By Kaitlin Mara
Progress made on the World Health Organization strategy on public health and innovation was highlighted to WHO members on Saturday, including the production of a key budgeting document detailing timeframes and estimated costs of implementing the strategy.

The Global Strategy and Plan of Action on Health, Innovation and Intellectual Property was discussed in the context of the WHO Executive Board, which met from 19 to 26 January.

The document on proposed timeframes and estimated funding needs [pdf] was released midway through the board meeting. It estimates that approximately US$149 billion in spending is needed between 2008 and 2015 to fully undertake the implementation process (IPW, WHO, 22 January 2009).

When the global strategy and plan of action document [pdf] was adopted at the May 2008 World Health Assembly, two “urgent” requests were made within its text. These were to finalise the plan of action for implementing the global strategy, and to establish a “results-oriented and time-limited expert working group” to examine new and innovative financing mechanisms for stimulating research and development on neglected diseases. The working group is seen by many member states as a key outcome of the negotiating process that led to the global strategy.

The plan of action was meant to be finalised by this Executive Board (EB) meeting, and a report on progress was hoped for from the expert working group.

Plan of Action

On the plan of action, there were still several bracketed (that is, not yet consensus) items in May: identifying timeframes for implementation, progress indicators, and estimated funding needs, as well as identifying the key stakeholders for each item.

With the release of the funding document midweek, the WHO completed most of the unfinalised actions. Work on identifying stakeholders does not appear to have been done by the secretariat, though informal progress was made by member states on this issue (IPW, WHO, 20 January 2009).

“We expected we’d finalise bracketed text at this meeting, the Executive Board,” a representative from Slovenia told the meeting. “We note that this isn’t possible but wish to express hope it will be done at the World Health Assembly.”

Also completed was a set of proposed progress indicators [pdf], released in mid-December.

The United States asked what action was expected of the board in regard to the proposed indicators, on which further work needs to be done. The country also commented that the magnitude of the funding needs listed – nearly US$150 billion — is “quite staggering” and would be difficult for member states to mobilise, but said it was taking the paper as “information and not action.”

Venezuela was similarly curious about the progress indicators, asking when it would become “a practical document” rather than theoretical, and asked about the possibility of regional consultations.

Switzerland said a formal negotiation on progress indicators would involve “technical difficulties,” and that further work should be in the secretariat’s hands. It agreed the costs in the budget document were “enormous” but said all actors, including the private sector, would be contributing. It expressed hope the plan of action would be finalised at the assembly, and asked the WHO to explain the process for working towards that goal.

Expert Working Group

The expert working group on innovative financing mechanisms for neglected diseases was established in November (IPW, WHO, 19 November 2008), though they did not meet until the week before the Executive Board.

That meeting was concerned with process questions, with substantive questions saved for later meetings to come (IPW, WHO, 16 January 2009). Elil Renganathan, who is leading the global strategy and plan of action coordination at the WHO, confirmed at the Executive Board that the two future meetings would be in June or July and November of this year. The group is meant to submit a progress report to the World Health Assembly in May 2009.

Barbados asked the secretariat to confirm that a set of prize mechanisms submitted by Barbados and Bolivia [pdf] would be presented to the group as possible innovative funding mechanisms. Bolivia asked when the proposal would be published on the WHO website and properly translated. They were later assured by the secretariat that the proposals are on the agenda for the next meeting of the working group, though an answer was not given on timing of publishing and translation.

Quick Start and Future Work

The WHO director general was also asked within the global strategy document to “prepare a quick start programme with adequate budget provision and begin immediately to implement the elements of” the global strategy that fall under the WHO responsibility.

While a progress report [pdf] released on 20 November said the programme has been “initiated” in four different areas, details on the current state of progress are still unclear.

Many countries asked the WHO to keep certain issues in mind when continuing to implement the global strategy.

“We should not forget the reasons we got into this process,” said Uganda. “Many people around the world do not have access to products critical for their health.” The nation then encouraged the director general to make sure other factors, such as access to medications, are well monitored to ensure goals are being met.

Bolivia asked that traditional knowledge and indigenous rights be acknowledged. The country “rejects the possibility of patenting forms of life,” including on microorganisms and said that international intellectual property standards were out of phase with developments in the UN Convention on Biological Diversity and the UN Declaration on the Rights of Indigenous People.

Nongovernmental agencies also weighed in. The International Pharmaceutical Federation (FIP) [Editor's Note: the speaker was incorrectly identified by the meeting chair] said that too many countries have a shortage of health professionals, and asked that the work environment of such people be improved.

Médecins Sans Frontières called the global strategy “proactive public health at its very best” and said they have high expectations for the expert group, but that transparent criteria need to be established for the selection of experts provided to give testimony to the working group. The group must hear the perspective of all stakeholders, MSF said.

Churches Action for Health urged the WHO as well as other involved intergovernmental organisations, development partners, research institutions to keep in mind incentives schemes that would de-link the cost of research from the cost of drugs, including via the Bolivia and Barbados proposals. The time is ripe, the organisation added, “to seriously consider a health and biomedical R&D treaty.”

Kaitlin Mara may be reached at kmara@ip-watch.ch.