Tobacco Documents Online

7 8-3 1986 WORLD HEALTH ASSEMBLY May 5-16, 1986 Background/General Principles Background The Thirty-ninth World Health Assembly provisional agenda contains three items of potential concern to the international corporate community. These include: ° Item 21 - Progress/Evaluation of Report on Implementation of the WHO Code on the Marketing of Breast Milk Substitutes. ° Item 22 - Resolution on "Tobacco or Health" and proposed WHO action pro,gram on tobacco. ° Item 25 - Rational Use of Drugs (Follow-up to November 1985 WHO Nairobi Conference of Experts on the Rational Use of Drugs). A. Re ort on Im lementation of WHO Code on the Marketin of Breast i u stitutes This Code, adopted by the WHO in 1981, was in the form of recommendations to national governments, to serve as the basis for possible national legislation on the marketing of breast milk substitutes. Among other provisions the Code prohibits point of sale advertising and advertising to the general public, and restricts the promotion of infant formula by health care professionals. Industry associations and research groups raised several concerns with the Code, among them its undocumented assumptions on the health and social impacts of infant formula, definitional ambiguities, and possible spill-over into other product areas. The Code called for a review of implementation of its provisions in three years. In a 1984 report the WHO noted that some 130 governments had taken steps to implement the Code. The WHO then voted to review progress on the Code every two years. The May 1986 WHA will be the occasion for the next of these progress reports. This report raises concerns in two respects. First, the 1984 WHA passed a resolution which asks governments to examine the promotion and use of foods unsuitable for infant and young child feeding, and calls for a report to the 1986 WHA. This raises the possibility that there may be attempts to expand the 1981 Code into the area of advertising of food in general to children. The report has not yet been circulated. N CJ7 0 ~ ~ ~ N o 0 ~

Second, the WHO has been examining the interpretation of Article 6 of the Co e, on supplies of low-priced breast milk substitutes for "infants who have to be fed on breast milk substitutes." Questions on this and other aspects of the Code raise the specter of reopening the divisive debate on the issue, with some likely to call for broadening the scope of the Code to subjects beyond breast milk substitutes as defined in the 1981 Code. This would run counter to the intent of the drafters not to expand the Code. Action: National committees should contact their governments and urge that ey take the following principles into account when preparing for discussion of this item at the WHA: ° In most cases breast milk is the chosen method of feeding infants. ° Malnutrition, hunger and famine continue as major problems, especially in developing countries. ° Processed foods offer a wide range of wholesome nutrients that have an important role in the diets of infants and young children as well as adults. ° Efforts to restrict the availability of these foods - either through direct prohibitions or through indirect marketing restrictions targeted at the same objective - are inimical to the interests of consumers in developing countries and their freedom of choice. ° Since marketing practices differ greatly from country to country, these should be s ep cific to needs, cultures, and mores. ° Extension of the International Code of Marketing of Breast Milk Substitutes should be resisted since it is an encroachment into the national authority of member states over the legitimate marketing of foodstuffs. B. Resolution on "Tobacco or Health"/WHO Action Program on Tobacco Since the early 1970s, the WHO has been conducting an anti-smoking campaign, which has received minimum financial support. Single-issue organizations have taken this fact as an opportunity to provide their time, money and effort in return for WHO worldwide influence. In 1986, prompted by pressure from such groups, the WHO Executive Board considered a report entitled "Tobacco or Health," and adopted a resolution which encourages developing country governments to adopt strong anti-tobacco legislation. The tone of the report is clearly set out by the Program Committee which openly establishes an adversarial relationship between itself and industry which it characterizes as "...the battle between health and commercial interests..." It is acknowledged that WHO has a useful role to play in educating the public on the alleged health effects of tobacco consumption, based on scientific evidence. However, the Report approaches the smoking and health issue not from a scientific viewpoint but rather represents one more example of the "politicization" of an organization supposedly devoted to health and objective science. N 6n 0 ~ .~ ~ N ~ 0 ~ -2-

The resolution includes a provision which "deplores all direct and indirect practices the aim of which is to promote the use of tobacco." In effect, it calls for government intervention into the private sector and calls for support by other U.N. organizations in WHO's anti-smoking efforts. The "Tobacco or Health" resolution advocates direct and far-reaching inter- vention in trade and economic issues. This resolution raises many concerns. ° It supports and encourages total bans of advertising, which deny both the freedom to advertise legal products and also the right of consumers to be informed about those products. ° It seeks the eventual elimination of tobacco leaf growing and trade along with all sectors of the tobacco industry worldwide. It has been reported that the WHO Director General will submit a program of action implementing the resolution to the 1986 WHA, the details of which will not be available until mid-April. Action: National committees should contact their governments and urge that t~iey take the following principles into account when preparing for discussions of this item at the WHA. ° The aim to eliminate tobacco is a direct attack on the entire industry - including cultivation, processing, manufacture and marketing of tobacco products of all kinds. As such it would result in major loss of revenue and exchange earnings in many countries. This is another instance of how WHO is expanding its scope beyond areas relating strictly to health and into areas affecting trade, economics and commerce. ° The call for advertising bans ignores empirical evidence in those countries where bans are in force. Bans have been found to have had no significant effect on overall consumption levels, but ,~ have rather removed a major means of market competition and com- a munication with consumers. ~ .~ C. Rational Use of Drugs ^' ~ ~ At its 1984 World Health Assembly, WHO adopted a resolution calling for a ° meeting of experts (including governments, the pharmaceutical industry, patients, and consumer organizations) in 1985 to discuss means of ensuring the rational use of drugs (through improved knowledge and information flow) and the role of marketing practices. That meeting was held November 25-29, 1985. Those experts agreed that WHO should not serve as supranational regulator, but should leave action to national governments as appropriate to their socio-economic health and legal systems. They then recommended that experts groups be set up to deal with six areas: -3-

° national drug policies ° registration and labelling ° WHO drug certification scheme ° information ° training ° norms for ethical promotion of drugs In February, the WHO released a "Revised Drug Strategy," incorporating the conclusions of the Nairobi meeting, for consideration at the WHA. The strate- gy notes that the WHO will: foster fulfillment by each concerned party of its responsibilities; support governments in formulating and implementing national drug policies; expand normative functions (including extension of the WHO drug certification scheme, guidelines for drug regulatory authorities, guidelines for formulating national drug legislation, and update of ethical criteria for drug advertising adopted by the 21st WHA), intensify information dissemina- tion; provide education/training of health care personnel; and promote collab- orative research. An area of major concern to industry is that relating to norms for ethical promotion of drugs (also referred to as the "update of ethical criteria for drug advertising"). This is seen as possibly opening the door for preparation of a code on the marketing of pharmaceuticals which would represent an intervention into national drug policy-making. Action: National committees should work with local chapters of pharmaceutical manufacturers associations, or the IFPMA, in contacting governments regarding the WHA discussion. General principles which could be stressed include the following: ° It is essential to evaluate the availability, promotion and use of drugs in the Third World in the context of each country and not according to the standards of the more developed health- care systems. Adapting the products of these systems to the circumstances found in the Third World - and meeting Third World health problems head on - is a continuing challenge that the pharmaceutical industry is committed to meeting. ° National and regional conditions and legislation vary so much that a highly detailed, universally applicable code would be impractical. ° IFPMA has in existence a widely publicized Code and has encouraged health-care authorities, health-care professionals and consumer groups to make use of its complaint procedure. ° For years, pharmaceutical companies have been working to improve the health and lives of people in developing countries. These activities include investing large amounts of capital, trans- ferring technology, training and employing thousands of local workers, setting up research centers, training health-care workers, and improving health-care services. t , -4-

° While allowing that progress in pharmaceuticals has been made, in- dustry critics claim it has come to an excessive cost resulting in too many drugs and high prices. Their solution is to restrict the number of drugs available on the market. In fact, restricted drug lists would remove from industry the incentive and means to conduct future R&D. Conclusion: All of the above contain a common element - attempts to restrict the advertising and promotion of products in accordance with national laws. In communicating with their governments, national committees should place great emphasis on the need to maintain the free flow of product information which enables consumers to make free and informed choices.