WHO Needs To Accelerate New Polio Vaccine Rollout & Action On Harmful Alcohol Consumption, Says Executive Board

After a total of 12.5 hours of consultations in five informal meetings, a bloc of countries led by Thailand won WHO Executive Board approval for a landmark decision to develop a new ten year-action plan to reduce the harmful use of alcohol.

Representatives of Norway and the European Union joined as co-sponsors in a compromise decision, which nonetheless saw an earlier reference to the possible development of an international legal instrument removed.

Civil society actors who had lobbied hard for the new action plan, described it as a “historic moment” but lamented that the “overarching need” for more binding international measures to limit alcohol marketing and advertising, particularly to youths, had not been answered.

However, the compromise text asked WHO to prepare a technical report on the harmful use of alcohol related to cross-border advertising, including marketing targeted towards youth.

The compromise also greatly softened a reference to WHO’s own internal policies, which generally tolerate alcohol consumption in office cafeterias and official events, including at the Geneva Headquarters.  An earlier draft had asked WHO to exercise of “global leadership” by refraining from providing or selling alcohol on all WHO-campuses and at WHO-sponsored events. The amended text simply acknowledges that some WHO offices do not offer alcohol as a practice.

Thailand expressed that the text was amended “in the spirit of compromise to move this very important agenda forward.”

Still, the Thailand delegation urged WHO to take action outside of the Executive Board framework and consider an “alcohol-free” policy for the Organization in the coming months.

In a win for the bloc of sponsors, the revised text retained a reference to alcohol’s carcinogenic properties, which had been opposed initially by the United States.

“Cancer is one of the diseases linked causally to alcohol, “ said Germany, on behalf of the EU. The delegate also expressed concern about the “cross-border “digital marketing” of alcohol towards minors.

“We have to do better,” Germany concluded. The reduction of the harmful use of alcohol “cannot be addressed effectively without cross-border collaboration.”

Norway, the second co-sponsor added to the resolution last night, has also made harmful alcohol use reduction a key cornerstone of a new development aid policy that focuses on non-communicable disease prevention and control.

In a statement, the NCD Alliance lauded the action by member states, saying, “Today’s decision, adopted by consensus, will ensure alcohol harm will be given greater time and attention….We are particularly pleased to see the EU co-sponsor the decision and call on all EU member states to walk the talk by tackling alcohol as a carcinogen in the EU cancer plan announced earlier this week on World Cancer Day. The EU Cancer Plan which so far overlooks alcohol as a major risk factor for premature death, in the heaviest alcohol drinking region in the world.

“The proposed new Action Plan holds great potential to provide a stronger whole-of-government and inter-agency framework for accelerated action, accountability and impact. It is also an opportunity to address barriers to progress, such as by ensuring a robust monitoring and accountability framework and providing guidance on managing alcohol industry conflict of interest and interference.

“It is important that the Action Plan addresses industry interference as a barrier to alcohol policy progress, as it has been acutely apparent that throughout recent months and days, the alcohol industry were actively lobbying Member States in efforts to dilute existing evidence based recommendations policies which are known to reduce alcohol harm, as well as undermining efforts by Member States to secure a stronger global response to alcohol,” he addded.

“We are also very pleased to see that attention will be given to the impact of cross-border alcohol marketing, particularly its impact on youth and adolescents. Marketing of health harming products such as alcohol and unhealthy food and drinks is insidious and inadequately regulated. The evolving marketing and sponsorship landscape demands far greater scrutiny and regulation to protect the health and wellbeing of people across the life-course.”

Maik Duennbier, director of Strategy and Advocacy at Movendi International, an alcohol abuse NGO, told Health Policy Watch that the EB action follows a decade of inertia. “It has taken 10 years for a substantive discussion of the global alcohol burden and the necessary policy response at the WHO governing bodies. Thanks to today’s decision, this will change: the issue will be on the agenda more often and more regularly,”

“But what this week of debating the response to alcohol harm has shown is: while we are where we need to be yet…  the action plan needs to be filled with bold targets and actions to turn the tide on alcohol harm. The overarching need is still a global binding treaty on alcohol to effectively protect the human right to health.”

Updating the WHO alcohol strategy was a key element of this year’s EB decisions on combatting NCDs. The EB recommendations also prioritize global action on cervical cancer control and stronger prevention and early detection services at the primary health care level.  A menu of treatment options for mental health is also under development along with a package of interventions for reducing air pollution risks and disease.

EB Members Urge WHO To Accelerate Roll Out Of New Polio Vaccine, Ensure Supply

Meanwhile the Executive Board also approved a recommendation urging WHO to accelerate the roll-out of a novel oral polio vaccine that could help reduce incidence of vaccine-derived polio virus – which was the cause of several polio outbreaks in Africa in 2019, according to WHO.

The new polio type II vaccine is expected to be available by mid-2020, Michel Zaffran, head of WHO’s Polio Eradication efforts, told the governing board.

The draft decision adopted Friday by the Board requested WHO to: accelerate the assessment and roll-out of the novel oral polio vaccine type 2, including through the “WHO Emergency Use Listing” procedure; and to initiate a process for prioritizing the “equitable allocation of limited supplies” of the novel vaccine.

The EB also urged WHO member states to expedite the processes for authorizing the importation and use of polio vaccines, including the novel vaccine on the basis of its emergency use listing, as well as stepping up domestic funding for vaccination.

Gabon, speaking on behalf of African states, said the decision represents a “major undertaking for the African region.”

Zaffran acknowledged that 2019 was “a very difficult year” for polio eradication, with wild virus outbreaks in Afghanistan and Pakistan as well. He underlined the need for stronger outbreak strategies in countries as well as stronger domestic resource allocation.

US Blocks Request for Report on Digital Marketing of Breastmilk Substitutes

In other EB action on Friday, Bangladesh requested the WHO to “collect data and prepare a comprehensive report to address digital marketing and promotion of breastmilk substitutes,” in line with the WHO Code of Marketing for Breast-milk Substitutes. However, the United States expressed concerns about the “resources involved” in conducting the study, ultimately leading to the request being tabled for further discussion.

The Bangladesh request was proposed as an amendment under an EB agenda item on “maternal, infant, and young child nutrition.” WHO and UNICEF both currently recommend exclusive breastfeeding until 6 months of age, with sustained breastfeeding up to 2 years. The Code of Marketing for Breast-milk Substitutes serves as strict guidance for marketing infant formula – which WHO called a “major factor in undermining efforts to improve breastfeeding rates” in a 2018 report.

Several countries supported Bangladesh’s request, including Benin on behalf of the Who AFRO region, and several countries of the PAHO region such as Guatemala and Chile.

The US, home to some of the largest infant-formula companies in the world such as Abbott, said that nutrition initiatives should “include the private sector” and initially declined to comment on Bangladesh’s proposed amendment.

However, once the decision on the amendment was brought to the floor, the US expressed concerns regarding the “implications of the amendment,” including reporting requirements from WHO Member states and other “resources” that would need to be involved.

“We respectfully ask for more time… We would be happy to continue the discussion into May,” said the US delegate.

Ultimately, the Chair of the EB proposed a compromise to suspend a decision on Bangladesh’s  request until Saturday, asking the WHO Secretariat to “facilitate discussions” on the matter.

Wider WHO guidance around nutrition and health was requested by several states – including a request from Austria asking for further guidance on how to measure childhood obesity in kindergarten and a plea from Sudan on behalf of the Eastern Mediterranean region to consider “conflict-affected countries” facing food insecurity and undernutrition. The discussion set the stage for the December 2020 Nutrition for Growth Summit in Tokyo, which will precede the release of new WHO Nutrition guidelines for 2021, including a specific roadmap for closing gaps for specific country needs.

EB Debates IP Protection, Access to Medicines

The Executive Board also approved a GSPOA that aims to balance access to medicines with innovation needs – but not without debate around intellectual property protection. The decision, which will now go to the May World Health Assembly for final approval, asks countries and the WHO to proceed swiftly on the implementation of recommendations approved by the 2018 World Health Assembly (WHA) on next steps for the 2008 Global Strategy and Plan of Action on Public Health, Innovation and Intellectual property. The European Union joined as a co-sponsor of the decision

Brazil, leading the charge on the draft decision, explained that the document is meant to renew the political push given by World Health Assembly in 2018 and 2019 on greater frameworks for discussions about medicines prices and the R&D costs of developing them. Germany, which fought alongside the United Kingdom during the last WHA against a resolution on price transparency of medicines markets, spoke for the European Union, co-sponsor of the draft decision. The German delegate, while acknowledging that millions of people have no access to medicines, said the issue should be tackled in a holistic manner, reflecting the complexity of the problem and considering the entire life cycle of medicines.

Still, the final decision left out more explicit language asking Member States to support disclosure of R&D costs; more explicit identification of supply shortages; and national commitments to allocate at least 0.01% of national gross domestic product to research “relevant to the health needs of developing countries.”

Instead, after five rounds of discussions, the final resolution simply left the door open to member states to consider such issues in the framework of national policies on patents and intellectual property rights. Low-income countries are accorded some flexibilities allowing them to override patents on certain medicines so as to increase access to generics and biosimilars, under the World Trade Organization’s (WTO) agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

The EB text also requests the WHO Director-General to report back by 2021 on the results of an informal consultation on drug price transparency, medicines shortages, and investments in research, including R&D costs.

Members of the EB were clearly reluctant to suggest more explicit language that might somehow impinge on intellectual property rights that protect medicines patents, which industry leaders are an important driver to R&D for new health products. The United States said intellectual property is “the corner stone of medical innovation,” while Switzerland said the protection of IP rights should be discussed at the World Trade Organization and at the World Intellectual Property Organization (WIPO). WHO’s discussions, the Swiss delegate said, should be focused on price transparency and on efforts to stop shortages.

Even so, the decision was largely seen as a step forward by civil society actors on an oft-polarized issue.

Jamie Love, director of Knowledge Ecology International, told Health Policy Watch, “This decision strengthens the mandate for the WHO to work on transparency of medicine prices.” We hope the member states will also spend some time looking at the R&D Observatory, which has failed to have much of an impact so far, at the WHA.”

Mariângela Simão, WHO assistant director-general of Access to Medicines and Health Products said the WHO has made substantive progress in response to some member states’ reticence to address the issue. The sheer number of recommendations in the first 2008 Global Strategy and Plan of Action (108) was paralysing, she said, and when in 2018, the recommendations were pared down to just 33 it became much more manageable.

Simão added that WHO, along with the WTO and WIPO, were working on the latest update to a trilateral study on “Promoting Access to Medical Technologies and Innovation: Intersections between public health, intellectual property and trade.” The report is due to be launched just before the WHA in May.

Israeli Proposal on Removal of Special Item on Palestine Knocked Down

Also at the Executive Board, Israel submitted once again a request to change the status of a WHA agenda item on health conditions in the occupied Palestinian territories and Golan Heights, where the matter is discussed every year, separately from other health and humanitarian emergencies. But the request was denied by the EB in a 15-7 vote.

“We heard many times that WHO is engaged in international emergencies and assisting people around the world… yet none of these programmes is presented by the Secretariat in a standalone item, and none receive the attention they deserve in the limited time in the Assembly,” said Israel’s delegate, protesting the singling out of the Israeli-Palestine issue at every WHA.

The Secretariat’s report could still be presented “without opportunity for political attack against one Member State,” added the delegate. The Israel delegation also expressed disappointment over the withdrawal of a draft WHO report that had included details of Israeli health and humanitarian support to Syrians, which was supposedly suppressed by the Syrian government.

Syria quickly shot back, “once again, Israel is trying to misuse its membership in this technical forum to achieve political gains by returning to proposals that this board has rejected last year.”

Palestine, a permanent observer to the EB proceedings, joined in and added that they did not find “any justification” for Israel’s request to move the agenda item from WHA’s Committee B to Committee A, which effectively would give the matter less attention at the Assembly.

“Health for all is and remains our goal… as the DG has said, we have to show solidarity and cooperate,” said the Palestine delegate. “We shouldn’t be referring to purely political matters… in order to deal with a draft decision to deal with moving an item from Committee B to Committee A, especially when we know this is an issue we’ve been debating for years… at committee B.”

The Israel proposal was then brought to the table and shut down in a 15-7 vote against amending the agenda, with 10 abstentions by EB voting members.

Updated on 8 February 2020

Image Credits: Flickr/Steven Miller.