<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">---------- Forwarded message ---------<br>From: <b class="gmail_sendername" dir="auto">Editor</b> <span dir="auto"><<a href="mailto:editor@phmovement.org">editor@phmovement.org</a>></span><br></div><br><u></u>
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<h1 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:26px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">Executive Board to review barriers to controlling TB epidemic</h1>
<h2 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">Also new strategy to drive research and development for TB</h2>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">Under Item 10 at its forthcoming meeting WHO's Executive Board will review progress in implementing the 2014 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=78c954dd5c&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">End TB Strategy</a> and fulfilling the commitments in the 2018 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=092203a6a9&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">UN Political Declaration on ending tuberculosis</a>.</p>
<blockquote>Tuberculosis is the leading cause of death worldwide from a single infectious agent, one of the top 10 global causes of death, the leading killer of people with HIV infection, and a leading cause of death due to antimicrobial-resistant infections. In 2016, tuberculosis was responsible for an estimated 1.3 million deaths and an additional 374 000 deaths among HIV-positive people worldwide. An estimated 10.4 million people globally fell ill with tuberculosis in 2016. Drug-resistant tuberculosis is a worldwide threat and a crisis in several Member States. In 2016, there were 600 000 new cases with multidrug-resistant and rifampicin-resistant tuberculosis, requiring treatment of longer duration with more expensive and more toxic second-line drug regimens. Globally, the tuberculosis mortality and incidence rates are decreasing annually at about 3% and 2%, respectively. However, by 2020, these annual rates of reduction need to be 4–5% and 10%, respectively, in order to reach the 2020 milestones of the End TB Strategy. (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=46f883e336&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB142/16</a>) </blockquote>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">It is evident from <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=95069678a7&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB146/10</a> that the End TB strategy is failing. The shortfalls in the targets are themselves disappointing but in absolute terms the global burden of TB is static if not increasing: </p>
<ul>
<li dir="ltr">the reduction in TB incidence and mortality is well below the targets set in the Strategy;</li>
<li dir="ltr">TB households are facing catastrophic health care costs: between 27-83%; 67-100% for drug resistant TB (or are not seeking treatment);</li>
<li>There is an estimated annual gap of around 3m people who are not registered and not treated.</li>
</ul>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=0865fad184&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM's comment</a> on this item argues that the continuing TB epidemic reflects health system weaknesses (including huge out of pocket costs for treatment); failure to act on the social determinants of the epidemic; and weak accountability for implementation. </p>
<h3 dir="ltr" style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Weak health systems</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">Weak health systems, in particular weak primary health care, jeopardise case finding, supportive treatment regimes, and case follow up and monitoring. Health workforce is critical for the implementation of the strategy and it is important that WHO gives priority to the strengthening and equitable distribution of the health workforce. Shortfalls in the health workforce are not mentioned in the report.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">WHO’s insistence, in its UHC rhetoric, that mixed (public and private) health care delivery and health insurance financing are compatible with effective health care, in this case effective TB control, is not credible. The End TB strategy repeatedly refers to engaging the private sector but implementing a TB control program through the private sector require well resourced program management, appropriate organisational support and regulatory capacity which in most cases is just not available. The preference of private sector providers to cluster in affluent areas is a major contributor to the poor distribution of health care resources and the shortages of skilled and motivated health workers in rural communities and informal settlements. PHM urges the MS to strengthen public health systems within the context of comprehensive primary health care and improve health care access.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The other major barrier on the health care side is the cost of medicines (particularly medicines for resistant TB), whether met through out of pocket payment or public subsidy. This underlines the importance of WHO’s work on access to medicines and the culpability of those who continue to obstruct effective action in this space. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">At another level of scale the neoliberal program of small government, low taxes and austerity is responsible for limits on fiscal capacity, for either health service development or underwriting the cost of essential medicines. </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Multisectoral action on the social determination of tuberculosis morbidity</h3>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The second challenge for the effective implementation of the End TB strategy lies in the barriers to action on the social determinants of the TB epidemic. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e896ad8bfc&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB146/10</a> reports that, of the estimated 10m new cases per year, 2.3m are attributable to undernourishment, 0.9m to smoking, 0.8m to alcohol abuse, 0.8m to HIV and 0.4m to diabetes; a total of 5.2m. There is no estimate of attributable fraction due to crowded housing, exposure in prisons, indoor air pollution or occupational dust exposure, although these are mentioned in the End TB strategy (and the draft R&D strategy). <br>
<br>
Proposed interventions include reducing poverty, ensuring food security, and improving living and working conditions as well as interventions to address direct risk factors such as tobacco control, reduction of harmful alcohol use, and diabetes care and prevention. The strategy goes on to call for multisectoral action, political commitment and adequate resources.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">Many governments, especially in the TB high burden countries, are still failing to address the basic social determinants of (ill-)health, including TB, such as poor housing, undernutrition, occupational exposure to dust, and HIV control, which creates an environment for TB to easily spread.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">These risk factors point to the importance of multisectoral action driven by political commitment, and multistakeholder buy-in as emphasised in the strategy.<br>
<br>
However, what the End TB strategy does not address is the political economy of poverty, inequality and austerity. The continuing epidemic is closely linked to the continuing and deepening inequalities between and within countries. In most of the high burden countries the majority of people live in impoverished communities including displacement settlements. </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Accountability</h3>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">In 2018 the World Health Assembly noted that;</p>
<blockquote>... global, regional and country-level actions as well as investments were falling far short of those needed and that high-level global support and regional and national commitments were required; [and noted] that progress is slow on all three targets of the Strategy (reducing TB incidence, reducing TB mortality, and eliminating catastrophic costs among TB patients and their households). (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fa06d45a01&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WHA71.3</a>)</blockquote>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The 'Multisectoral Accountability Framework' was first proposed at the 2017 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=88d728c3ca&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Moscow Ministerial Conference on TB</a>; a draft version was considered by WHA71; a revised version was endorsed in the 2018 UN high level meeting on TB; and the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d17ee8ff69&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">framework was finalised</a> in April 2019.<br>
<br>
The Framework is a brave initiative. It proposes that better indicators, given higher profile, and reviewed in high level multisectoral forums under the watchful eyes of 'key stakeholders' will accelerate progress to achieving the targets of the End TB strategy. <br>
<br>
Given the fact that the indicators are almost all TB-specific, it seems unlikely that this will be enough to drive action on nutrition, housing, overcrowding, HIV diagnosis and treatment, health system strengthening and real progress towards medicines affordability. <br>
<br>
Liberalised transnational capitalism is widening the gap between those people and countries who are well placed in global value chains and those countries and people who are excluded, who continue to carry the burdens of malnutrition, poor housing, occupational hazard exposure, and poverty and the financial and other access barriers which prevent them accessing care. Neoliberal austerity is restricting fiscal capacity and limiting health systems investment.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">PHM urges the Board to address the global economic and political pressures which continue to drive inequality, poverty, displacement, and austerity while protecting the interests of the large corporations, including Pharma. </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Draft global strategy for TB research and development</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b95904870e&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB146/11</a> presents a draft global strategy for TB R&D as requested in <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b4d6c089fd&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WHA71.3</a> (and presented in full <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=683f4752bf&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>).</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The draft strategy acknowledges the existing limitations in R&D capacity and performance and their significance in the continuing TB epidemic. The strategy addresses health system innovation as well as the need for medicines and diagnostics. </p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">Some of the barriers to the needed R&D which are identified in the draft strategy are: </p>
<ul>
<li dir="ltr">regulatory barriers and the management of innovation in health care practice;</li>
<li dir="ltr">institutional weaknesses in research capacity and links between academia and health service delivery; and </li>
<li dir="ltr">lack of funding for R&D.</li>
</ul>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The lack of funding for TB R&D is attributed to the low priority assigned to TB in rich country research (where most of the basic research capacity is located), to the lack of market incentives to encourage research-based pharmaceutical corporations to invest in TB, and to the lack of public funding to supplement private sector investment (and provide support for public private partnerships). </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The strategy reviews priorities for the development of diagnostics, medicines and vaccines and highlights the importance of implementing WHO’s <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4980e8387d&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Roadmap on access to medicines and vaccines 2019-2023</a> and the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4db36bdba8&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Global Strategy</a> and <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b64c426113&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Plan of Action</a> on Public Health, Innovation and Intellectual Property. Unforunately EB146/11 does not mention these. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b48220d3de&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM acknowledges</a> that the global strategy on TB R&D will be a very useful instrument. PHM particularly appreciates:</p>
<ul>
<li dir="ltr">the emphasis on data sharing (including ‘open access to research data and IP’ generated through international funding) although the draft does not mention the 2019 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7b0d15a969&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Transparency resolution</a>; </li>
<li dir="ltr">the endorsement of WHO’s <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=720fd520b9&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Roadmap on access to medicines and vaccines 2019-2023</a> and the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6cf08f4bc6&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Global Strategy</a> and <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=353c73989c&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Plan of Action</a> on Public Health, Innovation and Intellectual Property; and</li>
<li dir="ltr">the recommendations regarding capacity building for research, development and health service innovations, including strengthening the links between research institutions and service delivery programs. </li>
</ul>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">PHM looks forward to seeing the final draft adopted but has concerns about scope, intellectual property and transparency and urges the Board to clarify and strengthen these commitments before forwarding the draft to the Assembly. </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Scope</h3>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The scope of the draft strategy includes basic research into medicines, vaccines and diagnostics and operational research into health care delivery issues. These are all clearly vital. However the draft strategy fails to fully consider the need for research into the social determinants of the TB epidemic (including undernourishment, smoking, alcohol abuse, HIV, diabetes, crowded housing, exposure in prisons, indoor air pollution or occupational dust exposure). It fails to acknowledge or address the global economic and political pressures which continue to drive inequality, poverty, displacement, and austerity (all critical drivers of the TB epidemic) while protecting the interests of the pharmaceutical and vaccine manufacturers. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">WHO strategies, by themselves, are unlikely to resolve these social determinants and their economic and political drivers, but the first step in addressing them is to describe and analyse them and to report on ‘best practice’ in addressing them. </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Research funding and intellectual property</h3>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">PHM appreciates the clarity of the draft strategy regarding market failure in mobilising investment for TB research and innovation and the need to reform the IP based research funding ecosystem. In this respect PHM appreciates the reference to milestone prizes. However, the absence of any reference to the recommendations of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=efb7fcf99f&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">UN High Level Panel on Access to Medicines</a> is disappointing.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">In particular PHM regrets the lack of reference to the need for countries to fully implement the flexibilities available in the TRIPS Agreement to improve the affordability of medicines (in particular medicines for drug resistant TB). </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Transparency</h3>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">PHM recognises that product development partnerships can play a useful role in promoting research in situations of market failure. However, PHM urges that organisations funding PDPs make open access publishing and open patenting conditional upon receipt of such funds. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">PHM urges much stronger reference to the need for transparency with respect to private sector research and development costs. Estimates of R&D costs published by the pharmaceutical industry are generally wildly inflated and not accompanied by publication of any raw data. If public support for private sector research is based on these estimates it will be essentially contributing to marketing costs and profits. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">PHM appreciates the references to open patents and new policies on IP. In para 86 the draft highlights the patenting of specific medicines as a barrier to operational research directed to determining the most efficacious treatment regimes. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">PHM urges high burden TB countries to develop appropriate amendments to both the draft strategy and the draft decision to incorporate these suggested improvements into the strategy as finally adopted. </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">More</h3>
For further links and more detailed comment on the Cervical Cancer item on the WHO Executive Board agenda see the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e189ba8dd3&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM comment</a> on this item.
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The full agenda for the EB can be accessed through the WHO Tracker at <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=79aa5e658f&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">who-track.phmovement.org/eb146</a>, including PHM comments on most items.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">To provide feedback on this commentary please write to <a href="mailto:editor@phmovement.org" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">editor@phmovement.org</a>.</p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Spread the word</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The WHO Tracker and PHM item commentaries are produced through WHO Watch which is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=986747bad6&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">People's Health Movement</a> in association with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=456668282a&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Medicus Mundi International</a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6f99dafefb&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Third World Network</a> and a number of other civil society networks.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The purpose of WHO Watch is to contribute to democratising global health governance, through new alliances and new information flows.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">You can help by forwarding our updates, including on social media, and by inviting others to <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=621c4b010d&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">subscribe to the WHO Watch Newsletter</a> and follow us on @PHMglobal and @WorldHealthWatch.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">Update Reports from previous WHO governing body meetings and earlier Item Alerts regarding EB146 are <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ef33b7251e&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>.</p></td></tr></tbody></table></td></tr></tbody></table></td></tr><tr><td id="m_-7945805067812360557templateFooter" style="background:#fafafa none no-repeat center/cover;background-color:#fafafa;background-image:none;background-repeat:no-repeat;background-position:center;background-size:cover;border-top:0;border-bottom:0;padding-top:9px;padding-bottom:9px" valign="top"><br></td></tr></tbody></table></td></tr></tbody></table></center></div>
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