Civil Society Letter to Dr. Margaret Chan, Director General of the World Health Organisation regarding WHO's publications polic

Dr. Margaret Chan, Director General
World Health Organisation
Avenue Appia 20

CH - 1211 Geneva 27

15 May 2008

Concerns Regarding WHO's publications policy

Dear Dr. Margaret Chan

We are writing to raise our concerns pertaining to WHO's publication policy
outlined in the Secretariat's report titled "WHO Publications" (EB 122/20
dated 6 December 2007) and further elaborated in another Secretariat report
titled "WHO publications policy: guidance on implementation and evaluation" (EB 123/7 dated 14 April 2008).

For decades WHO at the HQ and regional levels has produced many excellent
publications and briefing papers to support and guide the development and
application of pro-public health policies in developing countries
particularly where it intersects with intellectual property rights. Some of
these publications include: Working Paper on Guidelines for the examination
of pharmaceutical patents: developing a public health perspective (January
2007); Implementation of the WTO General Council Decision on Paragraph 6 of
the Doha Declaration on the TRIPS Agreement and Public Health (April 2004).

Joint publications by WHO and other organisations for example: (1) a study
commissioned by the WHO Commission on Intellectual Property Rights,
Innovation and Public Health (CIPIH) titled "The Use of flexibilities in
TRIPS by Developing countries" (WHO & South Centre, 2006); (2) "Remuneration
guidelines for non-voluntary use of a patent on medical technologies" (WHO &
UNDP, 2005); (3) "Determining the patent status of essential medicines in
developing countries health" (UNAIDS, WHO & MSF, 2004) and (4) "Protection
of Data submitted for the Registration of Pharmaceuticals: Implementing the
Standards of the TRIPS Agreement" (WHO & South Centre, 2002) are also
evidence of WHO's notable work in the area of IP and Health

Civil society also often relies on these publications as the basis of its
advocacy work.

In our view, WHO's exemplary papers in the area of IP and Health are due
especially to WHO's independence in determining the topics it should speak
on, free from any member state¹s influence and interference.

However we are very concerned with reports that the WHO has come under
pressure from some developed countries that were unhappy with some of its
publications on the subject of IP and public health. For example, it has
been publicly reported that a letter was sent by a particular country to the
WHO Secretariat requesting it to withdraw one of the publications it has
co-published that is on the subject of IPRs and public health. (see news
story titled "US Seeks Review Of WHO Publication Policy After Report On US
Trade Deals" available at http://www.ip-watch.org/weblog/index.php?p=409)

It is widely believed that the recent proposed overhaul of WHO's publication
policy is a response to these recent pressures. We believe that such
pressures should not have been put on the WHO, nor should they be repeated.
The WHO Secretariat is mandated to provide independent opinion and research,
which are reflected in its publications. The independence of opinion and
intellectual integrity of the Secretariat are essential conditions for the
public confidence in the WHO.

We therefore believe that the Secretariat, and especially the Director
General, should not bow to pressures by particular member states. For
example, the WHO should not practice "self censorship" in an attempt not to
displease certain countries or parties, especially when it has a
responsibility to take a stand and speak up on behalf of public health.

In this context, we are concerned that the publication policy has the high
potential to result in such "self censorship" by WHO and its staff. We are
also very concerned that this policy will hamper timely advice and support
by WHO HQ and regional offices to member states over important issues such
as application of intellectual property rights and the use of TRIPS
flexibilities, other trade and health matters, reproductive health care and
other issues.

Some of our specific concerns and questions over WHO publications policy as
outlined in the Reports of the Secretariat EB 122/20 dated 6 December 2007
and EB 123/7 dated 14 April 2008 are as follows:

(1) Differential treatment of some publications.

Paragraph 13 of EB 122/20 requires publications "that describe the workings
of a particular government or national health service or that have policy
implications for the Organization or address controversial health-related
issues" to go through "additional clearance by the Director-General's
Office" while the final text of all other publications can be cleared by the
"relevant Assistant Director-General or Regional Director before
publication."

This requirement also seems to be applicable to "Any article, book chapter
or invited commentary relating to WHO's work that is to be submitted by a
staff member for external publication". (See paragraph 9 of EB 122/20)

Paragraph 13 raises several questions especially what is the rationale for
treating some publications differently from other publications and what are
the criteria that will be used to determine which topics "have policy
implications for the Organization or address controversial health-related
issues" and thus will require additional clearance by the DG's office.

Requiring differing treatment between publications raises the question of
whether publications (including papers written by staff members for external
publication) that are to be approved by the DG's office will undergo some
kind of political review or approval to ensure that it is politically
acceptable to member states before it is cleared. This would effectively
undermine the independence, neutrality and editorial freedom of WHO and
instead make WHO and its staff more susceptible to political and other
pressures.

We are of the view that the policy proposed above will result in a situation
where WHO and its staff will shy away from speaking up on topics that have
important implications for public health (such as intellectual property
rights) but that may be unpalatable to some countries, particularly
countries that are significant financial contributors to the WHO.

In our view, WHO reports and publications should be only subjected to
"technical review" to ensure that they are factually and technically
accurate, and that they take a public health perspective. In this regard all
publications should be treated equally.

(2) Publications produced by Regional offices

Paragraph (1) also applies to regional offices, which further raises the
question as to the rationale for requiring publications commissioned or
produced by regional offices to be cleared by the DG's office. Regional
directors are elected by member states; thus the regional directors should
have authority to provide clearance to all publications as was the case
prior to the proposed new policy.

In our view, WHO regional offices play an important role by raising
awareness on and supporting member states in developing and implementing
measures that promote public health by commissioning relevant publications,
preparing briefing papers, on request providing advice, participating in
workshops etc. Civil society groups have benefited significantly from the
services of the regional offices.

We are concerned that the proposed broad definition of the term
"publication" coupled with the policy mentioned in (1) would make it
difficult for regional or national-level pro-public health initiatives to be
taken on several important issues where support is needed by member state
and by civil society, as these issues may be considered "controversial."

The term "publication" is defined in footnote 2 of EB 122/20 as
"information products, i.e. Materials that are issued by WHO to the public
in whatever format and through whatever channel. It excludes materials
internal to WHO." Paragraph 3 of EB document 123/7 further defines
information products as "written or illustrated works that the Organisation
makes publicly accessible. Examples include documents on the website and
journal, articles, guidelines, reports, training materials and advocacy
materials in any format (printed, web, CD-ROM/DVD or audiovisual), whether
sold or distributed free of charge".

The extraordinarily broad definition of "publication" appears to include
materials such as briefing papers, leaflets, power-point presentations,
materials given to a government requesting technical assistance etc.

Where these information products relate to topics that "have policy
implications for the Organization or address controversial health-related
issues", then it would have to be approved by the DG's office.

In our view, the approach being taken is very worrying as it will hamper the
timely provision of advice and support particularly by regional offices to
member states. It can be expected that WHO staff would have to face time
constraints and several hurdles to get their views approved by the DG's
office before they can present them.

(3) Master List of planned publications.

Paragraph 8 of EB 122/20 requires that a master list of planned publications
be prepared for executive approval at the beginning of each biennium.

We are concerned that this will hinder WHO¹s ability to deal with new issues
or concerns that arise during the year.

(4) Need for more information and debate on the issue of publications:

In our view little information has been provided as to the need and
rationale for overhauling the present publication policy, and putting in
place measures mentioned in the EB 122/20 and EB 123/7. For example it is
unclear what is the rationale for requiring publications that "address
controversial health-related issues" to go through "additional clearance by
the Director-General's Office". Could the WHO please provide a list of what
these controversial issues are, and what is the criteria for designating an
issue as "controversial"?

Also the implications of the policy for developing countries should also be
assessed and discussed. For example while cost-effectiveness may be
appreciated, reducing copies that are printed and distributed (see paragraph
6 of EB 123/7) will simply shift printing costs to governments that will
have to go online to print WHO publications, and as a result hamper easy
access to hard copies that contain important information for developing
countries. The aim to reduce number of "titles" (see paragraph 6 of EB
123/7) may undermine functions of the WHO stated in its Constitution for
example "to provide information, counsel and assistance in the field of
health"; "to promote...research in the field of health" and "to assist in
developing an informed public opinion among all peoples on matters of
health".

EB 122/20 seems to indicate that the previous publications policy has
undergone a "fuller review" and yet there is almost no information as to
what was the previous publication policy, the persons involved in this
review and the outcome of this review.

(5) Policy will de-motivate WHO Staff

We are of the view that the numerous steps listed for the preparation and
clearance of publications in EB 123/7, present hurdles and will only result
in frustrating staff initiatives in emerging with good publications on a
timely basis. Ultimately the loser in this process will be the public
especially in developing countries.

We are of the view that prior to implementing the proposed publication
policy, the policy should be the subject of thorough discussion among all
member states. WHO member states should also be provided with full
information so as to enable informed decision-making.

As mentioned above we are much concerned that the publication policy will
result in a tendency towards "self-censorship" by WHO and its staff at
regional and HQ offices, to the detriment of the needs and interests of
public health, especially in developing countries.

Therefore we strongly urge you to reconsider the policy that is contained in
the two documents EB 122/20 and EB 123/7.

We the undersigned Organisations would also like to request as soon as
possible an opportunity to dialogue with you on this critical issue, as
there are other concerns that we have pertaining the policy.

Signatories

1. Act-Up Paris
2. Africa Action, USA
3. AID FOR AIDS International
4. AIDES, France
5. AIDS and Rights Alliance for Southern Africa
6. American Medical Student Association.
7. Argentinean Network of Women Living with HIV/AIDS
8. Baby Milk Action, UK
9. Brazilian Interdisciplinary Aids Association
10. Center for Policy Analysis on Trade and Heath
11. Coalition for Research and Action for Social Justice and Human Dignity
12. Consumers¹ Association Penang, Malaysia
13. Diverse Women for Diversity, India
14. Economic Justice and Development Organization, Pakistan
15. Empower
16. European AIDS Treatment Group, Belgium.
17. Essential Action, USA
18. Global AIDS Alliance
19. Health Action International
20. Health Action International Asia Pacific
21. Health Gap (Global Access Project) USA
22. IBFAN Africa
23. IBFAN Asia
24. IBFAN Latin America and Caribbean
25. IBFAN International Code Documentation Centre
26. INFACT Canada
27. INTAL, Belgium
28. Initiative for Health, Equity & Society, India
29. Institute of Science in Society, UK
30. Initiative for Medicines, Access & Knowledge
31. Knowledge Ecology International
32. Medico International
33. Medical Action Group, Inc., Phillipines
34. Mozambique AIDS Treatment Access Movement
35. Navdanya, India
36. Network of Zimbabwean Positive Women
37. Oxfam International
38. Osservatorio Italiano sulla salute Globale
39. Peoples Health Movement, Secretariat
40. Peoples Health Movement - India
41. Peoples Health Movement - Bangladesh
42. Positive Malaysian Treatment Access & Advocacy Group, Malaysia.
43. Program on Information Justice and Intellectual Property, American
University, USA
44. Public Personalities Against AIDS Trust
45. Research Foundation for Science Technology & Ecology, India
46. Sidaction, France
47. Stop HIV/AIDS in India Initiative, Washington DC
48. The Network, Pakistan
49. Third World Network
50. Treatment Action Campaign
51. Universities Allied for Essential Medicines
52. Vermont Global Health Coalition
53. World Alliance for Breastfeeding Action