Lancet special report examines direction new WHO director general should take on several HIV/AIDS-related issues

1 February 2003. Related: Treatment access.

In a special report, the 4 January issue of the Lancet offers 12 opinion pieces that make recommendations as to the role the new director general of the World Health Organization should play, the issues that need to be addressed and the direction in which the organisation should proceed.

Several of the pieces examine HIV/AIDS-related issues. Short summaries of some of these pieces follow:

Ken Bluestone, senior policy adviser, Voluntary Service Overseas: The HIV/AIDS epidemic places “unimaginable burdens” on the public health sector, as “more and more” trained health care professionals “succumb to the virus,” Bluestone writes, adding that without these professionals, “the best international policies are meaningless.” In order to “meet these challenges,” WHO must “strengthen its resolve to maintain its independence and lead its member states, even at the risk of causing controversy.” According to Bluestone, the agency is the “only global institution that has the remit to drive this agenda forward, yet has failed to do so convincingly.” In conclusion, Bluestone writes that the new director general “must support and reinvigorate the advocacy efforts of the organization and provide a proper counterbalance to the interests of the pharmaceutical industry and wealthy member states”.

Kenneth Roth, executive director, Human Rights Watch: The credibility of WHO’s “advocacy of the right to health for all has been eroded in recent years” because of the organisation’s “failure to challenge the pharmaceutical industry on access to medicines for people with HIV/AIDS.” According to Roth, the new director general must “lead the organisation to stand consistently with those most deprived of health services” in order to “re-establish WHO’s credibility”.

Nathan Ford, access to medicines adviser, and Jean-Michel Piedagnel, executive director, Medecins Sans Frontieres: WHO must continue to speak out “in clear support of allowing medicine production and export as an exception to patent rights” in order to provide “affordable antiretrovirals” for the estimated 5.7 million people with AIDS “who currently need treatment but are left without.” “In the face of rising infectious diseases such as AIDS, tuberculosis and malaria, and the increasing marginalisation of health problems that do not affect the developed world … the importance of an international, independent organisation that is brave, aggressive and vocal in its defence of global public health has never been more important”.

Harvey Dale, president, International Federation of Pharmaceutical Manufacturers Associations: Because “far more work is needed to improve access to health care and medicines,” the new director general “will have to look more fundamentally at the problems and issues” surrounding patents for antiretroviral drugs and the “barriers to drug access in poor countries”. According to Dale: “In its history, WHO has not, in its drug policies, focused sufficiently on the task of expanding access to inexpensive generic medicines that could make the greatest difference in reducing morbidity and mortality – and this fact does not bode well for success in the AIDS struggle as the patent debates are likely to subside over time”.

Mohga Kamal Smith, health policy adviser, Oxfam GB: The “inadequate international response” in the fight against HIV/AIDS “demonstrates the lack of serious commitment to health of many governments in both developed and developing countries”. Despite WHO’s “long history of effective leadership on medicines,” the “cutting edge advocacy in this area is being undertaken by non-governmental organisations”. According to Kamal Smith, WHO “has not been outspoken on the preeminence of patients’ rights to access to medicines over commercial rights in a worsening global health crisis”. Smith concludes: “The issue of access to medicines will be seen as a benchmark of WHO commitment to the interests of poor people.”

James Deane, executive director, Panos London: Because WHO has been “far from consistent” with its work on HIV/AIDS, the organisation needs to focus on three areas where it has “historically performed poorly: cooperation, communication and leadership”. According to Deane, the new director general must “put institutional pride and profile emphatically in second place to coherence and cooperation across the UN system”; follow the lead of South Africa’s Treatment Action Campaign, which “changed government policy and mobilised massive local and international public awareness”; and “engage in political and economic discourse, with all the vibrant debate and discussion this brings.” The “priorities” of the new WHO director, Deane writes, are “intensely political, often controversial and require serious vision and leadership”.

Free full text of all these reports is available online at:
http://www.thelancet.com/journal/vol361/iss9351/editorial_and_review

Source: KaiserNetwork Daily HIV/AIDS Report
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=15309