Day Six at the 64th WHA

Highlights from the fifth day of the 64th World Health Assembly

Geneva, 21.05.11

Only discussions in Committee A took place.
The first item discussed was Health System Strengthening. With no objections, the 5 amended resolutions were approved. See the fourth report of committee A approved: A64/59.

The following item was Prevention and Control of Non Communicable Diseases (NCDs; see here for background documents). A dedicated working group (only member states, no civil society allowed) had been working on a draft resolution since Monday. The focus of the resolution was limited to WHO’s role in the preparation, implementation and follow-up to the high-level meeting (HLM) of the United Nations General Assembly (UNGA) on the prevention and control of non communicable diseases, which will be held in New York in September 2011. Even if the focus was rather narrow, the discussion that followed has been quite broad. 47 countries and 14 representatives of civil society (including NGOs, consumers' associations, professionals' associations, patients' organisations and the private sector) made interventions.
Almost all countries referred to the increasing global burden of NCDs as to the major health challenge to be addressed in present times. Many low and middle income countries (LMIC) also stressed the fact that they face a "double burden of disease", as the NCDs are rising while there is still significant morbidity and mortality related to communicable diseases. Also, almost everybody pointed out to the fact that NCDs are largely preventable, and many countries highlighted also their impact on health inequalities (as a result of both higher exposure to risk factors and lower accessibility to health care). For LMIC, issues related to the required strengthening of health systems were highlighted, as well as the major problems related to the accessibility and affordability of diagnostic and therapeutic tools for NCDs. Finally, the social and economic impact was acknowledged by all countries, and LMIC particularly highlighted the role NCDs play in slowing down the process towards meeting the MDGs.
While all member states agreed on the description of the scenario, differences among countries emerged in the analyis of the causes, as well as in the related priorities for action. Several countries (including USA and Jordan) highlighted particularly the behavioural aspects of NCDs, therefore pointing to interventions such as health literacy and awareness campaigns in order to promote healthy lifestiles among the population. Others (including Hungary on behalf of the EU, Canada as well as Uruguay on behalf of UNASUR) emphasised more the role played by environmental and social determinants in shaping people's choices, as well as their impact on health inequalities. Finally, some countries (Mauritius, Thailand, El Salvador) were even more outspoken in addressing the role played by the corporate sector, particularly soft drinks, food, tobacco and alcohol industries, and the need for stronger regulations in order to prevent the marketing of unhealthy products. In order to face the shortage of financial resources, and fearing that the shift towards NCDs may penalise the already meagre budgets allocated for communicable diseases and maternal and child health, Congo on behalf of the African region advocated for the establishment of a global fund for NCDs. This request was then reinforced by the individual statements made by other African countries (including Kenya, Ivory Coast, Botswana).
Among the "civil society" statements, the representative of the International Federation of Pharmaceutical Manufacturers' Association (IFMPA) stressed the behavioural component of NCDs and advocated for health literacy interventions (in which many members of his Federation are involved in in LMIC, also because "prevention can increase economic growth"); he then called for multistakeholder actions in the health system and in other sectors which affect health, in which (of course!), the private sector "looks forward to share its experiences and knowledge". Finally, he said that for NCDs the industry has "1500 new medicines in the pipeline". The International Association of Patient's Organisations followed, aligning with IFMPA in the emphasis on treatment.
A call to include mental health came from several public interest organisations, while Corporate Accountability and Consumers International stressed the issue of corporate influence over public health policies and the need to protect WHO's independence (and people's health) avoiding conflicts of interest. The Cochrane Collaboration additionally emphasised this point, urging the WHO to build its guidelines on independent evidence-based reviews, avoiding to rely on biased or potentially biased literature (e.g. sponsored by a single drug company) and preventing and disclosing any conflict of interest.
A statement by Medicus Mundi International and the PHM was read by Ilker Kayı, highlighting the need to include mental health, address the social and structural determinants of NCDs, strengthen health systems and promote treatment accessibility together with policies supporting rational use of medicines and diagnostic tools. Moreover, the statement urged the WHO to avoid all interference of the private sector, while implementing regulations against the marketing of unhealthy products.
The Secretariat's response stated that mental health is a priority, and that the strengthening of health systems required and foreseen in the struggle against NCDs will also benefit mental health patients. He added that WHO documentation relies on evidence-based reviews and that the WHO follows specific guidelines when dealing with the corporate sector. On this matter also Margaret Chan spoke, saying that the WHO will follow civil society recommentation to avoid conflict of interest, but that they will continue to work will all stakeholders including the private sector. She added that a major threat is now posed by the tobacco indutry, that is "attacking our countries and giving them a hard time". She therefore urged all "193 countries to rally around and win the bottle, preventing tobacco to kill our people in the world".

Substandard/Spurious/Falsely-Labelled/Falsified/Counterfeit Medical Products

(An extensive background is provided here)
The resolution approved the extension of the mandate of the intergovernmental working group up to the WHA65. During the discussion every country pointed out the issue of poor QSE medicines as a relevant public health threat, an international regulatory mechanism was demanded, but terms – such as “fake”, “falsified”, “spurious” and “counterfeits” – have been still used in an voluntarily ambiguous way by the rich northern countries mainly. The debate showed the division among member states on the role of WHO in addressing issues concerning IP regulation and in the relations with the IMPACT taskforce.
Latin American countries (Brazil, Uruguay, Bolivia) supported the work of the working group, but demanded more commitment and proposed that the WG meets twice before the next WHA. They also specified that accessibility and affordability to good quality medicines, should not be weakened by the fight against “fakes”. 
African countries, headed by Tanzania, strongly emphasized the issue of poor QSE medicines as a major concern for African countries who do not have manufacturing capacity and supported an overarching regulation. However, Kenya in particular, underlined that only improving access to good quality medicines, will help to prevent the infiltration of poor QSE products. Moreover, Kenya openly spelled out that the term “counterfeit” refers to the infringement on trademark and demanded WHO to disengage from discussing IP issues and to interrupt any relation with IMPACT, which was accused to usurp the role of regulatory authority.
For India, on behalf of South-Eastern Asia region, there is deliberate effort to conflate quality issues and IP issues and the only way to get out of this confusion is to leave the definitions of QSE at national level. WHO and IMPACT relationship was called to be suspended.
Many rich countries (France, USA, Japan) supported IMPACT and its operate. However, Hungary on behalf of EC, expressed some member states’ concern about this taskforce.