TWN Info Service on Health
Issues No. 10
WHO Board debates and defers decision on trade and health
A draft resolution
on the international trade and health, tabled at the meeting of the
WHO Executive Board on 26-27 May was deferred by the Board much to the
disappointment of the Third World countries which introduced it.
This followed when
Australia proposed changes which would have diluted and made the resolution
ineffective. This will lessen the effectiveness of governments and WHO
to deal with the adverse impact of trade rules on health.
This report which
was published in the South-North Development Monitor (SUNS) of 1 June
2005 outlines the main points in the resolution and the reactions of
some of the members.
With best wishes
By Martin Khor*
30 May 2005
A recent meeting of the Executive
Board of the World Health Organisation (WHO) saw a lively discussion
on the need for health authorities to have a bigger say in the formulation
of multilateral and bilateral trade rules and trade agreements.
Many countries stressed the
need for these rules to uphold public health principles, and for policy
coherence between Health and Trade Ministries.
A draft resolution on "international
trade and health" was put forward by 14 developing countries, but
after a debate, the Board deferred taking a decision on it until its
next meeting in January 2006.
Suggested amendments to the
resolution by Australia were not acceptable to the main sponsors of
the resolution. The Australian-proposed changes would have considerably
diluted the message of the resolution and rendered it ineffective.
At the suggestion of the
Chair of the Board, who is from Pakistan, a decision was taken to continue
the discussions at the next Board meeting. This disappointed Thailand
and Bolivia, the main sponsors of the resolution, who felt that the
issue was important and a resolution at this meeting would send out
the right signals.
The discussions on 26-27
May at the Executive Board meeting, held just after the World Health
Assembly session, took place against the background of rising concerns
in recent years about the effects that trade agreements (such as the
TRIPS and services agreements in the WTO) are having on public health.
Even more recently, the intellectual
property chapters in bilateral and regional free trade agreements have
led to protests by citizen groups, particularly those representing patients
suffering from HIV/AIDS and other diseases, who believe that these provisions
limit the ability of their governments to make use of "TRIPS flexibilities"
such as compulsory licensing that enable the supply of cheaper generic
On 27 May, Thailand introduced
a resolution on "International trade and health" on behalf
of itself and Benin, Bhutan, Bolivia, Brazil, Canada, China, Iraq, Jamaica,
Kenya, Nepal, Sudan, Tonga and Vietnam.
The draft recognized the
demand for information about the possible implications of international
trade and trade agreements for health at national, regional, and global
levels. It was also "mindful of the need for ministers of health
and their colleagues in ministries of trade, commerce, and finance to
work together constructively in order to ensure that the interests of
trade and of health are appropriately balanced."
In the operational part,
the draft resolution urged WHO member states:
1.1. to promote dialogue
at national level to consider the interplay between international trade
1.2. to adopt policies, laws,
and regulations that address issues identified in that dialogue and
take advantage of the potential opportunities, and mitigate the potential
risks, that trade and trade agreements may have for health;
1.3. to create constructive
and interactive relationships across the public and private sectors
for the purpose of generating coherence in their trade and health policies;
1.4. to continue to develop
capacity at national level to track and analyse the potential opportunities
and risks of trade and trade agreements for health-sector performance
and health outcomes.
The draft also requested
the WHO Director-General to:
2.1. provide support to Member
States (at their request and in collaboration with the competent international
organizations) to frame coherent trade and health policies;
2.2 to respond to Member
States' requests for support of their efforts to build the capacity
to understand the implications of international trade and trade agreements
for health and to address relevant issues through policies and legislation
that take advantage of the potential opportunities, and mitigate the
potential risks, that trade and trade agreements may have for health;
2.3. to continue collaborating
with the competent international organizations in order to support policy
coherence between trade and health sectors at regional and global levels
and to foster the development of a global evidence base on the effects
of international trade and trade agreements on health;
2.4. to report through the
Executive Board to the Sixty-first World Health Assembly on progress
made in implementing this resolution.
Australia proposed some significant
changes to the draft. In Para 1.2, it wanted to replace "to adopt"
with "to consider adopting." It also suggested a change from
"risks" to "impacts." In Para 1.4, it suggested
changing "potential opportunities and risks" to "implications."
In Para 2.1, it proposed
that the words "trade and health policies" be changed to "trade-related
policies" and that Paras 2.1 and 2.2 be merged with the word "and".
The new text would thus be: "... trade-related health policies
and support their efforts to build "
Australia also suggested
that in Para 2.2 the words "take advantage" should be changed
to "take full advantage." Also, the words "mitigate the
potential risks" should change to "address the implications."
In Para 2.3, it suggested inserting a comma after "global levels".
The effect of the suggested
changes would be to water down the implications that trade and trade
rules can carry risks (as well as opportunities) and to also dilute
the actions that governments or the WHO are urged to take to mitigate
the potential risks of trade rules on health.
Some developing countries,
including Jamaica, Ecuador and Kenya, also proposed some changes to
the resolution, but these were not significant in changing the original
meaning of the draft and in fact served to strengthen the meaning.
In the discussions that followed,
Ecuador noted that the Australian proposals would change the context
and not just the text and that this seemed like a watering-down. Ecuador
stated that it did not want the resolution to be worded so mildly that
it does not mean anything and no longer helps the cause of public health.
"We need to be delicate
in diplomacy but we don't need to be so delicate that we end up being
indelicate with our own people," said Ecuador. "Since the
health of our people is the major objective, this should be reflected
in the wording of our documents."
Canada also expressed concern
with the proposal that would change the wording to "coherent trade-related
health policies," as it would dramatically change the meaning.
Thailand welcomed comments
on its resolution and understood the need to be flexible. However, it
was concerned with the potential consequences of international trade
on health in both a positive and negative way. It was especially concerned
with the proposed change in paragraph 1.4 from "potential opportunities
and risks" to "implications" as it would weaken the resolution's
substance. It agreed with Canada that in paragraph 2.1 "trade-related
health" is different from "trade and health" and thus
preferred to adhere to the original wording.
Supporting Thailand, Sudan
stressed the importance of retaining the word "risk" rather
than "impact" in para 1.2 as the resolution is about the risk
(posed by trade to health) and "we shouldn't lose track of that."
At this stage, the Chair,
who is from Pakistan, said the issue is very important but there was
a "lot of apprehension" and proposed that the members have
a "rethink" and defer this resolution to the next Board meeting.
Clearly disappointed, Thailand
said the sentiments of the meeting's views were such that the Board
had almost come to a conclusion and with a little more time the resolution
could be passed at this meeting. Ecuador stressed that this issue is
so important that the resolution should not be delayed as it would send
out the wrong signal. It suggested that a drafting group resolve the
matter. Bhutan also supported a decision to be taken now.
However, several other countries
including the Czech Republic, Madagascar, Luxembourg, France and Namibia
preferred to defer the decision. Luxembourg said the issue is important
and it would like additional time to consider appropriate wording. The
matter is too important to try and run it through too quickly, it added.
France said there is need for more time to specify technical matters
on the role of international organizations and agreements.
In concluding, the Chair
repeated that if this issue is very important, a revisit is very important.
He proposed that the decision on the resolution be deferred to January
to "make it so strong that we have less criticism later."
The stage for this debate
over the resolution had been set a day earlier when the Board discussed
a WHO secretariat report on international trade and health, particularly
in the context of WTO agreements concerning trade in health services
and food safety.
The report said that as the
potential effects of international trade and trade agreements on health
have become ever more apparent over the past decade, the WHO Executive
Board and the Health Assembly have addressed this topic in a number
of specific contexts. It mentioned WHA resolutions on the relationship
of pharmaceuticals and health policies with trade agreements, on the
use of TRIPS flexibilities, on international migration and on the International
It mentions four WTO agreements
that may affect public health that are of particular importance to WHO's
work: the General Agreement on Trade in Services (GATS), and the agreements
on Application of Sanitary and Phytosanitary Measures (SPS), on Technical
Barriers to Trade (TBT), and on Trade-Related Aspects of Intellectual
Property Rights (TRIPS).
On the consequences for health
of trade expansion, the report said that trade liberalization can affect
health in various ways. Conversely, national and international health
standards and rules can have important implications for trade. Increasing
trade in health services challenges the capability of ministries of
health to assess accurately and respond rapidly to the risks and opportunities
for population health.
There may also be the potential
of increasing openness in the health sector under GATS, in its four
"modes of supply" - cross-border supply of services (e. g.,
telemedicine, eHealth), consumption of services abroad (patients who
travel abroad for medical treatment), commercial presence (establishment
of health facilities in the country concerned), and presence of natural
persons (foreign doctors or nurses who seek to practise in other countries).
"Informed and evidence-based
approaches are needed to manage any future efforts to liberalize health-related
services so as to ensure greater access to affordable, better quality,
and effective services, leading to increased choice for consumers and
greater equity in health outcomes," said the WHO.
"Countries also face
challenges in ensuring compliance with the disciplines of SPS and TBT.
This is particularly the case in the areas of food safety, diagnostic
devices and medicines quality, safety and efficacy, respectively, in
which the trade agreement creates obligations to draw up regulations
based on science, conduct required risk assessments, and implement international
standards through independent and effective national regulatory authorities.
of health need the capability, in terms of expertise and access, to
provide their colleagues in the trade and finance ministries with the
best evidence on the potential impact of trade and trade agreements
on health outcomes, so that ongoing multilateral, regional, or bilateral
trade negotiations may be properly informed."
This need creates demands
on WHO's Secretariat from Member States and from the international organizations
involved in trade, including for guidance on international standards
for health-related goods and services, advice on potential implications
of trade rules from a public-health perspective, provision of tools
and methodologies to assess the possible implications of trade and trade
agreements on public health, and information on best practices in trade
negotiations that might affect health.
Some countries are seeking
a more integrated approach that would encompass all trade and health-related
issues. One option is to establish specialized units within health ministries
with overall responsibility for this area.
The report said greater interaction
is needed between policy-makers and practitioners in the trade and health
sectors to improve coherence of domestic and international policy. In
view of current and emerging international trade rules, ministries of
health need to become more aware of trade issues under consideration
within WTO and other international organizations, and need to help colleagues
in the ministries concerned with international trade to understand relevant
aspects of public health at both national and international levels.
Such interaction requires
research on the potential implications of trade agreements on health
and of trade liberalization in health-related sectors on health-sector
performance and health outcomes.
During discussions, Thailand
congratulated the WHO Secretariat for its report. It said that trade
liberalization has its pluses and minuses. Also, patents can generate
research and development but they also bring high cost and exclusivity.
Bolivia said the issue of
trade and health is both complex and difficult. It added that other
international organizations often comprise the same Member States but
have a vast difference in mandates. Specifically referring to the difference
between the WHO and the WTO, Bolivia said although their acronyms differ
by only one letter, they have quite different perspectives Sometimes,
policy makers in trade often do not take into account the health-related
consequences of globalization.
Portugal said that implementation
of the Doha Declaration (on TRIPS and Public Health) has been slow.
"We need more policy coherence between health and trade as the
Secretariat paper states."
Namibia commented that anti-retrovirals
are lifesaving medications. Medicines should not be subject to the same
rules as other commodities. Noting that TRIPS flexibilities are important,
it had great concern that the WTO was unable to find a permanent solution
to the Paragraph 6 problem of the Doha Declaration. There needs to be
more collaboration between the WHO and WTO and between health and trade
Iceland remarked that the
WHO report is a big step forward. "We need more cooperation between
policy makers in these sectors."
Brazil stressed the need
to find a balance between trade and health. It encouraged WHO to focus
on the implications of bilateral free trade agreements and regional
free trade agreements.
The Czech Republic recounted
a bad experience with the World Bank which had called for health sector
reform but only consulted the Ministry of Finance but not the Ministry
of Health. Their advice had negative health consequences. The WHO needs
to speak with a stronger voice on public health issues, it said.
Besides the Board members
who spoke, some countries that are not on the Executive Board also joined
in the discussion.
The US said that it did not
share the enthusiasm shown by other countries toward the Secretariat
report whose analysis it described as "superficial".The US
added that it had real concerns about the nature of WHO's technical
assistance activities and there is a perception that WHO's advice is
against industry, free trade, and intellectual property.
The WHO secretariat responded
that its technical assistance activities are demand driven and that
it shied away from taking an active role.
The Board Chair said that
the WHO should not shy away from advising Member States. Remarking that
much mention was made of international free trade, he said "what
we need is international fair trade."He added that "we do
need a more humane approach to dealing with this issue; we face the
risk of creating a 'Fourth World', the poorest of the poor, if we are
(* With contributions from
Thiru Balasubramaniam and Marina Kukso of the Consumer Project on Technology.)
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