Ideas on WHO Delegates at Odds

By David Brown

The Department of Health and Human Services and the World Health Organization have reached a compromise on the controversial issue of who gets to name U.S. government scientists to serve as advisers to the Geneva-based organization.

The trouble is that the two sides have nearly opposite views of what the compromise means.

WHO has agreed to send invitations to specific scientists through the U.S. government, rather than to contact the experts directly. This arrangement, largely a matter of protocol, is one the organization has with China, Russia and a few other of its 192 member countries.

HHS officials, however, believe WHO has acceded to its request that the U.S. government be allowed to "identify an appropriate expert who can best serve both of our organizations" after WHO provides a general description of the expertise it is seeking.

Among WHO's myriad tasks in global public health is the writing of policies and guidelines on topics as diverse as lab testing and drug manufacturing to disease treatment and nutritional advice.

The policies -- which are advice to countries and do not have the force of law -- begin with the work of expert committees consisting of about 15 scientists from around the world who meet in Geneva for three to seven days and review the scientific evidence on a specific topic. All the recommendations are reviewed by WHO officials, and important or controversial ones are voted on by the organization's member countries, whose representatives meet annually in May as the World Health Assembly.

In most cases, the people on the committees -- as well as in more hastily assembled "study groups" formed to address disease outbreaks and emergencies -- are drawn from a standing pool of scientists who agree to act as unpaid advisers for a certain period. These include experts at universities, government research agencies and nongovernmental organizations. In 2003, there were 1,064 scientists in the pool, in 54 named areas of expertise.

North Americans were 24 percent of that total, although the exact number of Americans or U.S. government scientists is not readily available. But the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration -- all HHS agencies -- are among the most important and reliable sources of expertise.

In April, William R. Steiger, HHS Secretary Tommy G. Thompson's special assistant for international affairs, wrote Denis G. Aitken, an assistant director general of WHO, and requested that when WHO wants a U.S. scientist for an expert panel that it first "provide us with the terms of reference and other relevant information." Steiger added that if WHO "has a specific expert to suggest, we will be pleased to consider that recommendation," but that HHS will ultimately come up with a name.

Steiger also noted that federal employees "do not and cannot" participate as individuals but "serve as representatives of the U.S. government at all times and advocate U.S. government policies."

In a response written earlier this month, Aitken noted that a WHO regulation requires that members of advisory panels "shall act as international experts . . . they may not request or receive instructions from any government." (WHO staff, and people lent long-term to the organization by governments, must swear a similar oath of independence.)

In his letter of response, Aitken said WHO will "consult with the U.S. government" on appointments. He said WHO will decide whether to "nominate a named individual or ask the U.S. government for a specific type of expertise without naming an individual."

In a recent telephone interview, however, he explained how the arrangement will work:

"We will write to the government and tell them we would like this individual to attend. If the government says no, well that's too bad, we won't take anybody else. We cannot insist on an individual. But what we can insist on is that anybody who attends [an advisory meeting] not represent a government position, and we can insist on no substitutes."

On rare occasions, WHO may not know the name of an expert and will ask HHS for one. But he added: "I wouldn't see it [that option] as a loophole . . . it should not be overplayed as a norm."

WHO has a similar arrangement with about a dozen countries, including China, India and Russia. In response to a question, Aitken said he believes the agreement with Russia dated from the Soviet period.

"We are not treating the U.S. any differently in this regard," Aitken said, adding that he was awaiting Steiger's response.

Last week, William A. Pierce, the HHS spokesman, said the department viewed Aitken's letter as an agreement to its terms and had no immediate plans to contact him.

"Denis said yes. He said okay. No way to get around that," Pierce said.

In the April letter, Steiger gave no reason for the new policy except to say that WHO's practice of inviting scientists directly "has not always resulted in the most appropriate selections."

But several government scientists, speaking on the condition of anonymity, said they believe the policy arose in part from federal employees' work on WHO's Global Strategy on Diet, Physical Activity and Health, which was adopted by the organization's assembly in May. Two CDC researchers and an NIH economist were involved in writing or reviewing scientific material that undergirded the strategy.

One of the supporting documents summarized evidence on the health effects of concentrated sugars and recommended they make up no more than 10 percent of a diet's calories. That position was opposed by sugar growers.

The strategy says that taxes and marketing restrictions on junk foods are possible ways to discourage their consumption. That suggestion was criticized by Steiger and representatives of the grocery industry, among others.

Derek Yach, formerly head of WHO's noncommunicable diseases section and now a professor of public health at Yale University, said HHS officials questioned the scientific basis of several conclusions about the role of diet and exercise in obesity even though some of the key underlying research had been "reported and published by their own scientists."

Pierce said one of the reasons the department wants to name the U.S. scientists who serve on expert panels is to spread that privilege around.

"This policy will give more of our scientists this career-enhancing opportunity," he said. The appointments "are good for their careers; they're prestigious."

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