58th World Health Assembly
WHO Executive Board 115th session January 2005

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Agenda Item 4.3: Responding to Health Aspects of Crises

Following the WHO Secretariat’s progress report and a direct video conference with the affected region in Indonesia, most EB Members took the floor to express their condolences to the affected countries and their peoples. Thailand, in particular, elaborated on various aspects of the initial international response. It was interesting to note the emphasis on country response which, at times, may be negatively affected by outside interventions. The Thai delegate, for example, mentioned the time constraints put on governments when they had to perform functions as hosts to high-level officials visiting the country, whilst in the midst of strategizing and delivering much needed help under an enormous time pressure. He thanked WHO for staying out of activities that would have imposed an additional burden.

The suggestion to draft a new resolution to be adopted by the Board was proposed and acted upon in the coming days. On January 24, resolution EB115.R11 "Health action in relation to crises and disasters, with particular emphasis on the south Asian earthquakes and tsunami of 26 December 2004" was adopted. Its text in operative paragraphs provides a number of handles that can be used in working with governments to ensure that the protection, promotion and support of breastfeeding is included in emergency-preparedness plans.

IBFAN, speaking on behalf of CI, was the only NGO that requested permission to speak (click here). The intervention was well received. Feedback from Board members as well as from NGOs highlighted the practical nature of our intervention. It was also acknowledged in the summary response given by the Secretariat (Dr. Nabarro). He emphasized the need for clear and strong advocacy, and highlighted the example of the importance of breastfeeding.

Agenda item 4.4: Infant and Young Child Nutrition (IYCN)

The first discussion on this agenda item was held on Tuesday, January 18. Tonga took the floor and stated their serious concern with procedural matters regarding the draft resolution. Despite the clear request by the 57th World Health Assembly (WHA 57) for the draft debated in May 2004 to be forwarded to the 115th EB, the WHO Secretariat undertook an initiative to substantially change the original: "31 lines out of 41 have been removed". The debate that followed ranged from some countries requesting to discuss the original draft (Tonga supported by Thailand and Nepal) to a suggestion to not discuss this matter at all which was voiced by USA, "since this resolution is premature and counter-productive". The USA preferred the Codex Alimentarius Commission to continue its work on the intrinsic contamination of powdered infant formula by pathogenic microorganisms such as Enterobacter sakazakii. However, Ecuador later noted that the outcome of this Codex work is 5 years away and that there would be more infant deaths along the way.

Following the illness of 9 infants in France in late 2004 and the sad death of 2 of them, France made a strong statement urging the EB to discuss the real danger posed by the intrinsic contamination of powdered infant formula even in highly controlled hospital settings. France highlighted the defects in the manufacturer’s quality control system and record keeping: "Unfortunately, it has come to light that certain batches which were produced a few months ago, more specifically in Spring 2004, were not sampled in a way that would make it possible to carry out retrospective analysis and therefore identify the stage of the production process where an error might have occurred."

Calling clearly for warnings it continued: "Both health professionals and the public, have an image of these products which means that for all practical purposes they continue to believe them to be sterile. People tend to forget only too often that this is not the case. And indeed, one thinks that at the moment it cannot be the case, so it’s absolutely essential that we as quickly as possible, to inform people, whether those be parents or people who are health professionals, that these products are not 100% sterile.
….All these babies were hospitalized in special units that were meant to protect them. We need to act now and to act fast".

The Maldives shared the concerns of Tonga, Nepal, Thailand and France that the revised and reworked resolution was not acceptable and regretted that the original text about the prohibition of sponsorship and the need for independent research had been removed. He asked the question: "I don’t understand on what grounds Paragraph 3 was deleted. Does it mean that the Secretariat or any member here supports sponsorship of health professionals and commercial influence on health research on infant feeding? I do not think any of us support that. However, both those two have been deleted and I do not see any alternative additions to replace these points."

13 delegations in all took the floor: Tonga, Nepal, Canada, Thailand, USA, Ghana, China, Ecuador, France, Russia, Maldives, Australia and Luxembourg, which spoke for the 25 Members and 3 candidate countries of the EU. Luxembourg proposed 3 strengthening amendments including that research should be ‘independent’ stressing that "the European Union attaches the highest possible level of importance to this issue."

The NGOS followed (click here): IBFAN on behalf of Consumers International, International Lactation Consultants Association, International Special Dietetic Foods Industries, with Ecuador adding further comment. In response to the interventions by Tonga and Nepal and others, the Secretariat made a guarded apology for not following WHO procedures in relation to the redrafting of the original resolution.

It was decided to convene an open-ended drafting group to resolve the matter and discuss the three versions of the draft resolution: the original resolution as proposed to the 57th World Health Assembly (WHA) in May 2004, the substantially reworked text proposed by the WHO Secretariat in October 2004, and the further revised text prepared by the WHO Secretariat after this first discussion. In addition, the USA circulated a "Non-Paper" by e-mail to Member States, and provided a room document for the drafting group. (They were the only Member State to provide such a document on the shelves of official WHO documents in the drafting room).

The fact that the drafting group was open-ended meant that Member States who are not EB Members were able to join the group, notably members of the European Union, Asian and African countries. There were three sessions chaired by Australia and which lasted seven hours in all.

The second discussion

On Monday, January 24, this drafting group reported back to the EB and presented the consensus text which had been achieved at a price: although the propositions and deletions of the USA were not incorporated, the wording on health claims, although slightly improved, remained weak, the call for warnings and reduction of contamination was qualified with "where applicable", or "explore the necessity" and the Director General was asked to promote ‘independently reviewed research’ rather than ‘independent research.’ This was thus a considerably weakened version of the original resolution that was proposed by the sponsors at the 57th WHA.

However, the new draft now had the endorsement of the European Union. This became clear during the discussion of the new draft. Ecuador took the floor to thank the drafting group "for a miracle. Chatting with NGOs who were concerned about the previous draft and with industry, apparently they now all agreed." This was already an indication of substantial weakening, as well as being inaccurate in that NGOs did not agree with all the text of the new draft.

Luxembourg (on behalf of the EU) expressed satisfaction and the wish of the EU to co-sponsor the resolution, because the draft reflected "the consensus on an issue that is of such great importance for all the countries of WHO". However, Russia replied that they could not agree about the provisions for warning information on labelling and packaging. Even though Russia had not joined the drafting group, they proceeded to expound all the industry arguments against the content of the resolution. Seated next to the USA in the Board room, they appeared to have been spoon fed by their neighbour, who took the floor to thank Russia for paving the way, but to say that the US supported the text as it stands. This allowed the USA to appear magnanimous while supporting the strong criticisms expressed by Russia.

Nepal was quick to propose counter-amendments to delete the words "where applicable" before the injunction to Member States that "this information is conveyed through an explicit warning on packaging". The balance thus achieved in the two proposed amendments allowed Tonga and Ghana to reply that they supported the text as it stood, for the purposes of working together. Tonga wished to be a co-sponsor. However it should be noted that as co-sponsors they are now rather ‘tied’ to the text. It seems crucial to ensure that other strong countries do not fall into this trap.

The USA made a congratulatory speech to the chair of the drafting group "for the carefully calibrated agreement to which all delegations had access" and urged that the text should not be opened up now. Australia understood Russia's concerns, which illustrated the different positions, but encouraged everyone to accept the text. The EB Chair then asked Russia and Nepal if they would agree to withdraw their amendments. Russia stated that in principle they had no objections but remained concerned about the labels. Finally, Russia withdrew its objections, Nepal its amendment and the resolution was adopted as EB 115/12: Infant and Young Child Nutrition.

Agenda item 7.4: Relations with Nongovernmental Organizations

Under this agenda item, there were two important elements. The first was discussion of the third submission of an application for the status of official relations with WHO by the International Council of Grocery Manufacturers Associations (ICGMA), operated by the Grocery Manufacturers of America (GMA), and the Confederation of Food and Drink Industries of the EU (CIAA). IBFAN, together with Corporate Accountability International (formerly Infact), have both been in the forefront of the opposition to the acceptance of two business associations as NGOs into official relations with WHO since the first application was debated (113th EB, January 2004). Infact and IBFAN prepared the attached briefing paper which summarizes the reasons for rejection of the applications. In the process, other NGOs joined in; for example, the Geneva-based NGO Forum for Health, a platform for NGOs working on health issues and with WHO, endorsed this briefing paper. The one-pager was distributed to the 5 members of the Standing Committee on Nongovernmental Organizations to inform their deliberations. However, the Standing Committee did not discuss the issue. It was directly up to the EB to consider the applications and the additional information provided by the associations and to arrive at a decision. The feedback from the corridors gave a lot of hope that the acceptance of these business associations may again be seen by a number of EB members as not acceptable.

When this agenda item came up for discussion, the WHO secretariat informed the Board members that the two associations had withdrawn their applications. This should be seen as a victory for our advocacy. However, it is important to remain vigilant. The issue is closely linked to the development of a new WHO policy on official relations with NGOs, which, in May 2004, was put on a back burner. If the Policy had been adopted last year, the acceptance of any business association into official relations with WHO as an NGO could not have been prevented. It is thus possible that there will be pressure coming from some Member States to reopen the negotiations over the new draft policy in order to facilitate better access of business to the WHO governing bodies.