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The engagement of actors such as industry, civil society, philanthropy and academia with the World Health Organization has been a subject of controversy, with some of those actors being potentially able to influence the work of the organisation. A framework for engagement with those stakeholders was agreed two years ago. At last week’s Executive Board meeting, the new WHO director general explained that engagement with those actors, and notably industry, is worth the risk, which he said can be managed.

The WHO Executive Board meeting, which took place from 22-27 January, adopted a decision [pdf] on 26 January, admitting new organisations into official relations with WHO, discontinuing relations with others, and delaying the review of some candidate organisations.

The WHO’s Framework of Engagement with Non-State Actors (FENSA) [pdf] was adopted in 2016.

In a long intervention, WHO Director General Tedros Adhanom Ghebreyesus (Dr Tedros) explained that the organisation cannot be risk-averse.  “We cannot avoid risk,” he said, “but we can manage risk, and that’s how we should move ahead.”

“If this organisation becomes a risk-averse organisation, it cannot move forward. It is actually dangerous for the organisation,” Dr. Tedros said, adding that since his election, he witnessed the WHO being risk-averse, which “is not really a good way to go forward.” Engaging the private sector and civil society “is a must,” he added.

Answering remarks by civil society about the invitation of food and beverage industry representatives at the WHO’s Global Conference on non-communicable diseases (NCDs) in October 2017, he said engaging industry is not a problem.

“At the WHO, we should not believe in disengaging with the private sector, and anyone for that matter,” he said. “There is nothing to hide. We have the facts, we have the science, while they were in the room, we were able to tell them the truth.”

He said he challenged industry representatives during his speech by asking them if they would knowingly give trans-fats to their children. If giving trans-fats to children is not right, and “you don’t do it to your child, would you feed others [trans-fats] because of greed, and see them die or their health being affected because they are children of others,” he asked them.

If giving trans-fats to children is not right, and you don’t do it to your child, would you feed others trans-fats because of greed, and see them die or their health being affected because they are children of others? – Dr Tedros to food industry

“My children and your children are our children,” he reportedly told the industry. “They are the future of our planet, and we have to take responsibility.”

Industry being in the room was not a problem, he said, as “we told them exactly what we feel about the wrong things they are doing to their face.” It actually helped to be in the same room and exchange scientific ideas, he added.

Having industry in the room does not mean that laws will not be enforced, he said.

Through this engagement “you can agree to disagree on issues we disagree,” and learn how they operate, understand them better, and identify areas of cooperation, and areas where measures will have to be taken.

“Engagement is always good,” he said, adding it does not mean there is conflict of interest in engagement. “I don’t even want to talk” to the tobacco industry, as “there is nothing to talk about,” he said. The same goes for the arms industry, he said. But beyond this red line, Dr Tedros said, “we should engage, even alcohol, what we said is [to be used] with moderation, no abuse should not be harmful, but you cannot go beyond that.”

Member States Approve Newcomers

Very few countries took the floor on the issue last week at the Board meeting. Those who did, such as Congo for the African region, and Mexico, approved the suggestions put forward in the draft decision by the WHO.

The United States urged the WHO “to adopt neither a risk-averse nor a cavalier approach engagement with non-state actors,” adding, “Management of risk is better than avoidance of risk, which can only diminish WHO’s leadership and partnership opportunities in global health.”

The decision states:

“(1) decided:

(a) to  admit into official relations with WHO the following non-State  actors: Association  Africaine  des  Centrales  d’Achats  de  Médicaments  Essentiels; Bloomberg Family Foundation, Inc.; Childhood Cancer International; International Society   of   Paediatric   Oncology;   IOGT   International; KNCV Tuberculosis Foundation;  Médecins  du  Monde;  Osteopathic  International  Alliance;  PATH; Public    Services    International;    The    Wellcome    Trust;    and    United    States Pharmacopeia Convention;

(b) to   discontinue official relations with the following non-State actors: European Centre for Ecotoxicology and Toxicology of Chemicals; Foundation for Innovative New Diagnostics; International Federation of Business and Professional Women; and Rehabilitation International;

(2) noted with appreciation their collaboration with WHO, commended their continuing dedication to the work of WHO, and decided to renew in official relations with WHO the 66 non-State actors whose names are listed in Annex  2 to  document EB142/29

(3) further noted that plans for collaboration with the following entities have yet to be agreed,  and  decided  to  defer  the  review  of  relations  with  CBM;  CropLife  International; International   Agency   for   the   Prevention   of   Blindness;   International   Air   Transport Association; International Association for the Study of Pain; International Eye Foundation;  International Network for Cancer Treatment and Research; International Society of Physical  and Rehabilitation Medicine; Project ORBIS  International,  Inc.; World  Blind  Union;  and  World Council of Optometry until the 144th session of  the Board in  January 2019,  at which  time reports should be presented to the Board on the agreed plans for collaboration and on the status of relations”

Civil Society Concerns

Concern over the participation of entities linked to the alcohol industry at WHO’s Global Conference on NCDs in October was raised by Medicus Mundi, who added in their statement, that they have similar concerns “regarding links to industry, related to the co-chair of the civil society Working Group for the third High-level Meeting of the UN General Assembly on NCDs in 2018.” The Medicus Mundi statement was supported by the Third World Network and the People’s Health Movement.

Medicus Mundi asked that more details be given about secondments of people from non-state organisations, such as the rank and position of personnel seconded to WHO.

The International Baby Food Action Network representative remarked on “unresolved conceptual problems of FENSA” in her statement.  She suggested providing different colour badges for types of non-state actors as a step towards transparency. She added that industry representatives attending WHO meetings with public badges should be listed.

Answering questions from member states about the FENSA implementation, Michèle Boccoz, WHO assistant director-general for external relations, said the deadline for FENSA implementation is the World Health Assembly in May, and the secretariat “is doing its utmost” to have the framework ready and finished by then. A new IT tool has been developed and the secretariat is making great progress, she said.