WHO Foundation Established to Support Critical Global Health Needs
The World Health Organization has established the WHO Foundation to support critical global health needs. But concerns remain about the ethical standards of the WHO Foundation around its corporate partnerships and donors. Health harmful industries such as the alcohol industry are seeking to break their way into WHO to influence its normative guidance and derail its policy-making processes. It remains to be seen which firewalls against conflicts of interest the new WHO Foundation will set up and implement.
The Foundation will operate from its headquarters in Geneva and fund the WHO and trusted partners to deliver on the Organization’s “triple billion” goals. These goals aim to:
- Protect 1 billion people from health emergencies;
- Extend universal health coverage to 1 billion people; and
- Assure healthy lives and wellbeing to 1 billion people by 2023.
Health is a global public good, and I believe we can create a world in which everyone can live a healthy and productive life regardless of where they live. WHO is dedicated to this goal and the creation of the WHO Foundation is an opportunity for a seismic shift in global health, redoubling our efforts toward this goal,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director–General, as per WHO Foundation.
The WHO Foundation is conceptualized as independent grant-making foundation with a focus on the most pressing global health challenges both in the present and future. It aims at funding high-impact initiatives and advancing strategies of innovation, effectiveness, and rapid response, to support the global health ecosystem.
Legally independent from the WHO, the Foundation will work responsibly with individual donors, the general public and corporate partners to strengthen health systems globally. Specifically, the WHO Foundation will support global public health needs, from prevention, mental health, and non-communicable diseases to emergency preparedness, outbreak response and health system strengthening.
The Board will govern and assume all responsibility, review all strategic decisions and act as the highest decision making body of the Foundation. Founding Board Members are: Mr. Bob Carter, Ms. Clare Akamanzi and Professor Thomas Zeltner.
The WHO Foundation will be first focusing on the current COVID-19 pandemic response. It will raise and disburse funds for all WHO global public health priorities in full alignment with the WHO Member State adopted General Programme of Work.
The WHO deserves a strong, independent, external advocate who can support and strengthen its impact. I am proud to lead these efforts and to create this missing piece in global health by founding the WHO Foundation,” said Professor Thomas Zeltner, Founder of the WHO Foundation, as per the WHO Foundation.
Ethical concerns about conflict of interest safeguards
Concerns remain about the ethical standards of the WHO Foundation around its corporate partnerships and donors. WHO only excludes the firearms and tobacco industries from any interactions. Other health harmful industries such as the alcohol industry are seeking to find their way into WHO through corporate social responsibility schemes to undermine WHO’s credibility, influence its normative guidance and derail its policy-making processes.
The WHO engages with so called non-State actors, i.e. NGOs, private sector entities, philanthropic foundations, and academic institutions, in view of their significant role in global health for the advancement and promotion of public health and to encourage non-State actors to use their own activities to protect and promote public health.
However, the alcohol industry is pursuing diametrically opposite goals as alcohol is a major public health concern. There have been instances when the alcohol industry has found their way into the WHO structures and processes. Most prominent was the case of the partnership between The Global Fund to Fight AIDS, Tuberculosis and Malaria and Heineken, the second largest beer maker in the world. This partnership caused a broad public outcry over the apparent conflict of interest at play in a global health agency partnering with an alcohol company. In February 2018, more than 80 civil society organisations signed onto the joint open letter requesting that The Global Fund to Fight AIDS, Tuberculosis and Malaria terminate the partnership. And after Norway, also the Swedish government publicly announced its criticism of the Global Fund partnering with the alcohol industry.
The partnership has since been suspended, as investigations illustrated exploitative business practices and grave human rights violations of Heineken in Africa.
Another example was the participation of the Big Alcohol lobby group, International Alliance for Responsible Drinking, at the WHO Global Conference on NCDs, in Montevideo, Uruguay in October 2017. It was an opportunity for the alcohol industry fron group to “shift health and development agendas away from taxation”, as experts analyzed. The IARD was lobbying against alcohol taxation to be included in the conference declaration. The lobby group claimed that “fiscal measures are not useful tools for reducing harmful drinking patterns” and linked taxation of alcohol with unintended consequences including lost revenue and increased illicit trade, according to analysis. In reality, alcohol taxation is the single most cost-effective alcohol policy solution. The framing of alcohol harm as being about “harmful drinking patterns” also contradicts consensus about public health evidence. It is first and foremost the total alcohol consumption in a population that is the most adequate measure for the alcohol burden and target of alcohol policy interventions, as evidenced by the Sustainable Development Goals. Target 3.5 includes alcohol as obstacle to development:
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.”
And the primary indicator (3.5.2) for this target is (after 2020 refinement):
Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol.”
Subsequent analysis of the lobby group’s presence at the conference, published in the British Medical Journal, revealed a bleak picture. Whitaker, Webb and Linou found that there was softening of language towards industry in the Montevideo Roadmap, shifting away from public health evidence in the draft declaration.
Taxation of sugar sweetened beverages and alcohol were included as possible options in the draft version but dropped from the final version (only tobacco taxation remained). Private sector entities, primarily representing the food and drink industries, were the only group to claim that taxing harmful products is inefficient and ineffective.
To protect the work of the WHO from potential risks such as conflict of interest, reputational risk (such as in the case of the Global Fund and Heineken) and undue influence (such as in the case of the Montevideo NCDs Conference), the World Health Assembly adopted the WHO Framework of Engagement with Non-State Actors (FENSA) in 2017.
In the FENSA guide for WHO staff, the organization recommends that the alcohol industry requires “particular caution” when engaging with.
WHO takes particular caution when engaging with non‐State actors whose policies or activities are negatively affecting human health and are not in line with WHO’s policies, norms and standards, in particular those related to noncommunicable diseases and their determinants, as well as to protect WHO’s normative work from any undue influence.
In these situations, as for other engagement proposals, a case‐by‐case assessment is conducted in accordance to FENSA. Examples of such non‐State actors may include entities from the alcohol industry…”
There is clearly an awareness about the serious risks that engagement with the alcohol industry poses to the WHO. How the new Foundation will manage this issue and ensure to keep the alcohol industry at bay is a serious concern.
That this is a serious issue and likely a pressing one became obvious when internal guidance to all WHO staff around the world leaked in December 2019. The subject of the information note was: “Principles and guidance for interaction between WHO Secretariat and the alcohol industry”.
Interaction with the alcohol industry within a given framework should not lead to or imply “partnership”, “collaboration” or any other similar type of engagement that could give the impression of a formal joint relationship, the reason being that such engagements would put at risk the integrity, credibility and independence of WHO’s work,” it said in the document.
Concerning funding from the alcohol industry, the information note advised WHO staff of the following:
WHO activities cannot be funded directly or indirectly by the alcohol industry as defined in paragraph 2. WHO programmes shall not enter into collaboration with third parties on projects / activities that have been funded directly or indirectly by the alcohol industry as defined in paragraph 2. In-kind contributions to WHO projects and activities from the alcohol industry, such as contributing products, services, secondment of staff, cannot be accepted…”
FENSA and the operationalization of FENSA-principle in this internal WHO guidance are quite clear. But how the WHO Foundation will live up to these standards remains yet to be seen. The Global Fund example clearly highlights the importance keeping the alcohol industry at bay.
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Sources:
World Health Organization: “WHO Foundation Established to Support Critical Global Health Needs“
WHO Foundation: “WHO Foundation Established to Support Critical Global Health Needs”
Global News: “WHO announces creation of foundation to source more funding“