Vaccines In Middle-Income Countries, Non-Communicable Diseases Discussed At WHO

Availability and accessibility of vaccines in middle-income countries was raised today at the World Health Organization as member states are ploughing through a heavy agenda. Non-communicable diseases were also discussed and delegates sitting on the Executive Board agreed on a formal meeting before the next World Health Assembly to complete terms of reference for a global coordination mechanism to prevent and control the growing epidemic. The WHO Executive Board is meeting from 20-25 January The first day showed swiftness through agenda items, encouraged at the outset by the chair warning against long statements due to the length of the agenda (IPW, WHO, 20 January 2014). In particular, member states took note of the WHO report [pdf] on the Global Vaccine Action Plan, and today approved a decision on non-communicable diseases.

The action plan was endorsed by the 65th World Health Assembly (WHA) in May 2012 and asked the WHO director general to monitor progress and report annually, through the Executive Board (EB) and the annual Assembly, until the 71th WHA.

Concern over Access to Vaccines

Some countries, including Lebanon, said that middle-income countries stand in a difficult position. They are not eligible to benefit from the funding of vaccines through the GAVI Alliance, a public-private partnership which funds vaccines for children in some 70 of the world’s poorest countries, according to their website. That leaves middle-income countries to fend for themselves and face high prices, and shortages in various vaccines, the delegate said.

South Africa and others remarked that data quality was a concern for many countries.

Public health advocates Médecins Sans Frontières (MSF), in their statement, said it is unclear what the majority of countries are paying for vaccines, except for the prices paid by the Pan American Health Organization Revolving Fund and by UNICEF for GAVI-supported vaccines. According to MSF, when the Global Vaccine Action Plan (GVAP) was adopted in 2012, several member states raised concerns on the lack of vaccine price affordability and the high prices paid by many middle-income countries.

“The cost of fully vaccinating a child has increased by 2,700 percent over the last decade, with a significant portion of the $51 billion dollar Decade of Vaccines allocated for the cost of the vaccines alone” they said, illustrating the need for the cost of vaccines to be monitored, in particular for countries not covered by GAVI. MSF urged “the GVAP secretariat to improve its role in the accurate and timely collection of vaccine price data,” with member states reporting on the prices paid by the public sector for vaccines.

WHO Director General Margaret Chan said GAVI is considering what support could be put into place for middle-income countries so that they can get better prices for vaccines. WHO does not engage in buying vaccines, she said, and has very little access to the prices of vaccines.

NCDs – Multisectoral Approach Needed

Today, member states adopted a draft resolution [pdf] proposed by the WHO secretariat on the Follow-up to the Political Declaration of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases.

The resolution includes the convening of a second formal meeting of member states to be held before the WHA “in order to conclude the work on the development of the terms of reference for the global coordination mechanism on the prevention and control of noncommunicable diseases.” The draft proposal envisaged a meeting before the end of March but this was pushed to the end of April, at the request of Brazil, to accommodate regional consultations.

Involvement of Non-State Actors Necessary, Delicate

All countries who took the floor insisted on the importance of tackling NCDs.

Many countries also underlined the importance of collaborative efforts going beyond public health actors, including non-state actors, but they said WHO should be protected from undue influence and potential conflict of interests. Coming up on the agenda is a discussion on a framework of engagement with non-state actors.

Chan concurred on the need to prevent conflicts of interest. Without a multisectoral approach, reaching the goals of the global action plan will be impossible, she said. But without safeguards on conflicts of interest, there would be no clarity, she added.

Healthier lifestyles and healthier environments where cited as factors of prevention of NCDs but some countries noted that industry influence, such as the global food industry lobbying runs against reducing some risk factors. Kazakhstan said very powerful lobbies made it difficult to adopt and implement “the right laws.”

Civil Society Wants in, Concerned about Industry Influence

The International Council of Nurses requested the involvement of nurses in the global coordination mechanism. The International Alliance of Patients’ Organizations (IAPO) said patients must be at the centre of the coordination mechanism, progress should be measured and reported. IAPO also asked clarification on how the global coordination mechanism will be financed.

Medicus Mundi, delivering a statement for the People’s Health Movement (PHM), said the terms of reference for a United Nations inter-agency taskforce on the prevention and control of noncommunicable diseases – which are expected to be completed at the next WHA and were referenced in the draft decision adopted today – is missing an important element. The representative highlighted the absence in the proposed objectives of the terms of reference of the need to preserve policy space for countries.

In particular, the cited concerns about bilateral and multilateral agreement, or investment agreements such as the one upon which tobacco company Philip Morris is suing the Australian government about its plain packaging for tobacco products legislation.

Such actions are powerful weapons to intimidate governments in particular in low and middle-income countries, he said. The PHM published a set of comments [pdf] on all agenda items of this session of the EB. The International Federation of Medical Students’ Associations also said economic interests should not undermine public health interest and underlined trade in unhealthy products, and the need to consider intellectual property rights in noncommunicable disease discussions.

Chan said that policy space is the prerogative of countries and the normative standard-setting is the WHO prerogative, and both should be protected. She called for guidance from the member states on how to include non-state actors.