WHO Board Meeting Playbook: Election Of New DG, Antimicrobial Resistance, Genetic Sequence Data

Although the main governing body of the World Health Organization is the annual World Health Assembly held in May, many decisions are made at the annual January session of the WHO Executive Board. Among the topics to be discussed next week are the election of a new director general, antimicrobial resistance, the financing of research and development for health products.

The 140th WHO Executive Board Meeting (EB) is taking place from 23 January to 1 February. The agenda is here [pdf]. The Board consists of 34 WHO members in rotating terms of office.

The Board is expected to consider candidates to replace Margaret Chan at the head of the organisation. A draft contract [pdf] has been posted, indicating that the new director general’s term would start on 1 July 2017 until 30 June 2022.

According to WHO’s dedicated page, the EB “will draw up a short list of 5 candidates.” “Executive Board members will then interview these candidates and up to 3 of them to go forward to the World Health Assembly in May 2017,” it said.

After considering and trying out secure electronic voting systems for the nomination and appointment of the next director general, the secretariat concluded [pdf] that none of the two systems considered was fit for purpose and that the use of paper voting is the only feasible way forward for the upcoming election.

Also on the agenda is a document [pdf] on WHO’s response in severe, large-scale emergencies. Another document [pdf] presents a blueprint for research and development preparedness and rapid research response for potentially epidemic diseases.

The Board is invited to note those documents.

Antimicrobial Resistance

The secretariat provided a report [pdf] giving an update on the United Nations General Assembly High-level Meeting on Antimicrobial Resistance, addressing the rising problem of resistance to antibiotics. The secretariat, according to the document, “is leading the development of a global action plan on HIV drug resistance (2017-2021).”

The document also states that some preparatory discussions have taken place on options for a “global development and stewardship framework to support the development, control, distribution and appropriate use of new antimicrobial medicines, diagnostic tools, vaccines and other interventions, while preserving existing antimicrobial medicines, and promoting affordable access to existing and new antimicrobial medicines and diagnostic tools, taking into account the needs of all countries, and in line with the global action plan on antimicrobial resistance.”

Further expert consultation is required followed by discussion with member states and all relevant stakeholders, and the secretariat is intending to provide options for the framework by the next WHA in May. The EB is invited to note the report.

Public Health Implications of the Nagoya Protocol

The secretariat prepared an analysis [pdf] of the public health implications of the implementation of the Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the CBD. The analysis is based on information-gathering including member states, stakeholders, experts, and various international organisations, such as the Convention on Biological Diversity and the Food and Agriculture Organisation of the United Nations. See detailed story (IPW, WHO, 17 January 2017).

The EB is invited to note the report and provide guidance.

Review of the Pandemic Influenza Preparedness Framework

The agenda includes the report [pdf] of the 2016 PIP Framework Review Group. The Review Group found that the PIP Framework “is a bold and innovative tool for pandemic influenza preparedness,” and is being well implemented.

The Review Group detailed key issues needing to be addressed, in particular the handling of Genetic Sequence Data. The report also includes comments on Standard Material Transfer Agreements 2 (SMTA2) and partnership contributions (IPW, WHO, 23 November 2017).

Global Strategy, Plan of Action on Public Health, Innovation, IP

Also expected to be considered at the EB is a follow up [pdf] of the report of the Consultative Expert Working Group on Research and Development: Financing and Coordination. In particular, the document includes a proposal for a voluntary pooled fund (Annex 2).

According to the document, the secretariat has undertaken a study presenting some possible financing options that could be used to feed the voluntary pooled fund. Further details ono the operationalisation of the fund are currently being developed by UNICEF, the UN Development Programme, the World Bank, and the WHO Special Programme for Research and Training in Tropical Diseases.

In January 2016, a demonstration version of the Global Observatory on Health Research and Development was published online, according to the document. “The Global Observatory on Health Research and Development aims “to consolidate, monitor and analyse relevant information on health research and development needs of developing countries, with a view to contributing to the identification and the definition of gaps and opportunities for health research and development priorities,” it said.

Following consideration of feedback from users, the Global Observatory will be released in early 2017, the document said, and include new elements compared to the demonstration version.

The EB is invited to note the report and to provide guidance on future strategic directions.

In addition, a document (EB140/20) before the Board is a summary of the evaluation and review of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA).

Also for consideration by the EB are the terms of reference [pdf] of an Expert Committee on health research and development. The proposed Expert Committee is expected “to provide technical advice to the director general on the prioritisation of health research and development for Type II and III diseases, and specific research and development needs of developing countries in relation to Type I diseases, as well as for potential areas where market failure exists.”

According to the WHO, Type I diseases are incident in both rich and poor countries, with large numbers of vulnerable populations in each, Type II diseases are incident in both rich and poor countries, but with a substantial proportion of the cases in poor countries, and Type III diseases are those that are overwhelmingly or exclusively incident in developing countries.

Substandard, Falsified Medicines

In November, the 5^th meeting of the Member State mechanism on substandard/spurious/falsely-labelled/falsified/counterfeit (SSFFC) medical products to discuss a range of activities for the period 2016-2017, according to the annotated agenda.

According to the report [pdf] of the meeting, the Member State mechanism “agreed by consensus to recommend the WHO to replace the use of ‘substandard/spurious/falsely-labelled/falsified/counterfeit medical products’ with ‘substandard and falsified medical products’ as the term to be used in the name of the mechanism and in all future documentation on the subject of medical products of this type.”

Appendix 3 of the document explained the rationale of the new working definition of SSFFC.

Global Vaccine Action Plan

The EB is also expected to consider a document [pdf] including a summary of the 2016 assessment report of the global vaccine action plan by the strategic advisory group of experts on immunization.

The report deplores that at the midpoint of the Global Vaccine Action Plan 2012-2020, progress toward the goals to eradicate polio, eliminate measles and rubella, eliminate maternal and neonatal tetanus, and increase equitable access to life-saving vaccines is too slow.

Global average immunization coverage has increased by only 1 percent since 2010, the experts found, calling for countries to expand immunization services beyond infants and children to the whole life course.

The experts also called for immunization donors to “look beyond their investments in Gavi (the Vaccine Alliance) to ensure that Gavi-transitioning and self-supporting countries as well as countries facing large decreases in polio funding have the necessary capacity, tools and resources to sustain immunization over the long term.”

The experts also recommended that vaccine research and development partners support vaccine R&D capacity in low- and middle-income countries, and that vaccine R&D partners accelerate the development and introduction of new vaccines and technologies.

The EB is also invited to note a report [pdf] on the global shortage of medicines and vaccines.

Non-Communicable Diseases

Non-communicable diseases, also known as chronic diseases, include cardiovascular diseases, cancer, and diabetes. The EB document [pdf] on non-communicable diseases (NCDs) includes a “draft approach that can be used to register and publish contributions of non-State actors to the achievement of the nine voluntary targets for noncommunicable diseases.” The EB is expected to provide guidance to the secretariat on this approach.

The document also includes a “Proposed workplan for the global coordination mechanism on the prevention and control of noncommunicable diseases covering the period 2018–2019,” as well as a description of the “preparatory process leading to the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases, to be held in 2018.”

Cancer

[Update] The Board also will consider a resolution in document, EB140/31 [pdf], (pages 6-9) on “Cancer prevention and control in the context of an integrated approach” that includes a reference to ensuring access to essential medicines and technologies. [end update]

2030 Agenda for Sustainable Development

On the UN-wide sustainable development agenda for the year 2030, the WHO secretariat provided a report [pdf] to be considered by the EB. The first part of the report explains that the central role of health in development is “still not widely appreciated.” The second part describes “some of the ways in which the 2030 Agenda is reshaping WHO’s work at country level.”

Programme and Budget, Reform

The secretariat is expected to present a report on the financing and implementation of the programme budget 2016–2017, and a revised draft of the proposed programme budget 2018-2019.

The EB is also expected to consider a report by the secretariat providing an overview of the current status of the WHO reform, and a review of progress made.

Engagement with Non-State Actors

A report [pdf] by the secretariat on the WHO Framework of Engagement with Non-state Actors, adopted in May 2016, describes the implementation of the framework. The report underlines the changes compared to WHO’s existing policies and practices of engagement. This includes an online public register providing basic information on all non-state actors with which WHO engages, as well as an electronic workflow, a process for due diligence, a guide for staff, and a dedicated coordination mechanism.

Also departing from the previous policies, each non-state actor is assigned to one of four groups: nongovernmental organisations, private sector entities, philanthropic foundations and academic institutions. And the framework differentiates five types of engagement: participation, resources, evidence, and advocacy, and technical collaboration. Oversight of the implementation of the framework is provided by the Programme, Budget and Administration Committee of the EB instead of the Standing Committee on Nongovernmental Organizations.

The Board is invited to note the report.

Criteria and Principles for Secondments

The secretariat provided a report [pdf] on the “Criteria and principles for secondments from nongovernmental organizations, philanthropic foundations and academic institutions,” which it has developed. That includes specifications such as the need for specific technical expertise, and the exclusion from managerial and/or sensitive positions. Secondments are temporary in nature, the report said, not exceeding two years.

An electronic consultation for member states was held between 18 November and 1 December 2016 on a set of proposed criteria and principles, which have been revised according to responses received, it said.

The Board is invited to note the report.

UN High-Level Panel on Access to Medicines

A note in the annotated agenda says that the director general and the officers of the EB met by teleconference on 28 September to review the draft provisional agenda. Some items suggested by member states were postponed or not retained for this session of the EB. This is the case of the report of the UN Secretary-General’s High-Level Panel on Access to Medicines.

But a WHO official was quoted later saying the issue could be covered under existing agenda items (IPW, WHO, 30 November 2016).

William New contributed to this story.