WPRJRC55/SRl4
SUMMARY RECORD OF THE FOURTH MEETING (Mandarin Hall, Shanghai International Convention Centre) Wednesday, 15 September 2004 at 09:00 CHAIRPERSON: Mr GAO Qiang (China)
CONTENTS page 1.
Outbreak response, including severe acute respiratory syndrome (SARS), influenza and a progress report on the revision of the International Health Regulations (continued) ......................................................... . Regional strategy for improving access to essential medicines in the Western Pacific, 2005-2010 ............................................................................ . Consideration of draft resolutions ......................................................................... . 3.1 3.2 Report of the Regional Director ............................................................... . Proposed programme budget, 2006-2007 and the eleventh general programme of work .................................................. .
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Departure of Chairperson ...................................................................................... .
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OUTBREAK RESPONSE, INCLUDING SEVERE ACUTE RESPIRATORY SYNDROME (SARS), INFLUENZA AND A PROGRESS REPORT ON THE REVISION OF THE INTERNATIONAL HEALTH REGULATIONS: Item 11 of the Agenda (Document WPRlRCSSIS) (continued) Dr TONG (Macao, China) said that Macao was following WHO's lead in strengthening
outbreak response. An interdepartmental review had found that basic capacity for implementing the revised IHR was adequate. However, support from WHO and countries with relevant experience was needed to develop a comprehensive quarantine system. In preparing for public health emergencies, WHO's support was requested for an evaluation of the response system and preparedness, i~uding
preparedness for specific diseases with the potential to cause pandemics; training of health professionals in public health emergency management; promotion of expertise and technology exchange among Member States; and the design and construction of a special facility to treat communicable diseases. Professor TRINH QUAN HUAN (Viet Nam) noted that his country had collaborated with the WHO network of laboratories and interested partners through the sharing of biospecimens for research into the SARS coronavirus and avian influenza H5NI virus. Viet Nam had also participated in studies on the mode of transmission of H5Nl. The Ministry of Health had formulated a master plan for strengthening the capacity of preventive health systems, particularly for disease surveillance, laboratory diagnosis and outbreak response. Regarding avian influenza, he noted there was
insufficient knowledge on the mode of virus transmission, and natural risk factors, such as humid conditions and bird migration, posed additional challenges. The unavailability of vaccine was another important issue. Further support from WHO and partners would also be needed to ensure effective implementation of the revised International Health Regulations. Dr ABU BAKAR (Brunei Darussalam) congratulated WHO for its role in interrupting the
spread of SARS and rapidly responding to the threat of avian influenza in the Region. He supported the actions proposed for consideration, several of which had already been initiated in Brunei Darussalam. Intersectoral collaboration had been strengthened through measures that had included the establishment of a national task force on zoonotic diseases. At the regional level, steps had been taken to strengthen border surveillance. He supported the basic principles underlying the revision of the International Health Regulations, but noted that it would be difficult for Brunei Darussalam to achieve the required minimum core capacity by the scheduled date for adoption of the revised Regulations in May 200S, in view of the limited trained human personnel, facilities and resources the country. needed. He hoped that WHO would consider formulating a regional strategy to address the
constraints that faced Member States and support them to attain the required core capacity where
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Dr ZHU (China) echoed the views of previous speakers on the necessity of joint efforts by Member States, strengthening of regional surveillance mechanisms, and exchange of technical expertise. WHO should provide training and technical guidance to Member States on biosafety, emergency response, surveillance and establishment of verification procedures. He supported the proposed revisions to the International Health Regulations. In China, priority had been given to the process and several government departments had been involved. He stressed the need to consider the capacities and conditions of Member States, including their existing laws and regulations. Mrs ELV ANDER (United States of America) supported the actions proposed to address the need for better national preparedness for threats of pandemics. The Department of Health and Human Services of her country had posted a draft national influenza pandemic preparedness plan on its website for 60 days to allow for public comment; comments from member countries were also welcomed. To prevent the recurrence of incidents of laboratory-associated SARS transmission, she called for strict implementation ofbiosafety and medical surveillance guidelines for workers handling live SARS coronaviruses. She supported the revision of the International Health Regulations and confirmed the participation of the United States of America in the intergovernmental working group meeting in Geneva in November 2004. The revised Regulations should include a list of diseases to be reported to WHO by Member States; the Department of Health and Human Services had prepared a paper on that proposal which was available to interested Member States for their perusal. Mr COURSE (France) recognized WHO's key role in managing the crises caused by recent outbreaks of SARS and avian influenza and the necessity of exercising strong leadership in controlling epidemics. It was important to develop international communication networks for
surveillance and to establish operational systems and procedures to respond to real and potential outbreaks. Good laboratory practices could have prevented the laboratory-related SARS cases in July 2003. Ensuring international health security was part of WHO's mission. France was actively collaborating in regional efforts to strengthen surveillance for emerging and re-emerging diseases and would continue to do so. He supported the basic principles underlying the revised International Health Regulations and recognized that some Member States would need WHO support to implement them. The revised Regulations should allow flexibility for countries to adapt their response t"
specific circumstances and risks. New Caledonia and French Polynesia were already taking steps to strengthen their capacity to meet potential and existing challenges. Ms HALBERT (Australia) noted the importance of local, regional and international cooperation in mitigating the impact of outbreaks of SARS and avian influenza. Australia was
committed to working in partnership with regional and global organizations to build regional capacity to prevent and control outbreaks of infectious diseases and to support the WHO Global Outbreak
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Alert and Response Network at the regional level. Australian laboratories were continuing to collaborate in international research on the transmission of the SARS coronavirus and development of diagnostic tests, and the Australian Agency for International Development (AusAID) was supporting the programme to improve regional capacity for surveillance and laboratory diagnosis. She supported the revision of the International Health Regulations and noted that the successful regional consultations in April 2004 had raised awareness. One important concern was the complex legal and political issues involved in their implementation; these would have to be negotiated by the intergovernmental working group in Geneva in November. In Australia, significant domestic issues related to legislation needed further consideration. She considered that the proposed time frame was ambitious and it would require strong commitment and considerable effort from Member States to achieve the target. Consensus was essential to develop the sense of ownership necessary for
acceptance and implementation of the Regulations. She called on the Secretariat to support countries to consider the new draft through such steps as establishing discussion groups for electronic sharing of views. She requested the view of the Secretariat on ways that countries could be supported in
implementing the revised Regulations. Dr LAM (Hong Kong, China) reported that a detailed review of the first draft of the revised International Health Regulations had been conducted in Hong Kong, with mputs from government departments and agencies. The Centre for Health Protection, established in Hong Kong after the SARS outbreak in 2003, had three commitments: real-time surveillance, rapid response, and responsive risk communication. Drills were being conducted in hospitals and communities, with the participation of government departments and agencies. Training in outbreak response and control was being provided to greater numbers of health staff in the public and private sectors. The curriculum in universities was being revised to provide more infectious disease courses. A system of exchange of information on
notifiable diseases and significant infectious diseases of known or unknown etiology had been established with Macao and Guangdong. Hong Kong had reserve laboratory capacity for diagnosis of SARS, and supported other countries in the Region through the WHO SARS Reference and Verification Laboratory Network. Microbiologists from Hong Kong had cooperated in the
management of human cases of avian influenza in Viet Nam, coordinated by WHO. Dr PARK (Republic of Korea) applauded the Regional Office's contribution to the successful containment of SARS in 2003 and the work done so far on containing avian influenza. Her country shared the concerns of the Regional Office on the limitations of the current International Health Regulations.
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The Republic of Korea had established a nationwide influenza sentinel surveillance system. Information on virus strains was entered promptly in Flu-Net, but if data were analysed internationally through the International Reference Laboratory and Flu-Net there was inevitably a time lag. That meant that, when an outbreak occurred in a neighbouring country, bilateral information sharing and joint research were more important than acquiring information from the International Reference Laboratory. Her country wanted to improve the sharing of information with the national reference laboratories of other Member States, with the help of the Regional Office. After the outbreak of avian influenza in poultry, the Republic of Korea had established a joint committee of officials from the Ministry of Agriculture and Forestry, the Ministry of Health and Welfare and academia, to promote collaboration and research on zoonoses, share information and strengthen response capacity. The Republic of Korea fully supported the draft revision of the International Health Regulations and, after a general consensus had been reached between the six regions, would pass the modified draft on to each department concerned and reach a consensus with the Korean Medical Association and other bodies. Her Government intended to participate in the International Task Force on the revision of the International Health Regulations in November. Mr NAIV ALU (Fiji) reported that the vulnerability of his country to public health emergencies had prompted the development of strategies and legislation for fast and effective response. The Pacific Public Health Surveillance Network and the Pacific Public Health Laboratory Network helped countries to improve their capacity to detect, investigate and respond to communicable diseases such as SARS and influenza. Fiji had established a partnership with animal health workers for forward planning to manage zoonotic diseases of public health significance, and the national public health laboratory services were being monitored by a quality management system, with the aim of creating a centre of excellence for the control of communicable diseases. The Ministry of Health had also incorporated two elimination initiatives in its Strategic Plan 2005-2008. In order to increase its readiness for public health emergencies, Fiji would revise its Public Health Act, and was strengthening its capacity in data management, surveillance and outbreak investigation. Bodies responsible for action on public health emergencies included the Central Bureau of Health, which worked with rural local authorities, town councils and city councils; the National and District Disaster Management Councils; and the National, Divisional and Subdivisional Health Disaster Committees. There was, unfortunately, no early warning system for outbreaks. However, information and communication channels for public health emergencies were clearly defined within each government department, and they liaised with other departments, nongovernmental organizations and the private
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sector through the National Disaster Management Council. Two focal points had been appointed for the International Health Regulations: the Director of Public Health and the National Adviser on Communicable Diseases. He noted that Fiji needed immediate support for training to increase its capacity to respond to public health emergencies. Dr DAYRIT (Philippines) observed that the fundamental issue was the threat of a pandemic,
whether of SARS, avian influenza or something else. The technical solutions had been listed in the document before the Committee - surveillance of humans. animals and micro-organisms; research: strengthening of systems; and collaboration among sectors. The issue for governments was how to allocate scarce resources, and that would depend on each country's assessment of its risk - an area in which WHO support was invaluable. Beyond the technical solutions and approaches expressed III
the
International Health Regulations, there were the psychosocial effects of illness. The larger problem with SARS had been mass hysteria, which had resulted in the loss of billions of dollars in revenue for tourism and other sectors. He therefore proposed that a strategy be devised for informing the public without causing panic, telling them what was being done and how to behave in emergencies. Education of the local and international media would be important. Dr POIMATAGI (Niue) informed the Committee that his country had been severely struck by a
cyclone in January 2004, and the newly renovated hospital had been demolished. His country was desperately seeking funds to build a new hospital. The emergence of SARS and avian influenza threatened all, especially small states. Often a small population became alarmed, even when response measures were in place. Niue had learned to work with civil society in reassuring people in the event of an outbreak. The revision of the International Health Regulations was important for health security. providing for electronic communication to stem the spread of diseases, and strengthening alert and response mechanisms, as well as determining when a disease constituted an international threat and when WHO assistance should be sought. Dr KING (New Zealand) agreed that the current revision of the International Health
Regulations should enhance early detection of and response to public health emergencies. New Zealand was actively participating in the International Health Regulations review process and fully supported the directions being taken. A new Public Health Bill would be passed in New Zealand
to implement the revision.
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Countries had to take the proper measures at home as well as taking part in the international response. Critical points where capacity had to be strengthened included a review of arrangements before the event and investing in public health infrastructure for day-to-day public health issues. Front-line health workers, including general practitioners, had to be kept well informed. Evaluation of the health sector response to health threats was also important; in New Zealand, that exercise had shown that, tor example, proper face masks for front-line health workers had been lacking during the SARS outbreak. Exercises to prepare for a pandemic, to identifY weaknesses and make a good communication plan, had to be part of risk management. The approach had to involve the whole Government, not just health officials. Customs, immigration, border control and other agencies had to be brought in quickly. Strong leadership was needed, especially to keep people well informed and to stop panic that might arise through lack of understanding. People had to be assured that nothing was being hidden from them. Timely sharing of information with WHO was important, and countries should seek assistance early, rather than trying to solve the problem alone. WHO had a global mandate and Member States should ensure free entry of WHO staff to their countries. Dr KUARTEI (Palau) supported the comments on hysteria that had been made by other
speakers. He raised the issue of stockpiling of medical supplies, and early mobilization of technical support. At the invitation of the CHAIRPERSON, a representative of the International Council of Nurses made a statement to the Committee. The REGIONAL DIRECTOR, in response to the question from the United Kingdom of Great Britain and Northern Ireland about the time frame for the biregional strategy, said that, early in 2005, experts on emergency response and animal health would be invited to meet. There would then be a meeting of experts from Member States, and the next session of the Regional Committee would be invited to comment on their findings. The same process would take place in the South-East Asia Region, and the two regions would share materials. Brunei Darussalam had asked how WHO could help Member States to develop core functions, and others had asked for support in research and capacity-building. He was optimistic that the Western Pacific Region would receive more extrabudgetary resources in the next, or even the current, biennium, and disease response was certainly an area that deserved a major share of additional extrabudgetary funds, along with control of noncommunicable diseases.
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Australia had raised the concern that the time frame for the process of revising the International Health Regulations might be ambitious, given that the process involved much discussion within and beyond the health sector. The Regional Director would transmit that concern to the global governing bodies, although it was still planned to submit the draft International Health Regulations to the next World Health Assembly in May 2005. The November meeting on the International Health Regulations would be the best forum at which to raise the issue of timing. The United States of America had suggested that a list of diseases be a part of the revised regulations; he agreed, as had most Member States at a recent meeting in Manila. The list of selected diseases could be attached as an annex and periodically adjusted without changing the main text of the Regulations. The Philippines had talked about reducing panic over outbreaks, and he undertook to work on that issue. The DIRECTOR, COMBATING COMMUNICABLE DISEASES said that the SARS outbreaks had shown that surveillance systems in many countries did not function well as early warning systems. The revised International Health Regulations would require Member States to have a minimum core capacity to detect and respond rapidly to all types of public health emergency. WHO was committed to supporting Member States to develop that capacity. The WHO Regional Offices for South-East Asia and the Western Pacific had already begun a series of meetings, which would eventually lead to the development of a bioregional strategy for strengthening capacity to control communicable disease outbreaks. WHO would study ways in which the better-resourced countries in the two regions could support others to build their capacity. In addition to capacity-building, representatives had commented on the proposed disease list the need to develop the capacity to implement the Regulations, legal and political concerns, and the need for support in communicating risks to the public and dealing with the mass media in emergency situations. The draft of the revised Regulations, to be considered in November 2004, would provide for a transition period of five years to allow all Member States to attain the desired level of national capacity. Several speakers had called for WHO to support sectorwide, interregional and international collaboration, especially with FAO and the World Organisation for Animal Health (OlE). WHO was continuing to strengthen its ties with FAO and OlE, in particular in relation to veterinary public health concerns. WHO was participating in relevant meetings. such as the FAO/OIE emergency regional meetings on zoonotic diseases control in animals in Asia, held in Bangkok in February and July 2004. WHO was also collaborating with country networks through ASEAN, the Mekong Basin Disease
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Surveillance Project and the Pacific Public Health Surveillance Network, and arranging meetings and workshops on information-sharing, national surveillance systems and capacity-building. The REGIONAL ADVISER IN COMMUNICABLE DISEASES SURVEILLANCE AND RESPONSE said that WHO had been working on pandemic preparedness for several years, but that the issue had become more urgent after the outbreak of avian influenza earlier in the year. WHO had convened a global consultation in March 2004 and a biregional technical consultation in Kuala Lumpur, Malaysia, in June 2004. On the basis of recommendations from those meetings,
WHO was developing more practical tools to support Member States in the preparation of national pandemic preparedness plans.
In response to the query from Singapore on vaccine development, he explained that WHO collaborating centres had already developed a prototype vaccine strain, which had been distributed to certain vaccine manufacturers. Clinical trials were planned in several countries. The suggestion to vaccinate in the pre-pandemic period was a distinct option, but certain technical questions needed to be resolved before such action could be recommended. The importance of biosafety was clearly recognized. Biosafety guidelines, including specific ones for SARS and avian influenza, had been drawn up. However, better mechanisms were needed to implement recommendations. WHO was setting up a more comprehensive biosafety programme to
provide better support to Member States. The PUBLIC INFORMATION OFFICER observed that it had been said that fear of SARS could be more damaging than the virus itself. WHO had learnt lessons from the outbreak about ways in which to raise risk awareness without causing panic. A meeting of communication experts, to be held in Singapore in mid-September 2004, would draw up a policy and a programme that could be applied in all WHO regions. That should help Member States to communicate with the media and the general public. The CHAIRPERSON requested the Rapporteurs to prepare an appropriate draft resolution for consideration later in the session. 2. REGIONAL STRATEGY FOR IMPROVING ACCESS TO ESSENTIAL MEDICINES IN THE WESTERN PACIFIC, 2005-2010: Item 15 of the Agenda (Document WPRJRC55/9) The DIRECTOR, PROGRAMME MANAGEMENT, introducing the item, said that, last year at the fifty-fourth session of the Regional Committee, the Committee had had a lively and productive discussion on how it could improve access to essential medicines in the Region. In particular it had
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reviewed a draft regional strategy for improving access to essential medicines in the Western Pacific Region. The strategy had been the product of a wide consultation process, involving experts and counterparts from WHO, from Member States and partner organizations. In general, the Regional Committee had supported the principle of the regional strategy, but some Member States had asked WHO to convene another round of consultations. Since it was essential that the Region should have a strategy that could be supported by all, WHO had been happy to do that. A small group consultation meeting had been held in the Regional Office in February 2004, and the draft strategy had been revised. The revisions included changes in format to make the document more user-friendly; modifications to the sequence of the issues, strategies and actions to make it more coherent; clarifications to the language; and modifications to some technical areas. The revised version had been then distributed to Member States for final comments. The strategy was intended primarily as a practical guide for developing countries, where access to quality essential medicines was problematic, and for WHO itself. Implementation guides and workshops were planned. The draft regional strategy would be an invaluable tool for countries as they designed their own national strategies to improve access to essential medicines. He hoped that the Regional Committee would discuss and endorse the regional strategy and that WHO could work with Member States to implement its provisions and to bring sorely needed medicines to people who currently had no way of benefiting from them. Mrs ELV ANDER (United States of America) noted that the draft strategy had been much improved; nonetheless, her Government still had concerns that needed to be addressed before it could endorse it. The draft strategy focused on production and distribution of medicines, although research on and development of medicines were also crucial to promoting access. There was a bias towards generic drugs, which were not always the most appropriate or cost-effective option. In some cases, prices had been negotiated with pharmaceutical companies that were lower than those of the generic equivalent. The need for governments to deal with research-based and generic industries in order to assure the supply of high-quality medicines should be reflected in the strategy. Governments also needed to avoid an environment that could encourage the misuse of medicines. With regard to assuring affordable prices for medicines, her Government believed that goal could be best achieved through market mechanisms and regulatory policies that ensured the rapid
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introduction of phannaceuticals to the market. Although provision of infonnation on comparative prices might promote competition, there were many reasons for price variations between countries, and lack of standardization could make comparisons misleading. The availability of counterfeit drugs was a serious problem, and ministries of health needed to initiate cross-sectoral dialogue in order to draw up strategies to penalize manufacturers and distributors of such products. She stressed that international agreements and national laws and regulations had to be rigorously complied with if the strategy was to be implemented effectively. With a view to producing a strategy that could be endorsed and implemented by all Member States in the Region, she proposed that a working group should be set up to refine the draft. Dr OOYUB (Malaysia), expressing his support for the draft strategy, observed that many of its elements had already been incorporated into Malaysia's National Medicines Policy, which was being finalized. The Ministry of Health had issued a national list of essential drugs in 2000, and was working with professional bodies on treatment guidelines that would promote their rational use. Patent laws were being amended to improve access to medicines, and use was being made of the public health provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to improve access to antiretroviral drugs. In that regard, Malaysia supported the idea that a compulsory license for manufacture of a phannaceutical product issued by one country should be valid in another. Mr YOSHIDA (Japan) endorsed the draft strategy and drew attention to several requirements for effective implementation. First, Member States should work with the Organization to ensure access to antiretroviral medicines through implementation of the strategy at country level; cooperation with international health security or financing mechanisms could also be explored. Second, there was a need for guidance to implement the actions recommended in the strategy and for indicators to monitor progress. Further, a publicly available source of infonnation was needed to facilitate
exchange ofinfonnation with WHO on implementation. He proposed that a technical advisory group should be set up to recommend measures for improving access. Third, mechanisms were needed to build consensus among all stakeholders involved and to encourage interregional cooperation, especially with the WHO South-East Asia Region. As a country with a well-established system of regulation, distribution and reimbursement of medicines, Japan would actively contribute to the international collaboration that should take shape to implement the strategy.
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Dr OUK (Cambodia) said that access to high-quality essential medicines was a Ministry of Health priority in her country. Health structures at all levels, particularly in rural a~eas, had the right to essential medicines of the same quality as those available in urban areas. A list of essential medicines, treatment protocols and a formulary had been drawn up for the public sector, in accordance with WHO recommendations. Activities to rationalize use of medicines included seminars, training, and information campaigns for the public and for doctors. Manuals for logistical management of medicines had been distributed to all health personnel. Currently, 76 districts, 67 referral hospitals and 942 health centres were supplied by the central pharmacy of the Ministry of Health. A system of bidding for drug provision had been established in 2000, to promote competition for prices and quality. The Ministry's budget had been increasing steadily since 1993: expenditure was currently US$ 3 per year per person and was projected to reach USS 7 by 2007. A law related to pharmaceutical products had been approved by the National Assembly in 1996. Much effort had been expended to eliminate or minimize the availability of counterfeit medicines, and a subcommittee to study counterfeit products had been established in 2000, with the support of WHO and the Australian Government. Planned activities included revision of the pharmaceutical products law, strengthening the capacity and role of inspectors, and public education. Cambodia, which was a member of ASEAN, participated in regional and international conferences to exchange experiences. As Cambodia was a developing country, it would not have to begin patent protection on pharmaceutical products until 2016. The country needed the cooperation of all organizations, especially WHO, and other countries that could provide support for training, technical information, materials and financing. Her delegation strongly supported the draft regional strategy. Ms HALBERT (Australia) strongly supported the efforts made by WHO to improve access to essential medicines in the Region and hoped that the draft strategy would be finalized as soon as possible. Her country supported the aims of the WHO strategy and would continue to provide financial support for rational drug use, quality, safety and access, through WHO and bilateral and regional programmes. Negotiation of bilateral trade agreements had focused attention on the relations between trade, intellectual property rights and access to medicines. In that regard, her country supported the objectives and directions presented under section 3.4 of the strategy, which also addressed the many other factors that affected access to essential medicines. Several issues remained to be addressed. Section 3.2 (Rational use) advocated the use of ethical criteria for pharmaceutical promotion. Her country had strong reservations about any activity that
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could be construed as direct advertising to consumers, and 'ethical criteria' for such promotion did not offer sufficient protection for either consumers or health systems. Pharmaceutical promotion should be strongly regulated. Direct advertising to consumers was distinct from educating consumers about the use of medicines. Educating consumers could improve their behaviour and, in turn, improve the behaviour of prescribers, thus establishing better information exchange between patients and prescribers. With regard to section 3.3 (Affordable prices), her country strongly supported dissemination of information about reference pricing mechanisms, but considered that those mechanisms alone were insufficient to ensure affordabiIi ty. Australia therefore advocated dissemination of information on formulary management, with explicit evaluation of cost-effectiveness. That would help Member States to determine opportunity cost and thus affordability. Use of that mechanism allowed Australia to maintain a comprehensive system of reimbursement for essential medicines at affordable cost to both individuals and the community. Dr NORLILA (Brunei Darussalam), noting that access to medicines was a basic human right, fully endorsed the draft revised strategy. In her country, many of the issues and challenges in improving access to essential medicines had already been addressed. Further technical assistance in the formulation of a national drug policy, including capacity-building, would, however, be required from WHO. Mr BIAN (China) commended the efforts made to revise the draft strategy. His country had received support from the Regional Office in its work on adverse effects and rational use of medicines, and the national policy was being improved. He hoped WHO would provide more guidance to developing countries in using the public health provisions of the TRIPS Agreement. Developing countries still needed support with regard to training and research, identification of adverse effects, and medical economics. Mr COURSE (France) congratulated WHO on its work and the wide consultation that had resulted in the draft strategy, in which his country had participated. The present draft was an improvement over the previous version in several respects: it promoted the manufacture of generic drugs, information exchange, consideration of the poorest segments of society, sustainable financing of access to medicines, the quality of medicines (with identification of substandard drugs) and improved indicators of access to medicines. In respect of financing, his country supported the WHO strategy to promote equitable financing through insurance schemes and various forms of community financing.
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His country strongly supported the draft regional strategy. whIch nevertheless could be strengthened in several ways. Greater emphasis should be placed on the TRIPS Agreement and the flexibility it afforded in access to medicines. WHO should support countries to implement that Agreement. Collaboration between governments and between international organizations and generic drug manufacturers, especially of antiretroviral agents. was essential. Mention should be made of the role of the private sector, local industry (particularly in the production of drugs for treatment of diseases specific to a region) and consumers as partners in natIOnal public health systems. Lastly, a section should be added to cover quality and adverse drug reaction systems. particularly in the framework of information exchange between countries and manufacturers. Dr TA:'\iGI (Tonga) said that he fully supported the draft strategy. Access to essential drugs was one of the six priority areas he had established as Mimster of Health. and WHO had made prompt responses to his requests for support. He could now concentrate on othcr aspects. such as procurement and supplies. He said that the draft strategy was merely a gUIdelIne. which each country could use to develop Its own policy. and he could testify to its usefulness in that respect. The REGIONAL DIRECTOR said that the finalization of the draft regional strategy was important if 'v1ember States were to improve access to essentIal mediCInes. However. it was clear that several delegatIons wished to make further proposals with a view to making the strategy more relevant. He suggested that. in the interests of saVIng time. the Committee might wish to establish a working group. to meet immediately after the meeting. in \vhIch all those interested could participate. The CHAIRPERSON invited comments on that suggestion. which might facilitate the work of the Committee. Dr KIl'iG (:-.iew Zealand) said that. while she had no objection to the approach suggested. she had a proposal to make which she would prefer to present to the full Committee rather than to a working group. She asked when she might have the opportunity to present that proposal. Dr DA YRIT (Philippines) agreed with the previous speaker that It would be preferable for the
Committee as a whole to hear any proposals that were designed to address the concerns expressed by the representative of the United States of Amenca. before establIshing a working group. Mrs ELV ANDER (United States of America) saId that she had no objection to the proposed option. It might also be possible to circulate her delegation' s comments in writing. The REGIONAL DIRECTOR suggested that representatives mIght wish to submit proposals for amendments to the draft strategy in wnting to the Secretariat. Those amendments would then be
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circulated in writing and the Committee could continue its discussion on the item the next day. The Committee could then determine whether it would be necessary to establish a working group to consider the matter further. Mrs ELVANDER (United States of America) supported that suggestion. It was so agreed. 3. CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions. 3.1 Report of the Regional Director (Document WPRlRC55/Conf.Paper No. I) Dr KING (New Zealand) proposed that, in the seventh preambular paragraph, the words "reflected in" should be replaced by "an explicit element of'. The change would emphasize that, in establishing biregional collaboration, it was important not to lose sight of the specific needs of the Pacific island countries. Ms HALBERT (Australia) proposed an addition to the end of operative paragraph 3, subparagraph I to read "to streamline data requirements to ensure efficient collection and analysis in preparation of the report". The REGIONAL DIRECTOR endorsed the proposed amendments. Decision: The draft resolution, as amended, was adopted (see resolution WPRlRC55.Rl). 3.2 Proposed programme budget. 2006-2007 and the eleventh general programme of work (Document WPRlRC55/Conf.Paper No.2) Dr TANGI (Tonga) proposed the addition of a new subparagraph at the end of operative paragraph 3 to read "(3) to work with the Director-General and other Regional Directors to better define the roles and functions of the three levels of the Organization, with a view to enhancing programme planning and management and improving efficiency". Ms HALBERT (Australia) proposed the insertion in operative paragraph 3, subparagraph 2 of the words "including a clear focus on outcomes" after "results-based budgeting". The REGIONAL DIRECTOR suggested that in order to reflect the situation more accurately, the Committee might wish to amend the last preambular paragraph by inserting "proposed" before
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"increased allocation" and by replacing "estimated extrabudgetary resources" with "of all sources of funds". Decision: The draft resolution, as amended, was adopted (see resolution WPRJRC55.R2). 4. DEPARTIJRE OF CHAIRPERSON The CHAIRPERSON announced that, regrettably, he had to return to Beijing on pressing government business so would be unable to continue chairing the session. He wished the Committee every success in its continuing discussions. The Vice-Chairperson would chair the remainder of the session. Dr T ANGI (Tonga) thanked the Chairperson and congratulated the host country on the excellent arrangements made for the session. The REGIONAL DIRECTOR also thanked the Chairperson and presented him with a gavel as a token of his appreciation. The meeting rose at 12 noon.