Public Private Interactions for Health:
WHO's Involvement

Madame Chairperson, Members of the Executive Board,

I am speaking on behalf of Consumers International (CI), Health Action International (HAI) and the International Baby Food Action Network (IBFAN).

At the 107th Executive Board Meeting in January 2001, we expressed concerns about WHO's promotion of Public Private Interactions.

We referred to the seminar in Rome, cosponsored by WHO in November 2000, entitled "Global Public-Private Partnerships (GPPP) for Health and Equity". This meeting concluded that before moving forward there should be a broad analysis and justification for GPPP and they encouraged the WHO to:

"examine the evidence for the pros and cons of GPPP, when they are appropriate and when not, and to define an open process about how to decide for or against partnerships…Furthermore the WHO should encourage the broadest possible range of inputs to this inquiry."

The background to this issue.

At the Executive Board meeting last year (the 107th session) there was a lively discussion on the Guidelines for Public Private Interactions (PPIs). Many members of the board expressed serious concerns about the potential of the for-profit sector to distort public health priorities and programmes.

The chairman said that the Board appeared to agree that the Director General should report back to the Board the following year with a document containing more precise guidelines. The aim was to refine the guidelines and to clarify their legal status.

Also a proposal was made to establish a distance working group whose task would consist of discussing the broader unresolved issues surrounding public-private interactions.

We are concerned about the lack of progress on these two commitments. The document EB 107/20 indicates that board members at their retreat in November put forward a number of suggestions to focus WHO work in this area. Furthermore in this document the Director General stresses the success stories of PPIs without any thorough and critical analysis of the known risks. Where are the revised Guidelines that EB members clearly called for? This issue has significant public health consequences for the entire world and deserves much more serious attention than it has been getting.

Therefore we urge WHO to:

1. Sponsor an open, transparent, inclusive, on-the-record debate on the concept of PPIs and whether they are an appropriate means to secure the human right to health care.

2. Conduct a comprehensive analysis of PPIs and to examine the evidence of their risks and benefits and how they may conflict with the WHO's functions as the highest health standard setting and regulatory authority in the world.

3. Make an analysis of PPIs including a clear categorization of the types of PPIs and which are acceptable and which are not in terms of public health.

WHO does propose developing a tool to "assess the good study and practices of companies with whom interaction is expected". We urge the development of broadly based criteria for this assessment, including WHO's international code, ethical guidelines and relevant resolutions. However, we propose that WHO delegates this task to an independent body.

Further, we refer to a recent critical look at the Global Alliance for Vaccines and Immunization (i) as an example of an important PPP today. We would suggest that what needs to be examined and discussed openly is the question of who is going to direct important efforts in the field of health and make sure that they reach the people who most need them?

Who will ensure that public health needs are addressed before the private sector agenda or that of the research-based industry?

Can private corporations be held accountable in the way governments or the UN agencies can?

Is it not an inherent conflict of interest for private sector corporations to be major players in developing health policy and equitable health care provisions?

It is clear that national governments are responsible for the development of equitable health policy, and that this must be a long-term commitment.

Certainly, it is not a year or two of help, or even five that is needed but a sustainable, accountable and transparent commitment to provide equitable health care for all and especially for the poor and disadvantaged.

Thank you Madam chair for this opportunity to address the Executive Board on this important issue.

(i) A.Hardon, GAVI, a critical look, 2001. www.haiweb.org