Letter from Ralph Nader to WHO Director General Gro Harlem Brundtland
July 23, 2001
Dr. Gro Harlem Brundtland
World Health Organization
Avenue Appia 20
1211 Geneva 27
Dear Dr. Brundtland:
It has been encouraging in recent years to see the WHO revive itself and begin to elevate its institutional profile and, more importantly, the international attention devoted to the horrific costs of worldwide under-investment in public health in the developing world. Your efforts to throw a spotlight on the scourges of malaria and tuberculosis have been important steps to congeal a global mission -- including, hopefully, appropriate resources -- to eradicate these diseases. And the Tobacco-Free Initiative is aggressively taking on an industry devoted to spreading death and disease.
However, it has been disappointing to see that the WHO under your tenure has not matched the toughness and certainty of purpose it has displayed with respect to malaria, TB and tobacco in the area of access to medicines, and more generally, the expanded use of generic drugs.
Many are concerned that the World Health Organization has permitted a handful of large pharmaceutical companies to exercise undue influence over its polices and programs, and that in particular, the WHO has been intimidated and deterred from exercising leadership on a wide range of trade related issues, and has shrunk from its traditional role in promoting the use of generic drugs in poor countries.
In the area of AIDS, the WHO has been collaborating with big Pharma companies on an ill advised public relations effort called the "Accelerating Access Initiative", which in our opinion, is designed to:
(a) Undermine the legitimacy of national campaigns for compulsory licensing of patents on HIV drugs,
(b) Pressure poor countries to adopt overly restrictive intellectual property policies in return for extremely limited and unsustainable donation strategies, and
(c) Undermine the success of Southern generics producers, who have been the most effective agents in bringing down the prices of HIV drugs.
In some cases the lack of sensitivity shown by the WHO has created problems, even when the putative intentions were good, such as your efforts to push down the prices of branded patented medicines. For example, on the eve of the April trial in South Africa over its medicines act, the WHO and the WTO held a highly publicized meeting in Hosbjor, Norway, where the central message of the WTO/WHO press communications was to endorse a model of restrictions on parallel imports on medicines and negotiated discounted prices by big pharma companies -- the IFPMA alternative to the approach taken in the South Africa Medicines Act. Whether intended or not, this meeting undermined the notion that broader use of parallel imports of medicines and compulsory licensing were sound policy goals. This provided a public relations boost to the IFPMA companies at a time when their opposition to the South Africa law was coming under increasing scrutiny.
In our view, at the Hosbjor meeting on drug pricing, the WHO did not present an objective analysis of the factors that actually drove down the prices of HIV drugs in poor countries, and if it had, the WHO would have emphasized much more the role of efficient procurement and competition from generic suppliers. Also troubling was the decision to feature as experts persons such as Professor Patricia Danzon and Richard Wilder, who posed as disinterested experts and failed to disclose to the meeting participants their professional ties to the big pharma companies, while presenting one-sided briefs for industry positions. Had these individuals been plainly identified as industry consultants, participants would have been better able to evaluate their views.
As you know, we have long been supportive of a larger mandate for the World Health Organization to investigate the impact of trade policies on public health, and worked on this issue during the 1998/1999 debate over the WHO Revised Drug Strategy (RDS). However, we are dismayed by the extremely limited response by the WHO secretariat to this resolution.
Since 1998, the WHO staff has been asked by public health groups to publish staff papers on such items as:
For two years, the WHO has hesitated when asked to make an official request to the US government for the right to use US government interests in patents, which is permitted under the US Bayh-Dole Act. WHO officials were reluctant to make this request on the grounds that it would anger big pharma companies. As a consequence, the WHO has no mechanism to obtain inexpensive versions of many drugs that were invented under a government grant, for which the US government could grant licenses for use in poor countries. Also, the WHO has no mechanism to use US government funded research tools. We raised the US Bayh-Dole rights issue as a priority for the new Bush Administration, as did the Trans-Atlantic Consumer Dialogue and many public health groups. On July 6, 2001 US Secretary of Health and Human Services Tommy Thompson wrote to reject our request that the WHO and other UN agencies have access to US rights in government subsidized patents. This rejection was likely due in part to the lack of interest shown by your own staff in acquiring such rights.
While we appreciate the modest effort of the WHO to support some national efforts to study the public health consequences of trade agreements, and to provide some limited technical assistance in these areas, it falls far short of what was expected when in 1998 you took over the WHO leadership and the World Health Assembly began its debate on these topics. Facilitating developing country access to medicines is part of WHO's proud tradition. We hope that as you continue to energize the agency, you will also renew WHO's commitment to give priority to public health in matters concerning trade and pharmaceuticals.