[Ip-health] MSF comment in The Lancet: Historic opportunity for WHO to re-assert leadership

[James ARKINSTALL]

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The Lancet 2006; 368:1405-1406=0D
http://www.thelancet.com/ (free registration necessary)=0D
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Historic opportunity for WHO to re-assert leadership=0D
Rowan Gillies a,   Tido von Schoen-Angerer b   and   Ellen 't Hoen c=0D
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When countries gather for WHO's Executive Board meeting next month, to=0D
appoint a new Director-General, they must select a candidate with the=0D
courage and political leadership necessary to address the most critical=0D
challenges the UN agency is facing today.=0D
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The recent appearance of extensively drug-resistant tuberculosis=0D
illustrates the scale of the work ahead.1 The health threat posed by this=
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microbe in settings with a high prevalence of HIV highlights the urgent=0D
need for action for WHO to set the agenda for the fast-tracked development=
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of new drugs and better and easier-to-use tests to diagnose tuberculosis=0D
and detect drug resistance, to replace today's increasingly ineffective=0D
tools.=0D
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WHO will need to lead a process involving health ministries, regulatory=0D
agencies, drug companies, product-development partnerships, funding=0D
bodies, and non-governmental organisations, and it will need to deliver.=0D
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HIV/AIDS is another immediate issue. With the end of the 3 by 5 programme,=
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WHO today lacks any strategic plan for the coming years, despite=0D
ambitiously calling for universal access to AIDS treatment.2 Now that=0D
newer compounds are increasingly needed to deal with resistance, the cost=
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of treating AIDS is set to skyrocket.3 How does the agency plan to=0D
respond?=0D
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Research and development needs are also pressing in AIDS. These needs=0D
include the development of new fixed-dose combinations of second-line=0D
drugs and formulations for children, and simpler field-adapted=0D
diagnostics. Drugs in research must be specifically developed to answer=0D
the needs of resource-poor settings=E2=80=94and not only cater for populati=
ons of=0D
patients in rich countries.=0D
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On a programme level, WHO will need to address more forcefully the crying=
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need for greater human resources in medicine, which has become a critical=
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bottleneck preventing further scale-up.4 It will also need to think of the=
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longer term and make sure that more patients are not only started on=0D
treatment but are also kept alive by making second-line drugs available. A=
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sufficient quality of country programmes must also be assured.=0D
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Malaria is another priority. The painfully slow implementation at country=
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level of artesunate combination therapies (ACTs) must receive urgent=0D
attention. Although many countries have changed their treatment protocols=
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to ACTs, these newer life-saving drugs are still not reaching patients who=
=0D
need them.5 Drugs are becoming available from an increasing number of=0D
suppliers but production costs are decreasing slowly. Will WHO play its=0D
role in ensuring the sustainable funding of ACTs, and challenge=0D
governmental complacency on this issue?=0D
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Possibly the greatest challenge facing the UN health agency today is the=0D
need to reverse the erosion of WHO's mandate, adapt to new international=0D
environments, and re-assert its leadership on health issues. WHO must now=
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deal with new stakeholders: large contributions to international health=0D
are made by the Bill & Melinda Gates Foundation and, not surprisingly, the=
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influence of this single private philanthropic organisation on the=0D
international health agenda is unprecedented. How will WHO assert=0D
leadership in view of new independent actors that come with vast=0D
resources?=0D
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Recent years have seen life-saving products become indistinguishable from=
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any other tradable commodity, and actual health concerns relegated to the=
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point of being superfluous during trade negotiations. WHO has become a=0D
follower rather than a leader while other agencies have promoted their=0D
respective agendas. Not least of these agendas is the standardisation of=0D
patent regimens by the World Trade Organization6 and assaults on=0D
flexibilities in patent law by the World Intellectual Property=0D
Organization.7=0D
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Ensuring access to medicines for those in need now depends more than ever=
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on the use of flexibilities in the Trade and Intellectual Property Rights=
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(TRIPS) scheme enshrined in the Doha Declaration.8 But Novartis' legal=0D
challenge to section 3d of the Indian Patents Act is the most recent in a=
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series of developments that goes against the spirit of the Declaration.9=0D
This challenge has far-reaching consequences that extend across the globe,=
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threatening access to essential generic medicines not only in India but=0D
also in developing countries that import Indian generic medicines. Will=0D
WHO take bold steps to defend health over competing interests, for example=
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by promoting implementation of TRIPS flexibilities in developing=0D
countries, or will it again choose to stay silent? Worse, will it continue=
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to stifle dissenting voices from its staff, as it has done in the past?10=
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In April, WHO's Commission on Intellectual Property, Innovation and Public=
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Health outlined many of the key problems in research and development,=0D
intellectual property, and access to medicines, and made several=0D
recommendations.11 Mandated by the 2006 World Health Assembly to follow up=
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these conclusions, will the agency and its new leader have the resolve=0D
necessary to seize this historic opportunity, and develop a global=0D
framework for research and development driven by health needs and not by=0D
commercial concerns?=0D
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Our questions can be rephrased more simply: will the WHO's Executive Board=
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choose a leader who is courageous enough to set the right health policies,=
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even if that requires standing up to vested interests, including those of=
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other international agencies, certain member states, and powerful lobbies?=
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We declare that we have no conflict of interest.=0D
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References=0D
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1. The Lancet. XDR-TB=E2=80=94a global threat. Lancet 2006; 368: 964. Full =
Text |=0D
PDF (37 KB) | CrossRef=0D
2. The Lancet. A missed opportunity?. Lancet 2006; 368: 1063. Full Text |=
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PDF (47 KB) | CrossRef=0D
3. MSF. . Untangling the web of price reductions=E2=80=93a pricing guide fo=
r the=0D
purchase of antiretrovirals for developing countries, 9th edn July 2006;=0D
http://www.accessmed-msf.org/documents/untanglingtheweb...=0D
(accessed Oct 16, 2006).=0D
4. The Lancet. Responding to the global human resources crisis. Lancet=0D
2004; 363: 1469-1472. Abstract | Full Text | PDF (218 KB) | CrossRef=0D
5. UNICEF, World Health Organization. . World malaria report 2005;=0D
http://www.rbm.who.int/wmr2005=0D
(accessed Oct 16, 2006).=0D
6. World Trade Organization. The legal texts: results of the Uruguay round=
=0D
of multilateral trade negotiations. Cambridge: Cambridge University Press,=
=0D
1999:.=0D
7. Geneva declaration on the future of the World Intellectual Property=0D
Organization. October, 2004:=0D
http://www.cptech.org/ip/wipo/futureofwipodeclaration.d...=0D
(accessed Oct 16, 2006).=0D
8. 't Hoen E. Access to medicines: why it's time to change the rules=0D
published in 2006 Commonwealth Health Ministers Reference Book. Henley=0D
Media Group, London: Commonwealth Secretariat, 2006:.=0D
9. Barraclough E. Indian patent law under question. Managing Intellectual=
=0D
Property Sept 26 2006;=0D
http://www.managingip.com/?Page=3D9&PUBID=3D 198&SID=3D653222...=0D
(accessed Oct 16, 2006).=0D
10. Williams DC. World health: a lethal dose of U.S. politics. Asia Times=
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June 19 2006;=0D
http://www.atimes.com/atimes/Southeast_Asia/HF17Ae01.ht...=0D
(accessed Oct 16, 2006).=0D
11. Commission on Intellectual Property, Innovation and Public Health. .=0D
Public health, innovation and intellectual property rights April 2006;=0D
http://www.who.int/intellectualproperty/en=0D
(accessed Oct 16, 2006).=0D
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Affiliations=0D
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a. M=C3=A9decins Sans Fronti=C3=A8res, Geneva, Switzerland=0D
b. MSF Campaign for Access to Essential Medicines, Geneva 1211,=0D
Switzerland=0D
c. MSF Campaign for Access to Essential Medicines, Paris, France=0D