WHO-EB132 Meeting Summary update

IFMSA was represented by Roopa Dhatt (IFMSA President), Usman Mustaq (IFMSA VPE) and Chantelle Willard (AMSA-Australia). We would like to share with you some updates about the meeting.

Chantelle Willard (LEFT), Dr. Chan (Middle), Roopa Dhatt (Right)
Chantelle Willard (LEFT), Dr. Chan (Middle), Roopa Dhatt (Right)

WHOEB132

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Day 1
Today was the first day of the WHO-EB 132. As an opening day, the discussions focused on key themes of the health agenda for the year–including special mention of the WHO reform, NCDs, and as well as the overall increased participation of member states on global health. A great deal of comments were made on the NCD resolution and indicators and the process that has been going on for sometime. The agenda for this WHO-EB is quite extensive thus they are being very selective about speaking rights.

Next Days..

The next days will be followed up with many more reports being presented and discussion of various resolutions. We have several follow up meetings scheduled with WHO representatives, WMA and other partners that are present.

Priorites selected by the delegation to focus on
IFMSA will be closely focusing on the agenda items below and consider delivering interventions on them based on the discussion and whether an intervention is appropriate. We passed several key policy statements in AM12 and MM12 that will be used as a foundation for our statements.

EB132/5
WHO reform

EB132/7
EB132/7 Corr.1
Draft action plan for the prevention and control of
noncommunicable diseases 2013–2020

EB132/8
Draft comprehensive mental health action plan 2013–2020

EB132/11
Monitoring the achievement of the health-related Millennium Development Goals

EB132/12
Monitoring the achievement of the health-related Millennium Development Goals
Health in the post-2015 development agenda

EB132/13
Follow-up actions to recommendations of the high-level commissions convened to advance women’s and children’s health

EB132/14
Social determinants of health
Report by the Secretariat

EB132/19
Neglected tropical diseases
Prevention, control, elimination and eradication

EB132/22
Universal health coverage

EB132/23
The health workforce: advances in responding to shortages and migration, and in preparing for emerging needs

Day 2

Mental Health

The morning has been spent discussing key health commitments in Mental Health. Member States across the board have supported the Mental Health Plan . This plan will potentially be used to impact the Mental Health Across the board.

Some key highlights:

Switzerland: protect mental health without sexual discrimination.

Australia: It is a very polished document. Mental health is a priority in Australia, there is a separate ministry.

Croatia: Mental health services should be paired with civil society organizations.

Lithuania: A call for universal call for mental health services coverage. By 2013, depression burden will be leading.

Thailand: The Mental Action plan requires health work force to implement.

Blindness & Visual Impairment 2014-2019 (Action Plan)

Member states discuss how this issue has been neglected, even though there are often preventable measures and treatments that are curable. Several express they hope this is on the agenda for the next WHA.

Some key highlights:

Saudi Arabia: We adopted the EMRO resolution on Universal Eye Care. We are delighted to co-sponsor this resolution on the Global Health Eye Action Plan.

Resolutions Submitted by IFMSA

WHO REFORM

Day 3: THEME DAY FOR REFORM

The day was used primarily for discussing WHO Reform. This is a process that WHO took upon itself in the past year to review how the entire organization works–from structure, to financing to engaging with civil organizations. It is a vast project and this could potentially impact our relations with them, as we are part of the Civil Society Organization (CSOs) group or NGOs. We will be delivering a statement on this WHO reform to areas that pertain to us. We want to focus on youth engagement, but also increasing transparency, inclusiveness, involvement and coordination to engage with CSOs more (all values we promote in IFMSA).

We networked on the Global Health Diplomacy Pre-WHA event. We had some successes, more to come. We also talked with the U.S. Mission, Norway Mission, and Australia Mission.


Health Promotion
, (Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.)

The department has sent us an invitation to be involved in this conference–the specifics are to be further defined. They are also considering internship opportunities.
Health Promotion

SDH (The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.)

The Rio Political Declaration of 2011 confirmed Member State commitment to take action to address the social determinants of health in five areas:

Adopt improved governance for health and development
Promote participation in policy-making and implementation
Further reorient the health sector towards promoting health and reducing health inequities
Strengthen global governance and collaboration
Monitor progress and increase accountability

The SDH momentum continues to grow. They have confirmed an internship opportunity in this area, more to follow. Furthermore, opportunities are being explored about pushing for an online module. The department expressed interest on documenting the value of sdh/global health curriculum–potentially meaningful measures for students.

Global Health Force Alliance

We received an invite to coordinate the youth component to this movement. We also received an opportunity to attend this meeting with a very large delegation of health students. The aim would be support this very key issue about health workers. We had the chance to meet with Robbert Duvvier an intern and LoME 2009/11. The department expresses continued interest on working with us. Very excited about IFMSA and the young voices being part of this.

THIRD GLOBAL FORUM ON HRH
3rd Global Forum on HRH
(more news, very exciting new to be delivered on this) These maybe potential areas that medical student and health students could get involved in. As well, we met up with the fellow IPSF representatives.

IFMSA and IPSF

Our statement is attached. Agenda Point 5.

Personal Comment–> The reform happening at WHO hasn’t happened at this level in almost 30 years. Things weren’t working well for them and they decided to do a major reform. TAKE HOME LESSON: REFORMs might be a huge investment of time and resources, but without them, organizations become ineffective. It might be time for us to consider in IFMSA to commit to a major reform process.

Chantelle, Roopa, and Bronwyn,

Day 4
Today was a day that IFMSA delivered its voice to the WHO-EB. It was a very tough day with only myself and Chantelle and many things to address.

Including, DG Maraget Chan jotted down notes. Day 4 was relevant to our key areas of focus Post-2015 and SDH.

Post-2015 was a very interesting discussion about how member states engage with either placing health into all MDG goals or making one goal. Another interesting point was universal health coverage (UHC) vs. vertical programs. The majority were supporting UHC. Interesting, it was noted that many do not know the definition of Universal Health Coverage and how it is easily confused with Universal Health Care (so what is UHC–> check out the link, I KNOW UHC. There was also concern about supporting the notion of UHC, especially in countries with weakened health systems. In other words, if the hospitals are bad, is UHC the answer. Our statement was well received. A few delegations in passing stated it was a good statement, including the representative from World Health Professions Alliance and UNFPA (United Nations Population Fund). Our statement focused on three key areas: considering health in all the 10 thematic discussions on Post-2015, using a human rights and human security (development and rights) approach, and a special attention to women & child related issues, especially reducing violence, ending child-brides and focusing on basic needs. PLEASE READ IT, AS IT WAS AWESOME. We also said a special thanks to Norway, as it was the only member state that mentioned youth.

We had the UK delegation approach and they spoke to us for an 1hr on our position. What we think. Of course.

SDH
The topic had more consensus in the room and is fully supported. Most states discussed how to implement and what are the next phases. They also discussed the range of SDH work in the regions with Africa being the weakest and PAHO doing great stuff. We delivered another great statement that focused on youth being a part of the innovative solutions.

We celebrated this awesome day with UN DRINKS–Bar De La Plage Geneva. Of course we were only there for professional networking–to hear how other young people are contributing to social change at the UN (loads of exciting thing…!)

WHOEB ROOM

Day 5, Key Discussions
Day 5 was an interesting day for the on-going discussions in WHO on a variety of topics. The key discussions were around the consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG). There was a lack of commitment on part of the members states on CEWG report and the draft resolution was weak in many opinions. However, some member states, including China, fervently stated that they opposed the resolution, whereas, other member states felt this was a step forward, while still more needed to be done. There was a great deal of disagreement in the room, resulting in DG Chan singing at one point.

Some key comments:

Medicus mundi international network: “We firmly believe that the independent evaluation of WHO should produce a comprehensive and strategic situation analysis of WHO’s current positioning on the overcrowded stage of actors influencing global health.” (Democratising Global Health coalition and MMI statement on the independent evaluation of the WHO reform #EB132 http://bit.ly/V0bVLo)

Disabled

@WHO Executive Board: #Disabled ppl face barriers in accessing services such as health care, education, transport, employment #EB132

@WHO People with disabilities also face barriers in accessing justice. #EB132 #disability
RT @WHO: An estimated 1 billion people live with disabilities; this number is set to increase as populations age. #EB132 #disability

Vaccines

Doctors w/o Borders: Decade of #Vaccines” plan must do more to address high prices and lack of products for developing world. Vaccine costs rose 2700% over the last decade, so why doesn’t the blueprint for the next decade have a goal to bring prices down? We need products that make vaccinating kids easier. We need a clear signal that this is a critical objective for the next decade.

CEWG
#EB132-Director-General Chan throws down the gauntlet on the CEWG process: “Let’s fight this out at the Assembly”

MSF Intervention on CEWG: Financing & Coordination at WHO #EB132 http://www.msfaccess.org/content/msf-intervention-cewg-financing-coordination-132nd-who-executive-board

Joint letter to WHO EB delegates on follow-up of CEWG report on R&D (HAI, KEI, MSF, Oxfam, PHM, Stop AIDS, TWN) http://lists.keionline.org/pipermail/ip-health_lists.keionline.org/2013-January/002758.html … #EB132

#eb132 Medico Mundis, TWN & PHM say CEWG report proposed a paradigm shift that draft resolution does not reflect

Day 6, Working on the Weekend, Reform
We came in today to follow up on the reform process and deliver our statement on WHO Reform. It was a low action day.
IMG_4976

It was also Aussie Day, as Chantelle Willard is from Australia, we were very fortunate to have lunch with the Australian Mission and Dr. Halton. Including having very important diplomatic discussions on Vegemite.

The remaining part of the day was spent prepping for Monday and also meeting with our colleagues from IPSF ( International Pharmaceutical Students’ Federation). We discussed the follow-up on the World Health Student Alliance (WHSA), as well as representation to the high-level discussions on Health Promotion in June in Finland. We concluded by discussing a bit about on-going reform. President Radek Mitura will join us at the MM13.

Some Comments:

25% of the @WHO #budget comes from regular “dues”, the rest is money that countries, agencies, other partners give to WHO voluntarily #EB132


Day 7, Delivering a Message

Today IFMSA delivered a message on Universal Health Coverage. A special thanks to Schi from St. Kitts for the input. The statement was well received and we were approached by Save the Children, as we as positive feedback. We also received a request from the PHM to have our statement. Our statement is attached below.


Discussions also focused on health workforce. There were encouragement on reporting and migration studies. The ILO expressed there needs to be ethical guidelines on international recruitment. (PERSONAL COMMENT: THIS IS A HUGE TOPIC THAT IFMSA AT THE MOMENT HAS NOT LOOKED AT, IT COULD POTENTIALLY BE A PRIORITY AREA FOR US TO ADDRESS THE EQUITY ISSUES).

Some Key Comments:

UHC
China: #UHC not only responsibility of health sectors. Governments should have primary responsibility for implementing policies.

Universal health coverage. Report by WHO Secretariat. Discussion will continue today at 132nd Session of WHO EB http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_22-en.pdf … #EB132

Italy: include human rights, equity and in particular gender equity. #post2015 #EB132 need to have simple subgoals under universal coverage

Argentina: free health care is best, but sustainability of these models is successful when implemented with health insurance #EB132 #UHC

Lebanon: involvement of NGOs and primary care important for #UHC (universal health coverage)#EB132 #WHO

Cuba: health is a human right and can’t be achieved without #UHC it fails when unequal distribution of wealth #EB132 #WHO

Lithuania: include #UHC in monitoring of healthcare systems, multi-sectorial approach required #EB132 #WHO

Yemen: quotes DG “#UHC is achieveable” #EB132 interplays of exisiting initiatives with #UHC and emergencies in our region #EB132

Health workforce

Brazil: analysis on migration patterns of health workforce must respect human rights #EB132 #WHO

Australia: self-sufficiency, spend 1.5 billion USD on this domestically to champion health workforce but still not there #EB132

USA: supports goals of global code, need health workforce training and health systems, increase medical, nursing school enrollment #EB132

Norway: Global code of practice-less than 1 in 4 member states submitted code report in 2012. Coordinate with GHWA #EB132 #WHO

Maldives: difficulty with their own eduction of health workers, trouble with forged medical degrees, massive expat health workforce #EB132

E-Health

@WHO Executive Board has adopted resolution on #eHealth incl. eLearning, capacity building and networks #EB132
Chad: protection measures need to prevent efraud, not enough resources currently in Africa for this IT health sector #EB132 #WHO

Day 8, the Conclusion
The last day was filled with many informal meetings among members states and discussions on WHO Reform. This was a quite day for IFMSA, but we followed up with some of the acquaintances we networked with and reminded them of the potential opportunities to engage with us for the pre-WHA, our GAs and additional chances. Ms. Chantelle Willard (AMSA-Australia) represented us to the last day.

Some Key Comments:
WHO’s Executive Board recommends adoption of a resolution on all 17 neglected tropical diseases.

E-Health

eHealth and health Internet domain names, Report by the Secretariat @WHO #EB132 http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_24-en.pdf

Global updates on eHealth, health Internet domain & the protection of domain names of intergovernmental orgs | http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_24-en.pdf … #EB132

Finances

At @WHO Board meeting, Director Chan resorts to crying to persuade members not to micro-manage her on budget. Story to follow. #EB132

Brazil: Don’t cry for us Dr DG. The truth is we never left you. We reelected you – Tune of don’t cry for me argentina #EB132 #WHO

Related to WHO Reform:
– WHO Secretariat will continue developing policies for engagement with both civil society and the private sector, to be presented at the World Health Assembly in May 2013.
-The Secretariat agreed that there are some overarching principles that will guide all relationships such as transparency, accountability, and the criteria of making a contribution to health.
-However, WHO must ensure that it properly and appropriately safeguards against vested interests.

WHO EB COFFEE BREAK

Thank-you for following IFMSA at the WHOEB132. If you have any questions, please email me at president@ifmsa.org or Renzo at lwho@ifmsa.org.

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[Day 4] 28th Pan American Sanitary Conference: A binding research and development treaty to improve access to medicines – Feasible?

Day 4 at the 28th Pan American Sanitary Conference was welcomed by clear blue skies and sunshine as opposed to the clouds and day experienced the day prior.  Perhaps, this was a symbol of hope as PAHO moves into a new period with the election of the new Regional Director, Dr. Carissa Etienne yesterday. There is hope that the results of this meeting will not only be on paper, but will also become a reality in our region – the Americas.

During the morning plenary session, one of the more controversial resolutions that was tabled the day prior would be discussed amongst member states and civil society. At the World Health Assembly earlier in May, a report entitled Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination by the Consultative Expert Working Group (CEWG) on Research and Development. The report comes at a pivotal time when not only is the global economy unable to affordable the rising costs of medicines and treatments but also a time where there is a dearth of new medical products especially for those of neglected disease populations.

The report in its recommendations strives to align the incentives of industry in creating medical products for the purpose of profit with that of public health needs to allow for affordable access for patients. Additionally, the CEWG calls for member states to sign onto a binding treaty recommending a 0.01% of the GDP contribution towards a R&D fund. Many member states were adamantly against this proposal – most notably the first speaker, the United States stating that the first goal should not be asking for a dollar amount from countries in trying to overcome the R&D crisis, but rather focusing on implementing new models for innovation. Ironically, however, the United States did acknowledge that they contribute much more than 0.01% of their GDP towards R&D. Other countries voiced similar concerns including France as an observer state. There were a few countries however who voiced support for the recommendation of a binding treaty including Argentina, Colombia and Suriname.

Following member-states, Médecins Sans Frontières (MSF) and IFMSA as representatives from civil society were permitted to read their interventions. To read MSF’s statement, go here: ow.ly/dTnbF. Reshma Ramachandran of the IFMSA delegation read aloud IFMSA’s intervention as follows:

The International Federation of Medical Students’ Associations (IFMSA) welcomes the CEWG report on financing and coordination for R&D. Traditionally, the strengthening of intellectual property rights has been used as a primary method to spur innovation. This incentive, however, has not always proven fruitful especially for treatments not taken chronically such as vaccines and antibiotics – pharmaceutical classes that have seen a decline in R&D investment. In fact, in the Americas, case documentation has shown a rise in “superbugs” leading to patient deaths due to the lack of new antibiotics in the pipeline.

With such low investment in essential medicines due to failed R&D incentives, millions of our patients will continue to be neglected. Additionally, stricter intellectual property rights have led to the emergence of pharmaceutical monopolies and higher treatment costs, further burdening member states under economic strain. We, as future physicians, support the CEWG report in its mission to “align better commercial incentives and actions by the public sector with health needs, while also seeking to minimize costs.”

Representing over 1.3 million medical students worldwide, IFMSA respectfully urges member states to begin formal negotiations towards implementation of the CEWG report proposals. As healthcare providers, we wish to provide the best, most-evidence based treatments possible to our patients. This report provides a rare opportunity to merge the need for increased biomedical innovation with our professional responsibilities to our patients through coordinated public investment.

FIRST, public investments of innovative approaches to global health research such as those detailed in the report have led to great progress in overcoming current market failures. The CEWG proposals are already in place in the Americas. For example, the NIH National Center for Advancing Translation Sciences (NCATS) assists firms with their pre-clinical efforts in order to meet FDA requirements for investigational new drug applications so that drugs can reach first in-human clinical trials. Smaller companies and academic centers particularly benefit from this, garnering additional contributors to innovation. We therefore believe member-states should begin implementation of such successful models as outlined in CEWG report.

SECOND, many institutions and governments have already adopted Open Knowledge R&D mechanisms as recommended by the CEWG. In May of this year, Argentina passed a law making all government-funded research freely available in an online repository. NIH in the United States through its Public Access Policy ensures that NIH-funded research is available for free online within one year of publication. Such commitments to open access not only benefit patients and providers but also allows for the free flow of information to hasten innovation.

THIRD, several countries in the Americas are currently involved in secret negotiations for the Trans-Pacific Partnership (TPP) Agreement. Leaked TPP text includes provisions that will severely limit access to research and affordable medicines through extended data exclusivity and patent periods as well as low standards for patentability allowing essentially copies of older medications to receive patents. We are concerned that the CEWG proposals will be undermined by adoption of such TPP provisions especially in those member-states in the partnership.

FINALLY, we believe it is necessary that member-states adopt the CEWG’s recommendation regarding financing by contributing 0.01% of their GDP. Such commitment to R&D requires secure financing and this can only be achieved through funding commitments, not voluntary contributions.  One model mentioned earlier, the Global Fund, has in fact suffered from a lack of accountability from voluntary national contributors leading to the lack of funding of new proposals in 2011 and an uncertain future. We urge member-states to make such a commitment through a binding convention in order to ensure the success of such proposals detailed in the report.

We again ask member states to begin negotiations to implement the report’s recommendations as there is a dire need for novel, life saving treatments for our patients, especially those of neglected disease populations

The intervention was well received by member-states as well as those in PAHO who drafted the CEWG, sparking interesting discussion between IFMSA members and others about the real possibility of a binding treaty. From IFMSA’s point of view, without such a binding treaty, there will be no accountability or hope that the recommendations will be adopted by member states. In November, discussion will continue regarding the CEWG report and its implementation. IFMSA hopes to be present there as well to offer its support and suggestions along with the rest of civil society.

During the lunch break, the IFMSA delegation attended the Second Information Session on the Global Fund. The overall objective of this meeting was “Improved positioning of the region of Latin America and the Caribbean in the Global Fund’s governance and operational structures”. The meeting was geared towards:

  • Reviewing recent changes on the funding modalities for the Caribbean and Latin America region
  • Exploring possible collaborations to increase the ability of the member states and the region to best address issues relating to Malaria, AIDS and Tuberculosis.

What is the Global Fund?

Malaria, TB and AIDS affect many persons worldwide and not only are these diseases devastating, but more importantly, they are preventable. The Global Fund dedicates financial support to about 150 countries to aid in the prevention and treatment of these diseases. This is especially important within the Caribbean and Latin America region where there are many developing countries that without these resources would have found it impossible to tackle these maladies.

One area of policy change of the Global Fund is that countries will now be placed in bands based on the earnings of the countries. The focus of the Fund will then be directed on those countries that experience the highest disease burden and have the greatest difficulty in funding interventions. It is purported that this change will ensure that there will be decreased morbidity and mortality from these diseases. The member states however questioned the use of the World Bank’s Income Classification in determining the economical status of each country. This classification uses the gross national income (GNI) per capita. It does not take into consideration debt or spending requirements of the countries.

Some countries within this region, however, thought this would present more harm than good for their nations. Jamaica, for example was listed as one of the countries that would have a cut in the funds that would normally be received. The Minister of Health, however, pointed out that as it relates to AIDS, this would have negative impacts for the island as the Ministry would now have great difficulty in funding wages for persons who were trained and now employed by the Ministry to head prevention and information campaigns in the move to eradicate HIV/AIDS.  The Minister suggested that when changes are to be made in funding policies, more time should be given to enable countries to better transition so that their achievements may be maintained or improved. Another issue with the changes was whether it would be taken into consideration those countries that have formed economical collaborations because they are unable to face to global market individually.

The meeting also reviewed the targets of the region for 2012-2013:

  • Promote treatment optimization in at least 5-7 countries
  • Accelerate Mother to Child transmission in at least 3-5 countries

Reshma Ramachandran (AMSA-USA) and Sachalee Campbell (JAMSA)

[Day 1] Welcome to the PAHO/WHO Regional Meeting!

IFMSA, being active on the international scene as usual, has an exceptional delegation to the 28th Pan American Sanitary Conference (also the 64th World Health Organization Regional Meeting). Altagracia Mares de Leon (IFMSA-Mexico), Daniel Tobon Gracia (ASCEMCOL-Colombia), Sachalee Campbell (JAMSA-Jamaica), Reshma Ramachandran (AMSA-USA) and I are representing the IFMSA delegation at the PAHO Meeting in the hopes to represent and voice out IFMSA’s views on the WHO Reform, Child health, NCD strategy and the Consultative Expert Working Group on Research and Development: Financing and Coordination.      Image

Any WHO meeting has some sort of thrill to it. The first day, and even the first speeches, usually determines the direction that the conference will take. From Dr. Mirta Roses (Director of PAHO) to Dr. Margaret Chan (WHO Director General), the focus was not only on social determinants of health and the past progress of the region in terms of health outcomes but also about the post-2015 health agenda and how Universal Health Coverage needs to be at the forefront of global negotiations. PAHO is a very active Regional Office and it is very well respected by its respective member states. Looking at PAHO’s track record, we can observe that major trends emanating from World Health Assembly resolutions actually come from previous PAHO activities: NCD prevention campaigns, vaccination week, etc.

The question that remains is how to move past the Millennium Development Goals? Are Sustainable Development Goals the answer? Official UN processes are already in place for such goals to be formed, but do they really represent the importance of health? Through discussion with Dr. Margaret Chan today, we learnt that if health has a chance in being included within the seven Sustainable Development Goals, it needs to be a goal which encompasses many avenues and doesn’t exclude specific diseases.

According to Dr Margaret Chan, the answer is simple: Universal Health Coverage. It is broad enough so countries can specify their needs and what needs to be covered but, at the same time, it doesn’t exclude any particular disease group such as infectious diseases or NCDs. We all have come to realize that the best indicator for sustainable development is health. Growing economies are only prosperous if there is a significant trickle down effect which entails an improvement in the health of the general population. Hence, this is why health has become a major issue in the Rio+20 discussion this past June. We can no longer deny the multi-sectorial effect of health and the multifactorial factors on health.

Take NCDs for example: healthy lifestyles are promoted, laudable goal, but it is fairly unrealistic to the majority of the population at-risk of NCDs. NCDs are prevalent in populations that do not have a choice but to make the wrong choice. Most of the time it’s not a case of health education, it’s a case of unavailability of making healthy choices. Low-income parents can only feed their children the cheapest way possible; what if the cheapest way is having breakfast at a fast food chain? Can you blame the individual for feeding their children while managing to pay rent? What if their two years old child gets sick, how would they be able to pay for patented drugs?

Such broad questions demand an answer. At PAHO, Member States are determined to give a direction to such solutions, realistic or not. Only time will tell if we are on the right track.

Stay tuned for the updates of the PAHO meeting!

Best,

Alexandre Lefebvre

IFMSA Treasurer 2011-2012,

On behalf of the IFMSA PAHO Delegation