(WPR/RC36/SR/2)
SUMMARY RECORD OF THE SECOND MEETING WKO Conference Hall, Manila Monday, l6 September 198) at 2.30 p.m. CHAIRMAN: Dr Terepai Haoace (Cook Islands) CONTENTS
1.
Report of the Regional Director (concinued) ••••••••••••.••
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- 97 -
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1.
REPORT OF THE REGIONAL DIRECTOR: Item 8 of the Agenda (Document WPR/RC36/2) (continued from the first meeting, section 8) Health manpower (pages 33-59) (continued)
Chapter 5:
Mr MAETIA (Solomon Islands) said that, during the two years covered by the report, his Government, in collaboration with WHO, had continued to implement its primary health care programme but there was room for improvement in other fields of health. Dr CHOUNLAMANY (Lao People's Democratic Republic) thought that the Regional Director's excellent report threw into sharp relief what had been achieved during the biennium in respect of the training and continuous training of health manpower and what still remained to be done. He wished to thank the Director-General for the constant support given to his country by the World Health Organization during the two-year period. Dr SIALIS (Papua New Guinea) said that an exercise 1n medium-term planning covering a five-year period was being conducted in his country. Emphasis was being placed on the training of nurses and of staff for the aid posts. The categories of aid post orderlies and nursing aides were being merged to form a new category, to be known as health aides. More women would be trained for the aid posts in order to overcome the reluctance of expectant mothers to attend posts staffed largely by men. Post-basic courses were being introduced with a view to developing management skills among existing health staff. Qualities of leadership were needed in the health services since, if health workers failed to set an example, they would have no influence in the local communities. Dr KHALID (Malaysia) considered health manpower development to be one of the most important aspects of the activities of the Organization and its Member States. In the past the emphasis had been on the numbers and types of staff required, the relevance of the education and training provided, and the development of improved curricula. In Malaysia during the biennium, the activities undertaken had included seminars and workshops, the sponsorship of students sent for training abroad and the improvement of educational technology and teaching skills. One problem in health manpower planning to which increased attention should be given was to find ways and means of coordinating the training of health personnel in categories that required post-secondary training for periods ranging from two to s1x years. Another problem that called for detailed study was that of the rising costs of health manpower, which in Malaysia accounted for roughly two thirds of the health budget and were tending to increase, sometimes to the detriment of other items of essential expenditure on health programmes. That had particularly serious connotations in countries where recruitment to the health services led to almost lifelong tenure. Dr SUNG WOO LEE (Republic of Korea) said that overproduction of some highly skilled categories of health manpower, such as physicians, was becoming a problem. A health manpower planning workshop on the subject was scheduled for November 1985. A programme had been developed in cooperation with WHO under which local fellowships were granted to health workers for training at the Graduate School of Health, Seoul National University. It had proved very successful and had the great advantage of obviating travel and per diem costs and the need for proficiency in a foreign language.
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Dr BASACA-SEVILLA (Philippines) reported that her country was providing continuous training for middle-level managers and. health workers as well as an integrated microscopy course to back up pr1mary tests for tuberculosis, leprosy, malaria, schistosomiasis and filariasis. Seminars and workshops had been organized for training in enteric bacteriology and water analysis. Dr TAPA (Tonga) thought that the third paragraph of the report summed up very neatly what had been done and what still remained to be done in respect of health manpower development. Tonga was very grateful to WHO for its collaboration in manpower development in the matter of fellowships. Dr BIUMAIWAI (Fiji) said that his Government was reviewing the nursing curriculum with a view to including more community health activities. Third-year student nurses would be expected to spend sixteen weeks in the rural areas, working in teams of six under the guidance of a sister tutor, on the basis of five newly established nursing stations, and carrying out the normal activities of a rural public health nurse. From the beginning of 1986 the Fiji School of Medicine was also planning to send its medical students for training in rural areas along similar lines. Like Malaysia, Fiji was worried by the escalating costs of health manpower development. In 1981 the Fiji Medical Department had found the cost of the Fiji School of Dentistry too high, closed it down and sent the dental students to Adelaide for training. The same might have to be done in regard to paramedical training, intakes in Fiji being too small to make the training courses cost-effective. In 1984 the Ministry of Health had decided to institute an eighteen-month course for training radiologists and laboratory workers for the rural areas. Roughly 1000 village health workers had been trained for the primary health care services and were serving all over Fiji. Dr VERMEULEN (Samoa) said that his country had been facing acute medical manpower shortages for several years and had had to employ United Nations volunteer doctors. For two years Samoa, in collaboration with WHO, had been studying ways of assigning an increased role to nurses in the running of the peripheral health services; post-basic courses for midwives and community health nurses had also been organized. There were plans for assigning a bigger role to the traditional birth attendants, who held a respected position in Samoan communities. Mr TIXIER (Cook Islands) called attention to the need for creative thinking and action as emphasized in the second paragraph of Chapter 5. Cook Islands had a five-year health manpower plan, forming part of the national health plan, aimed at strengthening areas in which implementation of the health-for-all strategy had shown weakness. All health workers in the islands were already engaged in primary health care activities and no major redeployment had been required. Younger staff were enthusiastic for implementing the health-for-all strategies but older health workers had taken longer to realize their importance. Nurses' field training also extended to the outer islands, although the high cost of travel and per diem had been a considerable obstacle and recourse had been had to external sources of finance. The lack of senior personnel in Cook Is lands was also an obstacle to the health manpower programme ·and no easy solution was to be anticipated. Creative thinking and action would imply the setting of targets in 1985 itself for the attainment of health for all by the year 2000.
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Chapter 6:
Public information and education for health (pages 61-65)
There were no comments. Chapter 7: Research promotion and development (pages 67-69)
Dr DE SOUZA (Australia) found the chapter highly encouraging. Steady progress had been made throughout the Region in research promotion and development and in many instances national research policies had been formulated. The setting up of a network of national research councils and the development of training in research methodology were positive steps forward. WHO was to be congratulated on its support for health systems research, training in the appropriate use of new technologies and research on health behaviour, a subject of essential importance for the effective implementation of programmes on health promotion and disease prevention. Dr SUNG WOO LEE (Republic of Korea) said the activities listed were most important and merited special attention. He particularly welcomed the stress laid on the development of research manpower by such means as short training courses, the award of grants, technical collaboration in the design of research protocols, and modest financial aid. He wished especially to thank WHO for its support for the Republic of Korea's own country programme in that field. Dr KHALID (Malaysia) expressed his thanks for the help given towards the development of a WHO Regional Centre for Research and Training in Tropical Diseases at the Institute for Medical Research in Malaysia. That was a fine example of collaboration between national governments and WHO, which benefited not only the host country but the Region as a whole. He hoped that it would continue. He wished to emphasize the importance of health systems research, a subject which had been discussed extensively at the Executive Board session in January 1985. In many countries such research was still in its infancy, and support was needed in order to develop skills and strengthen institutions. He hoped that WHO would continue to provide that support. Chapter 8: General health protection and promotion (pages 71-77)
Dr CHRISTMAS (New Zealand) complimented the Secretariat on the progress made in the particularly difficult field of accident prevention, which was of special relevance to many countries in the Region. He would be glad to hear the comments of the Malaysian representative on the workshop held recently on that subject. Dr KHALID (Malaysia) said the workshop had been an intersectoral one, with participants representing not only ministries of health but also nongovernmental organizations, such as those concerned with licensing of drivers, road constructions, and traffic law enforcement. The workshop had been a success, and his Government fully intended to follow up the recommendations made. Cha ter 9: There were no comments.
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Chapter 10:
Protection and promotion of mental health (pages 87-91)
Dr SUNG WOO LEE (Republic of Korea) said that the rapid pace of industrialization in his country meant that the problem of mental health was increasing. The approach taken in dealing with mental health cases had until now been an institutional and custodial one, and he was glad to note from the report that WHO was laying the main emphasis on a community-based approach, in the context of a pr1mary health care oriented towards prevention and control. Dr KHALID (Malaysia) said that drug abuse and drug addiction were a major problem in Malaysia, as in many other countries of the Region. Malaysia made no apology for the fact that it had made the death penalty mandatory for those convicted of trafficking in drugs. He understood that there was some support for bringing the question of drug abuse and drug addiction before the United Nations General Assembly for discussion. In that event, he would like to know what contributions WHO would be making to the proceedings. The REGIONAL DIRECTOR said that he had not yet received any formal notification that some WHO Member States wished the problem of drug abuse to be raised at the General Assembly. However, it had been proposed that one of the topics dealt with at the next Economic Summit Conference, to be held in Tokyo in May 1986 should be drug dependence, and WHO had been asked to make a preliminary study on the subject in preparation for that conference. There were also plans to convene a regional meeting on the same subject in Japan in February 1986, a meeting which would have no direct link with the Summit Conference. Dr SHINFUKU (Regional Adviser in Mental Health) said he was grateful to the Malaysian representative for his interest in the problem. The meeting concerned would focus on the prevention of drug abuse in adolescents, and would be held from 25 to 28 February 1986; it was planned to invite Member States of the Region which suffered from serious drug abuse problems. Chapter 11; Promotion of environmental health (pages 93-99)
Dr CHRISTMAS (New Zealand) pointed out that, following the recent review of progress made under the International Drinking Water Supply and Sanitation Decade, there was a need to highlight the importance not only of providing safe water supplies, but also of ensuring good systems of sanitation and sewage disposal. The latter seemed to be an area in which the Region was lagging behind. The REGIONAL DIRECTOR said that the Regional Office was indeed concerned about the gap between provision of water supplies and that for sanitation. Part of the reason was that in many countries provision of water supplies was the responsibility of m1n1.stries of health, while sanitation came under the control of a different ministry. Dr CARTIER (Regional Adviser in Environmental Health) said that more success tended to be achieved in urban than in rural areas in tackling these problems because there were usually more funds available. WHO workshops laid stress on the development of appropriate technology such as
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hand pumps in o.rder . t<l ensure that rural communities understood the importance of proper human wa~te disposal in their water systems. The Regional Office was conce.r ned that some countries might tend to identify as their priority only water supplies, or only sanitation, whereas the two should go together. Dr TAPA (Tonga) drew at tent ion to the opening sentence of the last paragraph on page 94 of the reporx, which stated that governments accorded low priority to the provision of -sanitation services. That was certainly not true of his own Govcernment, which gave high priority to the provision of sanitation in both rural and u.r ban areas. His experience was that it w a s the donor governments which g-Sve low priority to requests from Member States conce rning sanitatio.n services, and he appealed to representatives to see to i :t that that situation wa.s remedied. Mr GRlGGS (United States of Americ.a) was pleased _ t o note that workshops and seminars were being planned t,o ,promote environmental health, particularly \olithin the context of the lnte.r national Programme on Chemical Safety. Continuing action should be taken to s.ee that tragedies such as the recent one in Bhopal, India, did not recu.r . He was also .glad to note from the repo.rJ: that government-s were being encour aged to commit ·r esources for the deve lopment of w:ater suppl,y _ a nd sanitation programme$ in the rural a;r·.ea. He :agreed that the faul:t in .a llocating priorities did not lie entirely with recipient g.o~_rlllllen.t.s and urged donors to give greater attention to the needs of smaller count:ries, which could not afford to divert scarce .r esources. The REGIONAL DIRECTOR pointed out that many donor countries had developed sophisticated sanitation technologies, which often could no:t be applied in small countries, particularly sma U is land countries. In the report, he had stressed that recipient countries should participate both with WHO as the technic.al agency and w.ith .donors in the selection of the .technology that was most appropriate to :them; often, neither party participated in the selection process .• On the quest ion of chemica 1 sa.fe ty, WHO had a 1ready embarked on a ·study at headquarters' level on p-revention and read ine.ss measures to be taken in cases .o f natural dis as .t ers, and it was now .a lso considering equivalent measures to be taken in .the case of man-made disasters. The Region had an ,ever-increasing concern in regard to that important problem, which constituted a serious health haz:ard for mankind. Dr KHALID (Malaysia) said tha·t one of the problems highlighted at the recent inte.rnational cons.ultations on the International Drinking Water Supply and Sanitation Decade had b_ e en that of lack of maintenance for existing systems, which .could lead .to losses of :a s much as 20%-25% of piped water supplies. -Funds a !located to maintenance .were often inadequate. He understood there were t.o be consulta.tions with -a funding agency in Manila on the subject, and he urged that not on1y water supplies but also sanitation should be included on the a,genda of those consultations, since both needed to be taken into account. Dr SIALIS (Papua New Guinea) supported the comment by the representative of Tonga concerning financial contributions from donors. The latter should respect the ability of the planners in the countries concerned and the priorities established by them and should not try to tell countries what was good for them.
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Cha ter 12:
eutic and rehabilitative technolo
Dr DE SOUZA (Australia) said that rehabilitation appeared to be suffering from the low priority assigned to it, as were the scientific projects to which he had referred under the previous chapter. He would welcome any co..ent the Secretariat might be able to make on the subject. The REGIONAL DIRECTOR explained that some difficulty had first been encountered when identifying the rehabilitation needs under the International Year of Disabled Persona. Two collaborating centres - one in Hong Kong and one newly established rehabilitation centre at the New South Wales College of Health Sciences - had now been designated. A meeting was currently being held with a view to making recommendations for the further development of the regional programme. In view of the constant occurrence of natural disasters in China, the Chinese Government was also particularly interested in developing a nationwide rehabilitation programme, for which a strong foundation had been established, which was receiving support both from within and outside the country. WHO had already some contact with the foundation. Another ever-increasing problem in the Region was that of traffic accidents, which were the foremost cause of mortality and morbidity in some countries. This might represent a major area of future collaboration between WHO and Member States. Dr SIALIS (Papua New Guinea) said that one of the problems encountered by his country concerned the repair of equipment obtained from overseas as well as the spare parts, and the maintenance of such equipment. There had been some difficulty, for example, in the maintenance of X-ray equipment, but WHO had now arranged for someone to solve the problem. WHO had also made it possible for a national of his country to undertake training abroad. Dr BASACA-SEVILLA (Philippines), commending the Regional Director on his comprehensive report, said that her country wished to acknowledge the cooperation it had received from WHO in its immunization programme. Its own production was sufficient to meet its needs in BCG and tetanus vaccines under the expanded programme on immunization. It had established a quality control laboratory but ita production of OPT vaccines was still at the experimental stage. Studies had been conducted on the effectiveness of the cold chain. Her country had felt that more attention should be given to improving the blood transfusion services, particularly with regard to the transmission of malaria and hepatitis B. She expressed appreciation of the fellowships provided with respect to laboratory quality control procedures. Dr PHAM SONG (Viet Nam) said that, thanks to the support of WHO and UNICEF, Viet Nam had been able to intensify its activities, which had resulted in a fall in morbidity. His country was happy to implement an immunization campaign. He hoped that WHO would be able to increase its support for Kiribati and ·for other countries where maternal and childhood diseases were still a problem~
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Chapter 13:
Disease prevention and control (pages 111-135)
Dr KHALID (Malaysia) said that Malaysia had found that the mere provision of health services and improved accessibility did not necessarily ensure utili~ation, particularly as regards the immunization services. Some immunization programmes had not produced the degree of coverage expected. For example, with regard to measles immunization, introduced in the early 1980, coverage was only 30%-40% compared with the 80% target that had been established. Malaysia provided comprehensive irmnunization coverage against tuberculosis, diphtheria, whooping cough, poliomyelitis and measles. A study had been initiated to determine why the response to measles iiDIIlunization, the latest to be introduced, had been so poor. It was found that many health staff, although trained in measles immunization, were not familiar with it, and were not aware of the availability of vaccine, the complications of the diseases (and hence the need for immunization), when it should be done, possible side effects, etc. Among parents, many preferred their children to acquire natural immunity by contracting the disease, rather than risking the side effects of immunization. Other reasons were that they were not aware that immunization was available, thought their children were too sick to bring to the clinic, or were not aware of the possible complications of the disease. The study had shown that the children of health staff themselves had not been immunized and that staff gave similar reasons to those given by other parents. There was, therefore, a need to motivate both health staff and parents. It was also clearly necessary to follow up the provision of services to determine utilization. As the Director-General had said, monitoring should follow the setting of targets. In the control of diarrhoeal diseases in Malaysia, the use of oral rehydration salts was not as extensive as was desirable. The problem was one of acceptance by paediatrician& and clinicians. While undoubtedly saving some lives, oral rehydration salts were only useful for treating illness. In the final analysis, control of diarrhoeal diseases had to be effected at their source, through the provision of sanitation and water supply and improved personal hygiene. Dr FOLIAKI (Tonga) said that, earlier in 1985 and with the support of WHO, Tonga had undertaken a review of its immunization and diarrhoeal disease control programmes. While the former was shown to have been successful, the results of the latter were not as good as had been anticipated, although the programme had been under way for some time. Many factors had contributed to the lack of success: ( l) there was a need for wider health education, particularly among those in isolated communities, villages and islands; (2) a safe, potable water supply was not provided throughout the country; (3} sanitation was underdeveloped in most of the isolated islands because of the lack of water supply; etc. Oral rehydration salts were utilized successfully, but utilization was largely restricted to the main islands and health centres. There were serious problema of distribution to the isolated areas. Dr LIU XIRONG (China) said that hepatitis B was recognized as a major public health problem in the Region so that research on and control of the disease were of top priority. During 1984-1985, the Regional Office had undertaken useful work in that regard. The Regional Director and the
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Regional Adviser in Co1111unieable Diseases had visited Member States promote the hepatitis B prograane. WHO was cooperating with China conducting epidemiological surveillance for hepatitis B and in research and control of the disease. WHO had a lao invited experts from Japan collaborate in improving the production of plasma-derived hepatitis vaccine. In all those fields, gratifying progress had been made and appreciated WHO's support.
to in on to B he
Dr SUNG WOO LEE (Republic of Korea) recalled that, at the thirty-fourth session of the Regional Coanittee, his delegation had drawn attention to the deterioration in the malaria situation. In the Regional Director's report under discussion, it was stated that the epidemiological situation in the Region had remained stable in general, indicating that no progress had been made. He therefore hoped that more attention would be given to malaria control and that the next report would contain a more favourable situation analysis. With regard to parasitic diseases, the report stated that praziquantel was being used with some success for the control of clonorchiasis and paragonimiasis in the Republic of Korea. In contributing to the control of liver flukes and lung flukes, behavioural changes resulting from the health education of those living in endemic areas were probably proving more important than the drug therapy. Dr KHOO (United Kingdom of Great Britain and Northern Ireland) said that the acquired immune deficiency syndrome (AIDS) had e~erged as a major threat to health worldwide, although it was currently affecting some countries more than others. Although, fortunately, there were still relatively few eases in the Western Pacific Region, the potential threat of AIDS should be viewed with concern by Member States. In Hong Kong, three cases had been confirmed and there had been two deaths. The Government was committed to measures for controlling the spread of AIDS, including, inter alia, intensified surveillance, health education, information for and protection of health care staff and safeguards for blood supplies. Prevalence studies were being conducted in high-risk groups such as homosexuals, intravenous drug abusers and haemophiliacs. In 1983, the Hong Kong Red Cross had introduced procedures to exclude persons belonging to high-risk groups from donating blood. Further, screening of all donated blood using the ELISA serological teat to detect antibody to the HTLV-III virus had been available since August 1985. It was hoped that use of the test, together with voluntary restraint from blood donation by members of high-risk groups, would reduce the risk of AIDS transmission via the Territory's blood supply. Much research on AIDS was at i 11 needed. He hoped that the Secretariat and other representatives would share information in order to obtain an updated picture of the situation in the Region. Dr BIUMAIWAI (Fiji) said that in Fiji's Eighth Development Plan, 1981-1985, the Government gave a prominent role to immunization for the control of cOIDIIUoieab.le diseases. Targets had included: zero incidence of diphtheria, neoDatal tetanus, poliomyelitis, measles and congenital rubella syndrome; absence of morbidity from whooping cough; and a zero tuberculosis infection rate in school entrants. Fiji had an excellent maternal and child health prograiiiDe, which had played a vital role in achieving wide coverage, immunization being given at hospitals, health
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centres and nursing stations. An impressive follow-up was maintained at each health centre for all women with children living in a given zone, village or settlement. Each child was listed on a card and dates of all immunizations were recorded. The cards were updated monthly for hospital and home-delivered births (about 90% of births took place in hospital). Families and schools took an active interest in the programme, ensuring that cards were updated and details entered correctly. Child health cards were retained by the family and school cards by the schools. Public health sisters paid regular vu1ts to all cornmunlttes and schools and as a consequence there was great awareness of the importance of immunization. A national review of the expanded programme on immunization had been conducted and a sample survey of children aged 12-23 months had been undertaken to determine currency coverage throughout the country. The expanded programme on immunization was found to be well integrated at all levels of the health service, and included an impressive school immunization prograDIDe. The high priority and effort given to the expanded programme on iaaunization were evident at all levels. Coordination was achieved from the divisional level downwards through the divisional health officers and supervisory health sisters. The review team had found some problems relating to interpretation of the schedule. Immunization coverage was generally quite high except for measles. Vaccine supplies were of adequate quantity but of suspect quality and efficacy. Overstocking was common, leading to a tendency to use vaccines after the expiry date. Potential weaknesses in the cold chain had been found in some locations, particularly in remote areas.; Centrally there was a lack of back-up systems, monitoring of temperature and systematic storage methods, putting vaccine potency in doubt. In a potency assay of oral poliomyelitis vaccine, 40% of the fifteen samples tested were not potent or were of doubtful potency. Action had been initiated as a result of the review but it was concluded that the targets might be somewhat ambitious. However, the coordination and coverage found indicated that good progress would be made, particularly if the identified problems could be overcome. Action at the primary health care level played a key role in the success of immunization. Dr VERMEULEN (Samoa) was pleased to report that, thanks to the support of WHO, Samoa had improved its hea 1 th information system in the past two years. It usually took some time after upgrading such a system before any improvement in health care delivery could be seen. In August 1985 an evaluation of the expanded programme on immunization in Samoa had shown an 86% coverage against the six childhood diseases of children aged under two years and a 96.5% coverage of all newborn infants with BCG vaccine within the first two months of life. Thus, the design of simple, practical reporting forms and registers and appropriate training to familiarize the staff with the new information system could make an important contribution to the achievement of targets. Dr CHRISTMAS (New Zealand) • recalling some ten years of sessions of the Regional Committee, was heartened by the considerable progress achieved, much of it due to the Secretariat. The expanded programme on immunization was a great success despite the problems and a remarkable step forward bad been made since its inception.
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While he sympathized with the concerns of the representative of the Republic of Korea regarding malaria, he felt that the report showed that considerable progress had been achieved in controlling the disease. He hoped that time would be given to a discussion of AIDS, which, as the representative of the United Kingdom had said, was a major concern that was developing rapidly - possibly too rapidly for inclusion in the Regional Director's report. It might be useful to hear reports from other representatives as to how AIDS was affecting their countries. Dr SIAL IS (Papua New Guinea) said that, even though Papua New Guinea had a good health system, there were problems regarding the cold chain and storage facilities for vaccines. He thanked WHO for its cooperation in looking at new methods. Spraying programmes for malaria control had been stopped as they had proved unsuccessful, except in the highlands. Malaria remained a serious problem and communities were being encouraged to organize their own spraying programmes. In East New Britain women were undertaking house spraying. Papua New Guinea would be interested in trying malaria vaccine, once provincial government agreement had been obtained. He was pleased to report that clinicians, particularly paediatricians, had recently given their support to the use of oral rehydration salts. He supported the previous speaker's call for an exchange of information regarding AIDS. Facilities for diagnosing the disease were not available in the developing countries and he hoped that the developed countries would give assistance in that regard. Dr BASACA-SEVILLA (Philippines) said that, while diarrhoeal diseases continued to cause morbidity and mortality, a programme now under way in the Philippines had improved the picture. The main approach was oral rehydration therapy avoiding antidiarrhoeal drugs, antibiotics and starvation diet. Strategies included improved environmental sanitation and nutrttton, promotion of breast-feeding and proper weaning habits, and surveillance in various locations. The country produced sufficient oral rehydration salts for its own needs, and the tablet form was now being manufactured. A centre had been · established for the training of clinicians, who accepted oral rehydration therapy less readily than laymen. The Philippines had done little work on AIDS, but so far no reactivity had been found in the antibody test kit. She feared that the syndrome would eventually be imported, and she hoped that surveillance procedures would be improved. In the event of the transfer of AIDS patients, countries should be officially informed so that proper precautions could be taken. Dr SILVA (Portugal) expressed support for the coDDDents of the United Kingdom and Philippines representatives. AIDS could be expected to become an important public health problem, especially in countries frequented by tourists. WHO should therefore help to set up a monitoring system in the Region; he asked all countries to give their support. Dr KHALID (Malaysia) agreed that the Committee should give some time to updating its knowledge of AIDS. Both governments and the public wanted guidance. It would also be useful to discuss what countries were doing and
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what was required. Many countries, including his own, had no or limited experience in the diagnosis of AIDS. A regional reference centre might well be needed so that samples could be sent for checking. Malaysia was now sending suspicious samples abroad; all had so far proved negative. The REGIONAL c 01DIIlen t s • DIRECTOR thanked representatives for their valuable
With regard to diarrhoea and acute respiratory infections, recent surveys by WHO and, for example, the Tonga national laboratory, had shown that most cases in the Region were now of viral origin. Thus there was no specific curative remedy, and the emphasis was on saving 1 ife through measures such as oral rehydration therapy. The regional programme in viral diseases was being strengthened. A number of speakers had expressed concern about malaria. Despite countries' efforts, the obstacles had not been surmounted, and the general situation remained unchanged. The first priority should be given to tackling malaria control through primary health care, and not through vertical prograMmes. AIDS was not only a man-made but also a mass media-made catastrophe, in which panic was spreading before the disease reached the countries of the Region. The Western Pacific had been one of the pioneer regions in the study and control of blood-borne viral diseases, such as hepatitis B, hepatitis non-A, non-8, delta antigen-associated hepatitis and adult T-cell leukaemia, so the problem of AIDS, which was caused by a blood-borne retrovirus, LAV/HTLV-III, was not new. The AIDS virus had crossed the Pacific to reach several countries. The Secretariat had quite good information on incidence; knowledge of suspected modes of transmission, partly based on Australian experience, could be applied in countries where overseas travellers created a high risk. Since HTLV-111 could be transmitted by blood transfusion as well as by sexual contact, blood was being screened for HTLV-II1 antibody on the basis of the ELISA test. However, the latter gave a high rate (30%-50%) of false-positive reactions, which should be taken into consideration, particularly in the testing of sera from persons without any clinical signs related to AIDS. At present, only a few centres in the Region were capable of confirming the presence of HTLV-Ill antibody by the western blot method and by virus isolation. He agreed with the Malaysian representative that a regional reference laboratory was needed. At the same time, preventive measures - and especially sex education were being studied. A positive aspect of the panic about AIDS was the sharp fall in the incidence of other sexually transmitted diseases in some countries. Dr UMENAI (Regional Adviser in Communicable Diseases), referring to the current situation regarding AIDS, said that~ at the time of the international meeting on AIDS, sponsored by the United States Department of Health and Human Services and WHO, in Atlanta, United States of America, in April 1985, over 11 000 cases had been reported w9rld.-wide. In the Region,
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Australia had found 110 cases, Japan 7 cases, Hong Kong 3 cases, and China 1 imported case. The Philippines had tested for HTLV-III antibody, but found no positives. Dr CHRISTMAS (New Zealand) interjected that his country had found 11 imported cases. Dr NG KWOK CHOY (Singapore) said that his country had as yet no cases of AIDS, but several samples had proved positive for HTLV-111 antibodies. Dr UMENAI (Regional Adviser in Communicable Diseases) said that a commercial ELISA-based diagnostic kit was now available, but its high level of sensitivity had produced many false-posit~ve results. The western blot method, while reliable, was too complicated to be used in the laboratories of developing countries. · In October 1985 a scientific group meeting on hepatitis non-A, non-B, delta antigen-associated hepatitis and blood-borne human retroviruses was being held in Tokyo at which diagnostic methods, including a promising immunofluorescence assay technique, would be discussed. The meeting would also discuss another human retrovirus (HTLV-I) and means of preventing transmission of viral infections through blood or blood products, such as factors VIII and IX for haemophiliacs. After the meeting, collaboration in the development of diagnostic methods could be expected and reference laboratories identified. Fairfield Hospital, Melbourne, Australia, had already been designated as a collaborating centre and other centres were to be designated in the near future. Dr DEL ROSARIO (United States of America) said that public interest in AIDS was very high, but the media had conveyed much misinformation because of the gaps in knowledge of the disease. To his Government, AIDS was a major public health concern and was being given priority. Cases numbered well over 10 000 and would continue to increase, though he hoped for a plateau in incidence soon. Public health aspects, public information and research were centred at ·the Centers for Disease Control in Atlanta, which had co-sponsored the meeting mentioned earlier. The United States was willing to share any information it had on AIDS and to provide technical cooperation on request. It was equally ready to share resources and information on, for example, diabetes, kidney disease and cancer. He emphasized that concern about AIDS should not divert the Region from such important priority activities as the expanded programme on immunization and diarrhoeal disease control. Despite the high rate of mortality from AIDS, the number of deaths was still low compared with deaths from the major preventable communicable diseases, diarrhoeal diseases and so on.
The meeting rose at 5 p.m.