As Southeast Asian members of the World Health Organization executive board who are meeting in Geneva next week, Indonesia and Vietnam have crucial roles in setting the global health agenda this year. (Antara Photo/Didik Suhartono)

Indonesia Could Help WHO Focus on Its Strengths

BY : PHILIP STEVENS & AZRUL MOHD KHALIB

JANUARY 17, 2019

As Southeast Asian members of the World Health Organization executive board, which is meeting in Geneva next week, Indonesia and Vietnam have crucial roles in setting the global health agenda this year.

The WHO has a challenging year ahead. As recent outbreaks of Ebola and Zika have shown, new and deadly diseases can emerge without warning. There is a looming crisis of drug-resistant bacteria, threatening the effectiveness of today's antibiotics. Though global prosperity has increased, too few people have access to basic health care.

Despite being the United Nations agency responsible for global health and its critical role in addressing the diverse issues in this area, the WHO has limited resources. At around $450 million, it is sobering to realize that the agency's annual core budget is similar to that of a large hospital in a developed country.

To his credit, Tedros Adhanom Ghebreyesus, now in his second year as director general of the WHO, has increased spending on health emergencies, and mobilized resources to ensure that the world is better equipped to tackle the next pandemic.

Nevertheless, the WHO continues to spread itself too thinly, involving itself in areas that are best left to national or local governments to manage.

Alongside tropical diseases and immunization, the WHO also publishes recommendations on adolescent health, traffic safety, climate change, suicide, human rights, youth violence, depression, chemical safety, social determinants of health, headaches and prisons.

The WHO should instead strengthen and restrategize its efforts in the key areas where it has unique expertise. Its vital presence and role come to the forefront when responding to emerging health crises, tackling the transnational disease, preparing for international pandemics and advising countries on health care reform.

Jeremy Farrar, director of the Wellcome Trust, a UK-based global health research charity, argues that the WHO is being undermined by its inability to focus on a few core issues.

"It's so thinly stretched," he told Reuters. "There's arguably no organization on earth that could cover all those [topics] at sufficient depth to be authoritative."

In recent years, the WHO has raised eyebrows with its campaigning against "unhealthy" lifestyle choices. This has resulted in contortions, such as the previous director general praising North Korea for its low levels of obesity and supporting Vladimir Putin's campaign against e-cigarettes.

The WHO straying into the realms of politics could occur again. Large parts of the agenda for the upcoming executive board meeting are dedicated to an "access to medicines roadmap," which sets priorities for the WHO's work for the next five years on improving access to medicines around the world.

The intent is obviously good. However, the reasons for poor access in many countries have been well known for decades, yet they remain unaddressed.

Weak supply chains and poor infrastructure separate people and communities from essential treatments. There are too few doctors and clinics, and a lack of insurance coverage to protect people from the cost of health care expenditures. Burdensome national regulations make it extremely difficult to register new life-saving drugs, and a wide array of taxes and tariffs add unnecessarily to the price of medicines.

The WHO has specific expertise and decades of experience in overcoming these roadblocks and it fits squarely in its mandate.

Instead of dedicating its finite resources to these issues, the organization's roadmap envisages a quixotic campaign against the very intellectual property protections that drive and support the development of new health technologies.

The reality is that most treatments prescribed in both developing and developed countries are off-patent and therefore unaffected by intellectual property rules. It is therefore unclear what the roadmap hopes to achieve by aiming to overcome measures intended to motivate, invest and sustain scientific discovery and innovation, compromising the ability to develop new treatments and respond to existing and new diseases.

What is certain is that removing intellectual property rights from medicines would create enormous uncertainty for domestic and international investors. Why launch a new drug, undertake research and development, or build a complex high-tech manufacturing facility in a country whose government may undermine or not even protect property rights?

There would be less innovation and fewer new drug launches in countries that undermine intellectual property rights. What is certain is that patients would be the losers and be deprived of new medicines and life-saving treatment.

The WHO is most effective when it unites and mobilizes nations with practical solutions in the face of public health threats. It does not do well in ideological debates.

As members of the executive board, Indonesia and Vietnam, alongside other WHO member states, must help steady the ship. The WHO's future as a relevant and effective organization depends on it.

Azrul Mohd Khalib is the chief executive of the Galen Centre for Health and Social Policy, based in Malaysia, and Philip Stevens is the executive director of the Geneva Network, based in the United Kingdom

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