The 140th session of the World Health Organization (WHO) Executive Board (EB) is officially done and dusted. Despite one of the lengthiest agendas in the history of the EB, the meeting actually finished a day early on January 31. As GHTC noted before the meeting, there were several agenda items relevant to global health research and development (R&D), in addition to broader decisions about WHO’s overall future direction. Some resulted in substantive decisions, while others served as an opportunity for delegates to provide input to shape resolutions for the World Health Assembly (WHA) in May. Here are the highlights from the week:
The biggest news out of the EB was the narrowing of the pool of Director-General (DG) candidates from six to three in preparation for a vote at WHA. Contrary to expectations heading into the EB vote, Dr. Sania Nishtar (Pakistan), Dr. Tedros Ghebreyesus (Ethiopia), and Dr. David Nabarro (UK) made the shortlist, while Drs. Flavia Bustreo (Italy) and Philippe Douste-Blazy (France), both of whom many considered to be strong contenders going into the meeting, failed to make the cut. The three have all positioned themselves as reform candidates, committed to continuing many of the reform processes started under outgoing DG Margaret Chan. The campaign now kicks into high gear, and it will be interesting to see if and how the candidates evolve their platforms to respond to priorities from the full membership of WHO now that they have made the shortlist.
The EB approved a new terms of reference for the Global Strategy and Plan of Action on Public Health, Innovation, and Intellectual Property (GSPOA), recognizing the need for WHO to consult with private-sector companies and establishing rules for this engagement as set out by the Framework for Engagement with non-State Actors (FENSA). Adopted in 2008, the GSPOA guides WHO’s work on fostering innovation and improving access to medical technologies for people in low- and middle-income countries. It was designed to promote innovation, build capacity, and mobilize resources by positioning WHO in a central and strategic role managing the relationship between public health, innovation, and intellectual property. As it nears its decade anniversary, WHO is undertaking a review of progress, as well as identifying areas for reform moving forward. In line with WHO’s move to put in place more stringent conflict of interest protections, initial drafts of the terms of reference for the review would have limited the agency’s ability to engage with private-sector companies involved in health R&D. The final draft as approved, however, recognizes the need to consult with these groups.
The EB’s session to review progress on the establishment of an R&D observatory and pooled fund at WHO to finance R&D as recommended by the Consultative Expert Working Group on R&D: Financing and Coordination (CEWG) was largely sidelined by member state debate on how or whether to carry forward recommendations of the United Nations (UN) Secretary-General’s High-Level Panel on Access to Medicines (HLP), which has proved highly controversial among member state delegations. In the run-up to the meeting, the officers of the EB decided not to include a separate item for discussion of the HLP’s findings in the EB agenda. As a compromise, the president of the EB permitted discussion of the HLP findings to occur under the existing CEWG agenda point. A number of countries, including Brazil, India, Iran, and others had strenuously objected to the exclusion of a HLP agenda item, arguing that WHO is relinquishing its global leadership role on a topic fundamental to health in not taking the lead on implementation of the HLP recommendations. Others, including the United States and some European delegations including Switzerland, Germany, and the UK argued that there was no consensus on the panel’s findings, that the report unfairly targeted specific countries, and that the HLP process had been overly narrow from the start in focusing on intellectual property, as opposed to a broader set of factors that impact access.
The EB also did review progress on implementation of the CEWG recommendations. The final plan to establish an R&D observatory will be up for approval at this year’s WHA, while the proposal for a pooled fund to compliment the observatory is significantly less advanced, and work is still underway to determine exactly how a fundraising mechanism can be constructed to support it. GHTC delivered a statement at the meeting welcoming progress by WHO on the CEWG process and encouraging full funding of the observatory and ongoing consultation with stakeholders as the process moves forward.
Following on the heels of last year’s political declaration of the high-level meeting of the UN General Assembly on antimicrobial resistance (AMR), the EB reviewed progress made by WHO and other UN technical agencies to establish a plan to operationalize the declaration’s key recommendations, including spurring R&D for new antibiotics and other tools to combat AMR. As GHTC noted in our statement delivered at the EB, the effectiveness of follow up mechanisms to hold stakeholders accountable for their commitments on AMR will be critical to the overall success of the fight. Many delegates’ interventions focused on this need to deliver on commitments, and the tone of the session seemed to indicate that we will see a robust plan approved at WHA, which will be a great win for global health.
The EB reviewed progress by WHO on establishing an R&D blueprint for potentially epidemic diseases to reduce the delay between the identification of an outbreak and the deployment of effective medical interventions, calling for the agency to accelerate its work, given that the next outbreak can happen at any time. GHTC highlighted in its statement the importance of the blueprint addressing platform technologies, frameworks for collaborative R&D, and investing in regulatory/procurement systems strengthening. These efforts by WHO are part of its self-examination following lessons learned in the response to the Ebola outbreak.
Heading into WHA in May, the agenda will be very full. In addition to the items above, the Assembly will also consider WHO’s response in crisis situations, polio elimination, immunization, WHO’s overall budget, implementation of the International Health Regulations to enhance global health security, global shortages of medicines and vaccines, and dozens of other items. GHTC will continue monitoring and will provide updates before, during, and after WHA.