[A2k] SUNS: WHO Board debates "global health security", climate, IPRs

[Sangeeta]

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. +