Drug Policy at the 54th World Health Assembly

WHO's growing 'partnership' with the private sector: Addressing public health needs or corporate priorities?

WHO now actively participates in a number of international health initiatives involving powerful private sector interests. It also raises more and more funds from commercial enterprises and related groups to support its work programme. This growing dependence on the corporate sector and its financial resources risks diverting WHO from its normative function and role as a policy-making body on public health issues. It also discourages exploration of other possible funding sources more in line with WHO's primary health care goals.

As the world's leading public health organisation, WHO must set clear rules on how it collaborates with the private sector. It must step back and critically analyse if the well-publicised, public-private ventures in which it is now involved have more to do with corporations' political and economic aims than they do with public health outcomes. It must also demonstrate that the poor directly benefit from such public-private 'partnerships'. The extent to which WHO relies on corporate interactions and funding will fundamentally affect how well it can support public health goals and address current government limitations to do so.

Industry and WHO: too close for comfort?
Industry's involvement in 'partnerships' is often said to be the result of greater social responsibility, yet closer scrutiny suggests that it could be more closely related to 'enlightened self-interest'. For example, in 1999 HAI discovered that the pharmaceutical company, MSD, had succeeded in seconding a senior staff member to the staff of the WHO Tobacco Free Initiative (TFI). An internal company announcement called it "a marvellous opportunity to continue to build bridges", and said the corporation expected the person to be an "effective ambassador" [v]. When questioned about potential conflicts of interest between WHO's public health goals and industry's profit motive, WHO's Director General said she would not rule out the possibility of secondments to WHO from pharmaceutical companies. [vi]

Yet in October 2000, WHO announced it would take measures to counter tobacco company influence in response to a WHO Expert Committee's findings that tobacco companies had infiltrated the organisation and attempted to undermine its antismoking agenda.[vii] The report stated "Of greatest concern, tobacco companies, have, in some cases, had their own consultants in positions at WHO, paying them to serve the goals of tobacco companies while working for the WHO. Some of these cases raise serious questions about whether the integrity of WHO decision-making has been compromised." [viii]

How companies make their profits are often not systematically or publicly evaluated by WHO and other potential partners. Discussions about 'partnerships' often overlook the fact that the same companies that say they are stepping in to fill funding gaps once covered by governments, are often the same ones that have successfully lobbied for lower corporate taxes. In some cases, they are also known violators of international agreements on environmental protection, labour standards and promotion practices. [ix]

If WHO or member states give away their responsibility to promote public health and instead promote corporate involvement in global public health initiatives, what will this mean for citizens? There is a need for much more research on the long-term, societal consequences of public-private ventures.

WHO's guidelines on working with the private sector
At the January 2001 meeting of the WHO Executive Board, member states discussed WHO's guidelines on working with the private sector to achieve health outcomes (Executive Board document: EB107/20). While they were only listed as a report to be noted on the agenda, many countries including Venezuela, Italy, Congo, France, Belgium, Sweden, Brazil, Cote D'Ivoire, India, China, Guatemala, Bangladesh and Chad spoke out on the issue. Most of these delegates raised serious concerns about maintaining WHO's independence when the organisation had so much interaction with industry. At the meeting, the chair decided to form an electronic working group that would enable Board members and their advisors to revise and strengthen the guidelines (Report of the Executive Board on its 106th and 107th sessions, A54/2). [x] This 'virtual' group was to report back to the Executive Board next January. However, to date, this electronic working group has not yet been created.

Improving the guidelines
The guidelines presented to the Executive Board contain a number of flaws:

• They fail to give a clear definition of conflict of interest. One consequence of this is that secondment of staff from the private sector, including pharmaceutical companies, is not perceived as a conflict of interest.
• They do not emphasise the risks related to involving the commercial sector in research (such as potential broadening of disease definitions for increased product markets).
• The guidelines make no provision for independent evaluation of potential donors and their compliance with WHO agreed standards and international agreements on human rights, the environment, marketing and labour practices.
  

The cardinal principle of the guidelines should be complete accountability and transparency. HAI believes WHO's interactions with all private sector donors must be contractual and publicly accessible. The process of assessing and approving agreements, as provided in the guidelines, is now totally internal. For the sake of transparency, the guidelines must make independent review mandatory. As an interested party, WHO cannot also monitor its own contractual agreements. External monitoring and evaluation of work involving commercial enterprises must be carried to see if equitable and sustainable health outcomes are achieved. A major flaw of the guidelines is the lack of any substantive role for civil society in monitoring WHO's relationships with the private sector.

It is not only NGOs and member states that have raised concerns about industry's growing relationship with WHO and the present guidelines. It is also parts of WHO itself. The report of a seminar on public-private interactions co-sponsored by WHO last year [xi] clearly states that "it is timely for WHO to step back from the current situation and reflect on the appropriate role of GPPPs [Global Public Private Partnerships] in order to meet public health and equity needs". Seminar participants further called for an open discussion on these WHO guidelines. They said that such discussion should involve member governments, civil society and other interested parties taking into account evidence and analysis at the global and national level.

In principle, HAI, and many other public interest NGOs, are not against WHO's co-operation with the corporate sector. However, there are huge differences in the quality, sustainability and power relationships involved in the types of co-operation now being labelled as 'partnerships'. HAI supports initiatives that advance public health in a sustainable and equity way. For that reason, it calls for an open, public debate on the best way all stakeholders can work with WHO to reach that goal.

Recommendations

For WHO:

• A transparent, accountable mechanism involving member states and civil society should be developed by the organisation to monitor all of its interactions with the private sector.
• WHO should provide for independent evaluation of potential donors and their compliance with WHO agreed standards and international agreements on human rights, the environment, marketing and labour practices.
• Before participating in any public-private venture, WHO must demonstrate that the project's beneficiaries, particularly the poor, will directly benefit from it in an equitable and sustainable way. Each interaction should be evaluated according to public health criteria. This safeguard should apply to all types of interactions with corporations and their related bodies.
• All of WHO's public-private ventures must be based on contractual agreements, accessible to the public. A clause should allow termination of the contract and the possibility of negative publicity if corporations do not uphold their contractual agreement.
• The organisation's use of the word 'partnership' should be replaced with terms that more accurately describe the actual relationship.
• WHO should ensure that member states are involved in decision-making processes about public-private interactions so that national health priorities, such as essential drug policies and immunisation programmes, are not damaged.
• WHO should carry out a public assessment of past 'partnerships' to review if the poor have benefited from them, and if other alternatives could have provided better public health and policy outcomes, at less cost. · In order to protect its own mandate and integrity, WHO should explore other, non-corporate funding sources more in line with its own primary health care goals.
• WHO's Guidelines on working with the private sector to achieve health outcomes (EB 107/20) should be revised and strengthened to. (a) clearly define possible conflicts of interest (b) provide adequate mechanisms to ensure complete accountability and transparency (c) ban secondments of staff from the corporate sector, particularly the pharmaceutical industry and 'revolving door' employment between WHO and industries affected by its activities. Staff or consultants should disclose any potential conflict of interest when hired by WHO (d) require that all public-private interactions involving WHO should be based on contracts that are publicly available (e) include mechanisms for external monitoring and evaluation of all work involving commercial enterprises to see if equitable and sustainable health outcomes have been achieved.
• The secretariat should also facilitate and support the Executive Board's agreement to create an electronic working group aimed at improving the guidelines which will report back in January 2002.

For Member States:

• National governments should support a substantive role for civil society in monitoring and evaluating WHO's interactions with the private sector.
• Southern governments participating in public-private initiatives should request a decision-making role in how they are organised, implemented and evaluated so that their priorities and concerns are not marginalised at any time in the process.
• Until WHO is able to effectively show that it has mechanisms in place to guide and evaluate all of its joint activities with the private sector, member states should call for a moratorium on additional public-private interaction involving WHO.
• Interested member states should participate in the electronic working group aimed at strengthening and revising the WHO guidelines on working with the private sector to achieve health outcomes. They should also be encouraged to involve any desired advisors in this process as proposed by the Chair of the 107th Executive Board in January.
  
  
  

Health Action International (HAI) is an informal network of some 150 consumer, health, development action and other public interest groups involved in health and pharmaceutical issues in more than 70 countries around the world. It believes all drugs marketed should meet real medical needs, have therapeutic advantages, be acceptably safe and offer value for money.

This paper is based upon a statement produced by HAI and IBFAN which was presented at the 107th WHO Executive Board meeting. It also draws on material about public-private 'partnerships' prepared by Judith Richter for the HAI Europe seminar report "Public-private partnerships: Meeting real health needs or corporate agendas?" .