[Ip-health] Health Policy Watch: WHO’s EB Considers New Ways To Work With NGOs – Some Countries Criticise Activists’ Role At WHA 72

Thiru Balasubramaniam thiru at keionline.org
Thu May 30 22:56:09 PDT 2019


WHO’s EB Considers New Ways To Work With NGOs – Some Countries Criticise
Activists’ Role At WHA 72
30/05/2019 by Elaine Ruth Fletcher

In the wake of a World Health Assembly that became a focus of intense
activist and social media attention over a WHO resolution on medicines
price transparency
member states are now looking at new rules for shaping involvement of NGOs
and other “non-state actors” at public WHO meetings.

On Wednesday, an initial proposal for revising procedures on the Involvement
of Non-State Actors
<http://apps.who.int/gb/ebwha/pdf_files/EB145/B145_4-en.pdf> (NSAs) in
meetings like the World Health Assembly (WHA) was the focus of an initial
review at the 145th WHO Executive Board (EB) session
The EB meeting of 34 member states regularly convenes on the heels of the
annual WHA meeting, to plan agendas for the following year.

The WHO report, still under development, suggests the creation of a
separate, annual “World Health Forum” to provide a dedicated venue for
interactions between member states and non-state actors – while curtailing
their formal involvement in the WHA somewhat. Currently some 214 such
groups, including not only NGOs, but also philanthropies and the private
sector, are officially recognised and entitled to speak as observers in
governing body meetings such as the World Health Assembly.

“The increased interest reflected by the greater numbers of non-State
actors participating and requests for interventions has not led to a more
meaningful involvement,” says the WHO report.

“Dissatisfaction with the current system has been expressed by Member
States, and echoed for different reasons in communications from non-State
actors,” states the WHO review, which recommends options such as
consolidating NSA positions into more streamlined statements at public
meetings, along with the creation of a separate forum where actors could
meet directly with member states.

“A World Health Forum could be organized along similar lines to the World
Trade Organization’s Public Forum. Such a World Health Forum could be an
annual stand-alone event in November each year, as with the Meetings of
Interested Parties,” the WHO review suggests.

The EB debate over the role of NSAs followed expressions of dismay by some
member states on the very prominent role certain activist groups played in
the debate over the milestone resolution approved just the day before, to
support greater price disclosure of medicines purchased by national health

In the leadup to the final vote, the resolution was the focus of an intense
NGO campaign during the Assembly, as well as heavy media coverage by
national and international press, and social media.

NGO Activism and Media Coverage Rankles USA and Some European Member States

The raucous social media campaign clearly ruffled the feathers of some
member states, including major health donors such as Germany and the United
Kingdom, unaccustomed to being targeted for blocking medicines access. Both
ultimately “disassociated” themselves from the resolution.

Speaking at yesterday’s Executive Board meeting, Germany complained that
the intense media and social media attention had distracted negotiators and
intruded into their deliberations.

“Some member states felt unease in the negotiations and were really
concerned about being attacked from the outside, also through media
campaigns from the outside. That’s something that needs to be addressed and
reflected in the governance debate,” said the delegate from Germany,
speaking at yesterday’s EB wrap-up on events at the World Health Assembly.

The United States, which supported passage of the resolution, albeit with a
watered-down section on public disclosure of R&D costs, criticised the
aggressive Twitter campaign waged by some NGOs or their supporters.

“We do value the role of diverse non-state actors informing discussions of
WHO’s governing bodies… However, these efforts must respect the process,”
said the US delegate speaking before yesterday’s EB, adding: “We denounce
strongly the actions of some advocacy NGOs during the Assembly to
intimidate member state delegates during the transparency negotiations.”

“This behaviour, including spreading false rumours and half-truths about
internal negotiations, taking photos of our negotiators, and posting their
names online, and firing off ridiculous poisoned tweets – that sort of
behaviour, that is absolutely unacceptable,” said the US representative to
the Executive Board, speaking at yesterday’s session.

Médecins Sans Frontières, one of the groups that was out front on the
social media campaign, could not be reached today for comment. Another NGO
that led an advocacy campaign for strong transparency measures in the
resolution, Knowledge Ecology International (KEI), noted that, like it or
not, rough and tumble social media activism is part of the new normal in
politics – and that the sharpest comments on social media were not directly
from the NGOs in the room at WHA.

“Curious that the US complained about Twitter; have they talked to their
commander in chief?” quipped Thiru Balasubramaniam, of KEI, a major backer
of the transparency of medicines markets.

“Much of the hard-hitting social media was coming from people not in the
room, and not accredited. They were just following the debate online,” said
KEI’s Washington director Jamie Love, adding that more public debate also
helped air the issues and countries’ positions more transparently.

Member States, Not NGOs, Made the Difference

Ultimately, Love said, while NGOs may have publicised the issues, it was
among member states where “feeling about transparency was deeper and
broader than many diplomats thought they would be. They are used to no one
caring much about what WHA does.”

Early on, the resolution was taken up as a project by the new Director
General of the Italian Medicines Agency Luca Li Bassi, whose knowledge and
interest is anchored by years of field experience working with multilateral
and bilateral health and development groups, including the establishment of
the first procurement systems for the Global Fund
<https://www.theglobalfund.org/en/> that supplies drugs to low- and
middle-income countries for HIV/AIDs, Tuberculosis and Malaria.

“Luca was among the very first hires for the Global Fund and set up the
systems for drug procurement that have made this a scandal-free operation,
which is very impressive. I believe he began [at the] Global Fund in 2005.
Before that, he worked in Swaziland, where he was working on procurement of
HIV drugs,” remarked Love. “His extensive experience in Africa helped him
in terms of working with Africa Group negotiators.”

The resolution concept was also readily taken up by the Italian Health
Minister, Giulia Grillo, whose Five Star political movement had campaigned
on health issues such as medicine prices. Greece, Spain and other central
and southern European countries that are burdened by the increasingly high
costs of drugs were early co-sponsors, to be joined by other South-East
Asian, African and Latin American states – where prices create much higher
barriers for patient access to life-saving treatments for cancer, diabetes
and hepatitis.

Even so, the debate over non-state actors’ role in the WHA discussions and
ensuing media coverage reflect some of the broader dilemmas that WHO member
states will confront even more often in the coming years – posing a thicket
of complex questions regarding how to balance public debate, NGO
involvement and member state deliberations in the inner halls and outside
of the WHA.

While WHO Director General Dr Tedros Adhanom Ghebreysus has spoken
repeatedly about his interest in engaging civil society more deeply and
directly with WHO, how to do that remains a challenge.

“We support WHO’s ambition to improve the meaningful, effective and
efficient engagement of non-state actors in official relations with WHO and
recognise that full Governing Bodies agendas drive the need to streamline
statement processes,” said the Union for International Cancer Control. “We
do however harbour grave concerns that the measures put forward in the
report… could potentially undermine the ability of civil society
organisations (CSO) to positively contribute to WHO’s work.”

South-East Asian and Latin American Member States Satisfied with Resolution

Meanwhile, not everyone seemed unhappy with the attention the transparency
resolution received.

Brazil, speaking at the same EB meeting yesterday, lauded the “positive
atmosphere and dialogue that prevailed during the 72nd World Health
Assembly.” Maria Nazareth Farani Azevêdo, Brazil’s Ambassador to the UN in
Geneva, called passage of the resolution on transparency for costs and
prices of medical products among the “much-needed initiatives and
ground-breaking initiatives for this organization.”

Rajitha Senaratne of Sri Lanka, speaking on behalf of the South East Asia
Regional Office (SEARO), expressed “sincere appreciation to all member
states for adopting the resolution on improving transparency of markets for
medicines, vaccines and other health products, proposed by 19 countries,
including many countries from the SEARO region.” He called it a “key
determinant for accessibility for those products.”

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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