The World Health Organization has been soul-searching – and becoming more pragmatic – for several years since running into deep debt and seeing private organisations gather influence in global public health policy. Next week, the WHO Board will consider a proposal on how to allow the intergovernmental body work with such organisations and industry without giving up its own independence and oversight role.
The 134th Executive Board will meet from 20-25 January. The preliminary agenda and meeting documents are available here .
Also on the agenda: a global plan for vaccines, noncommunicable diseases (cancer, diabetes, cardiovascular and chronic respiratory diseases), fake and poor quality medicines, new ways to fund research and development for neglected diseases, access to essential medicines, and a pandemic influenza preparedness (PIP) framework for the sharing of influenza viruses and access to vaccines and other benefits.
The UN is a hotbed for long, complex names for things, and the WHO is certainly no exception. In order to help WHO stay relevant and find funding (in the absence of increased government support), it must work more closely with industry, foundations, academic institutions and other organisations. So WHO members asked for clear set of rules of engagement. And it referred to all such organisations “non-state actors.”
The WHO secretariat has prepared a framework for engagement with non-state actors (doc EB134/8 ) [pdf] for the Board meeting.
“The overall objective of WHO’s engagement with non-State actors is to work towards the fulfilment of the Organization’s mandate by making better use of non-State actors’ resources (including knowledge, expertise, commodities, personnel and finances),” it states.
Non-state actors are defined not only by their non-governmental status or work in international relations, but they also “have the power to influence and cause change in public health.
The document, dated 8 January, sets out five guiding principles for engagement:
“Any engagement should:
(a) demonstrate a clear benefit to public health
(b) respect the intergovernmental nature of WHO
(c) support and enhance the scientific and evidence-based approach that underpins WHO’s work
(d) be actively managed so as to reduce any form of risk to WHO (including conflicts of interest)
(e) be conducted on the basis of transparency, openness and inclusiveness.”
It also sets four “clear” boundaries on WHO’s engagement with them:
“(a) decision-making by the governing bodies is the exclusive prerogative of Member States
(b) WHO’s processes in setting norms and standards must be protected from any undue influence
(c) WHO does not engage with industries that make products that directly harm human health, such as tobacco or arms
(d) engagement with non-State actors must not compromise WHO’s reputation.”
Efforts are already underway to map WHO’s engagement with non-state actors in more detail, it said, by “compiling information on existing and recent engagements in terms of their frequency, the types of non-State actors, and the types of interactions.”
From a 17-18 October informal consultation by the WHO director general with member states and non-state actors, five broad areas interaction were distinguished: participation, resources, evidence, advocacy and technical cooperation.
On participation, the report said WHO increasingly uses informal consultations with non-state actors to develop policies.
On resources, a key element of the proposed reform is that financial contributions are separated from member state priority-setting. It allows human resources to be donated by non-state actors, as well as in-kind donations such as medicines.
The report also notes that non-state actors benefit from engagement with WHO, for instance, through its procurement.
In the area of evidence, it says an individual working for private-sector entities with an interest may not serve on advisory committees. They may be able to give their views in hearings, however.
In response to support expressed during the October informal consultation for strengthened management, the director general is “enhancing systems for increasing transparency and conducting due diligence, risk assessment and risk management of WHO’s engagement with non-State actors,” it said.
Risk assessment includes reputational risk, conflict of interest, undue or improper influence, or competitive advantage.
In addition, the secretariat proposed several other “adjustments to the practices of implementing the current policy regarding nongovernmental organizations are proposed for immediate application.
(a) Statements by nongovernmental organizations will no longer have to be submitted for clearance in advance, providing that they conform to existing guidance.
(b) WHO will provide webpages for sessions of the World Health Assembly, the Executive Board and regional committees that will be dedicated to the posting of statements from nongovernmental organizations in official relations with WHO. These statements may be posted in advance of the debates.
(c) Each nongovernmental organization shall designate a head of its delegation and indicate the organizational affiliation of all its delegates.
(d) Access to the documentation submitted to the Board’s Standing Committee on Nongovernmental Organizations is currently restricted. In the spirit of transparency, this documentation will be posted on the WHO website in future.”
More Changes to Come
WHO said there is a “clear need” to hold further consultations among member states, and proposed to hold consultations on the issue between this session of the Board and the next, which normally takes place immediately after the annual World Health Assembly in late May. The deliberations of this week’s Board meeting will be taken into account.
Based on the outcome of the consultations, WHO will “develop separate policies and operational procedures for the different types of non-State actors for the consideration of the Board at its 135th session.”
There are many issues on the agenda for the Board. Here are a few of the most relevant.
A key issue with relation to intellectual property rights is a follow-up of the report of the Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG).
A group of experts gathered to choose among projects presenting innovative ways to foster research and development of medical products for diseases primarily affecting developing countries last month selected eight projects out of 22. Civil society was quick to express concern that the selected projects do not propose a new way forward. Now WHO member states must narrow the list down further.
The Global Technical Consultative Meeting  on Identification of Health R&D Demonstration Projects took place from 3-5 December.
The list of projects is here (IPW, WHO, 6 December 2013 ).
The Board is “invited to note this report and provide guidance for implementation of a few projects, in order to report back to the Sixty-eighth World Health Assembly in May 2015, through the Executive Board at its 136th session in January 2015.”
Separately, the WHO also submitted a report to the Board on its work in promoting access to essential medicines. The report areas of activity to promote access, including: universal health coverage; monitoring and use of information; access to medicines for NCDs; rational use of medicines; antimicrobial resistance; access to medicines for HIV/AIDS; tuberculosis and malaria, reproductive and maternal and child health; and innovation and local production of medicines.
On noncommunicable diseases (NCDs), the Board will consider a progress report on the 2008-2013 action plan for the global strategy for the prevention and control of noncommunicable diseases. This is part of the follow-up on progress in implementing the high-level UN political declaration on the issue.
The document for the Board includes a report from a formal meeting of member states in Geneva from 11-13 November to conclude work on the terms of reference for the global coordination mechanism on the prevention and control of noncommunicable disease.
On the issue of substandard and fake medical products, the Board will take note of a report on progress. Members working on the issue have adopted a “non-exhaustive” list identifying “actions, activities and behaviours” that result in such products, according to a report of the second meeting of the so-called Member State Mechanism on Substandard/Spurious/Falsely-labelled/Falsified/Counterfeit Medical Products, which took place on 28-29 November.
They also have a workplan on these issues, and have drafted a budget of nearly US$13 million to carry out the range of workplan objectives (IPW, WHO, 15 January 2014 ).
The pandemic flu framework established an annual partnership contribution to be paid to WHO by manufacturers of flu vaccines, diagnostics and pharmaceuticals using the WHO Global Influenza Surveillance and Response system. For 2013, the secretariat identified 37 companies to contribute the total annual partnership contribution of $28 million, it said.
The report to the Board includes a summary of key points discussed by the PIP advisory group at its last meeting, on 7-9 October (IPW, WHO, 11 October 2013 ), and a summary of its second annual report.
And on the Global Vaccine Action Plan, endorsed by the WHA in May 2012, the Board will take note of an assessment report on the plan.