PHA-Exch> NGOs voice concerns over WHO's publications policy

[Claudio Schuftan]

   From:    cschweid at sas.upenn.edu
   From: Third World Network Gva

SUNS #6477 Tuesday 20 May 2008

Geneva, 19 May (Kanaga Raja) -- Some thirty-five civil society organizations
have voiced serious concerns over the World Health Organization's
publications policy, arguing that the proposed policy, if implemented, will
result in a tendency towards "self-censorship" by the WHO and its staff and
HQ offices, to the detriment of the needs and interests of public health,
especially in developing countries.

They are also very concerned that this policy will hamper timely advice and
support by WHO HQ and regional offices to member states over important
issues such as application of intellectual property rights and the use of
TRIPS flexibilities, other trade and health matters, reproductive health
care and other critical issues.

The focus of the civil society groups' concerns over the publications policy
were two Secretariat Reports - "WHO Publications" (EB 122/20 dated 6
December 2007), and further elaborated in another Secretariat report titled
"WHO publications policy: guidance on implementation and evaluation" (EB
123/7 dated 14 April 2008).

According to the NGOs, it is widely believed that the overhaul of WHO's
publications policy is a response to recent pressures from some developed
countries that were unhappy with some of its publications on the subject of
IP and public health.

In the NGOs' view, little information has been provided as to the need and
rationale for overhauling the present publications policy, and putting in
place measures as mentioned in the two documents. For example, it is unclear
what is the rationale for requiring publications (even those produced by the
regional offices) and that "address controversial health-related issues" to
go through additional clearance by the Director-General's office.

Outlining their concerns in a letter to WHO Director-General Dr Margaret
Chan, the NGOs were of the view that prior to implementing the proposed
publications policy, the policy should be the subject of thorough discussion
among all member states. WHO member states should also be provided with full
information so as to enable informed decision-making.

The NGOs also strongly urged the Director-General not to bow to pressures
from particular member states, and to reconsider the policy that is
contained in the two documents.

The letter to Dr Chan was signed amongst others by Act-Up Paris; American
Medical Student Association; Consumers' Association of Penang, Malaysia;
Economic Justice and Development Organization, Pakistan; Essential Action,
US; Health Action International; Health Gap (Global Access Project) US;
IBFAN; Initiative for Health, Equity & Society, India; Knowledge Ecology
International; Oxfam International; Peoples Health Movement; Third World
Network; and Universities Allied for Essential Medicines.

The letter by the civil society organizations comes just as the sixty-first
World Health Assembly got underway here Monday through Saturday.

In their letter to the WHO Director-General, the groups said that for
decades, WHO at the HQ and regional levels has produced many excellent
publications and briefing papers to support and guide the development and
application of pro-public health policies in developing countries
particularly where it intersects with intellectual property rights.

Some of these publications include: Working Paper on Guidelines for the
examination of pharmaceutical patents: developing a public health
perspective (January 2007); Implementation of the WTO General Council
Decision on Paragraph 6 of the Doha Declaration on the TRIPS Agreement and
Public Health (April 2004).

Joint publications by WHO and other organisations, for example: (1) a study
commissioned by the WHO Commission on Intellectual Property Rights,
Innovation and Public Health (CIPIH) titled "The Use of Flexibilities in
TRIPS by Developing Countries" (WHO & South Centre, 2006); (2) "Remuneration
guidelines for non-voluntary use of a patent on medical technologies" (WHO &
UNDP, 2005); (3) "Determining the patent status of essential medicines in
developing countries' health" (UNAIDS, WHO & MSF, 2004); and (4) "Protection
of Data Submitted for the Registration of Pharmaceuticals: Implementing the
Standards of the TRIPS Agreement" (WHO & South Centre, 2002) are also
evidence of WHO's notable work in the area of IP and Health.

Civil society also often relies on these publications as the basis of its
advocacy work, said the letter to Dr Chan.

"In our view, WHO's exemplary papers in the area of IP and Health are due
especially to WHO's independence in determining the topics it should speak
on, free from any member state's influence and interference."

"However, we are very concerned with reports that the WHO has come under
pressure from some developed countries that were unhappy with some of its
publications on the subject of IP and public health. For example, it has
been publicly reported that a letter was sent by a particular country to the
WHO Secretariat requesting it to withdraw one of the publications it has
co-published that is on the subject of IPRs and public health."

It is widely believed that the proposed overhaul of WHO's publication policy
is a response to these recent pressures. "We believe that such pressures
should not have been put on the WHO, nor should they be repeated," said the
letter.

The groups stressed that the WHO Secretariat is mandated to provide
independent opinion and research, which are reflected in its publications.
The independence of opinion and intellectual integrity of the Secretariat
are essential conditions for the public confidence in the WHO.

"We therefore believe that the Secretariat, and especially the Director
General, should not bow to pressures by particular member states. For
example, the WHO should not practice self censorship' in an attempt not to
displease certain countries or parties, especially when it has a
responsibility to take a stand and speak up on behalf of public health."

In this context, the groups said that they are concerned that the
publication policy has the high potential to result in such "self
censorship" by WHO and its staff. They are also very concerned that this
policy will hamper timely advice and support by WHO HQ and regional offices
to member states over important issues such as application of intellectual
property rights and the use of TRIPS flexibilities, other trade and health
matters, reproductive health care and other issues.

In their letter to the Director-General, the civil society organizations
went on to outline their specific concerns and questions over the WHO
publications policy that has been set out in the two Secretariat reports.

-- (1) Differential treatment of some publications

Paragraph 13 of EB 122/20 (dated 6 December 2007) requires publications
"that describe the workings of a particular government or national health
service or that have policy implications for the Organization or address
controversial health-related issues" to go through "additional clearance by
the Director-General's Office", while the final text of all other
publications can be cleared by the "relevant Assistant Director-General or
Regional Director before publication."

This requirement also seems to be applicable to "Any article, book chapter
or invited commentary relating to WHO's work that is to be submitted by a
staff member for external publication". (paragraph 9 of EB 122/20).

The groups said that paragraph 13 raises several questions especially what
is the rationale for treating some publications differently from other
publications and what are the criteria that will be used to determine which
topics "have policy implications for the Organization or address
controversial health-related issues" and thus will require additional
clearance by the DG's office.

"Requiring differing treatment between publications raises the question of
whether publications (including papers written by staff members for external
publication) that are to be approved by the DG's office will undergo some
kind of political review or approval to ensure that it is politically
acceptable to member states before it is cleared. This would effectively
undermine the independence, neutrality and editorial freedom of WHO and
instead make WHO and its staff more susceptible to political and other
pressures," said the civil society letter.

"We are of the view that the policy proposed above will result in a
situation where WHO and its staff will shy away from speaking up on topics
that have important implications for public health (such as intellectual
property rights) but that may be unpalatable to some countries, particularly
countries that are significant financial contributors to the WHO."

In the civil society groups' view, WHO reports and publications should be
only subjected to "technical review" to ensure that they are factually and
technically accurate, and that they take a public health perspective. In
this regard, all publications should be treated equally.

-- (2) Publications produced by regional offices

Paragraph (1) also applies to regional offices, which further raises the
question as to the rationale for requiring publications commissioned or
produced by regional offices to be cleared by the DG's office. Regional
directors are elected by member states; thus, the regional directors should
have authority to provide clearance to all publications as was the case
prior to the proposed new policy.

"In our view, WHO regional offices play an important role by raising
awareness on and supporting member states in developing and implementing
measures that promote public health by commissioning relevant publications,
preparing briefing papers, on request providing advice, participating in
workshops etc. Civil society groups have benefited significantly from the
services of the regional offices," said the letter to Dr Chan.

The groups are concerned that the proposed broad definition of the term
"publication" coupled with the policy mentioned in (1) would make it
difficult for regional or national-level pro-public health initiatives to be
taken on several important issues where support is needed by member state
and by civil society, as these issues may be considered "controversial."

According to the letter, the term "publication" is defined in footnote 2 of
EB 122/20 as "information products, i. e. Materials that are issued by WHO
to the public in whatever format and through whatever channel. It excludes
materials internal to WHO." Paragraph 3 of EB document 123/7 (dated 14 April
2008) further defines information products as "written or illustrated works
that the Organisation makes publicly accessible. Examples include documents
on the website and journal, articles, guidelines, reports, training
materials and advocacy materials in any format (printed, web, CD-ROM/DVD or
audiovisual), whether sold or distributed free of charge".

The extraordinarily broad definition of "publication" appears to include
materials such as briefing papers, leaflets, power-point presentations,
materials given to a government requesting technical assistance etc.

Where these information products relate to topics that "have policy
implications for the Organization or address controversial health-related
issues", then it would have to be approved by the DG's office.

"In our view, the approach being taken is very worrying as it will hamper
the timely provision of advice and support particularly by regional offices
to member states. It can be expected that WHO staff would have to face time
constraints and several hurdles to get their views approved by the DG's
office before they can present them." said the civil society groups.

-- (3) Master list of planned publications

Paragraph 8 of EB 122/20 requires that a master list of planned publications
be prepared for executive approval at the beginning of each biennium, said
the groups, voicing concern that this will hinder WHO's ability to deal with
new issues or concerns that arise during the year.

-- (4) Need for more information and debate on the issue of publications

"In our view, little information has been provided as to the need and
rationale for overhauling the present publication policy, and putting in
place measures mentioned in the EB 122/20 and EB 123/7."

For example, it is unclear what is the rationale for requiring publications
that "address controversial health-related issues" to go through "additional
clearance by the Director-General's Office."

Could the WHO please provide a list of what these controversial issues are,
and what is the criteria for designating an issue as "controversial", the
groups asked.

Also, the implications of the policy for developing countries should also be
assessed and discussed. For example, while cost-effectiveness may be
appreciated, reducing copies that are printed and distributed (paragraph 6
of EB 123/7) will simply shift printing costs to governments that will have
to go online to print WHO publications, and as a result hamper easy access
to hard copies that contain important information for developing countries.

The aim to reduce number of "titles" (paragraph 6 of EB 123/7) may undermine
functions of the WHO stated in its Constitution, for example, "to provide
information, counsel and assistance in the field of health"; "to promote...
research in the field of health"; and "to assist in developing an informed
public opinion among all peoples on matters of health".

According to the letter, EB 122/20 seems to indicate that the previous
publications policy has undergone a "fuller review" and yet there is almost
no information as to what was the previous publication policy, the persons
involved in this review and the outcome of this review.

-- (5) Policy will de-motivate WHO staff

"We are of the view that the numerous steps listed for the preparation and
clearance of publications in EB 123/7, present hurdles and will only result
in frustrating staff initiatives in emerging with good publications on a
timely basis. Ultimately, the loser in this process will be the public
especially in developing countries," said the letter to Dr Chan.

"We are of the view that prior to implementing the proposed publication
policy, the policy should be the subject of thorough discussion among all
member states. WHO member states should also be provided with full
information so as to enable informed decision-making."

The NGOs are much concerned that the publication policy will result in a
tendency towards "self-censorship" by WHO and its staff at regional and HQ
offices, to the detriment of the needs and interests of public health,
especially in developing countries.

They strongly urged the Director-General to reconsider the policy that is
contained in the two documents. +
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