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RUEKJCS/SECDEF WASHINGTON DC

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