Noncommunicable disease partnerships and conflicts of interest

KEI was invited to participate in the “WHO Global Dialogue on Partnerships for Sustainable Financing of Noncommunicable Disease (NCD) Prevention and Control,” which was held in Copenhagen, Denmark, April 9-11, 2018. A web page for the event is here.

Overall, the meeting was an uncritical promotion of partnerships with drug companies, banks and other industry groups. Two representatives from the WHO described the drug companies as “partners” who “shared values” and “not the enemy.” The audience was told drug pricing issues would be amicably resolved with the WHO and drug companies “sitting together” to “agree on fair prices.” During various plenary and breakout sessions I offered some dissenting views.

The WHO asked me to make a plenary presentation on the last day, and address the challenges of managing conflicts of interest in these public private partnerships. I used three slides, which are attached here:


The first slide simply presented the “risks of engagement” that are identified by the WHO on page 7 of its May 28, 2016 “Framework of engagement with non-State actors” (WHA69.10).

The second slide, which I was encouraged to summarize briefly, described the obvious conflicts over prices, intellectual property rights and business models.

The third slide presented five suggestions on how to manage such conflicts.

  1. Recognize that in price negotiations, there are sellers and buyers, and this is not a “partnership” with shared values.
  2. Don’t give the big businesses that lobby UN agencies an effective veto over agenda items that negatively impact their profits.
    • Limiting reforms to “win-win” outcomes protects incumbents and status quo winners
    • Often the industry objective is to narrow or change the conversation, certainly away from threats to commercial interests. (Note lack of focus on drug/vaccine prices or delinkage R&D incentives, in this meeting.)

  3. Require more transparency of industry funding and influence over patient groups. There are some patient groups that are free to challenge prices, but many that can’t.
  4. Set some red-lines and clear boundaries (e.g. Medicines Patent Pool policies).
  5. Provide objective evaluations of industry and non-industry proposals for policies, in terms of the costs and efficacy of achieving health objectives.
    • It isn’t enough to show a policy will have some benefits, if there are other policies that have greater benefits. The paths not taken can be lost opportunities.
    • Does the partnership realistically restrict the policies explored?