UPDATE: On 29 July 2019, the co-facilitators (Ambassadors of Georgia and Thailand) of the intergovernmental consultations on a UN political declaration on universal health coverage announced that the silence procedure was broken by “several delegations on paragraphs 29, 68, 69, 70 and 71.” Paragraphs 29, 68, and 69 contain references to sexual and reproductive health and rights (SRHR); paragraphs 70 and 71 contain references to indigenous peoples, refugees, internally displaced persons, and migrants in the context of ensuring that no one is left behind “reflecting the principles of equality and non-discrimination”.
Paragraph 70 reads:
Ensure that no one is left behind, with an endeavour to reach the furthest behind first, founded on the dignity of the human person and reflecting the principles of equality and non-discrimination, as well as to empower those who are vulnerable or in vulnerable situations and address their physical and mental health needs which are reflected in the 2030 Agenda for Sustainable Development, including all children, youth, persons with disabilities, people living with HIV/AIDS, older persons, indigenous peoples, refugees and internally displaced persons and migrants;
Paragraph 71 reads:
Address the particular needs and vulnerabilities of migrants, refugees,internally displaced persons and indigenous peoples which may include assistance, health care, psychological and other counselling services, in accordance with relevant international commitments, and in line with national contexts and priorities;
The co-facilitators informed the UN General Assembly that they would hold further consultations to resolve the impasse on references in the text to SRHR and the rights of indigenous peoples, refugees, internally persons, and migrants.
On 23 September 2019, the United Nations General Assembly will convene its first high-level meeting on universal health coverage. The theme of the meeting is: “Moving together to build a healthier world”. In preparation for the UN High-Level Meeting on Universal Health Coverage, the Ambassador of Georgia to the United Nations (H.E. Mr Kaha Imnadze) and the Ambassador of Thailand to the United Nations (H.E. Vitavas Srivihok) were appointed co-facilitators of the intergovernmental consultations on the political declaration. After two months of intense negotiations, on 24 July 2019, the co-facilitators presented the final draft of the Political Draft of the High-level Meeting on Universal Health Coverage. The co-facilitators described the final text as reflecting a “fine and delicate balance”. This text was placed by the co-facilitators in silence procedure from 25 July 2019 till 6 PM on 29 July 2019; consequently, countries had until 6 PM on Monday, 29 July 2019 to raise objections on the final text.
James Love, Director of Knowledge Ecology International (KEI) provided the following observations on the 24 July 2019 text:
The new text reflects the need to compromise with countries that want reforms and countries that want to block reforms. The language on transparency in paragraph 50 is overall good. It does mention the transparency of costs of health products, which is very important, in addition to prices, since prices will depend upon policies. It could have been better, and it could have also mentioned the WHA resolution. The language on R&D financing in paragraphs 52 and 53 is unnecessarily weakened by the reference to voluntary initiatives, but it closes strong with the reference to “incentive mechanisms that separate the cost of investment in research and development from the price and volume of sales, facilitate equitable and affordable access to new tools and other results to be gained through research and development.” This type of language on delinkage, in the context of incentives, is important.
Paragraph 50 of the UN political declaration on universal health coverage calls upon member states to improve “availability, affordability and efficiency of health products by increasing transparency of prices of medicines, vaccines, medical devices, diagnostics, assistive products, cell- and gene-based therapies” and encourages the World Health Organization (WHO) to “continue its efforts to biennially convene the Fair Pricing Forum with Member States and all relevant stakeholders to discuss the affordability and transparency of prices and costs relating to health products”. The reference to the transparency of prices and costs provides a strong mandate to the WHO to expand its work on transparency to include R&D costs.
50. Improve availability, affordability and efficiency of health products by increasing transparency of prices of medicines, vaccines, medical devices, diagnostics, assistive products, cell- and gene-based therapies, and other health technologies across the value chain, including through improved regulations and building constructive engagement and a stronger partnership with relevant stakeholders, including industries, private sector and civil society, in accordance with national and regional legal frameworks and contexts, to address the global concern on high prices of some health products and in this regard encourage WHO to continue its efforts to biennially convene the Fair Pricing Forum with Member States and all relevant stakeholders to discuss the affordability and transparency of prices and costs relating to health products;
Paragraph 51 of the draft UHC text provides a reference to the WTO TRIPS Agreement and the WTO Doha Declaration on the TRIPS Agreement and Public Health.
51. Promote increased access to affordable, safe, effective and quality medicines, including generics, vaccines, diagnostics and health technologies, reaffirming the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) as amended, and also reaffirming the 2001 WTO Doha Declaration on the TRIPS Agreement and Public Health, which recognizes that intellectual property rights should be interpreted and implemented in a manner supportive of the right of Member States to protect public health and, in particular, to promote access to medicines for all, and notes the need for appropriate incentives in the development of new health products;
Paragraphs 52 and 53 contain language on a “range of innovative incentives and financing mechanisms for health research and development” including mechanisms predicated upon delinkage, “the idea that temporary monopolies and the associated high drug prices should not be used to fund pharmaceutical research and development, as well as a set of policy proposals that would replace monopolies and high prices with alternative incentives based upon cash rewards, and expanded funding for research, drug development, and clinical trials through a combination of grants, contracts, tax credits, and other subsidies.” (Source: https://delinkage.org/overview/)
52. Explore, encourage and promote a range of innovative incentives and financing mechanisms for health research and development, including a stronger and transparent partnership between the public and the private sectors as well as the academia, recognizing the need for increasing public health-driven research and development that is needs-driven and evidence-based, guided by the core principles of safety, affordability, effectiveness, efficiency, equity and considered as a shared responsibility, as well as appropriate incentives in the development of new health products and technologies;
53. Recognize the important role played by the private sector in research and development of innovative medicines, encourage the use, where appropriate, of alternative financing mechanisms for research and development as a driver of innovation for new medicines and new uses for medicines and continue to support voluntary initiatives and incentive mechanisms that separate the cost of investment in research and development from the price and volume of sales, facilitate equitable and affordable access to new tools and other results to be gained through research and development;