April 2011: WHO to tackle pandemic influenza, de-linkage, prizes, R&D financing and non-communicable diseases

April 2011 ushers in a busy period for the World Health Organization. During the second week of April 2011, WHO will hold two important events: 1) the first meeting of the Consultative expert working group on research and development: financing and coordination (CEWG) which takes place in Geneva from 5-7 April 2011 and 2) a consultation with industry on 6 April 2011 in Geneva convened by co-chairs, Ambassador Bente Angell-Hansen (Norway) and Ambassador Juan Jose Gomez-Camacho (Mexico) of the Open-Ended Working Group (OEWG) of Member States on Pandemic Influenza Preparedness: Sharing of Influenza Viruses and Access to Vaccines and Other Benefits . On 27 April 2011, WHO will host the WHO Global Forum: Addressing the Challenge of Noncommunicable Diseases in Moscow, Russia. On 28-29 April 2011, WHO and Russia will host the “First global ministerial conference on healthy lifestyles and noncommunicable disease control“.

In contrast with the opaque Expert Working Group on R&D Financing (EWG), a body shrouded in secrecy under the leadership of Dr. George Alleyne, the Consultative Expert Working Group (CEWG) sets a model for transparent norm-setting. The CEWG’s mandate is provided by WHA resolution 63.28 passed in May 2010, Establishment of a consultative expert working group on research and development: financing and coordination. This resolution guiding the CEWG underscores the importance of de-linkage and prizes by noting:

Recognizing the need to further “explore and, where appropriate, promote a range of incentive schemes for research and development including addressing, where appropriate, the de-linkage of the costs of research and development and the price of health products, for example through the award of prizes, with the objective of addressing diseases which disproportionately affect developing countries”; (Footnote 1, Resolution WHA61.21, Annex, Element 5, paragraph 5.3a).

Resolution 63.28 instructs the CEWG to “review the five promising proposals identified by the Expert Working Group in its report; and …further explore the six proposals that did not meet the criteria applied by the Expert Working Group”. Consequently, with a clean slate, the CEWG will review the proposals of Bangladesh, Barbados, Bolivia and Suriname on prizes and the R&D Treaty.

The first meeting of the CEWG will hold an open session on Tuesday, 5 April 2011 from 9:30 AM to 3:30 PM open to all Member States and other stakeholders. The registration form for the open session can be found here: http://www.who.int/phi/news/cewg_2011/en/index.html. On Wednesday, 6 April 2011, the CEWG will convene an Open Forum from 9 AM to 6PM in the WHO Executive Board Room; member states and other interested stakeholders are invited to present their proposals and submissions before the experts. This represents an important opportunity for Member States, intergovernmental organizations, civil society, academics and industry to present their respective perspectives to the CEWG. The registration form for potential presenters to the Open Forum is: http://www.who.int/phi/news/phi_cewg_appl_form_2011_en.pdf. Finally, on Thursday, 7 April 2011, the CEWG will host an Open Briefing Session at 5:30 PM in Salle B at the conclusion of the CEWG;. According to WHO, the Chair of the CEWG will brief member states and interested stakeholders on the outcomes of the first CEWG meeting and outline its future plan of work.

While the CEWG holds its Open Forum on 6 April 2011, the co-chairs of the Open-Ended Working Group (OEWG) of Member States on Pandemic Influenza Preparedness: Sharing of Influenza Viruses and Access to Vaccines and Other Benefits will be sequestered in an industry consultation with Member States in attendance. The 3rd meeting of the OEWG will take place from 11-15 April 2011. The background documents for the fourth meeting of the OEWG can be found here: http://apps.who.int/gb/pip/e/E_Pip_oewg3.html. The first paper presents options for sustainable financing of benefit sharing in relation to pandemic influenza preparedness and the second paper is the finalized McKinsey paper funded by the Gates Foundation entitled, “Technical studies under Resolution WHA63.1“.

The process section of the report states:

Work to establish the terms of reference for studies, based on the report of the Open-Ended Working Group (document A63/48), began immediately after the Sixty-third World Health Assembly, in May 2010. The terms of reference were finalized and sent to Member States on 22 July 2010. Given the breadth of the areas under study and the limited human and financial resources of the Organization to carry out the full studies, the Secretariat sought external support. The Bill & Melinda Gates Foundation provided support through a contract with McKinsey & Company, which was selected on the basis of its broad expertise in public health, financing, health economics and influenza vaccines; its ability to start work on the project quickly; and its global team.
On the basis of the report of the Working Group and the terms of reference, the WHO Secretariat and the McKinsey team began to develop the outline of the study in mid-August 2010. First, the parameters of the study and the timetable for delivery were addressed, and, in view of the broad scope of the studies, a phased approach was agreed, so that preliminary findings could be shared at the meeting of the Working Group in December 2010 and the full study would be completed before the Sixty-fourth World Health Assembly.

For more information about KEI’s communication with WHO on this matter McKinsey’s involvement in vaccines work, please consult: /node/1084.

On 27 April 2011, WHO will convene the WHO Global Forum: Addressing the Challenge of Noncommunicable Diseases in Moscow, Russia. As alluded to in an earlier piece entitled, “Noncommunicable diseases in the 2011 global public health agenda“, the WHO Global Forum will serve as testing ground for the WHO to phase in a multi-stakeholder global governance model. As noted in my earlier piece, “although the details of the Global Health Forum are still nebulous, certain informed observers have noted the Forum is a response of the WHO secretariat to the “Committee C” concept proposed in 2008 in the Lancet by Gaudenz Silberschmidt (Switzerland), Don Matheson (University of Otago),and Ilona Kickbusch (Graduate Institute of International and Development Studies). As WHO is reeling from an expected shortfall of $200 million to $600 million in the 2010-2011 budget, it is seeking creative ways of leveraging unearmarked voluntary contributions from donor governments, foundations and the private sector. Whether the Global Health Forum can bridge this gap or be subject to “Trojan multilateralism” (Devi Sridhar, Oxford Global Health Governance) remains to be seen.” Certain observers see the Global Health Forum as Trojan mulilateralism to bypass the governance structure of the World Health Assembly, the highest decision making body of the WHO.

The concept note for the 2011 Global Forum states:

The WHO Global Forum: Addressing the Challenge of Noncommunicable Diseases will bring together a wide group of stakeholders to share views and experiences to date on the challenges and opportunities in noncommunicable disease prevention, treatment and control. Forum participants will identify and commit to priority actions to strengthen global action to prevent and control noncommunicable diseases prior to and beyond the HLM.
The Forum provides an excellent opportunity to raise awareness of the September 2011 HLM on noncommunicable diseases, and to provide input into the preparation for the HLM as well as discussions on noncommunicable diseases at the sixty-fourth World Health Assembly in May 2011.
The objectives for the Forum are:

• Provide an opportunity for a wide range of stakeholders to discuss and share perspectives on the prevention and control of noncommunicable diseases (NCDs)
• Understand expectations, roles and contributions of the different stakeholders in support of the September 2011 UN High-level Meeting (HLM) on NCDs and its expected outcomes, as well as activities post the HLM.
• Update knowledge and share experience on progress in addressing NCDs including through implementing the Action Plan for the Global Strategy for the Prevention and Control of NCDs.
• Promote ways of accelerating the implementation of actions for international and national partners under each objective of the Action Plan.
• Mobilize a broader base of stakeholders in support of NCD prevention and control, in particular in developing countries.

The expected deliverables of the Forum are:

• A short report that could be presented by one or more of the stakeholder groups during the World Health Assembly in May 2011 to support Member States’ preparation for the HLM.
• Lessons learnt in organizing multi-stakeholder discussion forums.
• A statement to be delivered to the Moscow Ministerial Meeting representing key
perspectives from the stakeholders.

The last event on the WHO calendar for April is of course the joint Russian/WHO “First global ministerial conference on healthy lifestyles and noncommunicable disease control” to be held in Moscow on 28-29 April 2011.

This invitation only ministerial conference is expected to attract 300 participants with each Member State being allotted two slots (one for the Minister and one for an additional member of the country delegation.

The conference website lays out the following aim and goals:

The aim of the conference is to “support Member States develop and strengthen policies and programmes on healthy lifestyles and NCD prevention. These efforts are based on the Global strategy for the prevention and control of NCDs and its action plan, which include multisectoral and innovative approaches in prevention and care.

The conference has three main goals:

* to highlight the magnitude and socio-economic impact of NCDs;
* to review international experience on NCD prevention and control; and
* to provide evidence on the pressing need to strengthen global and national initiatives to prevent NCDs”.

The Moscow ministerial is predicated upon the WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases endorsed at WHA 53 in May 2000 and the Action Plan passed at WHA 61 in May 2008. This Ministerial is expected to lay the groundwork for the United Nations General Assembly High-level Meeting on the Prevention and Control of Noncommunicable Diseases on 19-20 September 2011.