WHO Board: UN Report On Medicines Too Hot; DG Candidates To Be Narrowed

At the opening of the World Health Organization Executive Board meeting today, a call by India for an agenda item on the report of the United Nations Secretary-General’s High-Level Panel on Access to Medicines was denied. Meanwhile, WHO’s director general underlined the success of the organisation over the last year, including new financing arrangements with industry groups to finance the WHO Prequalification Programme. But all eyes are riveted to the election process for the new WHO director general, as three out of the six candidates are expected to be short-listed this week.

The WHO Executive Board (EB) meeting is taking place from 23 January to 1 February.

WHO Director General Margaret Chan in her report to the Board underlined successes of the organisation in 2016, in particular in the area of access to medicines, but did not mention the UN High-Level Panel on Access to Medicines, nor did she allude to any intellectual property-related issues in the access of affordable medicines. She did say, however, that “health inequalities are often aggravated by the high price of medical products.”

For example, she said that in September “WHO industry groups announced new financing arrangements, in line with industry practices, that will sustainably finance the WHO Prequalification Programme from now into the future.” The programme “is a service provided by WHO to assess the quality, safety and efficacy of those products that address global public health priorities,” according to the WHO.

“The programme is one of our most successful initiatives,” she said, adding, “It has transformed the market for public health vaccines and other medical products, making supplies more abundant and predictable, and prices affordable.”

She underlined “More good news for affordable medicines … when WHO released a report documenting dramatic price reductions for a revolutionary cure for hepatitis C infections. Strategies used include price negotiations, local production, and licensing agreements that promote competition among generic manufacturers.”

In other areas, she underlined the WHO and the US National Cancer Institute publishing of a report on the economics of tobacco and tobacco control.

She also mentioned that the World Economic Forum has identified rising income and wealth inequality “as the most significant trend that will shape global development over the next ten years.” She also remarked on the new US$500 million coalition to develop vaccines ahead of epidemics was announced during the Davos event, which she said “draws on the WHO list of priority pathogens.”

She also remarked on the publication by the WHO in December of final trial result of a promising Ebola vaccine.

India’s Call for Inclusion of High Level Panel Ignored by Group

The Indian delegation raised concern about the non-inclusion of a specific meeting agenda item on the recently released report of the UN Secretary General’s High Level Panel on Access to Medicines. India is not currently a member of the EB.

In September, India made a formal submission to the the Executive Board Bureau seeking a discussion on the report, supported by all member states of the South-East Asia region, as well as Brazil, Iran and South Africa, the delegate said, asking for the rationale of the Bureau’s decision not to include a distinct agenda item to discuss the high-level UN report.

A number of international bodies, such as the UN General Assembly, the World Trade Organization Council for Trade-Related Aspects of Intellectual Property Rights (TRIPS), and UNAIDS have initiated discussions on the report, he said.

“It would be simply inconceivable and inexcusable that WHO, which has a constitutional mandate to set and coordinate global R&D efforts and which is the main UN agency that should be at the forefront of the access to medicines agenda, does not discuss and take appropriate follow-up actions on the UN High Level Panel report,” India said.

“If the EB140 does not discuss the report, WHO risks losing its leadership on such a vital global health issue. This would be a serious setback to its credibility and integrity, particularly when it is trying to justify an increase in its programme budget,” the delegate added.

“We believe that an informed discussion, with an open mind, on the UN High-Level Panel will allow member states to consider potential innovative approaches to address some of the persistent challenges to access to medicines and provide appropriate directions to WHO to carry forward its work on health innovation and access,” he said.

The Indian request was supported by Iran and by Brazil, who said that it is “inadmissible” that an organisation dedicated to health refuses to discuss such a report.

EB Bureau Justifies its Decision

Board Chair Ray Busuttil, a consultant in public health in Malta, explained that the EB Bureau had received two requests from India referring to medicines in September. One was a request to split one agenda item, which was agreed upon by the Bureau, the other on the High-Level Panel report.

The Bureau, according to Busuttil, felt that sufficient items on medicines were already on the agenda and the High Level Panel report, which was unpublished at that time, could be considered under one of those.

There is no doubt, he said, that the report generated different opinions, some of them very divergent. Chances of reaching any substantial conclusions on a way forward seemed elusive, he added, thus the decision was taken to retain the decision to discuss the topic under existing agenda items.

Member states can then express their opinion on the report, he said, and those opinions can be collated and for a possible way forward to consensus and constructive discussions, he said.

None of the EB members supported India’s request, although Bhutan, Nepal, and Thailand are members of the WHO South East Asia Region, which supported India in its original formal request, according to the Indian delegate.

Elections: Down to Three Candidates by Week’s End

Six candidates are running to be elected as the next WHO director general: Tedros Adhanom Ghebreyesus from Ethiopia; Flavia Bustreo from Italy; Philippe Douste-Blazy from France;  David Nabarro from the United Kingdom, Sania Nishtar from Pakistan; Miklós Szócska from Hungary.

According to the WHO, on 24 January, EB members are expected to vote so that only five candidates remain. Those five candidates will each be interviewed on 25 January for 60 minutes, with an oral presentation, followed by a question and answer session. On 25 January, in the afternoon, the three remaining candidates will be known, according to the WHO.

Another voting is expected to take place so that only three candidates remain for the annual World Health Assembly in May.

NGOs: Candidates Answer Questions On R&D Agreement

In December, a number of non-governmental organisations, including Knowledge Ecology International, the European Public Health Alliance, Public Citizen, and Universities Allied for Essential Medicines published an open letter inviting the six candidates to say if they would support a  global agreement on the research and development (R&D) of medicines, vaccines, and diagnostics of public health importance.

The responses from the candidates are here:

• Response from Flavia Bustreo

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30031-1/fulltext

• Response from Philippe Douste-Blazy

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30030-X/fulltext

• Response from Tedros Adhanom Ghebreyesus

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30027-X/fulltext

• Response from David Nabarro

http://www.thelancet.com/pb-assets/Lancet/pdfs/S2214109X17300347.pdf

• Response from Sania Nishtar

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30026-8/fulltext

• Response from Miklós Szócska

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30029-3/fulltext