The case of the missing civil society at the World Health Summit

World Health Summit President Axel Radlach Pries took a few minutes at the outset of this year's opening ceremony Sunday to brag about the conference. In the shadow of the ongoing COVID-19 pandemic, he said more than 6,000 people were expected to listen to more than 370 speakers in over three days as they weighed in on the most pressing challenges — and opportunities — in global health. "Bringing together the different viewpoints from a diverse and vibrant global community united by the aim to improve health worldwide has always been the hallmark of this conference," he said. Conversations that, he suggested, could translate into initiatives and policies to help end the current pandemic and prevent future crises. The diversity of viewpoints he was celebrating was not exactly present in the opening ceremony he was kicking off, though. The evening featured no speakers from civil society organizations and few voices from outside the global north, though it did feature two representatives from the private sector. Members of German civil society say this reflects what they perceive to be the summit's real function, which is to amplify industry messages and bring their representatives into closer contact with policymakers. “Civil society, in particular from the global south, but also north, were seldom at the table.” --— Mareike Haase, international health policy adviser, Bread for the World "The major actors and the critical voices from the global south are missing," said Dr. Andreas Wulf, the Berlin representative of medico international. Even as he wonders at the extent of the private industry’s influence on the summit and “how much does it stifle critical debate?,” it has not stifled the summit's growing significance in high-level policy circles. Moments after Pries spoke, World Health Organization Director-General Tedros Adhanom Ghebreyesus took the stage and announced that his agency would partner with WHS to jointly organize next year's gathering. He also promised "to engage an even broader group of actors, committed to multilateral action for global health." In a partnership that appears set to further boost the summit's stature, civil society groups hope there might also be an opportunity to reshape WHS. Growing influence The WHS launched in 2009 under the auspices of Charité, one of Germany’s flagship hospitals and research institutions, with a vision of linking the scientists guiding technological and medical advances to the industrial and government representatives who could leverage that innovation to improve people's lives. It has drawn funding from other academic institutions, foundations, and the German government. But to civil society representatives, it always seemed more a trade show. "A bit of showing off the German health care industry to get them new clients," Wulf said. By several different standards, the summit's influence has grown rapidly though. It regularly attracts global leaders, including Tedros, who appeared in person for all three days of this year's event. It has also become a launching pad for major innovations and research, including the Global Preparedness Monitoring Board’s 2021 report that was released at this year's event. The surging status of WHS is intertwined with Germany's growing leadership in the field of global health, heralded by the launch of several Berlin-based hubs and by the government's emergence as WHO's chief booster and funder. The ministry of health clearly views WHS as a useful forum for championing the strategic direction guiding its expanding global role, underscored by the ministry's decision to organize an entire track within this year's summit. The track was an "effort by the German government to make this conference more accessible both for policymakers and actors to get in dialogue," said Caroline Schmutte, who leads Wellcome’s Germany office and has chaired one of the German policy track panels. Overrepresentation of industry Though it boasts a more expansive vision from its early days, with greater integration of governments and international organizations, civil society representatives say the private sector retains an outsized influence at WHS. Jörg Heldmann, the managing director of WHS, said 35% of the €2 million ($2.32 million) in turnover this year came from private partners, with the rest drawn from research organizations, foundations, and public funds. Excluding the ministry-funded track, at least 11 of the more than 50 panel discussions this year were hosted by the private sector or affiliate organizations. "They say they built a room for all parts of society, from civil society to private sector, government, and all that. It has never been like that," said Mareike Haase, international health policy adviser at Bread for the World. "There has always been an overrepresentation of industry,” while “civil society, in particular from the global south, but also north, were seldom at the table.” Following early attempts to collaborate with WHS, civil society groups were left with the feeling that the organizers were overly restrictive and unwilling to give them a significant role, which led them to retreat from the summit, Haase said. Heldmann disputed the idea that civil society was missing from the event. "We have long-standing and close relationships with dozens of civil society organizations and are generally as integrative as possible both on the panels and regarding the participants," he said. "The representation from NGOs was strong also in this year's summit." ​​WHS program does list civil society partners but includes organizations that are integrated into the international development system, such as The Global Fund to Fight AIDS, Tuberculosis and Malaria, and Gavi, the Vaccine Alliance, and political foundations, such as Friedrich-Ebert-Stiftung. And any presence that was at this year’s event was not enough to avoid some fairly lopsided conversations. There were no civil society representatives on a panel on vaccine preparedness, which also considered issues of access to medical products. The participants touched on South Africa and India's proposal at the World Trade Organization to temporarily waive protections on intellectual property that guard COVID-19 vaccines and treatments, but it gained no traction. The nearest voice of support came from WTO Director-General Ngozi Okonjo-Iweala, who advocated in support of her "third way" that would see manufacturers "finding partners in developing countries, trying to manufacture in those countries and transferring technology voluntarily to do this." Haase said this is indicative of the insularity of WHS. She is not looking for agreement on all of the positions civil society organizations are advocating for, such as the TRIPS waiver, but at least a recognition of the support their viewpoints receive outside the halls of the summit and an acknowledgment that they deserve to be considered in any discussions of the world's pressing global health issues. "We're very interested to open it up for a controversial debate," she said. "That's what we need and that's what we're missing here." Their points were not entirely absent. In his opening address, Tedros reiterated his demand that manufacturers share "know-how, technology and licenses, and waive intellectual property rights" on medical products that prevent and treat COVID-19. And the M8 Alliance, a coalition of health centers, universities, and national academies that serves as the academic foundation of WHS, voiced support for the TRIPS waiver in its annual declaration on the final day of the conference. Changes anticipated German civil society representatives, acknowledging the attention WHS receives, said they might be open to reengaging with the summit. But they would require some concessions, beginning with greater transparency around private sector influence. At the same time, it is not clear how much interest WHS organizers have in broadening its outreach to the groups, so long as they can continue to draw the high-level participants that have always been their main targets. The partnership with WHO may moot some of those issues. As a conference jointly organized with WHO, WHS will have to follow agency regulations that prohibit private sector sponsors. WHO might also be more responsive to criticism over imbalanced representation. A WHO spokesperson told Devex next year's summit will "aim at multisectoral participation including [the] private sector, civil society, and others." That may mean a markedly different opening panel next year.