KEI Comments to DHHS on WHA68 agenda 11.2, Framework of Engagement with Non-State Actors

On Friday May 8, 2015, the US Department of Health and Human Services held a listening session to solicit input on the agenda items for the upcoming 68th World Health Assembly. KEI delivered five interventions covering a range of critical WHA topics. The full provisional agenda of the 68th WHA can be accessed here:

Claire Cassedy presented the first intervention for KEI, addressing agenda item 11.2 Framework of Engagement with Non-State Actors. The relevant WHO documents are A68/5 and EB136/2015/REC/1, decision EB136(3). Her full intervention follows below:

Claire Cassedy, Knowledge Ecology International
Engagement with non-state actors

May 8, 2015

My name is Claire Cassedy, I work with Knowledge Ecology International, a nonprofit that focuses on innovation and access to medical technologies.

Under the agenda item on the framework of engagement with non-state actors, we would like to highlight the challenge of dealing with two types of non-state actors — those representing for-profit companies, and the non-state actors who fund WHO activities, or provide in-kind services to the WHO.

Interacting with Industry

We support the proposal to differentiate the types of non-state actors.

While we encourage drug companies and other industry groups to interact with the WHO, it also important to recognize the conflicts of interest inherent with such collaborations. The WHO plays a role as a regulator of commercial activities, and the term “partnership” is not always appropriate — the WHO needs to be independent, and restrain and curb some practices by companies.

Interacting with the Gates Foundation

Second, and we think more challenging in many respects, is the issue of excessive influence from large private philanthropic donors.

Specifically, I would like to speak to relationship between the WHO and the Bill and Melinda Gates Foundation.

In 2014, the Gates Foundation was the second highest single contributor to the WHO, second only to the United States. That year, the Gates Foundation contributed a total of $257 million to the WHO. This accounts for 13% of total WHO Total General Fund in 2014. The next largest funder was the UK, which contributed $100 million less than the Gates Foundation.

Beyond the Gates Foundation’s outright contribution, the fourth largest contributor to the WHO in 2014 was the GAVI Alliance. Since its inception in 2000, the GAVI Alliance has received almost a quarter of their funding from the Gates Foundation. In the last four years, Gates has been the second largest funder of GAVI, providing the Alliance with more than $1.3 billion dollars.

That amount of money often comes with strings attached. We believe the WHO has been discouraged from advancing very important reforms in how research and development for new drugs is financed, by the Gates Foundation, and influences personnel decisions, at the WHO.

Sometimes this happens through the inkind services the Gates Foundation provides to the WHO, such as through the consulting services of firms such as the Boston Consulting Group (BCG) or McKinsey&Co, two firms hired by Gates that have recommended staff changes at the WHO or the Global Fund, and which write strategy documents for the WHO. (Note that both consulting firms also have private sector clients, including the in pharmaceutical and vaccine businesses. )

The Gates Foundation has a talented staff, and their resources have done much to improve the lives of marginalized populations. There is much to admire about the Foundation and their good works. But it is also time to take stock of the relationship between the WHO and this powerful non-state actor.

KEI asks that DHHS ask the WHA to convene a special meeting to assess and discuss the relationship between the Gates Foundation and the WHO. For the WHO, this is the elephant in the room when it comes to the topic of non-state actors.