WHO Must Stop Putting Politics Ahead of Public Health
Common sense dictates that medical decisions with the potential to affect the health of millions shouldn’t be influenced by political considerations. Unfortunately, that quality appears to be in short supply at the World Health Organization (WHO), which has thrown caution to the wind with a series of decisions apparently swayed by national lobbies at the expense of medical knowledge and good judgment.
One need look no further than WHO’s response to the Zika virus, which is linked to birth defects. Last month more than 150 medical experts urged WHO Director-General Margaret Chan to move or delay the 2016 Summer Olympics scheduled to take place in Rio de Janeiro in August, citing the clear threat posed by Zika to the roughly half million foreign visitors expected to descend on Brazil. WHO brushed off the warning, doubling down on its assertion that “there is no public health justification for postponing or cancelling the games.” This is hard to square with what we know about Zika, which can spread from person to person via mosquitos and sexual intercourse, and has proliferated across the Western Hemisphere with alarming speed. What, if not expert consensus, is guiding the WHO decision?
This is not the first case of WHO bungling the response to an epidemic. Following the 2013-2014 Ebola outbreak in west Africa, medical experts from the Harvard Global Health Institute and London School of Hygiene & Tropical Medicine slammed the agency’s response in the Lancet: “Ebola exposed WHO as unable to meet its responsibility for responding to such situations and alerting the global community.” The expert council attributed this debacle in large part to political pressure on WHO from member states.
While the Zika and Ebola examples are particularly unsettling, they’re just two instances in a broader trend of what appear to be politicized decisions from WHO, which threaten to undermine public health.
There is a growing trend among governments to override medicine patents in order to treat diseases more cheaply with generic copies. In one case now unfolding, WHO is encouraging the Colombian government to disregard international norms by appropriating a patented drug developed by a U.S. pharmaceutical manufacturer. In a letter dated May 25, Dr. Marie-Paule Kieny, WHO’s assistant director-general for health system and innovation, advised Colombian health minister Gaviria Uribe that the country’s government issue a so-called compulsory license for a cancer drug developed by Novartis. In other words, WHO is advising Columbia that they can ignore Novartis’ patent.
This represents a gross violation of property rights.
The last time a compulsory license was issued for a cancer drug — by India in 2012 — it triggered a four-year diplomatic campaign by the U.S. government that finally prompted India to reverse its policy earlier this year.
As this high-level diplomatic tussle indicates, the costs of compulsory licenses to U.S. drug makers are not trivial: on average each new drug costs more than $2 billion to develop and shepherd through FDA approval, and for every drug approved, around 10,000 more don’t make the cut. Drug makers — or any investors for that matter — will naturally hesitate to put money into research and development if the intellectual property backing their investments isn’t secure. The impact on public health would be disastrous.
Furthermore, compulsory licenses aren’t even an effective means of reducing prices for new drugs. A recent comprehensive study of antiretroviral HIV drugs found that compulsory licensing typically doesn’t result in lower prices for these medicines compared with international procurement programs. In the Indian case, critics have pointed to evidence that compulsory license was issued to bolster Indian drug makers, not reduce prices.
In Colombia’s case, the price reduction argument is especially flimsy. Like much of the rest of the world, Colombia is struggling to balance healthcare costs, quality, and accessibility, but these structural issues all stem from Law 100, the foundational health care legislation passed in 1993. Indeed, the Organization for Economic Co-operation and Development’s (OECD) latest report on Colombia’s healthcare system focuses on the need to reform its unusually opaque public-private insurance system — mentioning drug costs only in passing.
Nor is there any reason to think these costs are excessive. Following key market reforms in 2012, 2013 total pharmaceutical spending was $4.35 billion, just 15.8 percent of Colombia’s total healthcare costs across the public and private sectors, comparable to other countries including the U.S., Canada, and Brazil. Above all, the OECD emphasizes that pharmaceutical regulation should “adapt to market conditions and not discourage innovation.”
WHO’s mission of coordinating global public health efforts is necessary and vital, but — as these cases show — when it comes to execution, the organization is failing its mission by allowing critical decisions to be derailed by political pressure from member states. Putting politics ahead of public health is a failing strategy both for short-term health emergencies and for the long-term investments needed to improve well-being around the world.
Eric V. Schlecht is President of OnPoint Strategies, a full-service consulting firm specializing in government affairs, providing legislative strategies and public relations expertise on a wide range of issues.