I recently sent the following letter to Andrew Bast, the editor of Foreign Affairs. The letter responds to a May 24, 2012 article by Devi Sridhar, Lawrence O. Gostin, and Derek Yach, titled, “Healthy Governance, How the WHO Can Regain Its Relevance,” which calls upon the World Health Organization to “embrace the private sector” and give “responsible partners in industry a seat at the table.” Foreign Affairs wrote back to say that they would not be printing the letter, and that the views expressed by Sridhar, Gostin, and Yach were balanced by a November 9, 2011 article by Sonia Shah, titled “How Private Companies are Transforming the Global Public Health Agenda -A New Era For the World Health Organization.”
The text of the rejected letter to the editor follows:
July 7, 2012Andrew Bast
Editor, Foreign AffairsLetter to the Editor: Healthy Governance?
Dear Mr. Bast:
In a May 24, 2012 article by Devi Sridhar, Lawrence O. Gostin, and Derek Yach, titled, “Healthy Governance, How the WHO Can Regain Its Relevance,” the authors call on the World Health Organization to “embrace the private sector” and give “responsible partners in industry a seat at the table.” This comes at the moment when big drug and food companies are pushing to have direct representation in the governance of the UN body dealing with health. This ill timed and wrongheaded proposal would further reduce the independence of the WHO at a time when corporate lobbying and influence are already blamed for a growing number of policy failures, and the WHO’s failure to deal with conflicts of interest is attracting more attention. One example of this concerns the recent UN negotiations on non-communicable diseases, where the food and pharmaceutical industries have had an appalling influence on UN resolutions and work programs, eliminating the possibility of needed norm setting in terms of access to medicines and regulation of harmful marketing practices.
James Love, Director, Knowledge Ecology International
The most controversial section of the Sridhar, Gostin, Yach article was the following paragraph:
“The WHO also needs to embrace the private sector. By giving responsible partners in industry a seat at the table, the agency will benefit from their expertise in science, operations, financing, and marketing. Unlike the tobacco and alcohol industries, which market and sell dangerous products, the food and beverage, pharmaceutical and medical, and sporting goods industries have clear interests in being part of the conversation. Firms recognize that markets are stronger when they are populated with healthier consumers. To embrace industry, the WHO will have to overhaul its budget process and rally support within the World Health Assembly. But given resistance from member states to open governance processes to nonstate actors, this has been a tough sell. In recent years, the World Economic Forum has played a leadership role in bringing the private sector together with the WHO to develop common approaches to NCDs.”
Yach works for Pepsi, and his advocacy of a greater corporate role in WHO governance is perhaps predictable. To many, the views of Sridhar and Gostin were a surprise. But they echoed earlier views published in an April 20, 2011 article in the Journal of the American Medical Association (JAMA), on Reforming the World Health Organization.” JAMA. 2011;305(15):1585-1586. doi:10.1001/jama.2011.418, also published right before the annual World Health Assembly (WHO) meetings.
In the section of the article titled “GIVE REAL VOICE TO MULTIPLE STAKEHOLDERS,” Sridhar and Gostin wrote:
In contrast to the WHO, representatives from civil society, the private sector, and foundations sit on the boards of the Global Fund and the GAVI Alliance. Even UN agencies such as the Joint United Nations Programme on HIV/AIDS engage civil society through advisory committees.
The WHO would be more effective by giving voice and representation to key stakeholders, including philanthropies, businesses, public/private partnerships, and civil society. While actively engaging with the private sector, the WHO should also set standards for and ensure compliance of key private partners such as the food, pharmaceutical, and biotechnology industries. At the same time, conflict-of-interest rules for expert committees and contractors require clarity and enforcement.
The director-general is taking a major step in proposing a global health forum, which would include regular multistakeholder meetings under the guidance of the WHA.2 The global health forum must afford stakeholders real voice and representation, effectively shaping the WHO’s decisions. The WHA should also pass a resolution lowering the bar to official nongovernmental organization status. Meaningful stakeholder engagement would instill confidence and spark investment in the agency.
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