E-drug: WHO's Role in Public/Private Ventures Criticised at EB
---------------------------------------------
Dear Friends,
On Monday 22 January, WHO's increasing enthusiasm for public/private
interactions was the focus of discussion at the Executive Board. As part of
the set agenda, members of the WHO Executive Board were asked to note the
organisation's Guidelines on working with the private sector to achieve
health outcomes (agenda item 8.3). Instead of merely accepting the
guidelines, 14 countries spoke on the issue: Venezuela, Italy, Congo,
France, Belgium, Sweden, United States, Brazil, Cote D'Ivoire, India, China,
Guatemala, Bangladesh and Chad. Most of the speakers, excluding the US,
raised serious concerns about WHO's independence in light of so much
interaction with industry.
As a consequence, the Executive Board decided to create a working group
comprised of member states and their advisors to discuss the guidelines in
greater detail and to look for ways to improve them. During the debate,
Health Action International and the International Baby Food Action Network
jointly criticised the guidelines in their present form saying that they
fell short in a number of key areas and urging WHO to consider the long-term
consequences for the organisation and public health if WHO continues to
pursue this type of funding strategy. HAI and IBFAN urged the Executive
Board to improve the guidelines, especially in terms of their scope,
transparency, and accountability. (The full statement made by the two
networks is copied at the end of this message.)
While the terms of reference for the working group remain a bit unclear,
this is a development that HAI and IBFAN will be monitoring with great
interest. We will report back when more information about this group and its
work are available. In the meantime, this is an issue that remains on the
forefront of our concerns.
With best wishes,
Lisa Hayes, HAI Europe
"Lisa Hayes" <Lisa@hai.antenna.nl>
-------------------------------------
Statement made on behalf of Consumers International on agenda item 8.3
Guidelines on working with the private sector to achieve health outcomes
Delivered by Patti Rundall, International Baby Food Action Network
22 January 2001, 107th Executive Board Meeting, Geneva
Mr Chairman, Members of the Executive Board,
I am speaking on behalf of Consumers International, Health Action
International (HAI) and the International Baby Food Action Network (IBFAN).
Protection of the public's health is part of the social contract between
citizens and their governments. WHO has been mandated by member
governments to ensure equity in health care, as set out in the
primary health care concept. It also sets standards in many
health-related areas. These include
internationally agreed standards on promotional practices as elaborated in
the International Code of Marketing of Breast Milk Substitutes, related
resolutions on infant feeding and the Ethical Criteria for Medicinal Drug
Promotion.
In response to the serious shortfall in regular budget funding from member
states, WHO now actively seeks funds from commercial enterprises in order to
fully implement its work programme. By doing this, WHO sends a message of
encouragement and inevitability about involving commercial enterprises in
its work. This course of action needs to be more carefully considered as it
risks diverting WHO from its mandate and role as the highest, global health
policy setting body. It discourages the exploration of other sources of
support possibly more in line with WHO's primary health care goals. WHO's
action could also negatively influence the funding policies of many other
traditional partners.
However clear WHO may be about its public health mission, it must recognise
that corporate donors will always have a fiduciary duty to their
shareholders to maximise profit. It is essential that funding from the
private sector be evaluated according to public health criteria. This
applies to all corporations, not just the tobacco and arms industries.
Under agenda item 8.3, the Executive Board members have been requested to
note WHO's guidelines on working with the private sector to achieve health
outcomes (EB107/20). The HAI and IBFAN networks would like to raise
concerns about this type of interaction with the commercial sector:
Do such
public-private interactions contribute to equity in health care? Do they
encourage vertical programmes focused on diseases calling for hi-tech,
expensive solutions rather than those identified as national public health
priorities? Are they a quick fix or do they contribute to sustainable health
benefits ? And, are these well-publicised collaborations actually about
donor image-building, product development and marketing?
The guidelines propose a framework for assessing these interactions, but
fall short in key areas. First and foremost, they fail to give a clear
definition of conflict of interest. One consequence of this is that
secondment of staff from the private sector, including pharmaceutical
companies, is not perceived as a conflict of interest. Another is the
guidelines' failure to emphasise the risks related to involving the
commercial sector in research. The guidelines answer to conflict of interest
seems to be to involve more companies. This is simply inadequate.
The cardinal principle of the guidelines should be complete accountability
and transparency. 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. WHO's contractual agreements with all
private sector donors should be made public. The process of assessing and
approving agreements, as provided in the guidelines, is totally internal. In
principle, in-house assessments are inherently flawed because of potential
conflicts of interest. Therefore, independent review should be mandatory.
External monitoring and evaluation of work involving commercial enterprises
must be carried out to see if equitable and sustainable health outcomes are
achieved.
The recent Rome Seminar co-organised by WHO, clearly stated that 'it is
timely for WHO to step back from the current situation and reflect on the
appropriate role of <Global Public Private Partnerships> GPPPs in order to
meet public health and equity needs'. Seminar participants further called
for an open discussion on these WHO guidelines. They 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. Particularly, stakeholders from developing countries
should be involved.
We therefore urge the Executive Board to ensure that the guidelines include:
- a clear definition of conflict of interest
- complete transparency on contractual agreements with all commercial
enterprises
- assessment of potential donor companies according to recognised WHO and
other international standards
- regular monitoring and evaluation of all private sector interactions by an
external body including representatives of governments and civil society
- a 'whistle-blowing' mechanism so that people can report problems without
damage to their professional position or reputation
- annual reports to the Executive Board on contractual agreements made, their
implementation and the public health outcomes, and
- finally, we believe that the guidelines should be reviewed by next years
Executive Board to determine whether these recommendations have been
included and how the guidelines are working in practice. We would be glad
to contribute to that review.
Thank you for the opportunity to speak on this important issue.
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.