WHO board discusses polio eradication endgame

Polio eradication and antimicrobial resistance were among the biggest issues at the World Health Organization’s weeklong executive board meetings, which concluded on Tuesday. After selecting the top three director-general candidates who will vie for the position come May, the board also put forth a recommendation for the assembly to use a paper-based voting system, citing errors and security issues in the electronic system. Sania Nishtar of Pakistan, Tedros Adhanom Ghebreyesus of Ethiopia, and David Nabarro of the United Kingdom will face the 194 WHO member countries come May for the position of director-general. Discussions beyond the elections, however, underscored the magnitude of issues the organization is dealing with and for which the next director-general will have to prepare. Polio, antimicrobial resistance, medicine shortage and access — as well as WHO’s budget constraints and staffing — highlight the need for diplomatic skills and the ability to manage and organize a largely bureaucratic institution. The challenge of eradicating polio and beyond The board called for the director-general to compile a thorough report ahead of the World Health Assembly in May, detailing any challenges and dangers posed by the winding-down of the Global Polio Eradication Initiative. With only three remaining polio endemic countries, the world is close to eradicating the disease. But challenges remain. There is a limited supply of inactivated polio vaccines, which would help provide immunity against all three strains of the wild poliovirus; there are gaps in surveillance; and there has been slow containment of type-2 wild poliovirus. During the board meetings, the U.S. representative also mentioned the “effects of complacency” as a concern. But most of the discussion centered on the post-eradication transition plan: How is the global body preparing for the eventual eradication of the disease? Polio funding through GPEI is currently the lifeblood of more than 1,000 WHO staff, costing the organization $97.3 million annually, according to the latest human resource update by the WHO Secretariat. These staff members play different roles — operations support, immunization and surveillance, technical support and coordination — and are spread out across the globe. Even offices in countries that have long been polio-free, such as South Africa, Tanzania and Zambia, continue to rely on GPEI funding. Apart from the potential loss of staff, shutting down the GPEI could leave the WHO with significant financial liabilities. According to a study conducted in 2013 that looked at a worst case scenario analysis, human resource liabilities could reach $109 million when the program folds in 2019. A new indemnity forecast could bring down that cost to $55 million spread out from 2017 to 2019. The WHO has so far set aside $20 million for a contingency fund to cover expected costs, but to further reduce its liabilities, WHO told member states of its plans to set up a dashboard allowing the directors of polio eradication and human resources to be aware of upcoming contract expirations, staff retirements and opening of new positions for better planning and management of resources. The aid agency also plans to better engage with the wider WHO network to identify opportunities for internal reassignments of skilled and high-performing staff on GPEI funding. Michel Zaffran, director of GPEI, assured member states the transition process will include a “very thorough analysis” of the consequences that the end of the polio program will have on other health programs and WHO offices that rely on polio funding. But he reminded member states that the world has yet to eradicate the virus and at the moment, the polio program still requires the best expertise and capacities. “Just a reminder, since 2013 when we thought we were so close, the program has to fight resurgence of the virus in outbreaks in Syria, Somalia, Cameroon, Equatorial Guinea, Iraq and Ethiopia, and more recently Nigeria,” he said. “So a premature ramp down of capacities… would have meant we won’t be able to respond actively to these outbreaks.” He was hopeful, however, that 2017 will be the year the world sees the last case of polio. The representative from Rotary International confirmed its continuing commitment to the push for global eradication and noted the organization, along with the Bill & Melinda Gates Foundation, will highlight their commitment to end polio at their international convention in Atlanta, Georgia, in June. The impending loss of polio funding does not bode well for WHO, whose budget is in dire straits. Programs such as the new health emergencies program remain severely underfunded. Director-General Margaret Chan has been discussing with member states her proposal for a 10 percent increase in contributions ahead of the 70th World Health Assembly in May, but some member states are already asking Chan to come up with a plan in case of rejection. The urgency of dealing with antimicrobial resistance Antimicrobial resistance across the world has become a priority topic in global health in recent years. In 2015, members of the World Health Assembly adopted an action plan to help tackle its rising threat, setting five priorities for government action. This was followed in 2016 by a U.N. General Assembly political declaration on AMR, under which governments committed to developing multisector national action plans that integrate these priorities. Drug resistance has long affected anti-TB efforts, causing an estimated 250,000 deaths in 2015 alone. WHO is also monitoring antimalarial drug resistance globally and working on a global action plan on HIV drug resistance. Some members of the board and civil society groups urged the organization to begin discussing new models to encourage investments in research and development, the delinkage of R&D costs from medicine prices and sales, and medicine access. After the board declined to include on its agenda the report of the U.N. secretary-general’s high-level panel on access to medicines, several member states called for its inclusion in the upcoming World Health Assembly. The report, according to Dr. Sumit Seth of India, addresses current challenges in medical innovation and medicine access, and former U.N. Secretary-General Ban Ki-moon has called for broader discussions on its findings and recommendations. “The WTO TRIPS Council, the UNAIDS PCB and even the Human Rights Council have already initiated discussions on the report,” Seth said during the board’s opening session. “It would be simply inconceivable and inexcusable that WHO, which has a constitutional mandate to set and coordinate global R&D efforts and which is the main UN agency that should be at the forefront of the access to medicines agenda, does not discuss and take appropriate follow-up actions on the UN High Level Panel report.” Seth confirmed to Devex that the board has agreed to include it in the World Health Assembly discussions in May. Read more international development news online, and subscribe to The Development Newswire to receive the latest from the world’s leading donors and decision-makers — emailed to you free every business day.