The passage of a landmark resolution on improving the transparency of markets for medicines at the latest WHA fails to narrow the political divide. John Zarocostas reports from Geneva.
Few issues are as politically charged in multilateral diplomacy forums as pricing and access for medicines, vaccines, and other medical products, as was revealed, once again, by the marathon negotiations that led to the adoption by the World Health Assembly (WHA) on May 28 of a resolution that aims to enhance transparency in global markets.
“We addressed one of the most complex and polarising issues in 21st century global health…We are glad that member states found common ground”, Silvia Paula Valentim Lutucuta, Angola’s minister of health and chair of a WHA committee that hosted the negotiations, told delegates.
Dagmar Reintenbach, head of global health at Germany’s federal ministry of health, said the negotiating process was marred by states being strategically targeted, among other things, “by leakage of perceived positions with a view to intimidate some delegations publicly, accompanied by incorrect information regarding the reasoning of this positioning”.
The resolution was initiated by Giulia Grillo, Italy’s minister of health, on Feb 1, 2019. It was initially backed by Portugal, Spain, and Greece, followed by a growing list of countries including Malaysia, Egypt, South Africa, Uganda, Turkey, Serbia, and Slovenia.
The negotiations became what WHA delegates called a real diplomatic thriller, as Germany and the UK, backed by Japan, Switzerland, Denmark, and Sweden—all countries with major pharmaceutical manufacturing sectors—attempted to water down the resolution, particularly when it came to the language relating to transparency for research and development (R&D) costs.
Although the USA supported the inclusion of language relating to transparency of medicine pricing, they also pushed hard against the inclusion of language that prescribed transparency on R&D costs—a red line for the pharmaceutical industry but an anathema for the sponsors of the resolution and health advocacy groups who were eager to address the inequities and hardships caused by high prices.
In an open letter dated 24 May addressed to Jens Spahn, Germany’s minister of health, a group of 66 civil society organisations working in sub-Saharan Africa—which included Médecins sans Frontières Southern Africa—called on Berlin to abandon “its obstruction” of the resolution. An identical public letter was addressed to Mathew Hancock, the Secretary of State for Health and Social Care, and also to Rory Stewart, the Secretary of State for International Development.
At the time of the drafting sessions, co-sponsors were forced to concede ground on the R&D cost language in a bid to save the resolution. But a series of late developments ultimately secured the passage of the resolution.
One such decisive event was when the WHO secretariat accidentally posted the drafting text of the resolution, which included the individual countries’ negotiating positions, without having secured the consensus of the drafting group. The text was quickly posted and widely distributed by advocacy groups before WHO pulled the text from the site. The WHO secretariat apologised for the error, but Germany, furious at the repeated press leaks and the targeted campaign by health advocacy groups, walked out of the negotiating session, sources said.
Germany’s exit from the negotiations coincided with the timely entry of a group of countries as co-sponsors of the resolution, which included India, Brazil, Kenya, Uganda, and Sri Lanka.
The co-sponsorship by India and Brazil, a surge of support coming from African nations, and a shift in position from the USA, which came in late with strong support for the language relating to transparency in drug prices, “turned the tide”, diplomats said.
However, the same sources said that the inclusion of wording such as “as appropriate”, “if publicly available”, or “voluntarily provided” in the language relating to R&D cost watered down what was originally quite a strong text. The big gain for the sponsors, diplomats told The Lancet, was the retention of language calling for measures to share information on net prices of health products, for rapid and timely adoption of generic and biosimilar products, and text requesting that WHO Director-General Tedros Adhanom Ghebreyesus analyse the availability of data on inputs throughout the value chain, including trial data and price information—viewed as a coded de-facto approach that can also capture R&D costs.
After the adoption of the resolution by consensus, Germany, the UK and Hungary went on the record saying they were dissociating themselves from the resolution, arguing it “was rushed through” and faulting the “serious governance concerns”. Julian Braithwaite, the UK’s ambassador to the UN in Geneva, declared: “…we believe that more time should have been allowed to enable all involved the time to carefully consider the potentially far-reaching implications of the resolution ….The UK is left with no option but to disassociate ourselves from this resolution.”