Professors Without Borders

After a selection procedure by our head delegates, Regina Schmidt and Anna Uhl, from the School of Economics and Management at the Free University of Bozen-Bolzano, I was selected as one of the 12 delegates from UniBz, to represent Kenya in the World Health Organization at the 16^th World Model United Nations simulation, which was held from 26-30 March 2007 in Geneva, Switzerland. The following report describes some background of the UN simulation and general programme, dynamics of and reflections on the WHO committee, and social events; suggestions are integrated in the main text.

Background

Harvard WorldMUN is a week-long conference comprised of 1700 university students from 42 countries. It is the most diverse Model UN conference in the world, and the largest outside of North America. Students simulate United Nations committees as well as other international organizations. Assigned to a specific country, students must debate topics in the committee from that country’s perspective. The goal at the end of the week is to produce a UN-style resolution that addresses the issues discussed over the week. Delegates must develop communication, negotiation, and public speaking skills, while engaging other students from around the world on a variety of interesting topics.[i]

To make the simulation as close-as-possible to the real procedural aspects of the UN, delegates have to adhere to the official Rules of Procedure, with role calls, moderated caucuses on specific sub-topics, unmoderated caucuses for free discussions, motions, submitting working papers, writing draft resolutions (structured according to perambulatory clauses and operative clauses), amendments, voting, and so forth.

19 UN committees were available for the 192 UN Member States and additional Observers (observers include the Vatican, Palestine, and several NGOs, such as Family Health International), thus not yet covering all UN committees and organizations (see Figure 1). Given that there were several double-delegations, ‘overfull’ committees, and several important issues wholly ignored, it may be useful to add a couple of committees. For instance, the FAO (provision of sufficient and healthy food is the first life’s necessity), climate change (also promoted by the EPFL Vice-president for International Affairs) to be put on the agenda of one or more of the committees (like the IMO and WMO), and water issues. Also, the science & technology committee and/or the ITU (International Telecommunications Union) may have some interesting topics to discuss about, e.g., Net neutrality, narrowing the gap of the ‘digital divide’, or on incentives for and promotion of introduction of environmentally-friendly (low-cost, sustainable) technologies.

Bolzano was assigned several countries to represent in several committees: Kenya, Lybian Arab Jamahiriya, lao Peoples Republic, and Romania in Social & Humanitarian (SOCHUM), Special Political and Decolonization (SPECPOL), Disarmament & International Security (DISEC), World Trade organization (WTO), World Health Organization (WHO), and the IAEA. 

The opening ceremony at the conference centre (CICG) had several speakers, such as Adolf Ogi (UN special advisor for sport and former president of the confederation), Paola Ghillani (former CEO of the Max Havelaar Foundation), and Patrick Aebischer (President, EPFL), after the yodelling and horn play and the usual welcome-speeches.

The organizers from EPFL managed to have the closing ceremony in General Assembly room on the premises of the UN in Geneva. The security checks, and, for some the rain as well (and cool snow afterwards), were definitely worth it! As visitors at the start of the WorldMUN, we were allowed only to have a quick look in the back of the large room, but this time around, 1700 students occupied almost all seats, including the front rows, balcony, and stage.

World Health Organization

The topic: Children & HIV/AIDS

“this session will focus exclusively on the provision of PMTCT and pediatric HAART and the participation of children in HIV vaccine trials.

·         With the existing financial constraints of the health sector, how much of a priority should treating children with AIDS be?

·         How can more anti-retroviral dosages and combination drugs be developed for children while also avoiding further dependence of less developed countries on more developed countries and taking intellectual property laws into account?

·         Is it right to treat children and not adults, or vice versa, if resources are scarce?

·         How can children’s access to Highly Active Anti-Retroviral Treatment be increased?

·         How can access to and uptake of Mother-to-Child Transmission Prevention programs be improved?

·         How, if possible, can the best interests of the individual child be protected when they participate in HIV vaccine trials for the best interests of children as a group?”

(Unlike several other committees, we managed to adopt a ‘comprehensive resolution’ [mk: the link to the adopted resolution will be added when the WorldMUN organising committee puts it online].) As preparation on the topics, each delegate had to write two position papers that reflect the situation and position on the two topics of the country s/he represents; mine is attached as Appendix A below. In short, Kenya is at the forefront of developing and implementing policies, that, first and foremost, emphasise prevention and then treatment, second, the focus is on adults and much less on children, third, Kenya recognizes the feminization of the HIV/AIDS pandemic and that more policies have to be developed to deal with the gender disparity, and, fourth, there are no clear guidelines for clinical trials other than ‘sort of’ adhering to “international” ethical standards[ii] (but is not a signatory of the Helsinki Declaration[iii] of the World Medical Association). Generalised block positions of the countries on the issues are on pp18-19 of the WHO reader.

After all this scene-setting, how did the WHO committee proceed? Mostly, ‘off-topic’ – or so it may have seemed. Given that HIV/AIDS is a multifaceted problem, it requires a comprehensive multisectorial approach to ameliorate the situation; looking at a few sub-topics only as required by the WorldMUN topic-reader did not quite happen. Related aspects that passed the revue were, among other things, education, structural improvements of the health sector infrastructure, generic drugs, TRIPS, and financing.

Also, in the first three days, it was mainly about adults. While this may seem off-topic too, this, in fact, was an implicit answer to the first and third question: adults take precedence over children in most, if not all, countries. Not that anybody dared to say it this blunt into the microphone, but it was obvious from the conversations with delegates from across the world during the unmoderated caucuses[iv] and a few very polite phrases during speaker time. The Chair of the Committee did not really picked it up – or she had her own preference that surely children should take precedence – so in the end, several more times the words “children” and “paediatric” were squeezed into the resolution to pay lip service to treatment of children with HIV/AIDS.

Ethics of HIV vaccine trials was hardly touched upon. First, some delegates used their intuition rather than hard facts about HIV vaccine trials, with the exception of the Delegate of Italy who clearly mentioned that Italy is at phase III trials for adults only, and any clinical trials for vaccines for children will take several more years, let alone adapting any future vaccine for affordable distribution in resource-constrained settings (a position that Kenya, among others, shares). This holds for all HIV/AIDS vaccine development. So, the ‘we need more research’ sections got into the resolution.

Second, although now may be the time for the WHO to devise policies, there are already three main documents one can draw upon: the Helsinki Declaration with its updates, the one of the Council for International Organizations of Medical Sciences (CIOMS) of 2002, and the UN Declaration of the Rights of the Child. The problem is that not all countries have signed up to these agreements, which leads to double standards of applying ethical behaviour in different countries. Put differently, so-called ‘culturally and socially sensitive flexible standards’ in resource-constrained countries versus adhering to ‘high standards of universal rights’ in countries like the UK, USA, and France (see also footnote 2). In addition, or part of the previous double standards, there are valid concerns about exploitation of people in poor countries to benefit drug development for people in rich countries. Only one small operative clause (nr. 24) made it into the resolution on this aspect[v], with an addition (clause nr. 25) calling for the creation of an advocacy group for oversight to minimize exploitation of children. 

Last, expensive HAART treatment for children was not specifically addressed, but the requirement to say something about prevention of mother-to-child transmissions (PMTCT) received ample attention in the final resolution. Probably, again, because it focuses on treating young adult women rather than children.
 

Dynamics in the committee

Most of the time, there was a rather uncooperative atmosphere, which improved slightly when the Chair mentioned we should work together and, above all, respect your fellow delegates. In the end, two of the several delegates who demonstrated utter disrespect toward other delegates walked away with an award for diplomacy. Including a third who won a diplomacy award (who was excellent at faking coordinating efforts between the different sub-groups that emerged during the unmoderated caucuses), appearance from the outside (by the organizers) is in stark contrast with the realities on the ground when one actually has to try to collaborate with these kind of people. What does one learn? Arrogance, indifference, and snobbishness pays off. In this respect, it is unsurprising that in the real-world politics some long overdue negotiations never commence, break down rather quickly, or some negotiators suffer from an imago problem because they do not promote themselves as good as others.

These people may want to take note of some notions from game theory: while in politics, deadlines are set to induce end-of-game pathological behaviour and ‘coerce’ negotiators into an agreement as if it is final, realistically, there is repeated interaction among the players, which comes closer to that of infinite games where current and future steps are influenced by past experience. The world is big with 6 billion people, but you never can anticipate if, when, and how people meet again; with the WorldMUN alumni networking project, the balance is intended to go to the ‘when’ and not ‘if’.

Example. To demonstrate some of the dynamics, a short recollection of successive events follows, which eventually became entertaining (for a majority of delegates).

Setting: before the official start of the last committee meeting (or: an unofficial unmoderated caucus);

Item: the Friday-morning draft of the draft resolution 1.3, which was a merger of draft resolution 1.1 (mainly providing perambulatory clauses), 1.2 (providing most of the content), and several new points resulting from the Thursday discussions.

More precise item: that what is now operative clause 24 (see footnote 5) about member states to recognize the ethical trial standards was then still part of point E in clause 25, and should have been up for proper discussion.

“this part [of point E] should go in a separate clause 24, because the topic is different from the rest of the clause.”

“hm, ok. Which opening word? ‘Invites’ all member states?”

“no, preferably ‘Urges’, else ‘Encourages’.”

“‘Invites’ is more than enough.”

“It’s better to use ‘Urge’, because otherwise we’ll have to go through the whole procedure of amendments.”

“I am writing here, so it will be ‘Invites’ and if you think you can pass an amendment, well, then, go ahead and try it later.”

“Look, I have all African and Latin American countries with me who do not like to be exploited in clinical trials, we’ll pass it with a large margin. It will be just a waste of time to do it through an amendment while now, during making the draft, it can be adjusted easily.”

“I don’t care. We’re writing it, and I decide that ‘Invites’ is enough.”

So, ‘Invites’ got into draft resolution 1.3. After official introduction of draft resolution 1.3, the obligatory reading time and Q&A session of the draft resolution, there was an unmoderated caucus for the purpose of writing amendments. We (delegates of Georgia and Kenya) collected the list of signatories (a minimum of 12 is necessary[vi]) within about 2 minutes, then another minute writing the amendment that “Invites” should be changed into “Urges”. After the unmoderated caucus, our amendment was up first, with the minimum of two speakers in favour of the amendment and two against (the first with a void comment and the latter missing the point entirely), and it swiftly proceeded to voting, where an overwhelming majority voted in favour of the amendment. Although the whole thing could have been avoided, getting the list of signatories, defending an amendment, and getting it passed is fun. Of course, ‘urge’ instead of ‘invites’ is more realistic, which therefore is better to have in the resolution, but is also a nice snub to the delegates of USA, UK, and France. In addition, it demonstrated that when countries do collaborate, one actually can get items into a resolution that has broad support despite presence of a few vocal opposing countries.

 
We got clause 27 on self-sufficiency[vii] and clause 7 on generic drugs[viii] without amendments, as the delegates of Malawi and Syria, among other writers, were more susceptible to adding these points to the draft resolution. Clause 7, however, should have been stated more strongly and not exactly mentioning strict adherence to TRIPS. While the delegate of Ecuador did his very best in promoting Brazil’s generic drugs policies and grouping the Latin American and African countries together to get at least something in the resolution about permitting generics, the delegate of Brazil’s ‘block-mate’ in leading the quest for generic drugs, India, did not live up to represent this important policy of India. In addition, the delegate of Brazil did not step into the limelight in the WHO committee and the delegate of India is a student at the United States Military Academy, who probably found it difficult to advocate India’s policies. Maybe better a next time; after all, there are enough countries that should be able to get together to push through the endorsement and use of cheaper generic drugs.

 
The whole competitive and, at times hawkish, behaviour is in no small part due to the “Diplomacy” Awards. Some even write draft resolutions and working papers already before the start of the simulation, so that one can score points by ‘leading a collaborative effort’. Getting a list of preambulatory clauses referring to previous agreements is certainly useful - having read them as well is even more useful. In addition, drawing a list of points (in plural!) that the country one is representing would like to see in any resolution is part of good preparation as well. (Then there are the prerequisites to know the Rules of Procedure at least as good as the Chair, and try to teach yourself as much English as possible, because you might be stuck with an unsympathetic Chair who does not allow you to ask/explain English from/to your fellow delegate during a committee session.)

Being from a country that generally frowns upon awards (the Netherlands), I would suggest to eliminate them, or to have them for entertainment only, like the fake awards in the SPECPOL Committee. After all, MUN is just an entertaining educative game. On the other hand, for some delegations, procuring funds to participate in a MUN partially or wholly depends on coming home with at least one award. More awards, or a randomizer, or both, may guarantee increased, funded, participation, which fits well with aims of the WorldMUN to get people from different countries together to foster cultural exchange and collaboration. Regarding ‘more awards’: letting committee members to vote for best diplomatic delegate seems a fairer popularity contest from the ‘inside’ of the negotiations among the country delegates than relying solely on the subjectivity of committee Chairs[ix].

Social Events

The social events are organised to foster communication, exchanges etc, and, at times, is seen as an informal extension of the unmoderated caucuses (some delegates look first at your badge before deciding to talk with you or not), but after intense debates, relaxing a bit or having a good conversation about other topics is also useful.

The first evening is always planned for the Global Village, where delegates from the different countries present primarily food and drinks from their country. Even though none in our delegation is Italian citizen, we did our best with promoting delicious Muri Gries Lagrein wine (sponsored by St. Benedikt), Parmesan cheese, sausages, olives, panetones, and limoncello. Due to the high demand for the real Italian food, it all disappeared like snow in summer, and we could go to other stands, tasting the real Turkish Delight, Swedish licorice, Dutch stroopwafels, baklava (several countries), Venezuelan coffee, many more foodstuffs and drinks, Pakistani merchandise, Bulgarian rose perfume, and other artefacts from the 42 countries that participated in WorldMUN 2007.

I have skipped the short pub crawl, but have made up for it during the Boat night on Lake Geneva and the Farewell party. The latter had a real chocolate fountain, where you can cover pieces of fruit or pie with chocolate, or just eat chocolate on its own.

Thursday we had a visit to the local organizers’ university, the Ecole Polytechnique Fédérale de Lausanne (EPFL). There were five topics to choose from, and, unsurprisingly, I ended up at the computer & communication sciences faculty. After an entertaining presentation by the Dean Prof. Zwaenepoel that computer science really does have some relation with reality, is even present everywhere, students could go to the IT history museum and attend workshops & demos. Afterwards, there was an aperitif and short dinner before going to the Cabaret in the Circus tent on the EPFL campus. After an impressive acrobatics act, it was the delegations turn to present something. Most delegations that had prepared an act resorted to singing, and, above all, dancing, with the Venezuelans and Lebanese as top acts for dragging the public into joining their dancing and starting a party.

Although the partying of the social events were fun and there were other in-conference visits and presentations organized to ensure a full programme from 9am to 1am, I would have liked to see some more topical current-affairs discussion sessions in the programme. Further, there was, unfortunately, too little time to speak with students from other countries, such as about perspectives from the Lebanese students on the most recent invasion, reports on the instability in Pakistan under Musharraf, comments on Chavez’ Venezuela, to name but a few.

Last, we had taken the opportunity to get a guided tour through the UN building. We did not cross the whole 1km long building, but a good part of it was covered. In addition to a recap of the historical context, the main point on the ‘by the numbers’ information was the following: the amount of money spent on arms in the world is 65 times higher than the entire budget of the UN (including all its organizations, such as UNICEF and FAO). Oops.

Finally

Despite – or maybe even thanks to – the mess in the WHO committee, participating in the WorldMUN was a valuable experience. Through a variety of approaches, several points got in the resolution that are important to Kenya, such as developing policies addressing the feminization of the HIV/AIDS pandemic, training and retaining of health care workers and other prevention- and treatment-based suggestions (such as education/information, home-based care, PMTCT clinics together with VCS), and collaborative research. In addition, it was an essential experience for picking up practical, unwritten, rules of the game.

Appendix A

Disclaimer: the position paper had to be short and therefore did not address all issues; any mistakes that might be in the text are mine.

Country: Kenya (Delegate: Marijke Keet, Free University of Bozen-Bolzano)

Committee: World Health Organisation

Topic A: Children and HIV/AIDS

Kenya’s National AIDS and STDs Control Programme to fight the “national disaster” AIDS – as our President Mwai Kibaki declared in 2002 – is coordinated through the National AIDS Control Council (NACC). Policies commenced with the Sessional paper No. 4 of 1997 on AIDS in Kenya, which was superseded by the Kenya National AIDS Strategic Plan (KNASP) 2000-2005, and renewed élan has been given to the battle with KNASP 2005/6-2009/10, thereby consolidating successful policies and extending it with new initiatives, a.o., concerning orphans & vulnerable children and women. Kenya supports, first, the “Three Ones” guiding principles agreed at ICASA 2003, being: i) One agreed AIDS action framework that provides the basis for coordinating the work of all partners ii) One national AIDS coordinating authority, with a broad-based multisectoral mandate, and iii) One agreed country-level monitoring and evaluation system. Second, the three main pillars of KNASP 2005/6-2009/10 are a) prevention, b) quality of life of people infected and affected, and c) impact mitigation.

First and foremost, prevention is very important – and is much less costly than treatment, such as prohibitively expensive [HA]ART and other medicines, which put a large burden on the country’s as well as individual household budgets, or vaccine development, which is medically, technologically, and economically not realistic for at least another decade. We are progressing toward prevention through providing information, stimulating behavioural changes, and condom usage; this also comprises voluntary counselling & testing and PMTCT services. The latter were introduced in 2000 and reached 759 facilities countrywide in 2006, which provide counselling and Nevaripine to mother and child to reduce MTCT. Kenya also has commenced with a paediatric treatment programme: by September 2005, about 3,500 children were on ART (Report on the Joint AIDS Programme Review 2005, NACC) and training for health workers is under way. The negative effect of HIV/AIDS on food production, commercial agriculture, and businesses, however, are grave for a low GDP country as Kenya (Impact of HIV/AIDS on Labour Productivity in Kenya. Trop. Med. & Intl. Health, March 2004). In particular, the cohort with highest HIV infection rates are young adults (20-40), at what should be the prime of their economically productive and family life and where education investments just start paying off for society at large. In this respect, HIV/AIDS is a cause of poverty, which could be counteracted by more and better organised treatment when more funds would be available.