WHO Director General Candidates Hold Colorful Meeting With The Press 26/01/2017 by William New, Intellectual Property Watch 2 Comments Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)The three remaining candidates to be director general of the World Health Organization today met at length with UN journalists in the WHO and highlighted their plans for reform including finding new sources of funding for the continually cash-strapped UN agency that now could face threats from the US president to cut US funding. The three candidates, to be decided amongst at the May World Health Assembly, are (in order of votes received yesterday), [IPW, WHO, 25 January 2017]): Dr Tedros Adhanom Ghebreyesus (Ethiopia) [note: goes by “Dr. Tedros”] http://www.who.int/dg/election/tedros/en/ Dr Sania Nishtar (Pakistan) http://www.who.int/dg/election/nishtar/en/ Dr David Nabarro (United Kingdom) http://www.who.int/dg/election/nabarro/en/ The candidates have been campaigning for many months, putting their jobs on hold and conducting nearly 200 bilateral meetings and using other means to interact with the global health community. Below are some key remarks from today by the candidates in order of their appearance. Nishtar Sonia Nishtar addresses the WHO press today Leading off, Nishtar said WHO’s role as “a lighthouse” has never been more important as new concerns “threaten to wipe out the gains of the last century.” She pointed to three pillars of her plan: reclaiming WHO primacy, focus WHO on its core mandate, and usher in a new paradigm especially with a “better appreciation” of partnerships. Nishtar raised concern about WHO’s reliance on a few donors, and said she is putting forward a vision of a new resource mobilisation strategy, and innovative financing. She also highlighted a focus on emergencies, again pointing to partnerships. She said she is aware that the next litmus test of the WHO will be another emergency. On relations with lobbyists and donors other than governments, Nishtar said the normative work of WHO (policymaking) needs to have a “firewall” between it and the partnerships. The private sector will come in at the implementation stage. Asked about access to medicines, she answered that there are major advancements in oncology and hepatitis C, for example. She said WHO has a clear role, referring to an access to medicines report that she said gave WHO a mandate to set up a surveillance mechanism, which she said would be helpful for industry to look at trends. She mentioned other initiatives such as an independent task force, and an agenda item on access to medicines at the annual World Health Assembly. And Nishtar was the only one (though in fairness Tedros was not asked this question) to mention the use of patent flexibilities in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). She said it is “one of the ways to address the price issue,” and that it has been used for hepatitis C. But while she referred to price and intellectual property issues as “one avenue” that can be considered, she highlighted also strengthening health systems, with governments providing more assistance. And she mentioned the need for vigilance, such as against “spurious” medicines. She repeated the possibility of helping countries build their capacities and to take advantage of the TRIPS Agreement, the Essential Medicines List, and the orphan drug list. She noted that in Pakistan some essential medicines are not available because the price is so low as to make it not commercially viable. She summarised by saying the WHO needs “different levers” at the global level to address access to medicines, such as best practices, regulatory norms and TRIPS flexibilities. On reform, she said, “We require a culture change in WHO because priority-setting in the past has only come up with a large wish list.” Now, she said, member states will either prioritise, or delegate it to the WHO to come up with priorities. Nabarro David Nabarro Nabarro highlighted his deep experience within the UN and international community as well as in the field as a medical doctor. But he stressed that he would seek to be “catalytic” and be a strong force for change in the organisation. “This is a job that I’ve been training for my entire life,” he said in the press briefing, adding later, “I am an insider-outsider.” He recognised that WHO is the only organisation that sets standards for global health and enforces them. It is in effect the leader for every person’s health on the planet, and global health is more of an issue now than at any other time in history. Among the many issues he talked about – such as noncommunicable diseases, emergencies, women’s health, and antimicrobial resistance – he also mentioned medicines prices. “Access to medicines is becoming an issue everywhere,” he said. “We will be working on prices.” On Zika, he said WHO has handled it well, and is not the same as the outbreaks of ebola and yellow fever. He acknowledged that “no organisation is perfect,” and he has been asked to help work on some of the global health issues that have needed extra help. Nabarro was asked by Intellectual Property Watch about ideas to address the long “impasse” at WHO on solving the problem of making new medicines affordable for all. In responding, he noted that he was answering as a candidate, so there are things he cannot know and will know when he is actually director general. He disagreed with the notion of an impasse, and highlighted several instances where there have been successful agreements through discussions. “Is there an impasse on medicines, or are we perceiving of it as an impasse when actually there is quite a lot of agreement in our world today?” he responded. “The situation is like this: it is always important to ensure that medicines are available for people at a reasonable cost for people and not to be in any way to be reaching a situation where people are being denied access to life-saving or life-enriching care because somehow the cost of the medicines are too expensive for them to be available, either for purchase by the patient, or for purchase by the government on behalf of patients or for purchase through some kind of insurance scheme.” “I think there have been times when the issue of affordable medicines has been presented as a controversial issue around, for example the way in which intellectual property is handled, or around the way in which medicines are priced by manufacturers,” he continued. “But I have noticed so often that if the issue is put at the centre of the table, and if the different parties come around that issue to focus on it, that solutions can be found. “If you want to find an impasse, then no doubt the impasse will be there, but if you want to find a solution, then a solution can be found,” said Nabarro. “We saw that for access to treatment for HIV/AIDS many years ago when I was working here in the Office of the Director General. And the price of AIDS care was reduced dramatically. We’ve seen it with access to artesunate combination for malaria. We’ve seen with the way companies have worked with governments on treatments for filariasus for oncocerosis, and other neglected diseases.” “So I’m not prepared to come into the issue of costs of medicines by defining it as an ‘impasse’, your words,” he said. “I define it as a problem to be solved together, and each individual problem to be solved in specific ways, whether it’s hepatitis C, or whether it’s HIV/AIDS, or malaria, or the development of new medicines to cope with antimicrobial resistance. The story is to be continued.” Asked if he is a “hands-on” kind of leader, Nabarro said, “You could say I’m hands-on and I wouldn’t mind that. But I’m somebody who wants others to get their hands on as well because I really believe if you’re not engaged in issues, then it’s very hard indeed to have impact.” That’s why he emphasises his “catalytic” role, he wants to bring out the best in others, like “pumping up the amplifier” on music at a festival. On the threat of loss of financial support to the UN from the United States (IPW, WHO, 26 January 2017), he said those threatening seem to be clear that there are purposes for international bodies, and they want to be sure that the purpose for which international bodies are working is absolutely clear, is in line with their national objectives, and the organisation is working for impact in the most effective, efficient and transparent way. “I don’t think if we do that that we’ll be cut off from money,” he said. “After all, dealing with health security and health threats matters whatever country you’re in, and indeed the United States has been an amazing supporter of work on emergencies and outbreaks, as well as on different health systems within the WHO over the years.” “So I’m not sitting here thinking that the noises that are coming from not the actual new administration, but from a number of people in the legislature, I’m not actually thinking that these are going to lead to terminal problems for WHO in the coming weeks or months. Instead, I think they’re an invitation to dialogue, and an invitation to openness, and I am totally up for that.” Nabarro also spoke at length about Zika virus when asked a question about it, saying it is a really important question that exposes complexities. In his view the WHO, the governments, and other agencies have handled it well, and it is not the same as outbreaks such as ebola and yellow fever. Tedros Dr. Tedros Adhanom Ghebreyesus Tedros said he believes he is the best candidate because of his mix of international and national experience. He said he instituted reform in Ethiopia, listing achievements such dramatically cutting mortality related to a range of diseases. He stressed his experience also with international organisations, such as being Board Chair of the Global Fund for AIDS, Tuberculosis and Malaria, and as a leader in the 2015 Financing for Development conference in Addis Ababa. His top priority is universal health coverage, which he attributed largely to a lack of political commitment. Second on his list is health emergency response. “There will be another round of pandemic and we need to prepare right away,” he said, adding that he would put at the centre national capacity to respond as well as WHO capacity, all harmonised with other UN agencies. His plan to reform WHO finances is to increase assessments, expanding the donor base, making voluntary donations more flexible, and creating more value for money. He also emphasised partnerships, mentioning UNICEF, the Global Fund and GAVI for example, and suggesting WHO would lead. This was also his answer to the question of any concern about President Trump cutting US funding to the UN. Expanding the donor base is important because the organisation “should have predictable funding.” “When you put all eggs in one basket that’s when the problems arise,” he said, adding that if WHO can show results that show it is relevant, “everybody will come.” On avoiding conflicts of interest at the organisation, he said the WHO Framework of Engagement with Non-State Actors (FENSA) – such as private entities, foundations, academia, and civil society – should be implemented. When expanding the donor base, he like Nishtar said normative functions should be “firewalled” and that any conflicts of interest should be avoided. If there is any supplier that supports that, “they are welcome,” he said. Asked about decentralisation of the organisation, he said what went wrong with ebola, for which the WHO was criticised for not responding quickly enough, was that countries such as Guinea with weak national capacity saw it go out of control, while countries such as Nigeria immediately put into effect its polio mechanism and stopped it. “Use what is at hand,” he said. He acknowledged that WHO is “overstretched and underfunded,” but dodged a question on priorities, saying he would prefer once in office to sit down with staff and partners and “through an inclusive process” choose what has to be deprioritised. Then they have to be decisive, he said. Tedros also talked about when political mobilisation is done at the top in New York and Geneva, that there is no “buy-in.” Rather, he would use a “grassroots” approach in a case like antimicrobial resistance (AMR) and start at the subregional level such as the Association of South-East Asian Nations (ASEAN) or the African Union (which has endorsed his candidacy). With AMR, despite the highest level declaration at the UN last September, he has seen the buy-in is “not enough” at the regional level. [Update] Tedros was asked a question about a Trump comment that “pharmaceutical companies are getting away with murder” by overcharging governments for products but did not answer the question. Finally, he was the only candidate asked about an issue in his personal background, as questions of human rights violations in Ethiopia during his time as a government leader have been swirling during his candidacy. He answered by saying “my record speaks volumes on that,” first pointing to his success in overseeing great gains in health in the country with meagre resources. As well, they have focused on advancing women’s health in the country, which brings economic power which brings political power. But on “general human rights” and democracy, he said the country “believes democracy is the alpha and omega of our existence. We are committed to it,” as it has no option as a highly diverse country. But the criticism is welcome, he said, because the democracy is “a nascent democracy, so we have more challenges than other countries that have more experience in democracy. It’s a process, we can build it overnight. It needs cultural change.” It needs things like increasing literacy rates. When it matures, it gets better, “the country goes from one level to the other,” he said. “Bring me any country that has not gone through this process,” he said. “Even those countries who claim to have the best democracy and human rights record, believe me, they still have a serious problem themselves. So it’s a relative status.” Tedros was the only candidate not available for follow-up questions after the briefing. Image Credits: William New Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Related William New may be reached at email@example.com."WHO Director General Candidates Hold Colorful Meeting With The Press" by Intellectual Property Watch is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.