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governmental agencies, more than 180 nongovernmental organizations, and nearly 1,200 leading health-related institutions around the world designated as “WHO collaborating centers."
During 1999, U.S. representatives participated in meetings of the World Health Assembly, the WHO Executive Board, regional committees for the Americas, the Western Pacific, and Europe, and the Governing Council of the International Agency for Research on Cancer. U.S. officials also participated in meetings of the management committees of WHO's major voluntarily funded programs, a working group beginning negotiations on a new tobacco-control convention, and the governing body of the Joint UN Program on HIV/AIDS (UNAIDS), which is cosponsored by WHO and six other agencies. Within the WHO staff, there were more American citizens in professional posts than citizens of any other country. At year's end, Americans held the senior posts of executive director of the communicable diseases cluster, legal counsel, director of internal audit and oversight, and director of the division of personnel.
This was WHO's first full year under the leadership of Dr. Gro Harlem Brundtland, former Prime Minister of Norway, who was elected by the World Health Assembly in May 1998. U.S. officials continued to support the wide-ranging reforms being implemented by Dr. Brundtland, including the refocusing of both the WHO organizational structure and the biennial budget along the lines of nine “clusters” of activity. At the same time, U.S. officials pointed out instances in which it appeared specific important programs were receiving less attention than they deserved. In general, throughout the year, Dr. Brundtland received high praise from WHO member states and from numerous outside observers, including visitors from the U.S. Congress, in particular for the fresh approaches and new enthusiasm she had introduced to WHO.
The chief substantive action of the year was the decision of the Assembly to create a process that could lead to adoption of a framework convention on tobacco control by the year 2003. The U.S. delegation told the Assembly that the United States shared its concern for harm caused by tobacco and applauded WHO for its leadership to address this problem. As a result of this decision, a U.S. Government interagency group was established, under leadership of the White House Domestic Policy Council staff, to set the parameters of the U.S. negotiating position on the proposed convention. A U.S. delegation was active in the first meeting of a working group, held in Geneva on October 25-29.
The Assembly also reviewed a recommendation from the 1996 Assembly that the remaining acknowledged stocks of smallpox virus be destroyed in June 1999. Prior to the convening of the 1999 Assembly, the United States made known a decision by President Clinton that the United States preferred retention of the virus, rather than destruction, in order to
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permit further research on it. After lengthy negotiations in Geneva, the Assembly adopted a resolution that “strongly affirms the decision of previous Assemblies that the remaining stocks of variola (smallpox) virus should be destroyed” and decided to authorize retention of the virus "up to not later than 2002 and subject to annual review" by the Assembly. The Director General was asked to create a new group of experts to guide research on the virus, and the group held its first meeting in December.
The Assembly gave extended attention to Dr. Brundtland's new program entitled “Roll Back Malaria,” as well as to polio eradication and HIV/AIDS. The Assembly also approved a resolution on WHO's "revised drug strategy" after several meetings led to revision of the text that had been first introduced in 1998. The original text, which had been very contentious, had contained negative references to global trade agreements, particularly the Agreement on Trade-Related Aspects of Intellectual Property Rights; it also had contained suggestions that countries need not honor patent obligations. Eventually, there was a consensus on a text that eliminated unacceptable language. The United States said it was pleased that Dr. Brundtland and her staff helped to stimulate this consensus. During the year, Dr. Brundtland also initiated her plan to develop a new dialogue with all interested parties, including industry, on issues relating to pharmaceuticals and infant formula. The United States succeeded in having WHO organize a review of the guidelines utilized by WHO's Expert Committee on Drug Dependence; in the course of the year, a working group met to revise those guidelines for later review by the Executive Board. The United States had argued that this review was necessary because of apparent confusion over procedures for imposing limits on the availability of pharmaceutical products under three UN drug-control conventions.
The Assembly spent most of its time debating the proposed WHO budget for 2000–2001. The Director General had proposed a budget with an increase of $25.3 million, but the United States and many other Western countries said they could accept only a budget with “zero nominal growth” (one that remained at the same level as the 1998–1999 budget). Most developing countries supported the proposed increase, and some requested even higher allocations.
After extended negotiation, the Assembly accepted a no-increase budget, but on the condition that $15 million in WHO's miscellaneous income, separate from the regular budget, be allocated to high-priority programs such as malaria, tobacco control, polio eradication, and tuberculosis. The resolution also asked the Director General to identify “efficiency savings" of 2-3 percent that could be allocated to high-priority programs, and asked for a study of WHO's financial rules governing key issues such as the operation of the working capital fund and provisions for
internal borrowing in the event of a shortfall in the payment of assessments. The new budget for 2000–2001 amounted to $842,654,000, the same level as in the two preceding biennial budget periods. U.S. assessments in each year of the biennium, at 25 percent of the budget, were set at $108,108,855, after credit adjustments. During the 1998–1999 biennium, the United States also made voluntary contributions to WHO programs of about $40 million per year; most of these funds came from the U.S. Agency for International Development.
U.S. reform initiatives within WHO in 1999 included efforts to persuade WHO and its member states to take steps that would permit U.S. certification of the "benchmarks" included in the U.S. legislation and thereby allow payment of U.S. arrears in WHO and other agencies. At year's end, the United States owed $35.7 million in arrears from prior years. U.S. representatives gave special emphasis to the benchmarks related to the scale of assessments, internal oversight, and evaluation.
Although supporting reform, the United States was not pleased with a set of seven amendments to the WHO constitution proposed by the Executive Board, and in May 1999 it persuaded the Assembly to reject those proposals. The proposals included new penalties for late payment of assessments and qualifications for membership on the Executive Board, both of which appeared intended to limit U.S. participation. Dr. Brundtland joined delegates in arguing that there was no need at the moment to amend the WHO constitution.
In promotion of more rapid turnover of individuals in WHO elected positions, the Executive Board had decided in 1997 and 1998 to apply a limit to the terms of office of the Director General and WHO's regional directors. The new policy provided for a five-year term, renewable once, but not applying to the incumbent at the time the new rule was adopted. In 1999, following up on those decisions, the United States persuaded the Directing Council of the Pan American Health Organization (PAHO) to amend the PAHO constitution so that the same rules would apply to the election of the Director of PAHO, effective with the election in 2002. As a result, this two-term limit now applies to all elected positions within the WHO structure.
In regard to Taiwan, as in the two previous years, the 1999 Assembly took no action on an effort to insert on the agenda an item for discussion of observer status for Taiwan. The initiative was once again undertaken by several countries that have diplomatic relations with Taiwan. Although there is no provision in the Assembly's Rules of Procedure for the conferring of observer status, it is understood that this can be achieved only if it is approved by a majority of the members present and voting. Delegates privately discussed a previous occasion on which the issue was put to a vote in the Assembly and the proposal for a new agenda item on Taiwan was overwhelmingly rejected. In that light, the Assembly's General Committee, after a brief discussion, decided without a vote not to recommend inclusion of this new agenda item. In the Assembly plenary, under a previously agreed scenario, there were two speakers on each side of the issue, after which the Assembly president said it appeared the plenary had agreed with the recommendation that there be no new agenda item, and it was so decided without a vote. (Note: In a report submitted to Congress in January 2000, following up on a legislative request in 1999, the Administration reported on its efforts to support ways for the people in Taiwan to benefit from—as well as contribute to the work of the WHO.
The Assembly gave only brief attention to the long-standing agenda item on "health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine.” A resolution highly critical of Israel was introduced by a number of Arab states and Zimbabwe. The United States called for a vote on the resolution in a committee of the whole because of its political elements, but the resolution was adopted by a vote of 60 in favor, 3 opposed (U.S., Israel, Palau), with 21 abstaining. In the plenary, there was no call for a repeated vote. However, the U.S. delegation pointed out it had provided more than $50 million in assistance to the Palestinians for child survival and maternal health programs and was continuing to do so. It said a WHO resolution should have concentrated on health, but instead had taken up inappropriate political issues.
Pan American Health Organization (PAHO)
The Directing Council of PAHO convened in San Juan, Puerto Rico, in September. Representatives of all 38 PAHO member states participated, mostly at the ministerial level. U.S. officials were active in that meeting as well as in meetings of the PAHO Executive Committee and its Subcommittee on Planning and Programming.
The Directing Council discussed and adopted resolutions on several pressing health issues, including tobacco control, health care reform, HIV/ AIDS, safe blood supply, immunizations, and persistent organic pollutants.
The Council also approved for 2000–2001 a PAHO budget of $177,136,000, an increase of 5.1 percent over the budget for 1998–1999. The United States, which pays 59.44 percent of the PAHO budget, objected to the increase and urged that the Council approve a new budget at the same level as the previous one. The U.S. delegation called for a vote on the budget, but the PAHO Director's proposal was approved by a vote of 32 in favor and 1 (U.S.) opposed. The U.S. assessment for each year of the new biennium was set at $52,258,062, after credit adjustments. U.S. Government arrears from prior years amounted to $14,941,094 at the end of the year. Following the vote, the PAHO Director thanked the member states for a show of confidence in him and thanked the United States for its support of PAHO and its continued generosity through the provision of voluntary contributions.
International Agency for Research on Cancer (IARC)
The Governing Council of IARC, a subsidiary of WHO, met at IARC headquarters in Lyon, France, in May. The 18-member Council decided to suspend participation of the Russian Federation, which had not made any payment to IARC since the breakup of the Soviet Union and was deeply in arrears.
In 1998, the Council had offered Russia, at its request, a payment plan under which it could eliminate its arrears and maintain its participation in IARC. However, at its 1999 meeting, the IARC Director, Dr. Paul Kleihues (Germany), told the Council that Russia had rejected the offer and said it was unable to pay. The Council then adopted a resolution stressing that suspension of participation was taken “as a very exceptional measure” until the Russian government requested resumption of participation and agreed to a plan regarding its extensive arrears. The resolution also said the Council took this action "with regret" and noted the desire of Russia to resume full participation “as soon as the stabilization of the financial and economic conditions so permits.”
The Governing Council also approved a new IARC budget for 20002001 of $36,880,665. This was a decrease of 1.51 percent from the budget established for 1998–1999. One component of the budget was real program growth of 4.15 percent, which was attributed entirely to the contributions of two new IARC members, Brazil and Argentina, for one half of their first direct assessment for the regular budget. Another component was a budget reduction attributed to the deletion of the share of the Russian Federation. There was also a cost increase of 6.03 percent, partly offset by exchange rate gains of 4.91 percent. Director Kleihues said this situation presented an outstanding opportunity for the Agency-real growth in the budget combined with an overall nominal decline and a reduction in the assessments for all member states.
All delegations except the United States supported this proposal. The U.S. delegate said that-leaving aside the real growth in the budget attributable to Brazil and Argentina, which was acceptable, and leaving aside the deletion of the Russian share—the budget should reflect "zero nominal growth,” and it did not do so because the cost increases were not fully covered by the exchange rate gains. The Council approved the budget, but the United States asked that the record show it had disassociated itself from this result. Under the new budget, the United States assessment was set at $1,673,482 in 2000 (9.29 percent), and $1,670,444 in 2001 (9.115 percent). At the end of 1999, U.S. arrears in IARC amounted to $352,126.