As delegates at the 75th World Health Assembly discussed health policies for diseases strongly associated to commercial factors, including obesity and alcohol misuse, they did so in the shadow of several new reports pointing to the many ways in which transnational companies manage to dodge public health guidance and attempt to influence decision-making processes at the World Health Organization (WHO) itself.
Despite ample evidence of the deterioration of global health governance under the multi-stakeholderism paradigm, the Assembly missed out on taking a strong stance against the industry’s interference with the WHO’s work. Instead, the United States’ delegation argued in favor of a completely different line of action, openly calling for a more open rapport between the United Nations (UN) agency and the industry through increased multi-stakeholderism.
A silent shift from multilateralism to multi-stakeholderism has been underway at the WHO for some time now. This, among other things, has enabled the industry to influence WHO discussions despite the existence of formal mechanisms regulating their relationship, e.g. the Framework for Engagement with Non-State Actors (FENSA). But in addition to trying to find a place at the table at WHO, transnational companies and other industry representatives have been looking for ‘innovative ways’ of circumventing existing WHO rules that impact their practices.
Reliance on industry undermines right to health
A recent report by WHO has shown that the breastmilk substitutes industry is relying on innovative forms of marketing to avoid regulation put into place by the International Code of Marketing of Breastmilk Substitutes. Among other things, producers are using direct marketing through social media, including through advertising through influencers and pregnancy/parenting social media support groups.
Such marketing campaigns undermine trust in breastfeeding among mothers who are in the position to feed their infants, and by doing so they contribute to worse health outcomes among both women and children. But while the producers’ attention has been shifting away from the Global North, the consequences of their practices have left a lasting mark on child nutrition in the US itself.
The baby formula shortage which the US has been experiencing for the past couple of months has a lot to do with the breastmilk substitute industry being given a key role in the field of child nutrition. This has deprived many children – particularly those from working-class and poor families, as well as Black and Latino communities – of the health benefits of breastfeeding. But it has also meant that even the slightest disruption in the production process of a chosen few companies would lead to problems in procurement of baby formula.
In other words, while US delegates at the World Health Assembly were busy advocating for heavy industry involvement in health policy making, at home they were experiencing the effects of this very approach.
A lobbying operation of wide scope
Avoiding existing WHO mechanisms and recommendations is not the only way that industry has interacted with global health governance for the past years. An analysis of lobbying expenditures by the various industries associated with negative health outcomes published in Global Health Governance has pointed to record-breaking amounts invested by the corporate sector into lobbying US positions at the WHO.
During a webinar on multistakeholderism hosted by the Geneva Global Health Hub (G2H2) in the week preceding the World Health Assembly, David McCoy, one of the co-authors of the report, stressed that when the US is concerned “since 2016, parties associated with production and marketing of breastmilk substitutes, alcohol, biotechnology and pharmaceuticals have consistently been among the top ten sources of lobbying expenditures related to WHO.”
The amount of money allocated for lobbying has steadily increased in the same period, going from an annual average of around US$ 12.5 million in the period 2006-2015, to US$ 14.2 million in the period 2016-2019, to US$46 million in 2020 alone, corresponding to the time when the Trump administration announced the US would leave the WHO. Investment in WHO-related lobbying has been steadily increasing since the establishment of Engaging America’s Global Leadership (EAGL), an industry umbrella organization which believes that WHO’s work undermines US interests and that, because of this, the US should secure firmer control over the organization’s operations.
Quite unsurprisingly, this effort would be supported by US-based companies who are already worried that public health international norms impede trade, and they might do so even more if they are shaped independently of industry inputs. To prevent that, EAGL and its members, as well as other corporate stakeholders, are allocating a lot of money to lobby against specific WHO programs, for example programs related to alcohol consumption.
But they are also investing in lobbying on WHO procedures, operations and mechanisms like FENSA, apparently with the intention of weakening the organization and making it more susceptible to industry interests. Finally, they also spend time and money to prepare US delegates who take part in WHO meetings. This is done in parallel to amplifying a narrative about how WHO is not capable of fulfilling its role, which includes accusations of the agency of being “anti-science”, “divisive”, and suffering from a “lack of transparency and accountability.” Basically, industry is describing the WHO with all the adjectives that have been used to characterize transnational corporations at one point or another – except those descriptions have much more ground.
True fences needed for limiting corporate influence over WHO
“We see the importance of WHO, of a multilateral system of governance in general. A way to protect that is to show the lines of attack: the industry’s questioning of the legitimacy of multilateralism, of the scientific basis of WHO, which is basically an attack on science itself. It is important to counter this narrative”, said David McCoy during his presentation.
To be able to do this, further research into corporate lobbying practices in other WHO countries who enjoy an informal and undeserved amount of power in the forum, like the European Union, will be necessary. But this alone will not be enough to block industry attempts to gain more influence over WHO. Instead, a lot of responsibility remains with WHO member states, who should be looking into ways of putting in place stronger mechanisms than FENSA. When it comes to industry involvement in the WHO, a fence might be more appropriate.
Read more articles from the latest edition of the People’s Health Dispatch and subscribe to the newsletter here.
