PHM Daily Briefings of WHO EB

People's Health Movement (PHM)PHM daily briefings of the WHO EB Meeting:
Day 1  – January 23, 2017
(See Day 2 below)

Report prepared by Aletha Wallace, Linda Shuro and Amit Sengupta
The meeting began with a briefing session on the election of the Director-General and a detailed description of the voting process. The next item was the adoption of the agenda. Thailand insisted and got approval for inclusion of ‘physical activity’.

Call for discussion on UN High Level Panel Report on Access to Medicines Rejected

India raised the issue of non-inclusion of a separate agenda item in EB 140 on the report of the UN High Level Panel (UNHLP) on Access to Medicines (see India’s intervention here: http://www.keionline.org/node/2711 ). SEARO had asked for this inclusion in September 2016 but the Secretariat (Sectt) had only proposed discussion in existing agenda items of EB 140 such as shortage of medicines. India’s proposal was supported by Venezuela, Brazil and South Africa. Unfortunately the Sectt. ruled that this could not be allowed and that member states can discuss the UN HLP report under other agenda items on medicines access. This was very unfortunate as was the Sectt.’s rationale that they hadn’t included a separate agenda point as the HLP report was contentious and consensus would not be arrived at through discussions at the EB! Taken to the logical conclusion such a contention would mean that only issues where everybody agrees upon will be discussed in the governing body meetings of the WHO.

Director General’s report and report by Program Budget and Administration Committee (PBAC)
Director General (DG) Margret Chan give her report on what WHO has achieved over the past year. The chair of the Program Budget and Administration Committee (PBAC) gave a report on the discussion in the PBAC meeting (item 5), and most member states voiced their concern of WHO funding especially regarding assessed contributions. There was a proposal from the DG to increase assessed contribution by 10%. Next on the agenda was item 6, reports of the regional committee.

Health Emergencies
Further item 7 on health emergencies was discussed, which focused on preparedness, surveillance, and response in times of health emergencies. The review documents for this item were EB 140/8, EB 140/7, and EB 140/9. The Independent Oversight and Advisory Committee (IOAC) gave their first assessment report on the WHO health emergencies program. The IOAC reflected on what has been done in four months; explained the reason it was established and gave an overview of the program. Their mandate is to monitor the WHO health emergencies program, guide activities and report findings to the governing body. It was claimed that even though it is too early to access real reform, the program is demonstrating real results. The results achieved were presented which included early detection and response to outbreak including Zika, a more structured response to a humanitarian crisis like in Syria, South Sudan and Haiti.  It was reported that the program has demonstrated new responsiveness, ability to scale up rapidly and shifting professional culture or professionalized management. The program has focused on eight areas: structure, human resources, incident management, risk assessment, business processes, partnerships, International Health Regulations (2005) (IHR) and finance. The program has made progress in recruiting health personnel. Some member states welcomed the report and the early work of IOAC.

Based on the assessment made, it was reported that some countries haven’t started to implement changes. It was articulated that the IOAC needs support and partnership with the Secretariat, as the IOAC has principally an advisory role.  Some Member States complained about the report being delayed and the Director General asked member states to accept the report in four weeks instead of six weeks in advance. The Director General also requested member states to have a five-year financing plan, and said the secretariat would provide the strategic plan in 2018 executive board meeting six weeks in advance.

Concern was raised about weak health systems in many countries and this being a reason for them not being able to cope with health emergencies. In response, the DG said the secretariat would focus on three C’s: country focus, cultural change, and cash. She said that the Secretariat will work to strengthen health systems, build core capacity under the International Health Regulations, strengthen country office capabilities and provide addition help. It was articulated that there is need for a cultural change within countries and in WHO, and that  there should also be close working relations between ministries such as health ministry and foreign affairs. For example, the foreign ministry in consultation with the health department should be able to issue visas quickly to emergency responders from the international community to ensure smooth response to emergencies.

Concerning the contingency fund for health emergencies, member states supported the report but raised concerns about the problem of funding, coordination at country, regional and headquarters of WHO.  The director general responded regarding funding and said that the program has significant funding gaps. Without the funding, the program cannot operate sustainably. The director general thanked Kuwait for their support in Syria and encouraged the need for member states to work together with the Secretariat. She also called for political and financial commitment.

Member states especially from the Africa region highlighted the necessity of the R&D blueprint and roadmaps and also applaud the progress made so far. The vulnerability of the African region was highlighted. They also stressed that products generated from R&D should be affordable, and data sharing should be ensured.  A proposal was made to use the Nagoya protocol, exploration of innovative sources of finance, and the expediting of the R&D roadmap.

 The session will continue on the 24th January.

Contact: Linda Shuro <linda at phmovement.org>

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PHM daily briefings of the WHO EB Meeting: Day 2 / January 24, 2017)

Report prepared by Amit Sengupta and Gargeya Telakapalli

The second day of the Executive board 140 dealt with the short listing process of candidates and was followed by discussions on technical topics.

Short listing of candidates for the post of the Director General (DG)
The executive board has commenced the process of short listing candidates for the position of Director General-WHO. The process of selecting DG has been spread over EB140 and 70th World Health Assembly in May 2017. On Tuesday, the Member States took part in voting, wherein 5 candidates were shortlisted from 6 candidates who were in the race. Dr Miklos Szocska was the candidate who could not make it to the top 5.

The 5 selected candidates – SaniaNishtar (Pakistan), David Nabarro (UK), TedrosAdhanom Ghebreyesus (Ethiopia), Flavia Bustreo (Italy) and Philippe Douste-Blazy (France) — would be interviewed by the EB and the list would be further shortened to 3. These 3 candidates would be eligible to contest for the post of DG, which will be finalised in WHA-70.

New Regional Director for Mediterranean region
Dr Mahmoud Fikri took charge as the new Regional Director for WHO Mediterranean region (EMRO).

Technical Topics
1. Health emergencies
The topics that were discussed under Health emergencies are as follows

1.1) WHO response in severe, large scale emergencies-
The countries expressed that the work done by WHO during the Ebola and Zika crisis was commendable. A request was made by few countries to help them in strengthening their laboratory and diagnosis capacity, while ensuring standards in the quality of work. The countries stressed on the importance of coordination and collaboration between different agencies and organizations in the United Nations and also of the departments belonging to country governments. All countries agreed on the fact that, there was a necessity to increase the funding for emergency response.
Response of WHO Secretariat: Noted the suggestions and comments made. Executive director of World Health Emergency program (WHE) said that personnel were being recruited for 24 clusters. Also recommended the Member States to undertake the Joint Evaluation of the emergency response. The need for a strong decentralized mechanism for implementation was stressed. The ED of WHE accepted that, there is a need for increase in funding.

1.2) Health workforce coordination in emergencies
The countries appreciated the WHO for the coordination by WHO for Human Resources. It was stressed that better coordination is required for mobilization of internal and external Human Resources. Member Countries felt that WHO should also take a lead in coordinating with other ‘stakeholders’ and Humanitarian Aid organizations. Countries stressed on the fact that HR should be protected from any kinds of attacks and the culprits should be punished. It was also requested that WHO should facilitate necessary logistics.

1.3) Research and development-
Member states supported the document on R&D blueprint. Countries felt that there should be a platform for the exchange of information and materials for better Research and Development. Need was also felt to have strong systems of laboratories for developing countries. Countries felt that WHO has to take into consideration that time taken for development of new vaccines and medicines needs to be reduced. This reduction in the time gap would mitigate the effects of the health emergency. USA felt that WHO should not be directly involved in issues related to Research and Development, but rather coordinate and provide necessary environment for R&D. It also asked WHO to protect the interests of stakeholders’ Intellectual property rights.
India and Brazil raised the issue that they were concerned with absence of discussions in the EB documents on de-linkage (delinking cost of development of new medicines from their price) and affordability of medicines. Countries also felt that principles of CEWG and UN High Level Panel report on access to medicines regarding access and affordability should be included in the R&D blueprint.
PHM’s statement on the issue that was read out by Aletha Wallace is available here.

2.International Health Regulation- draft global implementation plan

Countries expressed their support for the draft proposal for a 5 year strategic plan and for core capacities to be strengthened. Countries spoke about the importance of Joint External Evaluation plan, but raised concerns on it going beyond the health sector preparedness. They indicated that this should be a voluntary measure and not a mandated activity as the EB document appears to suggest. Countries stressed on the importance of inter/intra sectoral coordination for the implementation of IHR. It was also felt that WHO should support countries in framing and implementing national level plans. They mentioned that it would be optimal for partners to join WHO if resources were available, rather than creating parallel structures and coordinating later on.
WHO reply: Clarified the issues raised and informed that the draft will be reviewed by the Secretariat and then sent to the WHA for adoption in May.

3.AntiMicrobial Resistance (AMR)

Members States welcome the outcome of the UN high level Commission report on AMR and acknowledged the work of WHO with FAO and OIE (world organization for animal health) under the ‘One Health Approach’. Countries supported the formation of National Action Plans, and requested the WHO to provide technical help necessary for countries to accelerate the process of forming National Action Plans. Countries also stressed on the importance of Health systems strengthened to use Antimicrobials appropriately. Need was felt for increasing the surveillance, monitoring and infection control activities as regards AMR.
The AMR document also incorporates a section on sepsis. Some questions were raised as to why awareness should be increased only about Sepsis while it needs to be done about all infections regardless of whether they lead to sepsis. Also, some countries asked if the goals on sepsis were realistic for developing countries to follow.

PHM’s concern on the draft resolution on AMR that incorporates the issue of Sepsis: The resolution: “Improving the prevention, diagnosis and management of sepsis”, in agenda item 7.2 inter alia asks member states to “engage further in advocacy efforts to raise awareness of sepsis, in particular through supporting existing activities3 held every year on 13 September in Member States”. The reference here is to the ‘World Sepsis Day’ (www.world-sepsis-day.org) which is supported, among others, by 229 corporate entities. It is important for member states to exercise vigilance before committing to an activity that involves a range of pharma cos. diagnostics and device manufacturers.

The AMR discussions continue on 25 January.

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