Info Service on Health Issues (Jan15/06)
Geneva, 30 January (Mirza Alas) – A new time line with guidance from Member States is proposed for improving a framework on engagement with non-State actors at the World Health Organization.
Discussions on the framework document prepared by the WHO Secretariat began on Tuesday, 27 January at the meeting of the 136th session of the WHO Executive Board (EB) that is going on from 26 January to 3 February at the WHO headquarters in Geneva.
However, during the plenary session, when this agenda item was discussed, many countries expressed their dissatisfaction with the current draft framework and Argentina proposed a draft decision to convene a working group for deciding on the way forward.
(For details of the current draft of the framework please see: http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_5-en.pdf)
Member States then held two lunch meetings and one evening meeting, with Argentina as the chair, deciding on the best alternative for the way forward. A draft decision proposed by Argentina and resulting from a drafting group on the Framework on non-State Actors was published today (30 January) and is expected to be adopted by the EB in the next few days.
(For details see: http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_CONF5Rev1-en.pdf)
The draft decision notes that progress has been made on the elaboration of the framework but further improvements are needed. A new timeline for negotiations has been established and an annex with a “non-exhaustive list of issues” has been also added.
It invites Member States “to submit to the Director-General (DG) specific proposals for amendments, inclusions or deletion of text from the draft overarching framework of engagement with non-State actors and the four specific policies contained in the annex of EB136/5 by 16 February 2015”.
It also requests the DG to compile these proposals and to make them available for Member States by 9 March 2015, and to convene an open-ended intergovernmental meeting from 30 March to 1 April 2015 with a view to discussing the textual proposals submitted by Member States. Based on the outcome of the intergovernmental meeting, the DG is to submit a revised version of the Framework of Engagement with non-State actors to the Sixty-eighth World Health Assembly through the Programme, Budget and Administration Committee.
The topics currently on the “Non-exhaustive list of issues which seem to need more work amongst Member States” are:
· Conflict of Interest (including individual conflict of interest)
· Criteria of due diligence and process of risk management
· Secondments and provision of personnel
· Role of private sector (acceptance of funds, pooling mechanism, evidence generation and advocacy)
· Engagement with particular industries
· Criteria for attribution to type of non-State actors, including criteria applied to classify some nongovernmental organizations as international business associations
· In which kind of meetings can non-State actors participate
· Use of funds provided by non-State actors to support the salary of WHO staff
· Official relations (some aspects)
· Policy, norms and standard setting
· Applicability of the Framework to all levels of the Organization and all 6 regions
· General principles that guide collaboration
· Definitions of terms (“arm’s length”, “resources”, etc.)
· Support to policy making at national level.
This draft decision is a welcomed step for many Member States that expressed concerns that the framework, in its current form, is inadequate to reflect the range of issues that could redefine the role of the WHO. At the same time, some developed country Member States such as the United Kingdom and France referred to the framework as an important step in providing WHO the flexibility it needs to manage its relations with different actors and supported its adoption at the current EB session. However, there are still unresolved issues between the two positions and the months ahead could provide the necessary time to look in-depth into the list of topics currently in disagreement.
Dr. Margaret Chan, the WHO DG, has also signaled interest for this process to be completed since the start of the EB on 26 January when she struck an emotional note in the face of Member States’ criticism on the framework, especially on the issue of conflict of interest. While replying to the general statements made by several Member States at the plenary session, Chan said that, “Some of you get upset about industry but then what about the free medicines that are getting to people. There is no such thing as conflict of interest. Do you want me to support the 1 billion people in poverty? Otherwise I turn away and don’t deliver.”
She added that while looking at the framework, Member States should think of 1 billion people anchored in poverty. She further stated that, “you cannot tell me not to work with the private sector “ and cited the example of the Ebola crisis.
An observer at the EB meeting noted that Chan’s response misses the point. The issue is not about whether to engage or not with some types industry but how and what lines need to be drawn in order to not undermine the public health mission of WHO.
The draft framework has drawn red lines by excluding the tobacco and arms industries from any WHO engagement. However, there are no criteria for excluding other industries. Many Member States have expressed concern over the soft approach to other industries, which pose a public health risk such as the food and beverage industry. The framework in Paragraph 44 states: “WHO does not engage with the tobacco or arms industries. In addition, WHO will exercise particular caution when engaging with other industries affecting human health or affected by WHO’s norms and standards”.
However, no details have been provided in the framework on how the Secretariat is going to exercise caution while engaging with these parts of the private sector. The nature of WHO’s engagement with the food and beverages industry, for example, is absolutely critical as they concertedly lobby governments and international institutions to prevent regulation over their activities in the battle against non-communicable diseases.
Another example to underscore conflict of interest that has sparked controversy and public outcry for years is the tremendous influence that the transnational pharmaceutical industry has over intellectual property norm setting and exorbitant pricing of medicines. Some pharmaceutical giants have even taken sovereign governments to the courts to challenge national patent laws and decisions that reject patents on some life saving medicines.
Another observer familiar with the debate over the framework since 2012 said that the resistance of the WHO Secretariat to have concrete rules or guidelines to deal with conflict of interest, and even to make a clear distinction between public interest non-governmental organizations (NGO) and business interest NGOs, reveal precisely the kinds of situations that the framework needs to address.
During the plenary meeting on Tuesday, 27 January the concerns of many Member States about the adoption of the current framework were heard.
Below are the highlights of several country statements on the position pertaining to the Framework of engagement non-State Actors, including responses to Argentina’s proposal.
Brazil emphasized that dialogue is important as well as a clear basis for the framework. It reiterated that the centrality of the decision process should be with the Member States and the WHO should coordinate the process. Conflict of interest and all the interactions and process should be transparent and have participation from the Member States. Clear parameters need to be done for WHO participation. Brazil proposed the creation of a working group until the World Health Assembly in May 2015.
South Africa, in aligning with Argentina, emphasized the importance of ensuring a strong framework of engagement but it noted that there were a few areas that needed to be addressed. These were:
Argentina welcomed the report and acknowledged the importance of the framework as part of the reform process of the WHO. However, it noted that many issues are still unresolved. The proposal from Argentina was to set up a consultation mechanism and it asked the Secretariat to help make a room available for Member States to meet in order to define a road map and process to get to the 68th WHA (in May 2015) with agreement.
Iran on behalf of the Eastern Mediterranean Region (EMRO) remarked on the work of the WHO Secretariat on the framework and the importance of that work for the Organization, especially for the future implications that it will have and the credibility of WHO. However, the document requires further improvement before its adoption and further deliberation is needed in a time-bound open-ended process. It supported the draft decision proposed by Argentina.
Cuba welcomed the report and noted that engagement should be on the basis of public health and avoid any risk for WHO, in particularly conflict of interest. It also asked for clarification of how non-State actors can help in the implementation of national policies without interfering with national governments. Paragraph 46 (of the draft framework) suggests that WHO should not accept secondments but in the rules of procedure for NGOs and Academics there is acceptance of secondments. There should not be secondments for anyone, Cuba stressed.
Nepal on behalf of the South East Asia Region (SEARO) noted that the issue of conflict of interest is still not addressed, as there are still questions of governance concerning implementation. The political project proposes some activities but does not say any word on the concerns and prevention of conflict of interest. Nepal stressed that it was necessary to define the criteria to select non-State actors and foundations and it has concerns that otherwise WHO would choose its programs according to the expectations of donors.
The document says that collaborations can be stopped but is not clear, from the document, how it can be done. Nepal stressed the importance of ensuring the integrity and reputation of WHO regarding non-State actors and strongly emphasized that WHO should not engage with the tobacco and food industry. A revision of the document taking into account the concerns expressed was necessary, it said.
Uruguay, speaking on behalf of the Union of South American Nations (UNASUR), recognized that debate concerning reform transcended financial issues. Transparency of the process, risk management, defining of conflict of interest and earmarking of funds are key in this debate. The document does not describe, with enough details, the criteria that non-State actors should meet in order to be inside the categories and the decision making in WHO governing bodies must remain the prerogative of Member States, stressed Uruguay. This includes all decision making process, not just governing bodies. The document should include a roadmap – on WHO engagement – how it should be organized, along with official relations, partnerships. It supported the proposal to establish an ad hoc drafting group.
India emphasized that the real issue was avoiding conflict of interest. It noted that some of the issues raised by Member States have been addressed. However, there was need for more clarification. The draft document defines Conflict of Interest but does not include a comprehensive Conflict of Interest policy, said India.
Also, further clarification is needed about the application of the non-State actors framework on the existing policies, such as policy of external partnership, clarification on criteria of definition of “arm’s length”. India also noted concerns regarding the provisions for collaborating with private sector entities, for the purpose of gathering evidence, and accepting financing from private sector entities that have an indirect interest in the outcome of the project.
The process of classifying non-State actors as NGOs, philanthropic foundations or academic institutions should be more clear and transparent. India supported the view by Member States of the South-East Asia Region that WHO should not engage with certain industries such as infant formula and beverages, including alcohol and soft drinks. It pointed out that simply stating that WHO would exercise particular caution when engaging with other industries affecting human health or affected by WHO’s norms and standards may not be adequate.
The United States of America (USA) stressed that the framework encouraged engagement with non-State actors and that the WHO should adopt the document on 27 January itself. It also supported expanded sections on conflict of interest in the document. This policy should allow flexibility, for example in the case of Ebola, said the USA, emphasizing the benefits of engagement with non-State actors.
It said the scrutiny for private actors is “arbitrary” and noted that other global health agencies have conflict of interest and asked WHO to look at these to foster partnerships. Private Public Partnership (PPPs) have been useful models for developing countries, said the USA. In order to improve the framework it supported the creation of a drafting group, during the EB, to finalize the framework for the WHA.
Australia underlined the framework as a basis for providing WHO with sufficient flexibility to work with global actors while protecting its integrity. Also, on the issue of secondment, it wanted to seek comments and reassurance that preventing it won’t prevent WHO from getting technical expertise when needed and pointed out that it was necessary to finalize the framework as a priority to proceed to WHA.
The United Kingdom underlined that WHO should support more, not less, engagement and agreed that WHO must be careful not to compromise its name. It also agreed that the draft needed a little improvement and perhaps a short, additional, discussion with Member States to ensure revision for May (WHA session) and look for a time in which the discussion on the draft can be stopped to move to actual relations with non-State actors.
France noted that the adoption of this framework is very important and it was ready to adopt it as it stands. The framework does need fine-tuning and we all have the same goal of adopting this at the WHA so we need real contributions and really drive this process forward, it said.
Argentina recognized that achieving results would be good for everyone as well as avoiding lengthy ineffective discussion. It would like to be able to reach consensus at the right time.
Civil society organizations at the EB also made statements and were particularly concerned with the current draft framework.
The International Baby Food Action Network (IBFAN) stressed that the current framework “needs to stop blurring the fundamental distinction between public-interest actors and those whose primary interest is market-led”. Furthermore, it asked Member States to look carefully at the way in which conflict of interest is used in the draft.
IBFAN said that the 2014 WHA Decision (WHA 67.14) underlined the importance of sorting out the conflict of interest safeguards, a request reaffirmed in the deliberations of all Regional Committees. Yet, the revised Framework does not meet this request: its conflict of interest section still represents a misconception of the conflict of interest theory, which then permeates throughout the document. We re-emphasize that conflict of interest is about a conflict ‘within’ an individual/institution, not “between” actors.
Another area of concern expressed by IBFAN is the principle of inclusiveness in the framework which “opens up new channels for corporate and donor influence, including through the revised Official Relations policy which legitimizes accreditation of actors, whose primary aim, by nature, cannot be in “conformity with the spirit… of WHO’s constitution”.
(The complete statement can be accessed here: https://apps.who.int/ngostatements/content/international-baby-food-action-network-ibfan)
People’s Health Movement made a joint statement on behalf of itself and Medicus Mundi International emphasizing the need to clarify and “explicitly acknowledge the underlying conflict between the mandates of corporate actors on the one hand and WHO on the other”.
It also urged Member States to “lift their longstanding freeze on assessed contributions. This would liberate WHO from a donor dependence that is very problematic from the point of view of democratic global governance for health.” (The full statement is available here: https://apps.who.int/ngostatements/content/medicus-mundi-international-%E2%80%93-international-organisation-cooperation-health-care-mmi-2)
DG Chan commented that Member States seemed to be divided in two groups. One that was ready to accept the resolution and evaluate it over time and a second group that has concerns about the gaps in the document and want to work on them. The second group was the larger group and the DG thus proposed to find a room for countries to get together and also proposed Argentina as the chair for the group.
There is still unresolved tension between the Member States who wanted the draft to be accepted at this current EB session and the countries that still insist that critical issues are not address by the current draft. The following months will be essential for countries to unpack sensitive areas of concern and come up with a solid document to be presented to the WHA this coming May.+