142nd session of the Executive Board

22–27 January 2018, Geneva, Switzerland

CLICK HERE for the webcasts of all the meetings.

 

Elizabeth Sterken, IBFAN Dr Tredos Ghebreyesus, WHO Director General, Maryse Arendt, IBFAN/ILCA and Patti Rundall, Thursday 25th January.

This has been a hectic week once more at the WHO  Executive Board (EB)- and we have needed to give interventions every day on one topic or another.  Our major concern, as always, alongside the protection of breastfeeding, is to protect WHO’s integrity, trustworthy  and independence so that it  carries out its constitutional Mandate as the world’s highest health policy setting body.

This year is a reporting year on Infant and Young Child Feeding so there was much to do and it was good to have a small but  strong IBFAN team.   But there were also many related and cross cutting Agenda items: Climate Change,  the Prevention on Non Communicable Diseases (NCDs); Health Emergencies, WHO’s  Framework for Engagement with Non State Actors (FENSA),  the draft proposals to address Conflicts of Interest in Nutrition and the General Program of Work 2019-2013 (GPW).  We made interventions on all these items – see  below.

One good thing – two references to breastfeeding were  inserted into the GPW- a result of advocacy by IBFAN, other NGOs and Member States. However, the clear differences of opinion between  between Member States led to some very worrying developments.

Elisabeth Sterken, Maryse Arendt, Patti Rundall and Alessia Bigi. IBFAN and ILCA team

IBFAN Interventions

Agenda Item 142/3.1 Draft 13th General Programme of Work 2019-2023 (GPW) 

The WHO website has one link CLICK HERE  for all 6 days of the EB – so to see the webcast you need to navigate to each agenda item on the correct day.

I delivered the GPW statement during the morning session 23rd January        

CLICK HERE for PDF

As one of WHO’s longest-standing public interest partners, IBFAN places great value on WHO’s Core constitutional norm-setting functions and its independence, integrity and trustworthiness.

We appreciate the opportunity to comment on the latest draft of the GWP. While some of the concerns we and others raised in the consultation have been partially addressed, omissions remain, for example the importance of sound nutrition and especially laws to protect breastfeeding. However, most importantly, the plan fails to fully identify the risks of engagement and partnership with the private sector and the threat this poses to WHOs lead role in proposing and building the international Rule of Law.

In relation to undue influence, the GPW relies on the protection afforded by FENSA. Yet FENSA, like the SUN Initiative, uses a faulty concept of Conflict of Interest that needs to be corrected. It confuses conflicts of interest within an institution or person with conflicts between actors who have diverging or fiduciary duties. WHO’s internal conflict between its mandate and prime functions and its secondary interest to be adequately funded should not be ignored. Paragraph 129 recognises that the ‘quality of funds’ is more important than their ‘quantity’ and calls Member states to un-earmark their funding and increase assessed contributions. However the GPW call for private sector funding is clear.

The notion that funding and engagement with the private sector will speed up action in areas such as NCDs is not supported by evidence – indeed such engagement is more likely to slow things down – especially when it comes to regulation. Voluntary promises attract much publicity, but unless backed up by regulation can be little more than diversionary public relations – here today and gone tomorrow. WHO must not allow itself to be used as a cover for corporations whose practices damage health and the environment. The world’s poorest people are the ones who pick up the costs of misleading marketing, deforestation, mono-cropping, land and sea grabbing and risky technologies.

Agenda Item EB 3.3  (142/9)  WHO’s work in health emergencies.

I delivered this statement on Health Emergencies in the morning session of Wednesday 24th January Move to 12.38.00    CLICK HERE for PDF

As a global network that protects breastfeeding, IBFAN is pleased to comment on this important topic.

Breastfeeding is a lifeline in emergencies. Babies are born with an undeveloped immune system and are at greatest risk of water-related diseases – with diarrhoeal disease the second biggest killer of under-fives.  Breastfeeding provides both food, care and immune support, and protects babies from the worst of emergency conditions.

Despite this, all too often emergency responses are characterized by unsolicited donations of all manner of baby feeding products. Public appeals for funds often make this worse – with starving babies shown alongside the myths used by the baby food industry – that women can’t breastfeed because of stress or malnourishment.   Rarely do appeals highlight the resilience of breastfeeding or that artificially fed babies face many more risks to survival.

IBFAN’s World Breastfeeding Trends Initiative assessment of policies and programmes on Infant feeding during emergencies show that implementation of UN recommendations on this is dismal.

WHO can play a key role in reversing this situation by promoting emergency preparedness protocols that protect breastfeeding and improve food security.  The new updated Operational Guidance for Emergency Relief Staff and Programme Managers  is designed to give all those working in emergencies concise, practical guidance on appropriate infant and young child feeding and ensure that when breastmilk substitutes are required they are purchased, distributed and used according to the UN’s agreed strict criteria.

Emergencies are prime opportunities for commercial exploitation and the Business of Malnutrition is thriving. While the speedy delivery of products can be essential, over-emphasis on fortified products and quick-fix treatments of malnutrition – often traded globally and containing  25% sugar ­– can undermine breastfeeding and sustainable, local, bio-diverse foods that are more culturally appropriate.

We look forward to working with WHO to ensure that families in emergencies have the support and protection they need.

With Dr Tedros – after breastfeeding was inserted into the General Work Plan – note the Conflict of Interest Coalition statement in my hand.

Agenda Item: 3.5 Health, environment and climate change

IBFAN Chair Elisabeth Sterken delivering the Climate Change intervention

 

Elisabeth Sterken delivered the IBFAN intervention on Climate Change on Wednesday 24th January
 Click here for the PDF
Breastfeeding and Human milk’s contribution to environment sustainability and food security year-round should be considered in climate-smart development goals at national and global level. The promotion, protection and support of breastfeeding has significant impact on mitigating harm to the environment. When women breastfeed their contribution to the reduction of Green House Gasses (GHG) and water conservation is substantial and an unacknowledged contribution that women make to reduce the impacts of climate change.

Breastmilk is a natural, renewable food, environmentally safe and produced and delivered without pollution, unnecessary packaging or waste.Breastmilk substitutes leave a major ecological footprint. Breastmilk substitutes (BMS) need energy to manufacture, materials for packaging, fuel for transport distribution and water, fuel and cleaning agents for daily preparation and use. More than 4000 liters of water are estimated to be needed along the production pathway to produce just 1kg of BMS powder. In the US alone, 550 million cans, 86000 tons of metal and 364000 tons of paper are used annually to package the product, that ends up in landfills. Furthermore, the methane gas emanating from dairy herds is a potent form of GHG.

These effects are all mitigated when women and babies are supported for optimal feeding.
Breastfeeding is especially important and protective with the increasing food insecurity and extreme weather conditions that the world’s most vulnerable women and their children face.
Policies and practices that implement the International Code and resolutions and support women to breastfeed are unique ways to contribute to meaningful approaches to mitigate the impact of climate change and a cornerstone to global efforts to achieve the Sustainable Development Goals (SDG13 )  on climate change.
IBFAN’s study of the impact of infant formula production on GHG emissions can be found  HERE :ibfan.org/docs/Carbon-Footprints-Due-to-Milk-Formula.pdf

Agenda Item EB 3.8.  Preparation for the third High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, to be held in 2018 (EB142/15); Preliminary evaluation of the GCM (EB142/15 Add.1)

I delivered this statement on NCDs (ag 3.8 ) on  Thursday 25th  January (afternoon /evening)

CLICK HERE FOR PDF

IBFAN has supported WHO’s leadership role in the control of NCDs. We attended the 1st UN General Assembly on NCDs launching the Conflict of Interest Coalition, demonstrating the concern of161 NGOs to keep policy setting free from commercial influence.

Table 5 lists contradictory obstacles to the implementation of WHO’s Best Buys. Section 5 clearly points to industry interference in policymaking while No 3, makes sweeping assumptions that developing countries have no ‘policy backbone…and lack the capacity to find common ground between policy-makers and private sector.”  Suggesting partnerships with the private sector as the best way forward, with no evidence of efficacy.

If governments are to be in the drivers seat they need a clear assessment of the national situation based on hard data, with goals, a clear strategy (hopefully including good laws to protect breastfeeding)  and careful consideration of whether and what role private sector should play in its implementation. Finding ‘Common ground’ with the private sector – especially on regulatory issues – seems unlikely to us.

Since bad diets are one of the biggest causes of death and disease, WHO should remind Member States there is no time to waste. Incremental changes, self-regulation and monitoring according to industry’s criteria will be simply inadequate.

The power exerted by rich producer nations when global trading standards are set at Codex is evident. Developing countries advocating WHO recommendations are overlooked and WHO is increasingly called on to defend their integration.

Not surprisingly the analysis of WHO’s Global Coordinating Mechanism  “finds the effectiveness of the activities and outputs.. to be MODEST.”  Similarly, after over 10 years, the European Commission’s Platform for Action on Diet Physical Activity and Health shows no evidence of real effect. Meetings are now reduced from 4 to 2 per year. Is this a   sign of disenchantment with multi-stakeholder initiatives involving corporations?  Surely better to work with with town planners, small farmers and public health experts.

 

Agenda Item: 4.6.1 Comprehensive implementation plan on maternal, infant and young child nutrition: biennial report

Implementing supports for breastfeeding is vital for progress in carrying out the comprehensive plan. Progress remains slow with only 40% of infants under 6 mo exclusively breastfed. Thus 60% are not meeting the recommendations of the WHO GS for IYCF. Additionally we are concerned that sustained breastfeeding to 2 y or beyond is not included in the global target. IBFAN’s World Breastfeedin Trends Initiative which tracks policies and practices in over 84 countries to date reports an average rate of breastfeeding initiation within the 1st hour at just above 50%. Exclusive breastfeeding for the first 6 months to be 38%, and the median duration of breastfeeding to be 15.5 months.
On policies that are needed to support mothers, IBFAN’s monitoring found that only 21 out of 84 countries have a policy that includes infant feeding
in emergencies yet this need is increasing. Of 84 countries only 10% provide more than 26 weeks of maternity leave. Women in the informal sector, which form 90% of the world’s working women, have no maternity protection. Only 46 countries reported having some breastfeeding and child care facilities at work. For the elimination of commercial interference in IYCF through the implementation of the International Code, IBFAN since 2015 has worked with 77 countries on implementing some or all of its provisions and of 2016, 40 countries have implemented most of the Code. We are pleased to have worked with recent entrants – Armenia, Bolivia, Kosovo, Kuwait and Vietnam and have witnessed the opposition from baby food industries in their struggle to achieve this. Additionally another 31 have partially implemented the Code and 56 others, including EU members only some aspects as regulations, while 12 have voluntary measures. IBFAN does have concerns regarding the proposed revisions to the BFHI, however we are pleased that WHO has increased work on Code implementation through NETCODE and to make significant contributions to its independent monitoring work.

Agenda Item EB 4.6 Safeguarding against possible conflicts of interest in nutrition programmes (EB142/23) CLICK HERE for PDF

Since the first WHA resolution on CoI in 1996, IBFAN has worked on preventing and managing conflicts of interest in the nutrition arena.

We maintain that WHO’s CoI guidance is problematic because it is not based on legal definitions of conflicts of interest which refer to conflicts within a person or an institution, between their OBLIGATIONS (e.g. WHO constitutional mandate, roles and functions), and secondary interests (e.g. gaining access to funding). They are NOT conflicts between actors who have diverging interests.  If WHO does not correct this definition the institution’s integrity, independence and trustworthiness will be endangered.

The approach also introduces a problematic engagement typology, and folds “integrity” into a cost-benefit analysis. Any concern about integrity is thus likely to be overwhelmed by arguments about potential benefits.

The implementation of the proposed Approach will lead to a harmful redefinition of CoI at national level, an increase of financial CoI, and a weakening of any existing national safeguards. It will promote the development of measures that increase rather than reduce risks of conflicts of interest and undue influences, in particular by commercial corporate actors and venture philanthropies, on policy decisions and programme implementation. It will add to the confusion created by FENSA and the Scaling up Nutrition’s CoI guidance, and undermine government’s efforts to build effective CoI safeguards in the area of nutrition.

IBFAN calls on the EB to request WHO to:

  • correct the CoI concept, the ‘engagement’ typology and clearly distinguish between CoI assessment and risk assessment;
  • undertake a thorough review of this Approach by Legal CoI experts and public discussion of the findings;

Finally, IBFAN hopes that the EB will not simply note the Draft Approach

Agenda Item EB 28/29 Engagement with non-State actors (FENSA)

Alessia Bigi reading the IBFAN statement on FENSA at 19.40 Friday 26th January

This is an important agenda item – quite short – so worth listening to the whole thing. – webcast on the debate on Non State Actors  (move to 35.00.00)    Dr Tedros’ concluding remarks – (move to 35 minutes)  mirror the US position that being ‘risk averse’ is dangerous for WHO and that it is better to  just manage COI. However he also  talks about the need to regulate.   The US intervention   is at  19.14.00  – urging  neither a “risk averse nor cavalier approach”   The intervention from   India is at 20.00.00. IBFAN  at  22.55.00  followed by Medicus Mundi/People’s Health Movement and ThirdWorld Network.

This statement was delivered by Alessia Bigi at the very end of Friday 26th move to 22.50.00    CLICK HERE

IBFAN and many other public interest NGOs have consistently expressed concerns about the unresolved conceptual problems of FENSA, whose COI definitions mirror the flaws in Sun’s Guidance on Conflicts of Interest. SUN confuses conflicts of interest with disagreements and differences, depending on Trust and Collaboration rather than caution.

Not wanting to repeat concerns expressed in other agenda items, we look forward to FENSA being opened up to public and expert input and scrutiny in the initial evaluation due in 2019.

FENSA follows decades – long debates about how WHO should appropriately approach its engagements with the private sector, and in particular with public-private hybrid entities. OECD COI Guidelines describe sponsorships and lobbying as particular “at risk areas” for conflicts of interest – yet these issues are woefully absent.

As we feared, the Non-State Actors (NSA) terminology is creating many problems, as is the lack of due diligence in the approval of NSA Official Relations applications.

Providing different colour badges for NSA types would be at least one step towards transparency. Similarly, all participants, including those with public badges, should be listed. In what appears to be a growing trend, Senior members of ISDI – an NSA that lost its Official Relations status in 2013 – are attending this EB. At the Codex meeting in December – dozens of industry representatives (far more than in the official ISDI delegation) attended with Public Badges and were not listed. We urge Member States to ensure their delegations to WHO and Codex are free from commercial influence.

We welcome the assurances given by Dr Tedros and Dr Axelrod that WHOwill be safeguarded. In order to achieve this, we urgently suggest that WHO enlists COI experts to correct the wrong COi conceptualization in FENSA. If a corrected version could be ready by the forthcoming WHA, MS would then more safely proceed with COI in nutrition.

Statement from Medicus Mundi/People’s Health Movement and Third World Network

Thank you Chair, MMI appreciates this opportunity to speak on agenda 5.5. The statement is supported by TWN and PHM.

We thank the Secretariat for the reports. We would like to underline the importance of making available reports that are both comprehensive and detailed, to facilitate an informed discussion regarding implementation of FENSA. We thank the Secretariat for expanding the amount of information being provided. Nonetheless there is still scope for enhancing the quality of information provided. There is an urgent need to provide detailed information in areas such as the number of engagement in each category of engagements; and the details of secondments — including the rank and position of personnel seconded from NSAs to WHO.

We want to express the concern that Para 13 of FENSA which deals with the identification of NSAs which are not at arm’s length with the private sector, is yet to be implemented. Further, a perusal of the Guide on FENSA developed for WHO staff indicates that a comprehensive policy on Conflict of Interest is yet to be developed by WHO. We call upon the Secretariat to develop a comprehensive COI policy, which is crucial for implementation of FENSA.

Finally, we wish to express our concern on the participation of entities linked to the alcohol industry at WHO’s Global Conference on NCDs in October 2017. Further, we also wish to express similar concerns regarding links to industry, related to the co-chair of the civil society Working Group for the third High-level Meeting of the UN General Assembly on NCDs in 2018. We call upon the Secretariat to take steps to protect WHO’s integrity and credibility.

 


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