PHA-Exchange> WHO as seen by Le Monde Diplomatique

[Aviva]

Subject: HEALTH FOR ALL OR RICHES FOR SOME

Le Monde Diplomatique, July 2002
HEALTH FOR ALL OR RICHES FOR SOME
WHO's responsible?
----------------------------------------------------------------------C=
by JEAN-LOUP MOTCHANE *

----------------------------------------------------------------------
"We have to protect patent rights. We need them to ensure the research =
and
development will yield badly needed new tools and technologies. We need=

mechanisms to prevent re-export of lower priced drugs into richer
economies." This ringing endorsement of drug patents was not made by a
multinational CEO, but by Dr Gro Harlem Brundtland, former prime minist=
er
of
Norway and WHO director-general, at the World Economic Forum in Davos
(Switzerland) on 29 January 2001.
Dr Brundtland was also full of praise for the pharmaceutical companies:=

"The
industry has made admirable efforts to live up to this obligation throu=
gh
drug donations and limited price reductions." In her view the
pharmaceutical
industry's efforts were all the more laudable because they were made
despite
"the concern of companies that lower prices in the developing world not=
 be
used as a lever to influence negotiations in countries that can easily
afford to pay more." Dr Brundtland made her comments with respect to
"multinational morality" just five weeks before 40 pharmaceutical compa=
nies
brought legal action against the South African government, which they
accused of importing generic drugs from other developing countries.
Dr Brundtland took up her post on 13 May 1998 and wasted no time in
outlining her strategy to the WHO's member-states at the 51st World Hea=
lth
Assembly, where she insisted that WHO projects must be "open for our
partners to co-sponsor." But which partners? Primarily the private sect=
or,
which was offered a role, together with the primary multinational
organisations, including the World Bank, the International Monetary Fun=
d
and
the World Trade Organisation (WTO).
Dr David Nabarro, executive director at Dr Brundtland's office, justifi=
es
the director-general's chosen course of action: "We certainly need priv=
ate
financing. For the past decade governments' financial contributions hav=
e
dwindled. The main sources of funding are the private sector and the
financial markets. And since the American economy is the world's riches=
t,
we
must make the WHO attractive to the United States and the financial
markets".
Presented as a statement of genuine need, the belief that the WHO shoul=
d
submit to the dictates of Washington and global liberalisation while
seeking
charity from the large institutions is a matter of ideology, since
private-sector contributions account for a tiny fraction of the
organisation's resources. A diplomat with extensive experience with UN
institutions confirms this point: "Dr Brundtland's stance with respect =
to
the pharmaceutical industry stems from her faith in the current
globalisation process. Having already established closer ties with the =
WTO,
she is now reiterating the positions of the World Bank, the WHO's main
financial sponsor. If the director-general adopted a different position=
,
she
would be pitting herself against the US, which has a dominant role".
Policy reversed
The WHO held its fourth Ministerial Conference in November 2001 in Doha=

(Qatar). Developing countries with pharmaceutical industries won the ri=
ght
to make cheaper copies of patent-protected drugs, but only in the event=
 of
public health emergencies; and they are not authorised to re-export the=
se
drugs to poor countries unable to produce the drugs themselves. This
qualified victory was won without the help of the organisation's top
leadership, despite the courageous stand taken by some WHO representati=
ves
(1). It had more to do with the weight of public opinion and the
educational
efforts of various non-governmental organisations (NGOs), not to mentio=
n a
spectacular policy reversal by the US.
Following the 11 September attacks, the US took on the German company
Bayer,
which produces Cipro, the anti-anthrax antibiotic.  It told Bayer that =
it
would start producing the drug itself if the company failed to offer th=
e US
a substantial discount. Resorting to blackmail made it difficult for th=
e US
to oppose other countries that advocated the primacy of healthcare righ=
ts
over patent rights.
Although the WHO hierarchy had little to do with this development, on 1=
7
May
2002 the 55th World Health Assembly unanimously approved - with US supp=
ort
-
a resolution regarding access to essential drugs. The resolution called=
 on
the WHO director-general to take all steps to promote a worldwide polic=
y of
differentiated prices for essential drugs.
As a result of lobbying by numerous delegations - and because the WHO n=
o
longer had any reason to fear Washington - Dr Brundtland's organisation=
 has
finally taken on an active role with respect to drugs access, in contra=
st
to
its earlier perceived spinelessness.
Though such policy flaws predate Dr Brundtland's appointment, they prom=
pted
the UN to launch the Joint United Nations Programme on HIV/Aids (UNAIDS=
) in
1996 to coordinate the global fight against Aids. The executive directo=
r of
UNAIDS, Dr Peter Piot, took a very different stance from the WHO. On 29=

November 2000, prior to the legal proceedings in South Africa, Dr Piot
declared that he fully supported the rights of governments to pursue
compulsory licensing (2) and parallel importing, along with competition=

between generic and patented drugs. He said boldly: "The rules of the
liberal economy have become incompatible with the globalisation of the =
Aids
epidemic. We now need a new deal between drug companies and society" (3=
).
But the rules of the liberal economy govern current WHO policy
considerations. In 1980 Halfdan Mahler, then the WHO director-general, =
made
the Health for All initiative part of official development assistance
policy. This rallying cry is only occasionally invoked nowadays, since =
Dr
Brundtland - at least in her public statements - sees access to healthc=
are
not as a right but as a means to increase productivity. In a recent spe=
ech
to a group of business leaders, bankers and heads of state, she stated =
that
"good health is essential - to fuel the engine of development, to unlea=
sh
the forces of economic development and to permit the reduction of pover=
ty"
(4). Seeking to convince her audience of the need for investment in
healthcare, she also drew attention to disease's negative effects on
economic growth: according to some estimates Aids will reduce annual gr=
oss
domestic product (GDP) by 1% in the hardest hit regions. Within 30 year=
s
the
malaria epidemic will have brought about a $100bn drop in productivity =
in
Africa.
One banker offered this reaction to Dr Brundtland's speech: "It is help=
ful,
even crucial, to calculate the cost of disease and the resultant loss o=
f
earnings. Health is clearly a factor in development. Bismarck knew that=
 in
the late 19th century. He was the first to persuade management to creat=
e a
mutual health insurance system for workers so the factories could go on=

running. But it is na=EFve to think that business people will be persua=
ded to
invest in healthcare in a globalised labour market."
On 17 May 2001 the UN secretary-general, Kofi Annan, who is also facing=

re-election, muscled in on Dr Brundtland's turf when he called for the
creation of the Global Fund to fight Aids, tuberculosis and malaria, wi=
th
an
annual budget of $7bn-$10bn. Annan's intervention was made possible by =
the
WHO's failure to obtain convincing results in the fight against infecti=
ous
diseases. But despite promises by the Group of Eight nations at their
conference in Genoa in July 2001 to grant the Global Fund $1.3bn, it ha=
s
only received $200m to date. This contrasts starkly with the $1.9bn ple=
dged
by various donors or the $1.6bn already allocated by other donors to
comparable programmes (5).
Conflict of interest
The creation of the Global Fund was originally seen as an important ste=
p
forward, but its status as an independent foundation governed by privat=
e
law
(6) means that the UN will no longer be responsible for a key component=
 of
global health policy. The WHO's role is negligible and, with the creati=
on
of
UNAIDS, the WHO has been further marginalised in a field that at one ti=
me
was its raison d'=EAtre.
Many people have complained about Dr Brundtland's subservient policies.=
 In
an open letter to her (8), Ralph Nader, while recognising her efforts i=
n
combating malaria, tuberculosis, smoking and the tobacco industry, said=
:
"Many are concerned that the World Health Organisation has permitted a
handful of large pharmaceutical companies to exercise undue influence o=
ver
its polices and programmes. The WHO ... has shrunk from its traditional=

role
in promoting the use of generic drugs in poor countries." Dr Brundtland=

refuted these charges in her response to Nader's letter, saying she had=
 had
worked to strengthen the WHO's international credibility and to put hea=
lth
issues at the top of the agenda of global development policies.
One of Dr Brundtland's colleagues, Daphne A Fresle, recently submitted =
her
resignation from the WHO in a letter that amounted to a scathing indict=
ment
of the organisation and its director-general (9). Ms Fresle condemned "=
the
lack of enthusiasm" shown by the current administration in publicly
defending the developing nations' vital interests, which should be the
organisation's primary consideration. According to Ms Fresle, the WHO h=
as
abandoned its traditional goal of Health for All and now serves the
interests of the most powerful countries and of the pharmaceutical
companies. Owing to their lack of scientific rigour, she says the
organisation's latest reports have harmed its credibility and reputatio=
n
(10), and the WHO's administrative reorganisation has been a failure (1=
1).
The WHO's policies over the last three years had had two main consequen=
ces:
the WHO was facing ethics-related accusations and had squandered its
leadership role in the health field as a result of the Global Fund (12)=
.
At the WHO's enormous headquarters in Geneva many people we spoke with
discreetly confirmed that they shared these views. One bureaucrat, who =
is
critical of the Global Fund, commented: "In theory - despite its
shortcomings - the WHO allowed the 191 member-states to make their voic=
es
heard at the World Health Assembly. From now any new steps to fight the=

three most important infectious diseases will hinge on the virtually se=
cret
deliberations of a private foundation, whose executive board has no rea=
l
accountability to the international community."
For one high-ranking official who has served under several
directors-general, the WHO is at a crossroads. In his opinion, the
organisation must clearly redefine its mission in the light of
globalisation
and the competing interests of governments, individuals and the private=

sector (13). "Countries or regions should call on the WHO to put togeth=
er
global health guidelines, in which all parties concerned may clearly st=
ate
their expectations with respect to global health policy." It seems that=
 no
one any longer knows exactly why the WHO exists. But growing numbers of=

observers believe that the current trend towards privatisation of the
global
health system will only serve to exacerbate existing inequalities.