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UNCLAS GENEVA 000128 
 
SIPDIS 
 
DEPT FOR IO/T, S/GAC, OES, G/AIAG, PRM, EAP 
USAID FOR DALE GIBB 
 
E.O. 12958: N/A 
TAGS: TBIO WHO
SUBJECT: WHO: REPORT ON THE 124TH SESSION OF THE WORLD 
HEALTH ORGANIZATION EXECUTIVE BOARD 
 
REF: GENEVA 00060 
 
¶1. Summary.  The 124th Session of the Executive Board (EB) of 
the World Health Organization (WHO) met from January 19-26, 
2009, in Geneva.  This cable reports on the significant 
outcomes from the Board (and its Program, Budget and 
Administration Committee, which met prior to the EB), 
including resolutions forwarded to the 62nd World Health 
Assembly for adoption in May.  Discussions at the 124th EB 
were robust and substantive and, other than a 
voted-resolution on the health crisis in Gaza, the 
resolutions and decisions were approved by consensus.  The 
debate and voted resolution on the health crisis in Gaza are 
reported reftel.  Dr. Don Wright, Acting Assistant Secretary 
for Health at the Department of Health and Human Services 
(HHS), led the U.S. Delegation (USDel), which included 
officials from HHS, USAID, State (IO and PRM) and U.S. 
Mission Geneva.  The EB began under one Administration and 
continued under the new Administration.  USDel reflected, per 
guidance on select issues from the HHS Transition Team, the 
Administration's willingness to be more forward-leaning on 
issues such as the Millennium Development Goals, climate 
change and health and the WHO Commission on the Social 
Determinants of Health.  End Summary. 
 
¶2.  WHO Director-General Margaret Chan, in the second year of 
her five-year term, was actively engaged throughout the EB, 
seeking specific Board guidance on issues, proposing ways to 
find consensus, and reminding Member States about WHO's core 
business as a technical health organization (as opposed to an 
IP or development agency).  Her statement to the Board 
covered various humanitarian issues, such as the cholera 
outbreak in Zimbabwe and the health crisis in Gaza, in a 
non-political tone.  She addressed issues before the EB such 
as primary health care, Chagas disease, the health-related 
Millennium Development Goals, health worker migration, 
counterfeit medical products, human organ and tissue 
transplantation, the report of the Commission on Social 
Determinants of Health, and the Proposed Program Budget for 
2010-2011.  She closed with reference to how, in these times 
of economic and financial crisis, the health sector manages 
risks, such as disease outbreaks; contributes to good global 
governance, such as its ability to inspire collaboration and 
good will; and motivates ethical behavior, leading to greater 
health equity. 
 
KEY OUTCOMES 
------------ 
 
¶3.  UPDATE ON PANDEMIC-INFLUENZA PREPAREDNESS.  The 
discussion focused on a progress report related to the 
December 2008 intergovernmental meeting (IGM) on pandemic 
influenza preparedness. USDel emphasized the need to reach 
consensus at the next IGM on all remaining issues related to 
sample-sharing/benefit sharing in time for the 62nd WHA in 
May 2009.  Indonesia's Health Minister Supari, attending the 
first few days of the EB, said the IGM had agreed to the use 
of a standard materials transfer agreement for H5N1 viruses 
and to integrate benefit-sharing into such an agreement. 
(Comment:  the IGM did not reach such agreements.)  She urged 
countries to work cooperatively to resolve issues.  WHO 
Assistant Director-General for Health Security and the 
Environment, David Heymann, commented on the ongoing threat 
of a pandemic, referred to WHO's work on assisting countries 
on vaccine production capacity, and spoke to the need for a 
broad spectrum vaccine as the "holy grail" that could 
mitigate or prevent a pandemic, although it remained a 
research issue with no such vaccines in clinical trials. 
 
¶4.  IMPLEMENTATION OF THE INTERNATIONAL HEALTH REGULATIONS. 
Delegations spoke to the many challenges in their countries 
to implementation of the IHRs and development of the core 
capacities required.  USDel urged universal application of 
the IHRs and called on Member States to live up to their 
obligations, such as openly and transparently sharing 
information about disease outbreaks where the IHRs require 
reporting. 
 
¶5.  TAIWAN AND THE IHRs.  As a positive development that 
occurred just prior to the EB, WHO sent a letter to Taiwan 
health authorities on January 2, 2009, proposing ways to 
include Taiwan in implementation of the IHRs, specifically: 
designation of a contact point, direct communications between 
Taiwan and WHO, provision of documents and information, 
measures related to a public health emergency of 
international concern, and inclusion of a public health 
expert from Taipei in the IHR expert roster.  Taiwan's CDC 
responded on January 22, 2009, to accept the WHO offer. 
There was no public discussion of this matter at the EB. 
 
 
¶6.  PRIMARY HEALTH CARE.  USDel expressed strong support for 
primary health care initiatives and encouraged countries to 
take active steps to expand primary care services in all 
communities.  Japan and a group of WHO Member States from the 
Eastern Mediterranean Region,  including Afghanistan, Oman 
and the United Arab Emirates,  both tabled resolutions under 
this agenda item.  (Comment: It appeared the EMRO text was 
actually a product of the WHO Secretariat.)  The EB Chair 
asked a working group of Member States to meet informally, 
under the leadership of the Republic of Korea, to combine and 
deconflict the two texts.  After six sessions of informal 
negotiations the working group reached consensus on a text 
that, inter alia, requested Member States to ensure political 
commitment at all levels to the values and principles of the 
Declaration of Alma-Ata, keep the issue of strengthening 
health systems based on the primary health care approach high 
on the international political agenda, and take advantage, as 
appropriate, of health-related partnerships and initiatives 
relating to this issue, particularly to support achievement 
of the Millennium Development Goals. 
 
¶7.  PRIMARY HEALTH CARE AND TRADITIONAL MEDICINE.  The Board 
approved a PRC-sponsored resolution on Traditional Medicine 
under the primary health care agenda item.  The resolution 
instructs WHO to update the WHO traditional medicine strategy 
based on countries' progress in disseminating traditional 
medicine and to update policy guidance to Member States. 
While the final text did not include a proposal to hold an 
annual Traditional Medicine Day, the PRC may revive that 
proposal at the WHA. 
 
¶8.  COMMISSION ON SOCIAL DETERMINANTS OF HEALTH.  The 
discussion focused on the relevance of social determinants to 
the incidence of all diseases and, as such, the need to 
inform the design of and reforms to health systems.  USDel 
welcomed the Commission's report, referring to President 
Obama having spoken about the need to address economic 
inequities and health disparities, and noted the Commission's 
report adds to existing data on the way social determinants, 
such as income disparity or lack of education, might lead to 
worse health.  The resolution expressed appreciation for the 
work done by the Commission and called for a range of actions 
by all relevant players to reduce health inequities.  The 
resolution also called on WHO to convene a "global event" to 
"highlight the developments, progress and renewed plans for 
addressing the alarming trends of health inequities and to 
increase global awareness on social determinants of health, 
including health equity."  Brazil immediately offered to host 
a conference on social determinants of health in July 2010 
and suggested it could also focus on achievement of the MDGs. 
 
 
¶9.  ACHIEVEMENT OF THE HEALTH-RELATED MILLENNIUM DEVELOPMENT 
GOALS.  As agreed previously, the Board and WHA are to 
address the MDGs annually through 2015, the year the goals 
are to be achieved.   Speaking for African countries, Malawi 
lamented that Africa was unlikely to achieve the 
health-related MDGs, and only six countries in the region 
were making real progress on them.  South Africa noted it had 
gained no ground on maternal mortality rates in recent years. 
 Some countries, particularly in Asia, did say they were on 
track to achieve the goals.  USDel pointed to the importance 
of each of the MDGs and emphasized the need for reducing 
maternal mortality and improving mother and child health, 
including through better access to reproductive health 
services.  The WHO Secretariat pointed to the need for both 
sustainable and accelerated approaches to achieve the MDGs. 
 
¶10.  CLIMATE CHANGE AND HEALTH.  The EB approved a short 
resolution sponsored by the UK that endorsed the WHO 
Secretariat work plan on climate change and health and 
requested the DG to report annually on its implementation. 
USDel agreed that persuasive evidence exists regarding the 
impact of climate change on human health and urged WHO and 
Member States to take appropriate action. 
 
¶11.  WHO'S ROLE AND RESPONSIBILITIES IN HEALTH RESEARCH.  The 
discussion focused on the proposed WHO Secretariat's strategy 
on research for health and the degree to which WHO is either 
engaged directly in research or in disseminating research 
findings. Some countries sought a much stronger role for WHO 
in direct health research.  USDel cautioned that while WHO 
does engage in such research, for example at the 
International Agency for Research on Cancer (IARC) and in the 
Tropical Disease Research Program, WHO's primary role should 
be using research findings for technical guidance to  Member 
States.  The WHO Secretariat (Dr. Tim Evans) confirmed WHO's 
contributions related to the synthesis and translation of 
research into a useable form for policy processes in 
countries.  Dr. Evans also noted the role of WHO's Advisory 
Committee on Health Research in the provision of 
best-evidence, and agreed to revise the research strategy to 
reflect that copyright and intellectual property rights are 
not barriers to access to health data, tools, materials and 
literature. 
 
¶12. INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL: DRAFT 
GLOBAL CODE OF PRACTICE.  The WHO Secretariat-drafted Code of 
Practice (COP) on the International Recruitment of Health 
Personnel was not agreed at the WHO Executive Board.  Many 
Member States expressed diverse views on the Code and were 
particularly concerned that the Secretariat had not allowed 
for adequate consultations during the drafting process.  The 
EB agreed to a schedule for further stakeholder consultation 
and Member State input, beginning with the fall meetings of 
WHO Regional Committees. Each Regional Committee will discuss 
the Code and then submit reports on their consultations to 
the Secretariat, which will prepare a synthesis report for 
consideration by the 2010 Executive Board.  An open-ended 
meeting of Member States will then meet in Geneva to consider 
a revised draft Code, to be presented for consideration to 
the Health Assembly in 2010. Since discussions on the COP 
have been removed from the 2009 WHA agenda, the DG will 
include a brief statement regarding work completed to date in 
her report to the Assembly. 
 
¶13.  COUNTERFEIT MEDICAL PRODUCTS.  The Executive Board was 
unable to reach consensus on this agenda item.  Several Board 
members, including Brazil, Bangladesh, El Salvador, Paraguay 
and Sri Lanka, all spoke against the Board considering the 
agenda item and its accompanying resolution.  India, Thailand 
and Egypt (not on the Board) also spoke against the Board 
considering it.  The rationale used by these Member States 
was that matters pertaining to intellectual property rights 
were not appropriate to discuss at the WHO - the exact 
opposite position that this same group of Member States took 
in the context of the WHO Intergovernmental Working Group on 
Public Health, Innovation and Intellectual Property.  (NOTE: 
The Brazilian Permanent Representative delivered remarks that 
attempted to link the agenda item to the seizure by Dutch 
authorities of a shipment of losartan (a diabetes drug) 
manufactured in India and en route to Brazil.)  USDel, the 
European Union, Malawi and the European Commission all spoke 
in favor of the Board considering the item.  As a way 
forward, the Board instructed the WHO Director-General to 
prepare a revised paper for the WHA in May that focuses on 
the public-health aspects of counterfeit medical products, 
with particular regard to adulterated/sub-standard medical 
products.  The DG will also prepare a draft resolution to 
accompany the document.  There is no guarantee the WHA will 
act on it. 
 
¶14.  PUBLIC HEALTH, INNOVATION AND INTELLECTUAL PROPERTY. The 
Board considered a progress-report related to the Global 
Strategy and Plan of Action on Public Health, Innovation and 
Intellectual Property Rights.  Although in informal 
discussions progress was made in reaching a compromise to 
settle the bracketed text that remained in the Plan of 
Action, the Board took no action, as adopting the compromise 
is the purview of the Health Assembly.  USDel noted concerns 
about the estimated cost of implementing the Strategy and 
asked the WHO Secretariat to develop better indicators 
through which to measure progress.  The Secretariat will 
present the revised indicators to the WHA in May. 
 
¶15.  ROLE OF THE PRIVATE SECTOR IN PROVIDING ESSENTIAL HEALTH 
CARE SERVICES.  There was a robust discussion on this agenda 
item, proposed by Thailand.  Countries had a variety of 
experiences ranging from a high percentage of health coverage 
from the private health sector in a number of countries to 
some countries where there was little or no activity of the 
private sector in providing health care.  Most countries 
supported addressing issues related to appropriate regulation 
of private providers, the high cost of labor, and ways to 
increase access to quality care.  There was an acknowledged 
lack of definition about the scope of the private sector, 
including both for-profit and not-for-profit provider, and 
whether private physicians, clinics, and pivate insurance 
companies were to be included.  Several countries, namely 
Paraguay and Venezuela, opposed any resolution which did not 
acknowledge the government's role to ensure health care.  The 
Board decided against forwarding a resolution to the WHA at 
this time.  The Director-General agreed the Secretariat would 
provide a more fully-developed paper that reflected on the 
concerns of the Member States (such as the stewardship role 
of the public sector) and would lay out policy options for 
countries.  At USDel's suggestion, WHO will propose a draft 
resolution with the document to be prepared for the WHA. 
 
¶16.  POLIO ERADICATION. Several countries spoke on this 
information item, focusing on the agenda in West Africa and 
other remaining pockets of the disease.  The UK delegation, 
noting "we are tantalizingly close," reaffirmed its 
commitment to eradication in 2009.  To that end, the UK had 
pledged an additional 100 million British Pounds to the 
effort.  The UK also urged that the remaining endemic 
countries be invited to speak on this topic at the WHA.  Dr. 
Chan said there was nothing more important to her than 
finishing the job on eradication. 
 
 
BUDGET AND ADMINISTRATIVE ISSUES (includes PBAC discussion) 
--------------------------------------------- -------------- 
 
¶17.  WHO PROGRAM BUDGET FOR 2010-2011.  WHO noted the budget 
was now broken out into three segments -- WHO programs, 
outbreak and crisis response, and partnerships and 
collaborative arrangements, in an effort to provide more 
transparency.  Some Member States addressed the imbalance 
between assessed and voluntary contributions and concerns 
about the continuing high-level of earmarked resources and 
the relative imbalance among strategic objectives.  Some were 
also concerned about WHO's ability to raise sufficient income 
and its capacity to expend the budget increase, especially 
given low implementation rates in the current biennium. 
USDel spoke to the issues of miscellaneous income, 
partnerships expenditures, the possibility of setting up a 
separate fund for emergencies, exchange rate adjustments, and 
the budget level and the need for budget discipline. 
 
¶18.  On miscellaneous income, the Secretariat is to provide 
in the revised budget submitted to the WHA a figure for what 
it prefers to call "additional" income into the budget 
appropriation (thus reducing assessments -- see also paras 23 
and 24).  On creation of a revolving fund for emergencies, 
the Director-General committed to keeping that under 
advisement, noting WHO can draw upon the harmonized UN fund 
for emergencies in New York - the CERF - and this is working 
adequately for WHO for now.  WHO will include the most 
current exchange rate projections in the May budget.  USDel 
was also told informally that the voluntary resource 
projections for 2010-11 will likely be reduced in the final 
budget proposed to the WHA. 
 
¶19.  WHO GLOBAL MANAGEMENT SYSTEM (GSM).  WHO reviewed the 
status of implementation of the GSM and several countries, 
U.S. included, were concerned that based on anecdotal 
information received, the Secretariat was glossing over the 
significant difficulties in implementation.  The Acting 
Assistant Director-General for General Management responded 
that WHO did not wish to gloss over the difficulties WHO has 
experienced and the significant workload, but he indicated 
problems on the financial side were progressively being 
resolved while big problems in the human resources module of 
GSM remained.  More time was needed before the system would 
work as intended, although the new and better data being 
generated at Headquarters and the Western Pacific Regional 
Office (WPRO) was already providing benefits.  Introduction 
of the system to the remaining WHO regions was postponed for 
now until the system is stable. 
 
¶20. With regard to WHO's use of Satyam Computer Services, 
Ltd., as a main contractor, and its severe corporate 
problems, the Secretariat said WHO had been in contact with 
senior management of Satyam and there were no indications at 
present of disruptions to services to WHO, but contingency 
planning was under way to prepare for possible unfavorable 
developments. USDel was assured that additional costs were 
being met from existing funding for regional office 
implementation and system enhancements.  Board members noted 
the GSM underpins the achievement of WHO's strategic 
objectives and the Organization should persevere to complete 
GSM's implementation. 
 
¶21.  PARTNERSHIPS.  The Secretariat presented guidelines for 
WHO involvement with partnerships, which the EB endorsed. 
Denmark noted that many new actors are playing an increasing 
role in public health, which has an impact on the WHO budget, 
and cautioned this could lead to very complex processes.  The 
Member States, nevertheless, need to be able to guide the 
Organization and the goals of partnerships that WHO engages 
with must be in line with WHO strategic objectives.  USDel 
strongly agreed with this statement.  For AFRO, Malawi 
observed that African countries want WHO to play a leading 
role on partnerships in view of the complex development 
landscape.  While partnerships are helpful, there is a 
fragmentation of development that leads to high costs and 
reduces effectiveness.  Malawi appealed for harmonizing 
country level interventions to reduce transaction costs and 
for more effective monitoring and evaluation.  WHO, taking 
these observations into account, will work further on the 
partnership guidelines prior to the WHA. 
 
¶22.  ESTABLISHMENT OF AN AUDIT COMMITTEE.  USDel was joined 
by a number of other Geneva Group countries speaking in favor 
of an Independent Expert Oversight Advisory Committee at the 
WHO, especially in view of WHO's projected $5.6 billion 
overall budget for 2010-11.  Only China and Indonesia 
expressed mildly differing views.  The EB agreed to the 
recommendation of the Program, Budget, and Administration 
Committee for the establishment of a committee that was both 
independent and expert in the relevant fields and separate 
from the PBAC.  It was agreed  Member States will work with 
the Secretariat between now and the May PBAC to prepare draft 
terms of reference and study issues related to lines of 
reporting, legal status, and costs. 
 
¶23.  AMENDMENTS TO FINANCIAL REGULATIONS AND RULES.  USDel 
questioned three amendments to the financial regulations, in 
particular the insertion of a separate budget for capital 
expenditures and the deletion of miscellaneous income to be 
replaced by the concept of an income surplus.  For the 
separate budget for capital expenses, the Secretariat agreed 
to delete the language, although it was noted the DG could 
submit spending proposals as the Secretariat chose, even 
though there should not be an expectation of a separate 
budget in the regulations. On the concept of miscellaneous 
income, after some discussion the Secretariat agreed that 
"surplus" may not be the best word, but opposed the term 
"miscellaneous," noting it did not exist in the International 
Public Sector Accounting Standards (IPSAS) that WHO was 
adopting.  The compromise was the three main sources of extra 
income, including interest income plus "additional" income 
from regular budget sources, are now delineated explicitly. 
WHO stated  this income is to be used for appropriations in 
the budget.  The previously deleted section noted that in the 
case that estimated amounts fall short, the DG will adjust 
the budget. 
 
¶24.  The Secretariat noted an estimate for this additional 
income would most likely be reinserted into the next draft 
budget.  Privately, the WHO Treasurer cautioned USDel not to 
expect this estimated number to be as high as previous years 
given the current zero interest rates in the US.  It is 
expected to be in the range of $15 to $20 million rather than 
$30 million. 
 
¶25.  AMENDMENTS TO STAFF RULES AND REGULATIONS.  USDel 
succeeded in deleting a proposed new staff rule to allow 
national professional officers a language allowance, since 
the UN and its Funds and Programs (UNHCR excepted) did not 
pay this allowance.  USDel expressed concern the UN common 
system was undermined when different parts of the UN provided 
different employee benefits.  WHO withdrew the proposal but 
indicated it would promote its support of a language 
allowance for national professional officers to the ICSC. 
 
¶26.  WORLD HEALTH ASSEMBLY PROVISIONAL AGENDA. The EB 
approved the provisional agenda for the 62nd WHA in May 2009 
with the addition of four new items proposed by Board 
Members:  Food safety (UAE), international chemicals 
management (Slovenia), MDR-XDR tuberculosis (PRC), and viral 
hepatitis (Brazil).  Of note, when USDel raised concern about 
respecting the principle of the EB vetting issues before they 
go to the WHA, many Board Members agreed and sought to uphold 
the practice.  After some debate, it was agreed these new 
items would be identified on the provisional agenda as not 
having been discussed at the EB. 
 
 
 
 
STORELLA