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[e-drug] WHO as seen by Le Monde Diplomatique
- Subject: [e-drug] WHO as seen by Le Monde Diplomatique
- From: Claudio Schuftan <email@example.com>
- Date: Sun, 1 Sep 2002 23:16:18 -0400 (EDT)
E-drug: WHO as seen by Le Monde Diplomatique
[cross-posed from Afronets with thanks. BS]
Le Monde Diplomatique, July 2002
HEALTH FOR ALL OR RICHES FOR SOME
by Jean-Loup Motchane
"We have to protect patent rights. We need them to ensure the
research and development will yield badly needed new tools and
technologies. We need mechanisms to prevent re-export of lower priced
drugs into richer economies." This ringing endorsement of drug
patents was not made by a multinational CEO, but by Dr Gro Harlem
Brundtland, former prime minister of Norway and WHO director-general,
at the World Economic Forum in Davos (Switzerland) on 29 January 2001.
Dr Brundtland was also full of praise for the pharmaceutical
companies: "The industry has made admirable efforts to live up to
this obligation through drug donations and limited price reductions."
view the pharmaceutical industry's efforts were all the more laudable
because they were made despite "the concern of companies that lower
prices in the developing world not be used as a lever to influence
negotiations in countries that can easily afford to pay more."
Dr Brundtland made her comments with respect to "multinational
morality" just five weeks before 40 pharmaceutical companies brought
action against the South African government, which they accused of
importing generic drugs from other developing countries.
Dr Brundtland took up her post on 13 May 1998 and wasted no time in
outlining her strategy to the WHO's member-states at the 51st World
Health Assembly, where she insisted that WHO projects must be "open
for our partners to co-sponsor." But which partners? Primarily the
private sector, which was offered a role, together with the primary
multinational organisations, including the World Bank, the
International Monetary Fund and the World Trade Organisation (WTO).
Dr David Nabarro, executive director at Dr Brundtland's office,
justifies the director-general's chosen course of action: "We
certainly need private financing. For the past decade governments'
financial contributions have dwindled. The main sources of funding
are the private sector and the financial markets. And since the
American economy is the world's richest, we must make the WHO
attractive to the United States and the financial markets".
Presented as a statement of genuine need, the belief that the WHO
should submit to the dictates of Washington and global liberalisation
while seeking charity from the large institutions is a matter of
ideology, since private-sector contributions account for a tiny
fraction of the organisation's resources.
A diplomat with extensive experience with UN institutions confirms
this point: "Dr Brundtland's stance with respect to the
pharmaceutical industry stems from her faith in the current
globalisation process. Having already established closer ties with
the WTO, she is now reiterating the positions of the World Bank, the
WHO's main financial sponsor. If the director-general adopted a
different position, she would be pitting herself against the US,
which has a dominant role".
The WHO held its fourth Ministerial Conference in November 2001 in
Doha (Qatar). Developing countries with pharmaceutical industries won
the right to make cheaper copies of patent-protected drugs, but only
in the event of public health emergencies; and they are not
authorised to re-export these drugs to poor countries unable to
produce the drugs themselves. This qualified victory was won without
the help of the organisation's top leadership, despite the courageous
stand taken by some WHO representatives (1). It had more to do with
the weight of public opinion and the educational efforts of various
nongovernmental organisations (NGOs), not to mention a spectacular
policy reversal by the US.
Following the 11 September attacks, the US took on the German company
Bayer, which produces Cipro, the anti-anthrax antibiotic. It told
Bayer that it would start producing the drug itself if the company
failed to offer the US a substantial discount. Resorting to blackmail
made it difficult for the US to oppose other countries that advocated
the primacy of healthcare rights over patent rights.
Although the WHO hierarchy had little to do with this development, on
17 May 2002 the 55th World Health Assembly unanimously approved -
with US support - a resolution regarding access to essential drugs.
The resolution called on the WHO director-general to take all steps
to promote a worldwide policy of differentiated prices for essential
drugs. As a result of lobbying by numerous delegations - and because
the WHO no longer had any reason to fear Washington - Dr Brundtland's
organisation has finally taken on an active role with respect to
drugs access, in contrast to its earlier perceived spinelessness.
Though such policy flaws predate Dr Brundtland's appointment, they
prompted the UN to launch the Joint United Nations Programme on
HIV/Aids (UNAIDS) in 1996 to coordinate the global fight against
Aids. The executive director of UNAIDS, Dr Peter Piot, took a very
different stance from the WHO. On 29 November 2000, prior to the
legal proceedings in South Africa, Dr Piot declared that he fully
supported the rights of governments to pursue compulsory licensing
(2) and parallel importing, along with competition between generic
and patented drugs. He said boldly: "The rules of the liberal economy
have become incompatible with the globalisation of the Aids epidemic.
We now need a new deal between drug companies and society" (3).
But the rules of the liberal economy govern current WHO policy
considerations. In 1980 Halfdan Mahler, then the WHO director-general,
made the Health for All initiative part of official development
assistance policy. This rallying cry is only occasionally invoked
nowadays, since Dr Brundtland - at least in her public statements -
sees access to healthcare not as a right but as a means to increase
productivity. In a recent speech to a group of business leaders,
bankers and heads of state, she stated that "good health is essential
- to fuel the engine of development, to unleash the forces of
economic development and to permit the reduction of poverty" (4).
Seeking to convince her audience of the need for investment in
healthcare, she also drew attention to disease's negative effects on
according to some estimates Aids will reduce annual gross domestic
product (GDP) by 1% in the hardest hit regions. Within 30 years the
malaria epidemic will have brought about a $100bn drop in
productivity in Africa.
One banker offered this reaction to Dr Brundtland's speech: "It is
helpful, even crucial, to calculate the cost of disease and the
resultant loss of earnings. Health is clearly a factor in
development. Bismarck knew that in the late 19th century. He was the
first to persuade management to create a mutual health insurance
system for workers so the factories could go on running. But it is
na�ve to think that business people will be persuaded to invest in
healthcare in a globalised labour market."
On 17 May 2001 the UN secretary-general, Kofi Annan, who is also
facing re-election, muscled in on Dr Brundtland's turf when he called
for the creation of the Global Fund to fight Aids, tuberculosis and
malaria, with an annual budget of $7bn-$10bn. Annan's intervention
was made possible by the WHO's failure to obtain convincing results
in the fight against infectious diseases. But despite promises by the
Group of Eight nations at their conference in Genoa in July 2001 to
grant the Global Fund $1.3bn, it has only received $200m to date.
This contrasts starkly with the $1.9bn pledged by various donors or
the $1.6bn already allocated by other donors to comparable programmes
Conflict of interest
The creation of the Global Fund was originally seen as an important
step forward, but its status as an independent foundation governed by
private law (6) means that the UN will no longer be responsible for a
key component of global health policy. The WHO's role is negligible
and, with the creation of UNAIDS, the WHO has been further
marginalised in a field that at one time was its raison d'�tre.
Many people have complained about Dr Brundtland's subservient
policies. In an open letter to her (8), Ralph Nader, while
recognising her efforts in combating malaria, tuberculosis, smoking
and the tobacco industry, said: "Many are concerned that the World
Health Organisation has permitted a handful of large pharmaceutical
companies to exercise undue influence over its polices and
programmes. The WHO ... has shrunk from its traditional role in
promoting the use of generic drugs in poor countries." Dr Brundtland
refuted these charges in her response to Nader's letter, saying she
had had worked to strengthen the WHO's international credibility and
to put health issues at the top of the agenda of global development
One of Dr Brundtland's colleagues, Daphne A Fresle, recently
submitted her resignation from the WHO in a letter that amounted to a
scathing indictment of the organisation and its director-general (9).
Ms Fresle condemned "the lack of enthusiasm" shown by the current
administration in publicly defending the developing nations' vital
interests, which should be the organisation's primary consideration.
According to Ms Fresle, the WHO has abandoned its traditional goal of
Health for All and now serves the interests of the most powerful
countries and of the pharmaceutical companies. Owing to their lack of
scientific rigour, she says the organisation's latest reports have
harmed its credibility and reputation (10), and the WHO's
administrative reorganisation has been a failure (11).
The WHO's policies over the last three years had had two main
consequences: the WHO was facing ethics-related accusations and had
squandered its leadership role in the health field as a result of the
Global Fund (12). At the WHO's enormous headquarters in Geneva many
people we spoke with discreetly confirmed that they shared these
views. One bureaucrat, who is critical of the Global Fund, commented:
"In theory - despite its shortcomings - the WHO allowed the 191
member-states to make their voices heard at the World Health
Assembly. From now any new steps to fight the three most important
infectious diseases will hinge on the virtually secret deliberations
of a private foundation, whose executive board has no real
accountability to the international community."
For one high-ranking official who has served under several directors-
general, the WHO is at a crossroads. In his opinion, the organisation
must clearly redefine its mission in the light of globalisation and
the competing interests of governments, individuals and the private
sector (13). "Countries or regions should call on the WHO to put
together global health guidelines, in which all parties concerned may
clearly state their expectations with respect to global health
policy." It seems that no one any longer knows exactly why the WHO
exists. But growing numbers of observers believe that the current
trend towards privatisation of the global health system will only
serve to exacerbate existing inequalities.
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