CONFLICTS OF INTEREST – THE INTERNATIONAL CODE  AND RESOLUTIONS

Compilation on Multi Stakeholder Parterships: SUN, GAIN, N4G etc

How Conflicts of Interest affect policy setting

In 2000, our exposé of the COI  in the EU’s Scientific Committee for Food  (SCF), backed by Glenys Kinnock MEP and 50 NGOs,  prompted the European Commission to bring in rules on transparency and Conflict of Interest.  The SCF was closed down and replaced by the European Food Safety Authority (EFSA) with the aim of  protecting EU scientific advice from commercial and political influence.

Clamour for action to bolster Union scientists’ credibility. European.Voice. Renée Cordes, Jan 2000 vol 6.no.2.

Scientists bow to call for more transparency.,  European Voice, Renée Cordes, 16-22 March, 2000, Vol 6, No 11.

Click here for a chronology of our work to improve legislation in Europe.

The need for sound information on infant and young child feeding is at the heart of the International Code of Marketing of Breastmilk Substitutes  and the 19  World Health Assembly  Resolutions that have been passed since 1981.   Since 1996, eight Resolutions have specifically called for Conflict of Interest safeguards and  Paragraph 44 of the 2003  Global Strategy for Infant and Young Child Feeding also outlined the two clear roles for industry. (Page right down to see the texts).

Baby Milk Action is a founding member of the  Conflicts of Interest Coalition  launched at the UN General Assembly on NCDs  in 2011. The Statement is endorsed by 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.

Some useful resources:

RESOURCES ON CONFLICT OF INTEREST AND CORPORATE INFLUENCE ON PUBLIC HEALTH. CoI, Ethics, Commercial Determinants of Health and Industry Interference on Public Health.  https://www.wphna.org/resources

2021.15.2.21.Australia MSH world

IBFAN Africa 16.11.21

2021.30.6.21. N4G-GBC

IBFAN comments on a WHO Private Sector interactions. IBFAN NCD Tool FINAL

Excerpt from UNICEF_Webinar_1_Industry_Interference

7 Is any of this relevant to undernutrition and related policy-making?

UNICEF has long engaged with the salt industry, cereal flour industry and cooking oil industry as
key partners in implementing large-scale food fortification to tackle micronutrient deficiencies in children and women. But other food industry actors – such as manufacturers of ultra-processed foods, breastmilk substitutes (BMS), follow-on formula and growing-up milks – are also trying to gain influence by positioning themselves as partners in solving undernutrition through multi-stakeholder platforms and orgnaizations such as the SUN Business Network and GAIN. This is problematic because through these platforms and organizations, manufacturers position their products as part of the solution (e.g., fortified packaged noodles or cookies), and keep the focus on undernutrition and short-term, medicalized and product-based solutions to malnutrition rather than responding to all forms of malnutrition through regulations that ensure nutritious, safe, affordable and sustainable diets. Furthermore, they gain a seat at the policy table and are then able to influence the policy debate not just for undernutrition, but all forms of malnutrition. Over the last decades, they have leveraged this influence to shift the focus of undernutrition policy away from conflicts of interest, and take advantage of multi-stakeholder platforms to further their interests.

These companies’ products are ultra-processed and can contribute to overweight and obesity (e.g., many growing-up milks have almost the same sugar content as soda). The increased availability of ultra-processed foods and beverages in settings with child malnutrition increasingly replaces traditional foods and as such decreases dietary diversity and micronutrient intake, which contributes both to undernutrition and overweight/obesity. Additionally, the promotion of BMS discourages breastfeeding – a life-saving practice with life-long positive health impacts for children, including reducing their risk of overweight and obesity.

Alarm over WHO Foundation ‘Thank you’ to Nestle

Exclusive: WHO Foundation pushes back against criticism over Nestlé donation By Jenny Lei Ravelo // 15 April 2021https://www.devex.com/news/exclusive-who-foundation-pushes-back-against-criticism-over-nestle-donation-99656

Vandana Shiva on Bill Gates: https://twitter.com/ronin19217435/status/1580660491751665664?s=20&t=PJpMMfNtIdZrAK6arVQHew Vandana Shiva on Gates

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For a completely different take on  Private Sector solutions to global health see this interview with Leith Greenslade,  Co-Chair of the Child Health Pillar at the MDG Health Alliance at the 2012 GBC Health Conference and Dinner. Greenslade discusses the importance of cross-sector efforts, particularly in maternal and child health. CLICK HERE 

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Guidelines for implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control on the protection of public health policies with respect to tobacco control from commercial and other vested interests of the tobacco industry.FTCT GUidelines

Compilation by Constance Ching. CONFLICTS OF INTEREST & UNDUE INFLUENCE ASSOCIATED WITH THE BABY FOOD INDUSTR

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.

Conflicts of interest in the  NEWS:

95% of Committee Members Advising on U.S. Dietary Guidelines Had Ties to Big Pharma, Big Food

The Defender – Children’s Health Defence. 03/24/22 Michael Nevradakis, Ph.D.

Describing their findings as “particularly worrisome,” the authors of a study published Monday in Public Health Nutrition noted that in the U.S., the Dietary Guidelines for Americans form “the foundation for all national nutrition programs,” which amount to nearly $100 billion annually.

95% of Committee Members Advising on U.S. Dietary Guidelines Had Ties to Big Pharma, Big Food

Alarm over WHO Foundation ‘Thank you’ to Nestle

Exclusive: WHO Foundation pushes back against criticism over Nestlé donation By Jenny Lei Ravelo // 15 April 2021 https://www.devex.com/news/exclusive-who-foundation-pushes-back-against-criticism-over-nestle-donation-99656

COI in Health Professional bodies

BMJ ends formula milk adverts

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

The BMJ and our sister journals will no longer carry ads for breastmilk substitutes

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

Articles about Gates

How McKinsey infiltrated the world of global public health. The Gates Foundation brought billions of dollars to the sector — and a business-friendly ethos consultants could exploit. By Julia Belluz and Marine Buissonniere Dec 13, 2019, 9:10am EST

https://www.vox.com/science-and-health/2019/12/13/21004456/bill-gates-mckinsey-global-public-health-bcg

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.

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

Philanthrocapitalism

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

 Useful Human Rights articles

ETOs and the Code_Feb 2018

Discussion paper, February 2018 The Maastricht Principles on Extraterritorial Obligations of States in the Area of Economic, Social and Cultural Rights and the International Code of Marketing of Breastmilk Substitutes
1.

WHA Resolutions on Conflicts of Interest:

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” 3.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;  https://apps.who.int/iris/bitstream/handle/10665/179437/WHA49_R15_eng.pdf?sequence=1&isAllowed=yhttp://www.who.int/nutrition/topics/WHA49.15_iycn_en.pdf?ua=1

2001 WHA Res 54.2  3.2.    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; 

2(10) to recognize and assess the available scientific evidence on the balance of risk of HIV
transmission through breastfeeding compared with the risk of not breastfeeding, and the need
for independent research in this connection; to strive to ensure adequate nutrition of infants of
HIV-positive mothers; to increase accessibility to voluntary and confidential counselling and
testing so as to facilitate the provision of information and informed decision-making; and to
recognize that when replacement feeding is acceptable, feasible, affordable, sustainable and
safe, avoidance of all breastfeeding by HIV-positive women is recommended; otherwise,
exclusive breastfeeding is recommended during the first months of life; and that those who
choose other options should be encouraged to use them free from commercial influences

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…   This Resolution also urges Member States (4) “to ensure that the introduction of micronutrient interventions and the marketing of nutritional supplements do not replace, or undermine support for the sustainable practice of, exclusive breastfeeding and optimal complementary feeding.”  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: 1.4  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” https://apps.who.int/iris/bitstream/handle/10665/20382/WHA58_32-en.pdf?sequence=1&isAllowed=y

1.5 (5) “to ensure that research on infant and young child feeding, which may form the basis for
public policies, always contains a declaration relating to conflicts of interest and is subject to
independent peer review.”

2010 WHA 63.23 urged Member States to: “end inappropriate promotion of food for infants and young children and to ensure that nutrition and health claims shall not be permitted for foods for infants and young children,
except where specifically provided for, in relevant Codex Alimentarius standards or national  legislation”.

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)

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.

Short compilations of resolutions up to  2018  can be found  here and here.

Private vs Public Health care