HAI voices concern over WHO’s ‘partnership’ with private sector

by Chakravarthi Raghavan

Geneva, 13 May 2001 - - An international coalition of about 150 NGOs from over 70 countries has voiced its concern over the close relationships between the pharmaceutical and other corporate interests with the World Health Organization (WHO), and has complained that corporate profits and interests are being promoted rather than public health.

In a briefing paper on ‘Drug Policy’ at the 54th World Health Assembly, opening in Geneva Monday, the coalition, ‘Health Action International’ (HAI), has expressed reservations and doubts about the way the relationships have developed, with industry being able to second staff to key positions in the WHO secretariat and influence policy, which have raised serious questions about the “integrity of WHO decision-making”.

HAI is a network of 150 consumer, health, development action and other public interest groups involved in health and pharmaceutical issues in more than 70 countries.

The coalition has called on member states to call for a moratorium on additional new public-private interactions involving the WHO.

“Until WHO is able to effectively show that it has mechanisms in place to guide and evaluate all of its joint activities with the private sector, member states should call for a moratorium on additional public-private sector interaction involving the WHO,” the HAI briefing paper says.

Southern governments participating in some current public-private sector initiatives should request a decision-making role in how they are organized, implemented and evaluated, so that their priorities and concerns are not marginalised at any time in the process, HAI adds.

HAI has cited the much-publicised ‘partnership’ deal between transnational pharmaceutical corporations and the WHO, UN and other UN agencies in providing AIDS drugs to Africa and the way it has actually worked out, and the ability with which pharmaceutical corporations and tobacco companies have been able to put their own consultants in positions in the secretariat, paying them to serve corporate goals while working for the WHO.

“If WHO or member states give away their responsibility to promote public health and instead promote corporate involvement in global public health initiatives, what will this mean for citizens?” asks HAI, adding, “There is a need for much more research on the long-term, societal consequences of public-private sector ventures.”

Concerns similar to that of the HAI briefing paper (for governments and NGOs at the World Health Assembly) about the secretariat/corporate arrangements, have also been raised by civil society organizations over such cozy relationships that have developed between the UN and UN system organizations in the recent period, and the UN Secretary-General’s ‘Global Compact’ with corporations, and the International Chamber of Commerce- UNCTAD collaborations at country-levels and at the LDC meet in Brussels, ostensibly to promote TNC investments in LDCs.

Several NGOs, and governments too, have been privately pointing to the increasing relationship of TNCs in the WHO in recent years. This relationship began after Hafdan Mahler left as Director-General, and was replaced by Japan’s Nakajima, but appears to have grown greatly after Mrs. Gro Harlem Bruntland took over, and the World Bank and the Harvard University Group acquired a large influence. The issues raised by HAI in relation to the WHO, have also figured in the meetings of the WHO Executive Board in January, when the WHO secretariat’s drawn-up guidelines on working with the private sector had been put up for ‘noting’, but found several governments (Venezuela, Italy, Congo, France, Belgium, Sweden, Brazil, Cote d’Ivoire, India, China, Guatemala, Bangladesh and Chad) speaking up critically, and raising their concerns about maintaining WHO’s independence, when WHO had so much interaction with industry.

An electronic working group to enable the Board members and their advisors to revise and strengthen their guidelines was promised, but as of beginning of May, the electronic working group had not yet been created.

On the ‘partnership’ to provide AIDS drugs cheaply to Africa, HAI points out that the much-publicised year-old initiative, to date, has resulted in price-reduction arrangements with only five African governments. And HAI’s research showed that even with the 80% price reductions, the drugs remained far beyond reach - at $720 to $1,320 per person per annum, compared to the prices offered by three generic firms in India - who offered the drugs at $600. $347 and $ 285 respectively. But even at this price, access was a problem.

The WHO is now in active participation in a number of international health initiatives involving powerful private sector interest, and is raising more and more funds from commercial enterprises and related groups to support its work programme. This growing dependence on the corporate sector and its financial resources, “risks diverting WHO from its normative function and role as a policy-making body on public health issues... (and) also discourages exploration of other possible funding sources more in line with WHO’s primary health care goals,” HAI says.

“As the world’s leading public health organisation, WHO must set clear rules on how it collaborates with the private sector. It must step back and critically analyse if the well-publicised, public-private ventures in which it is now involved have more to do with corporations’ political and economic aims than they do with public health outcomes. It must also demonstrate that the poor directly benefit from such public-private ‘partnerships’.”

“The extent to which WHO relies on corporate interactions and funding will fundamentally affect how well it can support public health goals and address current government limitations to do so.”

Though this close involvement in industry-WHO ‘partnerships’ is often said to be the result of greater social responsibility on the part of TNCs, says HAI, closer scrutiny suggests that it could be more closely related to ‘enlightened self-interest’. For example, in 1999, HAI discovered that the pharmaceutical company, MSD, had succeeded in seconding a senior staff member to the staff of the WHO Tobacco Free Initiative (TFI). An internal company announcement called it “a marvellous opportunity to continue to build bridges”, and said the corporation expected the person to be an “effective ambassador”. When questioned about potential conflicts of interest between WHO’s public health goals and industry’s profit motive, WHO’s Director General said she would not rule out the possibility of secondments to WHO from pharmaceutical companies.

Yet in October 2000, the WHO announced that it would take measures to counter tobacco company influence in response to a WHO Expert Committee’s findings that tobacco companies had infiltrated the organisation and attempted to undermine its anti-smoking agenda. That report stated: “Of greatest concern, tobacco companies, have, in some cases, had their own consultants in positions at WHO, paying them to serve the goals of tobacco companies while working for the WHO.  Some of these cases raise serious questions about whether the integrity of WHO decision-making has been compromised.”

The WHO and other potential partners often do not systematically or publicly evaluate how the companies make their profits. The partnership discussions often overlook the fact that the same companies, now stepping in to fill funding gaps once covered by governments, are often the same ones that have successfully lobbied for lower corporate taxes.

In some cases, the TNCs are also known violators of international agreements on environmental protection, labour standards and promotion practices.

Referring to the secretariat guidelines that was presented to the Executive Board, HAI says they contain a number of flaws: they fail to give a clear definition of conflict of interest, with the consequence that secondment of staff from the private sector, including pharmaceutical companies, is not perceived as a conflict of interest.

The guidelines do not emphasise the risks in involving the commercial sector in research such as potential broadening of disease definitions for increased product markets. The guidelines make no provision for independent evaluation of potential donors and their compliance with WHO agreed standards and international agreements on human rights, the environment, marketing and labour practices.

The cardinal principle of the guidelines should be complete accountability and transparency, says HAI. WHO’s interactions with all private sector donors must be contractual and publicly accessible. The process of assessing and approving agreements, as provided in the guidelines, is now “totally internal.”

For the sake of transparency, the guidelines must make independent review mandatory. As an “interested party, WHO cannot also monitor its own contractual agreements.”

External monitoring and evaluation of work involving commercial enterprises must be carried out to see if equitable and sustainable health outcomes are achieved.  A major flaw of the guidelines is the lack of any substantive role for civil society in monitoring the WHO’s relationships with the private sector.

It is not only NGOs and member states that have raised concerns about industry’s growing relationship with WHO and the present guidelines, says HAI.

Parts of the WHO itself are raising these questions. The report of a seminar on public-private interactions, co-sponsored by the WHO last year, clearly states that “it is timely for WHO to step back from the current situation and reflect on the appropriate role of GPPPs [Global Public-Private Partnerships] in order to meet public health and equity needs”. Seminar participants further called for an open discussion on these WHO guidelines, and said that such discussion should involve member governments, civil society and other interested parties, taking into account evidence and analysis at the global and national level.

In principle, HAI, and many other public interest NGOs, are not against WHO’s co-operation with the corporate sector. However, there are huge differences in the quality, sustainability and power relationships involved in the types of co-operation now being labelled as ‘partnerships’. HAI supports initiatives that advance public health in a sustainable and equitable way, and calls for an open, public debate on the best way in which all stakeholders can work with the WHO to reach that goal.

Among its recommendations for action, HAI has called on the WHO “to develop a transparent, accountable mechanism involving member states and civil society...  to monitor all of its interactions with the private sector.”

The WHO should also provide for independent evaluation of potential donors and their compliance with WHO agreed standards and international agreements on human rights, the environment, marketing and labour practices.

“Before participating in any public-private venture, WHO must demonstrate that the project’s beneficiaries, particularly the poor, will directly benefit from it in an equitable and sustainable way. Each interaction should be evaluated according to public health criteria. This safeguard should apply to all types of interactions with corporations and their related bodies.”

All of WHO’s public-private ventures must be based on contractual agreements, accessible to the public, and have a clause allowing termination of the contract and the possibility of negative publicity, if corporations do not uphold their contractual agreement.

The WHO’s use of the word ‘partnership’ should be replaced with terms that more accurately describe the actual relationship.

And, WHO should ensure that member states are involved in the decision-making processes on public-private interactions so that national health priorities, such as essential drug policies and immunisation programmes, are not damaged.

WHO should carry out a public assessment of past ‘partnerships’ to review if the poor have benefited from them, and if other alternatives could have provided better public health and policy outcomes, at less cost.

And in order to protect its own mandate and integrity, the WHO should explore other, non-corporate funding sources more in line with its own primary health care goals.

The WHO’s guidelines on working with the private sector to achieve health outcomes should be revised and strengthened to: clearly define possible conflicts of interest, provide adequate mechanisms to ensure complete accountability and transparency.

Secondments of staff from the corporate sector, particularly the pharmaceutical industry and ‘revolving door’ employment between the WHO and industries affected by its activities should also be banned. Staff or consultants should disclose any potential conflict of interest when hired by the WHO

All public-private interactions involving WHO should be based on contracts that are publicly available, and include mechanisms for external monitoring and evaluation of all work involving commercial enterprises to see if equitable and sustainable health outcomes have been achieved.

HAI has also called upon the secretariat to also facilitate and support the Executive Board’s agreement (in January) to create an electronic working group aimed at improving the guidelines, which will report back in January 2002.

This last seems to imply that the delay in forming the working group to look at the secretariat drafted guidelines and improve on them is attributable to the secretariat’s failure too.

HAI has also called on national governments to support a substantive role for civil society in monitoring and evaluating WHO’s interactions with the private sector. Governments of the South participating in public-private initiatives should request a decision-making role in how they are organised, implemented and evaluated so that their priorities and concerns are not marginalised at any time in the process. And until the WHO is able to effectively show that it has mechanisms in place to guide and evaluate all of its joint activities with the private sector, member states should call for a moratorium on additional public-private interaction involving the WHO, HAI said, and asked all interested member states to participate in the electronic working group aimed at strengthening and revising the WHO guidelines on working with the private sector to achieve health outcomes, and encouraged to involve any desired advisors in this process as proposed by the Chair of the 107th Executive Board in January. – SUNS4895

The above article first appeared in the South-North Development Monitor (SUNS) of which Chakravarthi Raghavan is the Chief Editor.

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