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WHO Future In Question; Debate Over Industry Representation

17/01/2011 by Catherine Saez and William New, Intellectual Property Watch 3 Comments

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A seemingly overworked and impoverished World Health Organization opened its Executive Board session today with calls for reform amid deep concerns about its financial future. Meanwhile, dissension arose over an industry representative named by the WHO secretariat to a new research and development funding working group, sparking the WHO director general to cast doubt on the role of industry in such groups.

Also discussed was the sensitive topic of pandemic influenza virus access and benefit-sharing, with developing countries restating concerns that the new global approach will ensure they can obtain sufficient supplies of affordable treatments and vaccines.

Discussion is expected to occur as soon as tomorrow (Tuesday) on the WHO’s counterfeit medicines policy, despite the agenda item being reduced after a closed meeting on the issue was unable to be held in December. Concerned countries like India plan to use the agenda item to discuss the issue anyway, with concerns over issues like generics and pricing, according to sources.

WHO Director General Margaret Chan said in opening remarks that the United Nations agency is stretched thin due to a level of demands impacting its efficiency in some areas, and that far-reaching reform is needed. She also warned against big corporations’ influence on policies.

The 128th Executive Board session is taking place from 17-25 January. The rotating 34-government Executive Board is an advisory body which aims at giving effect “to the decisions and policies” of the annual May World Health Assembly (WHA). This session’s agenda includes discussions on pandemic influenza preparedness, public health, innovation and intellectual property rights, the WHO HIV/AIDS strategy, substandard medicines, and the future financing of the WHO.

In her remarks, Chan underlined the financial shortfall of the WHO, which some later said could range between US$200 and $600 million dollars in the biennium.

She also said the WHO issued its first report on neglected tropical diseases in 2010, and that the launch of the report was “accompanied by further commitments from the pharmaceutical industry to donate drugs in massive quantities,” as the very poor cannot afford drugs at any price.

Chan cited a new worrisome trend in the general public mistrust of vaccines. “Public perceptions about vaccine safety can be permanently altered by unfounded fears, to an extent that no amount of evidence can change,” she said.

Chan took aim at products that harm human health but are promoted by big businesses, making it difficult to make good public policy based on health concerns. The sectors and policies “that are driving the rise of non-communicable diseases are influenced by the actions of powerful industries and multinational corporations, like tobacco, alcohol, food corporations and the agribusiness giants,” she said, adding that “the objective of incorporating health concerns in all government policies, especially for controlling non-communicable diseases, faces some tough opponents.”

Chan also complained about the workload of the organisation, which operates at the behest of member states, and called for reform. “We are constantly asked to do more and more,” she said. “This has a limit. We are there.”

“WHO needs to change at the administrative, budgetary, and programmatic levels,” she added. “We do not need to change the constitution but we do need to undergo some far-reaching reforms.”

Possible Conflict of Interest in New Expert Group

During the last WHA in May 2010, a consultative expert working group on research and development financing and coordination was created. A previous group was shaded by concerns about lack of transparency and its final report did not meet the expectations of a number of member states (IPW, WHO, 21 May 2010).

According to an EB document, EB128_6 [pdf], following the May 2010 Assembly, the details of nominees were to be submitted to Chan through regional directors. The decision requested that Chan “establish a roster of experts comprising all the nominations submitted by the regional directors and to propose” a composition of the group to the EB for its approval, taking into account “regional representatives according to the composition of the EB, gender balance and diversity of expertise.” The list included in the document has 21 names chosen from 79 nominations sent by regional directors.

Among the 21 proposed individuals to be part of the working group, Switzerland proposed Paul Herrling, head of Novartis Institutes for Developing World Medical Research. The fact that a member of industry who could stand to directly gain from the outcome could be on the working group, prompted comments and reservations from some countries. The predecessor group was suspected of including members with a conflict of interest by some countries, and this year a declaration of possible conflicts by nominees was included. A document circulated [pdf] by non-governmental group Knowledge Ecology International suggests that Herrling previously submitted a proposal to the working group pitching his company’s services to address the problem of neglected diseases.

Bangladesh was first to raise the subject and said that a member of industry sitting on the working group was a major concern. The issue also was raised by Brazil, and especially by Thailand, which spoke as a non-member of the Board. Brazil said it would have appreciated Board members getting to see the full list of names and the CVs of the short-listed candidates.

Chan, who appeared to be near tears, said the secretariat “diligently” followed the process articulated by the WHA. She demanded to know from members – specifically Thailand – why it would be unacceptable to have a candidate with a pharmaceutical background in the working group and said that it would be naïve to think that all participants in such matters – even the WHO – have no vested interest.

Herrling brings “unique expertise” in this group, she said, and she did not see how “a group of this nature” could totally exclude people with rich experience in the pharma sector. If all people with a pharmaceutical background are unacceptable, in some working groups “we will have nobody,” she said. Two countries proposed that industry representatives such as Herrling should instead be invited to appear before the working group to offer their insights.

Chan’s remark about other working groups prompted commentary afterward among observers that it could be read as an admission that all working groups have conflicts of interest.

Canada and the European Union declared they were satisfied with the list as presented by the WHO. The United States said it disagreed with any assertion that last year’s working group was discredited, and that a number of countries had supported its outcome. It also called for the working group to respect its mandate and stay focussed on recommendations for R&D financing.

Before the opening of the agenda item, WHO said Ravindra Prasan Rannan-Eliya from Sri Lanka would be replaced by a candidate from India. India, whose nominee had been left off the working group initially, did not join in the criticism of the naming of a brand-name industry representative to the working group despite being an enormous generic drug producer.

Brazil asked that the agenda item remains open for further discussion between members about Herrling but at the end of today’s session it was unclear if the secretariat would keep the item open as there was discussion whether Brazil’s request came too late. The meeting chair had swiftly gavelled the agenda item closed after “seeing no objections” and citing the nearing end of translation services. Brazil shortly afterward raised a point of order to state a desire to keep the topic open for more discussion.

Several sources insisted afterward that the issue will be reopened again as soon as tomorrow. And a developed country official told Intellectual Property Watch that if Herrling were removed, it could lead to other nominees coming into question. One key nominee favoured by developing countries is Argentinian academic Carlos Correa, who is currently conducting research at the Geneva-based South Centre.

The People’s Health Movement issued a letter [pdf] to all Board members on its behalf and a number of “affiliated networks,” with comments on agenda items, including a concern about Herrling’s presence in the list. The NGO called for the appointment of Herrling to be disallowed on the basis that WHO’s conflict of interest policy would preclude the presence of an industry employee in a norm-setting forum.

Virus Sharing, Benefit Sharing discussed

Meanwhile, during discussion of the global pandemic policy, several countries called for the access and benefit sharing of viruses.

On pandemic influenza preparedness, some countries such as Burundi and Bangladesh brought up the new Convention on Biological Diversity protocol on access and benefit sharing as instrumental. The Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the Convention on Biological Diversity, adopted in October will be open for signature in February.

Burundi said IP rights should not constitute a barrier to public health issues. Brazil called for the WHO and its members to listen to the voice of developing countries and said that it is mandatory to solve the issue of the production of enough vaccines for developing countries. The increase of vaccine manufacture capabilities in developing countries was supported by the US.

Several brand-name producing developed countries specified that the existing system – constructed by and for developed countries – should be built upon, a position that varies somewhat from hints at calls for a new system that would be centred around ensuring full equal sharing of benefits of pandemic vaccine research. It was noted that the current system developed a vaccine for H1N1 in record time, six months. But it was also noted that not every country could get the vaccine for their populations.

What to Cut at WHO?

At a packed off-site session on the future of the WHO hosted by the German mission, speakers and audience members hashed through the reality that WHO will need to make great cuts and rethink its work. The message appeared to be that WHO will need to identify its core functions and priorities.

One speaker said, “the default question at WHO is what are we going to cut,” and raised questions about how health and development fit together, plus whether it should be branching into areas such as food safety. Gaudenz Silberschmidt of the Swiss health ministry said WHO remains central to global health governance and gave an analysis of things that could be done quickly or over more time.

Devi Sridhar of the Oxford Global Health Governance project said newer groups like the Global Fund and GAVI might be attracting more resources from traditional funders of groups like the WHO because they feel they can have more control and gain more favourable outcomes from the work of those groups. She termed this notion “Trojan multilateralism” in which countries are increasingly involved multilaterally for their own gain.

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Related

Catherine Saez may be reached at csaez@ip-watch.ch.

William New may be reached at wnew@ip-watch.ch.

Creative Commons License"WHO Future In Question; Debate Over Industry Representation" by Intellectual Property Watch is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Filed Under: IP Policies, Language, News, Themes, Venues, Biodiversity/Genetic Resources/Biotech, Development, English, Health & IP, Innovation/ R&D, Patents/Designs/Trade Secrets, Technical Cooperation/ Technology Transfer, WHO

Comments

  1. Miles Teg says

    18/01/2011 at 3:57 pm

    There should be no surprises about ‘conflicts of interest’ at WHO. It is endemic in the health sector generally, even in many scientific medical journals. It is not that there are not guidelines and policies on this. Health bureaucrats are just far too unpractised at using them, they have not seriously tried implementation in a systematic way. Chan is therefore just stating the facts that the health sector is riddled with conflicts. Not just at WHO, even government regulators get caught out with far too many faulty medicines approved; universities now limiting “professorial advertising” in classes; and Chan’s WHO operation run mainly by unpredictable AND “off-budget” donations: surprisingly mostly from governments (who then DO like to pay for play).
    But without WHO even really assessing the conflicts and managing it BEFORE the EB, this would hardly inspire confidence that it is appropriately managed in the committee itself; and the objectors – especially progressive civil society – must get brownie points (that’s all they really get, no?). Given that expert group composition is almost entirely discretionary by the Director General, one can only wonder at the kind of advice Chan gets. Perhaps the lessons that were to be learnt from elevating this issue under her direct supervision (a few years back) then down again (recently) have not been learnt or been unlearnt. Good management requires a diversity of opinions at the top, and no jest, a jester for Chan may be in order, especially if the the past repeats itself as tragedy, farce then hubris. But the preponderant culture at WHO is that of not managing conflicts, it is about compounding matters, by keeping expert meetings closed to civil society scrutiny with only a hint at the real machinations that drive the system (as the definition of what a “pandemic” really is/was attests). This is therefore just another instance of par for the course.
    Almost the entire norm setting in health for this neglected diseases “mechanism”, for which Herrling’s appointment is a concern, was conducted in private. Sure, some meetings were open or assisted by “experts” (who composition was equally questionable, rough score progressive 3-6 versus the rest 34-40), but in the main, these fundamental health norms were set behind closed doors (so much for health as a procedural human right!). The archaic (and I really mean archaic!) recognition procedures for civil society participation actually needed to be BYPASSED by a resolution of states to enable civic participation. This ability to participate was promptly undone by developing countries too easily acquiescing to US and EU demands to hold discussions behind closed doors, as if making the rich countries strut their positions in public was not a strategic advantage. And on the negotiations, the draft text limited the focus of “neglected diseases” to 14 even though no member proposed it as part of their input (it is not now limited), but which bears uncanny resemblance to a World Bank list.
    And Herrling is an interesting cat. His recent involvements make it difficult to believe he was selected for the committee, but… he had made an interesting proposal rejected during the initial discussions of this “mechanism” – that a board be set up to fund research, patents developed would be owned by the corporation conducting the research but the patent rights would be fully assigned to the board. Perhaps it was the fact that it was too market orientated, included patents, or came from industry, that it was rejected. It could have been one of the portfolio of mechanisms (and many were proposed, some were ditched unceremoniously) in the system (which is very plastic).

    Health innovation is a Titanic. It is sinking and collapsing faster than admitted, and WHO is found wanting as a specialist international civil service agency while its civil society iceberg spotters are kept below deck!

    Reply

Trackbacks

  1. IP Watch: WHO Future In Question, Debate Over Industry Representation | Don't trade our lives away says:
    18/01/2011 at 8:00 am

    […] Over Industry Representation Posted on January 18, 2011 by donttradeourlivesaway Source: Intellectual Property Watch, 17.1.2011, by Catherine Saez and William […]

    Reply
  2. WHO R&D Financing Committee Approved With Controversial Industry Expert | Intellectual Property Watch says:
    23/01/2011 at 3:32 pm

    […] A predecessor working group fell prey to allegations of conflict of interest and lack of transparency. The last World Health Assembly in May 2010 approved the establishment of a new working group, and a list of experts drawn from a roster of names provided by regional directors was provided to the Executive Board members (IPW, WHO, 17 January 2010). […]

    Reply

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