Steering committee for onchocerciasis control in the Volta river basin area : report of its fourteenth session, Geneva, 22-24 September 1975

RESTRICTED STEERING COMMITTEE FOR ONCHOCERCIASIS CONTROL IN THE VOLTA RIVER BASIN AREA REPORT OF ITS FOURTEENTH SESSION Geneva, 22-24 September 1975 i:i i fluT, 'it75 M -> w AB c -2 CONTENTS Opening of Session - Election of Chairman . Adoption of the Agenda Matters arising from the previous Session . . Recruitment of the Economist . . Closing date for SignaLure of Fund Agreement Research - Cost of Establishing S. damnosum Colonies Economic DeveloPment Activities Economic Development Advisory Panel D. Progress Report on the Onchocerciasis ConErol Programme for the second quarter of L975 E. Aerial Contract . . F. Purchase of Insecticide . c. BudgeE 1976-1979 H. Consideration of Ehe rePort of the Second Meeting of the Scientific and Technical Advisory Committee . . I. Report of the Third Meeting of the Ecological Panel . J. Economic Development Activities and FAO/IBRDReport on Fact Finding l"lis sions K. Second Session of the Joint Coordinating Committee L. Other matEers . . Funding of Economic DeveloPment QuarterlY RePorts M. Arrangements for the next Session . . N. Adoption of the RePort O. Closure of the Session ANNEX ParticiPants . Paragraph 1 3 15 I8 2t 33 35 Page 3 3 3 3 3 4 4 4 4 5 6 7 8 9 t4 4 5 5 5 30 6 7 44 46 47 48 49 7 7 8 8 8 8 8 8 9 -3- A. OPENING OF SESSION - ELECTION OF CHAIRMAN 1. The fourteenth session of the Steering Conunittee was opened by Dr A. Bellerive (WHO) at WHO Headquarters, Geneva, oo 22 September 1975. Dr Bellerive welcomed Dr Candau, Indepen- dent Chairman of the Joint Coordinating Committee (.lCC), l"lr E. peter hlright and Mr l"l. Burer(I{orld Bank), and introduced l,Ir F. WaIsh, progrannne Entomologist. 0n the proposal of the Bank, Dr A. Bellerive was elected chairman of the session. ADOPTION OF TTIE AGENDA The agenda adopted \das as follows: 2 B 3 I 2 3 4 Opening of the session Election of chairman Adoption of the agenda I"latters arising from the previous session: (a) Recruitment of the economist (Thirteenth session Report, para. 5)(b) Economic Development Advisory Panel (Thirteenth Session Report, paras. 29-30) Progress Report on the Onchocerciasis Control Progranune for the second quarter of L975 Aerial contract Purchase of insecticide Budget I976-1979 Consideration of the reporL of the second meeting of the Scientific and Technical Advisory CommiEtee Report of the third meeting of the Ecological panel Economic development activities and FAO/IBRD report on fact finding missions Second session of the Joint Coordinating Conrnittee: (a) agenda(b) distribution of documents(c) other arrangements Other Eatters Arrangements for the next session Adoption of the report Closure of the session 5 6 7 8 9 10. 11. L2. t4. 15. 16. 13. C. MATTERS ARISING FROI,I THE PREVIOUS SESSION 4. Recruitment of the economist Ihirteenth Session rt ara. 5 Following the agreement reached at the thirteenth session of the Steering CornmiEtee, FAQ selected Dr El-Kashef. The candidature was submitted on 13 June 1975 and was rejected by the Goverrunent of Upper Volta. Two further candidates were submitted in order of preference(Or n. Reeser and Dr Neumann-Damerau). The clearance from Upper Volta for Dr Reeser was received on 3 September 1975, by which time he had accepE.ed employu.ent elsewhere. FAO would make every effort to locate oEher candidates and to have the selected candidate in place weIIbefore the next session of the Joint Coordinating Conrnlttee. 5. Closins date for s Eure of Fund Agreement (l'hirteenth Ses sion Report. para. 9 ): Ihe Bank lnformed the CorunitEee by new donors. that the Agreement would remain open indefinitety for signature 46. Research - cost of ectablishi damnosum colonies (Thirteenth Session rt, paras 1O- t tee at two eements re een established or reseafch in this field: the first involving $ 4OOO, with the Center for Disease Control, Atlanta, USA; the second, involving $ 1800, with the University of Tubingen, Federal Republic of Germany. Further developments would be considered at a meeting which would take place in late October (paragraph 27). E conomic development activities (Ihjrteenth S ession Repo rt. para. 13): IINDP informed the cormnittee thar meetings had taken place between Mr Doo Kingu6 (UNDP) and represenEatives rojects for whichof various donors who had expressed interest in financing preinvestment P UNDP resources could not be available. lopment Advisory Panel (noeP) (ItrirteenEh Session RePort, Paras. 29-30) : 7, 8. Economic Mr Wright reported on his discussions with Mr Connnittee that a rePort would be prepared by the Ch 11. Brief details of probably came from out and other bodies of wa proportion, in manY ca batch of eggs; severa Onch ocerca volvulus. parasites than savanna PauI I'larc Henry and informed the airman of EDAP and circulated to the members of the Steering Committee for comments before the second session of the Joint Coordinating Conunittee. As for the composition of the Pane1, the CommiEEee agreed that iEs membership would be established later as more data became available on Lhe economic activities to be underEaken in the area. D. PROGRESS REPORT ON THE ONCHOCERCIASIS CONTROL PROGRA}'IME FOR THE SECOND QUARTER OF 1975 9. The progress Report was introduced by the Programme Director who briefly described developments which had taken place during the last two months, in particular regarding the entomological siEuation. I"Ir Walsh, Prolranrne Entomologist, explained that aerial application of Abate had proved extremely effective in controlling the breeding of Simuligm dalnnosum in the rivers and streams of the phase r zor.e. However, despite the effective larval control, there had been an invasion of flies in the southern peripheral areas. so far, entomological findings suggest that the flies were coming from outside the treated zone. This phenomenon began in May, and continued through June, July and August; however, a marked reduction in the number of flies had occurred by the third week in September' This reduction was not related to any operational act.ivities. At that time, the 33rd consecutive week of the aerial spraying oPerations,control of the vector was satisfactory in the greater part of the Phase I area. 10. The Bank expressed concern about Ehe extent of the invasion and its implications for economic development. wHO pointed out that it was not possible to predict the epidemiolo- gical implications of the $,eE season influx of flies into the control zone at this stage'and that in the densely populated region of south-west upper Volta excellent control of the vector had been achieved, and a satisfactory situation had also been maintained in the Bourgouriba va1leY. the entomotogical findings were given which indicated that the flies side the zone under control: extensive searches of breeding sites ter within the zone had yielded very few larvae; a very high ses 1007., of the flies were old, having already laid at least one 1 flies carried more than five infective stages of Ehe parasite As forest flies tend to carry a substantially larger number of such flies a southerly origin for the invading flies is suggested. -5- L2. Alt.hough a certain degree of reinvasion had been anticipated in the PAG report,l which was based on the best entomological knowledge available at the time, the exact extent of reinvasion could not be foreseen without the implementation of control operations on the Present scale. The Connnittee was informed that to meet the present situation, an intensive research Progralnme would be undertaken at Ehe beginning of the 1976 wet season Eo determine the origin of these flies. 13. InvestiSations to be carried ouE in the Phase I and II zones would indicat.e the pattern of implemenlation of control operations appropriate to the Phase III area. Ihe possibility was menEioned of the need to revise the approach to control operations in some areas to achieve satisfactory epidemlological results in certain peripheral zones. E. AERIAL CONTRACT 14. The Steering Committee, informed of the discussions held with Evergreen Helicopters Inc. for the expansion of the fleet for Phase II, expressed concern about the high cost presented to them. WHO was requested to negotiate the additional requirements based on the best available price on the market, and report to the committee. F. PURCHASE OF INSECTICIDE 15. The difficulties encountered during recent months in the procurement of the Abate insecticide were described by WHO. Ttrese were due mainly to the failure of the parent comPany (American Cyanamid) to provide sufficient active material to the manufacturer(Procida), and also to the delivery of poor quality material. According to information recent.ly received from American Cyanamid, production facilities were being extended which would enable the company to produce sufficient quantities of Abate to satisfy the demands of all consumers. 16. To meeE the needs of the Prograrmne in the first half of L976, and to avoid the necessity for repeated air shipments, WHO proposed, subject to the Committeers agreement, to place an order for 150 000 litres of Abate special formulation for delivery according to the following timetable: November - 50 000 litres January - 50 000 lirres March 1976 - 50 0OO lirres L7. With regard to the remaining 75 ooo litres required in L976 it was considereddesirable, in view of the high cost of Abate, to ar^7ait the results of the evaluation of anot.her promising insecticide. G. BUDGET L976-L979 18. The Conrnit.tee revi-ewed the draft budget estimates for L976. It was felt that the Progralnme f.or L976 should be reviewed to al1ow the budget for presentation at the second session of the Joint Coordinating Conrmittee to fo11or^r more closely the figures presented at the first session in Abidjan. 19. WHO pointed out that the changes were due in part to inflation and increases in salary scales in the Programme area. A1so, expenditure it L974 and 1975 had been lower than anticipated and certain items had been carried over to 1976. 20. It was agreed that wHO would prepare a revised budget based on the allocation for thethree-year period 1974-L976 which would be circulated Eo the Steering Committee for comments.At the request of the representative of UNDP it was agreed by the Committee that for future sessions of the JCC a comprehensive table would be prepared indicating the Eotality of the expenditures incurred under the Progranrne. Report of the PreParatory Assistance Mission to the Governments of Dahomey, Ghana,Coast, Mali, Niger, Togo and Upper Volta (OCp/Z:.f). 1 Ivory -6- H CONSIDERATION OF TIIE REPORT OF THE SECOND MEETING OF THE SCIENTIFIC AND TECHNICAL ADVISORY COMMITTEE 21, The report, and in particular the reconrnendations made by the Scientific and Technical Advisory Conunittee (STAC) at its second meeting, were reviewed by the Steering Committee. 22. In reply to a query from the Bank, VJHO explained that Cameroon was suggested by STAC as being a suitable country for the studles on the dynamics of transmission and the patho- genesis of onchocerciasis, because longitudinal epidemiological studies had already been under- taken in the north by a British Medical Research Council team. WHO sEressed that the possibility of pursuing such a comprehensive study in other countries, though under considera- tion, might present problems in view of the difficulties of recruiting personnel experienced in the differenE disciplines required. To be directly applicable Eo the Programme the reconrnended studies would require to be carried out in a savanna area. 23. Referring to the reconrnendation for the setting up of medical survey teams for the study of exisEing patterns of disease, the Bank expressed concern at the financial implications involved for the Participating Governments. It was agreed that this would be drawn to the attenEion of the JCC by the Steering Committee when submitting the STAC report. 24. The usefulness of a mathematical model in the control of onchocerciasis, not only in the Prograrrne area but elsewhere, was explained by WHO. ft v,/as further explained that Ehe establishment of a suitable clinical institution in the dry savanna zone of the Progranrne area only implied the provision, to existing facilities, of the services of a pharmacologist clinicianand a senior technical officer, with supporting equipment. 25. The Bank expressed concern abouE the apparent lack of progress in the development of new drugs and urged thaE more atEention be devoted to this subject. To motivate the drug industry to increase and accelerate the search for new filaricidal drugs, the Committee considered that it might be more stimulating to guarantee a market for a suitable product rather than to directly finance the develoPment costs. 26. WHO then reported on the results obtained using different regimens of treatment with existing drugs and indicated its intention Eo establish contracts with other institutions within the Programme area, and elsewhere, for the expansion of such studies. The Committee was advised that the Organization as a whole is devoting considerable attention to the development of new drugs for Ehe treatment of parasitic diseases. OCP was coordinating its work in this field with the other technical units concerned. 27. Action taken in Ehe field of entomoLogical research in line with the STAC recommen- dations was described, and mernbers were informed that a Scientific Advisory Panel (SAP) working group would meet in October to consider the development of self-perpetuating colonies of S. damnosum. 28. The Cormnittee was then informed of work planned on the evaluation of insecticides, including chlorphoxim emulsifiable concentrate, and microencapsulated methyl-dursban, and on refining the method for susceptibility testing. Zg. V,lith regard to training, WHO proposed that the funds available under the UNDP training component be used to enhance the expertise of national postgraduaEe specialists in fields of direct importance to the Progranrne. 7I. REPORT OF THE THIRD MEETING OF THE ECOLOGICAL PANEL 30. In reviewing E.he report of the third meeting of the Ecological Panel (EP), the Counittee noted that there was duplication of interest between the Scientific and Technical Advisory Committee and the Panel. 31. In view of the need to identify the roles of each body it was recommended that the Panel should meet with the Scientific and Technical Advisory Committee at the time of the latterrs third meeting scheduled for 2-4 March 1976. 32. Noting that members of other advisory bodies had been appointed for a specific term, the Committee recoflEnended that the period of office of the present Ecological Panel members should expire in June 1976. Future appointments would be for t\^,o-year periods without prejudice to reappointment. J. ECONOMIC DEVELOPMENT ACTIVITIES AND FAO/IBRD REPORT ON FACT FINDING I"IISSIONS 33. The CommitEee took note of the status report prepared by FAO on economi-c development activi-ties in five of the seven countries, and the supplementary tabulated information provided by UNDP covering the whole Progranrne area. The Committee considered the draft rePort of the June-July 1975 FAO/IBRD fact finding missions to fivel of the seven countries, and IINDP stated that the report had been carefully sEudied and was to be strongly commended. It was only to be regretEed that following Ehe preparati-on of the methodology in December 1974 it had taken so long to reach this point. In reply, FAO stated that at least two visits of FAO/IBRD staff to the countries had been necessary to achieve this, and that acEion progr€unmes for Mali, Ghana and Dahomey have still to be started. 34. Concerning the dist.ribution of the report, it was agreed that the fu1l report would be presented in a slighEly amended form to the seven Governments by the IINDP Resident Representati-ves concerned. In the case of Togo, Dahomey, Upper Volta, Mali and Ghana, a draft country paper on the development of Ehe onchocerciasis freed zones would also be submitted to the Governments. The Governments of Mali, Upper Volta, Ghana and Dahomey would furthermore receive draft Project Documents outlining those portions of the proposed economic foIlow-up Progranme to be financed under the special "Onchotrallocation of the IINDP/Regional Progrannne for Africa. K. SECOND SESSION OF THE JOINT COORDINATING COMMITTEE 35. At the request of the Independent Chairman,the Cornrnittee reviewed and conunented on the draft agenda for the second session of the Joint Coordinating Committee which would take place in Paris froa 2 to 4 December 1975. 36. It was agreed that while the session is scheduled to last three days, be made in the Information Circular of the possibility that the work of the be completed within two days. mention would Committee might 37. The session would be opened by the Independent Chairman who informed t.he Committee that he would make a statement during, or inunediately following, the opening. 38. With regard to documentation, the Independent Chairman pointed out that docr.rnents should be sent to members of the Committee 45 days before the session, i.e. mid-October. The Bank informed the Independent Chairman that the report of the Chairrnan of the Economic Development Advisory Panel would be available to the Steering Conrnittee by mid-October. 39. Regarding the economic development activities, it was agreed that statements would be made by LTNDP, FAO and the Bank,and that Ehe Independent Chairman would give the floor to the delegations thereafter. I Dahomey, Ghana, Mali, Togo and Upper Volta. -8- 40, The Conunittee felt that the report of the Ecological Panel to be presented to the JCC should be reviewed with the convener of the Panel. 41. With regard to the financing of the Programme, the Bank indicated that a statement of account would be circulated at the session. 42. It was agreed that WHO would be responsible for the distribution and translation of documents for Ehe JCC, and agency requirernenEs \^,ere indicated as follor,rs: UNDP - 4 English' 8 French; FAO - 20 English, 20 French; IBRD - 50 English, 25 French. 43. As specified in the Memorandum of Understanding, the Committee would be serviced by a joint IBRD/WHO secretariat. It was agreed that other arrangements for the session would be discussed by the Independent Chairman with WHO and IBRD personnel. L. OTIIER MATTERS 44. Funding of Economic Development: With regard to the securing of alternative sources of finance beyond the $ 3.5 million provided by UNDP for preinvestment, the Bank indicated that, although not geared to providing finance for technical assistance to Goverilnents, it might be considered as a source of last resort should UNDP and bilateral agencies not be able to provide sufficienE funds for these activities. 45. UNDp agreed to present to the next session of the Steering Committee an outline of the resource siEuation as it exists after having received from Participating C,overnments an indication of the use of IINDP Country Programme Funds. 46. Quarterly Reports: It was agreed that the third quarterly rePort could be circulated without its prior approval by the Steering Committee. M. ARRANGN,IENTS FOR THE NEXT SESSION 47, The Steering Conmittee agreed to meet at 4 p.m. on Monday, 1 December in the World Bank European Office, Paris, and, if necessary, to meet again immediately following the JCC Session. N. ADOPTION OF THE REPORT 48. The Committee reviewed and adopted the present rePort O. CLOSURE OF THE SESSION 49. In closing the session, Dr Bellerive expressed his appreciation to the members of the Committee for the objectivity and frankness they had shown in the discussion. 50. UNDp moved a vote of thanks to l"1r Groom and Mr Burer for the considerable amount of work they had carried out during the three day period of the session in producing the draft country papers on economic development. 51. On behalf of the Conrnittee, FAO thanked WHO for the hospitality offered and expressed appreciation for the assistance provided to members by the secretariat. I I 9 PARTICIPANTS Members of the Steerinq Committee Mr T. S. B. Aribisala, FAO Headquarters, Rome Mr M. Ls. Bazin, IBRD Headquarters, Washington Dr A. Bellerive, WHO Headquarters, Geneva UNDP was represented by t'Ir H. C. von Sponeck of IINDP HeadquarEers, New York Sec retar iat FAO lleadquarters IBRD Headquarters WHO Headquarters Onchocerciasis Control Prograrrne lleadquarters, Ouagadougou ANNEX Mr C. G. Groom, Senior 0fficer, (Policy and Planning) Agricultural Services Division Mr E. Peter Wright, Programs Director, Western Africa Mr M. Burer, Economist Mr D. Garff, Loan Officer, Western Africa Mr A. Groenendijk, Di.rector, Division of Budget and Finance Mr A. Imbruglia, Chief, Budget Unit Mr C.-H. Vignes, Chief, Constitutional and Legal I'latters, Legal Division Mr J. D. Marr, Entomologist/Biologist, 0nchocerciasis Control Progranrne Dr E. Onori, Epidemiologist, Onchocerciasis Control Programme Dr G. Qu6lennec, Entomologist/Chemist, Onchocerciasis Control Progranmre Miss R. Villars, Administrative Officer, Onchocerciasis Control Programme Dr M. G. Candau, attended the session. Dr P. ZLegler, Prograrnme Direct.or Mr F. Wa1sh, Entomologist Independent Chairman of the Joint Coordinating Committee, also I 1