WHO Engagement With Non-State Actors: No Deal This Year, Work To Continue

The annual World Health Assembly closed today following a decision to postpone for one year completion of a new policy on the UN agency’s engagement with industry, foundations and other “non-state actors.”

World Health Organization members adopted a resolution [pdf] (A68/A/CONF./3 Rev.2) requesting the WHO to convene “as soon as possible and no later than October 2015, an open-ended intergovernmental meeting to finalize the draft framework of engagement with non-state actors on the basis of progress made” during this week’s Assembly. The draft framework [pdf] was placed in an annex to the resolution.

The resolution also asks that WHO submit the finalised draft framework of engagement with non-state actors for adoption to the 69th World Health Assembly (May 2016), through the Executive Board at its 138th session, in January.

Finally, it requests that WHO develop a register of non-state actors in time for the 69^th WHA.

The 68^th World Health Assembly took place from 18-26 May.

If member states agreed to a four-fold increase in assessed contributions, engagement with non-state actors could stop. The same is true if members cut WHO’s agenda by one-third. – WHO official

One of the key issues of this year’s WHA was whether delegates would find agreement on a new framework governing the relationship between the WHO and other stakeholders interacting with it, including private sector, foundations, nongovernmental organisations and academics.

After a week of drafting efforts, delegates hailed the progress on the draft, but left large areas without agreement. The aim now is that the framework will be adopted at the next Assembly.

The framework of engagement with non-state actors is part of a broad reform of the WHO.

This morning, on the last day of the Assembly, the drafting group which had been working intensively on the draft framework issued a draft resolution [pdf] submitted by the Argentinian chair of the drafting group. The annexed draft framework bore large sections on which agreement could not be found.

The draft resolution contained two options on actions to be taken following the WHA. The first option called for the implementation of the framework and the establishment of a register of non-state actors in time for the 69th WHA. The other option proposed to continue working on the framework and to establish an intergovernmental working group to finalise the framework.

Divide Persists on Crucial Points

Delegations who took the floor in committee today commented on the progress achieved through nine formal sessions of the drafting group and three informal sessions. But some issues are left open and some hard lines are being drawn, according to some sources.

The drafting group chair said the complexity of the issue did not allow for the framework to be completed at this time. He also listed a number of modifications in the draft framework, expected to be published later and annexed to the resolution.

Monaco talked about “remarkable progress,” and the African region of “commendable progress.” France reflected on the necessity to send a positive message to the world and underlined “real progress,” despite the fact that it was a difficult exercise. Mexico proposed to co-sponsor the resolution, and Australia talked about “enormous progress.”

Analysis of Implications Requested

Malta expressed concerns on the financial implications of the implementation of the proposed framework and suggested that a new paragraph be added to the draft decision: “To submit a report to the 69th WHA through the EB at its 138 session on the practical and resource implications of the implementation of the proposed framework.”

After the secretariat committed to produce an analysis of resource implications, which it said is always done after a decision is taken, at the next Executive Board, Malta withdrew its proposal.

According to a developing country source, an issue underlying the framework is the engagement of the WHO with the private sector, which might unduly influence the work and orientation of the organisation.

A developed country source told Intellectual Property Watch that a single set of rules of engagement should apply in the same manner to all non-state actors, whether they are a private sector entity or a civil society organisation. This is resisted by a number of developing countries, which consider that the risk of influence cannot be comparable, according to the first source.

Paragraphs of the draft framework that were particularly controversial, according to the developing country source, were paragraph 18 (Resources), and paragraph 44 (Specific Provisions).

Paragraph 18 deals in particular with contribution from non-state actors and how they should be allocated.

Paragraph 44 deals with the engagement with particular industries. It states that the WHO does not engage with the tobacco or arms industries. Paragraph 44 bis adds WHO will exercise particular caution when engaging with industries affecting human health, or affected by the WHO’s norms and standards, such as the food and beverage industries.

Industry, Civil Society, Two Sides of the Coin

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in its intervention [pdf] to the committee, said, “A new framework should guarantee at the same time better protection and more interaction, in order to facilitate improved health outcomes rather than prevent them.”

However, the representative said, “the current draft framework appears to be restrictive in a number of areas that would hamper non-State actors in their ability to fully contribute to global health outcomes.”

“Where conflicts of interests, whether commercial or not, may arise, it is appropriate that these are managed in a robust, clear, transparent and equitable manner,” IFPMA said. “We call for equitable application of the provisions of this framework across different categories of non-state actors.”

The International Baby Food Action Network (IBFAN) said in its statement [pdf] that the current draft raises a number of concerns. In particular, the representative said, “it legitimises new channels of undue industry influence,” and “gives false impression that risks of interactions with transnational corporations and philanthropies, including conflicts of interest, are adequately addressed.”

Medicus Mundi International stated that “WHO is being undermined in its capacity to promote global health; by underfunding, tight earmarking of donor funding and the opening of spaces for corporate influence.”

According to the representative, “the present draft of the proposed Framework of Engagement with Non- State Actors is contested, obscure and complex. It does not provide a robust framework to prevent improper influence.” She cited “several incidents of improper influence in recent years,” including “the lobbying by the sugar industry and related ultra-processed food industries against the WHO recommendation of a 5 percent ceiling on sugar intake.”

“The proposed protocols say nothing about the accountability of the member states for protecting WHO’s integrity,” she said.

Why Are Governments’ Assessed Contributions So Low?

Meanwhile, a senior World Health Organization official said last week heading into the Assembly that the new measures would “put the organisation on more solid ground,” and make it “more clear what are the do’s and don’ts.”

He said the WHO often has dialogues with member states on whether they should accept something, such as a secondment or personnel from elsewhere. This should help clarify those cases, he said.

A primary reason the rules have come under scrutiny is the increased need for WHO to accept funding from sources other than member states.

If member states would agree to a four-fold increase in assessed contributions, the official said, engagement with non-state actors could stop. The same is true if members cut WHO’s agenda by one-third.

Assessed contributions are funds from governments that can be spent according to WHO’s priorities, without ties to specific programs or activities.

Either way, the best measure is transparency, the official said.

Meanwhile, agreeing a grand new policy for the organisation next year could be a little tougher, he observed, as it will then be just one year from the election of a new WHO director general.

Public health advocates were active during the Assembly cautioning against allowing industry and foundations being allowed to unduly influence and set priorities at WHO.

At a 19 May side event, David Legge of the People’s Health Movement calculated that member states are in fact giving very little to WHO in assessed contributions. He gave the example of Belgium, which he said gives about US$30,000 per year.

“We have to ask, why is it so low?” Legge said.

Warnings from Public Interest Non-State Actors

Corporations, meanwhile, have been imposing their own interests on the organisation, Legge charged. He listed several examples, such as the IMPACT program against counterfeit medicines that appeared within WHO a few years ago without approval by member states. Another example was a weakening of guidelines on sugar intake after the involvement of chocolate producers. A further example was a 2006 resolution that WHO should provide advice to countries on the impact on health of trade agreements, which is no longer happening.

The debate on secondments – “lending” an outside expert to WHO for a specific project – from the private sector was another example. The WHO secretariat paper said private sector secondments, which would put industry representatives at the table inside the organisation, would not be acceptable. But some developed countries with large industry interests have pushed for this to be allowed.

KM Gopakumar of the Third World Network pointed to the text in green (accepted), yellow (not agreed) and grey (proposed), and said delegations were under pressure to get the policy done at this Assembly, forcing them to make critical decisions to the organisation and their interests.

Legge said the issue became prominent again after the 2001 non-communicable diseases declaration at the United Nations General Assembly. There was increased concern about partnerships being offered with the food industry, including makers of unhealthy “junk” food, he said.

A representative of the International Baby Food Action Network (IBFAN) said at the side event that WHO already has three policies in place until replaced. They are on non-commercial nongovernmental organisations, partnerships, and enterprises. WHO has never provided a clear analysis on why the current policy didn’t work, she said.

Some of the foundations from which WHO is accepting funding are “not at arm’s length” from the food and beverage industries, she added.

Legge said the Gates Foundation’s increased involvement in WHO’s funding and programs does not explain why member states are not stepping up contributions. As a result, WHO suffers from highly vertical silos of its funds, designated for specific activities.

Image Credits: Flickr – Uwe Hermann