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World Health Organization Director General Tedros Adhanom Ghebreyesus (Tedros) admonished member states at the close of this week’s special session of the WHO Executive Board charged with examining the agency’s draft work programme for 2019-2023. A trust deficit among member states leads to the multiplication of national statements, impeding efficiency, he said. Meanwhile, a number of countries called for affordable and accessible medicines, and help to manufacture generic medicines locally, while the United States pushed the role of the private sector. 

The draft 13^th WHO General Programme of Work (GPW13) was generally well received by member states this week as a good basis for a future amended document, based on their comments.

The Special Session of the WHO Executive Board (EB) took place on 22-23 November. Member states still have until 29 November to submit additional comments to the GPW13.

A revised GPW13 is due to be released for the regular session of the EB, from 22-27 January. According to the EB chairman Assad Hafeez of Pakistan, the revised GPW13 is expected to be posted on the WHO website on 5 January.

Answering to numerous requests by member states on the financing of the GPW13, the WHO will be organising a meeting during January with member states to discuss resource mobilisation before the next Board meeting, Hafeez said at the close of the session (IPW, WHO, 22 November 2017).

Tedros Underlines Governance

The WHO has no board. Such was the observation made by Tedros on 23 November after two days of comments by numerous WHO members on the proposed GPW13.

In other organisations, he said, when the board meets, member states do not get involved, although they can be in the room and observe. They do not participate in active discussions. The way the WHO Executive Board works is contributing to inefficiency in terms of governance, he said.

There are some 28 items on the agenda [pdf] of the next Board meeting, and only a week to go through them, he said. There is no time for in-depth discussions, he deplored. The fact that a number of individual member states take the floor despite having regional representatives shows a trust deficit between member states, he said.

As an example, he cited the United Nations Security Council, with its 15 members. The others do not speak, he said. Many countries came to the Board meeting this week with prepared statements, he remarked, if less statements were delivered, more time could have been devoted to discussion and debate.

“Technically, we do not have a board,” he repeated, engaging countries to build trust and work through regional representatives. “We have to make the board work.”

Resource Mobilisation and 3,000 Grants

After several countries – such as Norway, Finland and Sweden – remarked during the EB on the necessity to increase the non-earmarked funding for the organisation, he said such funding is very important, and called for member states to commit to it.

The WHO has to juggle over 3,000 grants, he said, asserting, “it is a mess, we are in a crisis situation.” Many criticise WHO for being slow, but what should be expected of an organisation having to manage so many grants, he asked. The issue can only be addressed by member states, he said, adding that WHO needs to change but it takes “two to tango” so member states also have to do their share. WHO needs “quality money” of which the organisation can have ownership. With the same amount of funding, without the earmarking, “we will deliver more,” he said.

Answering to concerns about the role of the Global Policy Group, which is an internal advisory mechanism, including regional directors, deputy directors general and the director general, Tedros said at the end of the day he has the discretion to decide, but collective leadership is important.

On political advocacy, he assured member states that it will be done based on science and on evidence. Some countries voices concern about the GPW13 stating that the WHO will become more operational, particularly by delivering services in “a limited number of fragile states,” and providing technical assistance. They found WHO could enter in competition with other UN agencies and humanitarian organisations in the field.

Tedros dispelled concerns, saying the WHO should contribute to all actors working together, and create synergies.

Some developing countries asked that the WHO internship programme be modified so that the WHO can welcome more interns from developing countries. Tedros said over 80 percent of WHO interns come from developed countries, and that it is a problem on which the WHO is working. “Let’s make the opportunity universal,” he said.

Tedros did not, however, offer comments on remarks by some member states on the issue of accessing affordable medicines, and the organisation helping them with local production.

Access to Medicines

Some countries underlined the importance of access to affordable and safe medicines. Colombia, for example said the work of the WHO cannot be limited to the UN’s agenda for 2030 but said WHO also needs to focus on areas not necessarily included in that agenda. The Colombian representative said the issue of access to medicines should not be limited to access to essential medicines, but also to new innovative medicines, for which prices are a challenge for health care systems. The delegate asked that particular indicators be set up to measure access to medicines.

China remarked on the target of 40 percent increase for cervical cancer vaccine coverage, and said the price of these vaccines in some countries is very expensive. For universal health coverage (UHC), it is not enough to let WHO work alone, the delegate said, urging the WHO to use bilateral, regional and multilateral mechanisms to reduce the price of medicines, promote local production, and technology transfer.

Luxembourg said the WHO needs a clear definition of UHC, which needs to include access, quality of care and financial protection.

Nigeria also underlined the issue of the unavailability and unaffordability of medicines in developing countries. The GPW13 should include the review of intellectual property rights, the delegate said, adding that this would enable developing countries to manufacture their own essential drugs. It is the only way to make drugs available, accessible and affordable in those countries, she said.

The Philippines underlined the role of WHO in bringing down the cost of medicines for noncommunicable diseases, in particular for cancer. The delegate said the same effort that was made to bring down the price for antiretrovirals should now be applied for noncommunicable disease drugs.

Colombia, reflecting on the establishment of steering groups, said certain topics should have a particular focus, such as access to medicines. This is a clear opportunity to have a more integrated approach to issues related for example to research and development, storage, spurious medicines, and access to paediatric drugs, the delegate said.

India, a non-Board member, said the GPW13 should consider health emergencies as a development challenge rather than a security challenge. Access to affordable treatment and increased R&D activities should be reflected in each of the GPW13 priorities, the delegate said.

Algeria, a Board member speaking for the African region, called for an implementation strategy to allow developing countries to access digital technology to strengthen their national health systems, and to benefit from the flexibilities included in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) while obtaining licences to launch local production of medicines.

US Pushes Private Sector Inclusion, Warns on Trade Obligations

The US, another non-Board member, said the WHO should not encourage member states to take action on public health issues “in a manner that is inconsistent with individual member states’ national legal obligations, including trade obligations which are often relevant to the issues in which WHO works.”

The US delegate asked how the WHO was going to strengthen its voice to identify industries and organisations “whose actions are harmful” as proposed in the GPW13. “This can quickly become a subjective and political exercise,” the delegate said, and the US would advise caution in the matter.

The WHO policies and guidance can greatly benefit from the expertise of a wide range of healthcare actors, he said, and “it has been and would continue to be counterproductive to exclude these people and institutions….”

The US also said each country should be free to determine its own path to increase access to health care, arguing that the participation of the private sector in many countries is indispensable for universal health coverage. The private sector serves as health service provider, investor, innovator, and stakeholder, he said. The general programme of work should acknowledge this specifically, so the private sector can be engaged through market-based solutions, he added. Also important is a robust intellectual property system, he said.