Governments Scrutinise WHO On Pandemic Response, R&D Finance Group By William
New @ 8:29 pm - Jan 18 - 2010
The World Health Organization today declared it will launch a review of the
global – including its own - response to the H1N1 swine influenza epidemic, as
questions swirl around whether the UN agency trumped up the importance of H1N1.
The WHO also faces charges this week that it has acted without transparency and
inclusiveness in leading a process to find alternative financing for research
and development into medicines for diseases occurring predominately in
The WHO will prepare an interim version of its review of the global H1N1
response in time for the next World Health Assembly in May, WHO Director
General Margaret Chan announced to the WHO Executive Board today. Meanwhile, a
new proposal emerged from governments on how to proceed on the related issue of
pandemic flu access and benefit sharing, and is expected to be discussed
All the issues are on the agenda of the WHO Executive Board, meeting from 18-23
January. The board’s recommendations will be carried forward to the annual
World Health Assembly in May.
Bigger issues of governance and funding for the WHO are in the background this
week as well, as Chan on 12-13 January held a meeting on this with some 30
people from UN missions and ministries of health and finance. A report from the
meeting will be made public for comments on the WHO website and a paper
reflecting the results are expected to be submitted to the Board within a year,
Chan in her opening remarks listed several subjects that members see a need to
address at the international level, including public health, innovation and
intellectual property. The WHO in recent years has developed a global strategy
and plan of action on these issues, and the financing aspect is a final step.
It is under this topic that the World Health Assembly mandated (Resolution
61.21) an Expert Working Group on R&D financing come up with ideas for
encouraging research into diseases for which there are not significant markets
for private sector R&D investment. The board began work on the topic, agenda
item 4.3 of this week, late this afternoon.
The working group roduced a report in December that found there is no evidence
of global coordination on research and development in neglected diseases.
According to working group Chairman George Allewyn, the working group worked
through nearly 100 proposals, chose from among proposals they thought would be
most efficient and doable. Allewyn in his report to the board skimmed over
numerous proposals, such as prize funds and patent pools, which are generally
unpopular with industry.
Three proposals were highlighted by the working group report: some variation of
a new indirect, consumer-based tax; voluntary business and consumer
contributions (like purchase of a product that includes a donation to the
cause); and new donor funds for health R&D. The group also recommended the
creation of a global health research and innovation coordination and funding
But transparency questions plagued the working group, as media was shut out of
its progress for the past year, and non-governmental groups raised steady
concerns. “We have serious concerns about the transparency of the process,”
Health Action International said in a 15 January open letter to the Executive
Board, adding that the report avoids substantive issues and intellectual
property. Chan in the past has stated that intellectual property is not a
public health issue.
The most troubling accusation came from one of the experts on the working
group, Colombian Senator Cecilia López Montaño, who said in a 15 January open
letter urged board members to reject the report. She said she felt “utilized to
legitimize a process in which neither I nor the majority of the members of the
group participated in a full manner.” She said there was poor information from
the WHO secretariat, documents were sent at the last minute, meetings rushed,
and intellectual property issues were avoided despite being germane to the
group’s mandate. She also said she requested information from WHO official
German Velasquez, another Colombian, who would have normally been involved in
the issue, but he was “sidelined” him from the report. Transparency concerns
raised along the way were ignored by the WHO, she said.
Allewyn and the Executive Board Chairman quickly dismissed the Colombian letter
without mentioning specifics, saying only that it should have been brought up
in the same working group that López Montaño said was unresponsive. Allewyn
referred to the letter only as “that little mishap.”
Allewyn said it was “humanly impossible” to finish the report and get it
translated in time for the Board meeting, so they were only provided with a
summary. The translated full report will follow in the next 4-6 weeks, he said.
India and Brazil criticised aspects of the working group report. India said it
“falls well short” of the plan to address Type II and III diseases (affecting
mostly developing and least developed countries), and lacked a clear focus on
technology transfer, the best solution in its opinion. Brazil said intellectual
property issues can be addressed from a public health standpoint, proposed the
director general convene intergovernmental meetings in the lead-up to the May
assembly, and signalled support for the global health R&D coordination and
While all countries on the Board lined up to praise the WHO’s response to the
H1N1 pandemic that broke out in spring 2009, a variety of countries asked that
WHO review its work on the pandemic, and Japan suggested it could look at
measures in future to assess the seriousness of any flu outbreak, such as
number of patients hospitalised.
But developed countries such as the United Kingdom and the European Union
represented by Hungary particularly spoke against criticism that has arisen of
the WHO’s strong actions against what has amounted to a less lethal flu
pandemic than feared. The UK urged members not to become “complacent” as a
result of the criticism, but rather to continue to keep high levels of
response. The European Parliament recently begun considering launching an
investigation into the WHO’s behaviour on H1N1.
Chan proclaimed in her opening statement that the moderate nature of the
pandemic is the best health news of the past decade. She said a number of
things could have gone worse: the virus could have mutated, resistance did not
develop to oseltamivir and the vaccine could have been less effective, she said.
She cited the generosity that has led to “well over 23,000 viruses and other
specimens” being submitted to WHO network laboratories for analysis.
Chan said in some countries in the northern hemisphere the worst may be over,
but, she cautioned, “there is quite a lot of winter left,” and the southern
hemisphere will enter its influenza season soon. She urged countries to
continue to push their populations to get vaccinations, and said for developing
countries “concerned about their access to pandemic vaccines, WHO is ramping up
its donation programme.” She also noted the difficulties in communicating to
populations the need to get vaccinated.
Chan also said the pandemic has been the first test of the 2005 International
Health Regulations, which some countries are proposing to review. The
regulations are a “system of checks and balances,” said Chan. “They ensure that
no one, myself included, has unfettered power.”
Reliable estimates of deaths from the current pandemic will take one or two
years after the pandemic has ended, she said.
A WHO official said 265 million doses of vaccine have been distributed. Next
autumn and winter expect another influenza season, he added. The virus has all
the characteristics of one which will be long term.
Pandemic Access and Benefit Sharing
The international system for access and benefit sharing related to pandemic
influenza, a key agenda item of the week, was postponed to Wednesday to allow,
sources said, time for governments to discuss the issue among themselves. A new
proposal has emerged from about a dozen countries such as Canada and the United
States on procedure for what should be done next on the flu issue, which arose
about two years ago when Indonesia declined to share its strain of the avian
flu virus (H1N5) out of concern that it would be used in research by developed
countries, patented and sold back to Indonesia at too-high prices. It is not
about H1N1, the so-called swine flu, a proponent government source said.
The new proposal, not publicly available, would establish a member working
group at the next assembly in May, encourage governments to consult in the
meantime, and promote mission briefings on the issue, according to a copy seen
by Intellectual Property Watch.
>From the outset, the Board meeting quickly hit a subtle North-South overtone
>as two urgent late addition agenda items were discussed: pneumonia, which
>affects developed countries and was proposed by the United Kingdom, and
>Hansen’s disease (leprosy), which affects developing countries and was
>proposed by Brazil. Japan, the meeting chair, and the director general,
>pressured Brazil to postpone or marginalise its request (e.g., in an informal
>side meeting), but Brazil held its ground. Brazil raised the issue after 44
>WHO members met in New Delhi and drafted a global strategy on the disease, for
>which there was last a strategy in 2001.
Also, Uganda on behalf of the African region proposed the development of a
joint framework among the heads of the WHO, World Trade Organization, and World
Intellectual Property Organization, to report to the next meeting.
William New may be reached at email@example.com.