Geneva,
24 November 1999

Introduction to meeting with WEOG Ambassadors

Trade is - strictly speaking - not WHO’s core business. The founding fathers and mothers of WHO conceived a much more sectorized world than the one in which we are living. There was one agency for health, one for trade and one for culture – to mention but a few.

The very term ‘specialized’ agency is in itself slightly misleading. Specialized, yes, in the sense that health is our speciality. But specialized, no, in the sense that we can partition our interdependent world into slices. We need very close interaction between agencies – because the interaction between health and so many sectors beyond the health sector is so obvious. This call for interaction is even more called for at a country level where ministries all too often are pulling in opposite directions.

That is why the outcome of Seattle and a new round of trade talks is of interest to WHO, and that is why I have put such emphasis on establishing good and effective working relations with my colleagues at WTO - first Mr Ruggiero and now Mike Moore.

Why does trade matter? For many reasons.

Health is tradable. Health products such as pharmaceuticals are produced, marketed and sold across the globe. So the rules that regulate this trade are key.

Disease is tradable. As goods and people travel across continents health is affected. Foodborne disease, contaminated water or even transport of mosquitoes in aeroplanes represent new risks.

And health is opportunity. In few fields are the potential scientific innovations more striking than in health. The bottom line for every regulatory activity in the international system – including the trade system - should be to contribute to the enhancement of peoples health and well being.

Seen from these perspectives we have reason to be excited. Never has the level of innovation been more impressive. We are leaving a century of unprecedented gains in public health. Billions have had opportunities we could not have dreamt of when the UN system was created. Much of this is thanks to trade and incentives for innovation. Protectionism was never in itself good for health, and far too often a pretext for quite other domestic reasons than the protection of consumers and their health.

So more open trade and more accessible markets hold the potential of giving more countries the opportunity to reap the benefits of innovation – at prices they can afford.

But there are also reasons to be concerned. We need to be concerned when 1.3 billion fellow human beings live on less than 1 dollar a day – and 3 billion people – half of the world population – live on less than 2 dollars.

These people – the large majority of them – have been left out of the health revolution of this century. The reasons for this situation are many and complex. We can hardly say that they have benefited from the global trading system. Our inspiration must be to support measures which can make the international trading system work better to improve the health of the excluded billions.

We still have a long way to go to enable the poor to participate in the global economy and to take advantage of the potential benefits. We need creative thinking on a number of initiatives to support a broad integration of populations and countries into the world economy - initiatives such as accelerated debt relief, lowering of tariff barriers by the developed countries to low income country exports, and new ways of assuring sustainable, effective development co-operation.

When I took office at WHO, there was an ad hoc relationship with WTO at expert level. I wanted to change that to a relationship that was more systematic and based on clear policy objectives - that of making trade work better for public health. I am now meeting twice a year with the Director-General of WTO, and our experts are seeing each other frequently.

We benefited from this closer working relationship during the handling of the Revised Drug Strategy last year – as many of you will remember.

When I met Mike Moore a few weeks ago, we agreed in particular to support a better mutual understanding between Ministries of Health and Ministries of Trade and Finance on issues related to international trade related public health issues. We agreed to exchange views and knowledge on technical areas related to food safety, pharmaceuticals, and health services and we are discussing the recognition of the importance of the promotion and protection of public health in the implementation and negotiation of multilateral trade agreements.

On a technical level our cooperation covers areas such as:

• developing synergies between the SPS agreement and the new international health regulations we are formulating
• joint research in key areas of common interest related to pharmaceuticals and TRIPS
• continuing our work in areas related to food safety
• looking to develop closer consultations on synergies between the aims of the WTO multilateral trade agreements and tobacco control as well as obtaining observer status on the General Council, the Council for TRIPS and Council for Trade in Services.

All of this amounts to a closer network which I believe is absolutely necessary and which I believe will be of great use for our Member States. Again - we have to expect that national trade and health ministers talk to each other more frequently and sort out their differences before they go to either WTO meetings or the World Health Assembly. In both instances they are representing the same governments.

What are then our views on the upcoming meetings in Seattle?

First of all – WHO is not participating in Seattle – we are present as observers. I have sent Dr Michael Scholtz, Executive Director for Health Technology and Pharmaceuticals, as the chair of a WHO delegation. We will follow the discussions, hold a seminar for interested participants and be available for national delegations on their requests.

We go to Seattle, recognising that trade liberalization can contribute towards a more equitable distribution of economic benefits and a just society. But we also acknowledge that this requires linkage of the trading system to sound social policies, including the recognition of health as a global public good and the need to consider any side effects that trade and commerce may have for the protection of national health interests.

We go to Seattle with a clear message that the safeguarding and promotion of public health should be an integrated dimension of the trade negotiations and duly reflected in the agreements and negotiation texts. I believe that a new round of trade negotiations would not be completed if there was not explicit reference made to the broader purpose of trade – namely to contribute to development, progress and sustainable improvements of the environment and people’s health.

We go to Seattle to gather information on the possible impacts on public health of upcoming negotiations - particularly in trade in services. We are jointly organising with WTO an information session for delegates on emerging technical issues in trade and health, covering areas such as telemedicine and food safety. This is a part of the collaboration that I referred to previously, to better inform trade officials on trade related public health issues.

And we go to Seattle to be ready to answer delegations which seek better knowledge of the public health implications of trade. We have the foundation of knowledge coming out of our work on the Revised Drug Strategy and our advice to countries on how to safeguard public health concerns when implementing agreements such as TRIPS.

Let me end by encouraging all stakeholders to pursue dialogue and transparency on these crucial issues. The Member States of WHO have reached consensus on how to interpret the TRIPS agreement and the role of public health. But that does not mean that the issues related to health and trade and access to pharmaceuticals and essential drugs are settled and solved.

WHO will have to remain extremely preoccupied as long as so many people in real need are without access to drugs which exist but which are not within their reach. The example of AIDS drugs and the unfulfilled needs of the millions of patients in Africa comes to mind.

There are many more such examples. We still have a long way to go when one-third of the world population still lacks access to essential drugs. In the poorest parts of Africa and Asia, over 50% of the population are deprived of it.

WHO’s aim is to ensure equity of access to essential drugs, rational use and quality. This is simply part of the fundamental right to health care.

We need to address the issues of access and availability, and we need to discuss them openly. I have initiated such debates with industry and with NGOs. What we see around us is in fact a major market failure. There are drugs available – there is a considerable need among the poorest – but there is not a viable market to help offers match the demand. We cannot simply accept that this is how things are bound to be. WHO is seeking a dialogue where we can search for solutions - not exchanging locked-in positions.

That is also part of the message we will take to Seattle

Thank you.