Failure to Speak Out

Why is WHO not more consistently open in its support of the selection of essential drugs, the international drug marketing code and national drug policies?

The USA has consistently opposed WHO's policies on drugs in the interest of its own Transnational Corporations (TNCs). Recently it changed its position on the development of national drug policies in relation to Third World countries only. During the 45th World Health Assembly in Geneva in 1992, the US delegation opposed an amendment to a policy statement on essential drugs, which proposed that all member states should take steps to implement the concept of essential drugs in their national policies in order to expand access and affordability. The US delegation forced the house to add the words 'where appropriate' to the amendment to make sure that such resolutions have selective application only.

What prevents WHO from speaking its mind openly? Is it because of the USA's reluctance to endorse its policies? Is it that the withdrawal of the USA from UNESCO arouses fear that it will likewise withdraw from WHO if the organisation takes definitive action on drugs without its concurrence? This would be a major financial blow as the USA contributes almost 25 per cent of the total WHO budget (another 20 per cent being contributed by Germany and Japan together).

There are other possible explanations. WHO's staff consists primarily of doctors, from both Third World and industrialised countries, who are skilled in the scientific diagnosis and treatment of diseases but rarely show concern for social and environmental factors. Most of them fail to appreciate that a disease such as tuberculosis is an indicator of social inequality or that malnutrition and insanitary conditions contribute significantly to the incidence of the most common diseases of the Third World. They are unwilling to analyse these problems from a political or economic point of view.

WHO always takes an apolitical, neutral stand and, in adherence to its principle of non-interference, refrains from mentioning colonialism, neo-colonialism and imperialism, all of which have played a significant role in the causation and spread of diseases among the exploited and oppressed people of the world. As the British Medical Journal has pointed out, 'WHO should be doing more to tackle the root cause of most diseases - poverty - and doing more to improve infrastructure of health care in the developing world'.

Such action as WHO has taken on drugs is typical of the technological approach to health problems with which medical officers working for WHO feel familiar and comfortable. Doctors understand drugs in so far as they know about prescription and usage, efficacy and quality, but they do not apply their minds to the problems of how drugs reach the people who need them most. They do not realise that the class character and political will of the government determine the affordability and provision of essential drugs.

Nowhere in its documents does WHO clearly state that its essential drugs list is for both the private and the public sector. Moreover, WHO has not even highlighted the views of its own experts on this subject and allowed these to gain public attention. By the end of the 1980s the drug industry had come to accept, albeit reluctantly, the essential drugs strategy for the public or welfare sector but insisted that the private sector should be left to market forces and to the clinical wisdom of doctors. This provoked a sharp response from Professor Olikoye Ransome-Kuti, former health minister of Nigeria: `Drugs are meant for diseases not sectors. If you can demonstrate to me that the diseases affecting people in the private sector are different to those affecting people in the public sector we shall adjust the list accordingly'.

Although Professor Ransome-Kuti was the president of WHO's Executive Board for many years, he did not succeed in incorporating his arguments into WHO's essential drugs policy statements. Dr. Mahler and his successor, Dr. Hiroshi Nakajima, made the rules. Whether this was done in ignorance or in collusion with the industry needs to be investigated before essential drugs policies can be fully implemented in Third World countries. In the absence of a clear declaration by WHO, plenty of room exists for easy penetration of ineffective and harmful drugs, first into the private sector and then into the public hospitals and the primary health care (PHC) sector. In reality, inessential drugs eat up a large proportion of the PHC sector drug budget.

WHO is known for its fixation on medical technology - vaccines, drugs and doctors - (and) its unwillingness to grapple with the practicalities of delivering health care. It does not state clearly that disease is not merely the consequence of poor health services and that the provision of primary health care alone does not bring better health. To break the chain responsible for diseases among the poor requires a political decision to act. To publish materials and then not to distribute them widely; to produce documents on drug policy but not to defend them actively, as in the case of Bangladesh's National Drug Policy: these contradictions reflect a political decision not to act. They are also examples of WHO's double standards and its dubious role. Moreover, the organisation `escapes the moderating influence of public accountability and scrutiny from the international press.

Source: Chowdhury, Zafarullah.The Politics of Essential Drugs. New Delhi, 1995, Vistaar Publications, pp.137-139.