The recently concluded 68th World Health Assembly (WHA) adopted a resolution to continue the negotiations on WHO’s Framework for Engagement with Non-State Actors.
The seven days of hectic negotiation, which started on 20 May could not reach consensus on critical issues. The WHA took place from 18 to 26 May in Geneva.
The resolution welcomes the consensus reflected in many parts of the Framework for Engagement with Non-State Actors (FENSA) including in its introduction, rationale, principles, benefits of engagement, risks of engagement, non-state actors, and types of interaction.
The resolution requested the Director-General (DG) “to convene as soon as possible, and no later than October 15, an open-ended intergovernmental meeting to finalize the draft framework of engagements with non-State actors on the basis of progress made during the Sixty-eighth World Health Assembly as reflected in the Annex”.
Further, it requested the DG to submit the finalised draft text to the sixty-ninth WHA (in 2016) through the 138th session of WHO’s Executive Board (EB). The resolution also requested the DG “to develop the register of non-State actors in time for the Sixty –ninth World Health Assembly, taking into account progress made on the draft framework of engagement with non-State actors”.
Even though Malta suggested two amendments to the resolution it did not press for the amendment after the explanation from the Chair of the drafting group and the WHO Secretariat. Malta had proposed that the consensus mentioned in Paragraph 1 should clearly mention that it was the consensus reached at the drafting group. This was not pressed after the explanation from the Chair of the drafting group.
The negotiations on FENSA were initiated in accordance with the decision of the 136th EB in January 2015. The EB decision requested the DG to convene an open-ended intergovernmental meeting from 30 March to 1 April 2015 with a view to discussing the textual proposals submitted by Member States. The open-ended intergovernmental meeting was followed up with two more rounds of informal consultations.
Even though there is consensus achieved in major parts of the text there is no agreement on crucial issues such as the definition of resources, secondments, the relation of WHO with industries other than the tobacco and arms industry, transparency requirements, oversight mechanism of engagements with non-State actors (NSAs), ceiling on financial resources etc.
The initiative started in 2015 has not reached a conclusion primarily due to the divergence of views among Member States. While the original initiative in 2011 was to facilitate more engagement with stakeholders, it had to take a different direction due to opposition from a large section of Member States. The advocates for enhanced engagement with NSAs are developed countries and this was viewed by developing countries as an attempt to facilitate corporate capture of the WHO.
The origin of the policy for the engagement with NSAs goes back to the WHA Resolution 64.2 which endorsed the WHO reform. This resolution requested Member States “to present a detailed concept paper for the November 2012 World Health Forum, setting out objectives, numbers of participants, format and costs, to the Executive Board at its 130th session in January 2012”.
Member States later opposed this provision in the resolution during the Special Session of EB on reform and this lead to a silent burial of the idea of a Global Health Forum. The decision of the Special session of the EB then set the following rules for the engagement:
- the intergovernmental nature of WHO’s decision-making remains paramount;
- the development of norms, standards, policies and strategies, which lies at the heart of WHO’s work, must continue to be based on the systematic use of evidence and protected from influence by any form of vested interest;
- any new initiative must have clear benefits and add value in terms of enriching policy or increasing national capacity from a public health perspective;
- building on existing mechanisms should take precedence over creating new forums, meetings or structures, with a clear analysis provided of how any additional costs can lead to better outcomes.
Further, the Special EB requested the DG to further analyse proposals to promote engagement with other stakeholders.
The 130th EB in January 2012 agreed on an informal decision through the Chair’s Summary. It stated: “Further discussion will be required on WHO's engagement with other stakeholders, including different categories of nongovernmental organizations and industry, and the proposals to review and update principles governing WHO relations with nongovernmental organizations, and to develop comprehensive policy frameworks to guide interaction with the private-for-profit sector, as well as not-for-profit philanthropic organizations. These will be held during the Sixty-fifth World Health Assembly”.
However, there was no such policy submitted for the consideration of the 65th WHA in 2012. The 65th WHA through decision 65.9 requested the DG “to present a draft policy paper on WHO’s engagement with nongovernmental organizations to the Executive Board at its 132nd session in January 2013”.
The 132nd EB took a decision titled engagement with NGOs and requested the DG to harmonize the development of the draft policy for engagement with NGOs with the draft policy on WHO’s relations with private commercial entities, such development being guided by the principles stated by the Sixty-fifth World Health Assembly in decision WHA65.9, subparagraphs (9)(i)–(v) as listed above.
It further requested the DG to report on the development of the two draft policies to the Board at its 134th session in January 2014.
The 133rd EB then decided as follows: “(1) noted the outlined approach to engagement with non-State actors, in particular the overarching principles of engagement and the typology of interactions; (2) requested the Director -General to advance the work proposed, taking into account the deliberations of the Executive Board at its 133rd session, particularly in relation to transparency, risk and conflict of interest, towards the development of a more detailed framework of engagement with non-State actors for consideration by the Board at its 134th session in January 2014”.
At the 134th EB session the Secretariat submitted a draft FENSA, which was then forwarded to the 67th WHA in 2014. Even though a drafting group was formed to draft the policy the attempt was dropped after 3 days due to the lack of progress.
The 67th WHA decision requested the DG “to submit a paper to the Executive Board at its 136th session, in January 2015, ensuring that Member States receive it by mid-December 2014 in order to allow them sufficient time to study the content and to be better prepared for discussion and deliberation”.
The first round discussion on FENSA at the recently concluded WHA session took place as the last agenda item in the Committee A. Even though the agenda came up on 18 May, the first day of 68th WHA, the discussion was suspended after the announcement of the Secretariat on the formation of the drafting group.
The key interventions of Member States are highlighted below.
Argentina as the Chair of the drafting group reported that an outcome was reached, after formal and informal consultations and presented a revised draft resolution (Conf/3/rev1). Work is still needed on the document, and this framework is very important for the WHO. The atmosphere of trust will continue. The chair would have liked to have a document ready for adoption, but was convinced it will be next year.
Zimbabwe spoke on behalf of the African Region (AFRO) and reiterated its commitment on reaching consensus. It wants to ensure that WHO has a sound engagement framework and expressed its appreciation for the commitment and hard work of Member States particularly Argentina. It stressed the importance of having a common understanding of important elements of this framework. It is important to explore the possibility of meetings at the earliest possible in order to finalize this issue, and the final draft document should be ready by EB138. It supported the draft resolution presented by Argentina as chair of the drafting group.
Indonesia noted that considering the magnitude of global health challenges, it is important to have participation of all stakeholders, and so the formulation of engagement of all actors is welcomed. All stakeholders can positively contribute, it said, while at the same time respecting and preserving the credibility of this institution. However, the process should not be hasty. It is not as a delaying approach but rather a cautious approach in addressing this important issue, in view of finalizing the framework by the next WHA. Indonesia thanked Argentina for facilitating negotiation process.
Brazil stated its appreciation for Argentina as the chair of the process. It noted that these intergovernmental negotiations highlighted the commitment to seriously discuss the topic and this is crucial for the future of WHO, as the directing and coordinating organization in health work. Brazil remains committed to the process and remarked on the progress that has been achieved. It also indicated that it was important to continue moving to reach consensus by WHA69.
The paragraphs where no agreement has been reached are at the core of framework, and particular caution is necessary, stressed Brazil. The health landscape is changing, and Ebola has shown the growing role of NSAs. Similar emergencies may take place and need to be prepared. There is need to protect the role of WHO in operations and its norm and standard setting role in global health policy. This framework has to be robust to address all these challenges. It also supported the draft resolution as agreed in the drafting group.
Iran joined others in thanking Argentina in this challenging and non-stop negotiation. The document is important and we are committed to finalize this framework, noting that NSAs are increasingly important in WHO’s leadership in global health. Sying that further deliberation on this document is now necessary, and this document has long term implications for future, Iran supported the draft document that shows progress made until now and prepares for future consensus.
India commended the patience in deliberating on this important subject and said Member States made invaluable contributions. It said we see work of the drafting group as very positive, we stand strongly committed to process and look forward to work together with Member States and WHO to conclude and reach agreement. It supported the draft resolution.
China thanked Argentina and the secretariat for tireless efforts over the past few days, and supported the continuation of this reform process and it is committed to work with other Member States and work actively in this negotiation process.
Malta supported the proposal for the resolution to be adopted for the WHA69. It also had two comments on the draft presented. In paragraph 1 on the issue of consensus, it seemed to imply there is consensus in this room. Malta wanted the language to clarify that the consensus was reached in the drafting group and proposed to change the language to “consensus reached in the drafting group”.
The second comment on the resolution was about the implications on implementation and resources. Malta proposed to add an extra paragraph requesting the DG to submit through EB138 a report on practical and resource implications of implementation of proposed framework. Malta considered that it is important to have this information for adopting this framework. It also requested clarification on the third paragraph of the resolution which gave the DG an action regarding a framework that was not yet approved and was still in the process of being drafted.
Colombia thanked Argentina and stressed the importance for process. It fully supported the draft resolution, establishing clear responsibilities for Member States and Secretariat in view of the conclusion of FENSA at the next assembly. Regarding the proposed amendments of Malta, Colombia said all resolutions have a budgetary aspect so a specific mention is not needed and that this work is linked to continued work of WHO, not a specific budgetary expense.
France said that this framework is one of the most important issues for reform of WHO and for its capacity for taking action. It noted how close Member States had been to adopting it at this assembly. The fact that it did not happen means it is important to be careful of the message we give to people who were not in the drafting group and in the assembly. The message has to be positive. There was a lot of progress made and France supported the resolution.
Canada remarked on the efforts to work on the framework and how useful it is for WHO in order to cost-effectively carry on their work. Canada recognized the important role of NSAs and their role in many different fronts in cooperation with WHO. This Framework will help transparent engagement and help WHO in its role and in their world health mandate. There is good momentum for this and will need to continue and hope that the work will be completed for EB138.
Switzerland welcomed major progress made in the deliberations on FENSA. It hopes deliberations will continue at this pace and in a constructive way. WHO must adapt to the changing landscape of public health actors and have a unique normative role. Switzerland hoped that by WHA69 the framework will be adopted with a clear basis and transparent engagement with NSAs.
The United States commended the good work done and hoped that an excellent document will be presented to WHA and EB next year. The US would like to have the benefits and risks of engagement listed, including partners and Member States. There is a need for updating the policy for engagement for WHO. It noted the benefit of the process, making benefits more visible, reaffirmed safeguards, as core for WHO’s regulating function. The resolution hopes to empower WHO to reinforce its existing mechanisms, for both benefits and risks of engagement with NSAs; risks are better articulated, benefits highlighted. Risks should be managed and benefits made transparent, for the benefit of public health.
Argentina as chair of the drafting group said the draft resolution reflected the spirit of mutual respect and that any proposal is welcome. This was a long process (9 formal session, 3 informal sessions). All are aware of the importance of the issue we are dealing with, and every step was taken with great care. The drafting group tried to agree on balanced language and Argentina called on Member States to consider the draft resolution.
Regarding Malta’s amendments, the paragraphs they refer to took at least two hours to agree on. But we reached an agreement that there is kind of consensus on elements. They reflect a consensus at this assembly. Regarding the budgetary amendment, as mentioned by Colombia, any resolution has a document concerning budgetary implication and Argentina did not think it is necessary to state it in the text. Regarding a register of NSAs, there was already commitment given by the DG before the draft Resolution, and the drafting group decided to include it.
Malta expressed thanks for the explanations, and was supportive of moving forward and not trying to stall the process. It was satisfied with the explanation given for the issue of consensus. On the budgetary issue, Malta said this is a framework that will dictate the way of one of the life lines of work for WHO, so we still need more explanations for financial implications. There should be figures of implications of the framework, not only resources but a report also on practical implications. What are we approving? How it will impact the functioning of WHO in the future? These are serious matters that need serious analysis.
Interventions by NGOs
The following are highlights of several NGO statements.
Health Action International (HAI) said WHO should exercise particular caution when engaging with industries affecting human health or affected by WHOs norms and standards. We recall recent examples of industry interference on public health: Twenty-five pharmaceuticals were implicated in a planned campaign to delay South Africa’s draft intellectual property policy reforms, which aimed to increase access to medicines in their country. The NYC Board of Health’s limit on the size of sugary drinks was thwarted by a campaign funded by the beverage lobby and various legal challenges. Let’s not forget that in 2003, the US sugar industry threatened to slash WHO funding via the US Congress over planned guidelines on sugar intake. Just 2 months ago, it was revealed that IFBA engaged in direct lobbying of Member States to ensure their industries were not excluded from FENSA. We advocate for delineating industries up-front in FENSA where WHO should exercise caution.
HAI stressed that private interests cannot be allowed to drive policy-making. We urge Member States to ensure FENSA creates a strong enough “fence” to safeguard public health against private interests. WHO must be given the mandate to assess conflicts of interest, monitor ongoing risks of engagement, and manage engagements with full transparency. (For the full statement see here)
International Baby Food Action Network said the current draft as we understand it, still raises concerns: It reasserts old channels of undue influence: e.g. it contains a new Official Relations policy which, instead of re-examining the constitutionality of accrediting business-interest associations as “NGOs”, proposes their wholesale admission, and moreover that of philanthropies.
It legitimizes new channels of undue industry influence: ‘Participation’, provision of ‘resources’, ‘evidence’ creation and ‘advocacy’ are all categories of high risk for undue industry influence, usually considered as “at risk areas” for conflicts of interest.
It gives the false impression that risks of interactions with TNCs and philanthropies, including conflicts of interest (CoI), are adequately addressed. The conflict of interest section still presents an incorrect CoI concept and continues conflating CoIs, conflicts WITHIN a person or institution, with conflicts BETWEEN actors. Institutional conflict of interest are situations where WHO’s primary interest as reflected in its Constitution may be unduly influenced by secondary interests of WHO or its staff in a way that affects, or may reasonably be perceived to affect, the independence and objectivity of WHO’s work.
We call for reevaluation of the Framework. Concepts need to be clarified, missing evidence obtained, and a public review of the adequacy of existing relevant WHO policies carried out. This debate should include how best to assure adequate core funding of WHO. WHO’s budget is, after all, less than 1/3 of the budget of the CDC Atlanta.
Medicus Mundi International and People’s Health Movement said the present draft of the proposed Framework of Engagement with Non- State Actors is contested, obscure and complex. It does not provide a robust framework to prevent improper influence. Corporate interests which run counter to public health interests are the pre-eminent risk arising from WHO’ engagement with non-state actors. There have been several incidents of improper influence in recent years, all involving large transnational corporations. These include: the IMPACT debate, the EWG process, virus sharing in the context of PIP and lobbying by the sugar industry and related ultra-processed food industries against the WHO recommendation of a 5% ceiling on sugar intake.
The proposed protocols say nothing about the accountability of the Member States for protecting WHO’s integrity. However, in several of the above cases Member States were involved in initiatives which created risks for the integrity and decision making of the Organization. WHO is under continuing pressure to treat corporations as equal and legitimate ‘partners’ and ‘stakeholders’ in public affairs. Proposals for ‘multi-stakeholder partnerships’ would designate junk food manufacturers as partners in the task addressing obesity, heart disease and stroke.
We urge delegates to defend the integrity and independence of the World Health Organization and to take such time as is necessary to achieve a robust framework to protect the Organization from improper influence.
(*With inputs from the People’s Health Movement Global Health Watch team: Susana Barria, Claire Ellise Burdet, Ornella Punzo, Daniel Amoun.)