IHP news 559 : “Public enemy number one” ( 14 February 2020) The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium. Dear Colleagues, I know, I know, it’s Valentine today, so I probably shouldn’t talk about the eerily sounding “Covid- 19” in this short intro, let alone about the even more dreaded “P word” but WHO and dr. Tedros were clearly in no mood for Valentine earlier this week, when describing the virus as “a global threat, potentially worse than terrorism”. “The world must wake up and consider this enemy virus as public enemy number one,” Tedros said. With world media and public opinion going berserk all around the world for a few weeks now, I think that shouldn’t be too much of a problem. The other part of his message, however, that it’s about "solidarity, solidarity and solidarity", might prove much harder in the weeks and months to come, given how Sapiens is wired. When thinking of pandemics, in this visual culture of ours, we probably all have (subconsciously or not) a particular movie in mind when considering some of the most dire scenarios. For some of you, that might be “Contagion”, for me, it’s no doubt “Twelve Monkeys” (1995), with among others, Bruce Willis, a stunning Madeleine Stowe and a young Brad Pitt. Back in the innocent ‘90s, it all felt a bit surreal, even the obligatory rogue scientist popping up towards the end. But what a great movie! Now in the year 2020, with the scary ongoing public health experiment (aka ‘the coronavirus cruise ship quarantines’), occasionally I get the feeling that “Twelve Monkeys” is being mixed up with “the Poseidon Adventure” . Anyway, as you can imagine, lots of focus again in this week’s newsletter on the coronavirus, now labelled SARS-CoV-2. (PS: on a different note, I had to look up the word “pangolins” this week, this sort of vocabulary comes a bit less naturally to me than, say, neoliberalism or capitalism . ) In other news this week, the Munich security report 2020 coined the term Westlessnness, I let you find out for yourself what the term implies. It’s both good and bad, I’d say, but with huge implications for the world, not just for global health. In the featured article below, Priti Patnaik gives her in-depth take on the latest (146th) WHO Executive Board meeting. Enjoy your reading. (And Valentine, if you can !) Kristof Decoster 1 Featured Article WHO 146th Executive Board Meeting – the technical meets the political Priti Patnaik (Independent Journalist & Researcher) The 146th Executive Board meeting of the WHO was like an investment case in action for donors. Here was WHO leadership noting the passing of key resolutions, lending support to new initiatives, urging countries to work together to arrive at a consensus on vexatious issues, while briefing technical experts and the media every day on the emerging outbreak of novel Coronavirus (Covid- 19). In the midst of this, it was also responding to calls to reform the International Health Regulations in order to give WHO more nimble-footedness in addressing emergencies. The gigantic global health machine was in motion for all to see. This past month has also seen WHO take on disinformation and fake news. So there was much for donors to see, especially and not the least, the dwindling reserves of the Contingency Fund for Emergencies – now at less than $20 million. The technical is the political The dynamics of political health diplomacy were playing out in the main arena where a few member states gathered to variously speak for Taiwan’s inclusion in WHO processes and China dissuading them for “hyping up” the issue. WHO technocrats and member states expressed solidarity with China and cautioned against stigmatizing affected people. On a number of occasions, member states were reminded to stick to “technical discussions”, and not veer into political matters including on Taiwan and Palestine. But apart from these traditionally complicated political questions, the current dynamic unfolding between China and USA in the context of the coronavirus (Covid-19), has been a story to watch, particularly the travel and trade related decisions. It has inevitably drawn WHO into this bilateral dynamic. At another event in the same week, questions were raised on whether WHO had praised China too soon in its efforts to fight the outbreak, even as there were reports on forced restrictions on movements of people within the country. A member from the senior WHO leadership who was present, said “Damned if you do, damned if you don’t”. And added that it is only in hindsight that one can make these judgments, but for the time being the limited number of cases outside to China, showed that “something was working”. There is no doubt Director-General Tedros has had to walk a tightrope in delivering technical expertise, liaising with a multitude of actors to address the outbreak, while being rooted in political realities and operating in varied cultural contexts. (Earlier this week, in a budget proposal the US government suggested a 50% cut in its funding to WHO.) Like wheels within wheels, smaller, hugely pertinent informal negotiations rolled on throughout the week, many of which had commenced earlier to the meeting. Countries huddled together were engaged in long drawn discussions trying to reach a consensus or hammering out a compromise including on matters pushing for deeper engagement on price and availability of drugs, or asking for stricter norms to address alcohol related deaths, among others. Access to medicines Meetings at WHO are a great indicator of national priorities in many countries. It was sobering to hear the United States of America, several times during the week, somewhat restrained in its voice compared to previous years. Observers were of the view that high prices of drugs have become a 2 flash point domestically in many countries including USA. High income countries have been coalescing around efforts for greater transparency around prices of medicines. Unlike before, it seems countries may not have to struggle any more to have these issues on the WHO agenda. It might not be totally coincidental that it has finally become “an issue”, ever since high income countries started experiencing strains on their budgets in trying to procure expensive medicines. After five rounds of consultations, a proposal initiated and facilitated by Brazil eventually gathered enough support for it to be co-sponsored by a broad spectrum of more than 40 countries including the European Union, to arrive at a consensus. Essentially, the decision adopted by the Board, seeks to give a “political push” to prior commitments made to implement the recommendations of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPoA) review in 2018 [WHA71(9)]. Further the DG has been asked to convene informal consultations amongst countries in 2020 to “further discuss the recommendations of the review panel not emanating from the global strategy and plan of action on public health, innovation and intellectual property”. Some countries believe that these issues were beyond the original scope of the GSPoA including discussions on improving transparency in R&D costs, discussions on shortages of medicines and asking countries to commit to spending at least 0.01% of their gross domestic product to basic and applied research relevant to the health needs of developing countries. In addition, the DG has also been tasked with convening informal consultations in 2020 on promoting and monitoring transparency of medicines and actions to prevent shortages. It is understood that Switzerland and the USA were opposing efforts for greater transparency of costs around research and development. Also, that there was resistance on language around shortage of drugs. One source alluded to the hesitation on the part of some member states to commit resources to prevent shortage of drugs. Finally, the decision mandates the DG to allocate resources to implement prioritized actions addressed to the WHO secretariat as mentioned in the GSPoA review. The DG has also been asked to report on the progress on the implementation to the Assembly in 2021 following a discussion at the Executive Board. Discussions and negotiations around access to medicines have matured and have acquired a dynamic of their own. After all, the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPoA) is a dozen years old. And in a sign of things to come, other issues have come to the fore. The buzz around alcohol negotiations at the EB Of the number of competing objectives, negotiations around tougher policies to address alcohol- related deaths, to an extent, had observers guessing till the penultimate day of the closure of the meeting on how the discussions would conclude. Somewhat similar to the access to medicines ecosystem, a few big “producer” countries and others opposed stronger policies although the burden of deaths on account of harmful consumption of alcohol is distributed across the board causing 3 million deaths annually. There has been a worldwide increase in harmful alcohol consumption, particularly in low- and middle-income countries, in the last ten years. This effectively means that WHO and member states efforts on this have failed. 3 USA, UK, Japan, and Brazil mounted the strongest opposition apart from Haiti, Australia, New Zealand and Canada. However, France, Germany, Italy, also big producers, did not oppose, a source said. (The biggest overall alcohol burden is in Europe - which is the heaviest alcohol consuming region and has the biggest burden of harm.) The decision was eventually sponsored by Bangladesh, Bhutan, India, Indonesia, Islamic Republic of Iran, Philippines, the Russian Federation, Sierra Leone, Sri Lanka, Thailand and Viet Nam, Norway and the European Union.