[A2k] SUNS: Secretariat's publications policy questioned at Board meeting

[Sangeeta]

WHO: Secretariat's publications policy questioned at Board meeting
Published in SUNS #6485 dated 30 May 2008

Geneva, 29 May (Sangeeta Shashikant) -- Both developed and developing
countries vigorously questioned the WHO Secretariat during the WHO's
Executive Board meeting on 26 May on its publications policy and called for
further discussion on the matter.

Among the questions raised at the WHO's 123rd Executive Board meeting were
the need and rationale for the new publications policy, what the present
policy is, and what will be the criteria for determining which issues have
"policy implications for the Organisation" and which comprise "controversial
health related issues" and thus have to go through additional clearance by
the Director-General's Office.

Other concerns raised included how the centralization of the clearance
process may remove the clearance authority of the WHO's Regional Directors,
the broad definition of the term "publications" as it covers "materials that
are issued by WHO to the public in whatever format and through whatever
channel" including advocacy and training materials, and how the policy will
affect timely support by WHO to countries.

Concerns about "self-censorship" as a result of the policy and transparency
in the process were also raised.

A comment was also made that insisting on "evidence based" publications was
not always possible in the medical field.

Many delegations called for the need to have more discussions and to assess
the implications of the policy, before it was implemented.

However, it is not clear whether the policy will be subject to further
discussion and what the Secretariat intends to do about the various concerns
and clarifications raised, since the meeting "noted" the Secretariat's
report, following what some persons who follow WHO processes closely now
call a "trust-me" speech by the WHO Director-General Dr. Margaret Chan.

Some delegations indicated that they intend to follow up on the matter, as
they were dissatisfied with the explanations provided. They said that, in
particular, the explanation did not specifically address what criteria will
be used to determine publications containing issues that have "policy
implications for the Organisation" and what constitutes "controversial
health related issues" (which require clearance from the Director-General's
office) and why the differential treatment of publications was needed.

The WHO's publications policy contained in two Secretariat's reports, "WHO
Publications" (EB 122/20 dated 6 December 2007) and "WHO publications
policy: guidance on implementation and evaluation" (EB 123/7 dated 14 April
2008), has become the subject of controversy.

Many believe that the policy is due to pressure from the US. "IP Watch"
reported on 28 September 2006 that William Steiger, special assistant to the
secretary for international affairs at the US Department of Health and Human
Services, wrote to Acting WHO Director-General Anders Nordstrom asking
Nordstrom to withdraw a WHO publication on IPRs and public health and
calling for a "full review" of the WHO's publication policy at the Executive
Board meeting in January 2007.

[The publication titled "The Use of Flexibilities in TRIPS by Developing
Countries" was one of the 22 studies commissioned by the WHO Commission on
Intellectual Property Rights, Innovation and Public Health (CIPIH), which
was published by the WHO and South Centre in April 2006. The CIPIH
secretariat had given the go-ahead to publish the study.]

Prior to the 26 May Board meeting, serious concerns on the new policy were
raised by many NGOs as well as a senior member of the US Congress.

Fifty-three NGOs in a letter dated 15 May wrote to the WHO Director-General
urging her to reconsider the policy, adding that the policy, if implemented,
will result in a tendency towards "self censorship" by WHO and its staff.
(See http://www.twnside.org.sg/ <http://www.twnside.org.sg/> )

The letter also expressed concern that the policy will hamper timely advice
and support by WHO headquarters and regional offices to member states over
important issues such as the application of intellectual property rights and
the use of TRIPS flexibilities, other trade and health matters, reproductive
health care and other issues.

The Chair of the US House of Representatives' Oversight and Government
Reform Committee, Henry Waxman, sent a letter dated 19 May 2008 to Dr Chan,
urging the WHO "to minimize the possibility of inappropriate political
interference with the publication process", and expressing hope that WHO's
new publication policy will be "designed in a manner that is not politicized
and continues to prioritize scientific and intellectual freedom." (See www.
essentialaction. org/access/index.
php?/archives/154-Waxman-letter-on-WHO-Publications-Policy.html)

The new publications policy requires publications "that describe the
workings of a particular government or national health service or that have
policy implications for the Organization or address controversial
health-related issues" to go through "additional clearance by the
Director-General's Office" while the final text of all other publications
can be cleared by the "relevant Assistant Director-General or Regional
Director before publication." (paragraph 13 of EB 122/20).

This requirement is also applicable to "any article, book chapter or invited
commentary relating to WHO's work that is to be submitted by a staff member
for external publication" (paragraph 9 of EB 122/20).

The policy defines "publication" in footnote 2 of EB 122/20 as "information
products, i. e. Materials that are issued by WHO to the public in whatever
format and through whatever channel. It excludes materials internal to WHO."

Paragraph 3 of EB document 123/7 further defines information products as
"written or illustrated works that the Organisation makes publicly
accessible. Examples include documents on the website and journal, articles,
guidelines, reports, training materials and advocacy materials in any format
(printed, web, CD-ROM/DVD or audiovisual), whether sold or distributed free
of charge".

The policy documents also mention the aims of having evidence-based
publications, reducing costs, publishing fewer titles and reducing hard
copies while disseminating WHO's publications more through electronic means.

A "policy coordination group" (which will report to the DG) is to be set up
to oversee implementation of the policy. There will be forms for executive
and production clearance, which will be incorporated into the approval
process management tool. Those responsible for clearing a product must check
for technical accuracy and conformity with the Organisation's policies, and
they must recognize when to refer the products to the DG's office for
additional clearance where it concerns controversial health related issues
and policy implications for the Organisation.

According to the new policy, there will be categories of products wherein a
specific category will trigger the relevant pathway for content development,
production, dissemination and the appropriate criteria for clearance. For
example, if a product concerns guidelines, then it must be developed
according to the procedures put in place in the Guidelines Review Committee,
whereas advocacy materials must be created in accordance with standards set
by the Department of Communications in HQ.

A master list of planned publications will also be prepared for executive
approval at the beginning of each biennium (EB 122/20).

According to the Secretariat's report (EB 123/7), the policy will be
regularly evaluated. A full report on the implementation of the policy will
be submitted to the Executive Board at its 129th session in 2011.

Indonesia, on behalf of members from the South East Asian Regional Office
(SEARO), expressed concern that the policy defines "publications" very
broadly, adding that it takes away the authority of clearance from the
Regional Director and centralizes it to the DG on issues that are
controversial and that have policy implications. Indonesia sought
clarification as to what issues were considered to be "controversial health
related issues" and the issues are controversial to whom?

Indonesia added that the policy would result in difficulties in providing
timely information in case there are new controversial issues emerging. It
sought clarification as to whether the master list prepared at the beginning
of each biennium would hamper the ability to deal with new issues.

Indonesia urged the matter to be discussed thoroughly and for an assessment
of the implications before the policy is implemented.

Brazil said that it has doubts on the need for a new publications policy as
it was not yet recognized that the present policy is unsuccessful. It had
concerns with regards to the criteria that will be applied to determine
which topics have policy implications and concern controversial health
related issues.

It did not see any reason to implement this policy, which may result in
self-censorship. It believed that "controversial health related issues"
should be debated openly, as one of the objectives of the WHO is to provide
information without any interference or political pressure from member
states.

Brazil added that prior to implementing the policy and given its importance,
the policy should be subjected to discussion, which should be informed as to
the necessity of the policy, how to resolve the issue of what is
controversial, how other international organizations deal with this issue,
and the difference between the present and proposed policy.

Djibouti, on behalf of the Eastern Mediterranean Regional Office, said that
the WHO's greater stress on electronic publication must not run counter to
access to information, as access to electronic information is limited in
developing countries. It added that assessing the impact of information
products produced is not an easy task as it requires broad research to
identify whether WHO's publication has been used for the development of a
policy.

Slovenia, speaking on behalf of the EU, said that implementation and
evaluation of WHO's policy should be in line with WHO's normative mandate,
focused on evidence-based documents. It also called for a wide accessibility
to WHO's documents.

Slovenia stressed the importance of transparent and unbiased publications.
It also sought explanation as to what is the criterion for approval of
publications, stressing the need to avoid censorship with respect to what
may be considered as controversial issues.

Sri Lanka, aligning itself with Indonesia's statement, expressed hope that
regional offices will retain a certain degree of independence in order to
respond to countries' needs. It added that regional offices need to have
adequate representation in the policy coordination committee. It wanted
further discussion before the policy is implemented.

Afghanistan emphasized the need for scientific documents to be published
without censorship and for member states to allocate resources for
translating the publications into local languages.

Malawi said that while it appreciated "cost-effectiveness", this should not
be at the expense of access and should take into account capacity
constraints. It proposed that further work on the policy be considered.

Oman also expressed a need to study the situation before taking a decision
and for the information to be disseminated in other languages besides the
official languages.

South Africa requested more information as to what were the Terms of
Reference of the policy coordination group mentioned in document EB 123/7,
how it would function and its relationship between the production and
clearance mechanisms.

Zimbabwe stressed the need for "editorial freedom" and transparency and said
that cost- effectiveness should not hamper access and dissemination. South
Africa and Zimbabwe also supported the statements made by Malawi and Brazil.

The United States said that the publications policy must be widely
understood and implemented nationally, regionally and at the headquarters
level. It expected the DG to monitor implementation of the policy, adding
that the DG should establish an Executive Secretariat to look through the
publications. It added that disclaimers do not obviate the need for the
publications policy.

Kenya said that it was necessary for the policy to ensure the independence
of the DG, adding that in medicines there may not be evidence on everything
and thus there was a need to assess using "evidence" as a criteria. The
policy should be flexible in responding to the challenges of global health.

Canada, associating itself with the statement by the EU, stressed the need
to balance between excessive centralization and bureaucratization with
flexibility. It added that "transparency" was a critical element.

Responding to the concerns and questions raised, Dr. Tim Evans, WHO's
Assistant Director-General for Information, Evidence and Research said that
the process approval was intended to develop greater awareness,
responsibility and accountability of all those involved in the process, make
the approval process faster, avoid duplication and produce materials in line
of the Organisation's strategic objectives and priorities.

He added that the master list will periodically be updated. With regard to
executive clearance, he said this is "not a new clearance mechanism". He
added that access to publications will not be "compromised".

WHO's legal counsel Gian Luca Burci said that there are some issues with
regard to correctness of terminology, expressions and references to
political and legal status of states and taking care of the accuracy of
these descriptions falls under the corporate responsibility of senior
management. He added that there is already a review mechanism but the policy
is important to strengthen the programmes.

Dr. Chan said that this is not a "new policy", adding that WHO has a policy
that moved from centralization to decentranlisation but it is important to
review the policy, thus the issuing of the new documents.

She said that she guarded her "editorial independency with jealousy" and
there is "no question of censorship", adding that they will base documents
on best evidence possible, consistent with the WHO's core functions. She
added that the publications have to be "peer reviewed" but this also has
problems, i. e it can be "incestous" depending who is on the peer review
committee.

She said that there is no question of favouring vested interests or staff
members, and documents were produced to serve the interests of countries.
She added that she had to do a balancing act and walk a fine line.

On clearance process she said that it is a means to demonstrate
accountability of senior management, and regional directors should have
prerogative to decide what documents are important without undue cumbersome
process.

She added that in her short stint in WHO, there have been several
embarrassments with regard to names, maps and boundaries mentioned in
publications, and some publications have to come back to the HQ for her
review, so that she does not have "political difficulties."

After the Board meeting, Sarah Rimmington of Essential Information (one of
the NGOs following the issue) said that several countries, including Brazil,
Indonesia on behalf of South-East Asia and Slovenia on behalf of the EU, had
raised concerns that the WHO publications policy would lead to censorship of
undefined "controversial topics."

"Several countries also asked that the policy be placed before all member
states of the WHO for approval before implementation. Director-General Dr.
Margaret Chan and the WHO Secretariat responded by asserting that they would
jealously guard WHO's independence.

"The issue at stake, however, is not the personal integrity of anyone within
WHO. What matters is whether the agency will become overly centralized and
bureaucratized and, most importantly, how and whether WHO will approach
"controversial" topics.

"Centralized review will give corporate and ideological interests an
opportunity to protest against WHO publications, with profit or ideological
motivations dressed up in the garb of scientific argument. Moreover, the
requirement that undefined "controversial" topics require centralized review
inevitably will mean that country officers and others will steer away from
such issues, no matter their importance."

Rimmington said that it is worth reflecting on important public health
issues that might reasonably be considered controversial.

A partial list would include: alcohol, diet and nutrition, sugar
consumption, tobacco, chemical exposure, climate change, family planning and
reproductive health issues (for example, birth control, abortion and sex
education), health interventions targeting sex workers, intellectual
property and medical R&D, traditional medicine, the prices and
advertising/marketing of medical products, rational use of medicines,
malaria control, treatment of malaria, TB, HIV/AIDS and mental illness, car
and traffic safety, disaster relief, air pollution, arsenic, bio-terrorism,
baby food marketing, clinical trial conduct, gender-based violence,
genetically modified food, pesticide use, health insurance systems,
healthcare user fees, wealth inequality and health, and medical waste.

She commented: "Just to see such a list is to understand the need for a
re-think. Hopefully, Member States and the Secretariat will agree on such a
review - and make appropriate revisions - in the near term." +