WHA Roundup: Incremental steps forward on access and TB takes the limelight

The 71st World Health Assembly (WHA), held from May 21-26 in Geneva, featured all the expected verbal jousting over policy positions on key issues facing the World Health Organization (WHO) and the broader global health community, though the resolutions touching on research and development (R&D) ultimately passed by consensus. In particular, three items stood out.

Access to medicines

As anticipated, the debate on access to medicines featured some aggressive verbal sparring by member states, but in the end, all this talk produced only incremental action: Member states passed a resolution tasking the WHO secretariat with developing a roadmap to address access to medicines to be presented at next year’s WHA.

Member states have long agreed on the importance of improving access to medicines, but have long struggled to achieve consensus on actions WHO should take in pursuit of this aim, despite many working groups and expert committees offering their own sets of recommendations. Countries used this WHA agenda item as another opportunity to pontificate on their disparate and entrenched views. The US representative was particularly bullish in her remarks this year, stating that senior WHO officials should focus on WHO’s core mandate rather than becoming “political activists” on topics like intellectual property (IP) and arguing that other countries are “free riding” on the health R&D investments of US taxpayers.

Despite these verbal fireworks, it was clear that no country was willing to be the one to upset the carefully negotiated resolution language from the January Executive Board (EB) meeting calling for the WHO secretariat to establish this roadmap. As result, while strong language was the order of the day, the resolution passed unanimously without any textual changes. Per the resolution, WHO will now undertake a consultation process to develop a consensus work plan for consideration at next year’s EB and WHA. The team tasked with developing this plan has a tall order ahead of them, and it will remain to be seen whether they can forge a consensus path forward in an area where others before them have faltered. It is also unclear whether nongovernmental organizations in official relations with WHO will be included in the consultation process, but GHTC will continue to call for an appropriate role for civil society.

Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property

A close companion to the agenda item on access to medicines was WHA’s consideration of the WHO Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA-IP), which is the current iteration of a more than decade-long process to define WHO’s role in governing IP within the United Nations system. Up for debate was whether WHO should implement a diverse range of recommendations put forward by a WHO expert review panel—recommendations that have received mixed support among different member states. Coming out of the EB meeting, board members had hammered out what they saw as a compromise resolution—the text called for WHO to implement items from the report that were already “consistent with WHO’s existing mandate and authorities” to ensure some steps would move forward, while essentially tabling the other recommendations which lacked consensus. Many wondered going into WHA whether this consensus would stand or whether member states would attempt to re-litigate the resolution text.

Like the access agenda item, this debate also saw a lot of verbal jousting. Clashing comments from the United States and India provided—in microcosm—a view of the state of the debate on WHO’s mandate in IP. On one side, member states including India, Brazil, Colombia, and others argued for a robust and expansive embrace of the more far-reaching recommendations contained in the expert report. These include a call for a percentage of GDP spending target for R&D to support health in low- and middle-income countries, full implementation of the recommendations from the UN Secretary-General’s High-Level Panel on Access to Medicines, and the pursuit of mechanisms to move the global innovation ecosystem to delink pricing from R&D costs.

On the other side, the United States and other countries argued for a more limited mandate for WHO and supported the compromise resolution text calling for WHO to only implement recommendations already aligned with its strategy and mandate. Under this view, WHO could proceed to implement those points on which there is clear consensus, effectively confining future activities to the scope of existing ones. On a more positive note, the US statement also called out strong support for WHO’s regulatory strengthening and harmonization activities and for strengthening R&D capacity globally overall.

Despite the widely incongruent views of which direction WHO should take over the coming years, countries were not willing to take the risk of reopening the text of the resolution, fearing that they might very well have more to lose than they could possibly gain by re-litigating the text. As a result, WHO’s path forward in this space remains muddled and largely the status quo.

Preparations for the High-Level Meeting on Tuberculosis

In a refreshing change from the contentious debates on access and IP, the assembly also considered a number of documents and plans related to WHO’s input into preparations for the upcoming High-Level Meeting (HLM) on Tuberculosis (TB) in September. Of particular note, the draft multisectoral accountability framework cited, among example actions that should be taken, the “development and implementation of a global strategy for tuberculosis research and development, including the development and facilitation of international tuberculosis research networks.” While this language does not represent a concrete WHO commitment and no organization was identified as responsible for the strategy, it is still a positive acknowledgment of the need for R&D for TB technologies.

In addition, in his remarks concluding the debate on TB, WHO Director-General Dr. Tedros Ghebreyesus made a strong statement of his support for R&D to address drug-resistant TB and antimicrobial resistance (AMR) more broadly. He noted that one cannot talk about AMR without talking about TB and vice versa, and that one cannot talk about TB nor AMR without talking about R&D. He then singled out cross-sector collaboration on R&D as being particularly important, remarking that “FENSA [the Framework of Engagement with Non-State Actors] is not meant to be a fence,” and that he hoped to bring the private sector to the table in an appropriate fashion. The ways in which Dr. Tedros’ desire to foster cross-sector collaboration manifests (or not) in the preparations for the HLM will be highly indicative of whether FENSA will actually serve to foster or conversely hinder collaboration moving forward.

Key takeaways

Ultimately, debate at this year’s WHA reinforced what many watching the global R&D ecosystem already knew; there is a fundamental tension over the very foundation of how global health R&D should be supported, and this tension was in no way resolved. On the one hand are proponents for moving toward delinkage and mechanisms to reshape incentives for R&D in ways that separate the costs of R&D from the sale price of products. On the other are those who argue that access is a much larger question than simply IP and trade laws and that focusing on those topics to the exclusion of other issues like regulatory barriers does a disservice to the dialogue. The one thing we can all agree on is that this dialogue will certainly continue, and GHTC will continue keeping you up to speed.