U.S. sexual
health policy under fire with WHO during appointment
hearings

The Bush administration's drug and sexual health policy is a key issue as the World Health Organization chooses its next leader, a post that wields great power in allocating billions of dollars in funds to alleviate misery around the world.

After two days of closed-door deliberations, WHO is set to announce its new chief Wednesday.

Contenders for WHO's top job include Dr. Margaret Chan, a bird flu expert and former Hong Kong director of health; Dr. Shigeru Omi of Japan, who heads WHO's Asia office; Mexican health minister Dr. Julio Frenk; Spanish health minister Elena Salgado Mendez; and Dr. Kazem Behbehani, a veteran WHO official in Kuwait.

The United States has not declared a preference for any candidate.

Critics say the United States, WHO's largest donor, plays too large a role behind the scenes. They argue that the Bush administration is promoting the interests of its pharmaceutical industry -- at the expense of poor

AIDS patients who could be saved by cheap generic medicines -- and has adopted an ideological line on issues like abortion.

President Bush has made more money available for AIDS research than any previous American leader, but that largesse has not extended to programs in reproductive and sexual health. His administration has also challenged ideologically charged WHO programs such as needle exchanges and condom distribution.

U.S. officials deny they are seeking to force the administration's health policies upon the world.

"We are not giving WHO money because we want to have influence," said Bill Hall, a spokesman for the U.S. Health and Human Services Department. "We're doing this because we want to improve the human condition around the world."

Leading public health experts and senior WHO officials told The Associated Press that Washington consistently interfered with policy under the U.N. agency's last director-general, Dr. Lee Jong-Wook, who died in May.

"The U.S. government has a direct role in every significant decision made in Geneva, and even close to a veto role," said Dr. Richard Horton, editor of the influential medical journal, The Lancet.

In one prominent case of alleged interference, the United States requested the suppression of a book commissioned by WHO that criticized U.S. free trade agreements for jeopardizing poor countries' access to cheap medicines.

In a letter to WHO's acting director-general, a senior official from the U.S. Department of Health and Human Services said the report "spuriously" characterized U.S. trade policy. WHO has yet to make a decision on the U.S. demand.

"Standing up to the U.S. is not the easiest thing to do at the WHO," said Sisule Musungu, a Kenyan intellectual property specialist, who coauthored the report with a former WHO staffer.

The episode sparked concern from two Democratic lawmakers, Sen. Edward Kennedy of Massachusetts and Rep. Henry Waxman of California, who have called for an investigation into how American trade agreements threaten the health of people in developing countries.

"Attempting to suppress a report because it is critical of U.S. trade policy is unacceptable," Kennedy wrote in a letter to Mike Leavitt, Secretary of Health and Human Services.

In a widely reported episode in January, WHO's top official in Thailand was stripped of his post after he said in an editorial that a U.S.-Thai free trade agreement would jeopardize Thai access to cheap drugs, leading to the deaths of hundreds of thousands of AIDS patients.

"This was an example of an instance where there was probably pressure from a certain member state, in this case the U.S.," said Dr. Tido von Schoen-Angerer, of Doctors Without Borders, which works closely with WHO.

The United States denies it had anything to do with the transfer of the official, Dr. William Aldis, to the WHO's regional office in New Delhi, India.

"We had no role in that," said Hall of the Department of the Health and Human Services. Though Hall says Washington formally complained to the WHO about the editorial, he said no suggestions were made about disciplining Aldis.

Pharmaceutical companies argue that allowing developing countries to produce generic medicines may compromise their quality, endangering the lives of the patients they are meant to treat and leading to resistant strains of diseases.

The WHO's position has been that generic drugs are generally safe, and that the advantages of using them in cases like Thailand outweigh the relatively small risks.

Thailand has often been praised as a success story in its approach to tackling AIDS -- producing cheap, generic versions of antiretrovirals. More than 80,000 people depend on these life-prolonging treatments and AIDS deaths have dropped by nearly 80% in the last decade.

Since the publication of Aldis's editorial, the Thailand-U.S. free trade agreement has been stalled -- largely because of the attention drawn to what the pact would do to Thailand's strategy on fighting AIDS.

(AP)