Sisule F. Musungu - The 126th session of the Executive Board (EB) of the World Health Organization (WHO) meets in Geneva from Today (Monday, 18th January 2010) to Friday with a packed agenda. This meeting comes in the wake of increasing questions regarding the management and governance of the world health body which for far too long has escaped serious public scrutiny by hiding behind the perception that it is a technical body whose work ordinary mortals can not understand.

A Pretence to Efficiency

The 34 Member EB would have the world believe that in just five days it will have seriously considered over 46 specific agenda items ranging from the Report of the Director General through to programme, budget and administration matters, eighteen technical subjects (ranging from sharing influenza virus and access to vaccines to international health regulations to birth defects), financial matters, management matters, staffing matters through to a range of progress reports. Most of these subjects have not benefitted from any preparatory Member States deliberations or input let alone transparent inputs from other stakeholders.

This system of management may appear efficient but if you think so look again and look hard. The mistakes that the EB makes, the things it does not discuss seriously or those not discussed at all affect all of us and we have very limited chance to hold anyone accountable for getting observership at the EB and WHO generally appears to be harder than becoming a doctor. There is at least a transparent and objective way to become a doctor.

A Time to Rethink WHO Governance, Time is Running out

I have previously argued that there is an urgent need to rethink the governance of global health and the role of WHO (See my June posting on reforming WHO). The evidence abounds but two recent examples should be a wake up call for all.

First, serious questions have arisen with respect to the declaration of a global pandemic with respect to H1N1. Was there sufficient medical and scientific evidence for the declaration? Was the world health body used to scare and intimidate governments and the global community into panic buying of vaccines whose efficacy may have been in doubt? Did WHO use experts whose of objectivity was questionable due to their links to the pharmaceutical industry that stood to benefit from such a declaration? Many more question are out there. (For the record I found the whole thing suspicious and unscientific and I therfore have conscientiously objected to vaccination). What is missing is the outrage that should follow evidence that it is possible we were duped into a false panic by those who are charged with the responsibility of our health.

The second recent development that should have anyone concerned with global health seething is the handling of the Expert Working Group on Research and Development Financing (EWG). This expert group was set up by the Director General on the instructions of the Member States when they adopted the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property to examine the current finacing and coordination of R&D as well as proposals for NEW and INNOVATIVE sources of funding for R&D needs of developing countries. This is an issue that previous efforts by the Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH) and the Intergovenmental Working Group on Public Health, Innovation and Intellectual Property (IGWG) failed to resolve. What was hoped for was that the WHO Director General and the EWG would bring an enhanced level of seriousness, analysis, engagement and innovativeness that would take us forward. Unfortunately and almost criminally, the EWG and the WHO Secretariat may have taken us backwards. How?

To start with, the EWG process was secretive and opaque. The claims that the EWG engaged with interested stakeholders or that the invitations for written submission to the public constituted public consultations rings hollow when one compares it to the CIPIH process or processes in other international organisations such as the WIPO Development Agenda at the World Intellectual Property Organization (WIPO). Worst of all, there is credible evidence that the pharmaceutical industry innapproapriately influenced the process even getting the drafts of the report and exerting influence through what the industry has called “friendly members” of the EWG. You would think that with such evidence an immediate investigation would have been launched considering that the CIPIH process faced similar attempts. If you thought so, you thought wrong for it appears this is business as usual at WHO. If the EB does not take this matter with the seriousness it deserves, we all should be very worried because our health is at stake. We should all be asking is our health in the right hands?

With respect to the EWG, it is important to remember that this process only happened after years of pressure and efforts by developing countries and health groups. It was not, repeat, it was not, an initiative of the WHO Secretariat. The WHO Secretariat and experts such as those on the EWG should therefore not be allowed to squander what is an opportunity of a life-time.