WPRlRC52/SRll
SUMMARY RECORD OF THE FIRST MEETING
Main Conference Hall, International Convention Centre, lalan Berakas and the Indera Kayangan Ballroom, The Empire Hotel and Country Club Monday, 10 September 2001 at 9.00 a.m. and 2 p.m.
CHAIRPERSON: Dr Viliami TANGI (Tonga) later: Pehin Haji ABDUL AZIZ Umar (Brunei Darussalam)
CONTENTS
page
1. 2. 3. 4. 5.
Opening ceremony.. .................................... .............................. ... .... .......... Opening of the session ................................................................................ Introductory remarks by the Regional Director ........................................... Address by the retiring Chairperson ............................................................ Election of new officers: Chairperson, Vice-Chairperson and Rapporteurs ......................................................................................... Adoption of the agenda .............................................................................. Report of the Regional Director ..................................................................
59 60 60 61,91
61 62 62
6. 7.
ANNEX 1
Speech by the Honourable Pehin Orang Kaya Laila Wijaya Dato Ser Setia Haji Awang Abdul Aziz bin Begawan Pehin Udana Khatib Dato Seri Paduka Haji Awang Umar, Acting Minister of Health, Brunei Darussalam, at the opening ceremony of the fifty-second session of the Regional Committee in Brunei Darrusalam, 10-14 September 2001 ...................... . Speech by Dr Shigeru Omi, Regional Director of the Western Pacific Region of WHO at the opening ceremony of the fifty-second session ofthe Regional Committee in Brunei Darussalam, 10-14 September 2001 .................................. .
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ANNEX 2
81
57
page
ANNEX 3
Speech by Dr Gro Harlem Brundtland, Director-General of the World Health Organization at the opening ceremony of the fifty-second session of the Regional Committee in Brunei Darussalam, 10-14 September 2001 .................... Address by the outgoing Chairperson of th e WHO Regional Committee for the Western Pacific, Dr Viliami Tangi, at the opening ceremony of the fifty-second session of the WHO Regional Committee for the Western Pacific .............................................................................. . Opening address by His Majesty Sultan Haji Hassanal Bolkiah Sultan Haji Hassanal Bolkiah Mu'izzaddin Waddaulah, Sultan and Yang Di-Pertuan of Brunei Darussalam at the International Convention Centre Berakas, Brunei Darussalam ............................................................ . Address by the retiring Chairperson of the WHO Regional Committee for the Western Pacific, Dr Viliami Tangi, at the opening session of the fifty-second session of the WHO Regional Committee for the Western Pacific .................................... .
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ANNEX 4
85
ANNEX 5
87
ANNEX 6
91
.;•
,
I
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SUMMARY RECORD OF THE FIRST MEETING
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1.
OPENING CEREMONY The opening ceremony was held at 9 a.m. at the Main Conference Hall of the
International Convention Centre, Jalan Berakas, Brunei Darussalam. HIS MAJESTY SULTAN HAn HASSANAL BOLKIAH, presided over the welcoming ceremony. The Acting Minister of Health of Brunei Darussalam, Pehin Haji ABDUL AZIZ Umar welcomed the members of the Regional Committee and other guests. His country appreciated the technical assistance provided by WHO since Brunei Darussalam had joined the organization in 1985. Since that time, significant health gains had been made, such as the declaration of malaria-free status. He expressed particular interest in the area of telehealth (Annex 1). The REGIONAL DIRECTOR expressed his appreciation to His Majesty's Government of Brunei Darussalam for hosting the fifty-second session of the Regional Committee. He said that this would be a historic session, since it would be the first in a Region that had been certified as poliomyelitis-free. He said that WHO and Brunei Darussalam had enjoyed excellent relations since Brunei Darussalam had joined WHO in 1985 and this meeting would bind them more closely together (Annex 2). The DIRECTOR-GENERAL expressed her appreCiation to His Majesty's Government of Brunei Darussalam for hosting the session in the very diverse Region of the Western Pacific. She spoke of improving health as a means of combating poverty, and touched on how this could be achieved globally and in the Region, through regulations and conventions, in society and government, and through public and private sector action on women's health, the environment and specific diseases (Annex 3). The CHAIRPERSON of the Regional Committee, Dr Viliami TANGI (fifty-first session) thanked His Majesty's Government of Brunei Darussalam and wished the incoming chairperson every success with the meeting (Annex 4). HIS MAJESTY SULTAN HAll HASSANAL BOLKIAH thanked the Regional Director, the Director-General and the Chairperson of the Committee for their words of appreciation. His country was delighted to host the meeting. He observed that the twentieth century had already gone down in history as a period of unparalleled violence; nevertheless, it had seen a magnificent advance in health care and in length and quality of life. For fifty years,
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REGIONAL COMMITTEE: FIFTY-SECOND SESSION
WHO had inspired great progress in that area. He declared open the fifty-second session of the Regional Committee for the Western Pacific (Annex 5). After the completion of the opening ceremony, the participants reconvened at the Indera Kayangan Ballroom of the Empire Hotel and Country Club. 2. OPENING OF THE SESSION: Item I of the Provisional Agenda The retiring Chairperson, Dr Viliami TANGI (Tonga) declared open the fifty-second session of the Regional Committee for the Western Pacific. 3. INTRODUCTORY REMARKS BY THE REGIONAL DIRECTOR: Item 2 of the Provisional agenda The REGIONAL DIRECTOR welcomed representatives to the fifty-second session of the WHO Regional Committee for the Western Pacific. After thanking the outgoing
Chairperson for his excellent work over the previous year, he explained that draft regional strategies for food safety, traditional medicine and mental health would be presented for the Committee to discuss and endorse. The Committee would also be discussing the proposed programme budget for the biennium 2002-2003, the first to be based on the principles contained in resolution WPRlRC50.Rl, adopted two years previously by the Regional Committee. Another feature of the session would be a panel discussion before the ministerial round table on mental health. The REGIONAL DIRECTOR also acknowledged the presence of the Chairman of the Executive Board and said that this would help to strengthen the coordination between the global governing bodies and the Regional Committee. He also welcomed the Minister of Health of Cambodia, currently the President of the World Health Assembly. He explained that, as part of WHO's year-long campaign to raise the profile of mental health in the Region, a group of journalists from the Region would observe some of the sessIons. Despite the heavy schedule, he was confident that there would also be time for relaxation and enjoyment. ';1
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4.
ADDRESS BY mE RETIRING CHAIRPERSON: Item 3 of the Provisional agenda The retiring Chairperson, Dr Viliami TANG!, made a statement to the Committee
(Annex 6).
S.
ELECTION OF NEW OFFICERS: CHAIRPERSON, VICE-CHAIRPERSON AND RAPPORTEURS: Item 4 of the Provisional Agenda
5.1
Election of Chairperson
Dr HONG Sun Huot (Cambodia) nominated Pehin Haji ABDUL AZIZ Umar (Brunei Darussalam) as Chairperson; the nomination was seconded by Dr Puka TEMU (Papua New Guinea). Decision: Pehin Haji ABDUL AZIZ (Brunei Darussalam) was elected unanimously. Pehin Haji ABDUL AZIZ took the chair. 5.2
Election of Vice-Chairperson
Dr
Tauese
Pita
Fiti
SUNIA
(United
States
of
America)
nominated
Mrs Sandra S. PIERANTOZZI (Palau) as Vice-Chairperson; the nomination was seconded by Mr S. SOmINAlliAN (Malaysia). Decision: Mrs PIERANTOZZI (Palau) was elected unanimously.
5.3
Election of Rapporteurs
Dr Eliuel PRETRICK (Federated States of Micronesia) nominated Dr Eti ENOSA (Samoa) as Rapporteur for the English language; Richard SMALLWOOD (Australia). Professor DO Nguyen Phuong (Viet Nam) nominated Dr Jean-Paul GRANGEON (France) as Rapporteur for the French language; the nomination was seconded by the nomination was seconded by Dr
Dr Bounkouang PHICHIT (Lao People's Democratic Republic). Decision: Dr ENOSA and Dr GRANGEON were elected unanimously.
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6.
ADOPTION OF mE AGENDA: Item 6 of the Provisional Agenda (Document WPRlRC52/1 Rev.2) The CHAIRPERSON moved the adoption of the Agenda. Decision: In the absence of comments, the Agenda was adopted.
7.
REPORT OF TIlE REGIONAL DIRECTOR: Item 8 of the Agenda (Document WPRlRC52/2)
The REGIONAL DIRECTOR informed the Regional Committee that, in response to requests from Member States, his report now provided detailed analysis of the issues facing the Region in each of WHO's main areas of work and explained how WHO was responding to them. The report had been made more widely available by posting it on the Regional Office website and increasing the distribution network. Chapters 1-5 covered WHO's work with Member States to combat communicable diseases. A welcome, and in some respects unexpected, development was the reduction in HN transmission in Cambodia.
Government estimates published in 2000 indicated that,
since 1997, HN transmission had been decreasing in all the population groups studied. For example, the average rate of HN infection among pregnant women had dropped from 2.7% to 1.9% between 1997 and 2000. There were several reasons for that turnaround. Most importantly, HNIAIDS control in Cambodia had been supported over a number of years at the highest levels of government, including the prime minister. The international community had also played an important part, by providing support to the "100% condom use" programme since 1998. The programme had helped to reduce the rate of HN infection among young sex workers from 41 % in 1998 to 23% in 2001. Although a daunting task still lay ahead, Cambodia had demonstrated that the tide could be turned, even in a country with limited resources. Chapter 2 of the report included coverage of WHO's work with Member States to roll back malaria. In 1993, ambitious targets had been set for the Region: by the end of 2000, to achieve a reduction in malaria mortality of 80% and malaria morbidity of 50%. Data indicated that several countries had met, or were close to meeting, those targets, a remarkable achievement.
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In Viet Nam, progress stemmed partly from the introduction of artemisinin - a traditional Chinese and Vietnamese medicine - and its derivatives to treat drug-resistant malaria, but mainly from the combined effects of well-targeted vector control activities and early treatment of the disease. Vanuatu had also been successful in controlIing malaria; to such an extent that there had been no malaria deaths recorded in the country since 1996, a unique achievement for a country with endemic falciparum mala.ria. Very significant gains had also been made in Cambodia, China, the Lao People's Democratic Republic, Malaysia and Solomon Islands. As a result of the concerns about resistance to a range of antimicrobial drugs expressed at the fifty-first session of the Committee, the subject had been addressed in the present report. Turning to chapters 6-10 of the report, on building healthy communities and populations, the REGIONAL DIRECTOR pointed out that I million children under the age of five had died in the Region during the period covered by the report, mostly in its developing countries and from preventable causes. One of the most effective responses to childhood illness was the Integrated Management of Childhood Illness (IMCI), because more than 70% of childhood deaths and 75% of episodes of childhood illness were attributable to one or a combination of common and preventable conditions, namely: malnutrition, pneumonia, diarrhoea, dengue haemorrhagic fever, malaria and measles. During the period covered by the report, implementation ofIMCI had expanded very significantly in the Region. With regard to noncommunicable diseases, including cancer, primary prevention was
'\.
,
extremely important. Three simple lifestyle changes - giving up smoking, improving one's diet and becoming more physically active - could prevent 60%-70% of all cancers. People needed supportive environments to help them make healthy choices. WHO was, therefore, providing support to projects for the integrated prevention and control of noncommunicable diseases in China, Mongolia, the Philippines and Viet Nam, and in several Pacific island countries. Although it would be some time before WHO's efforts bore fruit, progress had been made in strengthening the Region's health systems (chapters 11-14). More and more
countries were recognizing the importance of a sound legislative context for the health aystem. Over the past year, WHO had worked with the Government of the Lao People's Democratic Republic on regulations related to hygiene and health promotion, and with
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REGIONAL COMMIITEE: FIFTY-SECOND SESSION
Mongolia on its Therapeutic Goods Act. The first workshop on health legislation in Pacific island countries had been held in Tonga in October 2000. WHO had also worked with Marshall Islands, Tonga and Vanuatu to draft or improve laws governing public health and had held two workshops with the Government of China on World Trade Organization (WTO) requirements on food safety. The internationalization of trade would affect pharmaceuticals in particular. WHO had conSiderably broadened its support for essential drugs policies, at country, regional and global levels. At country level it had been working with governments to strengthen national drug
policies, to expand rational drug prescribing and use, and, for those countries producing pharmaceuticals, to improve manufacturing procedures. At regional level WHO was ensuring that countries were informed about the impact on pharmaceuticals of the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS). At global level, it was collaborating with WTO and industrial partners to develop mechanisms to reduce prices for new essential drugs in low-income countries. Activities related to blood safety - the theme of World Health Day in 2000 - had increased. In Viet Nam, for example, WHO had been working closely with the Government to formulate a strategic plan for blood transfusion; the Government of China had been working with staff from both the Regional Office and Headquarters to strengthen planning, organization and management of blood services, including training. The Western Pacific Region led the world in the area of traditional medicine because of the wealth of experience and knowledge accumulated over centuries. strategy for traditional medicine would be discussed later in the week. In connection with the theme of Reaching Out (chapters 15-17), the REGIONAL DIRECTOR noted that the announcement at a meeting in Kyoto, Japan, in October 2000 of the Region's poliomyelitis-free status had been covered by at least 15 wire services and news agencies and 42 journals and newspapers. WHO estimated that more than 200 TV stations had used material on poliomyelitis provided by the Regional Office. To conclude, he made two general comments on the changing context of WHO's work. First, since he had become Regional Director, he had stressed that the international community must work together in a more coordinated way, with each partner playing to its strengths. WHO had therefore worked hard to deepen its relationships with its traditiond partners, including bilateral agencies, and nongovernmental organizations, such as Rotary International, as well as to establish or strengthen other relationships. For example, WHO A draft regional
/
SUMMARY RECORD OF THE FIRST MEETING
65
had worked closely with the Asian Development Bank to enhance food safety in Viet Nam, and with the World Bank to improve child health in China, the Philippines and Viet Nam. In view of the strong community component of many WHO programmes, WHO's most effective partners were often nongovernmental organizations. Second, WHO clearly had to continue to innovate if it was to meet the challenges that lay ahead. It had to expand its collaboration with consumers and other groups within civil society, if it was to make progress in such areas as food safety. It had to work with
adolescents to ensure that unhealthy habits did not take root. It had to look around for examples of innovative health fmancing that could be adapted for the Region. It had to do all that with a smaller regular budget, because resolution WHA51.31 had significantly reduced the budget allocation to the Western Pacific Region. The net effect was that WHO had to strive to work even more efficiently, particularly through even closer collaboration with outside partners and with WHO headquarters. Although the report covered only a short period of time, he hoped it provided a picture of an Organization that was both aware of the rapidly changing world and willing to change with it. The CHAIRPERSON invited the Committee to comment on the report. Dr THORNE (United Kingdom of Great Britain and Northern Ireland) praised the
Regional Director's excellent response to concerns expressed at the fifty-first session about increasing levels of antimicrobial resistance in the Region. The section on antimicrobial resistance in the report was informative and comprehensive. She looked forward to the development of a regional control strategy. Professor SMALLWOOD (Australia), referring to the Regional Consultation on Health System Performance Assessment that had been held in the Regional Office in July 2001, noted that the meeting had agreed on the importance of such measurement, and on WHO's lead role in developing appropriate tools. Australia would welcome the opportunity to work with WHO so as to ensure that existing measures were refined so they could be usefully applied by Member States of the Region. Dr TUKUlTONGA (New Zealand) concurred with the Regional Director that the
weakness of public health services was a serious problem in the Region. He welcomed WHO's financing of an ongoing project in Fiji, Malaysia and Viet Nam on essential public
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REGIONAL COMMITTEE: FIFTY-SECOND SESSION
health functions, and looked forward to the subsequent analysis of areas in greatest need of support.
In view of the importance of the work under way, he proposed that an item on strengthening of essential public health functions in the Region should be placed on the agenda of the fifty-third session of the Regional Committee. Professor DO (Viet Nam) reported that progress had been made in combating tuberculosis in Viet Nam, although expansion ofthe directly observed treatment, short-course (DOTS) strategy to remote areas and high-risk groups was a continuing challenge. Priorities in that area included improving the quality of laboratory diagnosis, strengthening surveillance, and monitoring drug resistance. His country had achieved remarkable results in controlling malaria: the death rate had dropped by 97% in five years due to the nationwide provision of impregnated bednets and use of locally produced antimalarial drugs. Continued vigilance would be needed to prevent a resurgence of the disease in the central provinces and high plateau. On the other hand, the rising number of AIDS cases was a great concern. Treatment represented a heavy burden for low-income countries. The efforts of WHO and other
organizations to secure drugs at affordable prices should lead to improved access by poor patients to treatment. Dr SUNIA (United States of America), while applauding the Region's achievement of poliomyelitis-free status, stressed the need to avoid complacency and to maintain surveillance of acute flaccid paralysis (AFP), which should be integrated with both monitoring of other communicable diseases and strengthening of laboratories. Development of human resources, including field and laboratory training, was essential in that regard. Although the burden of communicable diseases was high in the Region, control of noncommunicable diseases, in particular through promotion of healthier lifestyles, warranted increased attention. With regard to essential drugs, any revision of the List of Essential Drugs would require regional consultations and a carefully considered approach. His Government supported work under way to improve regional capacity in emergency preparedness and management.
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He looked forward to WHO's continued cooperation in control of communicable diseases, including lymphatic filariasis, measles and dengue, in collaboration with nongovernmental organizations, bilateral agencies and other partners, and expressed his support for science-based approaches to control. Dr lMADA (Japan), commending the Regional Office for its leading role in health and, in particular, for having achieved the eradication of poliomyelitis within the Region, said that his country would wish to contribute to decreasing the risk of a new outbreak of the disease, for example by sending Japanese experts to other regions where cases of infection with wild poliovirus were still observed. He welcomed the emphasis that had been placed on the prevention and control of tuberculosis. In his country, where the burden of tuberculosis was considered to be intermediate, nationwide surveys had been made and measures were focused on groups at high risk. The world was now entering the era of the mind and he therefore welcomed the priority that had been given to mental health, as that was closely related to overall well-being. He considered that the ministerial round tables that had been held at the Fifty-fourth Health Assembly, and that planned for the current session of the Regional Committee, provided an opportunity for useful discussions on the issue. He looked forward to hearing from the Regional Director about the new challenges facing the Region in the near future. Dato AHMAD (Brunei Darussalam) noted that the four themes contained in the Regional Director's report corresponded well with the national health care plan of the Ministry of Health in his country. He looked forward to the ministerial round table on mental health. Although he commended the inclusion in the report of a section on resistance to antimicrobial drugs, he suggested that future reports describe the patterns of resistance in neighbouring regions, which would be useful for monitoring trends in resistance and for managing cases imported from other regions. Referring to the Statistical Annex, he noted that the indicators of morbidity and mortality given were related mainly to communicable diseases. In view of the importance of chronic noncommunicable diseases in the Region, he suggested that future reports include the indicators for those diseases. Accidents and the resulting disabilities and requirements for health care should receive greater emphasis, as they were becoming more prevalent in many countries and tended to affect the young popUlation in particular. Dr OTTO (palau) said that the Regional Director's report represented a clear response to comments made on previous reports and was more 'reader-friendly'. He commended the
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REGIONAL COMMIDEE: FIFTY-SECOND SESSION
increased collaboration with other United Nations agencies, including UNICEF, with the Secretariat of the Pacific Community, and with donor governments and agencies, the latter ensuring extrabudgetary resources for the work of the Regional Office. He was pleased to see that the use of tobacco in forms other than for smoking was being addressed within the Tobacco Free Initiative. He was encouraged by the emphasis being placed on mental health, an area that had been neglected for too long. He looked forward to the discussions to be held later during the session on that issue and hoped for further assistance from WHO Headquarters. The increased effort in the area of emergency and humanitarian action was timely, as more severe, longer-lasting droughts due to the passage of EI Nif10 had been forecast for the second half of 2002. A national committee had been set up in Palau to mitigate the threat, and training for sustainable emergency and disaster preparedness was being organized. His country would be pleased to share any relevant experience in that regard. He commented that, with respect to avoidance of unwanted pregnancy in adolescents, the report advocated use of condoms, whereas he suggested that abstinence should also be encouraged as a viable option for adolescents and unmarried couples. He was disappointed that the report made no mention of oral health. Although he was aware that the available resources were limited, he emphasized that the oral cavity was the target for all forms of tobacco use, that poor oral health could contribute to cardiovascular disease and that oral health was directly related to nutritional status and self-esteem. Nevertheless, he acknowledged the assistance received from the Regional Office on that issue.
Dr DAYRIT (Philippines), also noting continuing improvements in the quality of the report of the Regional Director, reported that his country was faced with an epidemic of dengue fever and had documented 12000 cases since the beginning of the year. A two-month campaign, involving health education and media interventions, had resulted in greater public awareness and action to control and eliminate Aedes breeding sites. He asked whether there were any opportunities for collaboration on the development of a vaccine against the disease. On the topic of pharmaceutical products, he said that the President of his country had undertaken an initiative to reduce the prices of essential drugs. One of the ways in which that was being done was to import drugs so that domestic companies would be pressured to reduce their prices. He asked for advice in that respect. He thanked WHO for helping the
SUMMARY RECORD OF THE FIRST MEETING
69
Government of the Philippines to strengthen its regulations against the entry of substandard drugs into the country.
Mr LEO (Vanuatu) welcomed the attention given to food safety and mental health. He considered, however, that WHO should analyse national situations with regard to mental health and assist in the development of national mental health programmes, including identification of appropriate institutions in the Region that could provide adequate training on the management of mentally ill patients.
Mr MANUOHALALO (France) commented that the Regional Director's report clearly reflected the health situation in the countries of the Region, the main threats to public health and the possible responses. He shared the optimism of the Regional Director with regard to progress in controlling tuberculosis, as the incidence rate in New Caledonia had fallen to 40 cases per 100 000 inhabitants in 1999. It had been considered unnecessary to use the DOTS strategy, in view of the adequacy of health care access and systematic surveillance of drug resistance. The recommendations of WHO were being followed with regard to other infectious diseases. France participated actively in the fight against AIDS, and he welcomed the proposed global fund against diseases of poverty, which would assist in the prevention and treatment ofHIV/AIDS. He was pleased that mental health had been the theme of World Health Day in 200 l. The problem had been recognized only recently in New Caledonia, and a programme had been set up to find suitable responses and the appropriate funding, in order to provide the most efficient, humane access to care for all sectors of the population. New Caledonia had also undertaken a programme for the management of health care spending within the overall reform of its health system. The aim was to improve efficiency, with an emphasis on prevention. Dr ZHANG (China) noted the progress of the Regional Office in responding effectively to the needs of Member States. His delegation had noted at the previous session of the Committee that health care reform would itself engender new problems. He was pleased to report that WHO had provided useful technical assistance to his country in resolving problems encountered in the comprehensive reform of its health system. Progress noted in the report of the Regional Director with regard to the control of tuberculosis and blood safety had also been seen in China, owing to strong commitment from the central Government and from the international community.
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He commented that, although the Region had been certified free of poliomyelitis, the virus had not disappeared: a new stage had been reached in which efforts had to be made to maintain the poliomyelitis-free status. Vaccine-derived cases of infection could arise, for instance, as in the Region of the Americas. He requested guidance from WHO on dealing with new problems that might arise. AIDS had received intense international attention during the past year, including the special session of the United Nations General Assembly in June and the establishment of a global fund for health and AIDS. He hoped that WHO would provide timely information to countries on gaining access to that fund. He was gratified to note that the unique advantages of traditional medicine were of increasing interest to both scientific and business circles; furthermore, such forms of medicine were recognized and used in an increasing number of countries. As the Region led the world in the use of traditional medicine, it should assume a critical role in disseminating the relevant knowledge. He looked forward to a resolution on the issue that strengthened the use and further development of traditional medicine in the Region and throughout the world. Dr YEOH (Hong Kong, China) commended the Regional Director on the work undertaken by the Regional Office in the previous year in the face of difficult challenges. He welcomed the comprehensive Regional Director's report but noted that, in Table 5 of the Statistical Annex, the data for dengue fever in Hong Kong (China) should indicate 5 cases and no deaths for 1999. He welcomed the Regional Office response to the discussion on health systems reform held at the previous session of the Regional Committee. The Regional Director's report reflected the challenge resulting from the range and complexity of country health systems and drew attention to the first technical advisory group meeting on health sector development and to priorities for action in the Region. While essential public health functions and use of primary health care or community-based services were clearly important, there was a need to consider the health sector as a whole. In many Member States health systems were currently highly fragmented, with gaps between rural and urban services and between high-technology and primary health care services in more affluent urban areas. It was vital to find ways of improving coordination in order to achieve the goals and objectives highlighted in The World Health Report 2000.
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71
Dr TEMU (Papua New Guinea) commended the Regional Director's report and welcomed its wider distribution, which assisted Member States in health advocacy efforts at the national level. He agreed with the previous speaker that greater efforts were needed in the area of health systems reform, and that it was important to view the health sector in its totality at the country level. Papua New Guinea was currently reviewing its health system and acknowledged WHO support in that regard. Small Pacific island countries such as his own required effective and efficient health systems, and good coordination between the various parties involved was critical to programme implementation. In Papua New Guinea, for example, some 50% of rural services were provided by nongovernmental organizations, namely the church health agencies. Referring to human resources management, he pointed out that, in countries such as his own, with budget constraints, it was difficult for the health sector to negotiate for increased provision of health care providers. Papua New Guinea had succeeded in expanding basic health care provision by training voluntary community health workers. He would welcome a review of such options by the Regional Office. Finally he drew attention to the need to generate health information in a form suitable for use in advocating appropriate budget allocations to health sector development. The health sector needed the right negotiating tools in order to convince ministries of finance and other areas of government of the benefits of investment in health, and to provide evidence of specific problems, such as the economic burden arising from tobacco use. Dr PHICHIT (Lao People's Democratic Republic) welcomed the improved format and content of the Regional Director's report, which gave a clear picture of the health situation in the Region and the WHO response. He urged the Regional Director to increase efforts to mobilize resources for increased disease prevention activities. In his country, for example, facilities for the control of dengue haemorrhagic fever were currently very limited and greater support was needed in that regard. Mr CAPELLE (Republic of the Marshall Islands) said that the informative report drew attention to the significant progress made in the battle against tuberculosis and HIV/AIDS. It also focused on mental health, which his country was beginning to recognize as an area that was critical to overall health. The report had provided the catalyst for renewed efforts by the Ministry of Health and Environment to improve mental health services.
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REGIONAL COMMITIEE: FIFTY-SECOND SESSION
Professor NYMADAWA (Mongolia) commended the Regional Office on its responsiveness to the needs of the Member States of the Region. Referring to communicable disease control, he noted that the Global Alliance for Vaccines and Immunization was supporting activities for the introduction of new combinations of Expanded Programme on Immunization (EPI) antigens and for field trials of new vaccines. He hoped that the trial countries, Cambodia and the Lao People's Democratic Republic, would share information on the design for and results of the forthcoming introduction of the combination DTP-hepatitis B vaccine. Mongolia had many years of experience of measles control, having started mass immunization in 1973. Despite high immunization coverage, the last two years had seen significant measles outbreaks. Retrospective laboratory studies on blood samples had shown, however, that some 60% of the clinical cases recorded in the 2000 outbreak had in fact been cases of rubella. The 200 I outbreak had centred on adolescents and young adults in the age range 15-20 years. The outbreak had started in new military recruits and a preliminary study had indicated that most of those affected had received one dose of measles vaccine. It was clear that two doses were more effective and that greater laboratory support was needed to enhance measles control efforts. Mr MOOA (Kiribati) welcomed the format and content of the Regional Director's
comprehensive report, which were in line with the recommendations made at the previous session of the Regional Committee. He suggested that, in future reports, the Introduction should be expanded to give a fuller picture of the essential achievements and setbacks encountered in the Region during the period covered. He requested that countries be supplied with larger numbers of copies of the report. It addressed the real needs of the countries of the Region and would, therefore, be useful in advocacy for the involvement of ministries and other organizations outside the health sector in efforts to address key health issues. Mr PAUL (Solomon Islands), joining previous speakers in commending the report, welcomed the reference made by the Regional Director to the value of improving one's diet and taking exercise in preventing cancers. It was a useful message which he would transmit to the population of his country, where there was a high prevalence of those conditions. The Regional Director had also drawn attention to the reduction in malaria cases achieved in Solomon Islands. While that was true up to 1999, there had since been a resurgence of the disease and one fatality, mainly due to movement of people from island to
SUMMARY RECORD OF TIIE FIRST MEETING
73
island as a result of recent civil unrest. Increased support from WHO would be welcomed to help stem the rise in malaria morbidity. Solomon Islands would continue to support WHO policies, which were a key foundation for the country's health development programmes.
Mr KILEI (Tuvalu) commended the progress achieved in combating communicable diseases, in particular in relation to HIVI AIDS in Cambodia, which provided great encouragement to Member States as they implemented disease control strategies. The low prevalence of HIVIAIDS in Tuvalu was no reason for complacency and the country had recently completed a strategic HIV/AIDS plan, which was being implemented. In addition to problems with tuberculosis, Tuvalu had a high prevalence of lymphatic filariasis. lie had recently participated in a mass administration of medicine as part of the national filariasis control programme. The response to the event had been excellent, reflecting the importance of high-level government involvement in such activities. He hoped that it would be possible to include discussion of the Pacific Programme for the Elimination of Lymphatic Filariasis (pacELF) on a future agenda of the Regional Committee. Dr LEE (Republic of Korea) said that, although health conditions had improved over time in most countries of the Region, differences in health indicators had emerged between countries, and the spread of HIV/AIDS, tuberculosis and other infectious diseases were a threat to all peoples. WHO had already defined health as a key priority for sustainable development; leaders of the G8 countries had endorsed that view at their 2000 meeting in Okinawa, Japan. In recognition of the need for global action to scale up national efforts to achieve more efficient and accessible health care, the Regional Office should focus on raising awareness, strengthening prevention and improving health systems. He believed that the Member States of the Region were working together with WHO to meet that challenge. His Government would participate actively in those efforts and welcomed the opportunity to designate a member to serve on the WHO Executive Board as a representative of the Western Pacific Region from 2001. The CHAIRPERSON invited the Regional Director to reply to the issues raised. The REGIONAL DIRECTOR thanked the Representatives for their many helpful comments on the report. He welcomed the representative of the United Kingdom's expression of appreciation with regard to the information on drug resistance in the Region. He noted that the
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REGIONAL COMMITIEE: FIFIY-SECOND SESSION
development of drug resistance was a natural phenomenon in bacteria and viruses, which could not be completely stopped, al~ough
it could be delayed or restricted. As the Report had
said, all Member States were asked to control the availability and sales of antibiotics, to ensure their rational use, and to improve antimicrobial products. To do this would require political commitment on the part of Member States. With regard to the suggestion by the representative of New Zealand that essential public health functions be included on the agenda of the next session of the Regional Committee, the REGIONAL DIRECTOR explained that he wrote each year to every Member State to ask what topics it wished to include on the agenda of the next session. He would certainly take note of New Zealand's request, but asked that New Zealand make an official request in its reply to the next such letter. He noted that a study on public health functions in Fiji, Malaysia and Viet Nam was nearing completion. The REGIONAL DIRECTOR agreed with the representative of the United States of America that there was no room for complacency with regard to poliomyelitis. He also noted the representative's comments on essential drugs. The REGIONAL DIRECTOR thanked Japan for all its support, especially in communicable disease prevention and control. As to what the new challenges in the Region were, it was difficult to generalize for the whole Region, but there were several common factors: the epidemiological transition caused by socioeconomic changes; the increasing
inequity of health status and access to services, within and between countries; the need to strengthen partnerships with non-health sectors; increasing consumer demand for better quality of services; the emergence of new issues such as gene diagnosis and therapy, and genetically modified foods, associated with the advance of new technology, and conditions such as bovine spongiform encephalopathy, which were exacerbated by globalization. As a final challenge for WHO, he reminded the Committee that the regular budget allocation to the Western Pacific Region was decreasing, so more had to be achieved with fewer resources. In reply to the representative of Brunei Darussalam, who had asked whether WHO
could provide information on drug resistance in other parts of the Region, the REGIONAL DIRECTOR said that in the Mekong area that had already been done, but he would ensure that would be extended. To the representative's request for more data on noncommunicable diseases in the Regional Director's report, he said that the next World Health Report would cover risk factors, and in conjunction there would be associated reports on noncommunicable diseases which would go some way towards meeting: the representative's need. Data on
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injuries and accidents were not so easy to provide, since only a few countries had such data, but he assured Brunei Darussalam that WHO would work with countries to provide a clearer picture of the extent of morbidity and mortality caused by injuries and accidents. In reply to the representative of Palau, who had asked about oral health progranunes,
the REGIONAL DIRECTOR noted that Palau had also raised the issue at the Madang meeting hosted by the Government of Papua New Guinea, and that WHO had provided support to the Government of Palau for activities in this area. He agreed that the report before the Regional Committee had not covered oral health, although oral health had been included in the report covering the period 1998-1999. However, he assured the representative of Palau that the next report would include oral health. The REGIONAL DIRECTOR said that the Acting Director for Disease Prevention and Control would reply to the question from the Philippines about dengue vaccine. He said that the pricing of essential drugs was a complex and difficult issue involving several mechanisms. In the area of differential pricing, the Director-General was leading negotiations to reduce antiretroviral drug prices charged by pharmaceutical companies. A course of such drugs in the past had cost around US$ 10 000 per person per annum, and the price was now about US$ 800 for developing countries. Individual countries, especially in Africa and Latin America, were dealing bilaterally with pharmaceutical companies. Another option was compulsory licensing; under the TRIPS (Trade Related Aspects of Intellectual Property Rights) agreement, countries had the right to issue such a licence, as Brazil had done. Some Member States with manufacturing capacity could consider that option. A third mechanism was parallel importing, especially for non-manufacturing countries. One country in the Western Pacific Region was already studying that option. A fourth procedure was to encourage general competition after the expiry of patents, providing the drugs under generic names. The main principle was that Member States had to make an informed decision, in the light oflegal, medical and other information. WHO would be glad to help with that process. The representative of Vanuatu had mentioned support for country analysis of mental health. In this regard, the REGIONAL DIRECTOR said that WHO would work to meet this need through technical support and mentioned that meetings on workforce development and education would take place. The REGIONAL DIRECTOR thanked the representative of France for the valuable information it had provided on improving control of health expenditure.
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He agreed with the representative of China that vigilance against poliomyelitis should be maintained. The Regional Adviser on the Expanded Programme on Immunization would respond in detail on the matter of vaccine-derived cases. China had said that the Western Pacific Region should take the lead in traditional medicine, and the REGIONAL DIRECTOR took note of that. The representative of Hong Kong (China) had proposed a fresh look at health care systems, recommending that health care systems be seen in their totality rather than in a fragmented way. At its next meeting, the technical advisory group for health sector development would take a fresh look at this issue. The REGIONAL DIRECTOR endorsed the proposal made by the representative of Papua New Guinea that development of human resources and health care providers needed to be tackled in an innovative way. WHO was studying primary health care in at least 12 countries, and those studies would provide information on community-level care providers very soon. The REGIONAL DIRECTOR also agreed that WHO should work with departments of health to provide them with advocacy materials for use in their negotiations with colleagues from other government ministries. The representative of the Lao People's Democratic Republic had called for more resources to deal with dengue epidemics. The REGIONAL DIRECTOR replied that WHO had previously provided fmancial and technical support in that area, and would offer further support as and when it was needed. The REGIONAL DIRECTOR concurred with the representative of Mongolia that good laboratory capability was needed to diagnose measles. The laboratory network developed as part of the acute flaccid paralysis surveillance system could be extended to cover measles and other diseases. It was true that single-dose immunity to measles would fade over the years. Indeed, experts on measles vaccination had recommended at a recent meeting that countries should adopt national plans of action to ensure that all the children in each birth cohort should have two opportunities to receive two doses of measles vaccine where appropriate. The representative of Kiribati had asked that the next year's report be more comprehensive. The REGIONAL DIRECTOR appreciated that request, but the need for comprehensiveness had to be weighed against the danger of overwhelming the reader with excessive detail. He noted that Kiribati had received only a limited number of copies of the Report prior to the session; this was because it was not easy for the Regional Office to
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distribute large numbers of copies in advance of the session.
However, he assured the
representative that more copies would be distributed after the annual session. The representative of Tuvalu had suggested that PacELF, the Pacific Programme for the Elimination of Lymphatic Filariasis, should be discussed at the next session of the Regional Committee. This subject had been discussed in the Pacific health ministers' meeting at Madang. He took note of the suggestion and would give it fulI consideration, but he also respectfully suggested that, if Tuvalu wanted PacELF to be included on the agenda of the next session of the Regional Committee, it should refer to this in its reply to the letter he would be sending to alI Member States regarding the agenda for the next session. He thanked the representative of the Republic of Korea, and agreed with him that the preventive aspect of health systems had to be improved. The ACTING DIRECTOR FOR DISEASE PREVENTION AND CONTROL reported that an update on the many dengue outbreaks in the Region had just been made, and that the statistical tables in that update contained the correct data for dengue. Corrections would be made to the errors contained in the statistical annex to this year's report. Trials of vaccines against all four serotypes of dengue were very promising, and extended clinical trials were about to start, in Viet Nam and in other countries. The trials were being carried out primarily by the Centers for Disease Control, the RockefelIer Foundation and the International Vaccine Institute. A meeting on dengue vaccine would take place in December 2001 in Ho Chi Minh City, in Viet Nam. He believed that the Philippines had been invited, but if not he would try to ensure that such an invitation was forthcoming. The REGIONAL ADVISER IN THE EXPANDED PROGRAMME ON
IMMUNlZATION noted that the most recent vaccine-derived poliomyelitis outbreaks had occurred in the Dominican Republic and Haiti on the island of Hispaniola. The first case had been reported on 12 July 2000. This had been the only outbreak in the Region of the
Americas since the Region was certified poliomyelitis-free in 1994. The outbreak had been caused by vaccine-derived type 1 poliovirus. In July 2001 the fourteen cases from the Dominican Republic and the five from Haiti were confirmed in laboratories; the last case had occurred in April 2001. All the cases occurred in people who had been inadequately vaccinated or not vaccinated at all. In response, the two countries had performed three nationwide rounds of oral poliovirus (OPy) immunization. The cause of the outbreak had been low immunization coverage, allowing the vaccine-derived poliovirus (VDPy) to circulate among children who were inadequately
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covered. Inadequate AFP surveillance had allowed the VDPV to circulate undetected. The strategies for the prevention of vaccine-derived poliovirus cases were sustained and improved routine OPV coverage and continual supplementary coverage when necessary, until global eradication had been achieved. At the invitation of the CHAIRPERSON, statements were made on behalf of the International Federation of Otorhinolaryngological Societies (IFOS), and the International Society of Radiographers and Radiological Technologists (lSRRT). The meeting rose at 5.30 pm.
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ANNEXl SPEECH BY THE HONOURABLE PERIN ORANG KAYA LAlLA WUAYA DATO SER SETIA HAll A W ANG ABDUL AZIZ BIN BEGAWAN PEHIN UDANA KHATm DATO SERI PADUKA HAJJ AWANG UMAR, ACTING MINISTER OF HEALTH, BRUNEI DARUSSALAM, AT THE OPENING CEREMONY OF THE FIFTY-SECOND SESSION OF THE REGIONAL COMMITTEE IN BRUNEI DARUSSALAM, 10-14 SEPTEMBER 2001
On behalf of the Organizing Committee and Representatives, first of all I wish to
extend my deepest gratitude to Your Majesty the Sultan and Yang De-Pertuan of Brunei Darussalam, for Your Majesty's gracious presence and consent to officiate at the opening of the fifty-second session of the WHO Regional Committee for the Western Pacific. To all Distinguished Representatives, I wish you all a very warm welcome to Brunei Darussalam. Brunei Darussalam and its people are indeed privileged to have this opportunity to host the fifty-second session of the WHO Regional Committee for the Western Pacific. Brunei Darussalam became a member of this august Organization in March 1985. Since joining, we have been able to participate actively in the various programmes and activities organized by the WHO at national, regional and international levels. We have benefited extensively from WHO's collaboration and technical assistance, which have contributed to our achievements in health. Among others, we participated actively in the successful malaria eradication project in the early 1960s which led to the declaration of 'malaria-free' status in August 1987, the community health nursing training programme, infant and young child nutrition and the Expanded Programme on Immunization. Recently, consultancies have been extended to us in such areas as the Baby-Friendly Hospital Initiative; tuberculosis; rehabilitative medicine; health care financing and telehealth. On behalf of the Ministry of Health of Brunei Darussalam, I wish to thank Dr Shigeru
Omi, the Regional Director for all the technical assistance extended to us. We look forward to future collaboration with WHO. I also wish to thank the Secretariat from the Regional Office in Manila for all their assistance and guidance in hosting this meeting. I also wish to acknowledge Dr Gro Harlem Brundtland, the Director-General of WHO, for her presence at this important meeting.
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Annex 1
May I also take this opportunity to express my appreciation and thanks to all members of the Organizing Committee for all their hard work in ensuring the success of this fiftysecond session. Finally, this year, in conjunction with 'Visit Brunei Year 2001', I hope Distinguished Representatives will have the opportunity to enjoy the sights and sounds of our country and bring home with them pleasant memories of Brunei Darussalam.
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ANNEX 2 SPEECH BY DR SHIGERU OMI, REGIONAL DIRECTOR OF THE WESTERN PACIFIC REGION OF WHO AT THE OPENING CEREMONY OF THE FIFTY-SECOND SESSION OF THE REGIONAL COMMITTEE IN BRUNEI DARUSSALAM, 10-14 SEPTEMBER 2001
On behalf of the Western Pacific Region of the World Health Organization, I would like to express our sincere thanks to His Majesty the Sultan of Brunei Darussalam for his support for this meeting and to Honourable Pehin Haji Abdul Aziz Umar for his gracious welcome. We are delighted that Brunei Darussalam is hosting this session of the WHO
Regional Committee for the Western Pacific. Those of us who have been here for a few days have already had the pleasure of enjoying your beautiful country. We will all have an
opportunity to learn more about your country's considerable achievements in health in the days ahead. In many ways our host country is setting an excellent example. Brunei Darussalam has
already passed through the epidemiological transition. Traditional threats to public health, such as communicable diseases and malnutrition, now represent a smaller portion of the disease burden than noncommunicable diseases, such as ischaemic heart disease and diabetes. Combating these lifestyle-related diseases depends to a large extent on effective health promotion, and I was delighted to note that last year Brunei Darussalam conducted a "National healthy lifestyle" campaign, with the full support of His Majesty. If we are to prevent or delay the onset of noncommunicable diseases, we have to empower people to make decisions that will improve their own health. I therefore congratulate the Government of Brunei Darussalam for taking this far-sighted initiative. I also applaud the Government for making access to health services a central part of its health policy, by providing free health services to citizens and permanent residents and using innovative methods such as flying doctors to ensure that services are delivered to isolated communities. This is a historic session of the Regional Committee for the Western Pacific, as it is the first since the certification of the Region's polio-free status in October last year. It is also a year in which we can cautiously note some successes in the battle against AIDS in the Region. Cambodia has the highest HIV prevalence in Asia and a few years ago many experts doubted whether any reduction could be expected in the near future. However, recently
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Annex 2
published data have shown a marked and sustained decrease in HIV prevalence. This is a very significant achievement and one that we shall be looking at more closely in the week ahead. These important success stories should not blind us to the health challenges that face us. Mental health and food safety, for example, are issues that affect every country in our Region. Their importance is not decreasing; on the contrary, in most countries, mental illness and disability and foodbome illnesses are imposing increasing burdens on health services. Mental health and food safety are just two of the important issues that we shall be discussing during the busy week ahead. Your Majesty, Excellencies and other distinguished guests, Brunei Darussalam and WHO have enjoyed excellent relations since Brunei Darussalam joined WHO on 25 March 1985. It is a great honour for WHO to hold the fifty-second session of its Regional
Committee for the Western Pacific here in Brunei Darussalam. Hosting this meeting in your country will help to bind us even more closely together. Let me thank you once again, your Majesty, for helping us, and thank all our friends on the organizing committee who helped us to organize this meeting.
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ANNEX 3 SPEECH BY DR GRO HARLEM BRUNDTLAND, DIRECTOR-GENERAL OF THE WORLD HEALTH ORGANIZATION AT THE OPENING CEREMONY OF THE FIFIY-SECOND SESSION OF THE REGIONAL COMMITTEE IN BRUNEI DARUSSALAM, 10-14 SEPTEMBER 2001
Let me begin by echoing the thanks of my colleague Dr Orni to His Majesty the Sultan of Brunei and to His Majesty's Government of Brunei Darussalam for kindly agreeing to host this session of the WHO Regional Committee for the Western Pacific. The Western Pacific Region is an extremely diverse Region and it is always a pleasure for me to attend your sessions and to see how, despite the enormous differences in size, culture and stage of development, you are all united in your commitment to ensuring the best possible standard of health for the people of the Region. Such unity in diversity is extremely impressive and I can aSSure you that the World Health Organization will offer you every support we can, both from our Regional Office in Manila and from our Headquarters in Geneva. Dr Omi has already noted that many of Brunei's health indicators are excellent and I join him in applauding you for that. Brunei is one of the more prosperous countries of the Western Pacific Region, and I am pleased to note that you have used some of this wealth to invest in the health of your people. In fact on a per capita basis, Brunei's expenditure on health is one of the highest in the Region. Within WHO, the Member States see improvement in health as a critical element of the fight against poverty. This is the global imperative for this decade. Poor people will only be able to prosper, and emerge from poverty, if they enjoy better health. Member States of this Region are encouraging the WHO Secretariat to fight for health improvement at intergovernmental level, within the UN General Assembly, or in regional groupings - like the Association of South-East Asian Nations (ASEAN). You expect us to focus on ways to increase access to good quality medicines and other essential commodities, to improve skills and practice among health professionals and to establish better international means - such as agreed regulations or ratified conventions - to limit the spread of ill-health. Member States also ask the WHO Secretariat to work with them to improve health within communities, within civil society, or through government action. You seek our help in optimizing the performance and impact of health services, through effective stewardship of
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Annex 3
private as well as public action, and through realistic approaches to financing public health services. Member States look to WHO for inputs on specific issues • such as the health conditions experienced by poor people, especially when they are marginalized or subject to insecurity and conflict; • such as the challenges faced by women - particularly unsafe pregnancy - and by children - especially during the adolescent years; • such as the threats of infectious diseases like HN, leishmaniasis, dengue and diarrhoea; • such as emerging epidemics of noncommunicable diseases, particularly cancers, and injuries; • such as the impact of the environment on human health - through the water we drink, the air we breathe or the insects, animals or dust with which we are in contact. As health becomes more important to our Member States, the demands on the WHO Secretariat increase. One of WHO's real strengths is its regional structure, and its ability to respond to regional priorities. Your Highness, Excellencies and other distinguished guests, Improving health is one of the most complex and difficult of tasks. It is also one of the most inspiring and rewarding. By offering to host the fifty-second session of the Regional Committee for the Western Pacific in this beautiful country, Brunei Darussalam has shown its commitment to achieving a better standard of health for all. This is also WHO's mission. We are therefore extremely pleased to be working with His Majesty's Government in holding this important policy-making meeting here in Brunei Darussalam. Thank you.
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85 ANNEX 4
ADDRESS BY THE OUTGOING CHAIRPERSON OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC, DR VILlAMI TANGI, AT THE OPENING CEREMONY OF THE FIFTY-SECOND SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
As the current Chairperson of the Regional Committee for the Western Pacific, it is my privilege to express the Regional Committee's sincere thanks and appreciation to His Majesty's Government of Brunei Darussalam for its kind hospitality in inviting us to hold the fifty-second session of the Regional Committee in this magnificent capital of Brunei Darussalam. We are all deeply honoured to be your guests. On behalf of my fellow
Representatives, I wish to particularly thank Your Majesty for being our host, and to bring warm greetings to Brunei Darussalam from the 37 countries and areas that make up the WHO
Western Pacific Region. The sessions of the Regional Committee are an important event for all of us who work to improve the health and wel1-being of our countries. The sessions provide us the
opportunity to discuss current health issues and appropriate policies and actions. The event takes on a particular significance when it is held outside the Regional Office in Manila, as it al10ws us an opportunity to learn about one of our Member States. Some of my colleagues, I know, have taken advantage of our trip here to arrange visits to health facilities and institutions. In this regard, we truly appreciate the arrangements that have been made by His Majesty's Government to facilitate this learning experience. Your Majesty, Excellencies, I am sure I speak for the Regional Committee when I say that we are all delighted to be here. For most of us, this is the first time that we have visited Brunei Darussalam. The warm welcome we have been given and the efficient and
professional manner in which the excellent arrangements have been made for us are a tribute to the months of careful preparations involved in hosting a gathering such as this. We alliook forward with keen anticipation to the events of the week ahead, especial1y to knowing more about this beautiful country and its people. Distinguished Representatives, I will be shortly handing over my responsibilities to a new Chairperson. Let me just say that I greatly enjoyed doing the job that was entrusted to me. At our session last year we addressed important issues that required our careful
deliberation - issues like HIV/AlDS, tuberculosis, noncommunicable diseases, and the increasing challenge of tobacco use and production in the Region. We also introduced
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Annex 4
innovative ways of making sessions more interesting, interactive and productive. All these we have been able to do because of the spirit of mutual respect and regional cooperation that has characterized our meetings in the past. I am confident that my successor will be able to draw strength and inspiration from this same spirit of solidarity and from our collegial approach to addressing the health challenges in the Region. Your Majesty, allow me once more to thank you and your people for having us here. Thank you for your generous hospitality. This fifty-second session of the Regional
Committee will no doubt go down in history as one of the most memorable sessions. Thank you.
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ANNEX 5
OPENING ADDRESS BY HIS MAJESTY SULTAN HAll HASSANAL BOLKIAH SULTAN HAll HASSANAL BOLKIAH MU'IZZADDIN WADDAULAH, SULTAN AND YANG DI-PERTUAN OF BRUNEI DARUSSALAM AT mE INTERNATIONAL CONVENTION CENTRE BERAKAS, BRUNEI DARUSSALAM It gIves me great pleasure to welcome you all to Brunei Darussalam for this
fifty-second session of the WHO Regional Committee for the Western Pacific. It is an honour for us to receive Representatives from so many countries throughout
East Asia and the Pacific. You are our friends, our neighbours and above all our partners in an ever increasing number of Regional Organizations. This reflects a fundamental reality in international life today. Inspired by the great agencies of the United Nations, our world is now one of partnership between nations and regions. The cooperation on this involves now covers almost every aspect of our people's public and private lives. Whatever the subject and whatever the issue, whether it be political or economic, educational or scientific, cultural or social, we have all accepted the need to work together. The importance of this is perhaps nowhere more in evidence than in your own specialist field of health. Ladies and Gentlemen, Historians commenting on the history of the 20th century are already judging it severely. It has been judged the most violent and destructive period in the history of
mankind. There is one shining light of achievement they point to, however. This is the magnificent advance of medicine and health care. They are indeed right to single out this field of humanitarian endeavour. In a little more than 100 years, human life has been transformed in quality and expectations. For over half a century now, this work has been spearheaded by the World Health Organization. It has inspired truly remarkable progress. It has confronted the great scourges of human history and, in many cases, it has removed them from every continent. For us in the Western Pacific, for
example, it was truly a momentous occasion in Kyoto last year when our Region was certified as free from polio.
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Annex 5 In Brunei Darussalam, we are very pleased to be part of this vital regional work. We
are grateful to WHO for the guidance it has given us in our efforts to keep up with changes in medical and health care. With improvements in health standards in the country, our people are now enjoying overall good health. This is reflected by the satisfactory attainment of practically all the WHO global health indicators. Our country has been declared malaria-free. As well as this, major vaccine-preventable childhood diseases have been kept at a low level, thanks to the Expanded Programme on Immunization. I am sure all countries represented here can point to similar achievements. This means that we can all take pride in the progress that this Region has made. Having said that, however, we still face major challenges. HIV/AIDS and Ebola are perhaps the most alarming of all. They are potentially as devastating to our people and our societies as any ancient plague. In addition, previously controlled diseases, such as tuberculosis and malaria, are re-emerging. The situation is
compounded by rising co-infection with tuberculosis amongst HIV/AIDS sufferers. There is also the increasing problem of multi-drug resistance to tuberculosis in some countries. As well as these pandemics, we all face many new, sometimes self-inflicted, phenomena. They range from the effects of smoking on individuals, to the medical and social consequences of environmental and industrial pollution. I am indeed impressed by the scope of your agenda here. It appears to cover every aspect of modern health care that can affect the lives of our families and communities. I can assure you that we in Brunei Darussalam will be paying very careful attention to your discussions and recommendations. Recently, my Ministry of Health has implemented a lO-year National Health Care Plan (2000-2010). This has identified priority health issues under health sector development. It also sets policy directions and strategic goals in providing excellence in health care. Ladies and Gentlemen, You are covering a very broad agenda. Among the many items for discussion, we will be especially interested in the results of your Ministerial Roundtable on mental health. We
have recognized the need to address this important aspect of health care and were inspired by
SUMMARY RECORD OF TIlE FIRST MEETING
89 Annex 5
the messages from your World Health Day 2001. However, like many developing nations, we are at an early stage. We are therefore very keen to learn from organizations such as WHO. Happily, in this, and all other areas the modern world is offering us not only new challenges but also fresh new opportunities to meet them successfully. By this, I refer of course to the tremendous steps being taken to utilize modem technology, communications and the Internet. This is an exciting field. I am sure all developing nations will be keen to see how it can assist their basic services. We believe the potential of telehealth, for example, is immense. Consequently, we hope that the WHO will undertake to explore the possible uses of this new aspect of medical care. Ladies and Gentlemen, You are here to consider what is possibly the issue that is closest to the interests of every family in every community in our Region. This is an enonnous responsibility and I am sure you will discharge it with wisdom and dedication. We shall be following your
deliberations with very great interest. At the sarne time, you are our friends and our guests and we hope you will be able to spare a little of your time to learn something of our country and our people. We are honoured to have you here and wish you every success in your important discussions. With the Kalimat "Bismillahir Rahmanir Rahim", it gives me great pleasure to declare open the fifty-second session of the World Health Organization Regional Committee for the Western Pacific. Wabillahit Taufiq Walhidayah Wassalamu'alaikum Warahmatullaahi Wabarakatuh.
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REGIONAL COMMITIEE: FIFTY-SECOND SESSION
II II II
" II
" ~
I
SUMMARY RECORD OF THE FIRST MEETING
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ANNEX 6
ADDRESS BY THE RETIRING CHAIRPERSON OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC, DR VILIAMI TANGI, AT THE OPENING SESSION OF THE FIFTY -SECOND SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
It is a great pleasure to be with you here in Brunei Darussalam for the fifty-second
session of the Regional Committee.
At the opening ceremony this morning, which was
graced by the presence of His Majesty, the Sultan of Brunei Darussalam, we could all see that our hosts have done everything to make this a session we shall all remember for a long time. On behalf of the Representatives, therefore, let me take this opportunity to express our thanks
and sincere appreciation to His Majesty's Government of Brunei Darussalam for hosting this important meeting. On a personal note, I wish to thank our hosts for giving us the opportunity to see their beautiful country. Distinguished Representatives, I address this body as your retiring Chairperson with a sense of pride at what we have achieved and with heartfelt thanks to all who have helped in our work over the past year. As I said in my opening address last year, I feel very honoured to have joined the ranks of my distinguished predecessors. I must say that we did well, thanks to your kind cooperation in helping me carry out my duties. I also feel very honoured and proud to have been able to contribute in my own small way to the Regional Committee's and Member States' pursuit of a healthier and happier Western Pacific Region. Last year we discussed many important issues, including HIV/AIDS, tuberculosis, noncommunicable diseases and the growing threat of a tobacco epidemic in our part of the world. We also examined WHO's more unified budgeting process which is designed to focus clearly on priority issues and to enhance effectiveness and efficiency. There have been successes during the last year. Foremost is the certification of the Western Pacific Region as poliomyelitis-free. This significant achievement clearly
demonstrates what we are able to accomplish when we work together. Another example of nations working together was the fourth meeting of Ministers of Health for the Pacific island countries held in Madang, Papua New Guinea, in March this year. This led to a strengthened commitment to the vision of Healthy Islands, including addressing such important issues as noncommunicable diseases, tuberculosis, human resources development and communicable disease surveillance and response, among others.
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Annex 6
However, serious challenges to health in the Region still remain. The re-emergence of some diseases, the pressures and challenges brought about by rapid development and global competitiveness, competing priorities and the perennial problem of dwindling resources these are just some of the issues that face us. Those of you who were with us last year in Manila will remember that the Secretariat made considerable efforts to make our sessions more innovative, interactive, informative, transparent and efficient. For example, for the first time last year, our discussions were preceded by a keynote presentation which helped to broaden our lUlderstanding of the links between poverty and health and the policy and priorities of the Asian Development Bank. This year the Secretariat has organized a panel discussion on mental health, which will precede the ministerial rOlUld table. stimulating. Last year we also all made an effort to make our sessions more informal than in previous years. One aspect of this was the stretch break that we had last year. This allowed us to restore the circulation to our stiff and weary limbs and to resume our discussions with a lighter heart. I lUlderstand that something along these lines is also planned for this week and I am sure that we all look forward to that. Distinguished Representatives, as I look arolUld, I see some new faces. I welcome you all to this collegial body. For some of our colleagues who have taken up other responsibilities in their governments or who have gone on to pursue other endeavours, I would like to officially acknowledge their contribution to our work in the Region. As Dr Omi would say, we faced the challenges together and we all worked together in getting the job done. Distinguished Representatives, ladies and gentlemen, we shall soon elect a new Chairperson who will steer our deliberations over the next five days. I wish to thank you all for the privilege of working with you. I wish to thank my colleagues, in particular the Vice-Chairperson and Rapporteurs. My task was lightened considerably because of their support. I wish my successor every success during this fifty-second session of the Committee. Thank you very much. I hope you will find this session interesting and