After ten days of discussions, country delegates closed the annual World Health Assembly today with the adoption of a set of decisions, one of which is a drastic programme of reforms intended to restore the World Health Organization’s central place in public health governance.

WHO Director General Margaret Chan said in her closing speech today: “The most important message for me was your clear consensus on the need for reform and your clear desire to see these reforms reinforce WHO’s position as the foremost authority on international health.” She characterised decisions taken by delegates as “historical agreements.”

Chan also emphasised the importance of the WHA as “having a tremendous impact on the health of this world.”

The World Health Assembly (WHA) met from 16-24 May and addressed diverse health-related issues, such as the future financing of the organisation, pandemic influenza preparedness, falsified medicines, HIV/AIDS, communicable and noncommunicable diseases, and reforms of the organisation.

All WHA documents are here.

Chan obsequiously said today that she would follow all instructions delivered by the WHA, such as undertaking a number of managerial and administrative reforms, including a “streamlined, more realistic budget that works as an accountability tool.”

“You want reforms that make it easier to measure the impact of investments. You want greater transparency and alignment of work at all levels of the organisation,” she said.

“Many welcomed the proposed independent evaluation of WHO, and several suggested that work on the strengthening of health systems would be a good focus for evaluating WHO capacities and gaps,” she added. The independent evaluation will be “fast, light, focussed on all levels of the organisation, and designed to shape the reform agenda.”

However, Chan warned that good will would not be enough to reach the targets set by the WHA. “If you give us an average of 25 resolutions at each Health Assembly, yet give us insufficient funds, how can you hold WHO accountable for implementing your decisions and recommendations?,” she asked, calling for more predictable and flexible financing.

Reforms Start With Budget Cuts

Part of the reform package is a substantive budget cut. The 2012/2013 budget, approved by the WHA shows a 17 percent decrease compared to the budget submitted by the organisation to the Executive Board in January.

According to a WHO official, budget cuts likely will not affect programmes related to intellectual property rights, innovation and public health (IPW, WHO, 23 May 2011), although the organisation will have to part with 300 people at headquarters by December 2011. WHO has been working on these issues for several years, and is guided by the landmark 2008 Global Strategy and Plan of Action (IPW, WHO, 29 May 2008).

In the new budget, 24 percent comes from member state dues, and 76 percent from voluntary contributions, half of which is from governments, a WHO official said. The other half of the voluntary contributions are from other UN agencies, foundations, and the private sector, which include in-kind contributions, like drugs, he said.

Most of the voluntary contributions are earmarked for specific projects, which was a worry for some countries and civil society, who showed concerns over a possible growing influence of industry on WHO strategy and activities.

Bill Gates, chairman of the Bill and Melinda Gates Foundation, made an front-stage appearance at the WHA on 17 May, advocating the “Decade of Vaccines,” and preaching availability through low prices and intellectual property rights (IPW, WHO, 17 May 2011).

The reform programme also includes the establishment of a multi-stakeholder platform, which provoked concerns among WHO observers who fear it may open a door for industry influence in the organisation. It was also eyed cautiously by member states.

Chan said today: “Some delegates are reluctant to introduce a new mechanism, with clear financial implications, that could dilute the intergovernmental nature of WHO, which is clearly one of our strengths.” She said she “will work closely with the Executive Board to flesh out, in more detail, a coherent package of reforms. This will be a fully consultative process, fully engaging member states.”

In her opening speech, Chan said that the programme of reforms had the “potential to change WHO for the better,” and said she “will lead this programme of reforms myself” (IPW, WHO, 20 May 2011).

Given that her mandate will end in June 2012, some have said that Chan was positioning herself for a second term. She would be fully supported by the United States, Kathleen Sebelius, the US Secretary of Health and Human Services, told a press briefing on 17 May (IPW, WHO, 17 May 2011).

Work on Falsified Medicines Extended

The WHA also approved a recommendation to give an additional year to the working group on “substandard/spurious/falsely-labelled/falsified/counterfeit” medical products (SSFFC) to deliver a set of recommendations to fight falsified medicines to the WHA (IPW, WHO, 23 May 2011).

The main area of discontent is the issue of intellectual property rights, as some countries found that the current WHO taskforce to fight falsified medicines had strayed too far into a role of enforcing intellectual property rights, such as patents or trademark, instead of focusing solely on public health issues.

The working group is extended with its initial mandate, and member states asked for a clear schedule of meetings up to the next WHA.

The WHO International Medical Products Anti-Counterfeiting Taskforce (IMPACT), which involves law enforcement agency Interpol, was again in the centre of debates, with countries, such as India asking that the WHO suspends its relations with IMPACT until the outcome of the working group is finalised and its recommendations endorsed by the WHA.

Most countries asked for WHO to help countries to strengthen health systems and drug regulatory authorities, and emphasised the need for affordable medicines in developing countries, as one of the ways to fight falsified medicines. Countries are expected to discuss further the issue of IMPACT during the next meetings of the working group.

World Closer to Readiness for Next Pandemic

Member states also approved a framework intended to help the world address the next influenza pandemic in a more efficient and fair manner (IPW, WHO, 23 May 2011).

The Open-Ended Working Group on Pandemic Influenza Preparedness on the sharing of influenza viruses and access to vaccines and other benefits, produced in April, after four years of discussion, a “Pandemic Influenza Preparedness Framework” (IPW, WHO, 18 April 2011). The framework includes benefit sharing for developing countries in exchange for the expedited sharing of influenza viruses.

In particular, it includes standard material transfer agreements (SMTAs), which are contractual legal instruments between the countries sharing the virus, and the recipients, whether they are entities inside the WHO surveillance network, or outside of this network, such as companies. For the latter, benefit-sharing options are mandatory, to be chosen by the recipients from a list provided in the SMTA. Companies also will financially contribute through an annual partnership contribution to WHO.

Some countries, such as Brazil, called for companies to provide non-exclusive licences at affordable royalties, or royalty-free to developing countries. Countries also mentioned technology transfer as essential to building up vaccine capacities in developing countries.

Civil society said the monetary contribution decided on in the framework was not in proportion with profits that pharmaceutical companies derive from getting access to virus samples, and said the framework should have mandatorily limited intellectual property rights, as benefits.

Industry Warns Against Lack of Production Capacity for Flu Vaccine

International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) said today in a press release [pdf] that it had followed with particular interest decisions made by member governments on pandemic influenza preparedness and fake medical products.

However, they said, “areas remain for improvement especially in terms of sustaining the appropriate production capacity which may still be insufficient for global populations.”

WHO Board Warned Against Private Funding

The 129th session of the WHO Executive Board will take place tomorrow (IPW, WHO, 23 May 2011).

In a letter today [pdf], a group of non-governmental organisations expressed concern regarding the management of conflicts of interest and the role of private bodies in the financing and the governance of WHO.

Of particular concern, they said, is that a private foundation has pledged to finance part of the WHO overall design of the reform programme.

“It is entirely inappropriate that the blueprint for reform of a UN institution is funded by a private entity,” they said, asking that “a clear separation between WHO and the interests of private actors” is maintained.

They request that the Executive Board rejects private financing and “ensure that this reform is either funded from existing core contributions from member states or from additional member state contributions.”