Understanding global security - Peter Hough

HEALTH THREATS TO SECURITY
injections to public health programmes, but concerns have been expressed that this
could be detrimental to the public-service ethos and work of the WHO. Concerns
have focused on the possibility that the independence of the WHO could be compromised
by the need to satisfy sponsors and that its overall strategy might become
more diluted and/or fragmented (Buse and Walt 2000: 705). Corporations involved,
at least partially, for public relations purposes may be keen to focus resources on
projects likely to succeed rather than on those that are most deserving, and be hesitant
to tackle more stigmatizing diseases such as those that are sexually transmitted
(Walt and Buse 2000).
Some voices are more cynical about the whole concept of directly involving
industry in global public health ventures. Oxfam’s response to the development
of partnerships between the UN and manufacturers of HIV-retroviral drugs has
been particularly sceptical: ‘[C]orporations in the pharmaceutical sector are offering
islands of philanthropy, while promoting a global patents system which would
enhance their profitability, but which could also consign millions to unnecessary
suffering’ (Oxfam 2002: 8). Similarly, a 2002 study by the pressure group Save
the Children and the London School of Hygiene and Tropical Medicine criticized
the Global Alliance for Vaccines and Immunization (GAVI). The report, based on
extensive field research in four African countries, expressed concern that the focus
on supplying vaccines overlooked the fact that the means of implementing
immunization campaigns might not be sufficient and that the programme would be
unsustainable if GAVI funding was not replaced after the five years of its operation
(LSHTM 2002).
The behaviour of several US pharmaceutical firms in protecting their own
products against South African and Brazilian competition gave some credence to
the Oxfam claim. The governance of the GPPPs, however, is not as skewed in the
direction of donors and corporations as might be imagined and efforts have been
made to achieve a balance of stakeholders on the governing boards, in a similar
manner to that employed on WHO programmes and Expert Groups. The sort of
dominance by MNCs highlighted in studies of the membership of boards of the
Food and Agricultural Organization (FAO) and the Joint FAO/WHO Food Standards
Agency, the Codex Alimentarius Commission, is certainly not replicated in the public
health GPPPs (Avery et al. 1993). The Executive Board for the Global Fund to
Fight Aids, Tuberculosis and Malaria comprises 14 government ministers (seven
from donor states and seven from LDCs), two pressure group representatives, one
representative from the Gates Foundation (as a major private sponsor not functionally
involved) and one representative of the salient private sector (Global Fund ATM
2002). The Board acts on the advice of a Technical Review Panel made up of experts
selected from individual applicants chosen by the Executive Board according to
geographical and gender quotas. GAVI is governed by a 15-member board composed
of four permanent members: WHO, UNICEF, World Bank and the Gates Foundation,
and 11 rotating members: three donor governments, two LDC governments, one
NGO, one LDC industry representative, one developed world industry representative,
one foundation, one technical health institute and one research/academic body. The
Global Fund Board, in particular, safeguards against excessive influence from actors
for whom the value of profit may be the chief motivation, while recognizing the reality
of a situation where the involvement of those actors is necessary in pursuit of the value
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