World Health Assembly To Address Organisational Reform, IP Issues

The World Health Organization’s annual meeting of its member states will look at an array of subjects pertaining to reforms of the organisation and its financing, vaccines, fake medicines, and influenza pandemic preparedness, as well as communicable and non-communicable diseases.

The World Health Assembly (WHA) is in charge of appointing the WHO director general, to supervise the financial policies of the organisation, to review and approve the programme budget. It also considers the reports of the WHO Executive Board and decides on further action on those reports. The Executive Board is a 34 rotating member states body which agrees on the agenda of the forthcoming WHA, and adopts resolutions to be forwarded to the WHA. According to the WHO, the Executive Board’s main mission is to “give effect to the decisions and policies” of the WHA, “to advise it and generally to facilitate its work.”

The WHA is meeting from 16 to 24 May.

At the last WHO Executive Board meeting, from 17-24 January, several intellectual property-related topics were addressed along with the pressing issue of the financial shortfall in the WHO budget and consequent necessary reforms of the organisation (IPW, WHO, 25 January 2011). Also discussed was the process for the election of the next WHO director general, which led to the setting up to a dedicated working group to present its results next week.

“Substandard/Spurious/Falsely-Labelled/Falsified/Counterfeit”

The issue of bad medicines will be considered as the WHA will look at the report of the WHO working group on “substandard/spurious/falsely-labelled/falsified/counterfeit” medical products, which last met from 28 February – 2 March. Discussions in March were intense with some countries calling for the suspension of the WHO taskforce against counterfeit medicines, as they found the taskforce had been overly concerned with intellectual property issues (IPW, WHO, 3 March 2011).

At the Executive Board meeting, some countries expressed concerns that the group had not met as of January for its first meeting.

The report [pdf] of the working group to be presented next week said that WHO should continue to focus on and intensify its measures to make medical products more affordable, strengthening national regulatory authorities and health systems, which include national medicine policies, health risk management systems, and sustainable financing. One of the issues of the working group was the terminology used to describe products of compromised quality. It was finally decided to keep the denomination agreed at the 63rd WHA in May 2010: “substandard/spurious/falsely-labelled/falsified/counterfeit” medical products, abbreviated as SSFFC.

The relationship of WHO with the International Medical Products Anti-Counterfeiting Taskforce (IMPACT) was also addressed by the working group, as some countries have criticised the work of IMPACT as giving priority to intellectual property protection rather than on focusing on public health issues. No consensus was found on this issue, and the chair of the working group, Darlington Mwape of Zambia, asked that the WHA give extra time to the working group to complete its work.

Pandemic Influenza Preparedness Framework

The WHA also will have to examine a framework agreed in April by WHO members to better address pandemic influenza. The framework is intended to facilitate the sharing of viruses, and requests that industry participate financially in particular through an annual partnership contribution, from 2012. Developing countries in the past were reluctant to share their virus samples, out of concern that they did not have adequate access to the vaccines manufactured from those samples, either due to prices or supply constraints.(IPW, WHO, 8 April 2011).

The WHO Open-Ended Working Group of Member States on Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits (OEWG/PIP) met from 11-15 April.

The pharmaceutical industry said the framework developed there will result in an effective global system to prepare for potential future influenza pandemics, and that the industry would ensure that IP rights did not present a barrier when the next pandemic strikes. Civil society found industry’s financial participation insufficient, as it seemed industry had the capacity to contribute more to benefit-sharing.

Election of the Director General

At the last Executive Board meeting, the election process for future directors general was discussed as the next election is due to happen in 2012. The main discussion was about the geographical rotation, which was favoured by some developing countries. Previous directors, they said, have come from only three of the six regions of the WHO.

Some countries opposed the idea saying that geographical rotation was posing a danger of overriding more important selection criteria such as expertise and experience. A working group on the process and methods of the election of the WHO director general was set up, open to all member states.

An interim report [pdf] is being submitted to the WHA next week and a final report, including recommendations, should be submitted at the 130th session of the Executive Board in January 2012.

Organisation Funding: Reforms in Sight

WHO Director General Margaret Chan said at the January Executive Board meeting that the agency was under-funded, where “the best-case scenario presents a US$ 200 million difference between projected income and expenditure, a worst-case scenario presents an equally possible shortfall of up to US$ 600 million.”

Chan will submit a series of reforms [pdf] for consideration by the WHA on the future of financing for WHO. In the document, she said that “WHO has retained a rigid administrative and managerial structure. This is outdated, and impairs WHO’s ability to adapt to changing needs and respond to the shifting, complex web of international efforts to improve public health.”

Those reforms range from programme priority setting to management of human resources. “Reforms are needed to move from the current model that largely favours long-term or career employment to one that balances core staff with staff supported by short-term
project-based financing, as needs arise or decline,” the paper said.

On 13 May, the Berne Declaration issued a press release warning of a possible reduced role of WHO to an essentially technical role, with a growing influence of economic powers on global health priorities.

The committee reviewing the WHO’s response to the 2009 H1N1 flu pandemic was also supposed to present its report to the WHA (IPW, WHO, 29 March 2011).

The fourth and final meeting of the International Health Regulations (IHR) Review Committee took place from 28-30 March. The committee was inquiring about alleged pharmaceutical industry influence in WHO’s response.

The preview document gives three preliminary conclusions and 15 recommendations. The committee conducted interviews and assessed documentary evidence and written material, the committee chair said in March. The chair, Harvey Fineberg, president of the National Academies Institute of Medicine in Washington, DC, said the committee could not find evidence of pharmaceutical industry influence in WHO’s decisions.

Bill Gates, Vaccine Advocate

On 17 May, the WHA will host two invited speakers, Sheikh Hasina, prime minister of Bangladesh, and Bill Gates, co-chair of the Bill & Melinda Gates Foundation on 17 May. Gates “will challenge health ministers and global health leaders to make vaccines their top priority to save millions of lives,” according to the WHO.

The WHA preliminary journal issued on 2 May gives a tentative programme of work [pdf] for the assembly, and a list of documents can be found on the WHO website, as well as a provisional agenda [pdf].

The WHO published today the World Health Statistics 2011, which is an annual report based on more than 100 health indicators reported by WHO’s 193 member states.