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The WHO and the Public-Private Partnerships Debate

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.

142nd WHO EB Meeting in session. Photo credit: Danielle Heiberg, Global Health Council

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.

Agenda Item 3.3 Public health preparedness and response (and affiliated items EB142/8, EB142/9, and EB142/10)

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.
142nd World Health Organization (WHO) Executive Board (EB) Session

Organized by World Health Organization (WHO)

January 22 – 27
Geneva, Switzerland




GHC will be sending a delegation of its members to the meeting. Be sure to follow GHC on Twitter (@GlobalHealthOrg) for the latest updates from the delegation, including forthcoming statements.

The Executive Board is composed of 34 technically qualified members elected for three-year terms. The annual Board meeting is held in January when the members agree upon the agenda for the World Health Assembly and the resolutions to be considered by the Health Assembly.

Global Health Security: Why Women Matter
Maternal child health

As the world responds to a new outbreak of Ebola in the Democratic Republic of Congo, many may not realize that women tend to be at greatest risk. If this outbreak follows previous patterns, as many as 75% of those infected will be women, which has massive implications for families and society at large.
To help women survive and thrive, it is imperative that health security efforts focus not only on building response capacity to emergencies like the last Ebola pandemic, but on creating more resilient health systems. As I prepare for the World Health Assembly which begins May 22 in Geneva, Switzerland, I hope to help bring more attention to key components of effective healthcare delivery: the availability of quality assured medicines, and the human workforce to sustain services in the face of pandemic threats.
If these efforts are to have a lasting impact, it is critical that women, already the traditional caregivers in many communities, be part of those efforts.

Women’s Disproportionate Burden

Women are disproportionately affected during health crisis situations for several reasons. Lower socioeconomic standing means women often have poorer nutrition and lack access to education and basic health services. Traditional gender roles means women are more likely to be exposed to disease because they are the primary caregivers. Women prepare meals, care for the sick and attend to the dead. Women also make most health care decisions in the family.  Simply put, women are at the center of global health security.
High-profile emergencies, such as Ebola, Zika and Influenza, demand responses that require not only effective services, but also effective treatments. But in low- and middle-income countries regulatory authorities often face daily challenges assuring medicines quality, even outside a crisis situation. The growth of online distributors, according to the WHO, now means there is not a single country that is untouched by this problem of substandard or falsified medicines.
Shortages in quality-assured medicines hamper health emergency responses during outbreaks, they undermine continued efforts to reduce the impact of the tuberculosis, malaria and HIV/AIDS epidemics and impede improvements in maternal and child health outcomes.

Women Leaders in Science, Policy and Practice

Resilience during public health crises requires investing in health systems and people, especially women, as agents of change.
USP collaborates with the WHO, national medicines regulatory authorities, manufacturers and other partners to increase the supply of quality-assured essential medicines by building technical capacity and human resources at all levels. In Africa, for example, in 2015 USP created the Women in Science Exchange (W.I.S.E.), a program to empower and mentor female students and professionals in science and help them to advance into leadership positions. Recognizing that women are under-represented in the African health workforce, the program paired female students with mentors, African women who are established leaders in pharmaceutical, medical or regulatory science.
In a recent visit to Myanmar, I was struck by the efforts of the head of the recently accredited National Medicines Quality Control lab, Dr. Khin Chit, to mentor her staff, over 90% of whom were young women, reflecting a similar shift in opportunities in Southeast Asia.

Women leaders in science

USP also provides on-site training for quality-assurance professionals around the world. In 2016, USP facilitated the training of over 1,000 individuals from 19 countries – over 500 of which were women. Together these efforts seek to improve the pipeline of future women scientists. We can all do better to support women in science as part of building resilient health systems.

Looking to the Future

Neither pathogens nor medical products respect national borders. Substandard and falsified medicines may be uncommon in the U.S. and other industrialized and middle income nations but global supply chains and travel make all of us vulnerable to health threats associated with poor quality medicines. They fail to treat infectious diseases and contribute to drug resistance, elevating the risk of further spread, locally and globally.
To achieve the Sustainable Development Goals, everyone needs medicines that are accessible, affordable and  quality assured. USP is committed to investing in women and strengthening systems across the globe so the medicines people take are quality-assured, no matter their gender or where they live.

IMA cheers recognition of non-state actors at World Health Assembly

This post was provided by GHC member, IMA World Health, and written by Theresa Nyamupachitu, Health Systems Strengthening Advisor.

They were the busiest six days in Geneva and probably in the world as 194 countries converged for The 69th World Health Assembly. This was a moment set for world health leaders to pause and reflect on the progress made to meet the health needs of their countries and to set their health agenda. The world embraced the Sustainable Development Goals, also known as the 2030 Agenda for Sustainable Development, the new goals, targets and indicators being used to frame global health agencies and policies.

This was an opportunity that IMA World Health would not miss, and so my colleague Nkatha Njeru from the IMA office in Kenya and I were fortunate enough to be part of these proceedings. Putting on two hats as a Global Health Council Delegate and a World Council of Churches Delegate, my two main goals were to gain insights into the current global health issues to better align IMA’s contributions to the health and well-being of all, and to foster the engagement of faith-based organizations at this platform to increase FBO visibility and recognition in global health. IMA is a faith-based international public health organization that works in close partnership with local FBO networks in most African countries known as Christian Health Associations and their regional body, the African Christian Health Associations Platform.

Through several briefings from country delegations made up of high-level government officials, the world celebrated notable successes driven by the Millennium Development Goals, such as 19,000 fewer children dying every day; a 44 percent drop in maternal mortality; 85 percent of tuberculosis cases treated; and a 60 percent decline in malaria mortality. Leaders also noted that antiretroviral therapy, a life-saving treatment, has had the fastest scale-up in history, with more than 15 million people living with HIV now receiving it.

However, many countries reported gaps still remain and challenges lay ahead of meeting the goals and achieving universal health coverage. These include weak health systems; disease outbreaks, such as Zika and Ebola; and emerging health issues such as anti-microbial resistance, non-communicable diseases and mental illness.

Through numerous deliberations, a number of new resolutions were set to guide the new agenda. Among these, the most challenging during negotiations and yet the most exciting is FENSA—The WHO Framework for Engagement with Non-State Actors. After more than four years of intergovernmental negotiations, the WHA adopted a set of guidelines that will strengthen WHO engagement with non-governmental organizations (including FBOs), private sector entities, philanthropic foundations and academic institutions.


Theresa Nyamupachitu, Health Systems Strengthening Advisor for IMA World Health, makes a presentation on “Training and Formation: Lessons learnt and opportunities for ACHAP and CHAs” during a WCC-ACHAP event titled “Global Public Health: The future of faith-based organizations” on May 25, 2016, during the 69th World Health Assembly in Geneva, Switzerland. (Photo courtesy of Peter Kenny/WCC)

To coincide with this, IMA, ACHAP and several CHA leaders, including Ms. Karen Sichinga of the Christian Health Association of Zambia; Dr. Samuel Mwenda of the Christian Health Association of Kenya and a member of the IMA board; and Dr. Mwai Makoka of the Christian Health Association of Malawi, engaged in discussions and strategic thinking with partners including WCC, WHO and Global Fund on their future role in the 2030 health agenda. FBOs play a significant role in health, serving the most vulnerable populations in hard to reach areas where, in most cases, governments and the private sector have no reach. Yet FBOs remain under-recognized for their immense contributions to the health sector. In many contexts, FBOs are often not integrated into planning and resource allocations for national health systems, leading to service and system redundancies and gaps.

IMA applauds FENSA and views it as an opportunity for the voice of FBOs to be heard and for their role to be recognized at a global level. However, to achieve this FBOs face some critical questions—how prepared are they to extend their reach to those that have not yet been reached; to enhance evidence-based dialogue with governments and stakeholders and demand for inclusiveness; to strengthen capacities within networks to have more impact; and to have stronger religious messages on critical health issues such as immunization and HIV/AIDS.

WHA69: A New Delegate’s Perspective

This guest blog was written by Dr. Indira Paharia, Individual GHC Member

As a first time delegate at the World Health Assembly (WHA) in Geneva last week, I had an incredible opportunity to peer inside the inner workings of global health policy and even participate in the action.  When I first stepped into the Palais des Nations, I was struck by how large the structure was, consisting of Buildings A through E.  At the opening plenary, obtaining a seat in the upper observatory was an accomplishment, and seeing WHO Director-General Dr. Margaret Chan open the 69th WHA was a privilege.  The Assembly Hall was packed and the passion and excitement for the days ahead was evident.  The hall was filled with Ministers of Health, WHO and UN senior leadership, member state delegates, US officials, and NGO executives – all coming together around a common purpose of improving the lives and health of the world’s citizens.

As the days wore on, several topics were discussed in Committees A and B, and many of these meetings went on into the late evening. By the last day, I was quite familiar with how to use the lifesaving WHA app on my iPhone, as many of us were trying to track which items were moved from Committee A to B and vice-versa, in order to be present to speak on the Committee floor.  And I had the great privilege of presenting to Committee A on a Framework Convention on Global Health (FCGH) on behalf of the GHC. In between sessions and numerous side-events, I wondered the halls of the UN, stopping to admire the beautiful art work, gifts bestowed from many member states, and several WHO exhibits focused on some of the most important health issues of our time.  And of course, I also spent time in the Serpent bar vying for a power outlet and a chair like so many others!  I stayed until the very end when DG Chan closed the WHA at 7 PM on Saturday, May 28.

As a clinical psychologist and a national advisor to the Substance Abuse and Mental Health Services Administration (SAMHSA), I was initially struck and disappointed by the lack of inclusion I saw for mental health and substance use disorders. However, as I engaged in many of the topics, such as communicable diseases, violence prevention, Universal Health Coverage, and emergency preparedness, I began to appreciate how such life and death issues must take precedence.  Nevertheless, within non-communicable diseases, an integrated health systems framework, and women’s and children’s health, I do believe strongly that there needs to be more explicit inclusion of behavioral health. In moving from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs), WHO has broadened the focus of healthcare’s impact to include the social determinants of health, an important step in achieving global health equity.  Behavioral health plays a key role in this given that mental disorders are the leading cause of years lived with disability globally. We must harness the power of behavioral health in achieving SDG Goal 3.  Put simply, behavioral health is essential to overall health.