WHO Board Delays Decision On Trade-Related Proposal

The World Health Organisation Executive Board on Friday postponed to January a proposal urging governments to adopt national policies on international trade and health.

The draft resolution led by Thailand had the support of Benin, Bhutan, Bolivia, Brazil, Canada, China, Iraq, Jamaica, Kenya, Nepal, Sudan, Thailand, Tonga, Viet Nam, and others, but the board put it off after a variety of amendments were offered, including some by Australia aimed at softening the proposal’s mandate that met with resistance.

The decision on the resolution came a day after the board showed general support for a WHO secretariat report on international trade and health that called for stronger ties between health and trade officials at all levels. The support was particularly aimed at capacity building (such as training) on trade issues, sources said.

The United States, which is not formally on the rotating board, expressed dissatisfaction with the report in Thursday’s session, arguing that WHO should not reach too far into trade areas handled by other organizations such as the World Trade Organization, according to observers.

But WHO officials insist that they have no intention of expanding their reach or becoming involved in trade negotiations, observers added. “The WHO is not going to be launching a massive program [on trade and health]. That was never their intention,” one observing official said. Rather, it is seeking to strengthen regional and national programs for dealing with these issues and integrate trade into its broader activities.

The WHO receives numerous and constant requests for expert opinion on the public health impact of trade-related matters, especially since the completion of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), WHO sources said. A number of developing countries have argued in recent years that TRIPS has harmed their ability to address public health and other concerns, in part due to restrictions on intellectual property rights.

The annual WHO General Assembly has in recent years taken actions related to trade, such as urging them to adopt national legislation in order to use the “flexibilities” in the WTO Declaration on TRIPS and Public Health adopted at the November 2001 WTO ministerial in Doha, Qatar. Flexibilities are clauses within the agreement allowing countries to get around commitments in the name of public health or other reasons. An example is a government issuing licenses for cheaper generic versions of a patented drug in order to fight an epidemic.

Debate: Adopt v. Consider Adopting

The WHO secretariat said at Friday’s meeting that the proposed resolution would not produced additional changes to the program budget for 2006-2007. The secretariat representative also said support to the first two countries it assisted on trade and health issues amounted to $25,000 each, and that there are 15 pending requests. But she said it is expected this support would fall under country-specific activities with WHO “back-stopping” them – though “clearly not to the tune of $25,000 to the secretariat.”

The trade and health resolution as drafted “urged” member states to promote dialogue at the national level and to “adopt policies, laws and regulations that address issues identified in that dialogue and take advantage of the potential opportunities, and mitigate the potential risks that trade and trade agreements may or may not have for health.”

Australia proposed to change this to say, “consider adopting policies, laws and regulations…,” and to change the word “risks” to “impacts” later in the sentence. Ecuador, which at the outset indicated support for the proposal, had earlier suggested changing the “urging” of member states to “invites” in order to make it more palatable, but Australia’s proposed addition of the word “consider” before “adopt” led Ecuador to withdraw that proposal and declare that it would have to vote against the proposal. This is important because the board makes decisions by consensus.

“It’s too weak,” the Ecuadoran representative said. “We don’t want to word it in such a way that is acceptable to everyone but doesn’t mean anything anymore.” He suggested a small drafting group hash through the differences and bring back an agreed-upon text in the afternoon, but a number of countries supported postponing the resolution until the board meets again, in January.

Ecuador and Thailand are currently engaged in separate negotiations with the United States for bilateral free trade agreements and could potentially benefit from a WHO message reinforcing the terms of international agreements, sources said. Some developing countries have said U.S. terms for such agreements go beyond the terms of TRIPS and may weaken countries’ ability to use flexibilities. The Bush administration has denied this.

Australia’s proposal to change “risks” to “impacts” and in a later reference, to “implications” also met with resistance out of concern that it would weaken the resolution. Australia offered a number of less substantive changes as well.

Additional proposed amendments to the resolution by other countries included adding foreign affairs ministers to the list of health, commerce and trade ministers who need to work together on trade and health issues, and to establish national coordination mechanisms among all of these disciplines to address public health aspects of international trade.

Intellectual Property Rights Commission Report Noted

Also on Friday, the board noted a secretariat progress report from the WHO Commission on Intellectual Property Rights, Innovation and Public Health. The commission, established by the 2003 WHO General Assembly, is reviewing links between intellectual property rights, innovation and public health by analyzing current evidence and considering ways to “stimulate the creation of new medicines and other products for diseases that mainly affect developing countries.”

The commission is due to complete work by May 2006, but did not hold its first meeting until April 2004 and has had two meetings since. According to the report, the commission has held extensive discussions with governments, gathered data, and has used its website to stimulate debate.

The period of consultation will end next week, with a two-day workshop Monday and Tuesday, followed by a public consultation on Wednesday, all at WHO in Geneva.

Key issues raised by the report noted by the board Friday include the effect of the patent system on health research, the public sector and innovation, the impact of TRIPS on pharmaceutical research, and a variety of possible improvements to incentive regimes and new medicines.