May 20, 2019

WHO Reform Won’t Work Unless All Stakeholders Have a Voice

The World Health Organization (WHO) is in for big changes. 

This winter the WHO announced a restructuring plan to streamline the agency and break its infamous bureaucratic gridlock.  The goal is to position the agency to achieve its ‘triple-billion‘ target.

Making the WHO work better is vital.  The world needs an organization that can respond to the next flu pandemic and help countries strengthen their health systems.  This latest reform plan could help the WHO to achieve its core mission of improving public health

But this plan will fail if the WHO doesn’t fix one of its most serious problems.  For too many years, the WHO has been loath to work with business and private sector companies that could help the WHO achieve its mission.  Meaningful WHO reform must tear down the walls that prevent collaboration and consultation with all stakeholders.

The WHO’s leadership says they get this point.  WHO staff should consider the bold statements made by its Director-General, Dr. Tedros Adhanom Ghebreyesus, who said that working with the private sector is “essential” for achieving global health goals. [1] The alternative is to exclude private sector voices and double-down on ideologically driven policies that won’t work in the real world. 

A ripe area for collaboration is health innovation.  The WHO and the private sector can do more to spur investments into new treatments and technologies to make people healthier.  Intellectual property protections – which incentivize massive investments in medical research and development – are central to achieving this. 

There are strong, pro-health reasons for fostering such innovation. Strong IP rights coupled with market-based pricing policies promote greater competition and the creation of a wider variety of treatment options. In fact, a study observed that strong IP rights promote faster drug diffusion, meaning patients can access new cures faster, while price controls slow that access. Another found that price controls weaken drug innovation, undermining the ability to create new cures and harming future patients.

Regretfully, in many international organizations, IP rights have wrongly been portrayed as an obstacle to global health.  Recent years have seen short-sighted initiatives at international organizations such as the WHO, the United Nations Development Program (UNDP), the United Nations Conference on Trade and Development (UNCTAD) and Unitaid to undermine these longstanding protections and advance policies that undermine innovation and market mechanisms. This was recently illustrated in the WHO’s latest report on improving affordability and effectiveness of cancer medicines, where it listed mechanisms to bypass IP rights but failed to acknowledge the chilling role that such policies would have on innovation.

Improved dialogue between the WHO and the private sector could shine a light on this connection.  IP rights, by granting a limited period of market exclusivity, give the private sector incentives to invest billions in researching and developing new cures. Indeed, R&D requires a significant investment on the front end, and IP ensures that discover of a new cure can reap returns—at least temporarily—from their discoveries. It is especially important now, as a report recently suggested that R&D returns have declined to 1.9 percent, down from 10.1 percent in 2010—the lowest level in nine years—mainly due to the rising cost of bringing a drug to market.

Strong incentives for innovation, coupled with public-private partnerships, allow industry to develop innovative cures for patients and provide pathways to ensure access to patients around the world in times of need. For instance, the rise of multidrug-resistant tuberculosis (MDR-TB) threatened the recent strides made in combatting tuberculosis, which jumped above 600,000 cases in 2016. Janssen Pharmaceuticals developed bedaquiline, the first new class of antibiotics approved by the Food and Drug Administration in over 40 years, an innovative new drug that provided a lifeline for those suffering from MDR-TB. Bedaquiline was a costly drug, making access difficult for low- and middle-income countries, where MDR-TB was most prevalent. To help combat this mounting threat, Janssen donated 30,000 six-month treatments and partnered with the U.S. Agency for International Development (USAID) to distribute them in the affected nations over the following four years.  

If international institutions, and notably the newly reforming WHO, want to achieve meaningful results in improving global health, they cannot look at this narrowly claiming that innovation is an obstacle. Those critics have it backwards – innovation is a catalyst for the health products that patients need.

Improving access cannot mean shutting down the pipeline for tomorrow’s cures, but addressing today’s barriers to access, including underfunded health care systems, insufficient health personnel, and weak infrastructure.

Improving global health is a tough job.  To make the world healthier, it will take everybody — the private sector, civil society, international institutions, national governments – working together.  If WHO reform is to achieve its ambitious goals, the public health community needs a new spirit of collaboration.  Dialogue and partnerships with the private sector will leverage expertise to help tackle these global health challenges. Only by working together can we move forward.

[1] Fuller quote: “It’s true that leveraging the strengths of civil society, the private sector, philanthropic foundations and academic institutions is essential for achieving the Sustainable Development Goals. Governments, public institutions, the UN system and multilateral agencies simply don’t have all the needed skills, knowledge, expertise or resources.” (David Peters, “Inside the Mind of Tedros: A Q&A with WHO’s Director-General, Global Health Now, 9/4/18)