[Ip-health] TWN Info on Health: WHO -- Concerns that “official relations” are used for promoting business interests

K.M. Gopakumar kumargopakm at gmail.com
Fri Jul 17 09:40:26 PDT 2015


*Title :* TWN Info on Health: WHO -- Concerns that “official relations” are
used for promoting business interests
*Date :* 17 July 2015

*Contents:*

*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 134th 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 132nd session of the Executive Board
referring to GAIN’s source of finance states: “ … to a question 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 136th 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 132nd 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 132nd 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.+






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