The Guardian
There is a danger that WHO's new partnership with drug companies will skew
its health policies
Comment
by Sarah Boseley Guardian
Wednesday February 6, 2002
Just 18 months ago, the lid was lifted on a piece of commercial espionage
and covert manipulation that would not disgrace the pages of a John le
Carre blockbuster. Tobacco companies had penetrated the innermost sanctums
of the World Health Organisation. Philip Morris, the largest cigarette
manufacturer in the world, admitted paying scientists to turn up at WHO
meetings to which the company had been refused entry, but insisted nothing
it had done was improper.
But documents that came to light during tobacco litigation in the United
States suggested that this calculated and well-financed strategy went beyond
ordinary lobbying. A WHO report said tobacco companies "sought to divert
attention from the public health issues raised by tobacco use, to reduce
budgets for the scientific and policy activities carried out by WHO, to
pit other UN agencies against WHO, to convince developing countries that
WHO's tobacco control programme was a 'first world' agenda carried out
at the expense of the developing world, to distort the results of important
scientific studies on tobacco and to discredit WHO as an institution."
Tobacco companies rose from being the object of suspicion to public
enemy number one in the eyes of Gro Harlem Brundtland, WHO's director general,
and her staff. The infiltration should have been a salutary experience
for a benign organisation, but there are fears that the lessons may not
all have been learnt. Tobacco may have been locked out but pharmaceutical
companies now sit at the top table. There is a world of difference between
the two industries, it will rightly be argued - tobacco is a killer, medicines
save lives. But they have something fundamental in common: their duty to
their shareholders, to make money.
Brundtland and her closest advisers deserve admiration for their determined
efforts to spend a lot more money on health in the developing world. Brundtland's
macro-economic commission on health, chaired by Harvard economist Jeffrey
Sachs, last month said a further $8bn a year was needed.
It's an enormous amount of money to raise from reluctant donor governments.
Brundtland is convinced of the need to have the private sector on board.
Microsoft's Bill Gates, with his donations of billions of dollars to vaccine
development, has done more than anybody to make this policy look a winner.
But the pharmaceutical companies that have agreed to donate some medicines
to poor countries and cut the costs of others are not acting purely out
of selflessness.
What's in it for them? Most obviously, there is the global fund for
Aids, TB and malaria set up by UN secretary general Kofi Annan, which has
a purse now worth close to $1bn which will be spent on medicines and preventive
measures such as condoms and mosquito nets. The model for the fund is the
Global Alliance for Vaccines and Immunisation (Gavi). Save the Children
Fund UK recently publicly warned of conflicts of interest within Gavi,
which has vaccine manufacturers sitting on the board.
The pharmaceutical industry has lobbied hard for seats at the global
fund table too. Brundtland is very much in favour of public private initiatives
such as Gavi, which forge ahead (thanks to Gates's money) in a way UN agencies
cannot and get things done.
That could lead to tears, say some WHO staff and outside observers.
They fear this new reliance on corporate drive and cash is already in danger
of skewing health policy towards vested interests.
It is most noticeable in the continuing struggle over the absence of
drugs to treat people dying of Aids in Africa. Activists and organisations
such as Medecins sans Frontieres would like to see WHO back the use of
generic drugs - cheap copies of the expensive patented medicines produced
by big-name pharmaceutical companies. WHO has preferred to negotiate price-cuts
with a handful of the drug giants, which are still higher than generic
prices.
The macro-economic commission was also strongly against generics. One
of the papers commissioned for its discussions by WHO argued that prices
were not the block on the wider use of essential drugs in developing countries,
blaming corruption and lack of healthcare infrastructures instead. The
paper was written by Harvey Bale, head of the International Federation
of Pharmaceutical Manufacturers Associations, with help from Adrian Otten
of the World Trade Organisation.
The potential for conflicts of interests has been noted within WHO.
The executive board has discussed guidelines for staff. But rules on free
lunches are irrelevant when would-be persuaders are regulars in the staff
canteen. Drug companies, baby-milk manufacturers or the big food corporations
- they would all like a bit of influence at WHO. Brundtland may be right
to harness their money and energy in the cause of health, but she will
have to persuade her critics that it is she who is sitting in the driving
seat.
Sarah
Boseley is the Guardian's health editor