Ebola, Reform High On WHO Executive Board Agenda This Week

The World Health Organization Executive Board yesterday adopted a resolution on Ebola, on the eve of today’s opening of its 10-day meeting addressing a broad range of health issues, including several of relevance to the intellectual property and innovation community. Today, Italy requested that member states be involved in the setting of WHO guidelines, raising governance issues, while WHO Director General Margaret Chan called for strong health systems and reform to the WHO structure, and asked for room to move on WHO relations with industry.

The 136^th session of the WHO Executive Board is taking place from 26 January to 3 February.

On 25 January, the WHO held a special session on the Ebola emergency and adopted a resolution on “Ending the current outbreak, strengthening global preparedness and ensuring WHO capacity to prepare for and respond to future large-scale outbreaks and emergencies with health consequences.” This resolution was sponsored by a large number of countries. .

In her speech yesterday, she said that urgent change is needed in three areas: “to rebuild and strengthen national and international emergency preparedness and response, to address the way new medical products are brought to market, and to strengthen the way WHO operates during emergencies.”

The Ebola outbreak revealed some inadequacies and shortcomings in the WHO’s administrative, managerial, and technical infrastructures, she said, proposing a package of reforms to address the issue. Recruitment procedures should be streamlined to be able to respond to emergencies in a swifter manner, the International Health Regulations “need more teeth,” and need a more rigorous methodology for evaluation, she said. WHO needs to strengthen its own workforce, she further said.

Chan, commenting on the adoption of the resolution, said it was a strong political signal that member states want to invest in WHO and expect the organisation to be fit for purpose. It also sends a message to “some people trying to create another UN agency to replace WHO,” she said. “It is a no-go now.”

Addressing member states, she urged them: “You have to speak up… and put your money where your mouth is.”

Reform Needed in WHO Guideline Set-up, Italy Says

Italy asked that a new agenda be added to the Executive Board agenda this week. He said the WHO handbook for guideline development does not foresee any obligation to include member states into the process, and that the responsibility of the development of guidelines was left to each WHO department. Italy recommended that the process to develop guidelines be updated to ensure that a correct assessment of evidence is made and that international commitment of member states be taken into account. He linked the suggestion to update the handbook with the recent conclusions of the Second International Conference on Nutrition on sugar intake in November. Updating the handbook would increase the transparency and accountability of the organisation, the delegate said.

A number of countries supported the proposal for a new agenda item, underlining the need to have the best scientific evidence for guideline development, but most asked that the agenda item be taken up at the next EB meeting, whether in May following the annual World Health Assembly, or in January 2016, to allow time for consultation.

South Africa remarked that guideline development touched upon the normative work of the organisation, thus bringing forth a much wider discussion.

Belgium, vice-chairing the Board, said the Italian suggestion could be split in three items: the guidelines should be based on scientific publication, the process to establish the handbook not involving member states, and the link to the conclusions of the conference on nutrition, and suggested that those three items might benefit from separate discussions.

The issue is expected to be included in the agenda of the next EB meeting.

Health Systems, Anti-Microbial Resistance, Major Issues, Chan Says

Chan, in her report to the Board, said “social inequalities have increased, with more of total global wealth held by just a few rich and powerful people.” There is growing evidence that good health systems and supporting infrastructure are a priority. They are “not a luxury” to invest in, she said, insisting on the importance of universal health coverage, describing it as “one of the most powerful social equalizers among all policy options.”

She underlined the effect of climate change on health, the challenge of anti-microbial resistance, and the need to overcome market failure for medicines such as those addressing Ebola.

On anti-microbial resistance, she said it is happening in all parts of the world with few replacement products in the pipeline, and dire consequences, pushing the world into a post-antibiotic era “in which many common infectious diseases may once again kill.” She called for incentives to stimulate new medical products.

She said the United Nations Millennium Development Goals “have been good for public health” with several positive indicators, including child mortality rates falling faster than ever, progress in AIDS and malaria treatments. She announced the release next month of a report on the global status of neglected tropical diseases, showing “excellent progress” made by countries.

“Health everywhere is being shaped by universal pressures, like the globalised marketing of unhealthy products, population ageing, and rapid urbanization,” she said. She said the international conference on nutrition “showed how international systems, such as those that govern trade, have a major, sometimes detrimental effect on health and called for governments to establish coherent policies to avoid situations where policies good for one sector can have adverse consequences for health.”

Chan: Don’t Tell Me I Cannot Work with the Private Sector

In later comments, she commended industry for their contribution to the work of the organisation.

“Some of you get upset when I say that,” she said, referring to criticism of the fact that private sector sometimes contributes to personnel expenditure, she added. But she said when the private sector is donated medicines, somebody needs to deliver those medicines “in your countries.” That is not a conflict of interest, she said.

She asked that member states discussing the framework which is expected to govern the engagement with “non-state actors” and the WHO, to give her “some space” in areas where she can work with the private sector without compromising the decision-making power of member states. The private sector cannot have equal footing with member states in their policy decision-making or in setting standards, she said.

Other issues to be tackled by the EB during this session include rules of WHO engagement with non-state actors, fake medical products, financing research and development for neglected diseases, the Global Vaccine Action Plan, the 2016-2017 budget and financial strategy of the organisation, and non-communicable diseases (IPW, WHO, 14 January 2015).

Draft Resolution on Ebola

The draft resolution (EBSS/3/CONF./1 REV.1) that came out of the 25 January special session reflects the negotiations that took place in the meeting. Sources said the issue may be discussed further by the Executive Board.

The draft resolution is entitled, Ebola: Ending the current outbreak, strengthening global preparedness and ensuring WHO capacity to prepare for and respond to future large-scale outbreaks and emergencies with health consequences.

The draft resolution addresses issues of leadership and coordination, health systems, medical assistance, information flows, preparedness, therapeutic drugs and vaccines, WHO structure and human resources, research and development, and evaluation.

A key element of the draft resolution is the WHO structure and human resources. It says that “short-comings in WHO’s human resources systems and processes slowed down the Ebola response,” and calls for reform. It specifically calls on the director general “to review the process for nomination, selection, training, and performance review and improvement plan of WHO Country Representatives.”

On research and development, the draft “recognises the urgent need to encourage and maximise efforts on scientific, epidemiological and biological research….” It restates WHO’s “leadership role” on the research agenda for Ebola.

It also says that as appropriate, there should be “linkage to pooled funds for global health research and development to facilitate the development of quality, safe, effective, affordable health technologies related to the needs of affected countries,” and calls for nations to secure sustainable financing for health R&D on emerging and neglected tropical diseases.

And it calls on countries to collaborate on models for delinkage of the cost of new R&D from the prices of medicines, vaccines, and other diagnostics for Ebola and other neglected diseases.

The draft resolution does not explicitly mention the right of developing countries to use flexibilities under the World Trade Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Brazil proposed to include it during the negotiations yesterday, according to a source, but was prevented by developed countries. There is, however, a reference to the WHO Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, which includes a reference to the TRIPS flexibilities, which was accepted as sufficient.