WORLD HEALTH OID.ANIZATION RIDIONAL COMMLTTEE
WP/RC4/lJ
6th August, 1953 WESTERN PACIFIC RIDION
Fourth Session Tolcy:o 3rd to 8th September 1953 RESUME OF RESOLUTIONS CONCERNING SWI.LLPOX
SIM-ll<ynt engaged the attention of the Organization in its very ear:q days as it had ·tru:i attenti,on of the earlier international health organizations, The Irtter.illl Conrnission'Clppointed an OIHP;W'Ho Joint Study Group of SJ:Mllpox. (Off • Rec. li>'e ~121 p.l6) The i":irst World Health Assembly .arranged for the Expert Comittee on International Epidemiology a.r1d Quarantine to have available a Joint Stu:ly Group on Smallpox~ (WHA.l.l?)
The Third World Health Assembly oonsidered the desirability of establiShing a·centre·f'or the teeti~ and standardization of' smallpox vaccines. OiHA3.lB) The Fourth World Health Assembly consi dared smallpox in addition to other quarantinable diseases and urged administrations to improve sanitary and environtl\9ntal oondition:s and to raise the level of' protection b,y vaccination and requested the regional committees to take action in persuadif.@ Member States to ack>pt the· various recommendations. (WHA4.80)
A-t? the .Second Regional Committee Meeting the above resolution was considered am all governments were reooii'IIlended to iiilplement tho Health Assembly resolution. Marked progress was made at. the Thild"Regional Camnit'bee The .Conmitteo f'avo\lred Meeting ~an tlro new: measures wero adopted. a regional approach to the prciblEJil and also authorized the collection of facts regarding the continued ememicity of the disease by· means of a public health pcysician Who would be engaged for the purpose.
Crrf/Rd3/7) Subsequent:cy, the Executive Board at its Elev<mth Session . noted the action taken by the Regional ·Conmittee and considered that smallpox campaigns would be suitable as one oi''the world-wide programmes reoommdea by the Director-General. The Executive brd also requested the Dire~eneral to reC<Jl'IIOOnd ways in which such a worJ.d wide campaign could be undertakm. (EBll.R58) /rhe Sixth World Healtl'l
WP/RC4/l3 Page 2
The Sixth World Health Assembly considered the al:ove resolution of the Executive Board and requested trn ExecUtive Boa~d to consult reg:toml caTnnittees arxl to report back to the Seventh World Health Assembly (WHA6.18) At the conclusion of the Sixth World Health Assembly.. the Tweli'th Session of the Executive Board requested tho DirectorGeneral to obtain suggestions and itlf'CXE'Jlla.tiort and to report back to the Thirteenth Session of the Board. (EB12.Rl3) Smal1pax has always been one of the major concerns of international health o:rganizatl.ons including those ~~e duties of which 1 League of Nations, were taken over by WHO. Notable among these wereLJi!le Offl,ce International d 'Hygiene Publl.que and UNBRAJ The First World Health Assembly decided that the Expert OOllll'littee on International Epidemiology and Q'Oarantine "should have Available a joint study group on smllpox". (WHA.l.l6} The Assembly also decided to refer to the joint study group on smallpox the minutes of the discussion concerning a s'Ul11llla:ry report on the :arst session of the OIPHJWHO joint study group on smallpox. (WHAl.l?)
The Third World Health Assembly requested the Expert Committee on Blological Standardization to consider the desirability of
establiShing a centre for the testing and standardization of smallpox vaccines with p1rticul.ar reference to dried vaccine. (WHA3.1B) The Fourth World Health Assembly adopted a resolution which was concerned with quarantinable diseases including smallpox. The resolution was aa follO\olS & · Beli:sving that the Inte:ma.tional Sanitary Regulations (WHO Regulations No.2) represent only part of the action required to remove the international threat of quarantinable diseasesj Believ:i.ng that. parallel action is aqua~ necessary to remove insanitary conditions conducive to the existence of sooh diseases, especially in and around ports and airports; Believing that health administrations by :improving sanitary conditions and expanding their health and medica_l semces, especiallj' in and around ports ·and airports 1 are ther~ by .S6'uring their ow protection against the entry a:nd establishment of quarantinable diseases;
:&3liev:Lng that territories with satisfactory sanitary conditions and efficient health and medical services may reduce quarantine measures against international traffic; Believing -that .the· freest possible movement of international. traffic is highly. desirable in the ·ititerests of world eoonomic and social., including· health_, progress. /The Fourth World Health
WP/RC4/13 Page 3 The Fourth World Health Assembly
1. RECOMMENm to ·all goverlUllents that they improve sanitary am environmental condi tiona, especially in and. around ports and airports and1 in particular, that they : (l) el~to ani prevent the breeding of rodents, mosquito vectors of human diseases and· cctoparasitcs; (2) eliminate infection of cholera by prqviding 1 inter alia 1 pure water and food supplies and service, for the proper disposal of human wastes;
(3) raise the level of protection, by vaccination where appropl':Late or by other means, against plagues, cholera, yellow fever, smallpox and typhUSJ (4) relax when naQessary 1 and lwal·tb. circumstances are satisfactory, the application to their territories of apll" opriate articles of 'WHO Regulation No.2; 2. R~UESTS the regional committees of the Organization to take ear:q ·and continuous action to persuade Member States in the:ir regions to adopt the recommendations in }:Sragraph 1 above;
3,
R~UES'l'S
and othorwise 1 to give effect to the reconmendations in paragraph
the Executive Board1 in its ·preparation of programmes
1 above.
WHA.4.80 At the Second .Regional Conmittee Meeting the group of subjects was considered and the following resolution was adopted 1 The Regional Committee
NOTDD resolution A4/R/6~ of the FourtJI World Health Assembly; RECOMME.:NDS to all governments that they take urgent steps to improve sanitary and environmantal conditions in .ani around ports and a:irports and, in particular, that they intensif'y measures to
(l) eliminate and prevent tho breeding of rodents 1 mosquito vectors of human diseases and cctoparasitos, (2) el:l.m:Lnate infection of cholera b.Y' providing, inter alia, pure water and food supplies and services for the proper disposal of human wastes;
*
It is assuned tl'Bt this w-as a clerical error and that the reference should have been wHA4.80.
Page4
(3) raise th a level of protection, by vaccination mere appropriate or by other means, against plague, dlolera, yellow fever, smallpox and typhus;· and (4) relax, when necessary and health circumstances are satisfactory, the application to their territories of appropriate Articles of the WHO Regulations No.2. The Third Regional Conlllittee Meeting went further in r aspect to smallpox and arranged for a project to commence at ~he beginn.ing of 1954 ~eroqy a study would be made of tho various·roasons for whiCh smallpox st41l existed in the Western P"oific Region. The narrative description of too project was as follows : Sma.lipox is a problem in :rraey countries of the Region. In 1951 cases wore found in Korea, Japan, China (Taiwan), Viet-Nam, Laos, Cambodia and Malaya. .It is also a problem in adjacent comtries "'of South East Asia, notably &:Jrma, Thailand and Indonesia. It is a matter of serious concern to all member oountrieS in the Region. Tho means of CD ntrolli~ the disease is known. In order to eradicate it in the Region, it ·is nece~sary to stud;y the reasons why successful control has not yet been obtained in the·mE!I'lbar countries, and than to provide the necessary assistance. It is envisaged that the project will take tho foJ,lowi.ng foinu a medical officer employed by WHO will visit the various countries affected an:l will obtain information concerning the incidence, origin distribution of .the disease and the measures being taken in order to control tho ·disease. At .the conclusion of his survey, the Directors of Health of the countries ooncerned1 or ~eir representatives; 'Will meet and prepare a co-ordinated programme of eradication. The assistance required might be in the form of vaccines or personnel./ It might be possible for health personnel of certain countries to be lent to the health administrations of other countries • Thus each country would assist :in the ~ in which it. would be best able while WHO would co...:>rdinate activities. It is hoped that with th:s international appro~bh the disease can be eradicated from the Western Pacific.
ani
Provision has been made ~n 1954 for a consultant to carry out the work as described above.
WP/RC3/7 The ~outive ~ard 1
to a world-wide campaign against smallpox. "Was as .follows
at its Eleventh Session gave consideration The relevant resolution /The Executive Board
WP/RC4/JJ Page 5 The Executive :Ebard1 Having noted tho report of the Direotor~eneral dealing ldth further action on generaJ. world health probl.emsJ and Taking note of resolution WHA4.80 of the Fourth World Health Assembly, referring to the need for a gemral Co-<;)rdinated progrrunme calling for action by all governments to :lm;prove health · oondi.tions, to elimtnate sources and vectors of diseases am to raise tre Javel of protection against certain communicable diseases by vaccination and other methods; Noting alSo the interest expressed by two regioral oommittees in campaigns against smallpox, 1. REOOMMENJ.:S that the Sixth World Health 1\.ssemb:cy oonsic;lor the adoption of tho Director-General's suggestion that WHO should stimulate certain world..q.ide programmes; 2. COOSIDJm.S that a campaign against smallpox woul.cl be suitable for sooh a prograr.me; and 3. R~UESTS the Director-General to submit to the Sixth World Health Assemb~ a study on the ways of carryir:g out such a w:>rld-wide campaign., including :
(1) a general programme of worlc tD be implemented by WHOa
(2) the estimated casts to the Organization.
EBU.-R5.8 StibsGquantly, the Sixth:vlorld Heitlth Assembly apProved the recommendations of the Executive :Ebard and acb pted tm .followirg reso lutiana The Sixth World Health Assembly, Havmg oonsidered resolution EHI.l.R58 of the .eleventh session of too Executive Bearer concerning a campaign against smallpoxJ In view or the mail¥ economio, social and other tecilnical factors that must be considerodJ ~UESTS
the Ex:eoutive .Boarda
(1) to proceed with a detailed stuqy of the means of 1mplementiilg such a campaign, this study to include, inter alia, a consultation with Member States and w.tth WHO regional oommittces, and
(2) to report to the Seventh World Health Assembly. WHA6.1.8
WP/RC4/l3 Page 6 Assemb~,
At the conclusion of tm Sixth World Health the Executive Board at its Twelfth Session once again considered the-matter and adopted the following resolution The Executive B:>ard In pursuance of Assembly resolution WHA6.1B requesting the Executive B:>ard to ·proceed with a detailed stuey of the means of implementing a campaign against smallpox, REQUllSTS the Director-General to consult with ME!Ilber States, WHO Regional Committees and 'Ioombers of the relevant WHO Expert Advisory Panels, to obtain suggestions and information on which to base this study, and to report to the thirteenth session of the BoarEl on the results of these comUl.tations.
A year ago the· Oommitteo aonsidercd tha.t1 before making any progress with the Sl'adication of smallpox, it woUld be necessary to make an· investigation. During the past year the incidence· of the disease has remained much the same. There is still a large number of cases which constitutes a dangerous potential oource of epideml.cs both l-rl. thin and without the oounliries a'lready infected. (See attac!1ed table). There is still not available any precise ·or comprehensive informa.ti6n concerning the reasons for the continuation of the infection.
Initd.al work has been done in recruiting a qualified public health physician to carr.y out in 1954 th~ work authorized at the Third S0ssion of 'the Regional Corrmittee. The Connnittee might wish to inform the Diroctor...Oeneral that, until the survey o£ th e situation is carried out in 1954, the Western Pacific . Regional Committee is not in a posi ti.on to give to the Executive Board the information requested. The following draft rcsolution-mieht be considered appropriate s /I'he Regional COllllli.ttee:
Page 7 The Regional Committee: NOI'ES "the resolutions of the Sixth World Health Assem~
(WHA6.18) and the Twelfth Session of the Executive &>ard (EB12.Rl3) regar~ sma.llpoxJ REAFF'IRM3 the desirability of undertaking the regional survey authorized ey the Third Session of the Regiopal Committee;
INSTR'OOTS the Re{91onal. Director to proceed with the survey with the greatest expediti.on.possible,; and ~UESTS
the Secretary to inform the Direc-t.ol'oGeneral that the CoDmittee considers that it will not be in a position to furnish suggestions and information to the Exedutive Board in a.ey complete manner .before the conclusion of the regional survey.
Sl~~POX
mOltTEV CLJE~ i,Nu DEATHS _ _ _ _ _ _ _ _ _ _ _ _. _. . ._ _.........._ _ _..,.. . . _,.__~
....... P P J - I
F
-
F FT
•r ,..._.......
T ,__., • .....
•.........
£2~nlti~~
.:. , ·r
1~~~ .._ : •• 19~Q_. :.,_.JJ.,l_).._ ..1~2 • f I
• •
: • • • •
1~5J*.l:J f
J · .,.
t .•
t
t
•
•
•
t
t
,
:case,~-:de!th.~ £ill~.eaths: cases:de~s:_;a~~.§J.de~~-~s: . cases :. c~~ths. i t
t •
. • •
• •
t t
• •
• •
• •
t •
Laos ..................... : 1239*: 601*: 0: 0 :. 1~.: 0: 33 : 8: 46: 1 !Japan ,,,,,,,,,,,,, •• ,,., : 124 : 13 : ;: 1 : So : ,17 : 2 : 0: 4: 1Vietnarn ................. : 1092~<: 270*:· 266: 114. ·: 28J7*: lo/+8*: 22)~ : 10?7: J98 : !
Cambodia ................ ,• : 214*: ~9~~: 101: 20· : Jl9*: 64*: 1~06. : J66: 1220 : 247 China (T,·d~lan) ....... ,... : 192 : 20 : 78: 27 : · '1*: 0*: J9 : 0: 9: 0 67 Korea (South) '"'"'""': x.: x: 97* '*:)9802: 99'3: 8S': 1$4: 48): J,J
0 11~
.Hongkong •••••••••••••••• : I
. •
. •
. •
.. · .... ~ ...,........ : 46*: 0*· : 0 : c : 2: tiletherlands l~ew Guinea. •• : : : J : : 0 : jNorth Borneo •• ... " ....... .: 0*: 0*: 1~: 0 : '
~Ialaya
11*:
7*:
1~:
. •
. •
. •
.•
.
0*:
0*:
0*:
2:
3:
0:
J:
• •
0
!Adjacent c9untries .in ~E~ .;
.
. . . f • •
)rhailand ... ~ • .~ ....·...... : t l I
!Burma ......... · .... ;....... : J4~1: 1028: 10222: JS~J: 2414: )98: 2407: 989: ;Indonesia"""'":~~ ... : X: X: g3107: 1)388!10~76: 18)2): X: X: 52~~:
; ; ; : : : : : 10*: J72*: .41*: J4 : ' •
u6; •
•
2~: •
43 : 10: • •
26: 38: '
19 7
0
•
:·
•
•
•
•
•
•
•
* *Figures rr·om ~leelly F~Sticulus, Kpidenrl.ological Intelligence Station, Singapore, Imported
(:) . Janu&ry t~ June .l953
x Incl\11 es ]Jnported cases