TWN Info Service on Health Issues (June 06/6)

17 June 2006

An ‘exceptional’ World Health Assembly

This year’s World Health Assembly began and closed rather dramatically. The article below describes the highlights of the meeting and the decisions made on various health issues which include the selection of the next WHO Director General, a global strategy on IPRs and health research, the medical brain drain and the prevention of STIs. It is reproduced with permission from the South-North Development Monitor (SUNS) # 6036, 30 May 2006. 

With best wishes
Evelyne Hong

An "exceptional" Health Assembly ends with several decisions

Martin Khor, Geneva, 29 May 2006

The World Health Assembly closed on Saturday (27 May) after adopting several decisions on a range of health issues. The most important of these was a resolution establishing a working group to produce a global strategy and action plan on intellectual property, health research and public health.

The WHA also passed a resolution urging giving the WHO secretariat the mandate to assist governments to take on board health concerns in trade policies and trade agreements.

The most controversial issue related to smallpox, with many developing countries demanding a new date for the destruction of remaining stocks of the virus, now held in the United States and Russia. Both countries refused, with the US being particularly insistent, and refusing a compromise involving no mention of a destruction date but tighter WHA oversight of the research conducted on smallpox.

Despite several meetings in a working group, no conclusion was possible, and the draft resolution on smallpox was sent on to the WHO's Executive Board to discuss next January.

The 59th session started in solemn mood on 22 May morning with the shocking news that the WHO's Director General Dr. Lee Jong Wook had passed away just two hours earlier, following surgery two days earlier to remove a blood clot on his brain.

The WHA President, the health minister of Mozambique Prof. Paulo Ivo Garrido, remarked at the closing ceremony that this assembly had been "truly exceptional", with the demise and funeral of the DG, and at the same time the nomination of his successor had created "uncertainty and tension." Despite this, the Assembly proceeded well, and the priority now is to choose the new DG.

The tension he referred to was over the controversial announcement appointing one of the WHO assistant directors-general, Dr Anders Nordstrom, to the post of Acting DG, on the basis of a letter that Dr Lee had written. This controversy dogged the Assembly for two days until a special session of the Executive Board confirmed the appointment.

The Board, which began its regular meeting on Monday (29 May), is now discussing an accelerated procedure for selecting the next Director General. There are three possible options, with the DG in place either in October, next January or next May.

Under option 1, member states can nominate candidates starting from 1 June; the Executive Board will meet in special session on 9-11 October to choose the new DG; and a special session of the WHA will be held on 12 October to make the appointment.

Under option 2, nominations will be made from 1 June, but the Board will meet at its next regular session on 22-30 January to choose the DG and a special WHA session on 31 January will make the appointment.

In option 3, which follows the regular procedure, the Board will make a decision in its January meeting and the regular WHA session in May 2007 will make the appointment.

As the Assembly started on 22 May, there were news reports that a case of human-to-human transmission of avian flu could have recently taken place when six family members died in Indonesia. WHO officials were cautious, saying that a human-to-human transmission could not be confirmed, but also that it could not be ruled out.

Experts are worried that a flu pandemic can emerge when the flu virus evolves into a strain that can be passed on among people. So far victims get the disease from contact with poultry.

Issues discussed on avian flu during the week included the degree of preparedness by countries to deal with a pandemic, the lack of  availability of vaccines, whether the need for stockpiling of drugs has been  exaggerated and whether the recommended medicine to treat the virus really works.

A significant WHA decision was an agreement to voluntarily implement parts of the International Health Regulations immediately, in particular those which relate to avian influenza and to a potential pandemic of human influenza.

The provisions identified for early voluntary compliance include those relating to rapid and transparent notification, support to countries that request it in investigating and controlling outbreaks, and providing essential information including recommendations for control measures. The IHR (2005) were formally adopted at the WHA in 2005 and are to go into effect in 2007.

A major concern running through the Assembly was the effect of patents on the cost of medicines. In particular, many governments expressed opposition to provisions in bilateral trade agreements that remove their ability to make cheaper generic drugs available through compulsory licensing and through the use of safety data provided by the companies producing branded drugs.

At the sidelines of the WHA, ten South American health ministers issued a declaration on intellectual property committing themselves to avoid "TRIPS-plus" provisions in bilateral and regional trade agreements, to avoid broadening the scope of patentability and the extension of patentable areas, to also avoid a linkage being formed between patents and drug marketing approval, and to facilitate the use of compulsory licensing.

The Assembly's biggest decision was to set up an inter-governmental working group to draw up a global strategy and plan of action to follow up on the recommendations made by a WHO commission on intellectual property and health, whose report was launched in April.

The resolution establishing the working group noted that the patent system did not meet the need to develop new medicines to fight diseases that especially affect developing countries. The group will propose how to ensure an enhanced and sustainable basis for health research and development relevant to diseases that affect developing countries.

At present, most of the research is on medicines that sell in developed countries, while little funds go towards developing new vaccines, diagnostic tools and medicines for diseases such as AIDS, malaria and tuberculosis that kill millions in the developing world.

The new working group is tasked with proposing an action plan to correct this situation, including by suggesting how to handle the problem of the effects of patents on the prices and availability of health products.

Another big issue was what to do with the remaining stocks of smallpox virus which now reside in two centres in the United States and Russia under WHO supervision. Years ago, when smallpox was eliminated, the World Health Assembly authorized the two centres to maintain stocks of the dangerous virus with the aim of destroying them within a few years.

However, despite many deadlines for destruction of the stocks, they remain and recently the US proposed to expand research using the virus, including genetic engineering of the smallpox virus. This had raised safety concerns among many governments.

At the WHA, many countries (led by the Africa group) asked for a new deadline of June 2010 to destroy the stocks but this was refused by the US and Russia. Proposals to limit and control the research were also not acceptable to the US.

As a result, the WHA could not reach agreement on how to deal with this subject, and transferred it to the WHO's Executive Board for further discussion.

Many developing countries, especially from Africa, highlighted the medical brain drain, with their doctors and nurses migrating to rich countries, after receiving expensive education, heavily subsidized by the governments of the "source countries." This has depleted the medical workforce in developing countries, placing heavier burdens on the over-worked personnel who remain and stressing the whole health system.

An often heated debate took place at the Assembly, with some countries raising the issue of compensation from the countries receiving the medical personnel, and for ethical recruitment policies.

In the end, a mild resolution was adopted, on "scaling up of health workforce production", urging governments to consider having mechanisms to mitigate the adverse impact on developing countries of the loss of health personnel through migration.

Such mechanisms could include means for the receiving countries to support the strengthening of health systems, in particular human resources development, in the countries of origin. Donors and institutions are also encouraged to fund health training institutes in developing countries.

The intention, as made clear during the discussions, was for the rich countries to help fund medical education in developing countries so that more doctors and nurses can be trained, that could serve the needs of the home countries as well as supply personnel for other countries.

This is however seen by many (including an NGO that spoke at the WHA) as an inadequate solution, for it might only increase the number of doctors and nurses to be trained in poorer countries but who would eventually migrate to rich countries.

But more direct measures, such as disallowing out-migration of health personnel, or asking for compensation to the "source countries" that have trained the personnel at high cost, are considered too "sensitive."

A keynote speech was given by Prince Charles of the UK, on the importance of integrated health, which includes an integrated approach to nutrition, medicine, agriculture, the environment and social policies.

Other decisions of the Assembly included:

-- To support polio eradication, the Assembly adopted a resolution calling for increased focus on interrupting transmission in polio endemic areas, adherence to rapid response standards in case of importation of poliovirus and technical advice on planning for a post-eradication world.

-- On HIV/AIDS, the WHA passed a resolution calling on Member States to ensure that special attention be given to integrating nutrition into all HIV/AIDS policies and programmes.

-- A resolution on infant and young child nutrition urged governments to renew their commitment to implementation of the International Code of Marketing of Breast-milk Substitutes and to revitalize the Baby-Friendly Hospital Initiative, and requests the Director-General to mobilize technical support in the implementation and independent monitoring of the Code.

-- A global strategy for the prevention and control of sexually transmitted infections (STIs) was adopted, which calls for STI programmes to be linked with other services for family planning, maternal health, and HIV prevention and care. The WHA reinforced the importance of comprehensive interventions, particularly for young people, which provide full information, life-skills, education and care for the prevention and management of STIs.

-- The WHA expressed concern at the deterioration of the economic and health conditions as well as the humanitarian crises resulting in the occupied Palestinian territory. The Assembly adopted a resolution (by vote of 57 for, 9 against and 61 abstentions) requesting the WHO to organize a one-day emergency meeting to address this crisis, and to continue support to the Palestinian health services.

-- A new alliance to address the worldwide shortage of nurses, doctors, midwives and other health workers was launched on 25 May. The Global Health Workforce Alliance aims to improve working conditions, address issues of migration, and start a programme to train more health workers in countries where there are shortages.

-- Countries expressed their concern that emergency preparedness in many countries is weak, and may not be able to cope with large-scale disasters. The WHA passed a resolution on emergency preparedness and response, requesting countries to further strengthen national emergency mitigation, preparedness, response, and recovery programmes.

-- The WHA also set a goal to eliminate avoidable blindness by 2020 and to halt and reverse the projected doubling of avoidable visual impairment in the world.

-- The Assembly referred to The Global Strategy on Diet, Physical Activity and Health (DPAS) which was endorsed at the WHA in 2004, the aim being to address unhealthy diet and physical inactivity, two of the major risk factors responsible for the growing burden of chronic diseases, including heart disease, stroke, diabetes and cancer. A report notes that while some progress has been made to implement DPAS recommendations, the results are not universal. WHO will be developing additional recommendations.