Eight World Health Assembly Resolutions have called for Conflict of Interest Safeguards in infant and young child feeding since 1996. (the other resolutions are HERE) The Global Strategy for Infant and Young Child Feeding in 2003 outlines the two clear roles for industry. 

Baby Milk Action is a founding member of the  Conflicts of Interest Coalition  launched at the UN General Assembly on NCDs  in 2011.  Click Here for the Statement and list of 162 organisations representing over 2000 NGOs who endorse it.

For an overview of key issues  see this IBFAN Press Conference  Health governance in the public interest? WHO redefines conflicts of interest and risks undermining public health mandates

Conflicts of interest in the  NEWS:

Abstract
Objectives Professional paediatrics associations play
an important role in promoting the highest standard of
care for women and children. Education and guidelines
must be made in the best interests of patients. Given the
importance of breastfeeding for the health, development
and survival of infants, children and mothers, paediatric
associations have a particular responsibility to avoid
conflicts of interest with companies that manufacture
breast-milk substitutes (BMSs). The objective of this
study was to investigate the extent to which national and
regional paediatric associations are sponsored by BMS
companies.

Conflict of interest and the infant formula industry—a call to action

____________

Risk of bias and conflict of interest in clinical trials of infant formula

https://colloquium2019.cochrane.org/abstracts/risk-bias-and-conflict-interest-clinical-trials-infant-formula

Conclusions: in a comprehensive analysis of a field of research characterized by high levels of conflict of interest, RoB 2 reliably identified issues with selective reporting……Concerns [expressed] at the possibility that trial results may be subject to bias due to methodological errors or commercial interests.

____________________
Conflict of interest in systematic reviews and its implications for public
health policyRADHA HOLLA BHAR, DENNY JOHN

BMJ ends formula milk adverts

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1200 (Published 18 March 2019)

Royal College of Paediatrics and Child Health (RCPCH) statement on sponsorship   15/4/19

Commercial interests, transparency, and independence: a call for submissions.  Help the move towards independence from commercial interests. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1706 (Published 16 April 2019)https://www.bmj.com/content/365/bmj.l1706

Comments on the Scaling Up Nutrition Initiative:

SUN Spotlight_2019

SUN-GAIN-2014

SUN IBFAN 28.11.122

Multistakeholderism

They Call It Multistakeholderism. Where Does That Leave the UN?   

https://www.passblue.com/2019/09/02/they-call-it-multistakeholderism-where-does-that-leave-the-un/

See also:

the World Public Health Nutrition Association (WPHNA)  website  documents and reports on conflicts of interest in public health nutrition policymaking, program delivery and research. https://wphna.org/conflict-of-interest/

Concerns about the role of businesses in Scaling Up Nutrition (SUN)

Action to protect the independence and integrity of global health research  Storeng KT, et al. BMJ Global Health 2019;4:e001746. doi:10.1136/bmjgh-2019-001746

ConclusionFunding & Political CoIs biasing Global Research BMJgh 2019 e001746

The tensions between research ethics and the wider politics of the global health field are increasingly recognised. However, the repercussions of these tensions for individuals and research institutions need careful consideration. While ‘rocking the boat’ is uncomfortable and may threaten individual career progression and research institutions’ external income, biased evidence can harm health programme beneficiaries and public trust in research. There are certainly no simple, fail-safe, technocratic quick fixes to resolving issues of power and politics, but the ideas proposed here should at least create better relationships between the institutions involved in commissioning, undertaking and publishing research, and feed into more sophisticated and thoughtful mechanisms of accountability, which do not simply re-enforce existing frameworks that favour accountability towards donors. The ideas we propose should be considered within broader discussions on how to address north–south power imbalances within the research community, and will hopefully catalyse wider action on protecting the independence of public universities and other research institutions globally. We believe this is necessary to enable researchers to hold power to account and advance informed and healthy debate on issues of public interest.

WHA Resolutions:

1996 WHA Res  49.15:  Preambular para: “Concerned that health institutions and ministries may be subject to subtle pressure to accept, inappropriately, financial or other support for professional training in infant and child health”…urged Member States:….(2) to ensure that the financial support for professionals working in infant and young child health does not create conflicts of interest, especially with regard to the WHO/UNICEF Baby Friendly Hospital Initiative; (3) to ensure that monitoring the application of the International Code and subsequent relevant resolutions is carried out in a transparent, independent manner, free from commercial influence;  http://www.who.int/nutrition/topics/WHA49.15_iycn_en.pdf?ua=1

2001 WHA Res 54.2  2.    REQUESTS the Director-General: (2) to foster, with all relevant sectors of society, a constructive and transparent dialogue in order to monitor progress towards implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant Health Assembly resolutions, in an independent manner and free from commercial influence, and to provide support to Member States in their efforts to monitor implementation of the Code;

2002 WHA Res 55.25: “CALLS UPON other international organizations and bodies, in particular ILO, FAO, UNICEF, UNHCR, UNFPA and UNAIDS, to give high priority, within their respective mandates and programmes and consistent with guidelines on conflict of interest……”http://www.who.int/nutrition/topics/WHA55.25_iycn_en.pdf?ua=1

2003 Global Strategy for Infant and Young Child Feeding outlines the two – and only two – roles for companies in relation to infant feeding.    Paragraph 44 Commercial enterprises:
“Manufacturers and distributors of industrially processed foods intended for infants and young children also have a constructive role to play in achieving the aim of this strategy. They should ensure that processed food products for infants and children, when sold, meet applicable Codex Alimentarius standards and the Codex Code of Hygienic Practice for Foods for Infants and Children. In addition, all manufacturers and distributors of products within the scope of the International Code of Marketing of Breast-milk Substitutes, including feeding bottles and teats, are responsible for monitoring their marketing practices according to the principles and aim of the Code. They should ensure that their conduct at every level conforms to the Code, subsequent relevant Health Assembly resolutions, and national measures that have been adopted to give effect to both.”


2004  WHA Res  57.17  Global Strategy on Diet, Physical Activity and Health 
5. REQUESTS the Director-General: (6) to cooperate with civil society and with public and private stakeholders committed to reducing the risks of noncommunicable diseases in implementing the Strategy and promoting healthy diet and physical activity, while ensuring avoidance of potential conflicts of interest;

2005  WHA Res 58.32:  urged Member States: “to ensure that financial support and other incentives for programmes and health professionals working in infant and young child health do not create conflicts of interest”  

http://www.who.int/nutrition/topics/WHA58.32_iycn_en.pdf?ua=1

2012  WHA Res 65.6 urged Member States to implement a plan “establishing a dialogue with relevant national and international parties and forming alliances and partnerships to expand nutrition actions with the establishment of adequate mechanisms to safeguard against potential conflicts of interest”   http://www.who.int/nutrition/topics/WHA65.6_resolution_en.pdf?ua=1

2014 WHA Res 67(9) requested the Director-General to convene informal consultations with Member States2 to complete the work, before the end of 2015, on risk assessment and management tools for conflicts of interest in nutrition, for consideration by Member States at the Sixty-ninth World Health Assembly;  http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_DIV3-en.pdf?ua=1&ua=1

2016 WHA Res 69/9 welcomed with appreciation the WHO Guidance on ending inappropriate marketing of foods for infants and young children (WHA 69/7 Add1)  whose Recommendation 6 stated that: “Companies that market foods for infants and young children should not create conflicts of interest in health facilities or throughout health systems. Health workers, health systems, health professional associations and nongovernmental organizations should likewise avoid such conflicts of interest.” http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_7Add1-en.pdf?ua=1

16. Recommendation 6. Companies that market foods for infants and young children should not create conflicts of interest in health facilities or throughout health systems. Health workers, health systems, health professional associations and nongovernmental organizations should likewise avoid such conflicts of interest. Such companies, or their representatives, should not:

• provide free products, samples or reduced-price foods for infants or young children to families through health workers or health facilities, except:

– as supplies distributed through officially sanctioned health programmes. Products distributed in such programmes should not display company brands;

• donate or distribute equipment or services to health facilities;

• give gifts or incentives to health care staff;

• use health facilities to host events, contests or campaigns;

• give any gifts or coupons to parents, caregivers and families;

• directly or indirectly provide education to parents and other caregivers on infant and young child feeding in health facilities;

• provide any information for health workers other than that which is scientific and factual;

• sponsor meetings of health professionals and scientific meetings.

17. Likewise, health workers, health systems, health professional associations and nongovernmental organizations should not:

• accept free products, samples or reduced-price foods for infants or young children from companies, except:

– as supplies distributed through officially sanctioned health programmes. Products distributed in such programmes should not display company brands;

• accept equipment or services from companies that market foods for infants and young children

• accept gifts or incentives from such companies;

• allow health facilities to be used for commercial events, contests or campaigns;

• allow companies that market foods for infants and young children to distribute any gifts or coupons to parents, caregivers and families through health facilities;

• allow such companies to directly or indirectly provide education in health facilities to parents and other caregivers;

• allow such companies to sponsor meetings of health professionals and scientific meetings.

What is a Conflict of Interest?

‘[Individual] conflicts of interest are defined as circumstances that create a risk that professional judgments or actions regarding a primary interest will be unduly influenced by a secondary interest.’

‘Institutional conflicts of interest arise when an institution’s own financial interest or those of its senior officials pose risks of undue influence on decisions involving the institution’s primary interests.’ 

1  Lo, B. and M. Field, Inst of Med. (US) Committee on Conflict of Interest in Medical Research, Education and Practice, Eds. (2009) Conflict of interest in medical research, education and practice. Washington DC, National Academics Press, cf.

Find useful links and background information below.

Click on the Conflicts of Interest tag for blog posts on this topic.

Click here for the Alliance Against Conflicts of Interest in India http://www.aaci-india.org

CLICK HERE for a link to papers relating to IBFAN’s capacity-building conference on COI Dec 2015

CLICK HERE for  a paper by Judith Richter on Conflicts of Interest and Nutrition Governance

Articles on Philanthrocapitalism

 Birn, A.-E. & J. Richter (2018). U.S. Philanthrocapitalism and the Global Health Agenda: The Rockefeller and Gates Foundations, Past and Present. Health Care under the Knife:  Moving Beyond Capitalism for Our Health. eds. Howard Waitzkin and the Working Group for Health Beyond Capitalism, Monthly Review Press 
The advance English chapter can e accessed under e.g.: http://www.peah.it/2017/05/4019/ or 
 Curtis reference in the Birn-Richter paper.
Curtis, M. (2016). Gated development: is the Gates Foundation always a force for good? London, Global Justice Now.

http://www.aaci-india.org/doc/JRIchter_2016_05_IBFAN_CoI_and_nutrition_governance_FINAL_ANNOTATED.pdf

Valente, F. (2016). “Nutrition and food – how government for and by the people became government for and by the TNCs.” TNI.

https://www.tni.org/en/article/nutrition-and-food-how-government-for-and-of-the-people-became-government-for-and-by-the

Richter, J. (2014). “Time to turn the tide: WHO’s engagement with non-State actors & the politics of stakeholder-governance and conflicts of interest.” Rapid response to BMJ online letter by Nigel Hawkes, ‘Irrelevant’ WHO outpaced by younger rivals d5012 (Title of Hawkes’s BMJ print feature article: Will WHO reforms open the doors to private donors? http://www.bmj.com/content/348/bmj.g3351/rapid-responses

Birn, A.-E. J. Richter  (Forthcoming 2017). U.S. Philanthrocapitalism and the Global Health Agenda: The Rockefeller and Gates Foundations, Past and Present. Health Care under the Knife:  Moving Beyond Capitalism for Our Health. eds. Howard Waitzkin and the Working Group for Health Beyond Capitalism, Monthly Review Press

Posted in May on http://www.peah.it/2017/05/4019/

also posted 6 June 2017 by Oslo Academy of Global Governance

http://www.uio.no/english/research/interfaculty-research-areas/globalgov/globalgov-for-health/news-and-events/news/2017/us-philanthrocapitalism.html

Attempts to Redefine Conflict of Interest.  Accountability in Research.

December 6, 2017.  Marc A. Rodwin.    DOI: 10.1080/08989621.2017.1405728  English version  HERE    French version: HERE

Abstract: The traditional legal concept of conflict of interest is a practical tool to regulate conduct. In recent years several medical authors have defined conflicts of interest in ways that stray from its original legal meaning. The new definitions cause conceptual confusion and will result in policies that cannot be implemented effectively. Recent attempts to redefine conflicts of interest  deviate from the legal concept and will lead to deregulation of financial conflicts and overregulation of so-called intellectual conflicts.

New articles:

Philanthrocapitalism:

http://www.isags-unasur.org/uploads/eventos/ev[3814]ling[3]anx[951].pdf

Book by Jonathan Marks: The Perils of Partnership: Industry Influence, Institutional Integrity, and Public Health” (OUP, 2019)

see also: Partnerships and the opioid crisis:

Dialogue or engineering of consent? Opportunities and risks of talking to industry. Judith Richter