(WPBVRC17/Mln/3 Rev.1)
MINt1rES OF '!'HE THIRD MImrING
WHO Conference Hall Thursday, 22 September 1966 at 9.00 a.m. CHAIRMAN: Dr Thor Peng Thong CONTENTS 1
statements by representatives of the United Nations, the Specialized Agencies and non-governmental organizations in official relations with WHO {~ontinued)..... Place of eighteenth session of the Regional Committee Address by incoming Chairman of the Regional Director
149 152 153
2
3 r· __
.•.•••••••••••••••••••••••••.••
4 5 6
Continuation of the discussion on the Annual Report .......... ,. ...... ,. . . . . . . . . . . . . . . . . .
155 159
"
Smallpox eradication
proGl~amme
..•••••.••••••••••••••••••••••
Cholera: action taken in relation to the resolution adopted by the Committee at its sixteenth session •.•••••••• Establishment of a central registry en poisonin~s
IS8 159
7
••••••.••
-145-
146
Thiro Meeting
Thursday. 22 September 1966 at 9.00 a.m.
I.
Representatives of Member States >_F·
AUSTRALIA
Dr H.E. Down(:s Dr R. Taureka Dr Thor Peng Thong Mr Ok Sam On Dr C.K. Chang Dr T.C. Hsu Medecin-General M. Orsini
CAMBODIA
CHINA
.
,
FRANCE
JAPAN
Dr M. Matsuo Mr K. Watanabe
LAOS MALAYSIA
Dr Koukeo Saycocie Dr L.W. Jayesur1a Dr R. Dickie Dr C.H. James Mr Abdul Aziz bin Mohamed Dr C.N.D. Taylor Dr A.H. Cruz Dr V. Gahol Mr J .M. Morales Dr A.N. Acosta Mr V. Buencamino Mr W. !lustre Mr I. Bantug Mr B. Hizon Mr D. Gonzales Mr. P. Viray Mr A. Asuncion MrI. Nicanor Mr R. Austria Dr Nuno Campelo de Andrade Dr Manuel Florentino Matias Mr Carlos da Luz Nunes
. )
~
NEW ZEALAND PHILIPPINES
.
....
PORTUGAL
.
-
•
MINtA'ES OF THE ." , , THIRD MUrING
147
REPUBLIC OF KOREA
Dr Y.K. Cha Mr J.H. Sull Mr N.J. Choi Dr S.R. Sayampanathan' Dr P.H. Teng Dr C.H. Gurd Dr R.K.C. Lee Dr H. De Lien Mr M. K. Ko1zumi
SmGAPORE UNITED KmGDOM
UNITED STATES OF AMERICA
VIEr-NAM
Dr L8-Nhfu'l-Thuin Dr Duong-Cam-Chuong Dr J .C. Thieme
WESTERN SAMOA II.
Representatives of the United Nations and Sp6Cial1zed Agencies
UNITED NATIONS AND UNITED NATIONS DEVEIDPMEN'l' PROGRAMME Mr W.H. Cornwell
UNITED NATIONS CHIIDREN I S FUND III.
Mr 1. H. M:l.rkuson
Representatives of other intergovernmental organizations
SOUTH PACIFIC COMMISSION
DrG.Loison
IV.
Representatives of non-governmental organizations
mrERNATIONAL COMMlTI'EE OF CATHOLIC NURSES mrERNATIONAL COUNCIL OF NURSES mrERNATIONAL DEm'AL FEDERATION mrERNATIONAL PLANNED PARENl'HOOD FEDERATION IN!l'ERNATIONAL UNION OF ARCHITECTS MEDICALl wo~r I S niTERNATIONA:&. ASSOCIATION
Mrs M. Ordonez
Mrs R.S. Diamante
Dr E. Castillo Professor Han Su Shin
l>tr A. D1maJ.s.nta Dr T. Gomez
148
REGICBAL COMMITTEE: SEVENTEEN'rH smsION
v.
~]RO
Secretariat Dr P.M. Kaul
REPRESENl'ATlVE OF THE DlREOl'OR-GENERAL
Assistant Director-General Dr Francisco J. Dy
Regional Director
149
1
STATEMENTS BY
REPRES~IVES
OF THE UNITED NATIONS, THE SPECIALIZED
AGENCIES AND NON-GOVERNMENTAL ORGANIZATIONS IN OFFICIAL REIATIONS
WITH WHO (continued from the second meeting, section
1)
At the invitation of the Chairman, the following Representatives presented statements. 1.1 Representative of the United Nations Children's Fund
Mr MARKUSON extended the greetings of Mr Brian Jones, UNICEF Director of the East Asia and Pakistan Regional Office, Bangkok, whom he was representing at the meeting. As was known, assistance from UNICEF went
to five basic fields, namely, health services, education, social services, vocational trainin~
and nutrition.
Assistance in nutrition covered a
wide field and
mi~ht
include such projects as milk plants, school feeding The nature of the assistance
and the so-called applied nutrition projects.
given varied from country to country depending on the situation in the country itself. interpretations. Thus, UNICEF's policies 1.ere subject to quite broad Its objective was the well-being of mothers and children
(including youths) but here, too, assistance often extended to all who were affected by such diseases as leprosy, tuberculosis, malaria, etc. During the past seven years, increasin~
attention had been
~iven
to the
need for trained personnel in all the above-mentioned fields and about one-third of UNICEF's resources was eA"Pended for this purpose. UNICEF
had also been urged to seek out ways and means to extend assistance to
the pre-school child, and lastly, it
l~d
applied its attention and
resources to alerting governments to the problems to be faced as a result of the world-vide population explosion in the already rear future.
150.
REGIONAL COMMI1'l'EE: SEVEN'l'lNfrHSl!2SION
UNICEF had supported, along with co-<>perat1ng agencies, special conferences in Africa, South America and Asia on the subject of Children and Youth in National Development Planning, and the recommendations
resulting from these conferences were in the process of being followed
up in each country.
Proposed new projects came to their attention either ... _1,
directly from governments, governmental agencies, technical representatives who might be assiGned to a country, or from regional representatives visiting countries. a~encies
In all cases, it was necessary for the technical
to be informed, as by decision of the General Assembly, each
proposal must have the technical approval of the aJency concerned. 1.2 Representative of the United Nations and United Nations Development Programme Mr CORNWELL stated that the United Nations was waging Peace.
It
was against
hun~er,
poverty, slums, ignorance, disease and waste, but,
more important, it was for good food, [.:,ood health, good. homes, good education and human diunity. The weapons used were knowled-ge and science, technical assistance,
good will and dedication, much experience and a little money.
The field
marshals were the Director-Generals of the United Nations $pecia1ized Agencies and they provided the knowledBe and guidance required. The WHO y\
Regional Directors in WaShington, Copenhagen, Alexandria, New Delhi, Brazzaville and Manila were the generals who devised the strategy and saw to it that the diverse and difficult operatiOns were as successful as possible. In addition, there were the hundreds of seasoned, selfless,
self -effacing WHO consultants and technicians who, with their tireless teacl!ing, endless patience and brilliant application of proved techniques were winninc; the global campaign.
M[NUTJ!5
OF THE THIRD ME:E:.rma
151
The United Nations was poor.
It had no power to tax but lived from of~mber
year-to-year and hand-to-mouth on the voluntary contributions States.
Care must be taken, therefore, to allocate available resources It ,las better (and far cheaper) to prevent than to cure ..
carefully.
He congratulated the Republic of the Philippines on building multipurpose medical centres in the rural areas. I f these were backed-up by
sound provincial medical faCilities, the miGration to the already burdened urban centres could perhaps be slowed down. This was far wiser than
delaying until the ever-swelling slum areas swoll even more, so that many times as much money had to be appropriated in the name of rehabiliI~
tation and slum clearance. Through prudence, the careful selection of priorities, and. the courage to stick by them and carry them out in the face of sometimes understandable but often narrow self-interests, the children "ould be left a planet of peace and opportunity, with healthy citizens dwelling in clean cities and country tmms and upon fertile farm lands. Mr Cornwell, on behalf of the Secretary-General of the United
Nations, Mr U. Thant, the Administrator of the United Nations Development Programme, Mr Paul Hoffman, and on his own behalf, then w"elcomed the representatives to the Philippines. He hoped that the deliberations
would be useful and the recommendations workable, always remembering that a peso of prevention ,TaS
worth a dollar of cure.
1.3 Representative of the International Union of Architects Mr DIMALANTA stated that fifty-four countries "ere represented
on the Union.
The Headquarters was in Paris and there were national There was also a permanent delegate to WHO
centres in each country.
in Geneva.
WHO and the Union had cOllUllOn interests, as WHO's programme
of activities covering town planning, community development, concepts of hospitals and health centres, hygienic conditions of industrial plants and housing area} etc., demanded the participation of architects. The report on the proceedings of the seventeenth session of the Regional Committee would be sent to the Union's Secretariat in Paris for evaluation and proper dissemination to all member organizations.
2
PrACE OF EIGHTEENTH SESSION OF THE RIDIONAL COMvtrl'TEE Dr JAYESURIA (MI.laysia) stated that the Committee would recall
that in 1964, actin.::; on instructions, he had had the honour to invite the Regional Committee to hold its meeting in 1967 in Kua.l.a IAmlpur. Again in 1965, actin.::; on instructions, he had repeated the invitation at the meeting in Seoul. He was now placed in a most embarrassing
position as his Government had informed him by a cable that it regretted very deeply that it could not be the host country to the Regi.onal Committee meeting next year in Kuala ~ur,
because of the economic
drive now in progress and which was expected to continue for some time.
On behalf of his Government} Dr Jayesuria tendered most sincere apologies for the unforeseen circumstances which had led to this most disappointing and regrettable announcement.
The RIDIONAL DIRECTOR drew attention to the fact that the item on the time, place and duration of the eighteenth and nineteenth sessions of the Regional Committee would be talten up at a later date during the session. However} Dr Jayesuria had wished to make
his announcement now
so that the representatives might know in advance that it was not
Mmt1l'ES OF THE THIRD MI!iETlNG
--
possible to hold the Regional Committee meeting in 1967 in KUala Lumpur. A decision vTOuld, therefore, have to be made when the appropriate item on the abenda was held. tal~n
up., as to where next year I s meeting would be
As the M=mbers !mew, the meetings of the Committee were held in
Manila unless a Vember government invited the Committee to hold it elsewhere and such an iIlld'ta.tion ,las accepted by the Regional Committee. (For continuation of discussion and consideration of draft reso1ution, see minutes of the fifth meeting, section
5.)
3
ADDRESS BY mOOMING CHAIRMAn:
Item 5 of the Agenda
The CHAIRMAn stated that he did not ,rant to betray the tradition of the Committee whereby the Chairman made a speech. He would start,
therefore, by saying how glad and how proud. he was to have been elected to this office. This was a personal honour but he was even more grate-
ful for the honour accorded his Government and the country "bich he represented. The meeting represented a vast area with a numerous popu-
lation in which there vrere po11t1ca1, ideological and prestige conf1icts, which were not yet solved. It was, therefore, good that there were
within the United Nations organizations such as WHO, which enabled people to meet in peace to discuss, not only on the technical but also I -::,.-
on the administrative and financial planes, health problems of interest to the population. The developing countries could not do everything in
one day but each one of them must try, ,-Tithin available means, not only to solve its ovo problems but also to help others by sharing experiences and knowledge. arranged by W~O
This was the purpose of the international meetings so that countries were not isolated one from the other His country was not a b1g one in
and left to face their own problems. • L
terms of land area and number of 1nhabitants, but it was great because of its traditions and culture.
An active administration,under
" I
REGIONAL CO!fi['rTEE: SEVl!iN::L'EEN:L'H SESSION
the personaJ. leadership of the Chief of state, His Royal Highness Norodom Sibanouk, was trying to illl.Prove conditions throughout the rural areas. With or without the assistance of the internationaJ. organi-
".
zations, basic health services were being established or extended, efforts were being made to control the communicable diseases, such as malaria, tuberculosis, cholera when they occurred unexpectedly, to increase the number of doctors, nurses and midwives and also to raise continually the quality of teaching given to them. The health of the mother and
child was one of the principal concerns of the schools and health centres. The Takhmau pilot health centre, with the help of several internationaJ.
organizations, had stud.ied the problems of the rural population, including ~-
(
the economic and social conditions in which they lived.
The results
obtained had shown the feasibility of training more staff and it had also been possible to share the results of the experience gained with the rest of the country. Health workers in Cambodia fully appreciated
the importance of the disciplines of epidemiology and statistics so that, as the Regional Director had stated yesterday, each country might know its o.m problems better and then make its health plans, thus obtaining the maximum profit from available resources and the assistance given by international orga.'1izations. They also supported the statement that the
improvement of environmental health, combined with health education, was the first solution to illl.Proving the living conditions of the people. This
could be called economic and social development or community development, but progress must go forward at the same pace in all fields so that the people could enjoy better living conditions. If he mentioned these
problems, it was not that he was trying to remind the representatives of them, because he was convinced that they were constantly present 10
155
their minds, but that he wanted to show them the extent to which they were dependent on each other. In concluding, the Chairman expressed his pleasure at being once again in the Philippines. He also wished a long period of activity to
the new Regional Director, Dr Francisco J. Dy, whom they bad known since the time when he had been devoting his energy and knowledge to malaria control.
4
CONTINUNl'ION OF THE DISCUSSION ON THE: .ANNUAL REPORT OF THE: REGIONAL DIRECTOR: Item 11 of the Agenda (Document WPR/RCl7/4) (continued from the second meeting, section 2) Section Health Protection and Promotion (pages 35-40) Section 5.1: Dental Health pages 35-
• Dr ORSINI (France) stated that a dental health centre bad been opened
in Papeete last year with the assistance of WHO and the resources of the
..
Territory.
He hoped that by next year, work could be started on the
construction of a bigger building and, i f pOSSible, one which was better equipped than the present. In any case, the centre had already facUities
for mobile treatment, investigation, surveys and other such services. Section 5.2: Mental Health (pages 36-37)
Dr ORSINI said that special attention was beine; given to psychiatric
treatment in New Caledonia.
Three years ago, the Territory bad a psychiaSince that time the following mea-
tric hospital but that was about all.
sures had been taken: (1) establishment of a neuro-psychiatricservice at the General Hospital with a laboratory for electro-encephalography run by speCialists; (2) transformation of the mental asylum into a psychiatric hospital; (3) development of modern methods of treatment (chemotherapy,
• i '" It .(
vocational therapy) continued by post-cure and medical follow-up of old cases covering all the Territory, including the rural areas;
156 (4) establishment of a mental health dispensary in accordance with the metropo1itan pattern which provided external. treatment, post-cure and consul.tations free of charge; (5) establ.ishment of a local branch of the "Societe de la croix-Marine", a recognized private French association created in order to inform the :public of psychiatric prob1ems and their s01utions, especially in the field of rehabilitation and social. readjustment; (6) institution of an annual rtnAY" with a view to prolOOting normal. relations between the patients and the population and to further the recognition of mental. diseases as ordinary diseases. He hoped that in the national development plan for 1966-1970, it
-
{
would be possible to have special. services 'for children in the psychiatric hospital. It had not been easy to recruit nurses We> sPeCialized in neuro-
psychiatry but he felt that the target woul.d be completely reached within two years.
Dr CRUZ (Philippines) reported that the' Department of Health , t
was now carrying out a policy of decentralization.
This was one The
of the programmes initiated by the present Secretary of Health.
philosophy behind the decentralization scheme was first, to bring the mental. patients closer to their relatives so that 'they could contribute to their care, and second, to lessen the congestion in the mental. institution in IoBndal.uyong so that there could be a IOOre reasonable approach to the care and treatment of the patients. Section 6: Education and Training (pages 40-47)
Dr LEE (United States of America) said he had been very much impressed
by the statement of the Representative of UNICEF who bad pointed out that one-thixd of the UNICEF budget was earmarked for training. Throughout
the world, throughout the Region and all over the communities in the
• United states, the great demand was for health manpower.
151 Education and
training were extremely important i t the health administrators were to get the manpower to do the job. Concern had been expressed in the
Regional Director I s Report over the departure of trained manpower and brain power from many of the developing countries to other parts of the world. The United states had been fortunate in receiving this "lend It 'WaS
lease in reverse" to help its present needs. close this gap in professional manpower.
trying its best to
During the last five years, mal~
fifteen medical schools had been established and
more were developing.
There had been one school of public health accredited in 1965 and two more should have been established by 1969. He urged everyone to 'WOrk closely
with the educational institutions in order to persuade them to train people to an appropriate level. WHO was doing an excellent jOb in
strengthening teaching institutions but more could be done.
There 'WS.s
need for continuous communication between the consumers and the trainers of manpower. He hoped that even more attention would be given by the
Regional Director to the training of health workers and the strengthening of existing institutions. Dr SAYAMPANATHAN (Singapore), Vice-Chairman, endorsed the views of
the Representative from the United states.
The Singapore Government had
been the recipient of several fellowships from WHO and this assistance had proved most helpful.
His Government welcomed any foreign fellows
who might be sent to their country for study or observation. The REGIONAL DIRECTOR said that in his opinion, education and
I ,..
training was one of the most important subjects in the regional programme. than In the proposed programme and budget estimates for 1968, more
I •
9.5
per cent. of the allocation for field activities 'WS.s devoted
158
REGIONAL COMMI.1"l'tm:
~
SESSICIl
to th$.s field.
In addition, seminars were in themselves training ·pro-
grammes .and all WHO-assisted projects had, in fact, education and training elements. Another important point mentioned by the Representative of the
-.
United states was the departure of trained staff from many developing countries. This fact bad been mentioned in the intrOduction of the Annual
Report and he thought that the problem of how trained staff could be retained in their own countries, where they were undoubtedly needed much more, required further study. Dr ORSINI (France) stated that the population of the French terri-
tories in the South Pacific had no relation to that of the otrer countries represented on the Regional Committee. If most countries represented on
the Committee complained of the lack of medical auxiliaries, the French territories could conq:>lain of having recruited too many of them although they were not as highly qualified as required. It was difficult to ask
WHO for assistance in professional training because of the language barrier. It was also difficult to send the fellows to France because of the
distance and lenGth of study so that the only s01ution was to merge the two training centres now functioning in Noumea and Papeete. ~
new
school would be a government 'school with facUities for training state nurses and midwives. This would enable the staff of New Caledonia to However, this suggestion needed
work both in the Territory and in France.
further study as there was the danger of reaching saturation point rather quickly and the number of staff required would have to be defined, as well as the tempo of recru1.tment. Dr
ellA (Republic of Korea) said that his Government appreciated The Korean fellows usually
the many fellowships received from WHO.
..
studied within the Region but some were sent to the United states and
159
others to the United Kingdom. the so-called Michigan test.
These fellows were, however, subjected to Since·most KOrean students did not speak
English very flUently, many candidates failed the examinations once or twice, resulting either in the cancellation of the fellowship or its deferment, even thouGh their experience and professional knowledGe were good. He h~ed
the Regional Director would consider the situation faced
by his Government. Part IV: Co-ordination of Work with other OrGanizations (pages 67-69) Dr GURD (United Kingdom) referred to the second paragraph of section
1.4 on page 68 regarding the nutrition education and training centre in a.
Suva, Fiji, and reported that it had now been built.
It had been
constructed under the auspices of the South Pacific Health Service from funds provided by the Freedom from Hunger Organization. Having completed the review of the Regional Director's Annual Report J the CHAIRMAN, on behalf Of the Cambodian delegation, congratulated the Regional Director and his staff for having submitted such a comprehensive report. Each year a very clear, accurate and most interesting report was It
submitted to the Committee and this tradition had been maintained.
was pleasing to see that the activities of the Regional Office had become more numerous and that they remained as efficient as ever. The Chairman then aslted the Rapporteurs to prepare an appropriate
draft resolution on the discussion.
(For consideration of draft resolu-
...
tion, see minutes of the fifth meeting, section 1.) 5
SMALLPOX ERADICATION PROGRAMME: (Document WPR/RC17/5)
Item 12 of the Agenda
The REGIONAL DIRECTOR drew attention to document WPR/RC17/5 which contained the proposed objectives of a regional smallpox eradication
160
REGIONAL C<J.IMI'l"l'EE:··· SEVENi'EElIITH SESSION
..
programme, a suggested plan of action,and information on measures which should be undertaken to prevent the reintroduction of this infection. Be pointed out that there was no provision tor any of the activities
proposed in the regular programme and budget, although amounts bad beEn included in 1967 and 1968 under the Special Account tor Smallpox Eradication. As the implellientat10n of proposals under this account was subject
to the availability of contributions to the Special Account, governments interested in receiving the assistance proposed might wish to include requests for such in their future programme requests to the Organization. Dr GURD (United Kingdom) stated that the Government of the United
Kinsd0m wholeheartedly supported the deCision of the Nineteenth World Health Assembly to try to eradicate smallpox in the world by 1976. If'
this could be done, it would be one of the greatest technological achievements in an era of technoJ.ogical achievements. The fact that no case ~
of smallpox had been reported in the Region since 1961 could be viewed with satisfaction but not .dth complacency. A number of the representatives pre-
..
sent came from cOWltries into which smallpox could always be imported by an overland route. others were separated by sea from mainland Asia and they Previously,
had to be vigilant to see that smallpox was not imported by air.
the South Pacific Islands had been cut off from the rest of the world but air communications were developing so rapidly that the health authorities had to be extremely vigilant and examine the smallpox vaccination certi-
ficates carefully to ensure that everyone coming in had been vaccinated. The question sometimes arose as to whether a vaccination certificate meant
in fact satisfactory vaccination.
He understood that in some places
it was possible to receive a vaccination certificate properly completed, without in fact tIre person having been vaccinated at all.
He asked WHO
MINtl'l!m <F THE THIRD
~mG
161
to do all that it could to ensure that when an international certificate
or vaccination was issued the person concerned had in fact been vaccinated. Dr CRUZ (Philippines) stated that although the Philippines had been
free from smallpox since 1949, his Government had always been aware that it could be re-im;ported. A programme had, therefore, been adopted whereby those Priority
people who might be exposed to possible in:f'ection "ere vaccinated.
areas, particularly around the airports and seaports, had also been selected where the population had to be immunized against the disease. Particular
attention had been paid to the vaccination or children under one year of age and those who were admitted for the first time in grade I schools. " Dr ANDRADE (Portugal) stated that l-ticao and Portuguese Timor had had
no cases of smallpox during the last fifteen years.
He admitted that
vaccination coverage was insufficient but the health authorities were fully prepared to improve it. He then referred to the proposed checld.ng
and survey to be carried out by a WHO medical off"icer and said that in
both l-ticao and Timor the health authorities considered that this was their responsibility and should not be done by lVHO. If, however, any WHO medical
officer should visit M3.cao or Portuguese Timor he would always be welcome, whether or not he wished to discuss preventive measures against smallpox , -.....~
or any assistance related to this problem. The VICE-CHAIRMAN said that in Singapore aJJnost universal vaccination had been carried out.
Education was free and about 951> of the children
..
went to school.
It bad, therefore, been possible to cover almost 95'/0 of
the population from birth to 1n:f'ancy and almost 7aj, at the first year in school. L
The last outbreak had been in 1959 when a deck traveller, who act-
ually suspected that be was incubating smallpox, had disembarked in Penang
162
SEVENTEENTH SESSION'
and travelled by train to Singapore.
He bad gone into hiding and Singapore
bad bad, ten cases, which had been very difficult to diagnose.
First1y,
,
because they bad been in a vaccinated population and secondly, because there bad been no reason to believe tbat there was smallpox in Singapore. None of these cases bad been diagnosed on the first visit, and it bad only been during the second and third visits tbat the doctors had suspected smallpox. The quarantine station in Singapore bad enforced a two-day
detention for the purpose at: recognizing the early sYJl\Ptoms. end of the last war,
Since the
sixteen cases bad been isolated on twelve separate
occasions and eight had bad valld vaccination certificates without even a primary vaccination mark. Last year he bad visited Bombay and Madras In
and the two cities showed completely different pictures of sma1.lpox.
Bombay, vaccination bad not been universa1.ly carried out and even a layman could diagnose the cases. In Mulras, where the vaccination programme
bad been better effected, the cases were very difficult to diagnose. WHO's stateuent that it would provide fellowships to persons intending to visit the centres in India to study smallpox was welcomed, as most of the younger doctors had never bad experience of smallpox cases. Dr CHANG (China) reported that in Taiwan about one-third of the total
-.
population had been vaccinated every year from 1953 to 1963. the newborn were vaccinated.
In addition,
The coverage included first to fourth grade
eleuentary schoo1children and also a1.l the new students in junior and. high schools. This re-vaccination coverage of the population in a non-endemic It served to maintain an adequate immunity in
area seemed to be logical. the population.
Hhether the adults in non-endemic areas should be
re-vaccinated seemed to be a matter of controversy.
MINUrES OF '!'HE THIlID MIDETING
He then thanked WHO and UNICEI1' for their assistance in establishing
....
a laboratory for freeze-dried vaccine production.
He hoped that within
two to three months it would be possible to produce sufficient freezedried vaccine to satisfy their own needs and also to make contributions elsewhere. Dr ORSINI (France) supported the statement made by the United Kingdom
Representative with reg.ard to the importation of smallpox to territories of the South Pacific as a result of increased air communication. The
vaccination proera.mme in France was based on a law promulgated in 19l1, Article 7 of which made vaccination in the first year of life and re-vaccination at the ages of II and 21 compulsory. Parents and tutors
were held personally responsible for the implementation of these measures. In Seoul last year, the hope had been expressed that if smallpox were eradicated the funds normally devoted to its control could be used to combat other diseases. Personally, he did not Imow the amount of As an example, he cited the
funds which might be saved in this way.
situation in New CaledOnia where in five years, 32 000 vaccinations had been given or a yearly average of 6500. was very small indeed. The cost of the smallpox vaccine
The annual expenditure of maintaining smallpox
immunity in a population of about 90 000 people represented 93 000 CFP francs or US$933. The total annual expenditure for health in New Cale-
donia was about 300 000 000 CFP francs for 90 000 people or US$3 000 000. The
savings of US:;;1000 which the eradication of smallpox would represent Despite this Situation, the eradication programme
were not very great. •
should be encouraged by all possible means, particularly in the Western Pacific Region where the countries were exposed to the disease.
The French delegation would support the proposal presently under
study.
Nt- W.A!l'ANABE (Japan) stated that the smallpox eradication programme in Japan was carried out in three ways. First, periodic compulsory
\"aCcination of the entire population, that is, primary vaccination within a period of tuo to twelve months a.t'ter birth; the second, six months before children entered primary school and the third, six months before children finished primary school. Second, certain population
groups who mdght be exposed to possible infection were encouraged to have vaccination. Third, in the case of an outbreak of smallpox or an
imported cas"'l epidemic control measures were carried out by case-finding and case-confirming teams and the cases discovered were rapidly isolated.
His Government had been purchasing one million doses of
freeze~ied
vaccines and one million nine hundred doses of liquid smallpox vaccine for emergency purposes every year. He endorsed the suggestion that i-mO should organize a travelling
seminar for the purpose of observing clinical cases of smallpox and suggested that this proposal might be considered during the Committee's discussion of the proposed programme and budget for
1968.
Dr JAYESURIA (MUaysia) stated that his delegation s~orted the
proposal for a regional smallpox eradication programme.
Although Ma.laysia
had been free from smallpox for many years, there was always the risk that
cases might be ilIq)orted from abroad.
Infants were compulsoril.:y vaccinated
within the first six months of life and, with the co-operation of the education authorities, primary school-entra~ts were vaccinated at the time of entrance or at least within six months of entrance into school.
165 Smallpox vaccination ,ras carried out at request during the latter period of adult life. Staff at risk were also vaccinated. \fflO
His Government iTOuld welcome the visit of a carry out a s~le
medical. officer to
survey of the population to obtain information on
the immunity status of smallpox and to review' the national vaccination programme. The Institute for Medical Research at Kuala I.um:pur had been
undertaking tests for the laboratory diagnosis of smallpox for quite a number of years and its facilities would certainly be at the disposal of the WHO medical officer. The
Institute alsQ produced vaccine lymph
for use in Malaysia and a plan for the production of freeze-dried vaccine vas under consideration. The Government ,yould welcome WHO assistance in
the form of mteria.ls and eqUipment for the establishment d: a freezedried vaccine laboratory and in the training of medical. officers of health and other practitioners interested in the clinical diagnosis of smallpox. r -"-
Dr SAYCOCIE (Laos) supported the proposal for a regional smallpox cam;paign, although I.c.os was at present free from smallpox an:1 had. been able to avoid its introduction because the Government had adopted tha vaccination procedure established by the Government of France. r __
A freeze-
dried vaccine prepared by the Pasteur Institutes or Bangkok was used. and The
i~
Saigon, Phnom-Penh
province had been divided into three sectors
the yearly cam;paign would begin in November. Dr TAYLOR (New' Zdl.land) stated that his country was in much the
same position as Fiji and he was dismayed to hear of the possibility of false vaccination certificates being issued. The source of this
trouble appeared to be the travel agency and he would strongly recommend
REGIONAL COMMITrEE: SEVENTEENTH SESSION
that WHO encourage lember countries to ensure that the staff of travel agencies understood the magnitude of the crime they were committing, if they issued unvaccinated people 'nth an international vaccination certificate. Dr GURD reiterated that as far as the United Kingdom was concerned,
it expected the funds for the proposed budget.
progr~
to come from the regular
Dr ORSINI said that it would be desirable to state clearly that
if vaccination was compulsory, it should be free.
Dr KAUL, Assistant Director-General, agreed that occasionally some false vaccination certificates had been issued and this had been brought to the attention of IIHO. The International Sanitary Regulations clearly ,
described what constituted a valid international certificate of vaccination. The Regulations were binding on all Member States, except for those The
countries which had not signed or associated themselves with them. number of such countries was, in fact,felT acceptance of the Regulations. and
there was almost universal
As administrator of the International Sanitary Regulations, "I<JHO
had brought such reports to the attention of the International Committee
on Quarantine.
The Committee, in its turn,
~.ad
made this point repeatedly
clear in its reports to the Assembly.
The Assembly, in turn, had in its
resolutions pointed out the seriousness of the situation and had asked &~d
appealed to governments to take the necessary steps to see that The centres issuing vaccination supervised by the national health
vaccination certificates were valid. certificates should be authorized and
MINUrES CF THE THIRD. MEETnm
167
Mmi nj strations.
The cert:if'icates issued should have a clear indication The responsibi1ity for ensuring
of the national authority endorsing them.
that they were only issued when vaccination had actua11y been performed rested with Member States. The vaccination perfortled should be of the
type that was 1nternationa1ly recognized and in a form approved by the •
~>.
International Sanitary Regulations. Dr Kaul then referred to the experience gained during the past
several years since the smallpox eradication programme had been instituted. In tropical areas particularly li~uid
vaccines rapidly deteriorated and
in most instances iTere no longer potent even a few hours after they had been recognized as such. For this reason the EA~ert
Committee on Smallpox
had stated that under such conditions only the freezeoodried vaccines were dependable. The Organization had therefore recommended that only freezeAt the
dried vaccines should be used in the tropical areas of the ilorld.
Eighteenth World Health Assembly, the recommendation of the International Committee on Quarantine that the international certificate of smallpox vaccination should indicate the origin and batch number of the vaccine used (which should preferably be freeze-dried) had been accepted. Again,
it was the responsibility of the Member States to consider to what extent He believed that the threat of the re-importution of smallpox into the Western Pac:if'ic Region was great, in view of increasing air communication. It was very necessary that the most stringEmt measures should There was, of course, another way
be taken to prevent this happening.
of preventing the spread of smal1pox should a case happen to be imported, that was to detect, isoJ.ate and undertake promotive control measures, particu1ar1y the vaccination of contacts and of the community that might
168.
REGICfiAL CCMfI'l'TEE: SEV'l!:lf.rEENT SESSIClf
have come in contact with the case.
Wherever a country or collBl11lllity had
taken steps to maintain an immunity in the population by vaccination, such a population and community stood to gain when there was an imported case. It the community was protected with an effective vaccine, the risk So ~ong
of spread of' infection would be very much diminished. was threat of importation of s~pox,
as there
the Member states would be well
advised to see to what extent they could maintain immunity against it. He considered that it was well worth the effort, and with ~y
a very
marginal risk, to continue to vaccinate the population untU smallpox had been eradicated from the worM.
There being no further discussion, the Rapporteurs were asked to prepare an appropriate reso~ution.
(For consideration of draft ~.)
reso~u-
tion, see minutes of' the fifth meeting, section
6
CHOLEBA: ACTION 'rAKEN m BEWION TO THE BESOIlTl'ION ADOPrED BY THE COMMJ:'1."'rEE Nl ITS SIXTEENTH SESSION: Item ~3 of the Agenda (Document WPR/RO7/6) The REGIONAL DIRECTOR stated that the document sUllllllB.rized the action
taken by the Secretariat since the ast meeting of' the Committee. the document had been issued, a further two countries had ~tter rep~ied
Since to the
sent out earlier in the year. twe~ve.
This brought the
tot~
number of
countries replying to
Only four countries had expressed interest China, laos, Philippines and the
in receiving assistance, namely: Republic of Viet-Nam. An
inter-regional
cho~ra
team was stationed in Mmila and its ser-
vices would be made The Reg1~
availab~
now to any government requiring assistance.
Director urged governments to talre advantage of the services pre~iminary
offered as from the
information received not all were maincentre.
ta1n1ng a nat10nal cholera
contro~
169
The VICE-CHAIRMAN
fe~t
that the most important measure in cholera Following
....
control was the strengthening of environmental health services.
the outbreaks in 1963 and 1964, an intensified environmental sanitation programme had been launched and it .1as believed this measure would keep the country clear of' cholera f'rom no\! on. Dr IEE (United states of' America) asked if there was a standard
operating procedure devised or written up for health officers to follow when a suspected case could be taken. The REGIONAL DIRECTOR conf'irmed that there was such a procedure and ,TaS
reported so that some lund of immediate steps
copies had been sent to governments in the Region.
He would be
~ad
to
show a copy to the Representative of the United States if he so desired. Dr ORSINI (France) added that the measures to be taken in France were
part of the public health code and the law f'or the protection of public health dated back to 1902. The Committee decided to tal~
note of the report.
7
ESTABLISHMENT OF A CENTRAL REGISTRY ON POISOIm{GS: ITEM PROPOSED BY THE GOVERNMENT OF SINGAPORE: Item 14 of the Agenda (Document WPRjRC17/7) The
CHAIRMAN invited the Chief Representative of Singapore to
introduce this item. The
VICE-CHAIRMAN, speaking on behalf of his Government, said that ,TaS
when Singapore had sUCGested this item, it
believed that the GovernHowever,
ment would. be doing something for the first time in the Region.
11°,_ _ _ _ _ REGIONAL
COMMITl'EE: SEVENTEENTH SESSIClf
"
it now, realized that Australia t.a.d gone far ahead and, bad ,already done great deal of work. As,stated 1n the vIHO Bulletin, 'Lthe vast increase 1n the quantity and
:J.
,
variety of potentially lethal materials put into the bands of the
public was one of the main causes of injury and death due to poisoning". Singapore had become concerned about this. In Europe there vTete already
several centres vhich collected and disseminated information on poisons. Similar centres might be set up in countries of the Region, but as the situation in the different countries varied so enormously, the collection and dissemination of this information might pose problems beyond the
capabilities of some.
It might, therefore, be preferable i f standard
procedures were adopted so that it "ould be possible to have an interchanse of information between the centres established in the different countries. It might also be worthwhile to have a central intelligence centre
and perhaps the WHO Regional Off'ice would undertake to collect the information from the different countries and disseminate it to others. This was really what his Gar ernment desired. The
purpose of this
registry would be to build up a body of information on poisoning from household products, medical, agricultural, veterinary and industrial chemicals. Information, such as the relative frequency of pOisoning,
the treatment required and the outcome of treatment, properly compiled and readily available, would assist in the identification and treatment of future poisoning.
A rational system of control of pOisons and various be
chemicals, by legislation if necessary, should
established.
On several
occasions, his office had received enquiries from practiSing doctors regarding the proper antidotG, constituent and chances of recover; people who had swallowed poisons. of
Sometimes an a.clecuate reply could
MINt1rES OF THE THIRD MEElL'ING
l.7l.
nat
be g1ven.
Individual. centres would take years to build u;p an
effective body of information, but i f there was a means of "baring experience with other countries the compilation would be much more rapid. The REGIONAL DIRECTOR stated that this subject had been di~cussed
during the technical discussions held in connexion with the fifteenth session of the vniO Regional Committee for Europe, 7-11 September 19 65. Some of the aspects considered at that time were given in document
\.rpRj RC17/ 7. Dr LEE (United States of America) expressed the United States
delegation's
thanl~
to the Representative of Australia for the extensive This was a very valuable source
material provided by his Government.
of information as ':rell as a guide which countries could use and he thought that Dr DOl·mes and the Government of Australia should be commended on a job well done. Dr DOWNES (Australia) stated that this work had been started four years ago and Australian chemists, toxicologists and doctors had been ,Tor king on it ever since. The tvo immense volumes distributed were
only the beginning of the problem.
The ease by which poisons could be
notified had been brought to the attention of the medical profession by pubJ.ishing an article in the Medical Journal of Australia. In
Australia, efficacious medicines ;rere provided by the Government at a reduced price (approximately half a dollar) and the doctors had a booklet '1.
listing the drugs available.
The booklet also contained a fetf sheets This aided the medical These
which could be used for reporting purposes.
men to bring pOison cases to the notice 'bli'ethe p.eople' concerned.
manuals ;rere being circulated in all states and everybody knetf in what
112
REGIONAL COMMI'l'TEE: SEVErlrEEm'H SFSSIcti
hospitals they were available.
Unfortunately, health workers had to deal
with industry and many people trying to sell pesticides thought that they could do better and cheaper than the opposition. many new formulations on the market.
There were, therefore,
This gave the people controlling
the poison case register endless trouble and this situation would continue until some effective means of control could be established. Dr TAYLOR (Neu Zealand) stated that
Ne"l-l
ZealaDd had a developing
pOison information centre which had been started in December operated on a twenty-four-bour service. callers.
1964
and
It was used mostly by telephone
New Zealand was a small country with a small population but
out of the first 330 enquiries during its first year of operation answers had been given to 292. His country was particularly interested "l-lOuld.
in any developments in this area and
also be interested to know
about the pcssible use of computers and a common coding system. Dr ORSINI (France) said that he was greatly interested in what the
Australian Representative had said regarding pesticides.
He bad recently
launched a treatment campaign in Noumea and a commercial. firm bad offered a tender to provide a pesticide produced in Australia. He had asked
this firm for the qualitative composition of the product and bad been told that this 'Was covered by a conmercial manufacturing secret which could not be divulged.
Be had, therefore, cabled to the head office in Obviously
Australia and subsequently had obtained the information required.
he could not take any responsibility for using a pesticide in a community
without obtaining the necessary information as a precautionary measure.
It the firm had na1ntaiDed its original point at view not to divulge the
...
1.73
Net., Caledonia could have obtained the information from the Australian Government. Dr DOWNES stated he would certainly supply the information to any
person inside or outside the Region.
Although the manual had only been
circulated to the Chief Representatives of each country of the Region, he had received a Pacific. re~uest
for a copy from a colleague from the South
If other representatives were interested, he would be glad
to give them copies also. Dr LEE (United states of America) 1Il:t'ormed the Committee tbat nine
states in the United states had been undertaking long-range studies - over a period of about five to seven years - on pesticides and their presence in a COmmunity. In the state of Hawaii, an island-wide study on how much an 1 ma l s
D:rIr was present in man, pl.a.nts and studies should be done.
was in progress.
It>re such
Dr KAUL, Assist.ant D1rector-Genera.l, stated that the Organization
as a whole ,-tas interested in this very important problem and the Division of Biology and Pharmacology, with its unit of Pharmacology and Toxicology, ,las undertaking certain studies in order tv collect information. addition, Headquarters had food additive studies going on i~
In
collabora-
tion with FAO and an expert committee on this subject which met from time to time. There ,;ere certain studies being promoted on the long-
term effect of the use of insecticides anu pesticides on human beings. The information which Headquarters had so far been able to collect 1vaS
that poisoning control information centres existed III five countries in the Americas, in t'lrenty-two countries in Europe, one in the Eastern
174
REGICIiAL COMMI1'TI!:E: SEVEIt.l'EI!iltrH SESSICJf
Maditerranean, one in South-East Asia and tbree in the Western Pacific the countries being Australia, Japan and New Zea.J.and. The problem, as
Dr Downes bad clearly pointed out, was that al.though Australia bad started
this activity four years ago, it was still in its preliminary stages and was a very complex matter. It was certainly timely for the countries to
begin, at least at the national. level, to develop sorething.
a:r
course,
it was recognized that in most countries with big hospital.s, certain poison control centres existed to deal. with Clinical. cases of poisoning but the question before the Committee was more than just dealing with erergeney cases. Tbe suggestion
was to try to warn the public of the poten-
tial. hazards of pesticides and other pOisons and therefore it was desirable, wherever possible, to develop sore natiOnal. centres with a view to collecting am disseminating information. Although, as he bad rentioned
earlier, the Organization was interested in trying to collect information, it bad not had the opportunity nor the resources to tackle the problem in any substantive manner.
It was not in a position to do much at this stage
al.tbough it would try to do its best to disseminate information or assist any governlrents to set up their
own poison control information services.
Even the European Committee which, as bad been pointed out, bad held technical. discussions on the subject and wOOse recommendations bad been quoted in the paper I bad not been able to come to any agreerent as to the practicability of setting up even a regional centre for Europe. Tbe CHAIBMAN thanked Dr Kaul for his explanation.
Be then asked the (For considera-
Rapporteurs to prepare an appropriate dra:rt resolution.
tion of draft resolution, see minutes of the fifth meeting, section 1.) /
The reeting rose at 12.05 p.m.