Info Service on Health Issues (Jul15/01)
WHO: Intergovernmental meeting on engagement with non-State actors begins
Geneva, 9 July (K M Gopakumar) – The intergovernmental meeting of the World Health Organization on the draft Framework of Engagement with Non-State Actors (FENSA) is taking place on 8-10 July.
This three-day meeting at the WHO headquarters in Geneva is expected to conclude the FENSA negotiations.
The term ‘non-state actors’ refers to academic institutions, non-governmental organisations (NGO), the private sector and philanthropic foundations. FENSA consists of five parts: (i) the overarching framework of engagement with non-state actors (NSAs); (ii) the WHO Policy and Operational Procedures on Engagement with Non-governmental Organisations (Draft NGO Policy); (iii) the Draft WHO Policy and Operational Procedure on Engagement with Private Sector Entities (Draft Private Sector Policy); (iv) the Draft WHO Policy and Operational Procedure on Engagement with philanthropic Foundations (Draft Philanthropic Foundation Policy); and (v) the Operational Procedure on Engagement with academic institutions.
The FENSA negotiations were initiated according to the decision of the 136th Session of the WHO Executive Board (EB). Following the first round of negotiation on 29 March - 1st April, there were at least two rounds of informal consultations and 7 days of negotiations during the 68th World Health Assembly (19-26 May). In the absence of consensus, the Assembly adopted a resolution requesting the Director-General “to convene as soon as possible, and no later than October 15, an open-ended intergovernmental meeting to finalize the draft framework of engagements with non-State actors on the basis of progress made during the Sixty-eighth World Health Assembly as reflected in the Annex (http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R9-en.pdf?ua=1).
These negotiations clearly brought out differences between developing and developed country Member States. The developing countries are pushing for more regulation and transparency on WHO’s engagement with NSAs especially with the private sector. On the other hand developed countries are pushing for more engagement with NSAs especially with the private sector and want minimal regulation.
According to many pubic health experts and civil society organisations a liberal approach on engagement with NSAs especially with the private sector bears the danger of furthering of corporate capture of WHO and compromises the credibility, independence and integrity of WHO. Many developing country delegates have shared the same concerns with the author.
The original idea of the WHO Secretariat was to create a multi-stakeholder platform called World Health Forum. This was dropped due to resistance from a large section of Member States and the process moved towards regulating the engagement.
The past negotiations resulted in consensus in major parts of the text dealing with the conceptual framework of FENSA. However, operational details of the concepts are going to be negotiated at this on-going round. These include: conflict of interest, transparency, engagement with certain industries, transparency requirements, and oversight of FENSA, staff secondment from NSAs and scope of FENSA.
Conflict of Interest (Paragraphs 23-26): Even though one could find reference to conflict of interest in various World Health Assembly resolutions or WHO documents there is no document existing at least in the public domain providing details of the procedures to avoid or to effectively manage conflict of interests. As a result there are no uniform practices within WHO to address conflict of interests. This has pushed the Organisation into many controversies.
For instance, even though there is a Guideline for the Declaration of Interests for experts, in 2010 it was revealed that one of the experts Dr. Juhani Eskola who is the Director-General of the Finnish National Institute for Health and Welfare (THL) and a member of the WHO ‘Strategic Advisory Group of Experts on Immunization’ (SAGE), received almost 6.3 million Euros from GlaxoSmithKline for research on vaccines during 2009. GlaxoSmithKline, a pharmaceutical giant, produces the H1N1-vaccine ‘Pandemrix,’ which the Finnish government – following recommendations from THL and WHO – purchased for a national pandemic reserve stockpile.
Transparency (Paragraphs 37-38): Transparency is another contentious issue. Developing countries propose a high degree of transparency, especially the availability of due diligence reports in the public domain as well as details of financial contributions in the pubic domain of developed countries. However, the Secretariat does not support this view.
Engagement with certain industries (Paragraph 44): Developed countries would like to retain the Secretariat’s original proposal of explicitly excluding the engagement with the tobacco and arms industry but without naming any other industry. Developing countries propose that apart from the tobacco and arms industry, WHO needs to exercise particular caution when dealing with other industries that negatively affect public health such as those related to food and beverages, alcohol etc. Developed countries oppose any mention of the food and beverages and alcohol industry.
Oversight mechanism (Paragraphs 65-66): Similarly difference of opinion persists with regard to an oversight mechanism. Developed countries prefer to leave the oversight mechanism largely in the hands of the Secretariat. However, developing countries propose a role for the Independent Expert Oversight Advisory Committee (IEOAC) in overseeing the implementation of FENSA by the Secretariat.
Secondment (Paragraphs 18 and 46): Another contentious issue is on staff secondment i.e. NSAs deploy their employees to work as WHO staff and pay their salaries as well. According to several experts, this raises serious concerns on the independence of the WHO and compromises the independence of international civil servants.
Many developing country Member States have proposed to exclude personnel from the scope of the definition of resources because it would result in secondment and therefore they also proposed a blanket ban on secondments. The Secretariat is taking a position that they may need people from NSAs for health emergency-related work. However, there is no clarity on whether such people would be under secondment. Developed countries are opposing a blanket ban on secondments from NSAs.
Scope of FENSA (Paragraph 48): The alignment of other existing policies such as WHO’s partnership policy with FENSA is the other important unresolved issue for the on-going meeting. Whether FENSA would prevail over these existing policies, including the Partnership Policy, was the main issue that was another point of conflict between developing and developed countries in the last round of negotiations in May.
The first day of the current negotiations meeting focussed on Paragraph 48 of the draft FENSA, which spells out the relation of FENSA with other existing policies such as WHO’s Partnership Policy adopted at the 63rd session of the World Health Assembly (WHA 63.10). It is learnt that there is a consensus that existing policies would be implemented in alignment with FENSA and in case of conflict between existing policies and FENSA, the governing bodies would be informed for further action. According to a developing country delegate, this would ensure that the existing policies like the Partnership Policy could not operate independently after the adoption of FENSA.+