Understanding global security - Peter Hough

HEALTH THREATS TO SECURITY
continued to be attacked by the US Right, however, as epitomized by the article ‘WHO
Prescribes Socialist Medicine’ which appeared in the Wall Street Journal in 1996
(Peeters 1996). Brundtland’s reforms were welcomed in the USA but, in 2001, the
Bush (Jr) administration revived UN scepticism by trying to get WHA agreement for
a cut in the US share of the WHO regular budget from 25 per cent to 22 per cent.
Hence, entering the twenty-first century, the WHO found itself criticized on two
fronts and its overall direction caught between that advocated by vertical ‘eradicationsits’
(Godlee 1995) and horizontal proponents of containment. Brundtland’s
stewardship saw the WHO become more open and cost-efficient, to the satisfaction
of the USA and other major donor states, but it has not been afraid to court corporate
displeasure. This was evident in the revamping of the anti-tobacco campaign,
so that a Framework Convention Tobacco Control could be opened for signature
in 2003, and in a campaign in support of the ‘essential drugs’ programme which
spawned two significant legal victories in 2001. Several US American pharmaceutical
firms and the US government were persuaded to drop legal challenges preventing
South African and Brazilian firms from marketing cheaper versions of generic HIV
drugs. In both instances the legal cases had sought to uphold WTO Trade Related
Intellectual Property Rights (TRIPS). A global public outcry over the cases prompted
the backdown and marked a significant victory in this particular recurring clash
between competing international laws satisfying the sometimes rival values of wealth
maximization and human security.
The WHO’s twin funding mechanism may cause confusion and draw criticism
from two directions, but it does allow the organization to continue to attract public
and private monies for high-profile campaigns, while persisting with a more socially
oriented functionalist political direction driven by the organization itself. The
British Medical Journal in a 2002 editorial declared its qualified support for the twin
track approach: ‘both [horizontal and vertical programmes] are needed. Vertical programmes
will be unsustainable without well functioning healthcare systems, but
vertical programmes on, for example, immunization can achieve a great deal rapidly’
(Smith 2002: 55).
Global public and private partnerships
The bureaucratic centralization of the WHO introduced by Brundtland ‘to make
WHO one – not more than fifty’ (Brundtland 1999b) has been accompanied by
the partial outsourcing of some of its vertical operations into ‘Global Public and
Private Partnerships (GPPPs) (Buse and Walt 2000). Enterprises such as the Global
Programme to Eradicate Filariasis (GPEF), Guinea Worm Eradication Programme
and (the largest of all) the Global Fund to Fight AIDS, Tuberculosis and Malaria have
brought in substantial extra-budgetary funds, while retaining links with the WHO
as only one of a number of ‘partner’ institutions. This represented a trend throughout
the UN system from the 1990s in an effort to bring in funds and revitalize the
specialized agencies. Public health has been the most prominent of the issues affected
owing to the centrality of the private chemical manufacturing industry to any
immunization or pest control scheme. Corporations in recent years have become
more concerned with their public image and have provided much-needed cash
167