AIDS and health activists struggled to hold ground in the campaign for access to affordable and sustainable treatment during the 54th World Health Assembly (WHA). Developing countries proposed strong resolutions and amendments in favor of access to affordable medication and local generic drug production and the US and EU member country delegations worked overtime to weaken the proposals, one by one.

Brazil tabled two strong amendments on access, pricing, and HIV/AIDS treatment; their language stirred up support from developing countries and opposition from wealthy ones, with few exceptions. BrazilÕs original language included calls for the creation of a WHO database of drug pricing information, enhancement of the WHO assistance to developing countries increasing medication access, recognition of the importance of local generic drug production in promoting drug access, and affirmed access to medication as a human right.

In an interesting twist, the official text of the draft Brazil amendments in the six UN languages did not circulate among WHA country delegations until just before the amendments were proposed by Brazil. Typically amendments circulate 24 hours before they are proposed. Activists learned that the US and EU member country delegations were leaning on Brazil up until the eleventh hour, pressuring them to either throw out altogether or water down the amendments they would propose.

In the end, the Brazilian proposals were systematically weakened by the so-called "compromise language" pushed through by the US and the EU member countries. The US, too embarrassed to present its objections to the Brazil amendments to the full public committee, repeatedly obstructed open debate by requesting the formation of a small drafting committee, where sometimes there was no translation provided, and where the US bullied and pressured until their demands for weakened language were met.

In just one of many examples, the original concept of a comprehensive drug price database presented in BrazilÕs amendment to the WHO Revised Drug Strategy suffered dramatic changes thanks to the US and other rich countries. The final version of the amendment morphs the database into a request to the WHO to explore whether or not a voluntary price list would be feasible and effective.

A resolution that came to committee during the waning hours of the WHA on Strengthening Health Systems (from South Africa on behalf of the countries of the Non-Aligned Movement) originally contained strong language about trade, intellectual property, and affordable drug accessÑincluding generic drug access. But as with the two previous controversial amendments, this resolution suffered during an ad hoc meeting completely dominated by rich countries and their interests.

At a meeting with activists during the course of the week, Bill Steiger, Special Assistant to Secretary Thompson, discussed the US delegationÕs opposition to the proposals, as well as the US position on the Global Health Fund for HIV/AIDS, TB, and malaria.

He told Health GAP Coalition that the US opposes the creation of a WHO drug pricing database becauseÑaccording to PharmaÑcollecting and publishing the appropriate pricing information would violate US antitrust laws, and would reveal proprietary information. He did not provide evidence to support this doubtful claim.

The US delegation also argued during the week that it was not the role of the WHO to assist poor countries in obtaining essential drug access by creating a comprehensive price database. Clearly there is disconnect between what poor countries feel is the mission of the WHO, and what the rich countries, propped by Big Pharma, feel is the mission of the WHO.

When talk shifted to the Global Fund for HIV/AIDS, TB, and malaria, Steiger shared alarming new information:

1. The US government would meet its historic UN aid goal of contributing 25% to Kofi AnnanÕs overall aim of $7-$10 billion not by allocating the $2 billion or so it can fully afford to grant, but instead by kicking down a small amount, and requesting donations from businesses to make up the differenceÑhoping corporate charity will help deflect attention from complete unwillingness to commit billions of dollars to treat and prevent the global HIV/AIDS crisis.

2. The US will not allow its contributions to go toward any purchaseÑbulk or otherwiseÑof generic versions of HIV medications that under patent protection in the US, regardless of price difference. There is also talk that the Administration is threatening to try to kill the fund unless generic manufacturers are excluded from participation altogether.

3. While Steiger agreed that industry should not participate in the Fund in either a governance or an advisory capacity, he described the US desire for a group of clinicians and public health people to sit on a panel and evaluate and approve all grant proposals; there are no plans to ensure that panel participants are free from conflict of interest, as well.

The 54th WHA also marked about 20 months since Member States officially expanded the mandate of WHO regarding medication access: WHO was charged in the 1999 Revised Drug Strategy with ongoing monitoring and analysis of the impact of TRIPS and other trade agreements on the public health. However, WHOÕs current plan of action is far from proactive. The upcoming June TRIPS Council, with a day devoted to meeting regarding TRIPS and health, is a high-stakes arena where the active involvement of WHO is crucial. However, activists left the WHA with little hope that WHO would be anything more than a neutral and passive party during the TRIPS Council.

In fact, the US delegation used this WHA to campaign very vigorously against the idea that WHO should fully enact its expanded mandate and represent the interest of the public health at the table with WTO. The US made a concerted effort during the meeting to constrain the WHO to the position of official neutral note-taker on health and trade, at best.

When WHO was questioned about the structure and governance of the Global Fund, we were told there was "no decision" about whether money earmarked to purchase drugs would be spent by bulk procurement of drugs at best world price; likewise WHO Ðespecially enamored of partnerships with industryÑducked questions about whether or not the Global Fund would contain strict conflict of interest guidelines.

When UN Secretary General Kofi Annan addressed the WHA halfway through the meeting, we hoped he would have new information about the Global Fund--either an announcement of a new donor, less anemic than the US, or new details about how the Fund would actually operate. Unfortunately, he had nothing at all new to say.

Lobbying sympathetic country delegations during the week to champion a vision for a Fund that isnÕt run by Pharma, that operates on a bulk purchasing system that includes generics, and that builds on existing health infrastructure was extremely difficult when public information about the thing is all but nonexistentÑI think many countries believe the Fund is a figment. Unfortunately, it is quite likely that all the critical decisions are being made now behind closed doors, among players like Big Pharma and the US, who have already indicated their allegiance is not with poor people with AIDS.