With the worst pandemic since the Black Death reaching its 21st birthday and another World AIDS Day this week (Thursday), staff at the World Health Organization’s Geneva headquarters are preparing to strike over pay and conditions. Had the staff been striking in disgust at the woeful performance of the campaign to treat HIV around the globe then maybe they would gaine some sympathy.
As it is, the WHO director-general, Lee Jong-wook, has been forced to remind key office staff that others in regional postings such as Darfur or Baghdad will be more than willing to step in and cover any “essential” work they are doing. He has said that “the threat of a work stoppage risks bringing WHO, and our achievements, into disrepute. It is unprecedented in the history of WHO. It is out of proportion to the concerns expressed by some of the staff. It undermines the credibility of WHO.”
Lee should appreciate that the credibility of WHO has been undermined by his own staff’s performance. It’s ironic that they choose to strike on World AIDS Day. Toward the end of 2003 WHO established the 3 by 5 Initiative–to treat 3 million HIV-positive people with antiretroviral drugs (ARVs) by the end of 2005. It was a grandstanding, fundraising, overreaching epitome of counterproductive target-setting. To anyone monitoring the situation it was obvious that it would fail from the beginning, and that WHO had no real intention of the target being hit since they didn’t even consult the key countries (South Africa, for example) as to the target set for them. Remember WHO does not provide many of the drugs, funds, doctors, etc. to hit such targets, so consultation should have been necessary.
This oversite led to an ugly, unprofessional, and damaging spat with the South African government. WHO set a target of 375,000 people and then blamed the South African government in June when it was clear that its arbitrarily set target would not be hit. The South African health minister hit the roof; she said that her “government is not withholding treatment for opportunistic infections, including ARVs, but our objective is to promote quality healthcare. We are not just chasing numbers.”
Rather than help South Africa and other nations treat more HIV patients, WHO started a pointless war of words. Earlier this week WHO apologized for missing the 3 by 5 target–five months after it had attacked South Africa because its target would not be hit.
The cornerstone of this target-setting was WHO’s promotion of cheaper, generic copies of ARV drugs. Generic drugs certainly can have a role in combating the HIV pandemic, but using drugs with untested efficacy or non-bioequivalence leads to clinical uncertainty, which undermines patient performance evaluation, and increases the risk of drug resistance. It also undermines future drug development by lowering profits of originator companies.
Lee’s memo to his staff regarding the strike says that the threat of a work stoppage demonstrates “a betrayal of trust, and are neither in your interest, nor that of the hundreds of staff who are working in hardship posts around the world and field stations in Africa and Asia, nor those whom we serve.’ The effect of Lee’s administrative approach to combating HIV has been to betray the trust of the people of Africa and other increasingly HIV-prone locations. He should apologize to the world for that.
WHO has an important role as a purveyor of information and as an urgent responder to international concerns, like SARS (where it did well) or bird flu. Were it not for that I’d endorse the strike by WHO staff, not because I like strikes, but because WHO in so many of its roles is counterproductive–and fewer WHO staff on the job is therefore good news.