An article about the outcome of a model session of a simulated WHO meeting, as a journalist of GIMUNews.

photo by jonrawlinson (Lic CC-BY 2.0)

A Bottom-up Approach Against Aids

"Today we have the science, technology, medicine and wealth: what we now need is the unity and strength of purpose to employ the ingenuity and resources we have - and to employ them well - to help those who need it."

The delegate of the United Kingdom quoted its Prime Minister Gordon Blair (yes, Gordon Blair; read more in last Friday's edition of The Sun). It is in this sense that the resolution passed on Friday by the World Health Assembly plans to tackle the raging HIV/Aids epidemic in sub-Saharan Africa. Its main focus lies on the delivery, and not the research of new drugs.

Concerned about the wide-spread disease, the delegates of China, Russia, the UK, France, Cameroon, Benin, Eritrea and Swaziland had drafted a resolution on Thursday night and presented it the next day. Since the Assembly was under an enormous time constraint and thus no amendments were possible, the resolution had to be designed to find a broad consensus from the start. Since all delegates agreed that something had to be done quickly, the resolution succeeded with only three votes against, namely Peru, the Philippines, Vietnam, and one abstention, Uganda.

It addresses virtually every aspect of the epidemic, regarding both treatment of Aids and prevention of HIV infections. Only the development of new drugs, a long term measure, is not specifically dealt with.

In treatment of HIV/Aids, the WHO foresees to streamline the delivery process of health care. The approach is bottom-up, similar to the one envisaged by Venezuela's "Mission Barrio Adentro". Treatment should be decentralised, from central hospitals to local clinics. Obstacles to efficient and universal health care are to be eliminated. For instance, responsibilities are shifted from doctors to nurses, once appropriately trained. The Assembly however calls attention to keeping a balance between quality and efficiency.

In terms of prevention, the WHO continues following its strategy to promote education and de-stigmatisation in a cultural approach. The promotion of condom use was a topic of fierce debate and lead the Philippines, Vietnam and Uganda to vote against or to abstain in the voting. Abstinence and fidelity, the Filipina delegate argued, are the best protection and should at least be mentioned; moreover, condom use can lead to more risky behaviour.

The United Nations, unlike Venezuela, do not enjoy petrol revenue. The actions proposed by the WHO are therefore dependent on its donors, essentially the OECD countries. The UK and France as sponsors of the resolution and the United States, whose delegate has recently been suspected by other delegates to secretly hold a second mandate as delegate of the Federal Republic of Milk and Honey, have voted in favour. They are consequently expected to act as main contributors of the actions, which are to be financed essentially through existing UN agencies, such as UNAIDS. According to the Russian delegate to the WHO, this should reinforce transparency.

The delegations of Peru and Vietnam criticised the lack of concrete actions in the resolution. This lack, presumably due to time constraints, is not entirely a bad thing: The delegates have thereby created a rough summary of what needs to be done, explained in a short way and readable by laymen.

As a legally non-binding document, this resolution does what it is supposed to: help the different actors to find a common solution. It would be pointless to pass a resolution that imposes on some actors, thus excluding the chance that the clauses will actually be implemented. This resolution clearly enjoys the support of all the involved parties. It is, as the Brazilian delegate pointed out, not imposed by the developed countries, but it nevertheless managed to gain their support. What sub-Saharan Africa needs is a quick eradication or at least alleviation of HIV/Aids. Once it is relieved from this burden, further achievements such as political stability and economic prosperity are easier to achieve. It is therefore of vital importance that the member states stick to their promises.

Ivo Näpflin, GIMUNews, April 6, 2008