The US screws with WHO's mission

I've spent some time here (old site, here, here, here, here and here) explaining WHO's place in the international system. It explains certain things I thought important to understand.

An important part of the international "system" (Westphalian-style) is there is no official authority over sovereign nation states. That means that power politics operates, sometimes quietly, sometimes nakedly. WHO is not immune. A shocking case in point relates to some highly questionable decisions made by the late WHO Director General, Dr. Lee Jong-wook. It is awkward to bring this up in the wake of his tragic sudden death. But again, if we are to understand WHO, we must do so. It would be a mistake to think this characterizes all of WHO any more than the official International Health Regulations do. It is a complex intergovernmental organization operating in a rugged political landscape.

But it is also part of WHO reality.

The story is detailed in a long article from Asia Times Online, emerging as a courageous and in-depth source of information about the many countries in that part of the world. Some of this has also been discussed in The Huffington Post, where I picked it up. The focus is Thailand, a southeast asian hotspot for avian influenza that also has many other problems, especially HIV/AIDS.

The Asia Times story shows that Dr. Lee, at the time of his death, was doing a pretty good job of carrying water for the US government and US corporate interests. The issue was the clash between so-called intellectual property rights (not property in any ordinary sense of the word) and the need for affordable and effective HIV/AIDS medications for the people of poor countries like Thailand. The World Trade Organization (WTO) has explicit provisions allowing states to by-pass patent and licensing in the event of a national emergency.

Here is the gist of the issue, as told by an Asia Times Online investigative report:

An Asia Times Online investigation reveals that at the time of his death, Lee, a South Korean national, had closely aligned himself with the US government and by association US corporate interests, often to the detriment of the WHO's most vital commitments and positions, including its current drive to promote the production and marketing of affordable generic antiretroviral drugs for millions of poor infected with the human immunodeficiency virus (HIV), which can cause AIDS.

According to senior and middle-ranking WHO officials familiar with the situation, Lee blatantly bent to US government pressure in March when he made the controversial decision to recall the WHO country representative to Thailand, William Aldis, who had served less than 16 months in what traditionally has been a four-year or longer posting.

Aldis had made the mistake of penning a critical opinion piece in the Bangkok Post newspaper in February that argued in consonance with WHO positions that Thailand should carefully consider before surrendering its sovereign right to produce or import generic life-saving medicines as allowed by the World Trade Organization (WTO) in exchange for a bilateral free-trade agreement (FTA) with the United States, which is currently under negotiation.

The WHO official also wrote that the stricter intellectual-property protection measures in the proposed US-Thai FTA would inevitably lead to higher drug prices and thereby jeopardize the lives of "hundreds of thousands" of Thai citizens who now depend on access to locally produced cheap medicines to survive. He noted too that the Thai government's current production of generic treatments had allowed the country to reduce AIDS-related deaths by a whopping 79%.

Aldis' arguments directly mirrored stated WHO positions, but significantly were at direct odds with the objectives of current US trade policy, which through the establishment of bilateral FTAs aims to bind signatory countries into extending their national intellectual-property legislation far beyond the parameters of current WTO agreed standards.

A recent US Congressional Research Service report states that the United States' main purpose for pursuing bilateral FTAs is to advance US intellectual-property protection rather than promoting more free trade. The Bipartisan Trade Promotion Authority Act of 2002, the applicable US legislation for bilateral FTAs, states explicitly that Trade-Related Intellectual Property Standards, or TRIPS, are by law non-negotiable and must reflect a standard of protection similar to that found in US law. (ATol)

Dr. Lee received a visit from the US ambassador to the UN in Geneva on March 23 where he was said to have gotten an earful about the Bush Administration's upset over Aldis's newspaper commentary. On March 24, Aldis was recalled. The action was considered unusual even by WHO standards and to have crossed a line of interference by a member state in a WHO personnel decision. It is also suggested to ATol by some WHO personnel who wished to remain anonymous that it was meant as a signal to other international civil servants that they better not piss off the US by commenting publicly on US trade-polilcy that might conflict with WHO global health objectives. Many WHO staffers have only 11 month appointments. It is not a lifetime tenure. Aldis is an American whose private views of the Bush administration are said to be acerbic. I suspect they have not improved as a result of this episode.

Aldis reportedly chafed at WHO regional headquarters' instructions to receive representatives from US corporations and introduce them to senior Thai government officials to whom the private company representatives hoped to sell big-ticket projects and products.

In recent months, major US companies such as pharmaceutical giant Pfizer and technology company IBM have asked the WHO in Thailand to facilitate access to senior Thai officials. In turn, some senior WHO staff members have expressed their concerns about a possible conflict of interests, as the requested appointments were notably not related to any ongoing WHO technical-assistance program with the Thai government.

The US had already threatened to withhold funding in 1998 over WHO monitoring of trade agreements affecting public health, so this was also a problem in the Clinton administration, too. The Bush idea was to have the Thai - US bilateral FTA serve as a template for other bilaterial agreements. Aldis was mucking things up.

There is a lot in the ATol article, which I urge everyone to read, but two things seem clear to me about this. Dr. Lee behaved with less courage than is expected of a WHO Director General. And there are many in WHO who objected and pushed back.

These are grounds for both despair and hope. We should watch carefully who the US supports for next DG. That will be a clue (but not proof) the person is suspect. We should also do everything in our power to publicize the interference with WHO decisions by powerful states like the US so as to make this an issue with the selection of the next WHO leader.

The will is there in WHO. It needs the leadership to match it.


More like this

As promised, we have the full slate (13) of those running for Director General of the World Health Organization: Dr. Kazem Behbehani (Kuwait); Dr. Margaret Chan (China); Dr. Julio Frenk (Mexico); David Gunnarsson (Iceland); Dr. Nay Htun (Myanmar); Dr. Karam Karam (Syria); Dr. Bernard Kouchner (…
By Mary Carol Jennings In the setting of the upcoming elections, my Senator, Jim DeMint, recently wrote a letter of opinion to the Washington Times opposing a global HIV/AIDS, tuberculosis and malaria bill that will provide life-saving medications and prevention against infectious disease in the…
Thailand wants to provide free medicines for drugs and heart disease to its poorest citizens. That sounds good to me. Apparently my government doesn't agree: Thailand's Public Health Minister said U.S. trade officials didn't relent on their opposition to his plan to copy drugs made by companies…
Chapters of Universities Allied for Essential Medicines (UAEM) are pushing their local universities to sign Equitable Access Licenses (EAL) that would lift patent barriers on drugs developed by university labs. These agreements would effectively increase the access of medicines to poor countries…

Aha! The deep corruption oozes to the surface!

Thanks for bringing this to our attention. It is sad but not surprising that the U.S. government would coerce an international health organization to advance private profit.

A philosophy of "private gain at all costs" seems to underlie every action and policy of the current party in power (the corporate/war party, I mean). They no longer even make a pretense of advancing the "free market"; naked predation is the order of the day.

Thanks for digging up this bit of proof!

We need more such exposes. But where are the U.S. media? The average American citizen (and the citizens of other western nations) need to hear how their governments attempt to corrupt the mandates of such international bodies and routinely put corporate interests ahead of public interests (and ultimately their own citizens' interests) in their dealings in the international arena.

Recently, for example, many Canadians were outraged to learn about our own government's disagraceful behaviour, in concert with multinational corporations, in trying to subvert international efforts to protect Third World peasant farmers from so-called "terminator seeds".

This also goes to show the need for health professionals and others who care about health and well-being to keep close tabs on the bilateral Free Trade Agreements currently being imposed by the U.S. in Thailand, South Korea, etc. Organized opposition from the public health community in the U.S., in particular, may help prevent the passage of some of the more atrocious measures. South Korean civil society has been mobilizing mass protests to oppose the FTA with the U.S., including the public health community, which released a statement of opposition: See for additional info.

I have commented before in these threads, and elsewhere, on the importance of the DG's role within the WHO - particularly as stated in IHR(2005) - and the flexibility of interpretation given to a bold DG. I have also written to the Gates Foundation in an attempt to persuade them that, with the threat of a pandemic, now might be a good time to use their lobbying power to persuade a heavy weight with international, rather than healthcare, credentials to take the post for a short term to set precedent in the WHOs dealings with the nation states. A strong DGs legacy would be to have been instrumental in saving many lives and the creation of a precedent to the benefit of all their successors. This shift in the status quo would be to the foundations and our long term benefit in dealing with healthcare problems globally. e

Sledge Hammers, nuts and silver linings.

In the series of essays the reveres wrote they dated the structural weakness of the UN and WHO back to the treaty of Westphalia in 1648. This was a codifying of international relations reached at the end of the Thirty Years War (1618 1648). This was an appalling pan-european conflict with horrendous mortality (~30%) and no clear victor.

I would like to take you back even further to 1066 the time of the Norman Conquest. The Normans invaded England and as conquers imposed a new system of governance. To calculate the tax they could levy they performed a detailed census of people, property & livestock which was compiled into the Domesday Book and instituted a feudal system of governance. Under feudalism the Norman King owned everything, he appointed Barons with grants of land and everything on that land and the peasants were a captive workforce indentured to the Baron and through him to the King. This system continued without major change until the Black Death (1347 1351). This pandemic (they were a little short of epidemiologists at the time but possibly caused by Bubonic plague) killed about 30% of the population and left the land owners with a shortage of peasants. Up until this point peasants were chattel and not free to leave their masters land, it was not in the interests of other landowners to poach workers as the precedent could work both ways. The labour shortage caused a shift from a feudal and principally barter based economy to a more mobile cash based system with property ownership descending further down the social scale.

The aim of all this historical rambling is to show that events with global impact, principally wars and pandemics, have profound changes to social structures. The changes induced by the 1918 pandemic are difficult to detect as they have been subsumed into those of WW1 but the global impact of the combined event are legion.

Sledge hammers, nuts & silver linings: all of the above is a preamble to the consideration of the impact on society of another major event. Major wars tend to be between nation states and leave an even greater feeling of us & them. The aftermath is likely to cause polarisation along state or block lines with some mediation mechanism - be it the treaty of Westphalia, The League of Nations or the UN. But what of conflicts where us is humanity as a whole and they are aliens? In what direction might that impact propel us? Could it lead to a restructuring of our world view and humanities role in it? Might it make us realise that we can not see the wood for the trees and that it is in our best interest to research and develop vax plants for all, accept limitations of sovereignty for the benefit of all, view disease prevention, global warming, over fishing, water resources et al from a global humanitarian perspective rather than some arbitrary parochial view? Could a pandemic crack this nut and have a silver lining albeit at a horrific cost.

Apparently the Bush administration is aggressive enough on this issue to have intimidated Lee Jong-wook. But under a pseudonym, Revere is bold enough to fight it.

Aren't you the least bit nervous, Revere?

By Lisa the GP (not verified) on 19 Jun 2006 #permalink

Lisa: LOL. Compared to some of the things we've said here, it's nothing.

There was also a time, in late 2003, when DG Lee almost instantly cancelled the WHO Journalism Fellowship program -- after a senior U.S. official complained about an article one of the Fellows had written which quoted a WHO official saying something rude about the U.S.

By Cold Water (not verified) on 19 Jun 2006 #permalink

CW: I've heard there was unhappiness in the ranks with some of Dr. Lee's leadership. I can't speak to it, but I did know the paragon of strong DGs, Marcolino Candau. He was able to do things others couldn't because he was deeply respected worldwide. He didn't campaign for renewal, assuming I believe, it was an automatic. He was scuttled. I don't know the details, but WHO lost its strongest and best leader in the eary 1970s. There has not been another like him.

The article talks about "cheap, locally-produced or imported drugs" without mentioning that more than 40% of Thailand's drug supply is counterfeit, probably because they import their drugs from regional neighbors like China, Cambodia and India, who are some of the world's biggest producers of counterfeits.

These drugs from the U.S. may cost them more, but at least they will be the real thing.

Wyatt: Link? If Thailand makes its own generics, then the counterfeit problem is not an issue.

Grand posts and comments.


The problem is that DGs like Lee have too much power, as did his predecessors - Norwegian lady pol and Japanese pharmacologist. Following ones political, public health stances, or just plain old gut feelings, knowledge of international goings on, very strong criticism could be hurled at all three. Scandals to uncover - hooo....!

The position, and the system, rather than the person.

Such posts are apportioned by turn to different national type groups as is is a given that domineering and profiting and influencing (etc.) is very consequent and thus must be shared in a time - slicing arrangement. Each faction puts up with others command, waiting for their turn to influence events and cash in. Blatant violations of principles, rules, law (whatever...), common sense, basic mission, and so on, are put up with, or even covered up, as one will have ones turn.

A terrible system. An organisation like WHO should not be put in the position of counting on the DGs brilliance, probity, wisdom, fairness, bravery, political clout, etc.

Alternative arrangements are hard to dream up. Though I do think an executive director post, with a board of some small number of country representatives elected by the rest might do a little better. The little has to be judged in the light of WHOs recent past history and that I am unable to discuss. Then theres the question of evaluation.. arrgh...

..all a bit Westphalian, heh! Outdated model in its death throes!

Candau was a different time, a different world.

P.S. I have no intimate knowledge of WHO, newspapers and gossip are my feeds for this topic.

Apologies if the apostrophes, inverted commas, dashes, come out bizarre.

Alvin Toffler, the "future shock" guy (35-year-old book) suggested that a world govt. could be down with a sideways network. We would have the Senator from Japan, and they would have the Diet whatever from the US, as regular voting members of the national parliaments.

Not one bit Westphalian, but a viable counterweight to global corporatism.

By Ground Zero Homeboy (not verified) on 20 Jun 2006 #permalink

JJackson: I'd like your silver lining theory, but I am afraid it's just a psychological tendency in this horrendous future scenario to have some wishful thinking.
IMO I expect an emergency scenaro: first collecting, burying, cremating all corpses (in one way or the other); in the mean time trying to restore any infrastructural system (electricity, running water) by getting people to run those systems; in the mean time depending on the season chopping wood in the neighbourhood to burn it for heating the houses and boiling water, preparing food, desinfecting things. (The wood will not burn until next year because it will be too wet inside, but people aren't very well educated on survival these days). In the long run looking for future means of producing vegetable crops. And in the mean time looting people (not only notorious criminals who are posessing guns, where others - in my country - don't have those) desperately looking for food. Boy, how I cherish those canned food industries!
The point I am trying to make is in this emergency scenario I don't think the only survivors will be sophisticated, idealistic, prepared people who learned important lessons from our history of pollution, overcrowding and ennemy strategies. There will be major shifts in those nasty processes (individual confrontations, pollution, awareness), but I am expecting those to mainly shift from macro (inter/national) to micro (family/individual/community)level.
But I would very, very much like it to be that silverlined way.

One of the startups in a local biz-school contest wants to make papier-mache coffins. They're just going to burn anyway, and you might as well custom-make something cool. A viking ship, for example, with your beautified corpse as the maidenhead.

Someone has read "The Loved One".

By Ground Zero Homeboy (not verified) on 22 Jun 2006 #permalink