This post was written by Elizabeth Montgomery Collins, MD, MPH, DTM, Global Health Council individual member and delegate to the 142nd WHO Executive Board meeting. In January, Global Health Council (GHC) hosted a delegation to the 142nd Session of the World Health Organization (WHO)’s Executive Board (EB) Session. View complete WHO EB updates.
A recurring theme at the World Health Organization (WHO) 142nd Executive Board meeting (EB142) in Geneva was the extent to which the WHO should engage in public-private collaborations to achieve policy objectives such as universal access to medicines and vaccines. Most agenda items prompted two to three minutes of commentary from most of the 34 countries currently serving on the Executive Board, as well as additional comments from countries with observer status that could speak but not vote. This summary is intended to provide an overview of those comments and a sense of the WHO debate over public-private partnerships.
Representing the United States, Garrett Grigsby, Director of the Office of Global Affairs at the U.S. Department of Health and Human Services, articulated the U.S. position that the WHO would be better served by investing in prevention now rather than responding to emergencies later. He moreover argued that achieving universal access to healthcare in many countries will require the kind of resources only available through private sector investment and that the WHO should, therefore, utilize private sector partnerships to drive healthcare access availability down to the individual level.
Conversely, the People’s Health Movement, a global network of health activists, expressed concern with “the rise of private-public partnerships for global health security such as GAVI and CEPI,” concluding that such collaborations can “potentially undermine WHO’s leadership and confer undue influence to the private sector.”
Agenda Item 3.6 Addressing the global shortage of and access to medicines and vaccines
Director Grigsby reported that in 2017 the U.S. Food and Drug Administration (FDA) set an all-time record for approvals (763) granted for generic medications. This increase in approvals reflects the growing understanding that generic medications will play an essential role in expanding global access to medicines and vaccines. Director Grigsby further suggested that the private sector companies who develop and manufacture such medicines would make a logical (and perhaps indispensable) partner in the WHO’s efforts to overcome access barriers (such as scarcity and price) to medicines and vaccines. The U.S. also emphasized the importance of innovation, which typically originates in the private and academic sectors.
The representative from Portugal, however, cautioned that private sector partnerships fail to advance the three keys to global access: transparency, fair pricing, and joint public procurement. The representative specifically pointed out that a “lack of transparency regarding costs of production, research and development, and prices paid by other Member States and procurement agencies results in a lack of power to negotiate and a reliance on mechanisms for comparison such as international reference pricing, which is likewise opaque.” In addition, the “lack of transparency stimulates corruption, bad governance and allows for abuses such as the very high prices that are currently being imposed for some innovative medicines, namely for cancer, Hepatitis C or some new gene therapies.”
A number of non-state actors also offered comments on Agenda Item 3.6. Dr. Mychelle Farmer of the Global Health Council delegation, in a statement supported by the American Academy of Pediatrics (AAP), which represents 66,000 pediatricians, and NCD Child, a global coalition for prevention and treatment of non-communicable diseases (NCDs), stated that the WHO should consider pursuing Product Development Partnerships to target specific diseases, including non-communicable diseases.
Agenda Item 3.8 Preparation for the third High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases
Regarding the prevention and control of NCDs, the U.S. delegation highlighted the critical need for “collaboration and partnerships across sectors.”
Likewise, Canada, speaking on behalf of Canada, the Caribbean, Central and South America, and Mexico, said, “To effectively address the growing epidemic of NCDs and manage their shared risk factors we believe a whole-of-government and a whole-of-society approach should be promoted. Strong political will, investments and cooperation are necessary to tackle the social, economic, political and capacity challenges underpinning NCDs and to encourage action across sectors as well as multi-stakeholder engagement and partnership.”
The Global Health Council, supported by NCD Child, the AAP, and the International Federation of Psoriasis Associations, echoed this sentiment and indicated that the WHO must create linkages between non-state actors and non-health sectors to effect lasting change.
Commentary on Twitter, however, suggests that the European Union statement, while welcoming global efforts to combat NCDs, opposes corporate involvement in the effort, referencing the UN model policy on preventing tobacco industry interference.
Agenda Item number 3.9 Preparation for a high-level meeting of the General Assembly on ending tuberculosis (TB)
The U.S., which claimed to be the largest funder of TB prevention, treatment, and research worldwide, stated that the U.S. is committed to domestic TB elimination and believes that with effective collaboration, and increased multi-sector engagement, the WHO can end TB worldwide.
Agenda Item 4.2 Physical activity for health
The NCD Alliance noted that the inadequacy of existing resources to achieve the WHO’s physical activity targets may require “cross-sectoral collaboration, co-investments and accountability” but that any such collaborations should be “informed by WHO recommendations on restrictions of marketing of unhealthy foods and non-alcoholic beverages, and the Commission on Ending Childhood Obesity” and other “potentially incompatible partnerships e.g. those with the alcohol, gambling and fossil fuels industries, whose products and services drive modifiable NCD risk factors and contradict sustainable development principles.”
Ilona Kickbusch, Director of the Global Health Centre of The Graduate Institute of International and Development Studies in Geneva, similarly tweeted that “the food and drinks industry are complicit to the NCDs epidemic and must change”.
Meanwhile, the Infectious Diseases Society of America (IDSA) suggested that the WHO must strengthen its own research and vaccine development, and that it would be counterproductive to exclude private sector contributions when addressing the health of all people everywhere.
Although the debate continues, the WHO has acknowledged the potential benefits of public-private collaborations. In a January 19, 2018 article in The Wire entitled “WHO Gets to Work: 2018 a Litmus Test for New Team”, for example, the WHO reportedly has indicated a willingness to engage with a range of non-state actors, including private entities, because “outreach to such actors is critical for WHO’s work.” The WHO likewise acknowledges in its revised Global Plan for Work GPW13 that “Non-State actors and, in particular, the private sector can also contribute to [universal healthcare] UHC in service delivery, innovation, investment, and as employers.” At the same time, the WHO continues to reaffirm that it will always “speak up against practices from any sector, including industry, that, based on evidence, are harmful to health.”
- View Global Health Council’s 2017 World Health Assembly statement for Agenda Item 23.3: Engagement with non-state actors.