The UN World Health Organization Executive Board opened its annual January meeting today with a substantive agenda of reform, election, and a variety of issues that touch on intellectual property rights, research and development and innovation. And with the organization in reform and funding straits in a rapidly changing world, the director general stressed the agency’s steadfast approach and role in addressing the increasing global inequality between rich and poor.

In her prepared opening remarks today, WHO Director General Margaret Chan mentioned most of the key issues before the Executive Board, which is meeting from 16-23 January. This includes organisational reform, financing of R&D for neglected diseases, a framework for pandemic influenza preparedness, noncommunicable diseases, and even intellectual property rights.

Documents for the Executive Board meeting are here.

On IP rights, she used it as one of her examples of how WHO has shown “consistent ability to reach agreement on global governance instruments that provide collective protection against shared threats.”

“Like the need to manage intellectual property rights in fair ways, for industry, but most especially for public health,” she said in her prepared remarks.

Chan did not directly mention the issue of counterfeit and substandard medical products by name, perhaps because of the difficulty in finding acceptable words by which to refer to it. The issue of “substandard/spurious/falsely-labelled/falsified/counterfeit medical products” – as it has been dubbed by member states in an effort to appease all sides – has been controversial at WHO in recent years. But members managed to agree in October on a new mechanism for addressing the issue (IPW, WHO, 1 November 2011).

This week, the board will consider the report of the October meeting and the last World Health Assembly held in May 2011.

She also mentioned as an example of agreement, “influenza pandemics and the need to be prepared, with equitable distribution of benefits.” Despite controversy and suspicion, a new (and rather secretive) pandemic advisory group has been set up and began work in November (IPW, WHO, 22 November 2011).

“The negotiations that culminated in the framework for pandemic influenza preparedness were the most difficult and potentially explosive that I have ever witnessed in my 35 years in public health,” Chan said. “But the spirit of consensus and fair play eventually won, and we got a square deal for everyone, including the pharmaceutical industry.” Chan repeated several times that negotiations in the WHO lead to a “square deal” for all.

Such outcomes signal that “countries really want risks to be proactively managed,” she said. “They want rules of proper conduct, with clearly assigned responsibilities, and they want fairness, a fair deal for everyone.”

The action this week is for Chan to present a report on the work of the pandemic advisory group.

Meanwhile, the proposed negotiation of a treaty on financing and coordination of R&D for neglected diseases and other medical products may test the WHO’s ability to provide a forum for member states to reach agreement on sticky issues. A consultative WHO expert group in November agreed to recommend the negotiation of a binding treaty (IPW, WHO, 14 December 2011).

Chan referred to “how commitment to a limited number of time-bound goals has improved health outcomes in measurable and often significant ways.” She said: “We also see how this commitment has left a powerful legacy of innovations. Like financing instruments, like ways of securing money from new sources. Like a new breed of strategic R&D partnerships that are bringing to market innovative products tailor-made to tackle diseases of the poor.”

The board will consider a summary of meetings to date and the group’s call for proposals.

A key item on the agenda for the board is a “deepening” of the extensive reform effort at the 60-year-old organisation, following the approval of a reform plan in a special session of the board in November (IPW, WHO, 4 November 2011). The reform targets WHO programme and priority setting, governance and management. It looks to broaden WHO’s engagement with other actors (such as foundations and non-governmental organisations), create contingency funding, clarify roles at the various levels of offices in WHO, and establish independent evaluation.

On reform, the board this week will provide direction on the aspects of WHO reform to be considered at the Assembly in May, according to a WHO press officer.

If there is a competitive advantage emerging at the WHO, it appears to be the notion of the square deal. “WHO and its member states have long been concerned about equity, fairness, and social justice, and the interplay between social conditions and health outcomes,” Chan said, indicating that this makes it more important in a time of greatly widening inequalities globally. She cited a report from the Organization for Economic Cooperation and Development (OECD).

The board also will consider the re-election for five years of Chan, who is running unopposed, for the term 1 July 2012 to 30 June 2017. She has been DG since 2007, has geographic affiliation with Hong Kong and Canada (her CV, here, states she is Chinese), and has overseen a tumultuous time of positioning the WHO in an increasingly crowded field of foundations like Gates, the Global Fund to fight AIDS, Tuberculosis and Malaria, and the Global Alliance for Vaccines Initiative, that have closer ties to developed country private-sector funding. Chan has weathered concerns about undue industry influence, overblown reaction to pandemic flu, and an over-centralised management style within the organisation.

Chan’s annual salary will be US $251,188 before staff assessment (resulting in a considerably lower net salary). She also receives a US $20,000 “representation allowance”, which sources say is typically used to ensure the director of an international organisation dresses well and the like.

Among other issues on the agenda is to follow up on the UN High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control. This includes implementation of the global strategy for the prevention and control of NCDs and the action plan (IPW, WHO, 16 September 2011).

Additional issues include: progress on Millennium Development Goals, an update on a draft global vaccine action plan, and issues of food safety, as well as of climate change and public health.

In her remarks, Chan said WHO has “stayed the course, steadfast and surefooted.” In the past, the path forward may have been clearer. Whether WHO will continue to keep its footing, as it faces greater global and internal risks and problems than ever before, remains to be seen.