Tuesday, May 11, 2010

Global health ... WHO, GAVI drug recommendations and conflict of interest

Dear Colleagues

At least I am not the only person that does not get replies from the big establishment organizations.

The matter being raised in the following exchange between some members of the ALL INDIA DRUG ACTION NETWORK (AIDAN) and the World Health Organization (WHO) have many similarities with some of the issues that I have raised in connection with the use of resources to combat malaria, especially in Africa.

I would argue that the role of profit maximizing organizations in the health sector has some implications that are not fully understood ... and the growing integration of these organizations into both national governance institutions and UN agencies needs to be looked at with considerable concern. Conflict of interest should be taken a whole lot more seriously than it is at the present time.

Dr Gopal Dabade of AIDAN wrote to Dr. Margaret Chan of WHO as follows
10th May 2010
Dear Dr Margaret Chan,
This is with regard to AIDAN letter dated 23rd April 2010 since there has been no reply from your side, we have decided to take the issue for public opinion.
Best wishes
Dr Gopal Dabade
This is the AIDAN letter to WHO dated 23rd April 2010
Date- 23rd April 2010
To, Dr Margaret Chan,
Director-General of WHO,
Avenue Appia 20
1211 Geneva 27, Switzerland, chanm@who.int,

Dear Dr Margaret Chan

Greetings from India,

There have been deep concerns related to the New Vaccines. The HPV vaccine trials have raised many questions. The reports related to influence of the pharmaceuticals and vaccine manufacturers in having the Human Influenza H1N1 declared level 6 pandemic have definitely contributed to rising concerns about issues related to conflict of interest.

A letter published in the Indian Journal of Medical Research, April 2010, page numbers 588-589, titled - Incomplete reporting of research in press releases: Et tu, WHO - , (http://www.icmr.nic.in/ijmr/ijmr.htm) however is suggestive of something more sinister and grave. Here the WHO has issued a press statement (with some other international agencies) deliberately misleading decision makers. The press release suggests the vaccine was useful when actually the study showed no benefit (no statistical difference between those vaccinated and controls -not counting posthoc analysis presented without proper multiple testing).

It is interesting that soon after this study, WHO declared that the need for the Hib vaccine was proved and all countries must introduce it in their national immunization programme. (http://www.who.int/immunization/REH_47_8_pages.pdf)-

After the study, and after WHO made it compulsory for all countries to use Hib, they (WHO partner GAVI) supplied the vaccine to poor countries at highly subsidized rates, using funds from donor countries and the Bill & Melinda Gates foundation - meant for the MDGs (referred to as Global Fund below).

Given that the vaccine is not beneficial in Asia, this suggests that Global Fund was defrauded of millions of dollars meant for the poor and this money was siphoned off to vaccine manufacturers who sit on the GAVI board. In its place a worthless vaccine was supplied. It is no point saying that the vaccine has been useful in other areas of the world. The studies in Asia were done because it was felt the situation here was different.

Those who are responsible of issuing the misleading press release and defrauding the Global Fund of millions cannot go Scot free under protection of the UN charter. There has to be accountability.

We sincerely hope that you will hold an inquiry into how this has happened and that appropriate action is taken to prevent a recurrence of similar incidents. A press release with clarifications also needs to be issued.

In countries with limited resources, other unmet nutritional and health needs, introduction of such technologies is acceptable only if epidemiologically warranted.

You would obviously want to look into this as WHO is held in high esteem by millions who need its contribution. The concerns related to conflict of interest because of corporate partnerships are increasing The WHO under your leadership needs to look into these, take action and inform the concerned public about the measures taken.

As public health emergencies increase due to increasing food insecurity, climate change etc, decisions regarding optimum use of scarce resources becomes even more important for developing countries.

We hope you understand the deep concerns about recommendations being given by WHO under such circumstances and we hope to hear from you.

We stand committed to WHO's principles of Comprehensive Primary Health care and also Principles of Rational Use of Medicines.

1. Dr Mira Shiva, Co-convener,
mirashiva@gmail.com, +91 9810582028
2. Dr Gopal Dabade, Co-convener,
drdabade@gmail.com, +91 9448862270
3. Mr Srinivasan S, Joint-convener,
sahajbrc@youtele.com, +91 9998771064
4. Dr Anurag Bhargav, Member,
5. Dr Anant Phadke, Member,
anant.phadke@gmail.com, +91 9423531478
6. Dr S L Pawar, Member,
pawarsl@gmail.com, +91 9449354415
7. M.R.Krishnan, Member,
mrkrishnan44@rediffmail.com, +91 9382782657.
Copy to:-
1) Ms Sujatha Rao, Secretary for Health,
2) DG of ICMR,
This letter raises huge questions about how advances in science and technology and global health should be organized ... what role should there be for various organizations ... what role for money ... what role for profit. The idea that a market system driven by profit works best for allocation of resources in global health is not serious ... it is preposterous ... and yet widely supported. I would accept, that a market system that is driven by value would work ... but until "value" can be monetized it does not count!

Nevertheless ... it is good to see this conversation being initiated.

Peter Burgess
Contact information for Dr Dabade and for AIDAN is as follows
Dr Gopal Dabade,
57, Tejaswinagar,
Dharwad 580 002 INDIA
Tel 0836-2461722 Cell (0)9448862270

A-60, Hauz Khas, New Delhi 110 016, India, Tel: 91-11-26512385,
57, Tejaswinagar, Dharwad 580 002, India, Tel: 91-836-2461722,

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