[Ip-health] WHO Executive Board discusses avian flu issues

[Sangeeta]

WHO Executive Board discusses avian flu issues

Published by SUNS #6398 Wednesday 23 January 2008

Geneva, 21 Jan (Sangeeta Shashikant and Riaz K. Tayob) -- The sharing of
avian influenza viruses and access to vaccines, climate change and health,
were some of the issues discussed Monday at the Executive Board (EB) of the
World Health Organization.

The 34-member EB, which began Monday, is preparing for the 61st World Health
Assembly which meets in May. The EB also heard a report from the WHO
Director-General Dr. Margaret Chan and opening statements by EB members. The
EB meeting is from 21-26 January.

The EB, meets at least twice a year, with the main function of giving effect
to the decisions and policies of the Health Assembly, as well as to advising
and generally facilitating the WHA's work.

Director-General Chan, in her report, highlighted that primary health care
will be addressed in this year's World Health Report and that this year is
the 30th anniversary of the Declaration of Alma Ata and the 60th anniversary
of the WHO.

She said that primary health care is making a comeback on the development
agenda, and it is being revisited partly in the context of stalled progress
in meeting international goals. She further said that "we will not be able
to reach the health related Millennium Development Goals (MDGs) unless we
return to the values, principles and approaches of primary health care."

She added that "we must reach these goals as the ability of countries to
adapt to climate change will depend on the state of population health and
the systems in place to protect it."

Chan also referred to some of the issues discussed at the WHO's
Intergovernmental Meeting on avian flu. The IGM is seeking a timely, fair,
transparent and equitable system for sharing of viruses and benefits. She
further added that the Intergovernmental Working Group on Innovation, Public
Health and IP sought to influence supply and demand in industry.

The influenza virus and benefit sharing, discussed on the first day of the
EB meeting, is one of the most controversial issues that has dogged the WHO
in 2007.

In early 2007, Indonesia highlighted the issue when it suspended its
voluntary transfer of avian flu virus samples to WHO collaborating centres,
complaining that its viruses were being used for commercial activities
without its knowledge, and asking that a fair system be established whereby
developing countries are assured of vaccines and assisted with technology to
produce them.

The 2007 World Health Assembly that considered the issue adopted Resolution
WHA60.28, outlined the convening of processes to come up with a transparent,
fair and equitable virus and benefit sharing mechanism.

One of the processes, the Intergovernmental Meeting (IGM), met in November
2007 and considered several proposals by member states including proposals
by Thailand, Indonesia and the Africa Group.

On this issue, the EB had before it a set of documents, with a progress
report on the outcome of the last intergovernmental meeting on virus and
benefit sharing (EB 122/5).

The set of documents includes among others the scope of discussions of the
IGM, an interim statement of the IGM on virus and benefit sharing, a
compilation of proposed draft principles and operational elements for the
virus and benefit sharing mechanism etc.

Mali, on behalf of the 46 members of the Africa Region, said that about 8
members of the African region had suffered from bird flu and that the region
lacked national detection capacity and resources to implement preparedness
plans. It also stressed that the purpose of the WHA resolution was to have a
fair and transparent mechanism with fair access.

At the IGM, the interim statement was controversial (see SUNS #6374 dated 27
November 2007) with the African Group registering reservations, as it was
unhappy with the late presentation of the statement (it was presented only
on the final day of the IGM) and with the non-transparent process wherein
the African Group was not consulted.

The interim statement acknowledges a breakdown of trust in the existing WHO
influenza virus sharing system known as the Global Influenza Surveillance
Network (GISN). It requests the WHO Director-General to set up a
traceability mechanism to track all shared H5N1 and other potentially
pandemic human viruses and the parts thereof as well as an advisory
mechanism to monitor and guide the virus sharing system.

While awaiting the setting up of a permanent virus and benefit sharing
system, the interim statement says that members agree to share viruses with
GISN consistent with national laws and regulations.

Some members of the African Group also privately expressed concern that the
interim statement would be used as a tool to delay negotiations.

While subsequently, the statement was accepted by the Africa Group, several
of these concerns were again raised at the EB.

Malawi sought assurance from the Secretariat that the follow-up meeting (to
the IGM) will resume before May 2008 in time for the final report to be
submitted to the 61st World Health Assembly. It also sought clarification on
the legal status of the Interim Statement. "Can the Director-General act on
an interim statement by an intergovernmental Meeting before the Health
Assembly has approved it?"

It further sought assurance that the proposals submitted by the African
Region, Indonesia and Thailand on virus and benefit sharing mechanism will
be published by the WHO and made available before the end of the EB meeting.

This concern was raised as the African Group proposal, presented at the 2007
November IGM, has to date not been placed on the WHO website nor officially
issued.

Indonesia said that it looked forward to the interim statement and to a new
mechanism that is more fair, transparent and equitable including a
traceability and advisory mechanism.

China, a country very much affected by avian flu, stressed on equitable
sharing of benefits in order to increase developing countries' response to
avian flu. It said that the country providing the viruses should obtain
information about the research results and have as a priority, access to
relevant technologies. It also added that skilled technical personnel from
countries providing the virus should be part of the research so as to build
capacity of the provider country.

It further added that WHO should organize and coordinate member states on
standard operating procedures for sharing of virus, with the scope of use
clearly specified. It said that it hoped that the laboratories that receive
the virus strains do not use the viruses provided for other types of
research. It also supported stockpiling of drugs and vaccines to respond to
pandemic influenza.

Slovenia, on behalf of the EU, expressed concerns about the procedural
aspects of the IGM, while acknowledging the importance of the interim
statement. However, it said that the role of the interim statement was not
entirely clear and welcomed explanations. It also said that the statement
stressed the importance of timely sharing of viruses.

It said that the EU will continue to support integrated approaches to
pandemic preparedness and underlined the leading role of the WHO in the
Global Influenza Surveillance Network (GISN).

However, said Slovenia, it was necessary to improve the transparency,
efficiency and scope of the current GISN, and called for an independent body
of experts to establish an annual report on the GISN activity. It also said
that it was committed to existing initiatives such as the WHO Global
Pandemic Influenza Action Plan to Increase Vaccine Supply.

The US said that it would like as an outcome a projectable and reliable
virus sharing system that ensures broad access to the influenza viruses by
the academic and the private sector. As for benefit sharing, the US
supported it in the context of development assistance, access to stockpiles
and countermeasures.

Iraq, on behalf of the Eastern Mediterranean Regional Office (EMRO), said
that none of the EMRO countries could produce influenza vaccines and the WHO
should provide technical support to build adequate infrastructure to produce
vaccine. It added that international cooperation will be needed to
accelerate the much needed technology. It also stressed the need for a
reliable system for tracking the biological materials given to the WHO,
adding that without the tracking system, WHO's credibility was at stake.

Sri Lanka, supporting Indonesia, told the EB that it would be appropriate to
set up a slightly more efficient and modified approach to facilitate the
work of the IGM.

The legal counsel, Mr. Bill Kein, responding to the queries raised, said
that it was not common to issue an interim statement. However, he said, the
last paragraph of the statement invited the WHO Director-General to take the
actions mentioned in the Statement. He also said that in terms of the nature
of the measures, they were temporary and the IGM could agree on different
measures.

He agreed that the papers proposed such as the Africa Group proposal was not
yet up on the website, and that they will be put up following the EB.

In relation to the follow-up meeting to the IGM, the legal counsel mentioned
that it was not possible for the open-ended working group to meet prior to
the WHA in May and that the open-ended working group is most likely to take
place in August, while the IGM in November.

David Heyman, a WHO Assistant Director-General, mentioned that the tracking
mechanism would be about viruses shared with the WHO as of 24 November. It
would track which countries have provided viruses and where the viruses have
gone. The advisory mechanism and the definitive tracking mechanism are being
established, he added.

The issue of climate change and health was also before the EB on the first
day but its discussion was delayed following the US's request. On this,
there was a Secretariat report on Climate Change (EB122/4) and a draft
resolution sponsored by Germany, the Netherlands, New Zealand, UK and
Ireland. (EB122/Conf. Paper no. 3).

Right from the start of the meeting, the US complained that the Secretariat
report was produced late and pushed for the issue to be discussed later in
the week. It added that it could not support the Secretariat's report.

The UK, a proponent of the draft resolution, said that it pushed strongly
for the inclusion of climate change on the agenda as it was an area of
public health that was not given sufficient attention.

The issue is to come for discussion later in the week. +