Helping WHO focus on its strengths — Azrul Mohd Khalib and Philip Stevens

JANUARY 20 — Members of the World Health Organization (WHO) executive board are meeting in Geneva this coming week. South-east Asia’s representatives on the board, Indonesia and Vietnam, have crucial roles in setting the global health agenda this year.

The WHO has a challenging year ahead. As recent outbreaks of Ebola and Zika have shown, new and deadly diseases can emerge without warning.

There is a looming crisis of drug resistant bacteria, threatening the effectiveness of today’s antibiotics. Though global prosperity has increased, too few people have access to basic healthcare.

Despite being the United Nations agency responsible for global health and its critical role in addressing the diverse issues in this area, the WHO has limited resources. At around US$450 million (RM1.8 billion), it is sobering to realise that the agency’s annual core budget is similar to that of a large hospital in a developed country.

To his credit, Dr Tedros Adhanom Ghebreyesus, now in his second year as WHO’s Director General, has increased spending on health emergencies, and mobilised resources to ensure that the world is better equipped to tackle the next pandemic.

Nevertheless, WHO continues to spread itself too thinly, involving itself in areas which are best left to national or local governments to manage.

Alongside tropical diseases and immunisation, WHO also publishes recommendations on adolescent health, traffic safety, climate change, suicide, human rights, youth violence, depression, chemical safety, social determinants of health, headaches and prisons.

WHO should instead strengthen and restrategise its efforts in the key areas where it has unique expertise. Its vital presence and role come to the forefront when responding to emerging health crises, tackling transnational disease, preparing for international pandemics and advising countries on healthcare reform.

Jeremy Farrar, director of the UK-based global health research charity the Wellcome Trust, argues the WHO is being undermined by its inability to focus on a few core issues.

“It’s so thinly stretched,” he told Reuters. “There’s arguably no organisation on earth that could cover all those (topics) at sufficient depth to be authoritative.”

In recent years, WHO has raised eyebrows through its campaigning against “unhealthy” lifestyle choices. This has resulted in contortions such as the previous Director General praising North Korea for its low levels of obesity and supporting Vladimir Putin’s campaign against e-cigarettes.

WHO straying into the realms of politics could occur again. Large parts of the upcoming Executive Board meeting agenda are dedicated to an “access to medicines roadmap” which sets priorities for WHO’s work for the next five years on improving access to medicines around the world.

The intent is obviously good. However, the reasons for poor access in many countries have been well known for decades yet they remain unaddressed.

Weak supply chains and poor infrastructure separate people and communities from essential treatments. There are too few doctors and clinics, and a lack of insurance coverage to protect people from the cost of healthcare expenditures. Burdensome national regulations make it extremely difficult to register new life-saving drugs, and a wide array of taxes and tariffs add unnecessarily to the price of medicines.

The WHO has specific expertise and decades of experience in overcoming these roadblocks, and it fits squarely in its mandate.

Instead of dedicating its finite resources to these issues, WHO’s Roadmap envisages a quixotic campaign against the very intellectual property (IP) protections which drive and support the development of new health technologies.

The reality is that the vast majority of treatments prescribed in both developing and developed countries are off-patent and therefore unaffected by IP rules. It is therefore unclear what the Roadmap hopes to achieve by aiming to overcome measures intended to motivate, invest and sustain scientific discovery and innovation, compromising the ability to develop new treatments and respond to existing and new diseases.

What is certain is that removing IP rights from medicines would create enormous uncertainty for domestic and international investors. Why launch a new drug, undertake research and development, or build a complex high-tech manufacturing facility in a country whose government may undermine or not even protect property rights? 

There would be less innovation and fewer new drug launches in countries that undermine IP rights. What is certain is that patients would be the losers and be deprived of new medicines and life-saving treatment.

The WHO is most effective when it unites and mobilises nations with practical solutions in the face of public health threats. It does not do well in ideological debates.

As members of the Executive Board, Indonesia and Vietnam alongside other WHO member states must help steady the ship. The WHO’s future as a relevant and effective organisation depends on it.

·    Azrul Mohd Khalib is Chief Executive of the Galen Centre for Health and Social Policy, based in Malaysia.

·    Philip Stevens is Executive Director of Geneva Network, based in United Kingdom.

*This is the personal opinion of the writers and does not necessarily represent the views of Malay Mail.

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