WHO Director Highlights Noncommunicable Diseases, Pandemics; Blasts Industry Counter-Efforts

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World Health Organization Director General Margaret Chan today had strong messages for the opening day of the annual World Health Assembly: in these rocky times, public health work is a high ground that helps bring security and development, and if you are not doing all you can to advance global health for all, then you are part of the problem. She took a swipe at mega-industries – especially tobacco and junk food – that produce and market unhealthy products and spend heavily to work against effective public health policies.

In her speech, Chan highlighted several issues that relate to intellectual property rights and innovation – such as noncommunicable diseases (NCDs), pandemics, and research and development for neglected tropical diseases. But she kept the big picture in view in making a case for health issues to rank high on the United Nations priorities currently being drafted for the post-2015 period.

“Health contributes to and benefits from sustainable development and is a measurable indicator of the success of all other development policies,” Chan said. “Investing in the health of people is a smart strategy for poverty alleviation. This calls for inclusion of noncommunicable diseases and for continued efforts to reach the health-related MDGs after 2015.”

Competition among various sectors for a place in the new UN agenda is “very fierce,” Chan said.

NCDs

The noncommunicable disease (cancer, diabetes, cardiovascular and respiratory diseases) issue was taken up quickly by member states after her speech, with delegates moving to a committee room to give a long list of speeches on the issue and set up a special working group to draft a resolution on the issue this week.

The chair of the committee (Committee A) handling a range of issues such as NCDs is Dr Walter Gwenigale of Liberia. For the working group on NCDs, there will be two co-chairs: Sania Mishtar of Pakistan, who is the science and education minister and heads an NGO called Heartfile funded by the US-based Rockefeller Foundation, and Colin McIff of the United States, who is the US health attaché in Geneva.

On NCDs, Chan had tough words for industries promoting tobacco and unhealthy foods. She said the effort on NCDs “is not going to be easy,” as the forces they will be powerful.

“Today’s health challenges are vastly different from those faced in 2000, when the Millennium Declaration was signed,” she said. “Efforts to safeguard public health face opposition from a different set of extremely powerful forces. Many of the risk factors for noncommunicable diseases are amplified by the products and practices of large and economically important forces. Market power readily translates into political power.”

With the Millennium Development Goals (MDGs), there was no such power interfering with agreement, she said. “No PR firms were hired to portray the delivery of medicines for HIV and TB as interference with personal liberties by the Nanny State, with WHO depicted as the Mother Superior of all Nannies. No lawsuits were filed to stop countries from reducing the risks for child mortality. No research was funded by industry to cast doubt on the causes of maternal mortality. Mosquitoes do not have front groups and lobbies.”

“But the industries that contribute to the rise of NCDs do,” she said. “When public health policies cross purposes with vested economic interests, we will face opposition, well-orchestrated opposition, and well-funded opposition.”

“WHO will never be on speaking terms with the tobacco industry,” Chan said. “At the same time, I do not exclude cooperation with other industries that have a role to play in reducing the risks for NCDs. There are no safe tobacco products. There is no safe level of tobacco consumption. But there are healthier foods and beverages, and in some cultures, alcohol can be consumed at levels that do not harm health.”

There are no safe tobacco products. There is no safe level of tobacco consumption. But there are healthier foods and beverages. – Margaret Chan

Chan stressed that she is “fully aware that conflicts of interest are inherent in any relationship between a public health agency, like WHO, and industry. Conflict of interest safeguards are in place at WHO and have recently been strengthened. WHO intends to use these safeguards stringently in its interactions with the food, beverage, and alcohol industries to find acceptable public health solutions. WHO will continue to have no interactions whatsoever with the tobacco industry.”

Finally, she said, “The response to NCDs depends on prevention but also on clinical care which is cost-effective and financially sustainable. This is another challenge that lies ahead.”

Chan specifically referenced three draft global action plans to be considered during this Assembly: noncommunicable diseases, mental health, and the prevention of avoidable blindness and visual impairment.

Pandemics

Chan opened her speech on the subject of pandemics, citing the novel coronavirus in the Eastern Mediterranean, and H7N9 avian influenza virus that China reported in March. She noted WHO’s past work in tracking outbreaks, and called for vigilance, transparency in reporting, as well as collaboration and cooperation. She did not reference the specific actions to be taken at this Assembly (IPW, WHO, 17 May 2013).

R&D for Neglected Diseases

Chan also kept her references to other controversial issues indirect, such as the broad reform of the WHO itself that has dominated headlines in the past. She made no mention of counterfeit and substandard medicines. She also neglected to mention the years of work coming to a head this week of a committee seeking solutions to the lack of economic incentives for R&D for neglected diseases, those predominantly affecting developing countries for which there is little market for companies. That committee developed recommendations that were seen as unfavourable by the United States and were killed in a late night session in November 2012.

Now the recommendations of the so-called Consultative Expert Working Group (CEWG) are mainly about studying the issue and, if gaps are found, then deciding what to do about it, which could put off action for years. Public health advocates are working this week to get the R&D treaty back on the list of possible options, but it is unclear whether a WHO member state will try to reopen the CEWG discussions under threats that this could derail efforts altogether.

Meanwhile, last week, the WHO issued a set of four “draft working papers” looking at the gaps and other issues. These are not formally part of the WHA but may have influence on discussions, sources said. The four papers cover four main elements from the November 2012 decision: the Global Observatory for Health R&D; R&D coordination and prioritization; R&D financing; and options for demonstration projects.

The four draft WHO working papers are available here.

Another paper was floated by the chair of the CEWG, available here. A separate news article on the WHO R&D issue was published here. Addressing the concern for the development of drugs for noncommunicable diseases, an article [pdf] written by Ellen ‘t Hoen, former senior advisor intellectual property and Medicines Patent Pool at WHO/UNITAID, points to the impact of the Novartis decision in India to ignite new medical R&D frameworks.

Instead of mentioning the CEWG, Chan mentioned neglected tropical diseases in the context of new initiatives such as one with UNICEF, and one led by the Gates Foundation, WHO and others, outside of the direction of WHO member states.

She said she attended the Vaccine Summit in Abu Dhabi last month. “Participants explored how the Global Vaccine Action Plan can be used as a roadmap to save more than 20 million lives by 2020 by expanding access to ten existing vaccines,” she said, adding that polio eradication was “given special attention as a milestone in this visionary roadmap.” Polio eradication is a particular goal of funder Bill Gates, among others.

Chan highlighted a new action plan with UNICEF against pneumonia and diarrhoea, and said, “I find this integrated delivery approach an exciting way to move forward. The tremendous success in controlling the neglected tropical diseases clearly tells us that integrated strategies can stretch the impact of health investments – and stretch the development dollars.”

Chan also vaguely referenced the balance inherent in allowing patenting of medical products, which leads to high prices to pay for the R&D, and the need for making good health affordable. She cited a new Rockefeller Foundation study on the subject.

“[A] study from the Rockefeller Foundation revisited this issue with new data from a number of countries. That study leads me to a positive conclusion. Member States, we are doing a lot of things right, on the right track,” she said. “According to the study, factors that contribute to good health at low cost include a commitment to equity, effective governance systems, and context-specific programmes that address the wider social and environmental determinants of health. An ability to innovate is also important.”

Chan also stressed the importance of affordable generic products.” Specific policies that can make the greatest difference include a national medicines policy that makes maximum use of generic products, and a commitment to primary health care and the training of health care workers,” she said.

Other Issues

Separately, Chan hailed successes in the fight against HIV/AIDS, and said that in June, “WHO will simplify things further by issuing revised, consolidated guidelines for the use of antiretroviral drugs for both HIV treatment and prevention.”

Among other issues, Chan also had strong words to say about the conditions that health workers face, especially in countries of conflict. She condemned attacks on health workers.

At the outset of the Assembly, several speakers gave opening remarks. Shigeru Omi of Japan, president of the Assembly, gave a similar message touting the importance of health for development.

“The post-2015 development agenda will determine future global health and development,” he said. “Without health, no real development is possible. There is an urgent need for improving access to medicines and other pharmaceutical products for people in resource-limited settings.” He added that an adequate response would require partnerships between governments and private sector partners.

IP-Watch researcher Brittany Ngo contributed to this report.

 

William New may be reached at wnew@ip-watch.ch.

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