WHO stung by delegates’ criticisms
The World Health Organisation system was shaken up during the World Health Assembly in the past week over the way that the Secretariat has been dealing with the issue of intellectual property and its link to access to medicines.
Widespread and sharp criticisms from some member states as well as health-related NGOs were made on several aspects of how senior officials of the WHO have either recently neglected the traditional priority given by the WHO to public health over patents on drugs, and how the WHO system has operated in a biased way to the detriment of developing countries.
The issues include:
- Avian flu: Indonesia and 22 other developing countries complained about the inequity of the WHO requiring countries to contribute freely their viruses to the WHO system, but allowing parts of the viruses to be patented and commercialised without their knowledge; and with developing countries not getting affordable access to the vaccines and technologies to make them.
- Inter-Governmental Working Group on Innovation and Intellectual Property (IGWGIIP): The developing countries had fought hard to set up this group at the 2006 WHA. However, they are frustrated that there has been almost no progress in the group (after an uneventful first meeting) and that the Secretariat had done little to substantially service the group, and the Secretariat allocating little resources to its work.
- Commission on Social Determinants: This was originally a WHO effort to revive primary health care and highlight social factors in public health, and had been a high priority in the WHO plan. However, the latest budget plan put to the WHA removed the Commission from its priority list, while allocating little funds to its work.
The frustrations felt by many developing country delegates spilled over at several WHA events and meetings, including in Ministers' plenary speeches, at a WHO technical briefing on the IGWGIIP, and at a committee discussion on the WHO budget.
The most frank complaint was presented to the WHO Director-General, Margaret Chan, by Thailand's senior health official, Dr. Suwit Wibulpolprasert, during the session on the WHO's budget.
He said that in the Director-General's foreword to the budget document, the Commission on Social Determinants had been removed from the list of WHO priorities, as compared to the previous version of the budget presented to the Executive Board in January.
This clearly reflects inadequate understanding by the Secretariat on the social factors affecting health, said Dr Suwit. He added that while the new Director-General (DG) reiterated that she respects the previous DG Dr. Lee (who passed away on the eve of the WHA in 2006), her staff disrespects his initiatives. He urged the DG to investigate who prepared the foreword text.
If the WHO staff had done this, they should be punished and demoted as this had shown disrespect for the previous DG, the Thai senior official said.
Dr. Suwit added: if the DG herself had prepared the foreword, she may need to see the old DG at night! He suggested that there was need to re-insert the reference to Social Determinants in the foreword, implying that this was an indicator of the importance of the item in the budget allocation.
Dr Suwit also urged the DG to play an active role in the IGWGIIP. There was no leadership from the WHO in relation to this working group. This inadequate support was another evidence of disrespect for Dr. Lee.
Dr Suwit reiterated his concerns on the programme budget. Voluntary contributions were being made according to the donors' interests. There was concern that the WHO would become a donor-driven organization and the interests of developing countries would be neglected. There should not be hiring in the Secretariat for the interests of a few.
The Secretariat is not free from bias, said Dr Suwit, adding that in the avian influenza issue, there was a non-transparent process. One member state that has a WHO collaborating centre has shown disrespect for the agreed terms of reference by sending viruses outside the WHO-accredited laboratories and there has been patenting of the materials.
When the Secretariat was queried on this, instead of investigating the WHO centres, the Secretariat wiped out the terms of reference from the website. A developing country was bullied by another country who disobeyed the terms of reference. This has not been investigated.
Dr Suwit remarked that there is biased action by the Secretariat, which cannot be trusted. Trust is the main element of global solidarity. Without trust, it would be difficult to work together. He hoped that there can be a rebuilding of trust, which is very important for global solidarity on the influenza pandemic.
Director-General Margaret Chan later said that she wanted to respond as personal integrity and the credibility of the organization had been raised. On the point about the Commission on Social Determinants, she said that she took responsibility. She agreed that tackling social determinants is extremely important.
The Commission's report will not be ready until June 2008 and would be presented at the WHA in 2009, and the budgets for the years would reflect this, and there was respect for the member states by not pre-empting their debate and recommendations.
The DG acknowledged the major contribution of the WHO collaborating centres and the countries hosting the centres. She also recognized that there had been some behaviour that was contrary to the WHO guidelines. "We take full responsibility for not monitoring the centres and to have the centres implement the guidelines," she said. She had personal commitment to maintain the integrity and credibility of the organization. In the new terms of reference, for centres that do not adhere to the terms of reference or that behave in an inappropriate manner, sanctions on them may be considered and she looked to the member states for guidance and advice.
On Friday (18 May), Chan was in attendance at the committee session discussing the Inter-Governmental Working Group on Innovation and Intellectual Property. She made a significant introduction stating that the complexities of the intellectual property issue had hit her very hard in the past few days.
She explained that her professional background had been in health regulation and she had not been so familiar with the IPR issues. She had become increasingly aware of the importance of IPR issues to the member states.
She pledged to give her full commitment to strengthen the IGWGIIP process. She also revealed that she had held a four-hour meeting the day before with her WHO officials who deal with IP issues and the IGWGIIP, to get better briefed.
Before that four-hour meeting, at a WHO technical briefing session on the IGWGIIP on 17 May, the WHO Secretariat had come under fire for not taking the IGWGIIP seriously.
At question time, an NGO representative commented that at the end of the first meeting of the IGWGIIP late last year, some developing country delegates had remarked that it was a disaster, with no progress, and that the Secretariat had not taken the group's work seriously nor had it prepared for the meeting.
Several delegations criticised the process and the Secretariat's inadequate role.
A Kenyan health official, for example, said that African countries had not been able to meet at the regional level to prepare for the IGWGIIP sessions, and called for resources from the Secretariat.
Brazil and Thailand were among others who voiced disappointment with the slow process, with the latter saying that even the "low-hanging fruits" had not been harvested and that those who were longing for the fruits could only dream of the taste.
Another participant said that the WHO should be doing more to positively assist developing countries to implement "TRIPS flexibilities" (i. e. measures such as compulsory licensing that are allowed by the WTO's TRIPS agreement, to enable the supply of cheaper generic drugs).
According to WHO sources, Chan was informed about the strong criticisms made at the 17 May technical briefing, and about how the developing country members were evidently frustrated with the wrong signals coming from the WHO leadership and lack of interest of WHO senior staff on the IP issues.
Chan herself had been enveloped in controversy when she visited Thailand in February and was quoted by a leading daily as criticizing the Thai compulsory licenses for three drugs. It was then reported that a dinner with the Thai Health Minister was cancelled. Subsequently, the DG wrote a letter to the Minister, expressing her regret, and confirming that the Thai authorities had acted within their rights.
According to WHO sources and delegations at the WHA, on 17 May evening, Chan convened a small meeting of some of her staff involved with IP issues. It was a very frank meeting, where a post-mortem was done on the WHO's performance and where it had recently gone wrong, especially on its handling of the IGWGIIP and other IP issues.
The direct criticism in her presence by Dr Suwit at the finance session, and the concerns raised frankly at the 17 May briefing perhaps had shocked the Director-General to the extent that she sought an explanation from her staff, in the internal Secretariat meeting that stretched to four hours, said a keen observer of the WHO.
A draft resolution by Brazil on public health and intellectual property, presented on 18 May to a WHA committee, also emphasized the developing countries' unmet expectations of the WHO.
The draft resolution urged the WHO Director-General to be proactive and to support member states intending to use TRIPS flexibilities (such as compulsory licensing in relation to patented drugs). The draft is expected to be negotiated on 21 and 22 May.
Meanwhile, the issue of sharing of avian flu viruses has also been a thorn in the Secretariat's side at the WHA throughout the week, with some developing countries criticising the WHO Secretariat for neglecting to have oversight of the WHO system that is now shown to be facilitating the transfer of donated viruses to companies that patent parts of the virus and vaccines.
The developing countries are angry that their consent was not obtained, thus breaking the WHO guidelines. They also fear that the patenting of viruses and vaccines would raise the prices of vaccines, while also possibly creating barriers for developing countries that wish to use technology and virus parts in attempts to develop their own capacity for vaccine production.
In a plenary speech, Indonesian Health Minister Dr Siti Fadilah Supari, said that Indonesia had freely made virus samples available to WHO collaborating centres. But the principle of prior informed consent from countries in which the viruses originate were not followed when samples were passed on, thus violating the WHO guidance on this issue.
This situation forced Indonesia to stop sending the virus specimens abroad to shed light on an unacceptable situation, said the Minister. There are two negative consequences. First, the virus or its parts are patented, violating the spirit in which the virus is given.
Second, there is an unfair mechanism in which Asian flu virus samples are given free by developing countries, but drug companies patent the vaccines and sell them at an un-affordable cost and there is no guarantee that the poor countries would be provided with the vaccines as production capacity is limited, said Dr Supari.
On 16 May, at a WHO briefing to delegations on avian flu, Margaret Chan had given a stern warning to countries that they had to continue sending viruses. "I cannot have my hands tied, my mouth muzzled," she said, in what some present at the briefing described as a castigation of countries that have been reluctant to continue donating viruses.
Two days later, the Director-General's tone had changed from stern lecturing of developing countries to one of requesting patience while she developed her knowledge on why IP issues are important for public health.
Intense negotiations will be continuing on two IP-related issues - avian flu and the Brazilian proposal on public health and IP - as the WHA winds down to a close on Wednesday (23 May).