CIVIL SOCIETY LETTER TO DR. MARGARET CHAN, DIRECTOR
GENERAL OF THE WORLD HEALTH ORGANISATION REGARDING WHO’s
Dr. Margaret Chan, Director General
World Health Organisation
Avenue Appia 20
CH - 1211 Geneva 27 15 May 2008
Concerns Regarding WHO’s Publications Policy
Dear Dr. Margaret Chan
We are writing to raise our concerns pertaining to WHO’s publication policy outlined in the Secretariat’s report titled “WHO Publications” (EB 122/20 dated 6 December 2007) and further elaborated in another Secretariat report titled “WHO publications policy: guidance on implementation and evaluation” (EB 123/7 dated 14 April 2008).
For decades WHO at the HQ and regional levels has produced many excellent publications and briefing papers to support and guide the development and application of pro-public health policies in developing countries particularly where it intersects with intellectual property rights. Some of these publications include: Working Paper on Guidelines for the examination of pharmaceutical patents: developing a public health perspective (January 2007); Implementation of the WTO General Council Decision on Paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health (April 2004).
Joint publications by WHO and other organisations for example: (1) a study commissioned by the WHO Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH) titled “The Use of flexibilities in TRIPS by Developing countries (WHO & South Centre, 2006); (2) “Remuneration guidelines for non-voluntary use of a patent on medical technologies” (WHO &
UNDP, 2005); (3) “Determining the patent status of essential medicines in developing countries health” (UNAIDS, WHO & MSF, 2004) and (4) “Protection of Data submitted for the
Registration of Pharmaceuticals: Implementing the Standards of the TRIPS Agreement” (WHO & South Centre, 2002) are also evidence of WHO’s notable work in the area of IP and Health
Civil society also often relies on these publications as the basis of its advocacy work.
In our view, WHO’s exemplary papers in the area of IP and Health are due especially to WHO’s independence in determining the topics it should speak on, free from any member state’s influence and interference.
However we are very concerned with reports that the WHO has come under pressure from some developed countries that were unhappy with some of its publications on the subject of IP and public health. For example, it has been publicly reported that a letter was sent by a particular country to the WHO Secretariat requesting it to withdraw one of the publications it has co-published that is on the subject of IPRs and public health. (see news story titled “US Seeks Review Of WHO Publication Policy After Report On US Trade Deals” available at
It is widely believed that the recent proposed overhaul of WHO’s publication policy is a response to these recent pressures. We believe that such pressures should not have been put on the WHO, nor should they be repeated. The WHO Secretariat is mandated to provide independent opinion and research, which are reflected in its publications. The independence of opinion and intellectual integrity of the Secretariat are essential conditions for the public confidence in the WHO.
We therefore believe that the Secretariat, and especially the Director General, should not bow to pressures by particular member states. For example, the WHO should not practice “self censorship” in an attempt not to displease certain countries or parties, especially when it has a
responsibility to take a stand and speak up on behalf of public health.
In this context, we are concerned that the publication policy has the high potential to result in such “self censorship” by WHO and its staff. We are also very concerned that this policy will
hamper timely advice and support by WHO HQ and regional offices to member states over important issues such as application of intellectual property rights and the use of TRIPS flexibilities, other trade and health matters, reproductive health care and other issues.
Some of our specific concerns and questions over WHO publications policy as outlined in the Reports of the Secretariat EB 122/20 dated 6 December 2007 and EB 123/7 dated 14 April 2008 are as follows:
(1) Differential treatment of some publications.
Paragraph 13 of EB 122/20 requires publications “that describe the workings of a particular government or national health service or that have policy implications for the Organization or address controversial health-related issues” to go through “additional clearance by the Director-
General’s Office” while the final text of all other publications can be cleared by the “relevant Assistant Director-General or Regional Director before publication.”
This requirement also seems to be applicable to “Any article, book chapter or invited commentary relating to WHO’s work that is to be submitted by a staff member for external publication”. (See paragraph 9 of EB 122/20)
Paragraph 13 raises several questions especially what is the rationale for treating some publications differently from other publications and what are the criteria that will be used to determine which topics “have policy implications for the Organization or address controversial
health-related issues” and thus will require additional clearance by the DG’s office.
Requiring differing treatment between publications raises the question of whether publications (including papers written by staff members for external publication) that are to be approved by the DG’s office will undergo some kind of political review or approval to ensure that it is politically acceptable to member states before it is cleared. This would effectively undermine the independence, neutrality and editorial freedom of WHO and instead make WHO and its staff more susceptible to political and other pressures.
We are of the view that the policy proposed above will result in a situation where WHO and its staff will shy away from speaking up on topics that have important implications for public health (such as intellectual property rights) but that may be unpalatable to some countries, particularly countries that are significant financial contributors to the WHO.
In our view, WHO reports and publications should be only subjected to “technical review” to
ensure that they are factually and technically accurate, and that they take a public health perspective. In this regard all publications should be treated equally.
(2) Publications produced by Regional offices
Paragraph (1) also applies to regional offices, which further raises the question as to the rationale for requiring publications commissioned or produced by regional offices to be cleared by the DG’s office. Regional directors are elected by member states; thus the regional directors should
have authority to provide clearance to all publications as was the case prior to the proposed new policy.
In our view, WHO regional offices play an important role by raising awareness on and supporting member states in developing and implementing measures that promote public health by commissioning relevant publications, preparing briefing papers, on request providing advice, participating in workshops etc. Civil society groups have benefited significantly from the services of the regional offices.
We are concerned that the proposed broad definition of the term “publication” coupled with the policy mentioned in (1) would make it difficult for regional or national-level pro-public health initiatives to be taken on several important issues where support is needed by member state and by civil society, as these issues may be considered “controversial.”
The term “publication” is defined in footnote 2 of EB 122/20 as “information products, i.e. Materials that are issued by WHO to the public in whatever format and through whatever channel. It excludes materials internal to WHO.” Paragraph 3 of EB document 123/7 further defines
information products as “written or illustrated works that the Organisation makes publicly accessible. Examples include documents on the website and journal, articles, guidelines, reports, training materials and advocacy materials in any format (printed, web, CD-ROM/DVD or audiovisual), whether sold or distributed free of charge”.
The extraordinarily broad definition of “publication” appears to include materials such as briefing papers, leaflets, power-point presentations, materials given to a government requesting technical assistance etc.
Where these information products relate to topics that “have policy implications for the
Organization or address controversial health-related issues”, then it would have to be approved by
the DG’s office.
In our view, the approach being taken is very worrying as it will hamper the timely provision of advice and support particularly by regional offices to member states. It can be expected that WHO staff would have to face time constraints and several hurdles to get their views approved by the DG’s office before they can present them.
(3) Master List of planned publications.
Paragraph 8 of EB 122/20 requires that a master list of planned publications be prepared for executive approval at the beginning of each biennium.
We are concerned that this will hinder WHO’s ability to deal with new issues or concerns that arise during the year.
(4) Need for more information and debate on the issue of publications:
In our view little information has been provided as to the need and rationale for overhauling the present publication policy, and putting in place measures mentioned in the EB 122/20 and EB 123/7. For example it is unclear what is the rationale for requiring publications that “address controversial health-related issues” to go through “additional clearance by the Director-General’s
Office. Could the WHO please provide a list of what these controversial issues are, and what is the criteria for designating an issue as “controversial”?
Also the implications of the policy for developing countries should also be assessed and discussed. For example while cost-effectiveness may be appreciated, reducing copies that are printed and distributed (see paragraph 6 of EB 123/7) will simply shift printing costs to governments that will have to go online to print WHO publications, and as a result hamper easy access to hard copies that contain important information for developing countries. The aim to reduce number of “titles” (see paragraph 6 of EB 123/7) may undermine functions of the WHO stated in its Constitution for example “to provide information, counsel and assistance in the field of health”; “to
promote...research in the field of health” and “to assist in developing an informed public opinion among all peoples on matters of health”.
EB 122/20 seems to indicate that the previous publications policy has undergone a “fuller review” and yet there is almost no information as to what was the previous publication policy, the persons involved in this review and the outcome of this review.
(5) Policy will de-motivate WHO Staff
We are of the view that the numerous steps listed for the preparation and clearance of publications in EB 123/7, present hurdles and will only result in frustrating staff initiatives in emerging with good publications on a timely basis. Ultimately the loser in this process will be the public especially in developing countries.
We are of the view that prior to implementing the proposed publication policy, the policy should be the subject of thorough discussion among all member states. WHO member states should also be provided with full information so as to enable informed decision-making.
As mentioned above we are much concerned that the publication policy will result in a tendency towards “self-censorship” by WHO and its staff at regional and HQ offices, to the
detriment of the needs and interests of public health, especially in developing countries.
Therefore we strongly urge you to reconsider the policy that is contained in the two documents EB 122/20 and EB 123/7.
We the undersigned Organisations would also like to request as soon as possible an opportunity to dialogue with you on this critical issue, as there are other concerns that we have pertaining the policy.
American Medical Student Association.
Baby Milk Action, UK
Brazilian Interdisciplinary Aids Association
Consumers’ Association Penang, Malaysia
Diverse Women for Diversity, India
Economic Justice and Development Organization, Pakistan European AIDS Treatment Group, Belgium. Essential Action, US
Health Action International
Health Action International Asia Pacific Health Gap (Global Access Project) USA IBFAN Africa
IBFAN Latin America and Caribbean
IBFAN International Code Documentation Centre INFACT Canada
Initiative for Health, Equity & Society, India Institute of Science in Society, UK
Initiative for Medicines, Access & Knowledge Knowledge Ecology International
Peoples Health Movement, Secretariat
Program on Information Justice and Intellectual Property, American University, USA
Research Foundation for Science Technology & Ecology, India
Stop HIV/AIDS in India Initiative, Washington DC The Network, Pakistan
Third World Network
Universities Allied for Essential Medicines Vermont Global Health Coalition