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Cablegate: Who: Report On the 126th Session of the World Health

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DE RUEHGV #0138/01 0501104
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FM USMISSION GENEVA
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EUROPEAN POLITICAL COLLECTIVE
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UNCLAS SECTION 01 OF 06 GENEVA 000138

SIPDIS
DEPT FOR IO/HS, PRM AND OES
PASS TO USAID

E.O. 12958: N/A
TAGS: TBIO WHO
SUBJECT: WHO: Report on the 126th Session of the World Health
Organization Executive Board

1. Summary. The 126th Session of the Executive Board (EB) of the
World Health Organization (WHO) met from January 18-23, 2010, in
Geneva. This cable reports on the significant outcomes from the
Board, including key resolutions forwarded for adoption at the 63rd
World Health Assembly (WHA)in May. Discussions at the EB were
politicized on some topics, especially in interventions from Brazil
and India, who sought to advance an IP and trade agenda whenever
possible. (COMMENT: Both Brazil and India were primarily
represented by officials from Foreign Ministries and Geneva
Missions rather than Health Ministries - a trend we are also seeing
in other venues in Geneva. END COMMENT.) At Brazil's insistence
and despite objections from a number of Member States, the EB
agreed to add a new item on leprosy to its agenda. However, in the
face of opposition to the proposed resolution's intent to change
global leprosy elimination goals, Brazil then had to withdraw its
resolution. The Board:

- took action on a Global Strategy on the Harmful Use of Alcohol;
recommendations on the marketing of food to children; and a draft
Code of Practice on international recruitment of health personnel;

- discussed smallpox eradication, hearing largely familiar
positions on the issue of destruction of smallpox virus stocks, but
took no action pending the results of a review of on-going and
needed research due in 2011;

- approved long-sought U.S. revisions to WHO guidelines on the
review of psychoactive substances;

- appointed former State/IO official John Fox as part of a
5-member Independent Expert Oversight Advisory Committee;

- devoted part of an afternoon to a discussion of the WHO/PAHO
response to the earthquake in Haiti;

- and appointed Dr. Zsuzsanna Jakab (Hungary) as WHO Regional
Director for Europe and reappointed Dr. Luis Gomes Sambo (Angola)
as Regional Director for Africa.

As an Observer delegation, the U.S. played a constructive role
during the course of the Board and actively participated in
negotiating groups to finalize the alcohol strategy and several
resolutions. The U.S. delegation included officials from U.S.
Mission Geneva and State (IO and OES). End Summary.

2. The WHO Director-General, Dr. Margaret Chan, half-way through
her five-year term, was very active throughout the EB, seeking
Board guidance, actively promoting consensus, and emphasizing WHO
core business as a technical health organization. Her statement to
the Board addressed the situation in Haiti and the WHO response,
progress on specific health goals, and a chronology of WHO actions
in response to the H1N1 pandemic and its place as the first major
test of the revised International Health Regulations. The
Director-General also discussed an informal consultation of
representatives of some thirty Member States she had convened on
the future financing of WHO and its comparative advantages in the
crowded global public health landscape.

GENEVA 00000138 002 OF 006


KEY OUTCOMES

------------

3. UPDATE ON PANDEMIC-INFLUENZA PREPAREDNESS: SHARING OF INFLUENZA
VIRUSES AND ACCESS TO VACCINES AND OTHER BENEFITS. The discussion
focused on the all-too-familiar process related to finishing the
outstanding issues (including intellectual property, mandatory vs.
voluntary benefits, a Standard Materials Transfer Agreement)
related to the Intergovernmental meeting (IGM) on pandemic
influenza preparedness, whose mandate expired at the 2009 WHA. A
number of countries expressed support for reaching consensus by the
upcoming WHA, but cautioned against going over well-trodden ground
when countries already know each other's redlines. The Secretariat
was quite open that it had no additional resources to provide to
the effort. The U.S. and like-minded countries worked informally
to propose Board support for informal consultations among Member
States and an open-ended working group during the WHA to finalize
the outstanding issues. After discussions during the course of the
EB, however, certain countries led by Indonesia, Brazil and India
pressed hard for another IGM, and it was agreed to hold an
open-ended Working Group May 10-12, 2010, prior to the WHA.
Further consideration of this issue at the WHA will depend on the
outcome of that meeting.

4. IMPLEMENTATION OF THE INTERNATIONAL HEALTH REGULATIONS (IHR)
AND THE H1N1 EXPERIENCE. The Director-General took on recent
critics of the WHO response to the H1N1 pandemic, or "false
pandemic" as it had been called. She said she would not be
intimidated by critics, but was doing what was necessary to ensure
the most effective response based on the best evidence. The
Director-General agreed to convene the IHR Review Committee to
examine the experience gained in the global response in order to
inform the review of the functioning of the IHRs, to help assess
and, where appropriate, to modify the ongoing response, and to
strengthen preparedness for future pandemics. The DG will provide
an interim report to the WHA in May and a final report to the WHA
in 2011. The DG also noted that only 56 Member States had
nominated experts to the IHR Roster of Experts (although many more
have been added by the DG), and this was not enough. The DG issued
a draft plan for the review that can be found at:

http://apps.who.int/gb/ebwha/pdf_files/EB126/ B126_ID3-en.pdf

5. HAITI EARTHQUAKE. The Permanent Representative of Haiti in
Geneva attended a special session of the Board devoted to the Haiti
earthquake, the WHO/PAHO response, and the commitment of countries
to assist Haiti, both in short-term emergency rescue and relief
efforts and in longer-term response and recovery. USDel expressed
U.S. commitment to Haiti, both in the immediate aftermath of the
earthquake, noting the $100 million emergency commitment from
President Obama, and long-term reconstruction and recovery.

6. IP AND HEALTH: REPORT OF THE EXPERT WORKING GROUP ON RESEARCH
AND DEVELOPMENT FINANCING. The Secretariat updated the Board on
WHO activities in relation to mainstreaming implementation of the
Global Strategy and Plan of Action on Intellectual Property,
Innovation and Public Health (GSPA), including trends in technology
transfer and north-south and south-south cooperation, barriers to
access, and capacity problems. The Secretariat noted that the GSPA
includes 80 actions to be led by Member States and 49 to be led by
WHO. WHO has working agreements in place with WTO and WIPO, and

GENEVA 00000138 003 OF 006


the agencies have met at head-of-agency level. Responding to
criticisms about the Expert Working Group (EWG) report and the
process it followed, including a critical article in the Lancet,
the EWG Chairman, Dr. George Alleyne (Director Emeritus of PAHO),
reviewed the group's mandate, which he had interpreted as not
focused on IP but on innovative financing. He "rejected
completely" the notion that pharmaceutical companies had influenced
the results. The DG noted WHO had done "breakneck" work on the
GSPA due to its importance to Member States. She also noted
regional participation and integration is important. She agreed to
investigate the alleged leak of the report to the pharmaceutical
industry trade association and promised to take appropriate action.
Because the full report of the EWG was issued only at the opening
of the EB, Board members called for a further discussion of the
report's recommendations prior to the WHA, which was set for May
13.

7. MONITORING THE HEALTH-RELATED MILLENNIUM DEVELOPMENT GOALS. As
agreed previously, the Board and WHA are addressing the MDGs
annually through the goal year of 2015. USDel cosponsored a
resolution proposed by EU countries urging Member States to sustain
and strengthen commitments to achieve the MDGs. Delegations spoke
directly to the challenges of reaching the MDGs, particularly the
lack of progress on reducing maternal and child mortality. It was
noted Africa was unlikely to achieve the health-related MDGs, and
only six countries in the region were making real progress,
depending on the goal. At the proposal of the UK, a new agenda
item linked to MDG 4 was also added on childhood pneumonia. The EB
adopted a resolution focused on efforts to reduce childhood
pneumonia, which causes more than 1.8 million preventable deaths
each year in children under five, as a means to achieving the MDG
on reducing child mortality.

8. CODE OF PRACTICE ON INTERNATIONAL RECRUITMENT OF HEALTH
PERSONNEL. The EB agreed to forward the draft Code of Practice to
the WHA, although most EB delegations had some concern or
reservation about parts of the text and sought changes, some more
substantive than others. (Only Brazil was prepared to approve the
text as it currently stands.) A proposal from Canada, supported by
a number of delegations, including USDel, to hold further web-based
consultations between now and May with the aim of reaching final
consensus on a text by the time of the WHA was objected to by a
number of developing countries. African countries, seeking some
form of compensation mechanism not now included in the text, did
not want further consideration of the text prior to the WHA. In
the end, it was agreed that interested Member States could submit
any text changes they seek to the Secretariat, which will compile
them into a "discussion paper." That paper will be circulated in
advance of the WHA and would, in parallel with the current draft
text, be the basis for negotiations at the WHA. The U.S. submitted
comments/textual proposals on January 29, 2010.

9. INFANT AND YOUNG CHILD NUTRITION. USDel, giving high priority
to this item, supported WHO's normative work on improving global
nutrition and called for specific actions to strengthen prevention
programs that would have a positive impact on child survival and
maternal health. USDel urged WHO to strengthen its overall
strategy to improve infant and young child nutrition. Many
countries focused their comments on the lack of enforcement of, or
alleged violations by the infant formula companies of, the Code of
Marketing of Breast-milk Substitutes. The U.S. supported a
Peruvian-drafted resolution urging Member States to strengthen
implementation of the Global Strategy for Infant and Young Child
Feeding and called upon the food industry to observe the marketing
code.

GENEVA 00000138 004 OF 006


10. FOOD SAFETY. The EB supported a Canadian resolution on
"Advancing food safety initiatives." The resolution calls for
strengthening WHO's food safety work in relation to: a) building
WHO's food safety network (INFOSAN) by adding food safety
data-generation and data-sharing to its portfolio, b) monitoring
and reporting on the burden of foodborne and zoonotic diseases, c)
advancing the provision and sharing of international scientific
advice, and d) focusing on the public health aspects of zoonotic
diseases originating at the human-animal interface. It calls for
WHO to strengthen a coherent, integrated work-plan covering
science, burden estimation, food safety management and
communication and general coordination of zoonoses prevention, in
collaboration with FAO and the World Organization for Animal Health
(OIE). Canada helpfully included in the resolution U.S. proposals
related to the Codex Alimentarious Commission and an international
initiative to strengthen laboratory partners in support of
foodborne disease surveillance.

11. PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES. The EB
forwarded to the WHA draft recommendations on the marketing of food
and non-alcoholic beverages to children. Delegations cautioned WHO
to tighten the language in the recommendations and close some of
the loopholes, which the DG agreed to do. USDel highlighted the
need to tackle the growing obesity epidemic, an effort that
required the commitment of all stakeholders.

12. HARMFUL USE OF ALCOHOL. The EB considered and forwarded to
the WHA an amended draft Global Strategy on the Harmful Use of
Alcohol, a subject that has been pending at WHO governing bodies
for two years. Although the Secretariat draft had been improved
through a process of Member State consultations, an EB drafting
group, co-chaired by Sweden and Cuba, made further revisions that
garnered wide support.

13. VIRAL HEPATITIS. Brazil proposed a resolution that included
designating a World Hepatitis Day. Reflecting the differing health
priorities, there was significant push back, with African countries
and most developed countries opposing the establishment of such a
day. The compromise was to designate July 28 as World Hepatitis
Day but to allow countries to promote the celebration on a day of
their own choosing.

14. SMALLPOX ERADICATION. Delegations expressed familiar
positions, except for the statement from the African group.
Speaking for that group, Malawi referred to research progress and
expressed the belief that smallpox viruses exist in other than the
authorized repositories. Malawi did not mention setting a
destruction date. Somalia (for Eastern Mediterranean countries)
reviewed the long retention of the smallpox virus, noting research
was always to be outcome-oriented and time-limited and called for
setting a date for destruction as soon as possible. India noted
its national position to support destruction of the virus stocks at
the earliest time possible. France expressed caution about
long-term experimentation on the virus, supported enhanced research
transparency, and, referring to a proposed diagnostic network
through regional laboratories, asked if that would require sharing
the virus beyond the two official repositories. Iran reiterated
the history and the annual discussion, and said the EB/WHA should
make a "bold decision" to destroy the virus stocks. The
Secretariat noted the support from Member States for WHO's
regulatory processes related to smallpox and the major report going
to the WHA in 2011 and reassured France that the diagnostic network
does not involve use of or sharing of the virus beyond the two
repositories. Brazil noted the 30 years since eradication of

GENEVA 00000138 005 OF 006


smallpox and asked how WHO planned to mark the 30th anniversary.
Dr. Chan said WHO was planning to commemorate the anniversary on
the first day of the WHA, including installation of a commemorative
statue on the WHO grounds. NOTE: Two members of the Russian
delegation, from the Center for Virology and Biotechnology -
VECTOR, met with USDel on the margins of the EB to express concern
about the proposed diagnostic laboratory network. USDel has
conveyed those concerns to HHS/CDC for follow-up. END NOTE.

15. GUIDELINES FOR WHO REVIEW OF PSYCHOACTIVE SUBSTANCES FOR
INTERNATIONAL CONTROL. The EB approved the revised Guidelines with
U.S.-proposed changes. USDel coordinated with EB Members and made
the proposals as an Observer delegation. The several U.S. changes
were sponsored by the Board Member from Bahamas, with no other
comment. With other minor changes the EB adopted the Guidelines,
which require no further approval. The revised guidelines give WHO
an improved review process for its Expert Committee on Drug
Dependence and clearer procedures with respect to other UN bodies
with drug scheduling responsibilities - the Commission on Narcotic
Drugs (CND) and the International Narcotics Control Board (INCB).

16. POLIO ERADICATION. DG Chan said polio is one of the most
important issues for WHO, emphasizing that the last mile is the
longest mile. Polio Coordinator Bruce Aylward reviewed the
results of an independent evaluation of major barriers to
interrupting poliovirus transmission, and referred to a new plan
and strategy for the next three years to be presented to the WHA in
May. The Chair of the Evaluation team, Dr. Mohammed (Health
Minister of Oman and EB Member) went over details of the evaluation
in the endemic countries. He stated that India has a thorough,
well-managed polio eradication team. Noting some gaps in
protection of children and mobile populations, he was optimistic
that India is on track. The situation in Nigeria was getting
better, he said, where State and local governments have committed
to the task with the key element of success in local government
networks. Strengthening EPI in general is important for
post-eradication areas. Lastly, for Pakistan-Afghanistan (treated
as one epidemiologically), the security issues continued to be key.


17. The Africa group emphasized routine, synchronized prevention
campaigns. India noted it is on the verge of success, giving
priority to identification and mapping activities. Canada called
for improving countries' accountability, and strengthening dialogue
with donors in a way that does not compromise the work. UK called
for nuanced and country-led strategies, including addressing the
political/security challenges in the polio affected states, and
need for linkages with other health work where appropriate. UK
also noted the need to "revisit the original assumptions and update
the economic justification for eradication." Nigeria said it is
sustaining the momentum toward total eradication. The U.S.
emphasized the need to examine and adjust end-game strategies and
finish the job on polio as a positive example for eliminating other
threats to global public health. Lastly, the OIC Observer
delegation emphasized its cooperation on polio with Member States
and ties with religious and other communities. OIC also mentioned
that President Obama had addressed polio in his Cairo speech and
OIC was working with the U.S. on polio eradication.

18. OTHER RESOLUTIONS. The EB adopted and forwarded to the WHA
resolutions on birth defects; improvement of health through safe
and environmentally sound waste management; improvement of health
through sound management of obsolete pesticides and chemicals; and
availability, safety and quality of blood products.

GENEVA 00000138 006 OF 006


19. DATES OF THE NEXT WHA AND EB. The Board decided the 63rd
World Health Assembly would meet 17-21 May, 2010, followed by the
127th session of the Executive Board on May 22.
GRIFFITHS

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