[Ip-health] WHO: No consensus on draft policy on non-State actors

alexandra bhattacharya alexandra.bhattacharya at gmail.com
Fri Apr 4 01:38:19 PDT 2014

*WHO: No consensus on draft policy on non-State actors*

Geneva, 2 Apr (K. M. Gopakumar) -- Member States of the World Health
Organisation (WHO) are unable to agree on a draft framework and policy on
the organisation's engagement with "non-State" actors.

A two-day informal consultation that took place in Geneva on 27-28 March
2014 concluded with an understanding to entrust the WHO Secretariat to
submit a new version of the policy, taking into consideration the comments
from Member States, to the World Health Assembly (WHA) through the Program
Budget and Administrative Committee.

The WHA is to decide on the future process regarding the draft framework
and policy on NSAs (non-State actors).

A developing country delegate told Third World Network (TWN) that the WHA
is to decide on the next steps with regard to the finalisation of a draft
framework and policy and would not take any decision with regard to the
adoption of the draft framework and policy.

The draft framework for engagement with NSAs is part of WHO's reform agenda
which was kick-started in 2011. It was prepared after two face-to-face
consultations and two web-based consultations. The last informal
consultation, which was open to both NGOs and Member States, took place in
Geneva on 17-18 October 2013.

According to the WHO draft, NSAs include non-governmental organisations,
private sector entities, philanthropic foundations and academic


WHO is currently collaborating with all these NSAs without a comprehensive
policy for such engagement.

Some of the NSAs, especially philanthropic foundations and private sector
entities, provide financial and in-kind resources to WHO and are thus in a
position to influence the public health agenda at times to further business

For instance, WHO in 2012 received US$264,167,357 as voluntary specified
funds from Bill and Melinda Gates Foundation which is more than the US
Government's voluntary specified contribution of US$208,109,268.

Interestingly, the Bill and Melinda Gates Foundation does not provide any
core voluntary funding. Core voluntary funding provides spending
flexibility to the Secretariat.

In the absence of a policy, the last WHA put on hold the implementation of
certain elements of a global strategy for the control and prevention of
non-communicable diseases, which is to be implemented through partnerships
with NSAs.

TWN learned that many Member States are concerned over the draft framework
and policy with regard to the proposal on secondment, a lack of effective
safeguards to protect WHO from undue influence of private and philanthropic
organisations, and the silence of the framework with regard to engagement
with philanthropic and academic institutions.

Many Member States also said that there is not sufficient time to study the
draft framework and policy and to take a decision with regard to its
adoption at the upcoming WHA. Further, Member Sates also pointed out that
the Secretariat has not provided existing documents relevant for a
comprehensive understanding of the framework and policy for NSA engagements
such as a conflict-of-interest policy.

A diplomat who attended the consultation said that the United States and
the United Kingdom complained that the draft policy sets a high degree of
scrutiny for the private sector compared to other NSAs.

The Secretariat's document contains the following parts:

* Draft Overarching Framework for Engagement with Non-State Actors;

* WHO Policy and Operational Procedures on Engagement with Non-governmental
Organisations (Draft NGO Policy);

* Draft WHO Policy and Operational Procedure on Engagement with Private
Sector Entities (Draft Private Sector Policy);

* Draft WHO Policy and Operational Procedures on Management of Engagement
with Non-State Actors (Draft Management Policy) defining the common
policies and processes applied in the management of WHO's engagement with
all non-State actors; and

* Draft of a glossary on definition of terms.

The International Baby Food Action Network (IBFAN) has strongly criticised
the WHO's draft framework and policy on NSAs.

IBFAN stated that: "Despite the many statements of WHO's Director General,
Margaret Chan, that WHO's policies, norms and standards setting processes
should be protected from commercial influence, if the new proposals were to
be adopted, the corporate influence would increase. IBFAN fears that this
would compromise WHO's integrity, independence and its ability to fulfill
its mandate".

(See: http://info.babymilkaction.org/pressrelease/pressrelease26mar14)

The proposed overarching framework sets the basic principles, boundaries
and types of interaction for all NSAs.

The principles for interaction with NSAs are: Demonstrate a clear benefit
to public health; Respect the intergovernmental nature of WHO; support and
enhance the scientific and evidence-based approach that underpins WHO's
work; be actively managed so as to reduce any form of risk to WHO
(including conflicts of interest); be conducted on the basis of
transparency, openness and inclusiveness.

The boundaries are: Decision-making by the governing bodies is the
exclusive prerogative of Member States; WHO's processes in setting norms
and standards must be protected from any undue influence; WHO does not
engage with industries making products that directly harm human health,
such as tobacco or arms; engagement with non-State actors must not
compromise WHO's reputation.

The boundaries clearly exclude any engagement with the tobacco and arms
industry. However, it is not very clear whether the policy excludes
engagement with pharmaceutical firms that work against WHO, which has
established policies such as the use of flexibilities in the World Trade
Organisation's intellectual property rights agreement.

Often, pharmaceutical multinational companies work against the use of these
flexibilities. Recently, a set of emails leaked to the public showed that
Pharmaceutical Research and Manufacturers of America (PhRMA) had planned a
campaign against the proposed pro-public health changes in the South
African patent law.


The WHO document identifies five types of interaction viz. participation,
resources, evidence, advocacy and technical collaboration.

Both draft policies viz. draft NGO policy and draft private sector entities
policy spell out policy and operational procedures that relate to
interactions with NGOs and the private sector. It sets the norms for all
five types of interaction.

Both the policies set the same level of treatment for NGOs and the private
sector and thus completely ignore the inherent risk of engagement with the
private sector, which works primarily for profit. There are no new
safeguards against engagement with the private sector, including business
associations and business interested NGOs.

[Currently, public interest NGOs and business interest NGOs and business
associations are categorised as NGOs. All the three entities have official
relations with the WHO. Often, many "NGOs" are believed to be the front
organisations for pursuing business interests. Many patient organisations,
for instance, in official relations with the WHO, receive substantial
funding from pharmaceutical companies and often speak in support of
pharmaceutical companies during WHO governing body meetings.]

The most worrying part of the draft NGO and private sector policies is with
regard to the acceptance of resources and deployment of NGO and private
sector staff in the WHO on the basis of secondment.

The draft NGO policy allows the acceptance of resources from NGOs and also
provision of resources to NGOs from the WHO. Similarly, the draft policy on
private sector entities states:

* Paragraph 15: "Funds may be accepted from private sector entities whose
business is unrelated to that of WHO, provided they are not engaged in any
activity that is incompatible with WHO's work."

* Paragraph 16: "Funds may not be sought or accepted from private sector
entities that have themselves or through their affiliated companies have a
direct commercial interest in the outcome of the project toward which they
would be contributing, unless approved in conformity with the provisions on
clinical trials or product development, set out below."

* Paragraph 17: "Caution should be exercised in accepting financing from
private sector entities that have even an indirect interest in the outcome
of the project (i. e. the activity is related to the entities' field of
interest, without there being a conflict as referred to above). In such
event, other commercial enterprises having a similar indirect interest
should be invited to contribute, and the reason clearly described if this
does not prove possible. The larger the proportion of the donation from any
one source, the greater the care that should be taken to avoid the
possibility of a conflict of interest or appearance of an inappropriate
association with one contributor."

* Paragraph 18: "Unspecified financial and in-kind contributions from
private sector entities to WHO programmes are only acceptable under the
following conditions: (a) the contribution is not used for normative work;
(b) if a contribution is used for activities other than normative work in
which the private sector entity could have a commercial interest, the
public health benefit of the engagement needs to clearly outweigh its
potential risks; (c) the proportion of funding of any activity coming from
the private sector cannot be such that the programme's continuation would
become dependent on this support."

* Paragraph 19: "The acceptance of donations (whether in cash or in kind)
should be made subject to the following conditions: (a) The acceptance of
the donation does not constitute an endorsement by WHO of the private
sector entity, its activities, products or services; (b) The donor may not
use the results of WHO's work for commercial purposes or seek promotion of
its donation; (c) The acceptance of the donation does not award the donor
with any privilege or advantage; (d) The acceptance of the donation does
not offer the donor any possibility for advising, influencing,
participating in, or being in command of the management or implementation
of operational activities. WHO keeps its discretionary right to decline a
donation, without any further explanation."

The proposed policy thus does not provide any effective safeguard against
the dangers of accepting finance and in-kind resources from non-State
actors like private sector entities and NGOs. These draft policies thus
institutionalise the danger of funder-driven agenda setting in the WHO.

The draft policies also completely ignore the suggestion to address the
crucial issue of conditional funding or voluntary contributions tied to
specific programs, which set the funder-driven program priority setting.
One of the prominent suggestions was the creation of a pool in which donors
are free to contribute and the Secretariat would have the flexibility to
spend on underfunded but important public health priorities. The draft
policies do not put any restrictions on receiving financial contributions
from NSAs especially from private sector entities to specific programs in
the form of tied funds.

The language in paragraph 20 of the draft private sector policy gives the
discretion to the WHO Director-General without setting a clear policy
direction. It states: "The Director-General can set up mechanisms of pooled
donations from multiple sources, if the mechanisms are designed in such a
manner as to avoid any perceived influence from the donors on WHO's work;
the mechanism is open to all interested donors; and is subject to the
conditions in paragraph (19) above".

Alternatively, there should have been a ceiling on the specified financial
and in-kind resources from the private sector in the absence of pool

The draft private sector policy also does not bar the Secretariat from
accepting resources from the private sector for the salary of WHO staff.
Paragraph 37 states: "Funds designated to support the salary of specific
staff or posts (including short-term consultants) may not be accepted from
private sector entities if they could give rise to a real or perceived
conflict of interest in relation to WHO's work".

Paragraph 38 states: "The acceptability of contributions from private
sector entities to projects that have a staffing element should be reviewed
in the light of other relevant guidance provided in this document".

Further, the draft policy does not increase the level of transparency with
regard to NSAs. It reiterates the existing practice of disclosing through
financial reports and audited financial statements. These reports do not
disclose the details of donations. The draft policy is silent regarding the
disclosure of details of donations from NSAs especially the purpose of
their use and the agreement between WHO and the private sector donors.

Another major concern is related to the secondment of personnel to WHO.
Under this scheme, the salary of the person would be paid by the agency,
which deploys the person to WHO. The policy clearly states that secondment
is possible from NGOs and private sector. Even though the secondment
opportunities are open to NGOs, the most frequent user would be the private
sector considering the financial resources available with the private
sector. The NSAs are likely to use the secondment of personnel to leverage
the commercial interest. Further, the secondment person may compromise the
neutrality of the international civil service.

The draft policy also rejects the demand of many public interest groups to
be allowed to participate in WHO governing body meetings as observers.
However, the draft policy restricts the participation to NGOs which are
only in official relations with the WHO. Further, there is no clarity
whether NGOs would be differentiated from the business associations for the
participation in WHO governing body meetings. Currently, all non-State
actors who are in official relations with WHO including business
associations like the International Federation of Pharmaceutical
Manufacturers & Associations participate in the meetings as NGOs.

Even through the draft policy refers to philanthropic organisations, it
ignores the original decision to have a separate policy for not-for-profit
philanthropic organisations.

The Chair's summary of the 130th Session of the WHO Executive Board clearly
states that: "Further discussion will be required on WHO's engagement with
other stakeholders, including different categories of non-governmental
organisations and industry, and the proposals to review and update
principles governing WHO relations with non-governmental organisations, and
to develop comprehensive policy frameworks to guide interaction with the
private-for-profit sector, as well as not-for-profit philanthropic

According to IBFAN: "If these new policy proposals are adopted, IBFAN fears
that WHO will be unable to lead and support Member States in taking the
bold decisions necessary to tackle global health challenges."

There is concern therefore that the draft framework and policies could
legitimize the status quo and further the corporate capture of WHO. +

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