TWN Info Service on Health Issues (Jul15/02)
17 July 2015
Third World Network

WHO:  Concerns that “official relations” are used for promoting business interests

Geneva, 16 July (TWN) – The collaboration work plan that the World Health Organization (WHO) entered into with some non-State actors reveals that it will be used to pursue business interests.

This work plan is necessary to establish an official relationship with the WHO. Until recently collaboration work plans between non-governmental organisations and WHO were not available in the public domain. Only in 2015 did WHO remove the restricted status of the documentation submitted for the consideration of the Standing Committee on Non-Governmental Organisations (NGOs) on the basis of a proposal made at the 134^th session of the Executive Board. This is in paragraph 28 of EB 134 /8: http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_8-en.pdf).

However, the documentation failed to follow a uniform pattern of disclosure and also did not disclose the source of funding such as how much of their revenue is coming from commercial enterprises in a uniform manner. The collaboration work plan entered into prior to 2015 is not available in the public domain.

The joint work program between the Global Medical Technology Alliance and WHO as part of the documentation for the consideration of the Standing Committee on NGOs states: “Promote the safe use of medical devices through compiling and distributing materials and training on the safe use and proper disposal of medical devices for health care professionals, through the Alliance member associations” (http://apps.who.int/gb/NGO/pdf/B136_NGO_11-en.pdf).  This implies that a trade association would work with the WHO to promote use of medical devices through compiling and distributing materials. This would clearly result in economic benefits to the members of the association.  It would also result in unnecessary promotion of the use of medical devices without adequate evidence and putting commercial interests above public health.

(The members of the Global Medical Technology Allianceare national or regional medical technology associations, which represent companies that currently develop and manufacture 85 percent of the world’s medical devices, diagnostics and equipment.)

Similarly, documentation of Global Diagnostic Imaging, Healthcare IT and Radiation Therapy Trade Association states that it would collaborate with WHO and would be “raising awareness of the importance of health technologies for better clinical outcomes and the value of health technology and assessment in the process” (http://apps.who.int/gb/NGO/pdf/B136_NGO_12-en.pdf). Here again such ‘awareness raising’ can be misused by this trade association to pursue commercial ends rather than public health goals.

In their documentation both organisations reveal that they are commercial organisations. 

Similarly, Health Technology Assessment International reveals that WHO will participate in planning and organising its regional policy fora, which will convene health technology assessment stakeholders to build partnerships focusing on the role of health technology assessment in decision-making and strengthening the evidence-based selection and rational use of health technologies (http://apps.who.int/gb/NGO/pdf/B136_NGO_11-en.pdf).

This clearly falls within the identified risk of engagement under the draft Framework of Engagement with Non-State Actors (FENSA). The draft states that WHO’s engagement with non-state actors can involve risks which need to be effectively managed and, where appropriate, avoided. Risk relate inter alia to the occurrence in particular of the following: (a) conflict of interest … (d) the engagement being primarily used to serve the interest of the non-State actor concerned with limited or no benefits for WHO and public health. (http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R9-en.pdf?ua=1)

The work plan of the Foundation for Innovative New Diagnostics states: “The Foundation works to strengthen WHO leadership in the development of, and setting norms and standards for, diagnostics through representation on expert panels, and help with drafting diagnostics-related guidelines”.(http://apps.who.int/gb/NGO/pdf/B136_NGO_5-en.pdf)

This goes directly against the principles of engagement identified under the draft FENSA Principles of Engagement which states: “… any engagement must: Protect WHO from any undue influence, in particular on the process in setting and applying policies, norms and standards”.

The above illustrations clearly show that the collaborative plans for official relations could result in serious conflict of interest and risks for WHO that would compromise the credibility, integrity and independence of WHO.

The last round of negotiations on FENSA held in Geneva on 8-10 July addresses this concern.  It clearly states that “… These plans shall be free from concerns which are primarily of a commercial or profit-making nature.”  Draft FENSA paragraph 51 states: “Official relations shall be based on a plan for collaboration between WHO and the entity with agreed objectives and outlining activities for the coming three-year period structured in accordance with the General Programme of Work and Programme budget and consistent with this framework. This plan shall also be published in the WHO register of non‑State actors. These organizations shall provide annually a short report on the progress made in implementing the plan of collaboration and other related activities which will also be published in the WHO register. These plans shall be free from concerns which are primarily of a commercial or profit-making nature”.

The earlier draft contained a Chair’s text stated: “Official relations shall be based on a plan for collaboration between WHO and the entity with agreed objectives and outlining activities for the coming three-year period structured in accordance with the General Programme of Work and Programme budget This plan shall also be published in the WHO register of non-State actors. These organizations shall provide annually a short report on the progress made in implementing the plan of collaboration and other related activities which will also be published in the WHO register”.

The new Para 51 clearly states that the collaborative “shall be free from concerns which are primarily of a commercial or profit-making nature”.  However, in practice it depends on the interpretation of the term “primarily of a commercial or profit-making nature”. According to an observer this terminology needs further interpretation. In the absence of such an interpretation it gives the discretion to the WHO Secretariat to interpret the sentence in a way as to continue with the existing practice.  The observer cites the example of the Principles Governing Relations between the WHO and NGOs, which contains this exact same terminology.

According to the existing arrangements, industry associations are also classified as NGOs and in practice allow these to enter into official relations. As explained below this practice goes against WHO’s Principles Governing Relations between the WHO and NGOs. However, in reality many international business associations have obtained official relations status. According to an observer of the WHO, by allowing business associations and bodies funded by the private sector to be in official relations, WHO violates the principles governing relations between the Organisation and NGOs. According to this document the criteria for official relations is that an entity should be free from concerns which are of a primarily commercial or profit making nature. (http://apps.who.int/gb/bd/PDF/bd47/EN/principles-governing-rela-en.pdf?ua=1)

The current policy states: “The main area of competence of the NGO shall fall within the purview of WHO. Its aims and activities shall be in conformity with the spirit, purposes and principles of the Constitution of WHO, shall centre on development work in health or health-related fields, and shall be free from concerns which are primarily of a commercial or profit-making nature” (emphasis added).

A WHO staffer familiar with the issue told the author that extension of official status to international business associations under the existing NGO policy is perfectly in harmony with the NGO policy because the memorandum of association shows that international business associations are registered as non-profit organisations and therefore fall under the criteria mentioned in the NGO policy i.e. should be free from concerns which are primarily of a commercial or profit making nature. However, what is ignored in the explanation is that the international business associations consist of private sector-for profit entities and the primary objective of these business associations are to protect and promote the interests of their members i.e. profit making.

The draft FENSA treats the international business associations as private sector. However, it explicitly extends the official relations status possibility to international business associations along with philanthropic foundations.

There are currently 202 NGOs that have obtained that status of official relations with WHO. Many of these 202 organisations have private sector links.  The links to the private sector can be classified into three. Firstly, international business associations include entities such as CropLife (that promotes agricultural technologies such as pesticides and plant biotechnology),the Global Medical Technology Alliance, the International Federation of Pharmaceutical Manufactures Association (IFPMA), etc.  Secondly, there are sets of organisations where the private sector has a role in its governance. Lastly, some of these organisations’ agenda appears to control WHO through financial support, such as the Global Alliance for Improved Nutrition (GAIN).  Such organisations accept financial support from private sector-linked sources. WHO’s Standing Committee on NGOs in its report to the 132^nd session of the Executive Board referring to GAIN’s source of finance states: “ … to a ques tion concerning its income base, it was stated the Alliance’s main source of income was the Bill & Melinda Gates Foundation, with little revenue coming directly from commercial companies”.

As mentioned above one of the essential requirements for entering into official relations with the WHO is to have three years of collaboration plan. Some of the collaboration plans raise concerns of conflict of interests. According to the current practice all these plans are not in the public domain. It is only this year that WHO started publishing the documentation submitted to the Executive Board’s Standing Committee on Non-governmental Organizations.  The documents do not reveal the source of funding such as how much of their revenue is coming from commercial enterprises.

The draft FENSA does not insist on a disclosure of the source of funding, even without naming the funders.

At the 136^th session of the Executive Board 13 organisations applied for official relations and their submissions are publicly available (http://apps.who.int/gb/NGO/e/E_NGO_1.html). These organisations are: International Epidemiological Association, Medicines for Malaria Venture, International Society of Audiology, Foundation for Innovative New Diagnostics, World Federation of Chinese Medicine Societies, Global Medical Technology Alliance, International Organization for Medical Physics, Humatem, RAD-AID International, Health Technology Assessment International, Global Diagnostic Imaging, Healthcare IT and Radiation Therapy Trade Association, Tropical Health and Education Trust .

Out of these 13 organisations only two viz. Global Diagnostic Imaging, Healthcare IT and Radiation Therapy Trade Association and Global Medical Technology Alliance identified themselves as trade/business organisations.  However, there are organisations having private sector presence not only through financial presence but also in their governing structure.  The website of Health Technology Assessment International reveals some of the names of the commercial enterprises. These include: Abbott Vascular International BVBA, ADVI, AMGEN, AstraZeneca Plc, Bayer Healthcare/Bayer Pharma Schering, Bristol Myers Squibb, Covidien, Eli Lilly and Company, F. Hoffmann-La Roche AG, GlaxoSmithKline, Belgium & USA, IMS HealthJohnson & Johnson Medical Products, Medtronic, Merck & Co, Merck Serono International SA, Novartis, Pfizer Limited, Sanofi-Aventis, St. Jude Medical, Inc.  However, the application has not revealed the percentage of contribution it receives from industry.

International Organisation for Medical Physics has 3 commercial enterprises as members. Similarly Humatem has 8 commercial enterprises without voting rights.

According to some civil society organisations the collaboration work plan approach itself prevents a civil society monitoring of WHO. Unlike other UN agencies, WHO does not have an accreditation system to facilitate attendance at WHO governing body meetings. As a result only organisations entering into official relations can attend governing body meetings. As mentioned above a collaboration plan for three years is necessary to apply for official relations status. According to some civil society organisations the mere existence of an official relations status prevents many organisations from carrying out an independent monitoring activity. Further, it also bears the danger of non-renewal of the official relations.

Even though the draft FENSA proposes monitoring of WHO activities as part of NGO advocacy activities by stating that “WHO favours independent monitoring functions and therefore engages with nongovernmental organisations working in this field”, NGOs cannot carry out such monitoring effectively without attending the governing body meetings.

Although the draft FENSA’s Overarching Framework of Engagements with Non-State Actors contains a proposal for accreditation, this proposal is in brackets (signifying lack of consensus among Member States).  This is not the first time that a proposal for accreditation of NGOs has come before the Member States. In 2002 the review of WHO-NGO relationship (2002 Review report) contained a proposal for accreditation of NGOs but it did not get adopted (http://www.twn.my/title2/health.info/2012/health20120102.htm). 

As part of WHO reform the 132^nd session of the Executive Board decided “to work further on the draft policy of engagement with nongovernmental organizations, proceeding with the revision of accreditation procedures for nongovernmental organizations for WHO’s governing bodies (i.e. authorization to participate therein) and incorporating those procedures in the draft; including updated terms of reference and operational procedures of the standing committee on nongovernmental organizations; and incorporating the inputs provided during the deliberations of the Board at its 132^nd session”.

Such a reform has the potential to end WHO’s insulation from independent civil society monitoring. It is now up to Member States to move in that direction.+