So the World Health Assembly (WHA) has been going strong for about a week and is officially nearing an end. While just about every health topic under the sun was discussed, I'll highlight a few here - in particular, the international brain drain of health workers; Bird Flu in Indonesia; and Taiwan's attempted entrance into the WHO. This note builds on information from previous notes by Carolyn Bennett (Taiwan and the WHO; Gender, Docs and Canadians at the WHO) and myself (WHO must shift vaccine policy). I believe Carolyn (MP for Federal riding of St Paul's) attended the WHA in Geneva, so if you're reading her blog/notes I'm pretty sure it reflects views from somebody who was actually there shooting the sh^t with people and participating first hand. For additional information on all of the agenda items discussed, visit http://www.who.int . Ok here we go...
1. International brain drain of health workers
In one of her notes, Carolyn touched on a meeting she had with Dr Ndioro Ndiaye (Deputy Director, IOM) on how much the poor health status of so many developing nations is exacerbated by the exodus of their best health workers to the schools and salaries of wealthier countries. Some leave knowing they will not return, with the idea that their future holds more promise in Europe, USA or Canada. Many others leaving for educational reasons, for example, go away with the plan of a return to their native land, but often find incentive to stay and work in their new home. This type of international brain drain leaves behind in 'source countries,' a tremendous void in already-resource-limited sectors, with public health care leading the way. In Malawi alone, for example, the past five years have seen 85% of doctors/64% nurses/52% of health administrators leaving the local health care system for international NGOs or for work overseas (UK, followed by NAmerica). To say they are nowhere close to meeting their countries' needs would be an understatement of astronomical proportions - yet the case of Malawi is not dissimilar to what is happening elsewhere in sub-Saharan Africa and the poorer countries of Asia and Latin America. This cycle continues while countries such as the UK, USA and my home of Canada continue to have immigration policies that recruit highly skilled workers from developing nations, many of whom come to service health sectors which we are perfectly capable of producing homegrown talent for. So what can we do about it? In a globalized world, immigration provides so many economic and cultural benefits, not to mention a potential for increased tolerance across borders. For all the benefits I have to ponder the Q - can we do a better job of it? When managing our immigration trends can we consider the consequences to elsewhere in the world instead of only the benefits or potential for prosperity an applicant brings to our society? For the health professionals who have come to this country and found employment, can we develop a mechanism to work with them and provide incentives to return home for short/periodic professional rotations in their field? Finally, we must look at this not just from an immigration perspective but from a development one. In providing greater assistance to countries to develop their own industries, improve their schools and health systems, we can help reduce so many of the reasons that force people to leave their homes in the first place.
For further reading on this I recommend you to the following article: Coombes R. 2005. “Developed world is robbing African countries of health staff.” British Medical Journal. Volume 230, p.923.
2. Bird Flu & Indonesia
(For CBCs take on this, check out http://www.cbc.ca/health/s
Earlier this year I discussed Indonesia's role in spearheading the developing world's campaign for a fairer mechanism to distribute pharmaceutical products. For the past 50 years WHO has been collecting virus samples from all over the world, and sharing them with vaccine companies who generally charge prices for their products which are far too expensive for developing countries to afford. Fed up with the process, Indonesia (where majority of human bird flu cases exist) stopped sharing samples for a couple months earlier this year, putting global pandemic vaccine production on hold. They later resumed sharing once WHO acknowledged there must be a change in course from traditional policies and promised to negotiate a fairer deal with the developing world with all parties. This issue was once again debated at the WHA where all 193 members agreed that virus sharing will continue with it being conditional that a better mechanism be developed. While it is wonderful news that the sharing process has resumed, I am concerned at the prospects for success at reaching such a deal anytime soon. While this story has been developing, a handful of reports have brought to light the fact that most of the companies that are making PanFlu vaccines are based in Europe - and that these countries have national crises/public safety laws making it illegal for vaccine products to be exported during a pandemic before their own citizens have access to it, and that even if a guaranteed stockpile is allocated to the developing world free of charge (to them) - it may be too late in reaching them for their needs to be met. This means that solving this problem of fair access is not just about finances and the developed world putting up the funds for poorer countries to have a supply in a time of crises - the issue of timing and being able to get the vaccine to them at the time they need it is just as critical, making WHOs plate even fuller with these negotiations. A new imagination is needed about this - and if several countries lose patience in how long it will take to develop a new mechanism and consider another stop of sharing, then we've all got bigger problems.
3. Taiwan & International Health
Also in her blog, Carolyn informed us that it seemed as if several of WHO's members were prepared to vote to allow Taiwan meaningful participation in the WHA and in shaping the agenda for the coming year. When the motion was called, however, it asked the assembly of WHOs members to consider granting Taipei full membership (as opposed to a partial option) which was ultimately defeated after a long day of voting. For those who are out of the loop on this one, Taiwan has a tremendous interest in using its health workforce and technological brainpower in becoming more active in global health affairs, and as an important part of their strategy to do so they are seeking formal membership to the WHO. WHO, as an agency of the United Nations, has a membership consisting of independent countries. The big controversy in all of this is that China, being an important member of the WHO, considers Taiwan to be part of their country and does not recognize them as an independent sovereign nation. So when the annual vote comes to pass at the WHA, the majority of delegations have elected to vote with the Chinese and will likely continue to do so as long as the motion being voted on is asking for Taiwan to receive full membership. Now questions and proposals of various kinds debating the prospect of some special type of *partial membership* have been floated around, but (to my knowledge) have not been voted on. With several members in the position of wanting Taiwan to play a meaningful role in things, while not being comfortable voting for them to have full status - if a motion calling for some unique level of partial membership was ever put to a vote, it is certainly much more likely to pass than traditional motions on this have been and Taipei will be able to be much more involved than ever before - even if it's not to the level that they want.