The WHO veteran was caught in the middle of an intensifying global debate over how to reconcile intellectual-property protection with the pressing public-health need to expand access to expensive life-saving medicines, a hot-button issue that has sharply divided WHO member states along developed- and developing-country lines.
At the time of his death, Lee, a South Korean national, had closely aligned himself with the US government and by association US corporate interests, often to the detriment of the WHO's most vital commitments and positions, including its current drive to promote the production and marketing of affordable generic antiretroviral drugs for millions of poor infected with the human immunodeficiency virus (HIV), which can cause AIDS.
According to senior and middle-ranking WHO officials familiar with the situation, Lee blatantly bent to US government pressure in March when he made the controversial decision to recall the WHO country representative to Thailand, William Aldis, who had served less than 16 months in what traditionally has been a four-year or longer posting.
A wrong opinion
Aldis had made the mistake of penning a critical opinion piece in the Bangkok Post newspaper in February that argued in consonance with WHO positions that Thailand should carefully consider before surrendering its sovereign right to produce or import generic life-saving medicines as allowed by the World Trade Organization (WTO) in exchange for a bilateral free-trade agreement (FTA) with the United States, which is currently under negotiation.
The WHO official also wrote that the stricter intellectual-property protection measures in the proposed US-Thai FTA would inevitably lead to higher drug prices and thereby jeopardize the lives of "hundreds of thousands" of Thai citizens who now depend on access to locally produced cheap medicines to survive. He noted too that the Thai government's current production of generic treatments had allowed the country to reduce AIDS-related deaths by a whopping 79%.
Aldis' arguments directly mirrored stated WHO positions, but significantly were at direct odds with the objectives of current US trade policy, which through the establishment of bilateral FTAs aims to bind signatory countries into extending their national intellectual-property legislation far beyond the parameters of current WTO agreed standards.
A recent US Congressional Research Service report states that the United States' main purpose for pursuing bilateral FTAs is to advance US intellectual-property protection rather than promoting more free trade. The Bipartisan Trade Promotion Authority Act of 2002, the applicable US legislation for bilateral FTAs, states explicitly that Trade-Related Intellectual Property Standards, or TRIPS, are by law non-negotiable and must reflect a standard of protection similar to that found in US law.
A US ambassador to the UN in Geneva paid a private visit to Lee on March 23 to express Washington's displeasure with Aldis' newspaper commentary, according to WHO officials familiar with the meeting. A follow-up letter from the US government addressed to Lee strongly impressed Washington's view of the importance of the WHO to remain "neutral and objective" and requested that Lee personally remind senior WHO officials of those commitments, according to a WHO staff member who reviewed the correspondence.
The next day, Lee informed the regional office in New Delhi of his decision to recall Aldis.
Perhaps strategically, Aldis' removal coincided with the height of Thailand's recent political crisis, and failed to generate any local media attention at the time. Internally, Lee had characterized Aldis' transfer to a research position of considerable less authority in New Delhi as a promotion.
But a Geneva-based WHO official familiar with the situation said the article "was seen as stepping over unseen boundaries which the director general set for himself and his staff when dealing with the US. It was a disappointing reaction, a sad reaction, but under Lee's administration not a surprise."
Suwit Wibulpolprasert, senior adviser to the Thai Ministry of Public Health, early this month sent a formal letter to acting WHO director general Anders Nordstrom, requesting an official explanation for Aldis' abrupt removal.
According to a WHO official in Geneva with knowledge of the correspondence, the letter raised questions about possible US influence behind the irregular personnel rotation and said that if the WHO decision was motivated by Aldis' comments on the US-Thai FTA, then the WHO should reconsider the transfer.
Suwit also raised his concerns about the level of transparency and freedom of speech inside the WHO. In e-mail communication with this correspondent, Suwit said WHO officials had already denied that Aldis' recall was related to the opinions stated in the Bangkok Post article. A regional WHO official in New Delhi told a senior Thai public-health official that Aldis' removal was related to "inefficiency" in performing his functions - a characterization that Thai officials who worked alongside him through the 2004 tsunami and ongoing avian-influenza scare have privately contested.
News of Aldis' transfer, which oddly was first leaked by a Bangkok-based US official, quickly spread through the global health organization. The June edition of the highly regarded medical journal The Lancet, which otherwise painted a flattering portrait of Lee's tenure, drew on anonymous WHO sources to characterize Lee's decision on Aldis as a "clear signal of US influence on WHO".
It is believed that Lee's decision and its subsequent leak by the US government was specifically designed to engender more self-censorship among other WHO country representatives when they comment publicly on the intersection of US trade and WHO public-health policies.
A large number of WHO staff members are employed on renewable 11-month contracts, meaning that their standing inside the organization is on perpetually shaky ground and hence curbs their ability to voice critical opinions.
Mixing health and commerce
Aldis, a US national and permanent WHO staffer, was known among his colleagues for privately airing views critical of the Bush administration and its policy toward the WHO, particularly in relation to the US government's alleged tendency to mix its commercial and public-health agendas.
Aldis reportedly chafed at WHO regional headquarters' instructions to receive representatives from US corporations and introduce them to senior Thai government officials to whom the private company representatives hoped to sell big-ticket projects and products.
In recent months, major US companies such as pharmaceutical giant Pfizer and technology company IBM have asked the WHO in Thailand to facilitate access to senior Thai officials. In turn, some senior WHO staff members have expressed their concerns about a possible conflict of interests, as the requested appointments were notably not related to any ongoing WHO technical-assistance program with the Thai government.
It's not the first time that the US has played hardball with the WHO and Thailand. In 1998, when member nations proposed that the WHO be granted more power to monitor international trade agreements and their effects on global public health, particularly in relation to the access to patented medicines in developing countries, the US government threatened to withhold funding to the organization.
Under that financial threat, the WHO has since largely refrained from commenting critically on the drug-patent issue. International and independent non-governmental organizations (NGOs) such as Oxfam and Medecins Sans Frontieres have filled the WHO's leadership vacuum on the issue by filling the information gap with highly critical research reports.
From the United States' perspective, Aldis, and by association the WHO, had publicly sided with Thailand on the pivotal drug-patent debate during a crucial stage in the FTA negotiations. Washington reportedly hopes that the comprehensive deal it is pursuing with Thailand will serve as a template for other bilateral trade pacts in the region, including soon-to-be-negotiated deals with Malaysia and Indonesia.
Thai civil-society groups, meanwhile, have complained about the lack of transparency surrounding the negotiations, which caretaker Prime Minister Thaksin Shinawatra has unilaterally conducted without consultations with parliament.
The US and Thailand have in the past sparred over the Thai government's decision to use its WTO-approved compulsory licensing rights to produce certain generic antiretroviral drugs for HIV carriers and AIDS sufferers. In 2001, for example, Washington threatened retaliatory trade sanctions, including curbs on sensitive Thai export products, if the Thai government allowed the production of certain generic antiretroviral drugs.
Thai activists, meanwhile, have given certain US pharmaceutical companies legal fits. In 2001, for instance, they challenged the legality of US pharmaceutical company Bristol Meyer Squibb's patent over the antiretroviral drug didanosine, or DDI, because it was originally developed by a public US agency, the National Institutes of Health.
In 2002, a Thai court cited international statutes when it ruled that Thai HIV/AIDS patients could be injured by patents and had legal standing to sue if drug makers holding patents restricted the availability of drugs through their pricing policies.
The verdict was upheld in January 2004, and as part of an out-of-court settlement Bristol Meyer Squibb decided to "dedicate the [DDI] patent to the people of Thailand" of that particular version of the drug by surrendering it to the Thai Department of Intellectual Property.
The dedication, however, did not carry over to third countries. Under the provisions of a US-Thai FTA, future legal challenges to US-held drug patents would be nearly impossible, Thai activists and international NGOs contend.
WHO at the crossroads
Lee's unexpected death has already engendered some serious soul-searching inside the WHO. Lee was widely lauded after his death, but his final legacy to the organization he served for 23 years is very much in doubt.
US President George W Bush said, "Lee provided tremendous leadership to the international community as it confronted the challenges of the 21st century." UN Secretary General Kofi Annan, Microsoft founder Bill Gates and former US president Jimmy Carter all made similar eulogies to Lee's long commitment to improving global public-health standards.
Lee frequently denied allegations that US political pressure influenced his decision-making, most notably perhaps during a recent television interview with the British Broadcasting Corp. However, it is just as likely that Lee will be remembered for the many times he caved to US pressure on crucial public-health issues, frequently in areas where WHO positions and commitments required that he take a stronger stand, some WHO officials contend.
Moreover, the secretive way that Lee sometimes conducted WHO business, apparently in some instances at the United States' behest, already has some officials inside the UN agency talking about the need for greater transparency and accountability under the next director general. "It will be very rough waters ahead for the new [director general]," said a Geneva-based WHO official, speaking on condition of anonymity.
As the United States' strong influence over Lee comes into posthumous light, the selection process for his replacement will almost certainly be politicized along rich- and poor-country lines, and if the US openly pushes its favored candidate, that divide could widen into a full-blown schism inside the traditionally cohesive organization. Those sharp lines are already emerging.
A report by a WHO-mandated independent commission recently recommended that as a general rule governments should avoid bilateral free-trade treaties that reduce access to medicines in developing countries. An annex to that report, signed by mainly Western experts who adhered to positions held by big pharmaceutical companies, highlighted the glaring differences in opinion emerging among WHO member states.
For its part, the US has long advanced the argument that without strong intellectual-property protection, the pharmaceutical industry will not have the commercial incentive to conduct research and development for crucial new medicines.
However, Brazil and Kenya recently claimed that about 90% of total global health-related research and development of Western pharmaceutical companies went toward addressing the medical needs of about 10% of the world's population. Those two countries have since called on the WHO to adopt systems for intellectual-property protection that would increase developing countries' access to health innovations and medicines.
WHO staffers say they resent what they view as the United States' political agenda toward vital public-health concerns, ranging from reproductive-health issues to promoting good dietary standards.
At the 2004 World Health Assembly (WHA), the US broke with the meeting's proposed resolution that reproductive and sexual rights should be considered human rights, and strongly protested the meeting's focus on the public-health risks of unsafe abortions.
Lee had earlier that year held up a list of essential WHO-recommended medicines drafted by an independent expert committee for more than two months because of US objections about two listed abortifacient drugs that could be used to induce abortions in emergencies.
The US delegation to another recent WHA took issue with a WHO-proposed diet and health resolution, particularly concerning the acceptable level of sugar content in foods, which by the WHO's expert assessment would have cast US fast-food and soft-drink companies in an unfavorable light. Lee famously bent to the US objections and signed off on a significantly watered-down version of the original resolution.
US interference with UN personnel and policy decisions, of course, isn't an entirely new phenomenon. The US is the largest donor to the UN and by association to the WHO, and in light of the US-inspired events in Bangkok, senior WHO representatives throughout the organization are likely to be more guarded when commenting on public-health issues that Washington considers sensitive.
The Bush administration's tactics, often cloaked as reform measures, in reality aim to bring UN agencies like the WHO more in line with US commercial and political interests.
At the WHO, at least, that process has come at the expense of the UN agency's stated mission, commitments and, perhaps most significant, its global credibility as an impartial and apolitical actor.