Day Three at the 64th WHA

Highlights from the third day of the 64^th World Health Assembly

Geneva, 18.05.11

Future of financing for WHO (Item 11): the discussion is resumed and the reform plan approved

Committee A continued to discuss the future of financing for WHO (see here for background documents). Some member states were still to speak as well as the NGOs. The statement from Brazil brought up many of our concerns regarding the reform. It called for a more transparent and accountable WHO, that should be member state driven, by consensus, and led by the principles of social justice, considering social and economic determinants. Brazil stated that the WHO needs to listen more to what civil society has to say and less to the donors. Applauses followed! Next, we heard the voices of civil society, which were very much aligned with the ideas expressed by the Brazilians. We were happy to hear our friends Remco van de Pas speak for Medicus Mundi International (read MMI statement) and Chiara Bodini for the People's Health Movement, calling for a fairer WHO, financed through untied funds, less driven by the corporate sector and more by peoples’ needs (read PHM statement, or hear it on Youtube).
After all the 35 statements from the floor (31 from member states and 4 from civil society organizations in official relations with the UN), the DG asked for the word. In response to member states and civil society she affirmed that the WHO is committed to a transparent and inclusive process of consultation. She said that everyone needs to understand that the WHO needs to work with the private sector, and acknowledged that management of conflicts of interest has to be done. “The WHO listens to the voices of the people and we will consult, consult, consult, until everyone is satisfied”, she said. Unfortunately, we haven’t been seeing this happen very much until now. Without further objections, the resolution on the reform was finally approved. However, the delegation from Brazil asked to resume the issue and stated its disagreement with one of the annexes (the so called "Development plan"), which was released too late to be analysed with the needed attention. Brazil also reaffirmed its objection to the WHO pooling funds from the private sector. The DG then replied that the Development plan had not been voted and that all concerns by member states had been taken into account and will be considered before any further development.

Pandemic Influenza Preparedness (PIP)

The meeting on agenda Item 13.1 Pandemic influenza preparedness (see here for background documents) had 40 interventions in total, 37 from member states, 1 from Chinese Taipei and 2 from civil society. Australia was the first to comment by making the suggestion that PP5 of the draft resolution be deleteted in order to accomodate it acceptance. By doing so all mention of the Nagoya protocol would be omitted from the resolution. Many low and middle income countries (LMIC), including Kenya and Algeria, urged other states to support their efforts to build capacity for monitoring and dealing with pandemic disease. This was reinforced by a strong emphasis on the transfer of technology and know-how by Brazil, Thailand, Bolivia and others. Other LMIC emphasised the importance of the continuing process to develop the agreement and non exclusive lisenses. Of all the interventions only Bolivia's noted that condoning the patenting of parts of organisms, as the final framework does, is problematic. However, to allow the process to move forward they did not oppose the resolution. Jamaica made an unsuccessful proposal to add language to the resolution which calls for the WHO to facilitate access to vaccines and antivirals through stockpiling and affordable pricing. USA opposed it on the grounds that it would neccessitate a renegotiation of a substantial portion of the text. Germany added that the directive is already contained within the negotiated framework withing section 6. While Jamaica disagreed with these objections they decided to withdraw the amendment because DG Chan had personally committed herself to ensuring the implementation of the requested mechanisms .
Finally Sangeeta Shashikant spoke on behalf of CMC Churches Action for Health, PHM and TWN which can be viewed here [hyperlink]. The World organization for animal health stated their desire to cooperate with efforts to combat pandemic influenza.

Health Systems Strengthening (Item 13.04): final discussion and resolutions approval (see here for background documents)

Statements from civil society were resumed. We heard: International Confederation of Nurses, Save the Children UK, Chinese Taipei, International Confederation of Midwives and Nurses, World Vision International (WVI), International Federation of Medical Students' Associations (IFMSA), International Association of Patients' Organisations (IAPO) and the Cochrane Collaboration. WVI expressed great concern particularly towards user fees, which should be completely abolished. The IFMSA called for appropriate planning of human resources for health, adequate to countries’ population and burden of disease. They called on WHO to implement an international code of recruitment of health personnel. Next, many amendments to the resolutions were proposed, especially by Thailand, who brought an enormous list of suggestions!

Committee B - Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan (see here for background documents)

Committee B was opened with the discussion on this issue. Lebanon on behalf of the Arab Group and Palestine, introduced a draft resolution. The main issues addressed were the economic and health crisis endured by the population due to the Israeli occupation, as well as the limitation of the free movement in the West Bank and the blockade on Gaza Strip. The resolution called upon the international community to exert pressure on Israel to respect the International law, to lift the siege imposed on Gaza and to remove any obstacles to the free circulation in the West Bank which greatly prevent Palestinians to meet their needs. Moreover, it requested the DG to continue providing support and technical assistance to the Palestinian national health system and to establish medical facilities in the occupied Syrian Golan in order to meet the unheard health needs of the Syrian population living therein. The following discussion was animated by interventions of many Arab countries in support to the resolution proposed by Lebanon. Turkey, in particular, expressed great concern for the physical and psychological risk at which a number of Palestinians minors are exposed, being detained in the Israeli prisons or having to endure the burden of the occupation. Furthermore, Cuba stressed the responsibility of the illegal Israeli settlements in causing bad living, heath and economic conditions for Palestinians. Two strong speeches against the resolution came from Israel and the USA. The first pointed out the political nature of the discussion, arguing that it has no place in the WHA which is instead entitled to debate global health, and called upon member states to “leave WHA free from political issues”. The second, remembering in first place that the USA are the largest donors to UNRWA and to Palestinian National Authority and listing the amount of every single contributions in support of the health of Palestinians, concluded declaring the “inappropriateness of the biased resolution” in the context of the WHA. A roll-call vote was taken and the resolutions was approved. Arab countries, most of the Latin America and few African countries did vote in favour, all the countries of the Commonwealth and Israel voted against, many were absent and a large number abstained (among which the European countries).

Technical briefing: addressing NCDs - current status and moving forward

Side event: the Medicines Patent Pool

The Medicines Patent Pool is designed to provide a 'one-stop-shop' for countries and companies seeking information and perhaps licensing details regarding drug patents.  The Global Fund experience is there can be significant bottlenecks in drug procurement because of the complexity for countries of identifying the patent status of particular drugs in their countries. It is also the case that there have been serious delays in bringing fixed dose combinations to market and developing appropriate paediatric formulations because of the complexities of the different patents which have to be negotiated. The Medicines Patent Pool provides access to patent data to assist countries in negotiating these bottlenecks and perhaps to assist generic producers trying to develop FDCs and paediatric formulations.  See more detailed report of presentations.

Side event: Improving access to medicines in developing countries through local production and related technology transfer

Creating the conditions for local production is not simple but can be done. See report of presentations. But what happens when countries create the conditions for local producers?  Big pharma takes over?  As in India?  Perhaps public ownership should also be seen as a necessary condition for building local production capacity. 

Side event: Healthy markets for healthy people in developing countries

The event was organised by UNITAID, a new global health initiative which is part of the UN system, whose objective is to leverage price reduction and increased availability for medicines to treat HIV/AIDS, TB and malaria. Today, 29 countries participate in the initiative, which is funded by the member countries (in many cases through the air ticket tax), the Gates Foundation and the Global Fund. The panel was moderated by Brazil, main founder of the initiative. UNITAID and WHO experts spoke, as well as Medicines Patent Pool, delegates from Kenya and Cameroon. The session was very smooth, with many compliments to the initiative. The only provocative question came from Iraq, who asked about the interests of the Global Fund. Conclusion: this initiative seems to be bringing important benefits to developing countries regarding access to medicines, but it is in no way contributing to a change in the wider context which creates the problems they’re addressing, such as high prices and unavailability of essential medicines for the people who need them most. Profit driven market is itself the root problem.

• See PHM letter to UNITAID here
• See Official Summary of Day 3 in Journal No 4 (from page 7)

Watch this space