WPRlRC60/SRIl
SUMMARY RECORD OF THE FIRST MEETING (Run Run Shaw Hall, First Floor, Hong Kong Academy of Medicine, Jockey Club Building, 99 Wong Chuk Hang Road, Aberdeen, and the Grand Ballroom, Lower Levell, Kowloon Shangri-la Hotel) Monday, 21 September 2009, at 09:30 and 14:00 Chairperson: Dr Francisco Duque ill (Philippines) later: Dr P.Y. Lam (Hong Kong (China»
CONTENTS page 1.
Opening ceremony ................................................................................................. .. Opening of the session ........................................................................................... .. Address by the retiring Chairperson ....................................................................... . Election of new officers: Chairperson, Vice-Chairperson and Rapporteurs .......... .. Adoption of the agenda .......................................................................................... .. Address by the Director-General ............................................................................ . Address by and Report of the Regional Director ................................................... .. ANNEX 1Address by the Chief Executive of the Hong Kong Special Administrative Region, People's Republic of China, Mr Donald Tsang, at the opening ceremony Address by the Director-General of the World Health Organization, Dr Margaret Chan, at the opening ceremony ........... .. Address by the World Health Organization Regional Director for the Western Pacific, Dr Shin Young-soo, at the opening ceremony ............................ :: .................................... . Address by the Retiring Chairperson, Dr Francisco T. Duque ill, at the opening ceremony ..................... .. Address by the Retiring Chairperson, Dr Francisco T. Duque lll, at the opening session .......................... .. Address by the Director-General of the World Health Organization, Dr Margaret Chan, at the opening session
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2. 3.
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4. 5. 6. 7.
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ANNEX 2 -
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ANNEX 3
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ANNEX 4
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ANNEX 5 ANNEX 6
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1.
OPENING CEREMONY
The opening ceremony was held at 09:30 at the Run Run Shaw Hall of the Hong Kong Academy of Medicine Mr Donald TSANG, Chief Executive, the Hong Kong Special Administrative Region, the People's Republic of China, welcomed the participants. He said that an emergency response to the HI NI influenza pandemic had been in place in Hong Kong since I May 2009, in which every precaution was being taken to prevent spread of the virus. Hong Kong's relatively recent experience with avian influenza and severe acute respiratory syndrome (SARS) meant that it could provide useful advice to others. The meeting was a vital platform for the exchange of information and ideas on health and for encouraging collaboration among national public health authorities (Annex I). The DIRECTOR-GENERAL congratulated Hong Kong (China) on the rapidity of its broad-based response to the HINI influenza pandemic. She had received critical input from experts in all countries of the Region on appropriate responses to the current pandemic, which was the first true test of the efficacy of the International Health Regulations (2005). Especially in view of the severe global economic recession, it was essential to keep economic and social disruption due to the pandemic to a minimum. The solidarity among the vastly diverse nations that make up the Region would give them an advantage in minimizing the impact of the HINI virus and should be emulated globally. She thanked those countries that had donated vaccine to combat the pandemic (Annex 2). The REGIONAL DIRECTOR, speaking on behalf of the WHO Member States in the Region and their representatives, expressed appreciation to the Government of the Hong Kong Special Administrative Region, the People's Republic of China, for the excellent arrangements made for the sixtieth session of the Regional Committee. He paid tribute to Hong Kong's economic and public health achievements. He also recalled its admirable response to the SARS outbreak in 2003, in which the current WHO Director-General had played a major role. That experience had strengthened the public health system and Hong Kong was now a global leader in the fight against emerging diseases (Annex 3). The CHAIRPERSON of the Regional Committee (fifty-ninth session), Dr Francisco T. Duque ill (Philippines), thanked the Chief Executive of Hong Kong Special Administrative Region for opening the sixtieth session of the Regional Committee and for providing such an excellent venue for the Committee's work. The Committee would be considering, inter alia, two topics of particular urgency: the global financial crisis and its impact on health, and Pandemic (HINI) 2009, the technical name for the current HINI influenza pandemic. In the past, Hong Kong had clearly demonstrated its capacity to respond to such challenges. He was encouraged by the collective achievements in the Western Pacific Region over the past year and trusted that the customary spirit of partnership and commitment would ensure a successful session and further progress in the months ahead (Annex 4). After completion of the opening ceremony, the participants reconvened at the Grand Ballroom, Kowloon Shangri-La Hotel.
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2.
OPENING OF THE SESSION: Item 1 of the Provisional Agenda
The retiring Chairperson, Dr Francisco T. DUQUE ill (Philippines), declared open the sixtieth session of the Regional Committee for the Western Pacific. 3. ADDRESS BY TIlE RETIRING CHAIRPERSON: Item 2 of the Provisional Agenda The retiring Chairperson, Dr Francisco T. DUQUE ill (philippines) made a statement to the Committee (Annex 5). 4. ELECTION OF NEW OFFICERS: CHAIRPERSON, VICE-CHAIRPERSON AND RAPPORTEURS: Item 3 of the Provisional Agenda 4.1 Election ofChairoerson
Dr Masato MUGITANI (Japan) nominated Dr LAM Ping-Yan (Hong Kong (China» as Chairperson; the nomination was seconded by Dr Terepai MAOATE (Cook Islands). Decision: Dr LAM Ping-Yan (Hong Kong (China» was elected unanimously. Dr LAM took the chair. 4.2 Election ofVice-Chairoerson Dr Mark JACOBS (New Zealand) nominated Dr Kautu TENAUA (Kiribati) as Vice-Chairperson; the nomination was seconded by Mr KHAW Boon-Wan (Singapore). Decision: Dr Kautu TANAUA (Kiribati) was elected unanimously. 4.3 Election of RaPOorteurs
Dr Suyoi OSMAN (Brunei Darussalam) nominated Ms Cath PATTERSON (Australia) as Rapporteur for the English language; the nomination was seconded by Dr Francisco T. DUQUE ill (philippines). Dr PomnekDALALOY (Lao People 's Democratic Republic ) nominated Dr JeanPauIGRANGEON(New Caledonia) as Rapporteur for the French language; the nomination was seconded by Dr NGUYEN Quoc Trieu (VietNam). Decision: Ms Cath PATTERSON (Australia) and Dr Jean-Paul GRANGEON (New Caledonia) were elected unanimously. 5. ADOPTION OF THE AGENDA: Item 5 of the Provisional Agenda (Document WPRlRC60/1 Rev.2) The CHAIRPERSON drew attention to the provisional agenda (document WPRlRC60/1 Rev.2) and moved for its adoption. Decision: In the absence of comments, the Agenda was adopted.
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6.
ADDRESS BYTIIE DIRECTOR-GENERAL: Item 6 of the Agenda The DIRECTOR-GENERAL addressed the Committee' (Annex 6) Professor CHEN Zhu (China) said that the influenza HINI pandemic had continued to develop over
the past year, against a background of global financial crisis and climate change. The international community had, however, collaborated to mount a rapid response to curb the outbreak and protect people's health. He congratulated the Director-General on her leadership of the emergency response, which had strengthened the capacity of the global health system. China attached great importance to international cooperation, and remained in close contact with WHO and Member States. Following WHO's advice, China had adjusted its prevention and control strategy, gaining time to develop and produce a vaccine. China was concerned about health inequities, and stood ready to contribute to efforts to provide global access to the necessary vaccine. During a recent symposium, held jointly by the Chinese Ministry of Health, WHO and The Lancet, China had released efficacy data resulting from a survey on HINI vaccine that indicated that a single dose was effective for 90% of the population aged 3-60 years. A large-scale programme initiated for the key population in China had proved the efficacy of domestically produced vaccine, and his government hoped that WHO could support pre-qualification and offer guidance on the use of the vaccine for pregnant women. Of course the virus might mutate and increase in virulence, so a long-term plan was needed. He urged the international community to support WHO through the transparent exchange of information, under the framework of the International Health Regulations (2005). It was important to enhance the capacity of developing countries to meet their health needs, and he agreed with the Director-General that there was a need to intensifY capacitybuilding in health systems in order to reduce health inequalities, achieve the Millennium Development Goals, and establish people-oriented primary health care to provide universal access. Health care reform initiated in China in March 2009 aimed to provide universal access by 2020. He hoped that WHO could play an even more active role in promoting global health. Mr KHAW (Singapore) congratulated the Director-Genl~ral on her decisive and wise leadership in the current HINI pandemic. If WHO had wrongly - or even rightly, but prematurely - announced a pandemic alert, the global economy might have crashed. Any hesitancy, however, would have enabled the virus to cause avoidable damage. Influenza was unstoppable, but early waming offered an opportunity to try to slow its spread and reduce a sudden surge in cases in hospitals and clinics. Although the virus had turned out to be milder than originally feared, a major surge would divert limited resources and endanger patients suffering from other severe illnesses. While it would be for medical historians to assess the global response, the first wave of the outbreak seemed to have passed in the Western Pacific Region. So far, the world had avoided a repeat of the Spanish Flu of 1918 and the Great Depression of 1929. But neither health specialists nor bankers could yet declare "mission accomplished". There would be a global shorU\ge of HINI vaccine, and many in the developing world would not have access to it. Health ministers had to prepare for the evolution of the pandemic, including the possibility of a more deadly second wave. If the virus remained mild, the current alert level would gradually have to return to normal. The world looked to WHO for help in navigating through the pandemic in a humane and pragmatic way. Dr CHOW Yat-ngok York (Hong Kong (China» thanked the Director-General for highlighting major health concerns in the Western Pacific Region. He also thanked WHO and the Western Pacific Regional Office for acting as the health conscience of the Region and for leading the public health response, with a
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view to achieving better health and a better quality of life for everyone in the Region. Fortunately, the health indices for Hong Kong were among the best in the world, but there were challenges ahead. Urbanization and the globalization of trade posed common health hazards and lifestyle risks to people living in different parts of the world, with pandemic influenza being an example. Populations were ageing, and people were demanding better health outcomes from health care technology and services. All governments faced the challenge of providing stronger health care systems and more sustainable health care financing. There was a need to determine a level of funding that governments and citizens could afford, 'and to ensure that services were both effective and cost-effective, generating equitable and positive health outcomes. Furthermore, there was a need to educate citizens to be wise consumers of health services and to adopt healthy lifestyles. He looked forward to closer collaboration between the countries ofthe Region in order to achieve an even higher level of health. Mrs Gatoloaifaana Amataga Alesana GIDLOW (Samoa) commended the Director-General's visionary leadership, and thanked her for encouraging women professionals to improve and reorient the health systems in their countries. In particular, she welcomed the Director-General's focus on maternal and child health, on revitalizing and strengthening health systems through primary health care, and on climate change and food security. Those activities were of benefit to many countries, and especially to small island countries. She congratulated WHO on its leadership of the management of Pandemic (HINI) 2009, as well as in efforts to prevent the spread of the disease. Samoa would be guided by WHO advice on how to prepare for the second phase of the pandemic. Mr YOO Young-hak (Republic of Korea) appreciated WHO's efforts to tackle the pressing problems facing Member States at a time when countries across the world were struggling with the global financial crisis and the spread of the new HINI influenza. There had been fatal cases in the Republic of Korea, and the virus was spreading rapidly. His country looked to WHO for the latest information, which would serve as a benchmark for domestic control measures. He hoped that WHO's endeavours to enhance health equity would bear fruit, and that other initiatives towards the achievement of the Millennium Development Goals would make progress.
Dr MUGITANI (Japan) said that the Director-General had provided clear leadership in global health. The financial crisis and Pandemic (HINI) 2009 had greatly affected the health sector, and all relevant sectors needed to work together to address those global concerns. Health-related challenges, which also included lllVlAIDS, 1B and noncommunicable diseases, jeopardized the achievement of the Millennium Development Goals. It was essential to take a comprehensive approach that addressed infectious diseases, maternal and child health and the strengthening of health systems in a balanced manner. Improvements in health status in the Western Pacific Region had been especially great in countries where health systems had maintained effective primary health care. In particular, in order to strengthen health systems, it was crucial to strengthen the health workforce, health information and surveillance, and research and development. Japan would continue to support health improvement in the Western Pacific Region, in line with WHO's efforts to improve health globally. Ms Jane HALTON (Australia) thanked the Director-General for her timely reminder of the importance of solidarity and mutual support at a time of financial crisis and the first pandemic in 40 years. There was a need for vigilance in regard to the Millennium Development Goals, the role of women, and-a subject
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close to the daily lives of people in the Western Pacific---climate change. She underscored the comments on HINI made by the representative of Singapore, and thanked the Director-General for her leadership, as well as her willingness to consult and take expert advice. Australia had been affected by the pandemic very early on. To date, there had been 172 deaths, 300 patients were currently in intensive care, and there were 36 000 diagnosed cases. The pandemic had tested Australia's response plans, showing what the health system did well and what it did badly when academic theory had to be applied in practice. The knowledge gained from experience not only provided a salutary reminder of the need for vigilance, but also engendered confidence for countries to work as a team. Mindful of the need to show solidarity, Australia would donate 10% of the 21 million doses of vaccine that it had purchased, giving priority to countries of the Western Pacific. The pandemic was not finished, but a cooperative attitude would lessen its effects.
Mr Philippe DUNOYER (France) said that his country shared the Director-General's vision with regard to the improvement of health systems and commended her inspiring intervention. New Caledonia had been severely hit by the HINI pandemic at an early stage but had learnt useful lessons from the experience of Australia and New Zealand, which had allowed it to improve its response. Although nine people had died, the population had remained calm. In order to ensure greater equity at global level, France had decided recently to donate 10% of the 94 million doses of vaccine that it would be purchasing to WHO for distribution to developing countries, as a modest contribution to the global efforts that were being made to fight the pandemic. Mr LIOW Tiong Lai (Malaysia) said that Hong Kong (China) and the world were proud of Dr Chan for her hands-on commitment to combating the pandemic. She had shown individual concern and decisiveness in giving assistance to each Member State, such as sending a team to assist the Ministry of Health of his country to handle the pandemic at its peak. He looked forward to continuing support and asked further that WHO ensure that information on any side effects of the vaccine and any mutation of the virus be shared among Member States. Dr Terepai MAOATE (Cook Islands) said that the HINl pandemic represented a real threat for his country. The awareness-raising programme had had a deleterious effect on tourism, on which his country depended, and he asked whether the concern that had been raisf~d was justified in view of the low virulence of the virus. The real concern of the small-island states was their vulnerability to climate change, caused by other countries. The cost to his country of ensuring that the HI Nl virus did not spread was too high, especially in view of the global economic crisis. The DIRECTOR-GENERAL thanked representatives for their comments and emphasized the importance of cooperation and open discussion at the United Nations Summit on Climate Change to be held in New York on 22 September 2009. The small-island countries in the Western Pacific, and developing countries in other regions, were suffering the early consequences of a climate change towards which they had contributed little, and yet there were still scientists who refllsed to acknowledge any such event. Climate change adversely affected health, with associated increased and emerging incidences of dengue fever and malaria, greater prevalence of diarrhoeal diseases and cholera from flooding and water contamination, and reduced food production because of water scarcity. Diminished food security was also a direct consequence of climate change. Food production in some African countries, where malnutrition was already widespread, would decline over the next 10-20 years, and many countries in the Western Pacific would be equally affected.
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She noted the concerns of representatives over the lack of progress on Millennium Development Goals 4 and 5 on reducing child mortality and improving maternal health, and WHO was working with the United Nations and with development partners to ensure those issues were addressed. She thanked the development partners for their commitment to the global fight against malaria and reported that empty beds in hospital wards assigned to treating children suffering from malaria in the United Republic of Tanzania, Zanzibar and Uganda indicated that progress was being made. The High-level Consultation on the Financial and Economic Crisis and Global Health in January 2009, held just before the Executive Board meeting, had been called to emphasize the importance of avoiding the mistakes made during the oil and financial crisis 30 years ago. The goal of "health for all by the year 2000", set at the international conference held in Alma-Ata under the auspices of WHO and UNICEF, had been undermined because many countries applying to the financial institutions for help were obliged to carry out structural adjustments that led to cuts in social services, including education and health. Many weak health systems currently in place were a direct legacy of those cuts in social services. She acknowledged the commitment of many governments to "counter-cyclical investment" as opposed to cutting back on social services; Australia, China, France, Germany, Japan and the United States of America were maintaining commitments to official development assistance and were also trying to introduce domestic stimulus packages. It was hoped that the upcoming G-20 Summit, to be held in Pennsylvania, United States of America, on 24-25 September, would conclude with an announcement that the economic situation was improving. She encouraged governments not to cut back on health funding, a move which would reverse any gains made towards achieving the MDGs in recent years and might prevent some countries from reaching the MDGs at all. She acknowledged the appreciation of Member States for the work of WHO in helping them to meet the challenge of the Pandemic (HINI) 2009, and extended her thanks in return for the courage and resolve of the Member States themselves. Discussion and revision of the International Health Regulations (2005), which clearly laid down the obligations of the Member States and the obligations of the Secretariat, had helped to improve transparency, speed up reporting and encourage commitment to virus-sharing. Important lessons had been learnt from the A(H5NI) outbreak and national pandemic preparedness plans had been tested and improved, leading to better management of the Pandemic (HI NI) 2009. National infiuenzacentres had played a key role in helping to collect specimens for global risk assessment, and she praised Member States' commitment to virus-sharing and the contributions of the WHO Collaborating Centres in Australia, Japan, the United Kingdom, and the United States of America. She recognized the contribution of the United States of America, both in controlling the pandemic within its own borders and in providing assistance to developing countries, with contributions of laboratory equipment, diagnostics and reagents to more than 100 WHO laboratories. Referring to the comment by the representative of the Cook Islands with regard to his country's economic reliance on tourism, she pointed out that Canada, Mexico and the United States of America had been among those countries most affected by the pandemic and that Mexico, in particular, had suffered from a marked downturn in tourism. WHO did not recommend border closure or restriction of movement of goods and services. The HINI virus spread rapidly, but most people recovered fully. WHO took great care to issue
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responsible statements at all times, but it was unable to control how other agencies decided to interpret or report such statements. Looking forward, WHO had obtained a commitment from vaccine companies for 150 million doses of A(H1NI) influenza vaccine. The United Nations and WHO were working together to obtain funding for a further 150 million doses. Australia, Brazil, France, Italy, New Zealand, Norway, Switzerland, United Kingdom and United States of America were donating 10% of their vaccine supplies to developing countries and she thanked those Member States for their solidarity. With the 300 million doses of influenza vaccine and the additional 10% contributions of the nine Member States, there should be enough A(H1 N1) influenza vaccine doses to cover at least 15% of the population of the developing countries. She reiterated her promise to continue to work for the developing countries and to ensure that they received all the help that WHO and other Member States could provide. The Director-General acknowledged the comment by the representative of Australia on leadership and consultation and thanked her for her country's contributions. She assured Member States that the Secretariat kept abreast of national health situations and was prepared to extend support to all countries experiencing difficulties. Recently WHO, with support from Roche and GlaxoSmithK1ine and the Association of Southeast Asian Nations, had sent antivirals to 121 developing countries, including all developing countries in the Western Pacific Region. When the next donation of 5.6 million doses from Roche and 2 million doses from GlaxoSmithKline arrived, they would be sent directly to the developing countries so that they would have the wherewithal to meet the pandemic head on. She drew attention to the fact that no person currently in office, and very few people in the Member States, had first-hand experience in managing a pandemic, and that collective discussion and decision-making were imperative to ensure the best possible outcome. The International Health Regulations (2005) clearly defined all parties' obligations and, while WHO would not again impose travel restrictions, it was committed to taking the necessary steps to ensure appropriate management and optimum outcomes for Member States in the event of a health crisis. In conclusion, the Director-General urged Member States to focus on ensuring prompt treatment in
hospitals and medical clinics, which would be under pressure to deal with the flow of cases. Border control and quarantine measures were important to slow the spread ofthe virus, but they would not stop it completely. Medical services must receive priority support so that they might provide timely and effective treatment. Pandemic communications were extremely important and such information-sharing should be entrusted to technical departments rather than be disseminated by politicians. All vaccines were trialed, in compliance with drug regulatory authorities, to ensure quality and safety; however, no clinical trial would be great enough to pick up extremely rare side effects that might occur. WHO would support Member States in implementing vaccination programmes and carrying out post-vaccination monitoring and evaluation. Prompt investigation of unusual side effects to discover whether they were vaccine-related or coincidental and sharing of information on the results was of paramount importance. Public misinterpretation of any vaccine-related deaths arising out of misinformation had the potential to harm many important immunization programmes and endanger the lives of children from vaccine-preventable diseases.
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She assured the representative of Singapore that the Secretariat would consider his comment on the need for guidance from WHO to navigate through the pandemic. She was convinced that WHO had a responsibility to provide timely and appropriate announcements on potential health crises, both to fulfil its mandate and to ensure that Member States were equipped to tackle such events. 7. ADDRESS BY AND REPORT OF THE REGIONAL DIRECTOR: Item 7 of the Agenda (Document WPRlRC60/2) The REGIONAL DIRECTOR began by expressing the honour he felt in addressing the Regional Committee on the occasion of its sixtieth session and presenting the report on the work of WHO in the Western Pacific Region for the period July 2008 to June 2009. He noted that, inAsia in particular, the number 60 carried great significance; in the Confucian tradition, for example, 60 years was regarded as the completion of one life cycle and the beginning of the next. Regardless of personal persuasion, it was clear from looking at the present report and those before it that remarkable health gains had been achieved in the Western Pacific Region over the previous six decades, and he was proud to be leading Member States forward to further accomplishments. On the auspicious occasion of the sixtieth session of the Regional Committee, which also marked his first as Regional Director, he expressed his appreciation to the Government of the Hong Kong Special Administrative Region for having invited three former Regional Directors-Dr Hiroshi Nakajima, Dr S. T. Han and Dr Shigeru Omi-to attend. Dr Omi had unfortunately been unable to join the session, but it was indeed an honour to have two past Regional Directors present. Looking out across the conference hall, the Regional Director said that he recognized many familiar faces. Some he had met as fellow representatives at previous meetings of the Regional Committee, the World Health Assembly and the Executive Board. Others he had met more recently as he had travelled to many of the 37 countries and areas that made the Western Pacific Region the largest and most diverse of all WHO Regions. Still others he looked forward to meeting during the session and in the weeks and months to follow. He said that the session's full agenda was certain to give rise to very productive discussions. First, however, looking beyond his annual report, yet following a tradition set by other incoming Regional Directors, he expressed his wish to share his vision for the future, a vision shaped by over three decades of work in public health and by his extensive consultations with Member States. He noted that the sixtieth session was taking place at a time of great challenge; front-page headlines were warning of a growing influenza pandemic, noncommunicable diseases were on the rise and climate change would undoubtedly impact on health. Furthermore, all of that was unfolding against the backdrop of a global economic crisis that was squeezing resources and leaving at-risk groups, such as women and children, more vulnerable to ill health. Opportunity, however, often resided on the other side of challenge. At no other time in history had there been a greater awareness of the need to protect health and so great a demand for governments to take action on health. The challenges required leaders in public health who could maximize the use of limited resources and also influence other sectors to take bold steps in favour of development policies that protected health and improved the quality oflife.
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More than seven months ago, he had reported to work at the Regional Office with just a briefcase in his hand-no transition team and no entourage. He had been well aware of the tradition of effective leadership . in the Regional Office for the Western Pacific. The Region had taken a leading role on many global issues, including polio, SARS, avian influenza, tobacco control and tuberculosis. His election, however, had marked a break with tradition, being the first time in the history of the Region that a non-staff member had been selected as Regional Director. Without a doubt, his "outsider" status had presented certain challenges-from learning the nuts and bolts of the Organization's financial and administrative systems to getting up to speed on its various technical programmes. But being an "outsider" also had advantages: he had come on board with a fresh perspective. The mission-to work towards the attainment by all people of the highest possible level of health-had not changed. However, the way in which the Organization was organized and how it carried out its work must continue to evolve if the challenges being faced were to be met. Before assuming office, he had consulted broadly with Member States on how WHO could best achieve its mission. One thing had been crystal-clearthe need to be more effective in serving Member States. He had heard the same thing from Ministers of Health from the Pacific island countries during a meeting in July in Madang, Papua New Guinea. The ministers had agreed with him that WHO's guidance and support must make a difference where it mattered most. Following that meeting, he had taken a IO-hour overland trip to reach a remote area in Papua New Guinea-a journey which the United Nations security office had been hesitant to approve. Travelling with the Secretary of Health of Papua New Guinea, he had visited a poor community that lacked many of the basic necessities of life, including clean water. There he had asked himself, "How can we make a difference in p laces like this?" That question had been on his mind everywhere he had visited, including the home areas of Highland dwellers, ethnic communities in the Mekong, the urban poor and those living on remote atolls in the Pacific. He considered that, if WHO was not helping to improve the health ofunderserved people, then perhaps the Organization had lost its way. WHO was facing many challenges in striving to achieve its mission in today's context, but opportunities also presented themselves. The next five years would be critical, particularly with the approach of the 2015 deadline for the commitments contained in the United Nations Millennium Declaration. In the Western Pacific Region, many countries had made significant progress towards achieving the Millennium Development Goals (MDGs), but some still required more to overcome the barriers to progress, especially in the cases of MDG 4-on child health-and MDG 5--{)n maternal health. Without a chaJ?ge of course and a rethinking of approaches, the achievement of those two goals would be in peril. That had been on his mind during a June visit to the Lao People's Democratic Republic. Along with the Minister of Health and several other government officials, he had visited remote villages to see what could be done to prevent maternal and child deaths. The team had met with local officials, volunteer health workers and-most importantly-expectant mothers. It had been clear to him that a revitalized primary health care system, with village-level programmes and an effective referral system to provide the continuum of care, could save the lives of many mothers and children.
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To put such a system in place, what was most needed were the leadership of Government and strong political will. WHO could support such a model, together with partners such as development banks, other United Nations organizations and bilateral donor agencies. Innovative approaches, commitment and leadership were the keys to achieving greater success, not only in maternal and child health, but for all of the Millennium Development Goals. Emerging and re-emerging diseases would continue to be important. Pandemic (HINI) 2009 was a reminder of the constant need for vigilance and preparedness. The Western Pacific Region, having been "ground zero" in the battle against SARS and later avian influenza, was well prepared for HlNl. The main reason for that preparedness was the very active efforts of the Region's Member States in revising and implementing the International Health Regulations (2005) and in developing and implementing the Asia Pacific Strategy for Emerging Diseases (APSED). A technical briefing on pandemic influenza and a discussion on APSED would take place later in the week. At the same time, other emerging threats were also being addressed, not least the impact of climate change on health. Whether strengthening capacity to respond to environmental disasters or addressing the reemergence of threats such as dengue, WHO continued to stand ready to support Member States in responding to public health emergencies and risks. The alarming rise in noncommunicable diseases was a major concern. Reducing the associated risk factors and promoting healthy lifestyles and behaviours would continue to be high on the agenda; later in the week, for example, the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific would be discussed. It was well known that individual behaviour was strongly influenced by the social, economic and
physical environment. Such healthy settings programmes as Healthy Islands and Healthy Cities had proven to be very effective in advocating changes to environments to protect and promote the health of individuals and communities. In future, such programmes would become a significant part of the Organization's strategy to advance its work at the country level. Whether the aim was to achieve the MDGs, to counter threats such as emerging and re-emerging diseases, or to reduce the burden of noncommunicable diseases, health systems at the country level would need to be strengthened. Critically, that would depend on a combination of socioeconomic development and sustained political will. Every country was different in that regard, but if efforts could be built around the core values of primary health care, then the chances of reaching the underserved and at-risk communities could be maximized. The Regional Director pointed out that, although he had highlighted four important areas, WHO would not abandon its wider commitment to the full scope of public health. The Organization was committed to maintaining technical excellence and its leadership role in protecting and promoting health in the Region. In order to better serve its Member States, the Regional Office was embarking on a bold reform process which would take a critical look at how the Organization worked, and would not hesitate to make changes where needed. He had conducted extensive consultations with staff members at both Regional and Country Office levels, and had identified four key areas for the reform process: first, how to strengthen leadership and
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partnerships; second, how to sustain and build on resource mobilization capacity; third, how to ensure the best staff to deliver results; and lastly, how to find new ways of working to attain the Organization's mission. During the previous decade, public health issues had become one of the highest priorities for the international community and the public health arena was more crowded than ever. WHO therefore had to find innovative ways to maintain its leadership and to strengthen partnerships in a rapidly changing environment. Only one quarter of the Organization's budget was covered by assessed contributions, with the other three quarters coming from unpredictable and mostly earmarked voluntary contributions. It was necessary to do a better job of mobilizing resources to sustain WHO's work fully and consistently. The excellence of the Organization depended on the excellence of its staff. Other reform efforts had to be underpinned by a strong commitment to invest rationally in recruiting, developing and retaining the highest possible calibre of staff members. Lastly, as management was reformed, new ways of managing resources to maximize their impact would need to be found. One way that he intended to pursue that goal would be to begin tearing down the Organization's tightly sealed management silos to deliver multidisciplinary and cross-cutting programmes. Another would be to reach out proactively at the country levd and beyond-even down to the district and village levels, when appropriate-in an effort to bring health to where it mattered most. The Regional Director explained that he had created a new Director's position in his Office to develop and take forward the reform process, which encompassed the four areas he had mentioned. That task would not be easy, but he expressed his determination to lead a process that would produce whatever was required to achieve what the Organization was setting out to do.
In conclusion, he repeated his earlier question-"Can we make a difference where it matters most?" In the current complex and uncertain environment, WHO was committed to better serving countries in the Region by changing the way in which it was organized and the way in which it worked. There were clear opportunities for the Organization to lead in public health, to maximize the use of limited resources and to reach out to places where it could mak,e a difference. He looked forward to receiving the support of the Regional Committee in pursuing the goal of attaining the highest possible level of health by all people in the Region. Mr Sasa ZIBE (papua New Guinea) said that the comprehensive report of the Regional Director clearly articulated a vision that mirrored the goals set forth in his own country's national corporate plan and mediurnterm strategy. It would also serve as a useful tool for the further evaluation of individual country performances during the period covered. As a recent desktop review conducted as part of preparations for the 2011-2020 health plan had shown, Papua New Guinea's failure to prioritize had led to uneven progress in addressing its key health problems. Despite ample external support, its struggle to strengthen its health system and build the capacities vital to quality health services continued. On that score, the Regional Director's vision would undoubtedly aid the implementation of multiple externally funded programmes in smaller countries. However, he was concerned that implementation of parallel programmes by development partners was undermining local capacity. He hoped that could be prevented in order to achieve the intended results and sustain the progress already made.
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Mr Moses KAHU (Vanuatu) took note of the issues highlighted in the report, which was highly commendable in its comprehensiveness. He congratulated the Regional Director on his early activities as the new Regional Director, in which context his visit to Vanuatu had provided the opportunity for fruitful discussions on important health matters. Sharing as it did the Regional Director's strong commitment to such issues as primary health care, Healthy Islands initiatives and health systems strengthening, Vanuatu looked forward to working with him and his staff in order to improve and strengthen the provision and delivery of health services to its people. Sir Terepai MAOATE (Cook Islands) echoed the Regional Director's expression of appreciation to the Hong Kong Government for having issued an invitation to the meeting to three former Regional Directors, whose services to the Region - and the world - should be formally recognized. He further expressed full support for the Regional Director's report, which raised important points for consideration. Commitment at the highest level and ownership across the board were vital to achievement of the MDGs, for which socioeconomic and infrastructural development were equally essential. To that end, assistance from funding institutions and donor partners was a key factor. Neither should the multisectoral approach be overlooked. Dr CHOW (Hong Kong (China» concurred with the priority areas identified in the report of the Regional Director. As underlined by the outbreak of Pandemic (HINI) 2009, the strengthening of responses to and preparedness for public health emergencies was a top priority, including at the international level. The strengthening of primary health care and collaboration with other sectors were other important public health issues on which he looked forward to further guidance from the Regional Director. For its part, his Government emphasized prevention as the key to primary health care; it provided free or highly subsidized seasonal influenza and other vaccinations for at-risk groups, for whom it was also purchasing the HINI vaccine, and it had increased its expenditure on public health care, notwithstanding the economic downturn. In short, the priority areas identified in the report demanded enforceable, actionable and affordable solutions, not to mention the political courage and commitment to put plans into action. In that regard, he looked forward to engaging in further collaboration with Member States. Dr YOO (Republic of Korea), commending the outstanding work by the Regional Office, pointed out that many of the plans established under the new leadership of the Regional Director were already being implemented. That being so, the all-important efforts to achieve the MDGs in particular MDG4 and MDG5, create healthy cities, and strengthen primary health care would undoubtedly bear fruit, despite such phenomena as the global financial crisis and the spread of Pandemic (HINI) 2009. His country pledged its full support and cooperation in those efforts aimed at strengthening health capacities throughout the Region. The meeting rose at 17: 15.
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ANNEX I WELCOME ADDRESS BY THE CHIEF EXECUTIVE, THE HONG KONG SPECIAL ADMINISTRATIVE REGION OF THE PEOPLE'S REPUBLIC OF CHINA, MR DONALD TSANG, AT THE OPENING CEREMONY OF THE SIXTIETH SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
It is an honour for us to host the sixtieth session of the World Health Organization Regional Committee
for the Western Pacific. A wann welcome to all of you, especially to those who have travelled long distances to come here. The WHO Regional Committee for the Western Pacific is an important platform for health ministers and experts throughout the Region. This year's session is particularly significant. It was only about six months ago that a young boy in Mexico complained of feeling unwell with flu symptoms. He became the first confirmed case of HI NI swine flu. The boy has since recovered. In a very short time, though, the virus spread to virtually every comer of the globe. The infection and fatality rates continue to rise. We are grateful to WHO for its swift response in raising its alert levels and promoting awareness about the virus. In Hong Kong, the emergency response level has been in place since May I st. We have taken every precaution to prevent the spread of the virus, and in some cases we have even been accused of over-reacting. Following our relatively recent experiences with avian influenza and SARS, the Government has not and will not take any chances. From the outset, we have adopted a totally transparent policy. We report every confirmed case of HI NI. We explain to the public the evolving changes in our treatment protocol, and at the same time we have spread to every school, every institution how disease and how the virus can be prevented and how to slow down its spread. So far, we have convinced the population that we are on top of the problem, and there has been no panic in the community. Their confidence has been regained, and we can safely declare that it is a safe city. But we are alert. We will never be complacent. We look forward to working with WHO and our neighbours in the Region in overcoming the epidemic. Given our experiences with avian influenza and SARS, I believe-and no doubt our former Health Director Dr Margaret Chan will agree-that Hong Kong has a great deal to offer in the fight against HINI influenza. At the same time, there are a number of other key health issues to deal with. These include health care financing and reform to cope with an ageing population. There are also new technologies to consider as well as rising health costs and the impact of the global financial crisis on our economy's ability to sustain a firstrate public health regime. This is a problem that confronts every developed nation and territory. This session provides a valuable platform to exchange information and ideas on health issues of common concern. It can also serve to encourage collaboration among national public health authorities in the promotion of better health policies and practices. With an increasingly globalized world, regional and international cooperation in public health administration remains the most essential weapon against the spread of infectious diseases across countries.
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Annex 1
The last time Hong Kong hosted a session of this Regional Committee was back in 1992. We are delighted to welcome you back this year. I wish all the delegates and participants a successful meeting and an enjoyable stay in Hong Kong.
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ANNEX 2 ADDRESS BY THE DIRECTOR-GENERAL OF THE WORLD HEALTH ORGANIZATION, DR MARGARET CHAN, AT THE OPENING CEREMONY OF THE SIXTIETH SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
It is indeed a great pleasure to be back in my home town. This visit coincides with yet another
outbreak, this time on a global scale. In this connection, let me thank Chief Executive Mr Donald Tsang, for his leadership. Mr Tsang, I was watching Hong Kong from afar, and I appreciate what you have done in providing the very much needed political leadership in Hong Kong's very prompt and remarkable response to the influenza pandemic. The community, the health professionals, the scientists in Hong Kong collectively working with the civil servants have pulled together to combat a rapidly spreading threat. As you have put it, this virus moves very fast. It has gone to every comer of the world. Six months is usually how long a virus takes to go around the world; this time it took six weeks. So that is the kind of speed we are talking about. The kind of quick, broad-based response that we have seen in Hong Kong will be critical in the coming months here and everywhere else in the world. When WHO announced the start of the pandemic in June, attention focused very quickly on the winter influenza season in the southern hemisphere as the key indicator of how the pandemic might evolve. In this Region, national reporting of experiences has been a model of speed, openness, constant communication with the public and with the media and generous, very generous sharing of information with the international community. And on that, Dr Shin, I would like to thank you and your predecessor for having a very strong region within the World Health Organization. In the heat of the outbreak, experts in your countries, while working very hard, still found time to
advise me, participate in panels and contribute to the WHO's virtual networks. These networks were set up to monitor the evolving clinical, epidemiological and virological dimensions of the pandemic. The second wave of spread is now beginning, with guidance from a solid body of observations and research data. This too is a remarkable achievement in just five months after the new HINI virus was identified. In the early phase of this pandemic, doctors in countries like Australia and New Zealand, helped alert the world to a problem that warrants additional preparedness measures. Of course, as we are moving into the second phase, many countries in this Region, including China, Hong Kong (China), Singapore, Japan, and the list goes on, have provided extremely important information for the global community. As we are beginning to see now, intensive care units and emergency rooms are likely to feel much of
the heat and the pressure from the pandemic. While the overall clinical picture remains largely reassuring, health officials are increasingly concerned about a small subset of patients who suddenly and very rapidly fall very ill, usually on day 5 or day 6 after symptom onset. Their clinical course can deteriorate from normal respiratory function to severe respiratory failure in less than 24 hours. Saving these lives depends on very rapid access to highly specialized care in highly specialized facilities. Although the numbers of such cases have been small to date, we are wise to anticipate an added burden on intensive care units as more and more patients become infected.
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Annex 2
Research, conducted in this Region, is helping us to understand how to treat our patients and has also given us the very first cIues of what might influence individual susceptibility to severe disease. You have also helped us raise international concern about the increased risk of severe disease in indigenous populations. This pandemic is providing the first true test of how we, as an international community, can work together within the framework of the revised International He:alth Regulations. We are, I believe, doing well. We are also doing well in keeping the level of economic and social disruption associated with this global pandemic as low as possible. This is especially welcome news at a time of severe global economic recession. Let me make one final observation. This is a Region well known for its cohesion and spirit of mutual support, despite vast differences in levels of economic deve:lopment. Such vast differences also in health status, in access to care and the range of services that the health systems can offer, are seen throughout the world. Solidarity, global solidarity is very important. It gives us our best chance to minimize the impact these differences will have on the levels of illness, death and disruption caused by this pandemic. On that, I would like to applaud and welcome the announcement of pandemic vaccine donations to developing countries via the World Health Organization by nine countries, and two of those countries are in your Region. And I thank you Australia, and I thank you New Zealand for doing that, and I'm sure you are setting an excellent example and I hope to see more countries following suit, so that people in developing countries will benefit from your generosity and benefit from the spirit of global solidarity.
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ANNEX 3
ADDRESS BY THE REGIONAL DIRECTOR, DR SHIN YOUNG-SOO, AT THE OPENING CEREMONY OF THE SIXTIETH SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
On behalf of our Member States and the more than 150 representatives who are here in Hong Kong to attend the WHO Regional Committee for the Western Pacific, I would like to express my sincere appreciation to our friends in the Government of the Hong Kong Special Administrative Region, People's Republic of China, for these excellent arrangements and all their hard work in making possible this session of the Regional Committee. It is indeed a pleasure for all of us to gather here in Hong Kong for this, the sixtieth meeting of our
governing body-the WHO Regional Committee for the Western Pacific. This is also a homecoming of sorts for our Director-General, Dr Margaret Chan, who was serving as Hong Kong's Deputy Director of Health when the Regional Committee last met here in 1992. Thank you, Margaret, for joining us here today. This dynamic city can take great pride not only in its economic achievements, but also in its great progress in public health. Hong Kong's health indicators rank among the best in the world. You can take particular pride in your consistently low mortality rates in infants and children under five years, as well as your low maternal mortality rate. But, like many other developed economies, you have seen an increase in the disease burden associated with chronic noncommunicable diseases, including cancer, heart disease, stroke and chronic respiratory diseases. As most of us remember, Hong Kong, its people and their public health system were put to the ultimate
test early in 2003 during the outbreak of SARS-severe acute respiratory syndrome. Margaret is too modest to say this herself, but the world watched in admiration as Hong Kong fought back against that frightening disease. I remember a very senior WHO official at the time as describing Hong Kong's response as "heroic". Those were truly difficult days, but Hong Kong survived - and its public health system has come out of the experience with new strength. This city is now a global leader in the fight against emerging diseases. WHO has always enjoyed a strong relationship with our friends and colleagues in Hong Kong. The wannth they have shown us today in welcoming us to Hong Kong, as well as the excellent arrangements they have made for the sixtieth session of the Regional Committee for the Western Pacific, are greatly appreciated by all of us.
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ANNEX 4 ADDRESS BY THE RETIRING CHAIRPERSON, DR FRANCISCO T. DUQUE ill, AT THE OPENING CEREMONY OF THE SIXTIETH SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
It is September once more, the month that we are all looking forward to every year as the time when we gather together for the Regional Committee Meeting. Yet, it seems like so long ago when we gathered together in the Philippines, my home country, and in Manila, the city that is home to the WHO Western Pacific Regional Office, for the fifty-ninth session of the Committee. Many unprecedented developments have occurred so unexpectedly, holding our attention and demanding our energies so intensively that the passing oftime has seemed so swift. As the current Chairperson of the Regional Committee for the Western Pacific, it is a great honour and privilege for me to thank and express deep appreciation on behalf of the Regional Committee, to the Honourable Donald Tsang, Chief Executive, Hong Kong Special Administrative Region, for opening its doors and providing an excellent venue for the Committee's work. This is the third time in the history of the WHO Western Pacific Region that Hong Kong is playing host to us. I consider it providential that in its history and tradition of excellence in the finance and health sectors, Hong Kong is hosting this sixtieth session of the Regional Committee where two topics of urgency and import will be deliberated on in depth-the global financial crisis and its impact on health, and the 2009 HI NI pandemic. I am sure my fellow representatives will agree with me when I say that on not a few occasions in the past, Hong Kong has shown to the world its capacity, its resolve, and the bold actions it has taken as it engaged a broad spectrum of society to meet and respond to different challenges. I will be handing over my responsibilities to a new Chairperson shortly. So much headway has been achieved over the past year and I am quite proud and assuredly inspired by the encouraging results of our collective efforts in following through on what we planned to do in the Region, for the Member States and the WHO Secretariat alike. I trust that our partnership, friendship and commitment will see us through as we face new challenges ahead. Again, allow me to extend my felicitations and gratitude to the Government and the people of Hong Kong for their hospitality and for the excellent preparations for this meeting. I wish to thank all the delegations that have come to participate and to contribute towards making the Committee and its work significant and meaningful. Best wishes to all for a successful meeting and an enjoyable and memorable time of learning and sharing.
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SUMMARY RECORD OF THE FlRST MEETING
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ANNEX 5 ADDRESS BY THE RETIRING CHAIRPERSON, DR FRANCISCO T. DUQUE m, AT THE OPENING SESSION OF THE SIXTIETH SESSION OF mE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
I would like to start by, once again, expressing on behalf of the Committee, our sincere appreciation to the Government and the people of Hong Kong Special Administrative Region for graciously and efficiently hosting the sixtieth session of the WHO Regional Committee for the Western Pacific. It always feels good to be in Hong Kong. What we all witnessed and experienced since we arrived and during the Opening Ceremony this morning, are indications of how our hosts have meticulously planned and prepared for this Meeting. Thank you very much. I also wish to express my personal thanks to you Distinguished Ministers and Representatives for the privilege of serving as the Chairperson of the fifty-ninth session held in Manila last year. As you all know, the 59th session was very memorable. Among other things, we, the Committee, made a very important decision. We nominated a person who will serve as the Regional Director for the Western Pacific; a person who is to lead this Region and work with us in facing our health challenges over the next five years. Dr Shin Young-soo, welcome to your Regional Committee. Let us applaud the new Regional Director. As this is your first Regional Committee Meeting as Regional Director, we look forward to hearing from you how we as a Region would continue to work to achieve our shared vision of better health for our people. Let me assure you of the full support of this Committee. It is heartwarming to note that today, our very own health advocate and leader, Dr Margaret Chan, is here to address the session as WHO Director-General, in her home ground-among old, familiar places and hopefully not so old familiar faces, her colleagues and friends not only in Hong Kong but also in the far comers of the Western Pacific Region. I recall that during the opening session last year in Manila, Dr Chan stated that "prevention is the heart of public health. Equity is the soul." She cited the report of the Commission on Social Determinants of Health and intimated the gist of the then forthcoming 2008 World Health Report-<iocuments that provide a comprehensive view of current health challenges and a clear roadmap ahead of us. Indeed, more than ever, it has become clearer to us that primary health care is the way to go, grounded on and directed by the principles of universal coverage, people-centred services, healthy public policies and leadership. In all the health issues and concerns that we tackled last year and followed through to appropriate responses and interventions, these principles apply. They will serve us in good stead as we strengthen and sustain our work and as we face new challenges in the Region. Distinguished Representatives, the year that was, had once again demonstrated how we, as a Region could get together, share and learn from each other, and rally behind each other in addressing the health challenges that we faced. As I implied during the opening ceremony, the health sector is caught in the middle of two unprecedented crises. How we respond now and in the short- to medium-term would determine how our health systems would be better prepared for and cope with what the future brings. In light of globalization
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Annex 5 . and changes in disease patterns and the environment, as well as increasingly complex health needs of informed and empowered populations, vigilance is our shield and preparedness our strongest offensive weapon. What are these current challenges? First, the global financial crisis. We all know that, generally speaking, many of our health systems have inherent and persisting weaknesses and could be considered on sick bay at the time the crisis hit. Theirs is a compromised capability that is much wanting in the face of greater need brought on by the financial crisis. It is now straining under a double burden-already limited and probably even dwindling resources and an expanding demand for services. Weaknesses will become even more apparent under such stress, which will eventually impact on health services and health outcomes. And therefore, while addressing the financial crisis is not necessarily WHO's primary mandate, WHO had nonetheless helped us by raising its voice and elevating the cause of public health to the high level discussions on addressing the financial crisis. In the Philippines, the government has responded to the crisis by pouring funds on key social services
including health that give the poor economic opportunities and provide them with social protection. We have seen the steady and unprecedented increase in our health budget in recent years at levels that are unmatched in history. This significant increase in health investments has enabled us to expand the national health insurance programme (NHIP) to cover more indigents and to enhance our major public health programmes which are geared toward the achievement of the MDGs. Second, but not necessarily the lesser, we have the Pandl!mic (HINI) 2009. We were witnesses to how WHO demonstrated its leadership in handling the pandemic; how WHO Headquarters, Regional and Country levels closely and unselfishly collaborated in ensuring that infi)rmation and resources Hewed in a timely and responsive manner to where they are needed. The Philippines had its first case on May 21. In the three months that we have confronted the A(HIN1) virus, we coped with many pressures and challenges similar to those faced by other developing countries and governments with limited resources. We needed to closely watch the events with intensive surveillance and expand laboratory capacity to provide data that will help lIS adjust our planning and tweak our national policies accordingly. While we had a lot of uncertainty, the challenge largely was to instill a sense of calm in an atmosphere of confusion and panic and thus minimize the socioeconomic impact in our country. But we braved the challenge of doing so much despite the limitations that we have. And for this I wish to thank the WHO for its exceptional collaboration with the Philippines in the fight against the 2009 A(HIN1) pandemic. It is this spirit of unity and cooperation at the global level that will enable us to weather the storm that may be coming should this pandemic tum out for the worse. As we fear the coming of a second wave, together our governments must remain vigilant. Jointly, we must confront this pandemic in a collective, proactive and open manner. We all appreciate how the whole Region has been on its toes to remain on top of the situation in dealing with these two unprecedented crises that have taxed and stretched our health systems and resources to their limits.
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Annex 5
But allow me to just refresh ourselves on some of the discussions we had this time last year; the decisions and commitments we made. I believe that what we have set out to do last year resonate well with what we needed to do to help us in our current work. We discussed and provided guidance on future directions for strengthening health systems in the Region and to renew our commitment to Primary Health Care. We recognized that there is a need to critically look at country-specific health systems issues and address these appropriately. We all agreed that strengthening health systems is fundamental to accelerating achievement of our global health goals. For example, when we reviewed our progress towards achieving the Millennium Development Goals 2 years ago, we noted that progress has been uneven and that we needed to strengthen our collective efforts for a more systematic and targeted approach. The Committee also deliberated on two other rapidly escalating health issues - the increasing burden of noncommunicable diseases and the worsening situation brought about by climate change and its impact on health. We appreciated WHO's response to requests from Member States for guidance in addressing these two issues. We reviewed and endorsed the Western Pacific Regional Action Plan for Noncommunicable Diseases which would guide our collective response and take us to the next level in addressing the multisectoral challenge posed by NCDs. The same is true with climate change. The Regional Framework for Act~on to Protect Human Health from the Effects of Climate Change called for increasing awareness of the health consequences of climate change not only within the health sector, but more especially, among sectors outside of health whose decisions have implications on climate change and health. It therefore called on the health sector to strengthen the capacity of health systems to prevent andlor provide protection from climate-related risks, and maybe as important, to participate more actively in national and international processes related to climate change. Dengue fever and dengue haemorrhagic fever have been with us for quite some time. We could say we had a checkered performance when it came to addressing this major public health problem. The Region had experienced several dengue outbreaks over the past two decades; the geographic distribution had greatly expanded, also because of emergence of more and more factors that contribute to its spread. The Dengue Strategic Plan which we discussed and endorsed provided concrete steps and sound guidance for a more comprehensive approach to dengue fever prevention and control. Here we are again gathered for the sixtieth session of the Regional Committee. We have a heavy agenda for the next few days. We had commitments; we have the support of each other and our international partners; we had guidance on how we could, as individual countries and as a Region, meaningfully address the difficult challenges to the health and development of our Region. I believe that we should all grab this opportunity, have a holistic perspective, and a sense of urgency for aggressive action.
In our day-to-day work and in these times of crisis, the Regional Committee has shown its solidarity and resilience, learning from and supporting one another and doing our best for the common good of our people. I am confident that such solidarity even in diversity will guide our deliberations and dictate our decisions at this
meeting.
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Annex 5 I would like to express my deep appreciation to my fellow office bearers: Mr Iakoba Itateli of Tuvalu, our Vice-Chairperson; Professor Chew Suok Kai of Singapore, our English Rapporteur; and Dr Sok Touch of Cambodia, our French Rapporteur. And again to all of you, Distinguished Representatives, my colleagues, the WHO secretariat, my sincerest thanks. You have all given me not only honour to be able to serve as Chairperson, but the excellent support that has made my work an easier and most enjoyable one. To the incoming Chairperson, I offer you my personal congratulations. In your hands I know that we could look forward to a successful meeting. I expect to continuing to work closely with you to translate what we agree on and commit to do here into actual and meaningful actions in our own countries for a truly inclusive and equitable sharing of the fruits of development--health most of all, for all. My best wishes to everyone for a memorable time--in and out of the meeting.
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ANNEX 6
ADDRESS BY THE DIRECTOR-GENERAL AT THE OPENING SESSION OF THE SIXTIETH SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
It is a great pleasure for me to be back in my home region, back in my home town. I thank the Government of Hong Kong for its hospitality in hosting this sixtieth session of the Regional Co=ittee for the Western Pacific. Let me also extend my congratulations to Dr Shin for his first report to this committee and for the clear priorities it defines. The report reinforces this region's co=itment to the Millennium Development Goals, the tenets of primary health care, and the plight of the poor.
It is encouraging to see a record of progress in many areas. This is a tribute to the Region's cohesion and spirit of mutual support among countries at vastly different levels of development. Grounds for optimism and encouragement are especially welcome right now. We are meeting at a challenging time, as public health struggles to position itself in a cross-current of strong trends. On one side, prospects for progress are battered by global crises on multiple fronts. The world faces the most severe economic downturn in at least three decades, a climate that is changing for the worse, and an influenza pandemic that is now unstoppable. All of these crises have profound implications for health. On the other side, prospects for progress are bolstered by unprecedented determination to solve longstanding problems and achieve greater equity in health outcomes. The Millennium Declaration and its goals give this world its best chance ever to introduce greater fairness and balance into the very fabric of societies, especially for health. We cannot allow this momentum to stall. Precisely because of these global crises, the price of failure keeps getting higher. At the international level, I see some reasons for optimism. Commitment to the health-related Millennium Development Goals is steadfast. Efforts to accelerate progress are actually increasing. And they are doing so with a solid awareness of the challenges. In the nine years since the Millennium Declaration was signed by heads of state and heads of government of 198 countries, countries and donors have come face to face with two fundamental problems that consistently block progress: weak health systems and ineffective aid. The importance of these problems is readily apparent in the reports before this committee. In the absence of well-functioning health systems, powerful interventions and the money to purchase them will not be enough to reduce the great gaps in health outcomes. The Millennium Declaration revitalized the values of equity, social justice, and universal coverage set out in the Declaration of Alma-Ata thirty years ago.
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Annex 6 Last year's report of the Commission on Social Detemlinants of Health concluded that health systems organized to achieve universal coverage do the most to improv<e health outcomes. The Commission recognized that equity is strongly influenced by the way health care is organized, financed, and managed. It endorsed primary health care as a model for a system that acts on the underlying social, economic, and political causes of ill health. Progress in health development is not measured by national averages. True progress is measured by how well we reach the people left behind and enrich their live:s through better health. The best way to do this is through people-centred primary health care. We know this. As noted in your reports, improvem~:nts
in health status in this region have been
especially great in countries where health systems have maintained effective primary health care. The need for stronger health systems is closely linked to the need for more effective aid. The logic is straightforward. Good aid builds the foundation, the capacity, and the infrastructure needed to move towards self-sufficiency. Good aid aims to eliminate the very need for aid. If aid does not explicitly aim for selfsufficiency, the need for aid will never end. Both of these realities are fully reflected in the health financing strategy for the Asia Pacific Region, which you will be discussing. As noted, one way to stretch limited funds is through greater efficiency in the performance of health systems. As further noted, greater efficiency is not only badly needed. It is also entirely feasible. Let me give just two examples. Your report cites evidence that more than half of medical product use is irrational use. I repeat: more than half of medical product use is irrational use. Last year's World Health Report, on primary health care, cites evidence that effective use of available preventive measures could reduce around 70% of the global disease burden. Again, these estimates recall the advantages of primary health care as a strategy that stresses the need for appropriate technologies, promotes the rational use of essential medicines, and places prevention on a par with curative care. At the same time, you do not underestimate the challengl!s. Countries in this region are deeply concerned about the effects of the economic downturn on health. You are rightly concerned, for all the right reasons. The conclusions of your report on the global financial crisis are stark. Some hard-won economic and social gains have already been erased. Countries in this region, with their strong reliance on export-oriented sectors and on tourism, are especially vulnerable to job losses and to reduced employment-related social benefits. The Asia Pacific region has the world's highest reliance on user fees, co-payments, and out-of-pocket expenditures as a strategy for financing health care. This is an unfortunate legacy from policies introduced during previous economic crises. Such a strong reliance on user fees is incompatible with your policy objectives of universal coverage
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Annex 6 and equitable access to quality health services. It is incompatible with strategies for poverty reduction as a route to better health As noted, countries in this Region are under strong pressure to reduce health budgets and extend user fees and co-payments. You are painfully aware of what this means: a further deterioration in access, equity, quality, and utilization of health services. This region, which struggled so long to lift millions of people out of poverty, does not need a setback that again pushes millions below the poverty line. This Region, which has struggled against the unfairness inherent in user fees, does not need to see the
situation grow even worse. We simply must not make the same mistakes again. Sadly, the policies and international systems that contributed to the economic crisis are beyond the influence of the health sector. Sadly, health bears the brunt of the consequences. As I mentioned at the start, grounds for optimism are very welcome now. Let me refer to two trends in
this region, evident in your agenda, that I find especially encouraging. First, you are building on success and setting your sights ever higher. This is true for your progress in reducing child mortality and especially in setting even higher goals for the elimination of measles and the control of hepatitis B infections. This is true for malaria and the goals set for elimination. This is also true for tobacco control, where this Region has long been a leader. This is the first and only region in which all eligible member states have ratified the WHO Framework Convention on Tobacco Control. You are now moving on to the next level, the highest one: complete implementation of the Framework Convention within the next five years. In a second welcome trend, countries in this region are taking command of the health agenda through comprehensive cross-cutting strategies that tackle the need for stronger capacities. With the Asia Pacific strategies, whether for the response to emerging diseases or the upgrading of laboratory services, you offer a clear direction forward in a step-wise approach, with indicators for measuring progress that match conditions in your countries. In this way, you put countries in a much stronger position when aligning aid with national priorities and capacities. Support for stronger health systems and more effective aid is also growing at the international level. Major sources of financial support, like the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, and the World Bank, have established platforms for strengthening health systems. Instruments such as the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action support efforts, including responsible actions by donors, to make aid for health more effective. Momentum to reach the Millennium Development Goals continues to be propelled by a strong sense of urgency. Later this week, a forceful and focused drive is being launched in New York to accelerate progress
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Annex 6 . towards improving maternal, newborn, and child health. In just a few months, world political and financial leaders have put together a series of ambitious recommendations for the innovative funding of stronger health systems. These recommendations will also be announced this week in New York. While we need optimism, we also need to be frank and realistic, especially when we consider the health impact of faulty or short-sighted policies made in other sectors. In a sense, the Millennium Development Goals are a corrective strategy. They aim to compensate for
international systems and policies that create benefits, but have no rules that guarantee the fair distribution of these benefits. The Goals and the many initiatives and funding mechani.sms launched to support them are badly needed and do much good. But they do not address the root cause of inequities in health outcomes. As we know from the Commission on Social Determinants of Health, the root causes lie in flawed policies. Greed seeded the financial crisis, which sprang out of control as corporate governance and risk management failed at every level of the system. Climate change is now the price the world will inevitably pay for short-sighted policies. The pursuit of economic wealth took precedence over the protection of the planet's ecological health. The Western Pacific Region is especially vulnerable to the effects of climate change. In a world of radically increased interdependence among nations, the consequences of mistakes made
in one country or in one sector are highly contagious. The consequences of this contagion are profoundly unfair. Developing countries have the greatest vulnerability and the least resilience. They are hit the hardest and take the longest to recover. As the influenza pandemic continues to sweep around the world, I believe we will see what the world's collective failure to care about equity really means. A virus that causes manageable disruption ~ealthy countries is very likely to cause devastation elsewhere. " In June, when WHO announced the start of the 2009 plmdemic, many eyes looked to countries:: <.he southern hemisphere for clues about how the pandemic might evolve. Let me thank countries in this rt),J.< ,
for their intensive surveillance and rapid and comprehensive reporting. This response has helped countnes elsewhere know what to expect and how to prepare. As a tt)Chnical discussion of the pandemic is scheduled tor tomorrow, let me focus on a few issues that I find important at the international level. The past two weeks have brought some good news. Evidence is growing that antiviral drugs can reduce the risk of severe disease. And results of early clinical trials suggest that a single dose of pandemic vaccine
SUMMARY RECORD OF THE FIRST MEETING
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Annex 6 may be sufficient to confer protection in healthy adults. If confirmed, this finding will literally double the amount of vaccine available. Here is the big question: will this result in more equitable distribution of vaccines? Let me assure you: I am pursuing this opportunity from several angles. I am concerned on another issue. Evidence from all outbreak sites confirms that pregnant women are at increased risk of severe or fatal infection. This increased risk becomes all the more important for a virus, like this one, that preferentially affects a young age group. The deaths of pregnant women during the pandemic will be tragic everywhere, but most especially so in the developing world, where the numbers will be so much higher. Since taking office, the health of women has been one of my top priorities. A renewed commitment to primary health care underpins efforts to improve the health of women. This relationship is starkly evident in a report on Women and Health that I have commissioned. The report, which will be issued in November, explores the many health risks that women face throughout the life course, and sets out an agenda for change. As we all know, weak health systems are wasteful. They waste money, and dilute the return on
investments. They waste training when health workers are lured away by better working conditions or better pay. They waste resources when needless procedures are performed, or when regulatory systems fail to control the price and quality of medicines. They waste opportunities for poverty reduction when poor people are driven even deeper into poverty by the costs of care or the failure of preventive services. Above all, weak health systems waste lives. I believe we will see, in a measurable and tragic way, what inequities really mean as the pandemic sweeps through a world where differences in health status and standards of care 'are greater than at any time in recent history. Perhaps now, some of our long-standing arguments about equity, fairness, and social justice will have a greater chance of being heard, though the price for such attention will be measured in human lives.