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TWN Info Service on Intellectual
Property 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
email: ssangeeta@myjaring.net
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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.
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