[Ip-health] SUNS: An "exceptional" Health Assembly ends with several decisions

[Sangeeta]

=A0SUNS #6036 Tuesday 30 May 2006

An "exceptional" Health Assembly ends with several decisions

Geneva, 29 May (Martin Khor) -- The World Health Assembly closed on Saturda=
y
(27 May) after adopting several decisions on a range of health issues. The
most important of these was a resolution establishing a working group to
produce a global strategy and action plan on intellectual property, health
research and public health.

The WHA also passed a resolution urging giving the WHO secretariat the
mandate to assist governments to take on board health concerns in trade
policies and trade agreements.

The most controversial issue related to smallpox, with many developing
countries demanding a new date for the destruction of remaining stocks of
the virus, now held in the United States and Russia. Both countries refused=
,
with the US being particularly insistent, and refusing a compromise
involving no mention of a destruction date but tighter WHA oversight of the
research conducted on smallpox.

Despite several meetings in a working group, no conclusion was possible, an=
d
the draft resolution on smallpox was sent on to the WHO's Executive Board t=
o
discuss next January.

The 59th session started in solemn mood on 22 May morning with the shocking
news that the WHO's Director General Dr. Lee Jong Wook had passed away just
two hours earlier, following surgery two days earlier to remove a blood clo=
t
on his brain.

The WHA President, the health minister of Mozambique Prof. Paulo Ivo
Garrido, remarked at the closing ceremony that this assembly had been "trul=
y
exceptional", with the demise and funeral of the DG, and at the same time
the nomination of his successor had created "uncertainty and tension."
Despite this, the Assembly proceeded well, and the priority now is to choos=
e
the new DG.

The tension he referred to was over the controversial announcement
appointing one of the WHO assistant directors-general, Dr Anders Nordstrom,
to the post of Acting DG, on the basis of a letter that Dr Lee had written.
This controversy dogged the Assembly for two days until a special session o=
f
the Executive Board confirmed the appointment.

The Board, which began its regular meeting on Monday (29 May), is now
discussing an accelerated procedure for selecting the next Director General=
.
There are three possible options, with the DG in place either in October,
next January or next May.

Under option 1, member states can nominate candidates starting from 1 June;
the Executive Board will meet in special session on 9-11 October to choose
the new DG; and a special session of the WHA will be held on 12 October to
make the appointment.

Under option 2, nominations will be made from 1 June, but the Board will
meet at its next regular session on 22-30 January to choose the DG and a
special WHA session on 31 January will make the appointment.

In option 3, which follows the regular procedure, the Board will make a
decision in its January meeting and the regular WHA session in May 2007 wil=
l
make the appointment.

As the Assembly started on 22 May, there were news reports that a case of
human-to-human transmission of avian flu could have recently taken place
when six family members died in Indonesia. WHO officials were cautious,
saying that a human-to-human transmission could not be confirmed, but also
that it could not be ruled out.

Experts are worried that a flu pandemic can emerge when the flu virus
evolves into a strain that can be passed on among people. So far victims ge=
t
the disease from contact with poultry.

Issues discussed on avian flu during the week included the degree of
preparedness by countries to deal with a pandemic, the lack of availability
of vaccines, whether the need for stockpiling of drugs has been exaggerated
and whether the recommended medicine to treat the virus really works.

A significant WHA decision was an agreement to voluntarily implement parts
of the International Health Regulations immediately, in particular those
which relate to avian influenza and to a potential pandemic of human
influenza.

The provisions identified for early voluntary compliance include those
relating to rapid and transparent notification, support to countries that
request it in investigating and controlling outbreaks, and providing
essential information including recommendations for control measures. The
IHR (2005) were formally adopted at the WHA in 2005 and are to go into
effect in 2007.

A major concern running through the Assembly was the effect of patents on
the cost of medicines. In particular, many governments expressed opposition
to provisions in bilateral trade agreements that remove their ability to
make cheaper generic drugs available through compulsory licensing and
through the use of safety data provided by the companies producing branded
drugs.

At the sidelines of the WHA, ten South American health ministers issued a
declaration on intellectual property committing themselves to avoid
"TRIPS-plus" provisions in bilateral and regional trade agreements, to avoi=
d
broadening the scope of patentability and the extension of patentable areas=
,
to also avoid a linkage being formed between patents and drug marketing
approval, and to facilitate the use of compulsory licensing.

The Assembly's biggest decision was to set up an inter-governmental working
group to draw up a global strategy and plan of action to follow up on the
recommendations made by a WHO commission on intellectual property and
health, whose report was launched in April.

The resolution establishing the working group noted that the patent system
did not meet the need to develop new medicines to fight diseases that
especially affect developing countries. The group will propose how to ensur=
e
an enhanced and sustainable basis for health research and development
relevant to diseases that affect developing countries.

At present, most of the research is on medicines that sell in developed
countries, while little funds go towards developing new vaccines, diagnosti=
c
tools and medicines for diseases such as AIDS, malaria and tuberculosis tha=
t
kill millions in the developing world.

The new working group is tasked with proposing an action plan to correct
this situation, including by suggesting how to handle the problem of the
effects of patents on the prices and availability of health products.

Another big issue was what to do with the remaining stocks of smallpox viru=
s
which now reside in two centres in the United States and Russia under WHO
supervision. Years ago, when smallpox was eliminated, the World Health
Assembly authorized the two centres to maintain stocks of the dangerous
virus with the aim of destroying them within a few years.

However, despite many deadlines for destruction of the stocks, they remain
and recently the US proposed to expand research using the virus, including
genetic engineering of the smallpox virus. This had raised safety concerns
among many governments.

At the WHA, many countries (led by the Africa group) asked for a new
deadline of June 2010 to destroy the stocks but this was refused by the US
and Russia. Proposals to limit and control the research were also not
acceptable to the US.

As a result, the WHA could not reach agreement on how to deal with this
subject, and transferred it to the WHO's Executive Board for further
discussion.

Many developing countries, especially from Africa, highlighted the medical
brain drain, with their doctors and nurses migrating to rich countries,
after receiving expensive education, heavily subsidized by the governments
of the "source countries." This has depleted the medical workforce in
developing countries, placing heavier burdens on the over-worked personnel
who remain and stressing the whole health system.

An often heated debate took place at the Assembly, with some countries
raising the issue of compensation from the countries receiving the medical
personnel, and for ethical recruitment policies.

In the end, a mild resolution was adopted, on "scaling up of health
workforce production", urging governments to consider having mechanisms to
mitigate the adverse impact on developing countries of the loss of health
personnel through migration.

Such mechanisms could include means for the receiving countries to support
the strengthening of health systems, in particular human resources
development, in the countries of origin. Donors and institutions are also
encouraged to fund health training institutes in developing countries.

The intention, as made clear during the discussions, was for the rich
countries to help fund medical education in developing countries so that
more doctors and nurses can be trained, that could serve the needs of the
home countries as well as supply personnel for other countries.

This is however seen by many (including an NGO that spoke at the WHA) as an
inadequate solution, for it might only increase the number of doctors and
nurses to be trained in poorer countries but who would eventually migrate t=
o
rich countries.

But more direct measures, such as disallowing out-migration of health
personnel, or asking for compensation to the "source countries" that have
trained the personnel at high cost, are considered too "sensitive."

A keynote speech was given by Prince Charles of the UK, on the importance o=
f
integrated health, which includes an integrated approach to nutrition,
medicine, agriculture, the environment and social policies.

Other decisions of the Assembly included:

-- To support polio eradication, the Assembly adopted a resolution calling
for increased focus on interrupting transmission in polio endemic areas,
adherence to rapid response standards in case of importation of poliovirus
and technical advice on planning for a post-eradication world.

-- On HIV/AIDS, the WHA passed a resolution calling on Member States to
ensure that special attention be given to integrating nutrition into all
HIV/AIDS policies and programmes.

-- A resolution on infant and young child nutrition urged governments to
renew their commitment to implementation of the International Code of
Marketing of Breast-milk Substitutes and to revitalize the Baby-Friendly
Hospital Initiative, and requests the Director-General to mobilize technica=
l
support in the implementation and independent monitoring of the Code.

-- A global strategy for the prevention and control of sexually transmitted
infections (STIs) was adopted, which calls for STI programmes to be linked
with other services for family planning, maternal health, and HIV preventio=
n
and care. The WHA reinforced the importance of comprehensive interventions,
particularly for young people, which provide full information, life-skills,
education and care for the prevention and management of STIs.

-- The WHA expressed concern at the deterioration of the economic and healt=
h
conditions as well as the humanitarian crises resulting in the occupied
Palestinian territory. The Assembly adopted a resolution (by vote of 57 for=
,
9 against and 61 abstentions) requesting the WHO to organize a one-day
emergency meeting to address this crisis, and to continue support to the
Palestinian health services.

-- A new alliance to address the worldwide shortage of nurses, doctors,
midwives and other health workers was launched on 25 May. The Global Health
Workforce Alliance aims to improve working conditions, address issues of
migration, and start a programme to train more health workers in countries
where there are shortages.

-- Countries expressed their concern that emergency preparedness in many
countries is weak, and may not be able to cope with large-scale disasters.
The WHA passed a resolution on emergency preparedness and response,
requesting countries to further strengthen national emergency mitigation,
preparedness, response, and recovery programmes.

-- The WHA also set a goal to eliminate avoidable blindness by 2020 and to
halt and reverse the projected doubling of avoidable visual impairment in
the world.

-- The Assembly referred to The Global Strategy on Diet, Physical Activity
and Health (DPAS) which was endorsed at the WHA in 2004, the aim being to
address unhealthy diet and physical inactivity, two of the major risk
factors responsible for the growing burden of chronic diseases, including
heart disease, stroke, diabetes and cancer. A report notes that while some
progress has been made to implement DPAS recommendations, the results are
not universal. WHO will be developing additional recommendations. +