending common sense, excellencies.

Because it is common sense that, in the face of those who have decided that some should live and others die according to the postcode in which they were born, we defend peace.

Common sense, therefore, in the face of war.

Common sense in the face of those who impose unilateralism over multilateralism when the easy thing to do would be to back down.

And common sense by placing global health not at the periphery of our external action, but at its very heart.

The problem is that, in these times, Your Excellencies, defending common sense has become a form of rebellion, because there is a pandemic that no one wants to stop: the pandemic of selfishness. That is the pandemic that is really affecting our societies and that too is contagious.

That is why, when some withdraw, my country has decided to step forward. Since I have had the honour of presiding over the Government of Spain, Excellencies, we have doubled our official development assistance.

Last year alone, while many other countries were cutting official development assistance, we have increased it by 13% and committed 315 million euros to the global health system for the period 2025-2027, with contributions to GAVI, to the Global Fund and, of course, also to the World Health Organisation.

I know that this is not enough to fill the gap left by others. I know, but I am also certain that our example will be followed by many others sooner rather than later.

Because the drive to strengthen global health can only be collective and must rest on at least three fundamental pillars that I would like to share with all of you.

The first: we need to invest in global capacities to respond to future health crises.

We have been working for years to bring the Pandemics Treaty forward. The agreement reached in 2025 was, I believe, a great achievement. We must now give it a definite boost. Let's do it.

We must also strengthen regional drug production chains, increase rapid response capacities, ensure that never again will access to vaccines, as was the case during COVID-19, depend on the economic power or place of birth of our societies.

The second pillar is to reform the global health financing architecture.

We need more resources, certainly, but also new mechanisms to mobilise them and a much fairer overall taxation.

3.4 billion people live in countries that spend more money on debt interest payments than on financing the health or education of their people.

This is simply unacceptable.

No international system can call itself fair when it forces a choice between paying creditors or health professionals who defend the health of their fellow citizens, between saving lives or saving the bottom line.

We must therefore strengthen debt relief and debt swap mechanisms and prevent millions of people from continuing to pay the consequences of a deeply unequal system.

And the third pillar is to democratise global health governance and make it more effective and more efficient.

The countries of the global south must have their rightful role in international decision-making. We must also improve coordination and reduce the still excessive fragmentation of this multilateral system. And we must put the strengthening of national health systems at the centre, because there will be no global health security as long as millions of people depend on fragile or under-funded health systems.

Therefore, let us never forget the greatest lesson of the COVID 19 pandemic: there can be no national security in a world that is not secure in terms of health. Anyone who has not yet understood this, after an episode like the one we experienced in 2020, is either ignorant or foolish.

Let us therefore show that we have learned our lesson now that the World Health Organisation has declared the Ebola outbreak in the Democratic Republic of Congo and also in Uganda to be an international public health emergency.

Excellencies, I conclude. As you know, and this is why I have also had the opportunity to address you from this podium, at the invitation of the Director-General, my friend Tedros, as you all know, just a few days ago, almost 150 people were trapped on a ship due to a hantavirus outbreak. 150 people with fear, with great fear, with uncertainty, with families waiting for news of them.

And in my country there were those who questioned whether we should help these people or abandon them to their fate. And when we got the call from the World Health Organisation asking for our help, we certainly didn't hesitate.

The question of whether to help them or abandon them may seem a minor issue after the decision to help them has already been made. But this question contains one of the most important dilemmas of our time and one with which I would like to conclude this speech.

Because there are still those who believe that international law is like an à la carte menu, that obligations are therefore optional, that solidarity depends on convenience. And Spain answered that call. And that decision made it possible to evacuate more than 120 people, detect cases early and treat them before it was too late.

But there was a second, at least equally important consequence that I would like to share with all of you: that when one country acts responsibly, others respond in kind. It's a kind of contagion of solidarity.

The WHO, the World Health Organisation, the European Community institutions, the countries that had compatriots on that ship, together we worked with loyalty and commitment to make this operation a success.

Ultimately, what I mean by this is that when international law is respected, we all win.

Spain, your excellences, is a middle power. We cannot compensate for the huge cuts in the international health system by ourselves. But we can do something, and that is, together with many other countries, to take a step forward.

A few months ago, at the Seville Conference on Development, we launched the Platform for Action on Global Health, an initiative created to mobilise the political will, economic resources and alliances necessary to confront the setbacks that threaten global health today.

And, why not, to imagine and build together that system of global health governance that is more effective and more equitable than the more than 8 billion citizens of our planet are demanding.

Today, therefore, Your Excellencies, I am here in Geneva as President of the Government of Spain, the first President of the Government of Spain to address this World Health Assembly to tell you that we are ready to join you and that we also ask you to join us.

Because global health reform can be carried out by those who cut funding or by those of us who defend a multilateral order based on mutual trust and global public health systems; by those who believe in imposition or by those of us who believe, as I am convinced is the case for most of our societies and, of course, most nations, in shared leadership; by those who build walls or by those who understand that no one is saved alone.

That, I believe, is the decision before us. Because international leadership is not just about having more power. True international leadership begins when one country decides to act, even if others stand back. And it is about being able to weave alliances in which we are stronger together.

History, Excellencies, will judge all of us present here. And it will say whether we were able to care for life when we knew how to do so, and whether we did so with the same conviction anywhere in the world. Even where war puts it at risk every day.

And we can only respond with our heads held high if we understand something very simple: either we fight together or we will fall separately.

That is all, thank you very much.

(Transcript edited by the State Secretariat for Communication)