TWN Info Service on Health Issues (Jan08/03)

30 January 2008

The Executive Board of the WHO in its 122nd session discussed the WHO publications policy. Screening of WHO publications became a controversial issue two years ago when a United States government health official wrote to the WHO's then acting Director-General asking him to withdraw a report on intellectual property and access to medicines that the WHO co-published with the South Centre.

Please find below news story on the WHO’s report on the publications policy and on partnerships presented to the EB. The news story was first published in the SUNS and is reproduced here with permission.

Best Wishes
Sangeeta Shashikant
Third World Network

WHO publications will come under committee review
Published in SUNS #6402 dated 29 January 2008

Geneva, 27 Jan (Riaz K. Tayob) -- Documents prepared for publication by the World Health Organisation are to be subject to review and clearance by a Guidelines Review Committee, while certain sensitive publications on controversial issues will have to be cleared by the Director-General of the WHO herself.

These are parts of measures in a paper on WHO publications policy that was presented to the WHO's executive board meeting held last week.

Screening of WHO publications became a controversial issue two years ago when a United States government health official wrote to the WHO's then acting Director-General asking him to withdraw a report on intellectual property and access to medicines that the WHO co-published with the South Centre.

The US health official also complained to the previous WHO Director-General Lee Jong-wook about the Secretariat's lack of review of the various reports and studies the WHO publishes, and said he expected a "full review" of the WHO's publication policy at the Executive Board meeting in January 2007.

It is common knowledge that the US in recent years has been upset by WHO reports that take a public health perspective of IPRs and their effects on access to medicine. In 2006, it took exception to a report on the use of flexibilities (such as compulsory licenses) allowed by the WTO's TRIPS agreement.

According to Geneva diplomatic sources, several reports prepared by WHO staff or consultants on IPRs and access to medicines have been held back from publication in the past two years, following the US complaint.

At the executive board meeting last week, several developing-country delegations raised concerns that the proposed publication policy was too "centralised" and put too much work in the hands of senior officials such as the Director-General and the Assistant Directors-General.

Brazil said it is very concerned that political pressure may be exercised to block publications on relevant matters, for instance on health and IPRs. It called for the WHO's papers to be released.

The WHO Director-General Dr. Margaret Chan said it was putting the WHO's publications policy to the Board to get member states' guidance and advice. She also introduced a paper on the WHO's partnerships.

The Board took note of both reports. The reports are to be revised and transmitted to the 26-29 May 2008 World Health Assembly (WHA), noting the concerns raised by Board members.

The report on WHO Publications (EB120/20) presents a publications policy with a comprehensive coverage as publication refers to "information products" issued by WHO "to the public in whatever format or through whatever channel" (footnote 2). It also covers the "life-cycle" of publications including from "planning" to "archiving."

Not only does it apply to WHO publications, it includes "any article book chapter or invited commentary relating to WHO's work," by WHO staff for external publication (paragraph 9). A Guidelines Review Committee will clear guidelines, best practice and normative documents.

While Assistant Directors General or Regional Directors will clear final texts, the DG, as Editor-in-Chief, will in addition clear publications on particular national health systems, that have policy implications for WHO or "controversial health-related issues" (paragraph 13).

As a "matter of principle" WHO copyright will remain with it and "will not be assigned to an outside institution." Also, a master list of planned publications will be prepared for executive approval at the beginning of each biennium.

In its report, the Program, Budget and Administration Committee (PBAC) urged that the Publications Policy be "understood and implemented." It requested the DG to continue work on this issue and to provide the Committee at its next meeting with more detailed guidelines on how the policy would be implemented and evaluated (EB122/3).

Brazil said it is very concerned that political pressure may be exercised to block publications on relevant matters. WHO has an important role to play, for instance, on health and IPRs and other issues.

It said it was important to ensure that such papers be released if they meet the technical criteria for quality. It added that those publications (that have been held up) must be released. It said the executive clearance should be transparent and member states must be kept duly informed.

Brazil cited the World Health Report of 2007 where concepts were used like global health security', collective defence', threat' and menace' which were more akin to issues in a UN Security Council agenda which finds logic in confrontation and is neither within the scope and purpose of the International Health Regulations nor of the World Health Report. It said that member states had previously had a hard time in the IHR discussion to define health measures without law enforcement implications.

Iraq for the Eastern Mediterranean Region said it did not want to burden the DG with approving so many publications and intimated a preference for greater decentralisation.

Malawi for the African region said WHO should evaluate the impact of its publications on health outcomes. There should be effective delegation of publications. While recognising the importance of quality, it said the policy puts undue pressure on the DG, Assistant Directors General and regional directors and that the clearance review process in paragraphs 9, 12 and 13 of the policy required work from them that was unnecessary.

Bhutan for the South East Asia Region, commenting on the master list of publications, which is required to be prepared two years in advance, questioned how WHO would respond to new issues. It said the policy which is "very centralised."

Slovenia, for the European Union, welcomed the efficiency this policy would bring and the need for clearance for sensitive health issues in certain circumstances.

The US said the policy was a good start and would like to see additional work on it. It suggested that the DG establish an executive secretariat not only for publications but for all policy documents for clearance.

The UK asked for clarity whether the master list of publications would require approval of the EB or WHO management and what the role of member states was. It also asked the Secretariat to clarify what exactly the implication of paragraph 13 might be (paragraph 13 refers to the additional clearance required for publications describing the working of a national health system, those with policy implications for WHO and controversial health-related issues').

The Assistant DG for Information, Evidence and Research, Tim Evans, said the master list is not intended to be approved by member states or the Board but is an internal planning tool. If emergency issues arise it can be revised as necessary, Evans said.

Dr. Chan said the organisation has had periods of centralisation and decentralisation and will use this policy review to see what can be learnt. She hoped this review will help the organisation find the right balance. The choice between decentralised and centralised policies is a fine balance.

Chan reassured member states that "in no situation during my tenure will I compromise editorial independence" and publications have to be based on evidence.

To Brazil's allusion to political pressure, Chan said, you "don't worry I can stand the political pressure - it is our duty to guard publications based on science and that are peer reviewed."

Some diplomats privately remarked that the review of the publications policy seemed to be a response to US complaints following the publication of a study entitled, "The use of flexibilities in TRIPS by developing countries: Can they promote access to medicines?" by the WHO and the South Centre. It was co-authored by a staff of the WHO and a staff of the South Centre.

The "IP Watch" reported on 28 September 2006 that William Steiger, special assistant to the secretary for international affairs at the US Department of Health and Human Services wrote to Acting WHO Director General Anders Nordstrom asking Nordstrom to "withdraw this publication and remove the WHO logo from it.

According to IP Watch, the letter asserted that the joint publication "spuriously characterizes the trade policy of the United States as a threat to public health, and it makes unnecessarily inflammatory and prejudicial recommendations as to how the United States can improve its trade policies."

IP Watch also reported that Steiger called for a "full review" of the WHO's publication policy at the Executive Board meeting in January 2007.

Prior to that incident, US officials had in the past shown concern about the way WHO may be addressing trade issues. It referred to Steiger stating that he wrote on 30 March 2004 to former WHO Director General Lee Jong-wook regarding his office s "lack of review of the various reports and studies" the WHO publishes, adding that he was then assured that a review process had been set up, which is why he is "dismayed to see the publication on flexibilities" that are available to developing nations to use for public health reasons under the WTO Agreement on TRIPS.

The joint publication was one study out of the 22 studies commissioned by the WHO Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH), which was published in April 2006. The CIPIH secretariat had given the go-ahead to publish the study.

The Board also discussed the Secretariat report on partnerships in which WHO is involved in (EB122/19).

The proliferation of partnerships has raised the issue of a lack of clarity of roles and responsibilities amongst partners, including WHO. Several efforts to resolve these issues have been made. Included in core elements of partnerships, the report states, should be an increase in the coherence of activities, in alignment and harmonisation, and broader stakeholder representation in the governing bodies of partnerships.

The Program, Budget and Administration Committee (PBAC) report suggested that the Secretariat consider reporting on aligning of partnership policies and directions with WHA resolutions and priorities and on ways of increasing information flow, transparency and accountability to all Member States.

Namibia for the Africa Region said that while it engages with partners, there is pressure to the WHO to adapt its systems to theirs, and this increases the demands for technical assistance. Much more additional work needs to be done to meet the challenges and it said the Secretariat should draft policy guidelines.

Bolivia was concerned about some aspects of the report. Partnership with WHO was not a shared partnership of organisations on equal footing. What are the rules of the game when one partner is not willing to operate under WHO rules or how does WHO operate when up to two thirds of its budget are spent where governments do not have the final word on how it is used. "WHO is not for sale nor for rent", it said.

The International Lactation Consultants Association said that all forms of partnerships need to be defined. They also needed systems of safeguards to guarantee transparency, accountability and avoidance or appropriate management of situations of conflict of interest.

It urged that the Guidelines on Working with the Private Sector to achieve health outcomes (EB107/20) be publicly revised and updated given the increasing knowledge of big industries' attempts to undermine public policy making.

Chan appreciated the robust discussion about this complex issue before a governing body. Partnerships are an extremely important though difficult issue. Chan said she would come back to the WHA about the issues raised and seek advice and guidance. +