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Example from Ollie - WHO FCTC guidelines

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Example from Ollie - WHO FCTC guidelines

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The Guidelines to the FCTC were created to help governments understand the provisions of the convention and to take action. They have been at the centre of quite a lot of litigation, and have helped in the defence of tobacco legislation. For example they were relied upon to defend the EU"s tobacco products directive. They have therefore been very effective, and this is perhaps attributable to the high level of consensus that exists on the direction of tobacco policy, the high level of agreement over the science, and the widespread rejection of the tobacco industry.

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Who - Guidelines for Safe Drinking Water Quality

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Who - Guidelines for Safe Drinking Water Quality

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The WHO have proposed guidelines for ‘drinking water quality.’ The WHO have recognised that access to safe drinking water is a basic human right, thus, the WHO’s proposed recommendations and guidelines to ensure safe drinking water standards worldwide. The WHO safe drinking water guidelines encompass a wide range of aspects in its efforts to ensure safe drinking water. Various aspects include water treatment process and monitoring of such process, guidance on acceptable levels of water contaminants including bacteria, chemicals and viruses.

When considering the success of the WHO ‘Guidelines for Drinking Water Quality,’ on one hand it can be said that implementation of guidelines have been successful in certain parts of the world. A WHO survey in 2022 recognised that 73% of the global population (approximately 6 billion people) utilized a safely managed drinking water service. The effectiveness of the WHO drinking water quality guidelines can be attributed to the extensive scientific research and evidence which are reflective of up to date understandings of waterborne diseases etc. Additionally, the WHO ensure independence and impartiality in their scientific research enabling individual scientists conduct such research who are not representative of any government or organization. Thus, the research put forth by the WHO is sincere and in the best interests of the global population.

However, while the WHO’s ‘Guidelines for Drinking Water Quality’ have proved somewhat successful, low-income countries still face challenges. Again, WHO survey conducted in 2022 estimated that at least 1.7 billion people are still subject to the use of using a drinking water source which is contaminated with feces. It can be said that without a doubt, increased funding and resources need to be pumped into insuring safe water supplies for these third world countries. On another note, perhaps, implementation of the WHO guidelines may be regarded as excessive by lower-income countries governments because their populations have adapted to and are almost immune to the water contaminants. Thus, implementation of the safe drinking water guidelines are lagging in these countries. However, despite adaption to such diseases, these countries have the right to the same level water quality as first world countries therefore increased investment is necessary.

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Reading the articles you posted on Moodles on Soft Law, one can deduce that the WHO performed a better role at the start, when it was first set up, after WW2, it acted as a promoter for better health and keeping the world population physically and mentally safe. Recently, especially after the Covid-19 pandemic, it seems WHO did not use their responsibility to the fullest. They are good are providing soft law and guidelines but not so much prioritizing their soft laws to become hard law.

Based on the grid( from no. 1 below), I think they have been some effective guidelines:

1.     Antiretroviral therapy for HIV infection in adults and adolescents

2.     Prevention and treatment of HIV and other STIs among men who have sex with men and transgender people:

The above 2 guidelines/soft law seems to be quite effective, they collaborated well, involved the stakeholders, they had good formulating methods and it is effective fully and received by infected people. It is a life/death situation so well done, for involving non-state actors, state health departments and corporates etc.

Although in my opinion,  I feel that domestic violence or zero-hunger, eradicating poverty should have some hard law and prioritized above many other guidelines - with enforcement and treaties to get buy-in from States (they are on the SDGs now)non-state actors, philantropists etc. WHO cannot priortize every health need, but they can be more efficient with their powers.

(1)Health Organization; 2010,Appraisal of guidelines developed by the World Health Organization (B.U. Burda, A.R. Chambers J.C. Johnson)

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WHO - The Doha Declaration on TRIPS and Public Health

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WHO - The Doha Declaration on TRIPS and Public Health

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One of the major advantages of soft law that struck to me was the consensus that these instruments could bring, especially when two interests have to be chosen over one another. The Doha Declaration aimed at determining which law would prime when there would a "clash" between international trade law and global health law.

This thus enabled states to prioritise health over the right to intellectual property to ensure the access of generic medicine and guarantee their affordability.

However, I have noticed when doing my personal researches on this declaration, it has many downsides when it comes to its implementation for least developed countries, because they do not have enough assistance from developed countries or by intergovernmental organisations like the WTO or the WIPO, to implement its provisions.

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 International Code of Marketing of Breastmilk Substitutes

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 International Code of Marketing of Breastmilk Substitutes

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The International Code of Marketing of Breastmilk Substitutes ('The Code') was published by the WHO in 1981. As a voluntary code of practice, it is a good example of soft law.

The Code addresses the marketing of infant formulas, follow-on formulas and any other food or drink for infants and very young children, including bottles and teats. The remit is wide in scope, covering public marketing, direct marketing or influence of parents, engagement with healthcare workers (including through gifts and incentives), engagement in hospital environments, as well as labelling and quality of products.

The aim is to ensure that parents are able to make full and informed choices, and that the influence of commercial interest in driving critical decisions about infant feeding are regulated.

While there has been much written about the challenges of implementing the code, it has also had an enormous governance effect on the sector. Where formula trolleys were once the norm on maternity wards (company reps pushing their brand figuratively and literally on new mothers through free samples), this is no longer the case in many countries. Even the design of maternity hospitals are no longer allowed to be influenced by commercial interest - where they were once influenced by funding from formula companies, with nurseries far from the mother's wards, reducing optimal breastfeeding and enabling higher formula sales, design is now based on evidence-based medicine.

A long standing piece of guidance, it gas been influential, and the Code continues to receive much attention and monitoring by various bodies, including through local volunteers and public interest groups linked to the International Baby Feeding Action Network. To me this is an excellent example of soft law in action.

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The call to action on e-cigarettes is a recent document in December 2023 by the World Health Organisation urging governments to treat e-cigarettes also known as vapes, similarly to tobacco and ban all flavours. The e-cigarettes are not without risk, the tobacco industry is being undermined with a fallacy that e-cigarettes help smokers to quit smoking. E-cigarettes with nicotine are highly addictive and are harmful to health, they are not just water vapour as indicated by the marketing of these products.

E-cigarettes are often promoted as a less harmful alternative to conventional cigarettes. They can contain chemicals and cancer causing agents. Globally, the market is growing rapidly and unregulated in many parts of the world, with a large diversity of products and attractive flavours, aggressively marketed and targeting children and young people . There is no evidence that e-cigarettes help smokers to quit smoking. There are urgent measures necessary to (1) prevent the promotion and uptake of e-cigarettes and counter nicotine addiction to non-smokers and youth. (2) minimise the health risk to both smokers and non-smokers of cigarettes. (3) prohibit unsubstantiated health claims. (4) to prevent the tobacco industry from undermining the success that we have seen in tobacco controls. Where countries ban the sale of e-cigarettes, the should ensure strong implementation. Where countries allow commercialisation of e-cigarettes strong regulation is necessary. Ireland passed legislation in December 2023 making it an offence to sell vaping products to anyone under the age of 18. Many countries have banned the sale of e-cigarettes/vapes. The tobacco industry is now a major producer and manufacturer of e-cigarettes and related products.

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WHO - Position Paper on Mammography Screening (2014) 

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WHO - Position Paper on Mammography Screening (2014) 

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In 2014, the WHO published a position paper on mammography screening. The aim of the paper was to examine the balance of benefits and harms to offering mammography screening to women after they have reached the age of 40 across a range of settings.

The report made various recommendations based on age group and resource setting, recommending that women in well-resourced settings should begin screening at age 40, provided such programmes are conducted in the context of comprehensive research, monitoring and evaluation. Moreover, it also recommends that for women in limited resource settings with a weak or relatively strong health system, population based screening programs should not be initiated at the lower age of 40.

This soft law in the form of a position paper appears to have been influential, as a number of jurisdictions have since undertaken clinical research to determine whether there are increased benefits to reducing the national mammography screening programme age from 50 to 40.

More recently in the US, a draft paper was published by the US Preventative Task Force, entitled "Breast Cancer: Screening." This paper recommends that all women should be screened every other year from age 40 to reduce breast cancer related mortality.

However, it appears the WHO position paper has been effective in some regards, but not in others. Whilst the report has clearly been influential and sparked further research and recommendations, its recommendations have not yet been adopted as part of any national healthcare screening programme to date, possibly due to the additional resources this would require. On a positive note, it does appear to have also mobilised a charitable initiative in the UK to provide mammograms to women from the age of 40, 10 years prior to the NHS screening program begins, in recognition of the recommendations made in relation to this topic.

Overall, it appears that the 2014 position paper has been effective in some ways at mobilising further research and recommendations, and charitable initiatives, but has not resulted in the recommendations being fully adopted at this time.