The WHO EB debate over membership of the new R&D Financing consultative expert working group (CEWG)

At the end of the day on Monday, the 128 WHO Executive Board meeting took the agenda item for creation of a new R&D Financing consultative expert working group (CEWG). (Yesterday’s blog on this topic is here)

At the beginning of the debate of the membership of the CEWG, the Assistant Director General, Marie-Paule Kieny announced that she was modifying the list to eliminate the Sri Lankan expert, to be replaced by an expert from India. When the member states had the opportunity to intervene, Brazil asked the Secretariat for additional details on the names of the persons not selected for the CEWG, as well as for background materials on the experts, including, for example, the CV’s of the experts. Bangladesh echoed Brazil’s concerns. Thailand diplomatically raised an objection to the inclusion of Paul Herrling, the Novartis executive recommended for the CEWG by Switzerland. Thailand indicated that Herrling had an impressive resume, but they thought persons from the pharmaceutical industry would have a conflict of interest and gently suggested that Herrling could best serve by providing advice and expertise to the CEWG during its deliberations, rather than being a member of the CEWG itself.

Herrling’s nomination was then defended aggressively by Dr. Chan, the WHO Director General. Chan began by basically attacking Thailand for raising the issue, said that the WHO often has persons from industry on WHO advisory boards, and that everyone has conflicts. She did not mention that Herrling was the author of the proposal for “The Fund for R&D in Neglected Diseases (FRIND),” which was seeking $10 billion in grant money, to undertake R&D on 10 neglected diseases, that this proposal was among the 3 proposals recommended by the previous EWG, and one that would be reevaluated by the CEWG. According to the EWG:

three proposals are in circulation to provide reliable, long-term funding to product development partnerships, and to automate or centralize funding decisions across product development partnership portfolios to a lesser or greater degree. These are:

  • Fund for Research and Development in Neglected Diseases
  • Industry Research and Development Facilitation Fund
  • Product Development Partnership Financing Facility.

According to the official WHO participant list, the EB meeting is chaired by Dr M. Kökény, a former minister of health from Hungary. The Hungarian delegation is lead by Dr H. Páva who speaks for the European Member states in the EB discussions. The Hungarian Chair then undertook what some observers saw as a “fast gavel” and declared the DG’s recommendations approved, and the agenda item concluded. Brazil then intervened to indicate that it was not in agreement with the Chair, and wanted to have to the DG respond to its concerns, and those of Thailand. The chair then offered some perplexing statements about how the agenda item was closed, but also how the EB would in some ambiguous way, think about the issues raised by Thailand. The session then broke, for an event previously organized by Germany, on the future of the WHO. There was considerable buzz in the room when meeting broke with the strong possibility that the issue of the conflicts of interest will be revisited by the EB at some point this week.

KEI was quite surprised the WHO Secretariat tried to place Herrling on the CEWG, given that he is the author of a proposal asking the CEWG for $10 billion in grants to subsidize pharmaceutical industry research into neglected diseases. We would have thought the previous controversy over the industry influence on the influenza pandemic expert group would have make the WHO more sensitive to the public’s concerns over conflicts of interest. Apparently not.

For some background on the Herrling proposal, see Malini Aisola’s analysis from a year ago:A closer look at the WHO EWG endorsed proposals on funding product development partnerships

For those who have not followed the history of the WHO CIPIH/IGWG/EWG/CEWG process, there has been considerable tension and controversy over proposals to de-link R&D costs from product prices. Proposals for a biomedical R&D treaty or the expanded use of innovation inducement prizes to replace product monopolies are particularly controversial, to the degree that they advance a de-linkage agenda. Paul Herrling’s FRIND proposal was presented as the IFPMA alternative to reform proposals, and it was criticized in several areas, including those discussed in the Aisola comment. Whatever one thinks of the merits of the $10 billion Herrling proposal, it seems bizarre that Herrling would be asked to serve on the body that was asked to evaluate his proposal, an issue that KEI and others have raised with several EB delegates.

And that is not all. During the 2010 World Health Assembly, when some thought the earlier Expert Working Group report would be accepted, there was an attempt to merge the three proposals for funding that the EWG had endorsed, even though they were extremely different in their designs. This included a high profile meeting at the Intercontinental Hotel, where Herrling, Holly Wong from IAVI, and Mary Moran spoke, and presented a new initiative called PDP+. So at this point, not only is Herrling the author of the FRIND proposal, but he is also now a collaborator in the PDP+ proposal, which is an attempt to merger the three leading contenders for the CEWG approval.

None of KEI’s concerns suggest negative views on Paul Herrling himself. In fact, among public health groups, Paul Herrling is one of the highest regarded big pharma executives, and someone that KEI and others respect and enjoy working with. We just do not see how the WHO can have him evaluate his own funding proposals.