May 24, 2019
On the Agenda – The Transparency Resolution
By Caitlin Allen
Today in Geneva, another day of the 72nd World Health Assembly (WHA) is taking place. At this annual 8-day event, the decision-making body of the World Health Organisation (WHO), comprised of representatives from the WHO’s 194 member countries, gather to discuss global health issues. Among these, there is the transparency resolution.
Marked ‘Item 11.7’ on WHO’s agenda, part of the Access to Medicines and Vaccines, is a discussion on ‘improving the transparency of markets for medicines, vaccines and other health-related products’. Why is this important? As Médecins Sans Frontières states, if the resolution is passed, it would be ‘a major step’ towards providing ‘affordable prices for all essential medical tools worldwide’. Currently, a lack of transparency around what different countries pay for medicines, and the actual cost of researching, developing and manufacturing a particular medicine, allows pharmaceutical corporations to charge exorbitant and arbitrary prices’. 
But even before the World Health Assembly commenced this week, a transparency resolution, drafted in the build-up to the conference, had created controversy. On 1 February 2019, Dr Giulia Grillo, Italy’s Minister of Health, sent a letter to Director General of WHO with an attached “first draft” of the resolution.  This draft gained the support of 10 other countries including Greece, Malaysia, Portugal, Serbia, Slovenia, South Africa, Spain, Turkey, and Uganda.  However, when an informal pre-WHA meeting to negotiate the text took place on May 7, amendments made by some of the high-income countries created opposition. On 9th May, an open letter, written to WHA delegates expressing concern at ‘harmful’ attempts to weaken the transparency resolution, was signed by over 100 civil society organisations and health experts. They claimed that a group of Northern European countries, led by Germany, Denmark, Sweden and the UK, plus Australia, had attempted to water down the resolution. The changes made by the countries in question are recorded in this KEI analysis.  Knowledge Ecology International (KEI), Médecins Sans Frontières (MSF) and AllTrials have been especially vocal in their opposition to the resolution amendments.
AllTrials is a global clinical trial transparency campaign, launched in 2013, calling for all clinical trials to be registered and results fully reported. The campaign has been joined by 95,000 people and 750 organisations worldwide, including Transparency International. AllTrials have homed in on the resolution’s watering down of point 7, pertaining to the importance of sharing results from clinical trials. Point 7 states that the overriding ethical obligation on researchers to report results from all clinical trials, as set out in the World Medical Association’s Declaration of Helsinki, is not always being adhered to. However, AllTrails claim that amendments made to the draft resolution deliberately detract from its impact. In AllTrial’s document commenting on individual changes, they argue that the replacement of ‘all clinical trials should be made publicly available’ with ‘some clinical trials’, puts the WHO in direct opposition to the World Medical Association’s Declaration of Helsinki – the internationally agreed statement of ethical principles for medical research involving human subjects – which says that every researcher has a duty to share results from research involving human subjects.’ Additionally, by replacing ‘the declaration outlines the ethical imperative to.’ with ‘the declaration promotes’, they ‘misrepresent the status of the declaration and the weight it carries’. AllTrails have also challenged the addition of the word ‘can’ to certain statements, claiming for example, that ‘it would be disingenuous to say that when data from clinical trials is not publicly available it “can”’ reduce access to knowledge. It does. When results from research are not publicly shared, access to this knowledge is by definition reduced.’
MSF have been equally vocal about the need to push back against attempts to ‘drastically weaken the language of the resolution’. Els Torreele, executive director of MSF Access Campaign, has stated, ‘It seems contradictory that the very governments that espouse the importance of transparency in almost every other sector are in this case standing against the tide…We urge all country negotiators to cease all attempts to dilute the resolution and instead work together to ensure that people worldwide can access the medical tools they need to stay alive and healthy, at prices they can afford.” 
With the World Health Assembly now in full flow, transparency resolution discussions continue. Yesterday, KEI, MSF and 44 other organisations released another open letter. Again they urged the WHA ‘to reach consensus on a strong WHO transparency resolution that addresses every topic in the original proposal’, and encouraged delegates ‘to support the specific language in the original resolution’. Additionally, they requested that ‘the negotiating text be released after every negotiating session, with country positions identified for any brackets or alternative texts proposed, in order to ensure that the negotiations on the transparency resolution are themselves transparent.’ While it remains unclear how discussions will unfold over the next few days, what is certain is that transparency resolution discussions are being keenly monitored.
Caitlin Allen is a freelance journalist.
The TI-HI blog features thought and opinion from guest writers as well as TI staff. Any opinions expressed by external contributors do not necessarily reflect the views of Transparency International.