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AFRO-NETS> WHO as seen by Le Monde Diplomatique

  • Subject: AFRO-NETS> WHO as seen by Le Monde Diplomatique
  • From: Claudio Schuftan <aviva@netnam.vn>
  • Date: Sat, 31 Aug 2002 03:29:19 -0400 (EDT)

WHO as seen by Le Monde Diplomatique

Le Monde Diplomatique, July 2002

WHO's responsible?

by Jean-Loup Motchane

"We have to protect patent rights. We need them to ensure the re-
search and development will yield badly needed new tools and tech-
nologies. We need mechanisms to prevent re-export of lower priced
drugs into richer economies." This ringing endorsement of drug pat-
ents 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

Dr Brundtland was also full of praise for the pharmaceutical compa-
nies: "The industry has made admirable efforts to live up to this ob-
ligation through drug donations and limited price reductions." In her
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 moral-
ity" just five weeks before 40 pharmaceutical companies brought legal
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 Interna-
tional Monetary Fund and the World Trade Organisation (WTO).

Dr David Nabarro, executive director at Dr Brundtland's office, jus-
tifies 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 pri-
vate 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 ide-
ology, 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 pharmaceuti-
cal industry stems from her faith in the current globalisation proc-
ess. 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".

Policy reversed

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 author-
ised 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 non-
governmental organisations (NGOs), not to mention a spectacular pol-
icy 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 le-
gal proceedings in South Africa, Dr Piot declared that he fully sup-
ported 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 con-
siderations. In 1980 Halfdan Mahler, then the WHO director-general,
made the Health for All initiative part of official development as-
sistance policy. This rallying cry is only occasionally invoked nowa-
days, since Dr Brundtland - at least in her public statements - sees
access to healthcare not as a right but as a means to increase pro-
ductivity. 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 de-
velopment 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 economic growth:
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 productiv-
ity 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 re-
sultant loss of earnings. Health is clearly a factor in development.
Bismarck knew that in the late 19th century. He was the first to per-
suade management to create a mutual health insurance system for work-
ers so the factories could go on running. But it is naïve 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 fac-
ing 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 marginal-
ised in a field that at one time was its raison d'ètre.

Many people have complained about Dr Brundtland's subservient poli-
cies. In an open letter to her (8), Ralph Nader, while recognising
her efforts in combating malaria, tuberculosis, smoking and the to-
bacco industry, said: "Many are concerned that the World Health Or-
ganisation 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 ge-
neric 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 is-
sues at the top of the agenda of global development policies.

One of Dr Brundtland's colleagues, Daphne A Fresle, recently submit-
ted 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 ad-
ministration in publicly defending the developing nations' vital in-
terests, 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 administra-
tive reorganisation has been a failure (11).

The WHO's policies over the last three years had had two main conse-
quences: the WHO was facing ethics-related accusations and had squan-
dered 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 mem-
ber-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 pri-
vate 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 to-
gether global health guidelines, in which all parties concerned may
clearly state their expectations with respect to global health pol-
icy." It seems that no one any longer knows exactly why the WHO ex-
ists. But growing numbers of observers believe that the current trend
towards privatisation of the global health system will only serve to
exacerbate existing inequalities.

Claudio Schuftan
Hanoi, Vietnam

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