[Ip-health] TWN Info: WHO: Developed countries turning against non-State actor engagement framework

Mirza Alas mirzalas at gmail.com
Thu Apr 21 02:19:34 PDT 2016

*WHO: Developed countries turning against non-State actor engagement

Geneva 21 April (K M Gopakumar) – Developed countries are turning against
the World Health Organization’s framework of engagement with non-State
actors (FENSA).

Many European countries are putting conditions for the adoption of FENSA,
as negotiations enter into the last stage when the Open-Ended
Intergovernmental Meeting on the draft FENSA meets on 25-27 April at the
WHO headquarters in Geneva.

Member States from the European Region are citing three issues to block the
adoption of FENSA. First, the adoption of FENSA is possible only when there
is a clear understanding on the implications of its implementation,
especially financial and human resource implications. Secondly, these
countries also warn that the Secretariat should be given flexibility to
suspend FENSA norms while engaging with non-State actors to respond to
emergencies. In other words, FENSA could be suspended to engage with
non-State actors while dealing with an emergency. Thirdly, these countries
also want the implementation of FENSA at all three levels of WHO viz. head
quarters, regional and national.

Responding to the demand of analysing the implications of FENSA
implementation, the 138th meeting of the Executive Board (EB) took a
decision based on the recommendation of the Program and Budget Advisory
Committee  (PBAC). This decision requested the WHO Director-General to
“present an objective and balanced report on the implications for WHO of
the implementation of the framework, well in advance of the final
session”.  The External Auditor prepared the report titled  ‘Implications
for the World Health Organisation of the implementation of the framework of
engagement with Non-State actors’.

The Report concurs with the Secretariat’s non-paper circulated in October
2015 and states that, “the adoption and implementation of FENSA will
involve considerable costs from a policy, financial and human resources
perspective, at all levels of the organization.” However, it refuses to
make an estimation of the cost and states:  “… the financial and human
resource implications cannot be estimated with sufficient degree of
accuracy to provide a solid figure, but will be monitored as FENSA is
progressively implemented.”

Further, the Report states that “FENSA as an overarching framework can
already stand on its own and can be considered for adoption.” However the
Report favours implementation in a phased manner rather than a full and
complete implementation of both the framework and the operational
procedures at the same time.

Disappointed at the absence of any reference to the exact cost implications
of implementation of FENSA, a few Member States from the European Region
have jointly written to the WHO Secretariat expressing concerns on the
external auditor’s report.  The letter from the Czech Republic, Finland,
Germany, the Netherlands, Norway, Sweden, Switzerland and the United
Kingdom states, “We understood a key purpose of the current document to be
to substantiate and document those claims. It does not appear to do so”.

The letter seeks information on the following areas: (a) an estimated
figure or figure range for the current volume of engagements annually; (b)
an estimated figure or figure range for the cost of implementing FENSA as
it currently stands; (c) an estimated figure or figure range for the number
of additional staff expressed as work years that implementation would
require, as well as for the additional overall workload on existing staff
in technical and other units not primarily tasked with operating the
mechanisms FENSA would establish.

According to a developing country delegate, the request for additional
information is an indirect way of putting conditions to block the adoption
of FENSA even after the conclusion of negotiations.

Another developing country delegate who attended the Secretariat’s briefing
on 18 April said that during the briefing Switzerland stated that FENSA
could not be adopted at this stage without information on resource

Many delegates view the letter as a digressive move during the
Secretariat’s briefing, and as a strategy to prevent further strengthening
of safeguards against undue influence especially from the private sector.

It is noteworthy that on 18 February, six US industry associations
(Biotechnology Innovation Organisation, National Association of
Manufactures, National Foreign Trade Council, Pharmaceutical Research and
Manufactures of America, US Chamber of Commerce and United States Council
of International Business) wrote to Senator Orrin Hatch, chairman of the
U.S. Senate Finance Committee, expressing concerns mainly on the UN High
Level Panel on Access to Medicines which could “degrade the global
ecosystems of innovation ”. The letter further states that, “This is not,
however, the only example of UN institution constraining business
involvement to the detriment of innovation. Similar exercises are currently
underway in the World Health Organisation (WHO) with its ‘Framework for
Engagement with Non-State Actors’ (FENSA) …”
Interestingly most Member States who are now opposing FENSA had earlier
supported the adoption of the FENSA text drafted by the Secretariat during
the 134th and 136th Executive Baard meetings.  The cold feet developed only
when the drafting process shifted from the Secretariat to a Member
State-driven process of the Open Ended Intergovernmental Committee. The
interventions of some of these Member States are quoted below from the
Summary of Records of the two sessions in January 2014 (
and January 2015 (

Norway at the 134th Executive Board meeting “expressed support for the
objectives, overarching principles and boundaries described in the report
and for the proposed next steps set out in paragraph 28. He welcomed the
proposal to hold further informal consultations during which the various
elements to be included in policies and operational procedures for
different types of non-State actors could be examined.”

Switzerland at the same meeting stressed that “WHO needed to adapt to the
changing cast of actors in the global health sphere and that it should
continue to play its unique normative role. She welcomed the overarching
principles outlined in the report, that any engagement should respect the
intergovernmental nature of WHO, demonstrate a clear benefit for public
health, be conducted on the basis of transparency and prevent conflicts of
interest. In order to put those principles into practice, it would be
necessary to regulate the Organization’s engagement with non-State actors
using clear and precise procedures. That was an essential condition for
maintaining the reputation of WHO and respect for its mandate”.

The UK stated that, “The development of a code of conduct, rules of
engagement or a general policy that was applicable to all non-State actors
would ensure a shared understanding and hence avoid extensive discussions
on conflicts of interest during each negotiation. Such a document could be
used to identify the purpose and scope of any engagement and whether there
were any real or perceived conflicts of interest”.

At the 136th Executive Board meeting “Lithuania speaking on behalf of
Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway and Sweden,
commended the clear structure of the revised draft framework which took
into account Member States’ concerns. It established uniform rules and
clear expectations for non-State actors, facilitating interaction while
managing risks and protecting WHO’s reputation. … He recommended adoption
of the framework by the Sixty-eighth World Health Assembly, and noted the
possibility of evaluation and review after two years to address the lessons
learnt from implementation”.
At the same meeting, Germany said that, “non-State actors made a
significant contribution to shaping global health and could provide
valuable support to help WHO to play its global health leadership role.
Germany did not consider that adoption of the draft framework would
infringe on the independence of WHO activities or on the decision-making
power of Member States, but was willing to refine further the draft
framework during the current Executive Board session”


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