TWN Info Service on Health Issues (Jan08/01)

30 January 2008

Please find below news report on WHO Executive Board's debate on a draft Resolution on the implementation of the international health regulations and draft resolution on climate change and health.

The EB also discussed WHO Secretariat's report on the second session of the Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (IGWG) that was held in November 2007.

The news report was first published in the SUNS and is reproduced here with permission.

Best Wishes
Sangeeta Shashikant
Third World Network

WHO Board debates "global health security", climate, IPRs
Published by SUNS #6399 Thursday 24 January 2008

Geneva, 23 Jan (Riaz K. Tayob) -- The meaning of the term "global health security" has been a significant subject of discussion at the 122nd session of the Executive Board of the World Health Organisation taking place this week in Geneva.

Among other items discussed on the first days of the meeting were climate change and health, and a report on progress of the WHO group on intellectual property, innovation and health.

The concept of global health security was challenged by Brazil during a discussion on the implementation of the International Health Regulations (IHR). Its representative said that there was no clear meaning of the term and that it enjoyed no consensus among members of the World Health Assembly (WHA).

The IHR was adopted by the WHA in 2005 and came into force in June 2007. It focuses on collective action on emergencies with international repercussions for health and includes surveillance and response systems.

Brazil noted that the IHR does not mention the term "security", yet the WHO secretariat's report on implementing the IHR mentions "global public health security".

The Secretariat report uses the term when describing the 2007 World Health Report. In that Report, "global public health security" is defined in relation to the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries.

The Secretariat report also mentions that the Director General has established a new Health Security and Environment cluster as of November 2007 in order to bring together the work of technical programmes with major responsibilities under the IHR.

Two resolutions relating to the implementation of the IHR was discussed on Tuesday and Wednesday at the Executive Board meeting.

One was a draft resolution, appended to the Secretariat's report on implementation of the IHR. The resolution underscored the importance of establishing a schedule to review and evaluate the functioning of the Annex 2 of the IHR; urges member states to comply with the regulations including to ensure the national core capacity requirements are put in place and to collaborate with WHO to implement the IHR in accordance with its provisions and resolution WHA58.3.

The resolution also decided that the states parties and the WHO Director General shall report to the WHA biennially on the implementation of the IHR and that the first review of the functioning of the Regulations be made at the 63rd WHA.

The secretariat's report that accompanies the draft resolution refers to global public health security as mentioned in the World Health Report 2007and refers to the IHR as an "important instrument for ensuring that the goal of international public health security is fully met".

Brazil told the Executive Board meeting that the report by the Secretariat and the appended resolution use wording and concepts on which there is no consensus. The term "global public health security" is not defined nor was there consensus on it, yet the report has made a linkage between this concept and the regulations.

Pointing out that the IHR does not mention the concept of security, Brazil pointed to the Secretariat report's reference to the IHR is an important instrument for ensuring that the "goal of international public health security is fully met" and said that it had no idea what the "goal of international health security" was.

Brazil also said that its concern must be taken care of before sending (the report and resolution) on to the WHA.

The Executive Board discussion on "global heath security" in relation to the IHR can be better understood in the light of the controversy that this term evoked at the November 2007 meeting of the inter-governmental meeting on the sharing of avian influenza viruses and the sharing of benefits (such as viruses) derived from the use of the viruses.

At that meeting, the developed countries had attempted to get agreement that countries which have human cases of avian flu are obliged to share the viruses, under the provisions of the IHR. This was successfully objected to by developing countries which argued that the IHR did not contain such an obligation.

On the last day of the November meeting, when a statement was being negotiated, the EU tried to have the term "global health security" and the phrase "due consideration to international laws and regulations" included, in a sentence on member states agreeing to share viruses within the WHO system.

The EU proposal was strongly objected to by several developing countries, including Indonesia, India, Brazil and Thailand. Brazil had then said there is no reference in the resolution WHA 60.28 (on avian flu) to "global health security" and that it was not committed to working under the security concept.

Eventually, the term "global health security" was dropped from the statement of the November meeting.

At the Executive Board meeting on Tuesday, the US explained its understanding of the meaning of global health security, and seemed to reinterpret Brazil's comment by imputing that Brazil has suggested that when the Secretariat report is rewritten that there be an elaboration of this concept.

A Secretariat senior official implied that the WHO would provide a definition of global health security in a revised report.

Brazil responded that while there is a definition in the World Health Report, it was not the agreed definition. It requested that when the revised report and the resolution are sent to the next WHA, member states should work on what definition to give to the term.

Afghanistan for the Eastern Mediterranean Region (EMRO) said the IHR is the collective responsibility of state parties. Meeting the core essential requirements of and building capacity on the IHR will need resources for implementation.

Malawi for the Africa Region (AFRO) requested more information on the challenges for implementation of the IHR and requested details on the action taken by the DG in this regard. It was a major challenge for Africa to mobilise adequate resources for implementation of IHR for surveillance, response and core capacity requirements.

It proposed amendments to the resolution that support be provided to member states with the most vulnerable health systems to strengthen core capacity requirements for surveillance and response at airports, ports, ground crossings, paying special attention to the Sub-Saharan Africa laboratory network.

China said more support should be provided to developing countries to help with capacity building. It had no difficulty with universal application of the IHR and implementation should be guided by the Charter and practices of the UN.

Slovenia, for the EU, said the implementation of the IHR should be a very effective tool to establish and strengthen a shared surveillance, alert and response system. All this also implied mutual trust, transparency and solidarity and strong international partnership. It supported standard operating procedures for communication and coordination under the IHR including roles and responsibilities for each of the parties.

The US strongly supported the IHR which it believed should be universally applied. Member states should live up to their obligation by sharing information on disease outbreaks and cited H5N1 and other novel influenza strains as one such example.

[During the November 2007 Intergovernmental meeting on Avian Flu the EU asked for clarity from the WHO about the obligations that countries had to share the flu virus under the IHR.

The WHO legal advisor said, in what he called a preliminary view, there is no specific obligation to share the virus as such (see SUNS #6372, 23 November 2007). However, he also argued that the most important WHO function is dissemination of information, which it cannot do unless the information is shared and thus it needs to be up to date on the strain of the virus.]

Another issue that the Executive Board considered was climate change and health. The Secretariat provided a report on this theme (EB122/4). A resolution sponsored by Germany, the Netherlands, New Zealand, UK and Northern Ireland was made available as a conference paper on Monday and after discussion it was adopted with a few changes on Wednesday by consensus.

The Secretariat report said that global warming is disrupting the balance of natural systems that supply the necessities of life, including the most fundamental determinants of health, food, air and water. The report states that the "estimated direct and indirect health-care costs and lost income due to several environmental illnesses match or exceed the expenditure needed to tackle the environmental hazard itself."

The earliest and most severe threats are to developing countries, with negative implications for the achievement of the Millennium Development Goals and for health equity.

Climate change threatens public health security and adverse health impacts will be disproportionately greater in vulnerable populations. It states that "production and transport of food, especially red meat in developed countries, are major emitters of greenhouse gases." The report also advocates eating foods that are grown locally.

In a section on Actions, the report said that the overarching goals for the international response to protect health from climate change are to ensure that public health security concerns are placed at the centre of the response to climate change; to implement adaptive strategies to minimise the impacts of climate change on health; and to support strong actions to mitigate climate change and avoid further health impacts.

Actions needed include raising awareness of the need to ensure public health security by acting on climate change; strengthen public health systems to cope with threats posed by climate change; ensure capacity to deal with public health emergencies; and enhance applied research on health protection from climate change.

During the opening session on Monday, the United States complained that it could not support discussion on the report on Climate Change as it was made available only three days before the meeting started. It wanted discussion to be delayed so that it could review the document thoroughly.

The United Kingdom said it had pushed strongly for the inclusion of climate change on the agenda as this was an area of public health that was not given sufficient attention. It was anxious that the issue could fall off the agenda and recommended at least a preliminary discussion.

The resolution on climate change requests to the Director General to consult member states on the preparation of a plan of action to scale up assessing and addressing the implications of climate change for health and to present it to the 124th Executive Board session.

It also request the DG to draw attention to the threat of climate change, work with the UN Framework Convention on Climate Change's Nairobi Work Programme on Impacts, Vulnerability and Adaptation, and to cooperate with UN organisations, member states and other funding bodies to assess the risks for human health and to implement effective response measures.

Many more countries joined as co-sponsors to the resolution. Brazil said it was high time that this organisation takes on global warming but that the correct concepts must be used.

The US said that it is effectively confronting climate change. It cited President Bush as saying that the US approach is science based and encourages research and global participation, adding that the US pursues action that focuses on prosperity and that it has "spent billions (of dollars)."

The US said the report of the UN International Panel on Climate Change uses conditional language to show that the science is evolving and it characterises the likelihood of outcomes with (ratings of) high, medium and low.

It said this contrasts with the WHO Secretariat report which strips (out) the qualifying language. Giving some examples, it said that there is also no robust data that mitigating the effects of climate change can have direct and immediate health benefits, as stated in the report. It added that the report contained a misrepresentation of the references to health impact which goes beyond scientific consensus.

Sri Lanka for the SEARO region fully supported the resolution. It said that policies are made on available evidence and that we must not only wait until evidence is conclusive. Denmark supported the resolution on the basis of overwhelming scientific consensus.

China said that it hoped the international community would show more concern on this issue and help developing countries enhance capacity to cope and supported that member states carry out assessments and applied research on health protection.

The US noted that its proposed amendments to the resolution were not intended to weaken it but to align it to the state of science as published by the IPCC. On health and climate change it said the IPCC speaks very clearly about probabilities and likelihoods.

Because of this, it would like to see a preamble with that scientific consensus so that we are not "overstating" (the impact of) climate change on health or "understating" it but we are "lock-in-step with the science." It said this does not weaken the resolution but strengthens it to as is shows that WHO does not move from the technical area into advocacy.

Australia said it supported the inclusion of climate change on the agenda. It said that it had concerns about the assertion in the report about "eating foods locally" as a complete account needed to be taken of agriculture before these issues are addressed at the WHA.

Thailand said that the impact of climate change is unequally distributed and those with least capacity to adapt are most vulnerable and a comprehensive approach was needed to address this.

It said that "global health security" should not be linked to peace and security issues under the UN, and that "public health security" is the term that should be used.

Bolivia sad that certain words were used to disguise the phenomenon of climate change and it is a new idea for some. Climate change was known in Bolivia for many years. Why do we build cars that can go at 225 miles per hour when no highway could take them?

Madagascar for the AFRO region said that Africa will bear 28 percent of the burden of health by some indicators unless action is taken immediately. Mali said it had seen an increase in transmission of some diseases in areas where prevalence was very low and these were due to eco-climatic changes. It also supported the resolution.

The Executive Board also discussed on Tuesday the Secretariat's report on the second session of the Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (IGWG) that was held in November 2007.

The IGWG is discussing a global strategy and plan of action to improve access to health care in developing countries, in particular, health research and development on diseases that disproportionately affects developing countries. The second session of the IGWG was suspended and will reconvene tentatively in April or May this year.

Iraq for the EMRO region said that work was being taken forward after a "lukewarm start at the first IGWG session." It expressed unease on two issues. It said that during the second session there could not be consensus on the principle of the right of people to the enjoyment of the highest state of health, as recognised in international human rights law. If member states cannot agree on such a principle then we have to get back to the constitution of the WHO.

Iraq said there is an attempt to limit the draft strategy and plan of action to a list of diseases and said that the focus should be kept open so that it can anticipate the future and it expressed the hope that this problem can be overcome.

[Although member states in their submissions to the IGWG had not proposed any limitations to the scope of diseases to be covered, the Secretariat document of 31 July 2007, which was used as the basis for discussions, limited the focus to 14 diseases (see SUNS #6364, 13 November 2007).]

Namibia for the AFRO region expressed concern at the slow progress of the discussion and that much was still not agreed. It hoped that the global strategy and plan of action would be finalised and presented to the 61st WHA. It wanted a solution quickly so that parents and their children do not suffer and die when solutions are available.

China said this issue is of long term significance that is both scientific and a key to balancing public health interests with commercial interests. It supported both the respect for innovation and protection of IPRs as well as public health needs, and these efforts can help developing countries with access to relevant medical technologies in primary health care.

The Holy See emphasised the need to remove tariff and taxes on medicines and to monitor supply chains.

Peter Oldham, the chair of the IGWG, said tentative dates for the meeting of the IGWG subgroup were March 17 to 19. The EB noted the Secretariat's report. +