[e-drug] WHO as seen by Le Monde Diplomatique

[Claudio Schuftan <aviva@netnam.vn>]

E-drug: WHO as seen by Le Monde Diplomatique
---------------------------------------------
[cross-posed from Afronets with thanks. BS]

Le Monde Diplomatique, July 2002

HEALTH FOR ALL OR RICHES FOR SOME
WHO's responsible?

by Jean-Loup Motchane

"We have to protect patent rights. We need them to ensure the 
research and development will yield badly needed new tools and 
technologies. We need mechanisms to prevent re-export of lower priced 
drugs into richer economies." This ringing endorsement of drug 
patents was not made by a multinational CEO, but by Dr Gro Harlem 
Brundtland, former prime minister of Norway and WHO director-general, 
at the World Economic Forum in Davos (Switzerland) on 29 January 2001.

Dr Brundtland was also full of praise for the pharmaceutical 
companies: "The industry has made admirable efforts to live up to 
this obligation through drug donations and limited price reductions." 
In her
view the pharmaceutical industry's efforts were all the more laudable
because they were made despite "the concern of companies that lower
prices in the developing world not be used as a lever to influence
negotiations in countries that can easily afford to pay more."

Dr Brundtland made her comments with respect to "multinational 
morality" just five weeks before 40 pharmaceutical companies brought 
legal
action against the South African government, which they accused of
importing generic drugs from other developing countries.

Dr Brundtland took up her post on 13 May 1998 and wasted no time in
outlining her strategy to the WHO's member-states at the 51st World
Health Assembly, where she insisted that WHO projects must be "open 
for our partners to co-sponsor." But which partners? Primarily the 
private sector, which was offered a role, together with the primary
multinational organisations, including the World Bank, the 
International Monetary Fund and the World Trade Organisation (WTO).

Dr David Nabarro, executive director at Dr Brundtland's office, 
justifies the director-general's chosen course of action: "We 
certainly need private financing. For the past decade governments' 
financial contributions have dwindled. The main sources of funding 
are the private sector and the financial markets. And since the 
American economy is the world's richest, we must make the WHO 
attractive to the United States and the financial markets".

Presented as a statement of genuine need, the belief that the WHO 
should submit to the dictates of Washington and global liberalisation 
while seeking charity from the large institutions is a matter of 
ideology, since private-sector contributions account for a tiny 
fraction of the organisation's resources.

A diplomat with extensive experience with UN institutions confirms 
this point: "Dr Brundtland's stance with respect to the 
pharmaceutical industry stems from her faith in the current 
globalisation process. Having already established closer ties with 
the WTO, she is now reiterating the positions of the World Bank, the 
WHO's main financial sponsor. If the director-general adopted a 
different position, she would be pitting herself against the US, 
which has a dominant role".

Policy reversed

The WHO held its fourth Ministerial Conference in November 2001 in
Doha (Qatar). Developing countries with pharmaceutical industries won
the right to make cheaper copies of patent-protected drugs, but only 
in the event of public health emergencies; and they are not 
authorised to re-export these drugs to poor countries unable to 
produce the drugs themselves. This qualified victory was won without 
the help of the organisation's top leadership, despite the courageous 
stand taken by some WHO representatives (1). It had more to do with 
the weight of public opinion and the educational efforts of various 
nongovernmental organisations (NGOs), not to mention a spectacular 
policy reversal by the US.

Following the 11 September attacks, the US took on the German company
Bayer, which produces Cipro, the anti-anthrax antibiotic. It told 
Bayer that it would start producing the drug itself if the company 
failed to offer the US a substantial discount. Resorting to blackmail 
made it difficult for the US to oppose other countries that advocated 
the primacy of healthcare rights over patent rights.

Although the WHO hierarchy had little to do with this development, on
17 May 2002 the 55th World Health Assembly unanimously approved -
with US support - a resolution regarding access to essential drugs.
The resolution called on the WHO director-general to take all steps 
to promote a worldwide policy of differentiated prices for essential 
drugs. As a result of lobbying by numerous delegations - and because 
the WHO no longer had any reason to fear Washington - Dr Brundtland's 
organisation has finally taken on an active role with respect to 
drugs access, in contrast to its earlier perceived spinelessness.

Though such policy flaws predate Dr Brundtland's appointment, they
prompted the UN to launch the Joint United Nations Programme on 
HIV/Aids (UNAIDS) in 1996 to coordinate the global fight against 
Aids. The executive director of UNAIDS, Dr Peter Piot, took a very 
different stance from the WHO. On 29 November 2000, prior to the 
legal proceedings in South Africa, Dr Piot declared that he fully 
supported the rights of governments to pursue compulsory licensing 
(2) and parallel importing, along with competition between generic 
and patented drugs. He said boldly: "The rules of the liberal economy 
have become incompatible with the globalisation of the Aids epidemic. 
We now need a new deal between drug companies and society" (3).

But the rules of the liberal economy govern current WHO policy 
considerations. In 1980 Halfdan Mahler, then the WHO director-general,
made the Health for All initiative part of official development 
assistance policy. This rallying cry is only occasionally invoked 
nowadays, since Dr Brundtland - at least in her public statements - 
sees access to healthcare not as a right but as a means to increase 
productivity. In a recent speech to a group of business leaders, 
bankers and heads of state, she stated that "good health is essential 
- to fuel the engine of development, to unleash the forces of 
economic development and to permit the reduction of poverty" (4). 
Seeking to convince her audience of the need for investment in 
healthcare, she also drew attention to disease's negative effects on 
economic growth:
according to some estimates Aids will reduce annual gross domestic
product (GDP) by 1% in the hardest hit regions. Within 30 years the
malaria epidemic will have brought about a $100bn drop in 
productivity in Africa.

One banker offered this reaction to Dr Brundtland's speech: "It is 
helpful, even crucial, to calculate the cost of disease and the 
resultant loss of earnings. Health is clearly a factor in 
development. Bismarck knew that in the late 19th century. He was the 
first to persuade management to create a mutual health insurance 
system for workers so the factories could go on running. But it is 
na�ve to think that business people will be persuaded to invest in 
healthcare in a globalised labour market."

On 17 May 2001 the UN secretary-general, Kofi Annan, who is also 
facing re-election, muscled in on Dr Brundtland's turf when he called 
for the creation of the Global Fund to fight Aids, tuberculosis and 
malaria, with an annual budget of $7bn-$10bn. Annan's intervention 
was made possible by the WHO's failure to obtain convincing results 
in the fight against infectious diseases. But despite promises by the 
Group of Eight nations at their conference in Genoa in July 2001 to 
grant the Global Fund $1.3bn, it has only received $200m to date. 
This contrasts starkly with the $1.9bn pledged by various donors or 
the $1.6bn already allocated by other donors to comparable programmes 
(5).

Conflict of interest

The creation of the Global Fund was originally seen as an important
step forward, but its status as an independent foundation governed by
private law (6) means that the UN will no longer be responsible for a
key component of global health policy. The WHO's role is negligible
and, with the creation of UNAIDS, the WHO has been further 
marginalised in a field that at one time was its raison d'�tre.

Many people have complained about Dr Brundtland's subservient 
policies. In an open letter to her (8), Ralph Nader, while 
recognising her efforts in combating malaria, tuberculosis, smoking 
and the tobacco industry, said: "Many are concerned that the World 
Health Organisation has permitted a handful of large pharmaceutical 
companies to exercise undue influence over its polices and 
programmes. The WHO ... has shrunk from its traditional role in 
promoting the use of generic drugs in poor countries." Dr Brundtland 
refuted these charges in her response to Nader's letter, saying she 
had had worked to strengthen the WHO's international credibility and 
to put health issues at the top of the agenda of global development 
policies.

One of Dr Brundtland's colleagues, Daphne A Fresle, recently 
submitted her resignation from the WHO in a letter that amounted to a 
scathing indictment of the organisation and its director-general (9).
Ms Fresle condemned "the lack of enthusiasm" shown by the current 
administration in publicly defending the developing nations' vital 
interests, which should be the organisation's primary consideration.
According to Ms Fresle, the WHO has abandoned its traditional goal of 
Health for All and now serves the interests of the most powerful 
countries and of the pharmaceutical companies. Owing to their lack of 
scientific rigour, she says the organisation's latest reports have 
harmed its credibility and reputation (10), and the WHO's 
administrative reorganisation has been a failure (11).

The WHO's policies over the last three years had had two main 
consequences: the WHO was facing ethics-related accusations and had 
squandered its leadership role in the health field as a result of the 
Global Fund (12). At the WHO's enormous headquarters in Geneva many 
people we spoke with discreetly confirmed that they shared these 
views. One bureaucrat, who is critical of the Global Fund, commented: 
"In theory - despite its shortcomings - the WHO allowed the 191 
member-states to make their voices heard at the World Health 
Assembly.  From now any new steps to fight the three most important 
infectious diseases will hinge on the virtually secret deliberations 
of a private foundation, whose executive board has no real 
accountability to the international community."

For one high-ranking official who has served under several directors-
general, the WHO is at a crossroads. In his opinion, the organisation
must clearly redefine its mission in the light of globalisation and
the competing interests of governments, individuals and the private
sector (13). "Countries or regions should call on the WHO to put 
together global health guidelines, in which all parties concerned may
clearly state their expectations with respect to global health 
policy." It seems that no one any longer knows exactly why the WHO 
exists. But growing numbers of observers believe that the current 
trend towards privatisation of the global health system will only 
serve to exacerbate existing inequalities.

--
Claudio Schuftan
Hanoi, Vietnam
mailto:aviva@netnam.vn
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