GENEVA — The 72nd World Health Assembly wrapped up Tuesday with the passing of landmark resolutions and a few new initiatives, including the establishment of a new special program at the World Health Organization.
But member states found some topics harder to find consensus on, in particular taking responsibility for the health of refugees and migrants and promoting transparency over costs of research and development of medicines and other health-related technologies. In both discussions, some member states sought to weaken the language, making it more of a voluntary exercise. Negotiations over these two agenda items went over the weekend, with the latter spurring disagreement between member states to the bitter end.
In his closing speech, WHO Director-General Tedros Adhanom Ghebreyesus announced the institution is establishing a special program on primary health care. The program will “support countries in strengthening the foundations of their health systems and of universal health coverage.”
He also announced the establishment of the WHO Academy to “transform the training of WHO staff and public health professionals.”
Both the WHO Academy and the WHO Foundation, which he announced earlier in his opening speech before the World Health Assembly and that Devex found to be in the conceptual stage, were ideas put forward by staff. Tedros had mentioned both in January’s executive board meeting.
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The announcement follows eight days of discussions and negotiations on a number of important health issues, during which time the assembly adopted several resolutions, including, for the first time, recognizing the importance of water, sanitation, and hygiene in health care facilities, and investing in community health care workers.
“Investing in health workers, both their education and employment, has been a central feature of this year’s assembly,” Jim Campbell, health workforce director at WHO, told Devex.
“During discussions on primary health care, emergency preparedness and response, emergency care services and other items member states have identified the absolute necessity for a multidisciplinary team responsive to population health needs. The key will be turning this realization into action across all countries.”
Member states agreed to establish World Chagas Day on April 14, World Patient Safety on Sept. 17, and make 2020 the Year of the Nurse and Midwife. They also adopted a new global strategy on health, environment, and climate change, and formally launched a strategy to address snakebite.
They also approved WHO’s proposed budget for the biennium 2020-2021, with some member states commenting positively on the direction of WHO’s reform agenda despite some areas of concern.
A race for transparency
Advocates anticipated the issue of transparency concerning access to medicines would be one, if not the most, contentious topic at this year’s WHA. They were right.
Informal negotiations on the draft resolution took place prior to the opening of the assembly, and by Thursday, May 23, a drafting group composed of member states was created to negotiate the text, which called on member states to make public the cost of medicines, vaccines, and other health-related technologies, including the results and costs of clinical trials. The resolution also urged member states to improve the transparency of patents of medical technologies, including biologic drugs, vaccines, cell and gene therapies, and diagnostics.
But for over four days, including Saturday, the group was hard pressed to find consensus. Advocates following the negotiations closely have called out countries that were particularly opposing the publication of R&D costs in the resolution, including Germany, Japan, Switzerland, the United Kingdom, and United States.
If anything, these countries, in particular Germany and the U.K., want to make public this information on a “voluntary basis.” A briefly available draft resolution listed country positions — what they wanted to add, retain or delete, in brackets. Both original and negotiated resolutions were captured by Knowledge Ecology International, one of the nonprofits known to be strong proponents of the transparency resolution.
The resolution is connected to the draft roadmap on access to medicines and vaccines, which member states took note on Monday amid U.S. opposition to parts of it, including WHO’s involvement on transparency promotion, noting it is not part of its “mandate.”
The International Federation of Pharmaceutical Manufacturers and Associations also raised concerns on the focus on transparency and intellectual property issues in line with the roadmap, noting it would deter from “holistic and sustainable solutions to access.”
But for many, the debate is really about those not in the room, the people who needed the drug, vaccine, and other health-related technologies.
“This is a story about rheumatic heart disease, or RHD. RHD is a preventable, treatable form of cardiovascular disease that affects over 33 million people around the world, a number comparable to those living with HIV. It affects the world’s poorest and most vulnerable, mainly children and women,” said the representative from the World Heart Federation.
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By Tuesday morning, advocates were faced with what they describe as a “diluted” version of the original resolution, which was eventually adopted by WHA. The speeches that followed, however, revealed the delicate nature of the agreement; not everyone was happy with the contents of the resolution, nor the process by which it was connected.
The representative from Germany was first to relay their discontent over the process, noting it was “rushed,” “bypassed” the executive board, and “in breach of the Geneva spirit” that allows for a “culture of respect” in negotiations among member states. The representative was particularly complaining of the “leakage of perceived positions” by member states on parts of the resolution, arguing it was used to “intimidate some delegations” and with “incorrect information” as to delegations’ reasons for the position.
For these reasons, which the representative described as “unhealthy,” Germany expressed its position to “disassociate” itself from the resolution, a decision that was followed by the U.K. and Hungary.
The U.S., which was also actively engaged during the negotiations and was reportedly in opposition to some of the text around transparency of R&D costs in the resolution, however, said it is “pleased to join consensus” on the resolution, to the applause of many in the room.
The representative from Brazil pointed out that the process taken was standard in negotiations. In direct response to questions over the process, they reminded member states how the resolution regarding the public health implications of the Nagoya Protocol on Access and Benefit-sharing was similarly not put forward before member states during the 144th session of the executive board, but still, the assembly found consensus on the issue.
Beyond the process, however, the representative pointed out how the consensus arrived at the assembly underscores the “very pressing problem [of access to medicines and other health-related technologies] to every country in the world, across regions, and across different levels of development.”
Thailand meanwhile disassociated itself from the part of the resolution calling on member states to disclose clinical trial costs on a voluntary basis, arguing Thailand reserves its right “to implement policies related to mandatory cost declaration within Thailand.”
The resolution is far off from what many civil society advocates were pushing for, but the recognition by countries at the assembly of the need for transparency in the market for drugs, vaccines, and other health-related technologies — as gleaned in the negotiations and speeches — a welcome development and a partial win toward access.
“This is a welcome first step to correct the power imbalance that exists today during negotiations between the buyers and sellers of medicines; giving governments the information they need to negotiate fairly and responsibly for their peoples’ health,” said Gaëlle Krikorian, head of policy of Médecins Sans Frontières’ Access Campaign.
One nascent initiative at WHA72 was the Epidemic Big Data Resource and Analytics Innovation Network, or EPI-BRAIN. This was flagged by Tedros in his executive board speech in January as a new concept WHO had developed to predict epidemics using artificial intelligence. The World Economic Forum is collaborating with WHO on the initiative, which aims to promote public-private collaborations in data sharing — the subject of a McKinsey report WEF released last week.
The details are still being worked out, however. In Geneva last week, representatives from Facebook, the Bill & Melinda Gates Foundation, Flowminder Foundation, Gavi, the Vaccine Alliance, Harvard University, and Johnson & Johnson, among others, met in a closed-door workshop on the governance and main challenges of the plan.
According to a flyer distributed at the meeting, EPI-BRAIN aims to be “a sustainable, shared, accessible, and integrated data innovation ecosystem to reduce the impact of outbreaks through forecasting and predictive analytics.”
Sylvie Briand, WHO infectious hazard management director, told Devex that for now only a few staff are working on EPI-BRAIN, but “we hope that with the transformation, we will have something more formal and solid.”
Briand said the AI would aim to mimic the input of her current, human, team members. “Each of them, for their own disease, can tell you, ‘I’m very worried we will have a big outbreak there in the next few months’,” she said. “But it’s in their mind ... they have experience so they know how to bring together different datasets and then they can make this kind of prediction. It’s quite reliable actually. The problem is, first, it’s disease-by-disease, what we would like is to have something that covers many diseases. And [second], it has taken them many years to get to this point. So we would like to translate what is in the brain of those experts into an algorithm and then we can improve over time because it will be able to get more data than the normal human brain.”
WEF plans to present more on EPI-BRAIN at Davos, Switzerland, in January next year.
Another contentious item on the agenda was the global action plan to promote the health of refugees and migrants. After lengthy debate, member states “noted” the plan, the preparation of which was called for in a resolution at the 2017 assembly.
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There are some 258 million international migrants and 763 million internally displaced, many of whom lack proper access to health services and financial protection. The plan’s six priorities include promoting refugee and migrant health through short- and long-term public health interventions, and countering misperceptions about their health.
But Davide Mosca, a commissioner of the UCL-Lancet Commission on Migration and Health, and former director of migration health at the International Organization for Migration, told Devex that “some countries don’t want to be called to report and therefore the language has been that member states in collaboration with WHO and other parties will report on a voluntary basis. That voluntariness of the reporting on progress is a way for some countries to not feel any obligation coming from this action plan.”
That angered the likes of Portugal, which co-sponsored the 2017 resolution calling for the action plan, and whose delegation lamented that, “Since the action plan was already deprived of recommendations to member states, we would have hoped that at least the decision of this assembly contained a strong invitation for states to report on progress made at a national level.”
Mosca said the main question was how the health needs of migrants would be met.
“I was eager to see this page turned and finished, because now we can go to the real work,” Mosca said. “Yes, I would like to see a world that is homogeneously in favor of solidarity and rights, but this is not the time … I think we need to be pragmatic and say ‘OK, we have something, it’s not perfect but let’s move on.’”