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Info Service on Health Issues (June08/01) At the WHO's Executive Board meeting on 26 May, the publications policy of the WHO was the subject of much questioning by WHO Member states. Developed and developing countries raised concerns pertaining the policy (e.g. self censorship) and its impact on the intellectual integrity, editorial freedom and independence of the WHO. A news report on the discussion is reported below. These concerns follow a letter signed by more than 50 NGOs, and a letter by the Chair of the US House of Representatives' Oversight and Government Reform Committee Henry Waxman addressed to the Director General of WHO, Dr. Margaret Chan. A copy of the NGO letter was sent in an earlier TWN IP Info. A copy of the letter by Representative Henry Waxman is attached below. Best
Regards WHO:
Secretariat's publications policy questioned at Board meeting Geneva, 29 May (Sangeeta Shashikant) -- Both developed and developing countries vigorously questioned the WHO Secretariat during the WHO's Executive Board meeting on 26 May on its publications policy and called for further discussion on the matter. Among the questions raised at the WHO's 123rd Executive Board meeting were the need and rationale for the new publications policy, what the present policy is, and what will be the criteria for determining which issues have "policy implications for the Organisation" and which comprise "controversial health related issues" and thus have to go through additional clearance by the Director-General's Office. Other concerns raised included how the centralization of the clearance process may remove the clearance authority of the WHO's Regional Directors, the broad definition of the term "publications" as it covers "materials that are issued by WHO to the public in whatever format and through whatever channel" including advocacy and training materials, and how the policy will affect timely support by WHO to countries. Concerns about "self-censorship" as a result of the policy and transparency in the process were also raised. A comment was also made that insisting on "evidence based" publications was not always possible in the medical field. Many delegations called for the need to have more discussions and to assess the implications of the policy, before it was implemented. However, it is not clear whether the policy will be subject to further discussion and what the Secretariat intends to do about the various concerns and clarifications raised, since the meeting "noted" the Secretariat's report, following what some persons who follow WHO processes closely now call a "trust-me" speech by the WHO Director-General Dr. Margaret Chan. Some delegations indicated that they intend to follow up on the matter, as they were dissatisfied with the explanations provided. They said that, in particular, the explanation did not specifically address what criteria will be used to determine publications containing issues that have "policy implications for the Organisation" and what constitutes "controversial health related issues" (which require clearance from the Director-General's office) and why the differential treatment of publications was needed. The WHO's publications policy contained in two Secretariat's reports, "WHO Publications" (EB 122/20 dated 6 December 2007) and "WHO publications policy: guidance on implementation and evaluation" (EB 123/7 dated 14 April 2008), has become the subject of controversy. Many
believe that the policy is due to pressure from the [The publication titled "The Use of Flexibilities in TRIPS by Developing Countries" was one of the 22 studies commissioned by the WHO Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH), which was published by the WHO and South Centre in April 2006. The CIPIH secretariat had given the go-ahead to publish the study.] Prior to the 26 May Board meeting, serious concerns on the new policy were raised by many NGOs as well as a senior member of the US Congress. Fifty-three NGOs in a letter dated 15 May wrote to the WHO Director-General urging her to reconsider the policy, adding that the policy, if implemented, will result in a tendency towards "self censorship" by WHO and its staff. (See http://www.twnside.org.sg) The letter also expressed concern that the policy will hamper timely advice and support by WHO headquarters and regional offices to member states over important issues such as the application of intellectual property rights and the use of TRIPS flexibilities, other trade and health matters, reproductive health care and other issues. The Chair of the US House of Representatives' Oversight and Government Reform Committee, Henry Waxman, sent a letter dated 19 May 2008 to Dr Chan, urging the WHO "to minimize the possibility of inappropriate political interference with the publication process", and expressing hope that WHO's new publication policy will be "designed in a manner that is not politicized and continues to prioritize scientific and intellectual freedom." (See http://www.essentialaction.org/access/index.php?/archives/154-Waxman-letter-on-WHO-Publications-Policy.html) The new publications policy requires publications "that describe the workings of a particular government or national health service or that have policy implications for the Organization or address controversial health-related issues" to go through "additional clearance by the Director-General's Office" while the final text of all other publications can be cleared by the "relevant Assistant Director-General or Regional Director before publication." (paragraph 13 of EB 122/20). This requirement is also applicable to "any article, book chapter or invited commentary relating to WHO's work that is to be submitted by a staff member for external publication" (paragraph 9 of EB 122/20). The policy defines "publication" in footnote 2 of EB 122/20 as "information products, i.e. Materials that are issued by WHO to the public in whatever format and through whatever channel. It excludes materials internal to WHO." Paragraph 3 of EB document 123/7 further defines information products as "written or illustrated works that the Organisation makes publicly accessible. Examples include documents on the website and journal, articles, guidelines, reports, training materials and advocacy materials in any format (printed, web, CD-ROM/DVD or audiovisual), whether sold or distributed free of charge". The policy documents also mention the aims of having evidence-based publications, reducing costs, publishing fewer titles and reducing hard copies while disseminating WHO's publications more through electronic means. A "policy coordination group" (which will report to the DG) is to be set up to oversee implementation of the policy. There will be forms for executive and production clearance, which will be incorporated into the approval process management tool. Those responsible for clearing a product must check for technical accuracy and conformity with the Organisation's policies, and they must recognize when to refer the products to the DG's office for additional clearance where it concerns controversial health related issues and policy implications for the Organisation. According to the new policy, there will be categories of products wherein a specific category will trigger the relevant pathway for content development, production, dissemination and the appropriate criteria for clearance. For example, if a product concerns guidelines, then it must be developed according to the procedures put in place in the Guidelines Review Committee, whereas advocacy materials must be created in accordance with standards set by the Department of Communications in HQ. A master list of planned publications will also be prepared for executive approval at the beginning of each biennium (EB 122/20). According to the Secretariat's report (EB 123/7), the policy will be regularly evaluated. A full report on the implementation of the policy will be submitted to the Executive Board at its 129th session in 2011. It did not see any reason to implement this policy, which may result in self-censorship. It believed that "controversial health related issues" should be debated openly, as one of the objectives of the WHO is to provide information without any interference or political pressure from member states. Djibouti, on behalf of the Eastern Mediterranean Regional Office, said that the WHO's greater stress on electronic publication must not run counter to access to information, as access to electronic information is limited in developing countries. It added that assessing the impact of information products produced is not an easy task as it requires broad research to identify whether WHO's publication has been used for the development of a policy. The
Responding to the concerns and questions raised, Dr. Tim Evans, WHO's Assistant Director-General for Information, Evidence and Research said that the process approval was intended to develop greater awareness, responsibility and accountability of all those involved in the process, make the approval process faster, avoid duplication and produce materials in line of the Organisation's strategic objectives and priorities. He added that the master list will periodically be updated. With regard to executive clearance, he said this is "not a new clearance mechanism". He added that access to publications will not be "compromised". WHO's legal counsel Gian Luca Burci said that there are some issues with regard to correctness of terminology, expressions and references to political and legal status of states and taking care of the accuracy of these descriptions falls under the corporate responsibility of senior management. He added that there is already a review mechanism but the policy is important to strengthen the programmes. Dr. Chan said that this is not a "new policy", adding that WHO has a policy that moved from centralization to decentranlisation but it is important to review the policy, thus the issuing of the new documents. She said that she guarded her "editorial independency with jealousy" and there is "no question of censorship", adding that they will base documents on best evidence possible, consistent with the WHO's core functions. She added that the publications have to be "peer reviewed" but this also has problems, i. e it can be "incestous" depending who is on the peer review committee. She said that there is no question of favouring vested interests or staff members, and documents were produced to serve the interests of countries. She added that she had to do a balancing act and walk a fine line. On clearance process she said that it is a means to demonstrate accountability of senior management, and regional directors should have prerogative to decide what documents are important without undue cumbersome process. She added that in her short stint in WHO, there have been several embarrassments with regard to names, maps and boundaries mentioned in publications, and some publications have to come back to the HQ for her review, so that she does not have "political difficulties." After
the Board meeting, Sarah Rimmington of Essential Information (one of
the NGOs following the issue) said that several countries, including
"Several countries also asked that the policy be placed before all member states of the WHO for approval before implementation. Director-General Dr. Margaret Chan and the WHO Secretariat responded by asserting that they would jealously guard WHO's independence. "The issue at stake, however, is not the personal integrity of anyone within WHO. What matters is whether the agency will become overly centralized and bureaucratized and, most importantly, how and whether WHO will approach "controversial" topics. "Centralized review will give corporate and ideological interests an opportunity to protest against WHO publications, with profit or ideological motivations dressed up in the garb of scientific argument. Moreover, the requirement that undefined "controversial" topics require centralized review inevitably will mean that country officers and others will steer away from such issues, no matter their importance." Rimmington said that it is worth reflecting on important public health issues that might reasonably be considered controversial. A partial list would include: alcohol, diet and nutrition, sugar consumption, tobacco, chemical exposure, climate change, family planning and reproductive health issues (for example, birth control, abortion and sex education), health interventions targeting sex workers, intellectual property and medical R&D, traditional medicine, the prices and advertising/marketing of medical products, rational use of medicines, malaria control, treatment of malaria, TB, HIV/AIDS and mental illness, car and traffic safety, disaster relief, air pollution, arsenic, bio-terrorism, baby food marketing, clinical trial conduct, gender-based violence, genetically modified food, pesticide use, health insurance systems, healthcare user fees, wealth inequality and health, and medical waste. She
commented: "Just to see such a list is to understand the need for
a re-think. Hopefully, "The Chair of the US House of Representatives' Oversight and Government Reform Committee, Henry Waxman, sent a letter dated 19 May 2008 to Dr Chan, urging the WHO "to minimize the possibility of inappropriate political interference with the publication process", and expressing hope that WHO's new publication policy will be "designed in a manner that is not politicized and continues to prioritize scientific and intellectual freedom." (See http://www.essentialaction.org/access/index.php?/archives/154-Waxman-letter-on-WHO-Publications-Policy.html The text of the letter follows Congress
of the May
19, 2008 Dear Dr. Chan: It has come to my attention that the World Health Organization (WHO) may soon be adopting and implementing a new policy regarding publications. I am writing to express my hope that any new policies adopted will be designed in a manner that is not politicized and continues to prioritize scientific and intellectual freedom. My understanding is that the proposed policy would provide special review for publications that "describe the workings of a particular government" or discuss "controversial" issues. I am concerned about this change because of past demands by the current U.S. Administration that WHO withdraw a publication perceived to be critical of U.S. policy.[1] At the time, U.S. officials also called for "a full review" of WHO's publication policy.[2] Though the publication in question was not withdrawn, the proposed changes could increase the likelihood of inappropriate interference with the work of 'WHO in the future. WHO publications cover a broad range of medical and scientific issues and range from journal articles to reports to technical guidance documents. They are an important resource for policymakers, health care professionals, and public health advocates around the world. Under current policy, as described in a WHO Secretariat report, documents are reviewed by appropriate WHO offices and by independent experts, under the supervision of assistant directors-general and regional directors.[3] Documents are "expected to reflect the latest scientific and medical research" and those designed to "facilitate debate" are to be "evidence-based. balanced and constructive."[4] At recent meetings, the WHO Executive Board has discussed proposals to change the publication process. Stated objectives include minimizing costs, maximizing the availability of documents, and ensuring the reliability and validity of scientific information in WHO documents.[5] These are important objectives. However, I urge you to oppose additional changes that could increase the risk of politicization of the WHO publication process. For example, extra review of publications that address "the workings of a particular government or national health service" could invite protest and interference from any country that feels it has been criticized, no matter how valid the policy analysis. Similarly, extra review of publications on "controversial health-related issues" could introduce a similar level of protest, obstruction, or delay. Moreover, this kind of scrutiny of publications could produce a chilling effect on researchers and experts, discouraging the exploration of topics that could trigger an extra layer of review. The WHO is a crucial and trusted source of medical and health information for governments, health professionals, and the public in every corner of the world. I urge the organization to continue to prioritize scientific independence and minimize the possibility of inappropriate political interference with the publication process. Sincerely, Henry
A. Waxman [1] Letter from Sen. Edward M. Kennedy and Rep. Henry A. Waxman to Secretary Michael Leavitt, U.S. Department of Health and Human Services (Oct. 13, 2006) (online at http://oversight.house.gov/documents/20061013142520-31371.pdf); citing letter from William R. Steiger, HHS Special Assistant for International Affairs, to Acting Director General Anders Nordstrom, World Health Organization (Aug. 18, 2006). [2]
[3]World Health Organization, Programme Budget and Administration, Committee of the Executive Board, Provisional Agenda Item 3.2, WHO publication policy: Report by the Secretariat (May 3, 2007). [4]
[5] World Health Organization Executive Board, l23nd Session, Provisional Agenda Item 6.2, WHO Publications Policy: Guidance on implementation and evaluation, Report from the Secretariat (Apr. 14, 2008).
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