ATol INVESTIGATION World health: A lethal dose of US politics By Dylan C Williams
BANGKOK - When World Health Organization (WHO) director general Lee Jong-wook
died of a cerebral hemorrhage last month before the start of the United Nations
agency's annual World Health Assembly, the world's most prominent public-health
official was arguably of a conflicted mind.
The WHO veteran was caught in the middle of an intensifying global debate over
how to reconcile intellectual-property protection with the pressing
public-health need to expand access to expensive life-saving medicines, a
hot-button issue that has sharply divided WHO member states along developed-
and developing-country lines.
An Asia Times Online investigation reveals that at the time of his death, Lee,
a South Korean national, had closely aligned himself with the US government and
by association US corporate
interests, often to the detriment of the WHO's most vital commitments and
positions, including its current drive to promote the production and marketing
of affordable generic antiretroviral
drugs for millions of poor infected with the human immunodeficiency virus
(HIV), which can cause AIDS.
According to senior and middle-ranking WHO officials familiar with the
situation, Lee blatantly bent to US government pressure in March when he made
the controversial decision to recall the WHO country representative to
Thailand, William Aldis, who had served less than 16 months in what
traditionally has been a four-year or longer posting.
A wrong opinion
Aldis had made the mistake of penning a critical opinion piece in the Bangkok
Post newspaper in February that argued in consonance with WHO positions that
Thailand should carefully consider before surrendering its sovereign right to
produce or import generic life-saving medicines as allowed by the World Trade
Organization (WTO) in exchange for a bilateral free-trade agreement (FTA) with
the United States, which is currently under negotiation.
The WHO official also wrote that the stricter intellectual-property protection
measures in the proposed US-Thai FTA would inevitably lead to higher drug
prices and thereby jeopardize the lives of "hundreds of thousands" of Thai
citizens who now depend on access to locally produced cheap medicines to
survive. He noted too that the Thai government's current production of generic
treatments had allowed the country to reduce AIDS-related deaths by a whopping
Aldis' arguments directly mirrored stated WHO positions, but significantly were
at direct odds with the objectives of current US trade policy, which through
the establishment of bilateral FTAs aims to bind signatory countries into
extending their national intellectual-property legislation far beyond the
parameters of current WTO agreed standards.
A recent US Congressional Research Service report states that the United
States' main purpose for pursuing bilateral FTAs is to advance US
intellectual-property protection rather than promoting more free trade. The
Bipartisan Trade Promotion Authority Act of 2002, the applicable US legislation
for bilateral FTAs, states explicitly that Trade-Related Intellectual Property
Standards, or TRIPS, are by law non-negotiable and must reflect a standard of
protection similar to that found in US law.
A US ambassador to the UN in Geneva paid a private visit to Lee on March 23 to
express Washington's displeasure with Aldis' newspaper commentary, according to
WHO officials familiar with the meeting. A follow-up letter from the US
government addressed to Lee strongly impressed Washington's view of the
importance of the WHO to remain "neutral and objective" and requested that Lee
personally remind senior WHO officials of those commitments, according to a WHO
staff member who reviewed the correspondence.
The next day, Lee informed the regional office in New Delhi of his decision to
Perhaps strategically, Aldis' removal coincided with the height of Thailand's
recent political crisis, and failed to generate any local media attention at
the time. Internally, Lee had characterized Aldis' transfer to a research
position of considerable less authority in New Delhi as a promotion.
But a Geneva-based WHO official familiar with the situation said the article
"was seen as stepping over unseen boundaries which the director general set for
himself and his staff when dealing with the US. It was a disappointing
reaction, a sad reaction, but under Lee's administration not a surprise."
Suwit Wibulpolprasert, senior adviser to the Thai Ministry of Public Health,
early this month sent a formal letter to acting WHO director general Anders
Nordstrom, requesting an official explanation for Aldis' abrupt removal.
According to a WHO official in Geneva with knowledge of the correspondence, the
letter raised questions about possible US influence behind the irregular
personnel rotation and said that if the WHO decision was motivated by Aldis'
comments on the US-Thai FTA, then the WHO should reconsider the transfer.
Suwit also raised his concerns about the level of transparency and freedom of
speech inside the WHO. In e-mail communication with this correspondent, Suwit
said WHO officials had already denied that Aldis' recall was related to the
opinions stated in the Bangkok Post article. A regional WHO official in New
Delhi told a senior Thai public-health official that Aldis' removal was related
to "inefficiency" in performing his functions - a characterization that Thai
officials who worked alongside him through the 2004 tsunami and ongoing
avian-influenza scare have privately contested.
News of Aldis' transfer, which oddly was first leaked by a Bangkok-based US
official, quickly spread through the global health organization. The June
edition of the highly regarded medical journal The Lancet, which otherwise
painted a flattering portrait of Lee's tenure, drew on anonymous WHO sources to
characterize Lee's decision on Aldis as a "clear signal of US influence on
A senior WHO official who spoke to Asia Times Online on condition of anonymity
believes that Lee's decision and its subsequent leak by the US government was
specifically designed to engender more self-censorship among other WHO country
representatives when they comment publicly on the intersection of US trade and
WHO public-health policies.
A large number of WHO staff members are employed on renewable 11-month
contracts, meaning that their standing inside the organization is on
perpetually shaky ground and hence curbs their ability to voice critical
Mixing health and commerce
Aldis, a US national and permanent WHO staffer, was known among his colleagues
for privately airing views critical of the Bush administration and its policy
toward the WHO, particularly in relation to the US government's alleged
tendency to mix its commercial and public-health agendas.
Aldis reportedly chafed at WHO regional headquarters' instructions to receive
representatives from US corporations and introduce them to senior Thai
government officials to whom the private company representatives hoped to sell
big-ticket projects and products.
In recent months, major US companies such as pharmaceutical giant Pfizer and
technology company IBM have asked the WHO in Thailand to facilitate access to
senior Thai officials. In turn, some senior WHO staff members have expressed
their concerns about a possible conflict of interests, as the requested
appointments were notably not related to any ongoing WHO technical-assistance
program with the Thai government.
It's not the first time that the US has played hardball with the WHO and
Thailand. In 1998, when member nations proposed that the WHO be granted more
power to monitor international trade agreements and their effects on global
public health, particularly in relation to the access to patented medicines in
developing countries, the US government threatened to withhold funding to the
Under that financial threat, the WHO has since largely refrained from
commenting critically on the drug-patent issue. International and independent
non-governmental organizations (NGOs) such as Oxfam and Medecins Sans
Frontieres have filled the WHO's leadership vacuum on the issue by filling the
information gap with highly critical research reports.
From the United States' perspective, Aldis, and by association the WHO, had
publicly sided with Thailand on the pivotal drug-patent debate during a crucial
stage in the FTA negotiations. Washington reportedly hopes that the
comprehensive deal it is pursuing with Thailand will serve as a template for
other bilateral trade pacts in the region, including soon-to-be-negotiated
deals with Malaysia and Indonesia.
Thai civil-society groups, meanwhile, have complained about the lack of
transparency surrounding the negotiations, which caretaker Prime Minister
Thaksin Shinawatra has unilaterally conducted without consultations with
The US and Thailand have in the past sparred over the Thai government's
decision to use its WTO-approved compulsory licensing rights to produce certain
generic antiretroviral drugs for HIV carriers and AIDS sufferers. In 2001, for
example, Washington threatened retaliatory trade sanctions, including curbs on
sensitive Thai export products, if the Thai government allowed the production
of certain generic antiretroviral drugs.
Thai activists, meanwhile, have given certain US pharmaceutical companies legal
fits. In 2001, for instance, they challenged the legality of US pharmaceutical
company Bristol Meyer Squibb's patent over the antiretroviral drug didanosine,
or DDI, because it was originally developed by a public US agency, the National
Institutes of Health.
In 2002, a Thai court cited international statutes when it ruled that Thai
HIV/AIDS patients could be injured by patents and had legal standing to sue if
drug makers holding patents restricted the availability of drugs through their
The verdict was upheld in January 2004, and as part of an out-of-court
settlement Bristol Meyer Squibb decided to "dedicate the [DDI] patent to the
people of Thailand" of that particular version of the drug by surrendering it
to the Thai Department of Intellectual Property.
The dedication, however, did not carry over to third countries. Under the
provisions of a US-Thai FTA, future legal challenges to US-held drug patents
would be nearly impossible, Thai activists and international NGOs contend.
WHO at the crossroads
Lee's unexpected death has already engendered some serious soul-searching
inside the WHO. Lee was widely lauded after his death, but his final legacy to
the organization he served for 23 years is very much in doubt.
US President George W Bush said, "Lee provided tremendous leadership to the
international community as it confronted the challenges of the 21st century."
UN Secretary General Kofi Annan, Microsoft founder Bill Gates and former US
president Jimmy Carter all made similar eulogies to Lee's long commitment to
improving global public-health standards.
Lee frequently denied allegations that US political pressure influenced his
decision-making, most notably perhaps during a recent television interview with
the British Broadcasting Corp. However, it is just as likely that Lee will be
remembered for the many times he caved to US pressure on crucial public-health
issues, frequently in areas where WHO positions and commitments required that
he take a stronger stand, some WHO officials contend.
Moreover, the secretive way that Lee sometimes conducted WHO business,
apparently in some instances at the United States' behest, already has some
officials inside the UN agency talking about the need for greater transparency
and accountability under the next director general. "It will be very rough
waters ahead for the new [director general]," said a Geneva-based WHO official,
speaking on condition of anonymity.
As the United States' strong influence over Lee comes into posthumous light,
the selection process for his replacement will almost certainly be politicized
along rich- and poor-country lines, and if the US openly pushes its favored
candidate, that divide could widen into a full-blown schism inside the
traditionally cohesive organization. Those sharp lines are already emerging.
A report by a WHO-mandated independent commission recently recommended that as
a general rule governments should avoid bilateral free-trade treaties that
reduce access to medicines in developing countries. An annex to that report,
signed by mainly Western experts who adhered to positions held by big
pharmaceutical companies, highlighted the glaring differences in opinion
emerging among WHO member states.
For its part, the US has long advanced the argument that without strong
intellectual-property protection, the pharmaceutical industry will not have the
commercial incentive to conduct research and development for crucial new
However, Brazil and Kenya recently claimed that about 90% of total global
health-related research and development of Western pharmaceutical companies
went toward addressing the medical needs of about 10% of the world's
population. Those two countries have since called on the WHO to adopt systems
for intellectual-property protection that would increase developing countries'
access to health innovations and medicines.
WHO staffers say they resent what they view as the United States' political
agenda toward vital public-health concerns, ranging from reproductive-health
issues to promoting good dietary standards.
At the 2004 World Health Assembly (WHA), the US broke with the meeting's
proposed resolution that reproductive and sexual rights should be considered
human rights, and strongly protested the meeting's focus on the public-health
risks of unsafe abortions.
Lee had earlier that year held up a list of essential WHO-recommended medicines
drafted by an independent expert committee for more than two months because of
US objections about two listed abortifacient drugs that could be used to induce
abortions in emergencies.
The US delegation to another recent WHA took issue with a WHO-proposed diet and
health resolution, particularly concerning the acceptable level of sugar
content in foods, which by the WHO's expert assessment would have cast US
fast-food and soft-drink companies in an unfavorable light. Lee famously bent
to the US objections and signed off on a significantly watered-down version of
the original resolution.
US interference with UN personnel and policy decisions, of course, isn't an
entirely new phenomenon. The US is the largest donor to the UN and by
association to the WHO, and in light of the US-inspired events in Bangkok,
senior WHO representatives throughout the organization are likely to be more
guarded when commenting on public-health issues that Washington considers
The Bush administration's tactics, often cloaked as reform measures, in reality
aim to bring UN agencies like the WHO more in line with US commercial and
At the WHO, at least, that process has come at the expense of the UN agency's
stated mission, commitments and, perhaps most significant, its global
credibility as an impartial and apolitical actor.
Dylan C Williams is a Bangkok-based correspondent.