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Western Pacific Advisory Committee on Medical Research, Manila, Philippines, 10 - 12 April 1979 : report of the fourth session

December 31, 1979 World Health Organization

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ICP/RPD/OOl

WPR/ACMR/79.20 30 April 1979 LIMITED DISTRIB!1l'ICIf EmLISH ORLY

WESTERN PACIFIC ADVISORY CCM<iITl'EE ON MEDICAL RESEARCH

Report of the Fourth Session Manila. Philippines 10-12 April 1979

Printed and distributed by the

Regional Office for the Western Pacific of the World Health Organization Manila. Philippines April 1979

oJ l.., . , l :; • L. .... Sunnary page 1

SUMMARY Provided the recommendations made to the Regional Director in the present Report are accepted. the following outcomes would be expected from this fourth session of the Western Pacific AdYisory Committee on Medical Research (WPACMR IV). These expected outcomes might also serve as a guide to the Secretariat for reporting progress to the Committee during its fifth session which will take place from 14 to 16 April 1980. For the sake of brevity. this introductory summary is limited to new initiatives; ongoing activities are specified in the full report. 1. Strengthening national research capability

WHO would assist with the preparations for a meeting of bilateral donors which would take place in Beijing early in 1980 for the purpose of catalyzing support for China's efforts to modernize her medical soience. Extrabud.getary support would be secured for the programme of support to virus laboratories in Fiji. as specified i~ a feasibility study. Following an observation visit by health and research administrators from the Republic of Korea. Japan and the Philippines to long-established medical research councils in Australia and New Zealand. and following a Chinese mission to study the modern organization and management of scientific research. a seminar for directors of the medical research councils in the Region would take place in February 1980. A report would be prepared on the training and career structure of health researchers in the Region. 2. Research within WHO's programmes of technical cooperation

Research on clonorchiasiS and paragonimiaSiS would be supported. particularly in the Republic of KOrea and in the people's Republic of China and increased (extrabud.getary) allocation would be secured for this embryonic programme. A regiQnal programme on diarrhoeal disease control would be developed jointly by the Secretariat Focal Group and the WPACMR subcommittee on diarrhoeal disease for presentation before the global Advisory Committee on Medical Research in November 1979. at which time extrabudgetary support would be sought. An independent group of ellperts meeting on 'Z7 to 28 September 1979 would help redraft the Secretariat's regional programme on acute respiratory infections. with a particular focus upon initiating intervention studies in Papua New Guinea. Fiji and the Philippines. Modern immunological techniques will be applied. with resources provided from bilateral sources. by participants returning from the Seminar on Tropical Immunology to be held in Sydney. Australia. from 28 November to 4 December 1979.

WPR/ACMR/79.20 S_ry pase 2 The WPACNR subcommittee on cardiovasoular and metabolic diseases would report on re.earch needs on diabetes allOng Polynesian and Micronesian island populations. Opportunities tor research on the heaUh hazards of working populations would be exaadnsd by the newly appointed WPACMR subcommittee on health serYtces and occupational health. eapeolally in countries where oooupational environJMnt. are ohanging. With a Yiaw to MOre etteotive malaria oontrol. the Secretariat would sti.ulate proposal. troll att.ot.d countries for research on the relatively n.glect.d area ot yector control tor submission to the appropriate SCi.ntitic Working Group ot the UNDP/World Bank/WHO Special Progra..e tor Research and Tra1ning 1n Tropical Diseases. .

Training in rese.roh ..thodology An intercountry worlulhop on re.earch design would be held in Chine

in 1980. A position paper would be prepared on training prosra-. tor research laboratory technicians. A further report would be received on tra1ning and career development ot epidemiologi.ts in the Region. 4. Resouroes for research

The 1979 researoh prog~. Whether supported trom regular budget or trcm extrabudgetary .ources. would be reported not only with reapect to the Re.earch Pro_tion kDd nevelop. .nt Proara- but al.o to the re.e.rch co..,onents at prcgraa.. covered by the WPACNR subc08l1ttees ant - parasitiC disea.es. - diarrhoeal di ..... s. - other oommunic.bl. d1 ••••••• - he.lth •• rvio •••nd oocupational health. - taadly health. and cardi~.soular

and metabolic diseases.

'!.'be outCOII8 ot a meeting betwe.n donors ot extrabudg.tary funds and a Jo!nt Seoretariat/wpACJIR group would be reported.

5. Exchange of research intor.tion Support would be obtained. although only a .oo.eat &IIOunt f'rom WHO source.. to enoourage the initi.tive. taken by librarians in the Region tor inte:r-l1brary cooperation and tor the proYi.1on ot current awarene •• • erYloes to researchers.

Provided specific criteria are met, a .ud._ of six meetings would be co-sponsored with outside agencies, one each in the areas covered by the six subcollDllittees listed above. Details of scientific and technical meetings scheduled to be held in 1980 and 1981 in the priority areas specified by the six WPACMR subcoftlllittees would be reported by the regional progranae managers. 6. Inter-regional cooperation

Information transfer mechanisms, similar to those developed by the UNDP/World Ban~O Special Programme for Research and Training in Tropical Diseases, would be deVised, partioularly with regard to diarrhoeal diseases research. An appropriate Secretariat staff member from the WHO South East Ad. Regian would be 1nvited to Join selected meetings of the six WPACMR subcommittees.

7. WPACMR membership In add1tion to the existing complement of members, an additional member from China, preferably with e:xperiences in health service management, would be invited to join the COllDllittee.

Research management

A clear set of procedures would be formulated to guide the Organization in its research activities. These would highlight the mechanism of peer review and spell out clearly the role of outaide scientists in relation to technical and funding decisions. peer review procedures for assessing proposals submitted to the Regional Office for funding would be reviewed.

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COHl'ENl'S

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CHAIRMAN'S ADDRESS

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A PLAN FOR THE MANAGEMENT OF RESEARCH •.•••••••••••••••••••••..••••• WHO GLOBAL PROORAMME ON DIARRHOEAL DISEASE CCB.l'ROL ••••••••••••••••• IMPI.EME:N'l'ATICltl OF ACMR 20 ,". '" .. '" '" '" .. '" ...... '" '" .. '" '" '" .... '" '" .. '" '" '" '" '" '" '" '" .... '" .. '" ,. '" ........

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SUMMARIES - SESSION OF SUBCOMMI1TEE A ••••••••••••••••.•••••••.••••• Report of Secretary of Task Force on Paras1tic Diseases Report of Task Force Meeting on Clonorchiasis and and I,ep l"O sy '" '" .. .. .. '" '" '" '" .. '" '" '" .. '" '" .. '" '" '" '" '" .. .. .. .. '" .. '" '" .. '" '" .. '" '" '" '" .. '" '" .. '" .. '" '"

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Austra11a/WH0 Seminar on Tropical Immunology.................. Report of Secretary of Task Force on Cardiovascular Diseases...

Paragonimiasis '" '" '" '" '" '" '" '" '" .. '" .. '" .. '" .. '" '" '" '" '" '" '" '" ...... '" '" ........ '" '" '" '" .. '" .. '" .. ..

RE:PORr OF' Sl.JB:::~l'EE B .. '" .... '" '" '" '" '" .. '" '" .. '" '" .... '" '" '" '" .. '" '" '" '" '" '" '" .. '" '" .. '" .. '" .... '" .. '" ..

Report of Secretary of Task Force on Health Services Research •• Research on the Education of Health Personnel •.••••••••••••••• Biomedical Research Information .•••••.•••.•••••.•.•••••••••••• Report of Secretary of Task Force on Communicable Diseases and Other Research Areas ••.•.••••••••.•••••••..•••••••••• Acute Respiratory Infections • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • PIENARY DISCUSSION ..................................................................................... 'REPORT OF 'WPACr.1R SF;CRE'I'ARY ............................................................................

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REPORT OF CONVENOR, WPR FOCAL GROUP ON llPEClAL PROORAM'E FOR RESEARCH AND TRAINING IN TROPICAI, DISEASES..................... Progress Report on Malaria Research

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FEASIBILITY STUDY ON STRENGTHENING THE WELLCOME VIRUS J.ABORATORY IN FIJI ........................................................................................

RESEARCH ON HEALTH HAZARDS OF WORKIN:l POPULATIONS ••••••••••••••••••

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JACQUES PARISar POUNDATION AWARD •••••••••••••••••••••••••••••••••• EXECt1I'IVE BOARD STUDY ON WHO EXPERT ADVISORY PANEUl AND WHO COLI,ABORATIm CENl'ImS ................................ ".............................................. A PRoPOSED MEETItll OF NATIONAL MEDICAL RESEARCH COUNCILS CO-SPONSORSHIP OF RESEARCH MEETItllS

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<>'!tIER BUS IJtIE:SS ................................................................................................... ..

Future subcommittee structure

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'WP ACMR V ............................................................................................ " .......... .. CI,()SItI() REJ4AR1(S ........................................................................................... "" ...... ..

ANNEX 1 - PROGRAMIIE AND BUDGE'!'. RESEARCH PRCIIOI'ION AND DEVEWPfr1E:NI', 19'79-1gBl ........................................................ ..

ANNEX 2 ANNEX 3 ANNEX 4

STUDY GROUPs ON PARASITIC DISEASES •••••••••••••••••• LIST OF MEMBERS AND amER PARl'ICIPANTS AGENDA

39/40 41 47 49

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ANNEX 5

LIST OF WORKING DOCUMENTS •.••..•••••••••.•..•••••.•

Cl'BIIJIJ CBRDiDIl'

(Ite. 1 ot the Asend&) III . . laoll1l1S • •bel'll to thi. tOlU"tb ....ion ot the WPACNR. the Repoual D1reator. Dr Dy. paid tribute to the aative leacl8l'11b1p ot the Cbai~ in p_tillS the repoual develop_nte 1n re...1'Oh 1Ib1ah bave oaaUl'Nd durillS hie own t1ual teN 1n offiae. He then save a briet review or the 'bwenty-nine. ;yea.re di.trlllS whi'Oh he hall ..e!'Y8d i:o~-Mjt_ amf.ilxpreriitd the Ti.. that aooperaticSn"ot'J!Nber Statu . ._ e ••ential i t the soal ot health tor all 111 to be attained. '!be lley to the soal i. priary health cal'll. wblah II1Ibt be I'IiDUred _re effeotive tIn'ouch nab p~. &II health .e!'Viae. 1'II. . .rob. lie elllll'll.Ad pl_ _ at banns had help aDd adviae tro. the WPACIIIR 1n reoent yea" and propoAd tar di.cueeion a .t1'llllSthen1ns ot it. ..bel'tlhip by &11 expert 1n the tield ot -se-at and a bebanoural .oieuti8't to 1'01IDd ott the ellpllrti. . at preeeat available.

".J.

In reply. the Cbai~. P!'Ote.eor Sir Ouatav JIoaeal. DOted that Dr D:1 had 1IDderetatad hill own aoh1eve_te 1n eupport ot reeea1'Oh. ~ a elender ba. . he hae ba11t up a reeearoh baMet ot eo_ 1 1I11Uon dollal'll. ind1catms a very I'IIal a..mt.nt to the etrengthenillS ot ree. .roh 1n the Resien.

'!'he previe1_1 aprada (WPR/ACIIIII/79.1 Rev. 2) . .II adopted w1thaut altel"&tion. (Attaobed a. " - x Il)

BI1!IC'1'IOII 0lP OlflI'ICIRS

(Ite. , ot the Apnda) ProtellllGr ...eal oontiJNad Wllre eleated. &II Cbai~

and the tollowillS offioel'll

Viae-Cbai~1

Prote.eor 15.15. RatDIUI Dr J. v. Jfodse

Rapporteur '!be Uet

ot Mllbel'll and otbe!' partioipant. 111 siven a. Almex ,.

WPR/ACMR/79.20 Report page 2

CHAIRMAN'S ADDJIESS

(Ite.. 4 at the Agenda) Protessor Nospl weloo..d new _lIbars and invited all ....bars to provide a briet synopsis at their aotivities and tields at interest. He welcomed Secretariat membars oolleotively and espeoially weloomed the Chairman ot the global ACJIIR. Protessor S. Bergstrom. and later the Regional Direotor-designate. Dr H. NakaJia. Atter pointing out the duty ot all ..mbers to act as catal.ysts ot international oollaboration in ..dioal research. the Chainnan went on to review the development ot research under WHO aUllpices. eepecially those IIl1Ir1.ma the past eight or nine years. He highlighted the first_Jor atep - the WHO Special Program.e fit Research. Development and Research 'ha1n1ng in Human Reproduction (HRP); the eub.equent UNII'/World Bank/WHO Special Programme tor Re.earob and Training in Tropioal Diseases (TOR). 1Ih1ch has a current operating budget ot $ 28 III1llion per year; and the 19'76 deoillion of WHO that 6OJ' at its resouroes should be spent in clenloping countries. thus lead1ng to the concept ot regionalization in wbich research is an integral part. He went on to review the recent re...roh pro~ ot WPACMR itself. oommenting br1etly on the activities ot the various Task Forces which it has establiBhed and suggesting to _bere that they should take every opportunity to conduot reg10nal ACIIIR bus1ness between annual meetings as oontacts oocur. He described the work at WPACMR in peer review of research proposals Of 94 prvpoab submitted to the Regional Office in 1978 only some 11 were funded. 'Dw aoh:lnery is still in need of amendment and in November an inter-regional ~t~ w111 be reviewing progress; hence a full disoussion w111 be ..n.duled on this top1c at WPACJIIR's titth sess10n in 1980. Professor lINeal al~ spoke of achievements in linking the aotivities of WPACMR w1th thoee ot the global ACJIIR. In view of budgetary limitations. WPACIIIR activit18S in strengthening institutes within the Region are likely to relain the IIIOst useful way to use funds wisely. and the "Chan1811111 whioh have been developed for this purpose.

In a later section of his address. the Chainnan gave a provisional . _ r y of the observations and reoo_ndations of the WPACMR group which carried out a technioal visit on re.earoh promotion to the people's ft8public of China between 30 March and 8 April 1979; the first ever site visit by WPACMR. Although the report was still being drafted. some aspects were seen to be too 1mportant to wait. He noted that the group had visited th~ c1ties and one rural centre. examined ten proposed collaborating centres, met over 100 scientists and obtained detailed documentation which would be available from the Secretariat. '!'he detailed preparations. the eft10ient arrangements and the overwhelJd.ng hosp1tality and kindness de.. rvsd special co_nt. 'ftle group _s greatly 1mpressed by ~e ded1cation and ability of any scientists, who were working often under difficulties and successfully maintaining old and inadequate equip..nt; they had shown an urgent desire

both for wider contacts and for constl'Qctive criticism of their work. '!be organizational stl'Qcture of the health services in China lends itself to studies in primary care and disease prevention and the unique epidemiological research opportunities should.be seized. '!be scale of such studies is so great that the time frame needed might be considerably shorter than in other countries. The Chairman drew attention to some problem areas identified by the group and to the steps needed for designation of the institutes proposed as WHO collaborating centres. He indicated the great potential value of exchange visits by senior soientists, as well as the probable need to seek outSide funds, since the priorities for research as identified in China do not ooincide with WHO priorities in several respeots. -He concluded by summarizing the recommendations of the visiting group under the following ten headings. 1. The present plan for iJl1)lementation of the Memorandum between China and WHO~ signed in October 1978, with its heavy eJl1)hasis on research training and exchange of research personnel, should be iJl1)lemented as rapidly and fully as possible. . 2. A workshop on research design,and on the methodology of preparation of grant proposals should be held in China in 1980.

3. '!be prooess of designation of the twenty-four Chinese oentres as WHO oollaborating oentres should prooeed as appropriate prograunes for oollaboration are developed. 4. Proposed WHO oollaborating centres in China should be urged to develop fully their role as national oentres of excellenoe. '!bis oould be helped by regular internal seminarsJ by increased collaboration between national oentres within ChinaJ by specialized domestio scientific meetings in ChinaJ and by linkage of Chinese institutes with other WHO collaborating oentres in the same disciplines.

5. The Speo1al PrograaM of Research, Development and Research Train1ng in Human Reproduction (HRP) and the Speo1al Programme for Research and Tra1ning 1n Trop1oal D1seases (TOR) are urged to oonsider institution strengthen1ng aotivities of sizeable dimensions in seleoted oentres in China. 6. New outside funding sources should be mobilized for the support of research within Chins in areas such as oommunity disease control, oard1ovasoular research diseases and oancer. This poss1bility oould be explored through a well-prepared meeting of donor agenoles oonvened in Beijing around April 1980. 7. WHO soientific working groups and other meetings should (a) soientists from ChinaJ (b) be held in China from time to time. inolude

8. Every opportunity should be taken to strengthen China's oapablli tiss in epidemiology and research on oommunity disease prevention and control. 9. Scientists receiving foreign training should playa major role in guiding the modernization of equipment in Chinese medical research institutes.

WPR/ACMRI79.?O Report page II

10. The giant effort which China is making in medical research should be drawn to the attention of the Executive Board and the World Health Assembly. This vindicates the Assembly's decision to place a new emphasis on research within WHO. Considerable interest in this aspect of the Chairman's report was evident from the subsequent discussion. It was noted that the report of the WPACMR teohnical visit would be completed as soon as possible for consideration by the Regionsl Director, after which it was hoped that it would soon be generally available to scientists, since it contained a considerable amount of new information. A PLAN !'OR THE MANAOEMEIfl' OF RESEARCH

(Item 5 of the

A~enda)

Dr H. Minners opened disouasion of th1s item by a summary of hIgh11ghts from the souroe document (000/78.2). He drew attention to the soope of the Regional Direotor's responsib1lities (p.}), the intention of WHO that national self-reliance (not neoessarily self-suffioiency) should be enoouraged (p.S), the possible ohange of' Committee I\IIIII8S to Advisory Committees on Health Research (ACHR) (p.9), the unity of the WHO Seoretariat with regard to progI'IUIIIIB anagBlDBnt (p.16) and the illportanoe of designating a research coordinator for eaoh progranne (p.16). The implelll8ntation of this new ..nagement plan will take plaoe quite BOon - possibly in July 1979.

'""" The plan was further explained by Dr R. W11son from the aeneva WHO Seoretariat, who noted that administrative prooedures for research should be baaed on f'our premises, (i) the administration should be oriented towards WHO programmes, not WHO structures, (11) research should be done by national institutions and soientists. not by WHO, (iii) research activities should be relevant to needs of Member States and to WHO priorities as agreed colleotively; (iv) research aotivities must be of high scientific quality and subJeot to peer review. The Seoretary of WPACMR, Dr D. Mao fadyen , noted that the doownent of'fered the first speoifI0 authority for the Involvement ot WHO regional statt in research aot1vities and was weloomed for this reason. He pointed out that the derivative dooument,WP1!/ACM!.V'79.2 (agenda item 5.1) was an attempt to apply the plan within the Western Paoific Region. 'Dte manager of the regional malaria progranne. Dr W. van DiJk. provided details of how the plan was aotually working with respeot to his progt'1U1118 and the WHO Progranne Coordinator tor Malaysia and Singapore. Dr L. Verstuyft. did likewise for the re..arch oomponent of WHO proare-e at the oountry leftl. Other points raised in a wide-ranging disoussion inoluded the need to state more olearly the role ot outside soientists in the management ot the speoial proSt'lUlll8sJ the important role of the oountry level WHO ooordinator. the ne.d for flexibility in implementing the management plan at regional and oountry level. the pOSSibilIty ot a small tund tor seeding grants by

WPR/ACJIIR/79.20 Report page 5

Regional Directors and the suggestion that Regions mIght be totally responsible for _nagement of large special prosra-s. The latter point _a debated at some length and it _a concluded that truly global progr&llllll8a should be managed from Head Office. but that special prog~s of particular relevance to one Region could be anaged at the regional level. The number of steps currently required for WHO research contract approval. and -u. long-turn around time were also criticized; ~ro_nts in both aspects are being atte~ted at the present time. Pinally the Chairman summarized the debate as follows:

The WPACMR endorses the need for a clear set of policy guidelines to guide the Organization In the conduct of its research prog~s. The WPACMR also endorses the Director-General' s action in appointing ProfesllOrs Bergstroll!. Cravioto. and Professor Nossal aa the subcommittee deaigned to monitor the i~lementation of this Plan over the next two years. The WPACMR strongly supported the general principle of regionalization of research 80 long as this does not mean fragJIIentation of effort. duplioation and ~ediment of global information flow. In endorsing this principle of reglonalization. heavy involvement of the Region In global teohnical pro~s. and heavy Involvell18nt of the Region in peer group review prooesses _s supported. The fine all1111 of the Di reotor-General ' e regiDnalization programme were begInning to be realized and the WPACMR 'certainly endorsed the high profile of outside solentists in the eventual management of the research programme of the Organization. However. the document does not spell out clearly enough a new element whioh has orept into the Organization through the two special programmes, which between them now acoount for ten times more research money than the rest of the Organization's put together. It has been these large programmes with their heavy e~hasis on peer review which have stimulated WHO's widening involvelll8nt in research. The weakness of the document is that this role of outside scientists in IIIII.king tne technical and funding decisions Is not spelt out clearly enough. WPACMR is very 1...,resaed by the WHO country programme coordinator's role and acknowledges difficulties of the health ministries. particularly in developing countries, if the ministries are not kept informed about negotiations concerning support for reaearch programmes and projects.

The Committee was very pleased with Dr van DiJk's agreement with the main thrust of the proposed plan since such regional programme _nagers have a key role to play in the management of WHO's research activities. The question _s raised: Did the Western Pacific have resources to finance IIIII.Jor researoh programmes on its own? The Committee believes quIte strongly that programmes like TDR and HRP which by their very essence are global in nature. should have the administrative management centralized in Geneva to avoid unnecessary waste of resources and duplication. WPACMR feels. however. that as and when programmes oome up that have exclusively a regional connotation. for example on clonorchiasIs and paragonimiasis or a special programme for institution strengthening in the people's Republic of China. then the Committee strongly endorses the prinCiple that if such

WPR/ACJIIR/T9.20 Report page Ii

programmes beoome a reality through availability of extrabudgetary funds. the Region not only oould but should be responsible for managing them. Rowever. if extrabudgetary resouroes are seoured. there would have to be a realistio figure for management since staff resources within the Regional Offioe are very heavily stretohed and oould not be oalled upon to oope with suoh an extra load. 'ftte meohanism for awarding researoh oontraots through international agenoies is much more oomplex than giving a researoh grant by a national research body. Therefore. while appreciating the Director-General's efforts to limit the WHO bureaucracy, it is inevitable that some officers will be necessary to support the management of WHO's growing research prograane. WHO GLOBAL PROGRAI'f/IE ON DIARRHOEAL DISEASE CONTROL (Item ~

of the

A~enda)

Professor D. Rowley introduoed this topio (dooument WPR/ACMR/19.3) by co_nding the full dooument which the Seoretariat had prepared and whioh oontained reference to all the important measures needed for the reduction of diarrhoeal diseases. After touching on some of the headings in the dOoument he then raised two points for discussion. 'ftte first was the inaoouraoy of statistics on diarrhoeal diseases in this Region. At present the only meaningful indicator is the death rate for ohildren under five years and in his view there is a major need to establish surveillance units which wOuld monitor aspects of this problem at a local level. The second was the observation that the global programme may be too wide in soope for adoption by the Region and that WPACMR should perhaps oonoentrate only on a few aspeots with other Regions foousing upon others. For this to be effective, better inter-regional information flow would be essential. As a personal suggestion on his second point, Professor Rowley considered that good epidemiological surveillanoe would be his top priority, with other topios being dependent on the strengths already identified as available within the Region. Disoussion of this item dealt with the need to convinoe local administrative authorities of the importance of the problem and the n....d for a national programme) possible mechanisms for int.. r-regional information exchange such as the TDR information transfer mechanism) the stat.. of basic researoh leading to availability of new vaccines and drugSI and the link between this prog~ and the interests of the WPACMR Task Force on Health Services Res..aroh. Attention was drawn to the need to emphasize to looal health authorities the pri_ry importance of good sanitation and water supplies, rather than allowing the prolllise of vacoines and druge to induce a false sense of security. In summarizing this discussion, the Chairman noted that 'ftte COlllllittee endorsed document WPR/ACMR/T9. 3 in its broad teI'lllll and complemented the authors for its oomprehensiveness.

WPR/ACMR/79.20 Report page 7

The Committee is very dissatisfied in the surveillanoe mechanisms available wi thin countries and all agreed on the il!lportanoe of establlllhing data bases. Secondly. an within this broad identify regional areas where there ambitious progra_ is outlined in the dooument and programme the WPACMR should. through its Task Forces. strengths so that the regional programme can foous upon are appropriate skills.

Thirdly. and the Committee debated this point at eonsiderable length. is the illlPortanoe of inter-regional oooperation. This is illlPortant not only with respeot to sophistioated laboratory balled research which is reported in the international literature but with respect to information transfer concerning s1n.,le field trials. so that the risk of duplioation of such trials can be kept under some reasonable oontrol. Nevertheless the WPACMR felt that because of the varied patterns of disease and the variability in infrastruoture. that SOlll8 duplioation of research _s inevitable particularly with regard to field intervention studies since field study findings in one oountry may not be practical and feasible in another. The group regretted that the initial response of countries in the Region to this new initiative in WHO had been somewhat disappointing and called for efforts on the part of the Seoretariat to generate support for the Diarrhoeal Diseases Programme. Attention was drawn to the information transfer mechanisms developed under the '!'DR programme and it is hoped that a Similar mechanism would be developed as part of the global Diarrhoeal Disease Programme as a mechanism to support inter-regional information exchange. It was felt that at this early stage plurality should be the order of the day; that Headquarter's resources must be used to the full. and regional resources, likewise. National medioal research councils, should be involved in information exohBnge. There is a need for an active interface between health authorities. i.e. those actually illlPlementing services. and the researchers. This is an interface lIhich is not strong in any oountry in the Region. and the need applies partioularly to the Diarrhoeal Disease Programme whioh is essentially a very praotical programme. The WPACMR proposes that the newly established WPACMR subcommittee for diarrhoeal disease should work very olosely with the WPACMR suboommittee on health servioes researoh. (nefer item 16.1. page 2Q) Finally. potential benefits from laboratory based research. such as new drugs or vaccines. should not lull countries into a false state of security about diarrhoeal disease control and. in particular. there~ould be no slackening of effort to illlProve environmental sanitation and safe water supplies.

WPR/ACMR/79.2O Report page 8

IMPIEMENrATION OF ACMR 20 (Item 7 of the Agenda) The ACMR Chairman, Professor Bergstrom, epoke to the report on the

first an outline of the advisory and operating mechanis.s for research as used by WHO at global and regional levels. He showed the ti_table for ..etings of ACMR subgroups on information, health services reeearch, nutrition, diarrhoeal di.eases, ethics of research and researoh a~istration and described some of their actlvit!es briefly. Average research grants under ordinary WHO contraots (C'I'3) is .ome $ 2000 - $ 4000, while those for the HRP and TDR epecial programmes are nearer $ 40 000 - $ 50 000. The need to integrate activities with tho.e of national research councils was stressed. Professor Bergstrom noted that WHO's medical research expenditure now was on average only about one cent per person per year - in contrallt to the budget of the countries themselves which reached a level of $ 5 - $ 10 per person. A mode.t increase in bilateral aid for this purpo.e could make a very large difference to a national research programme. He concluded by co..snding the achievements of the WPACMR. In the discussion of this it.m WPACMR noted that, if the flow of research fundi through the AeMR .ubcommitt•• s is to come about, an ess.ntial first step would be the preparation of conci •• and coh.rent regional progr&m.ss, preferably including both •• rvice and research cor..,on.nts. Involve..nt of national authoriti.s in all such planning is e.sential. Th. lateral flow of information between task foroes in different Regions was id.ntified a. a probl•• area at the present time. StMWUBS - SESSION OF SUBCatlliI1"1'EE A

20th session of the ACMR of June 1978 (document ACMR 20/78), giving

REPORT OF SBCRI'l'ARY OF TASK PORCB ON PARASITIC DISlA8BS AND lBPROtlV

(Agenda Item 8.2, dooument WPR/ACMR/79.5) Th. subDo.-1ttee received a oareful analysiS of the doclIIIBnt WPR/ACIII/79.5 from Dr Tanaka, iluppl...nted by .o.s furth.r remar.ks by Dr Guinto, Dr Daze and Dr Self. and reoorded its gratification at the vigorous .YOlution of re.earch prog~. in para.itio dis.a ••s and lepro.y within our R.gion, and endorsed the dual funding mechanillll8 - the _Jority funding oomng fl'OlD TOR with SOIllll minor fund1ng oomng from the Region (with the .xception of oourse of the WHO R.gional Centritfor Re ••arch and Training in Tropioal Di ...... at the Institute for Medical Research in Xuala Lwlpur, Jlla1&18ia, whioh is getting very sub.tantial funding from the Regional Offioe). The eubeoma1ttee focused its attention on oertain .oientifio ..tters which were d.bat.d and discussed. In the- fi.ld of

WPR/ACMR/79.20 Report page 9

schistosomiasis, it was important that information be exchanged between the major research groups active in the field of S. japon1cum. Study missions and visits should be supported and a small ad hoc subcommittee (chaired by Professor Mao and including Professor So~~Dr Guinto) made a proposal on this matter to the plenary session which followed (Annex 2). In discussing how the Kuala Lumpur centre could be strengthened, it was noted that while some difficulties had been encountered in recruitment of suitable staff for the various institution strengthening posts that had been approved by WPACMR and by the Organization itself, these difficulties were gradually being resolved and hopefully suitable appointees would soon be in place in most if not all of the approved posts. The subcoDlllittee received a report from Dr Macdonald, a consultant on the field of vector biology and control as it applies to the Regional centre; this report was endorsed in principle and the hope expressed that mechanisms would be found whereby the TDR programme could fund the initiative, not for the creation of a subset of international employees within the Institute (forming a kind of internal elite) but much rather for the two proposed entomologists to be integral members of Dr de Witt's team answerable to Dr de Witt in just the same way as any other staff member and forming therefore a portion of the IMR in the true senee, not an elite peer group within it. The subcommittee wished to record its delight that this particular session of WPACMR IV was full of most interesting scientific highlights and hope that this pattern can be continued in WPACMR further sessions. REPORT OF TASK FORCE MEETIm ON CLONORCHIASIS AND PARAGONIMIASIS (Agenda Item 8.2.1, document WPR/ACMR/79.6) ~

Professor Soh introduced document WPR/AcMR/79.6, being the report on an important meeting that was held on the relatively neglected diseases, paragonimiasis and clonorchiasis. The WPACMR congratulated the Task Force on its report and on having tackled this difficult problem. The group is aware that this is almost exclusively a regional problem and WPACMR therefore accepts the responsibility for leading the coordination of world research, insofar as WPR' s limited financial resources will allow, and strongly endorses and gives high priority to the suggestion made by the Task Force that the Regional Director find seed money for research to a total of not less than $ 150 000 over the next three years, so that research can be strengthened. The group noted with interest the development of pra~iquantel and its independent synthesis reported from the People's Republic of China. The compound may be of some interest in the treatment of these diseases but trials are at too early a stage yet for a definite answer on this point to be received. The subcommittee gives high priority to chemotherapy research in this field. The search for a good drug which can be given as a single dose orally might be about the finest achievement that the research could produce.

WPR/ACJIIR/79. 20 Report page 10

The subcommittee is also very interested in more precise diagnostic methodologies and commends the efforts of the Task Force in this regard, particularly on the search for a good skin test reagent and the search for monoclonal antibodies that would be helpful in specifio immunoserological diagnosis. AUSTRALIA/WHO SEMINAR ON TROPICAL IMMUNOLOGY

(Agenda Item 8.2.2, document wpR/AcMR/79.7) Professor Mao introduced the proposal for a seminar on tropical i..unology to be Jointly sponsored by the Australian Development Assistance Bureau, the Australian Society for Immunology and WHO, in Sydney towards the end of 1979 and endorsed this proposal. An excellent disoussion followed, in which the following suggestions are made to the organizers of this seminar I First. there should be a considerable effort made when invitations go out to the lOVernments for an emphasis on the criteria for participation. so that every effort 1s made to get the right participants for this seminar. While WHO can do a certain amolmt in this regard, the members of WPACMR the_elfts mould help. Acting as individuals they should go to the1r IOvel'llMnts and say "we believe Dr and Mr so and so would be the best ,artioipant from our knowledge of the situation in our own oountry". Ths seoond point 1e that empha.is .hould be plaoed on re.earoh activitie. of the partioipant. after the seminar. and perhape they oould be given enoouragement in their work by being asked to report their work annually or bi-annually to the Regional Office so that the Regional Office can develop _re knowledge about what has actually happened to their trainees. The WPACMR _kes this suggestion not exclusively to the participants in the tropical immunology seminar but offer. the suggestion as a reasonable one for all trainees supported by WHO-sponsored programmes. Finally, the WPAC\IIR placing more emphasis on parasitic diseases which implication and deserves wishes the organisers of the selllinar to consider the important subJeot of immunodiagnosis of currently is included 1n the progra_ only by more elliphasis.

WPACMR elliphasizes the illlortance of technioal laboratory training for correot illllementation of i..unologioal teohniqus and hopes that the Seoratariat will give prosraaas of this sort due elllphasis in fuuure years.

WPR/ACMR/79.20 Report page 11

REPORT CF SECRETARY OF TASK FORCE ON CARDIOVASCULAR DISEASES

(Agenda Item 8.4. document WPR/ACMR/79.9) The WPACMR considered the report of the Secretary of the Task Force on Cardiovascular Diseases and dealt with it in two portions. Firstly. it reviewed the course in epidemiology held in Wellington. New Zealand. some months ago and endorsed the value of suoh courses and congratulated the organizers on a largely successful activity. The course had identified some minor detects which were drawn to the attention of the subcommittee; namely the need for more time for the development of protocols for experimentsl projects and the suggestion is made that in future courses such assignments should be given to participants well in advance of the actual meeting. There was a minor problem about the heterogeneity of background and abil1ty. problems that were deemed to be inevitable and probably nothing very much can be done about them. Thirdly. the Co_Utee eaphasized the iq,ortance of this self-evaluation process.

The COlllllittee debated at some length the structure of the next course and realized that any deviation from the past pattern was of necessity a coapromise; but bearing in mind the importanoe of cancer and cardiova.oular diseases. the fact that the methodologies of the two sorts of epidemiology are related (though not Identical). on balance the subcommittee favours a 3-4 week course comprising both cancer epidemiology and carrliovascular disease epidemiology (but not communioable disease epidemiology) and it suggests that such a course should have some COnjoint sessions where that is appropriate. but also some sessions in sub-groups where that is more appropriate and satisfying to the course participants. There would then be some limited coaplementation of the two sets of disciplines. The subcolllllittee next suggested that communioable disease.·epedimiology was also a topic of great iaportance and suggests to the Task Force on Communicable Diseases that it gives due attention to the importance of epidemiology. (Refer item 8.3. page 13) The subcommittee reoeived the report of Dr Endo on metabolio diseases. partioularly diabetes; it did not have time to debate this report at length but it wished to draw everyone's attention to the importanoe of metabolic diseases. particularly diabetes. within the Region and heartily endorses Dr Endo's proposals for further researoh in this field. REPORT OF SUBCOMMI'l'l!EE B REPORT OF SECRETARY OF 'l'AaK FORCE ON HEALTH SERVICES RESEARCH

(Agenda Item 8.1) The report of the Secretary of Task Force on Health Servioes Research (document WPR/AcMR/79.4) was summarized and presented to the subcommittee by Professor Kwon. The subcolllllittee also heard reports from Dr R. Heminan and Dr E.P. Mach.

WPR/ACMR/79.20 Report page 12 The following observations were made: 1.

There is a lack of trained personnel to do health services research. There is a need for a co-ominating body or focal groups at the national level, whose activities should include: a) b) training of health services research (HSR) workers, maintaining a national health service regiater/ inventory.

Recoanendations for further dnvelopm'mt of H:JR prop:rammes should include the study of a) primary health care systems, b) economic aspects of health care and resource allocation for health service projects, and c) a regional information system. The future role of the Task Force on lISR and the t'ormation ot' a panel ot' experts on lISR should be considered. (Refer item 16.1, page 26) consider in detail the report of the working group on HSR held 1n Manila in August 1978 and rep;r&tted that this had not been distributed earlier to WPACMR members. RESEARCH ON THE EDUCATION OF HEALTH PERSONNEL (Agenda Item 12.1. dooument WPR/ACMR/79.16)

5. The subcommittee felt that there was inadequate time to

'!'he paper on "Research on the education of health personnel" (dooUMnt WPR/ACMR/79.16) was summarized and presented by Dr N. Chandrasekharan. The main points considered were,

1. 2.

Maq,ower planning and management to meet health service requirements, Promotion ot' training ot' all categories of health staff;

3. Educational development and support. The committee recognized the importance of laboratory technologist training programmes as essential t'or the implementation of WHO-eupported researeh. The subcommittee also would like to have information on the career structure available t'or scientists in the Region. The rele of the Regionel Teacher Training Centre in Australia in educational development 1n the Region was supported.

WPR/ACMRI79.20 Report page 13

BIOMEDICAL RESEARCH INFORMATION (Agenda Item 8.5.1, document WPR/ACMR/79.11) The document on Biomedical Research Information (document WPR/ACMR/79.11) was sununarized and presented by Professor Ratnam. The importance of indexing of local Journals and articles should be given priority and self-reliance in these matters was to be encouraged. 'nIe gro~ 'was pleased to note that librarians in the Region have offered to undertake projects with resources available to them. The financial implications of the use of MEDLINE services for countries in the Region should be examined. 'nIe mRC and SEAMIC should be approached as they are interested in the transfer of information. It was the general feeling that WHO has not the resources to finanoe all the recommendations contained in the documents under reference. As a means of conserving resources, abstracts of local articles, and reprints of articles could be made available to selected scientists/libraries in the Region, particularly in the developing countries of the Region. REPORT OF SECRETARY OF TASK PORCE ON COMMUNICABIE DISEASES AIm amER RESEARCH AREAS

(Agenda Item 8.3, document WPR/ACMR/79.8) The section on Diarrhoeal Disease Control of document WPR/ACMR/79.8 was summarized and presented by Professor Rowley. The importance of developing a regional diarrhoeal disease oontrol programme with a view to implementing the already known solutions aas stressed. It was felt that there was a need to stimulate interest amongst Member States in diarrhoeal diseases in view of their importance, and because the commitment of governments was essential. The importance of epidemiological services for control programmes was appreciated and stressed. It was recommended that the WPACMR subcommittee on Diarrhoeal D1seases should work with the Secretariat in developing the regional programme. The Committee was given a brief account of the training of epidemiologists in the Region (document WPR/ACMR/Inf/79.1) by Dr A.C. Reyes. The problem concerned with the training and recruitment of epidemiologists was considered. 'nIe lack of epidemiologists affects the proper collectiDn of valuable information. Promotional activities by the WHO should be continued to stimulate interest in developing good epidemiological services in the Region. ACUl'E RESPIRATORY INFECTIONS

(Agenda Item 8.3.1, document WPR/ACMR/79.8) The relevant section of the Report of the Task Force on Communicable Diseases and other research areas (document WPR/ACMR/79.8) was summarized and presented to the group by Professor Kaneko.

WPR/ACMR/79.2O Report page 14

It was the feeling that some of the proposals on aoute respiratory infeotions, though relevant to control programmes, lack scientIfic merit and appear over ambitious. In view of this, it is necessary that the proposals be re-examined in September 1979 by the regional expert group on respiratory diseases. After due deliberations, disoussion and clarifications, the Suboommittee B endorsed the doouments and reoommended that they be transmitted to the WPACMR. PLENARY DISCUSSION Plenary diSCUSSion of the subconunlttee sununsries oentred on the topios dealt with by Subcommittee B. There was some debate on the requirements in the health services researoh field and the need was noted to appoint a new chairman to the Task Force on Health Services Research and to oonsider again the matter of establishing an expert panel in this field, as recommended earlier by the Task Foroe and agreed to by WPACMR III. Professor E. Hyook Kwon was unanimously eleoted as the new chairman of the Task Force, now callsd the WPACMR subcommittee on Health Services and Oocupational Health. I t was agreed that identification of the right people was needed and that the matter of an expert panel oould be held over for the present. Dr Hodge drew the attention of WPACMR to steps taken by the Health Services Research co_ittee of the New Zealand Medioal Re.earch Counoil to identify priority areas from the many oompeting projeots in the health servioe. field. There was a broader disoussion of the whole matter of Task Force I18mbership and nomenolature, and the status of temporary adYisers, whioh i. reported under Item 16.1, page 26. ftEPORT C1l' liP ACMlI ru«:fIIo7J'AIIV

(Item 8.5 of the

Ag~nda)

Dr Macfadyen introduoed his report (WPR!ACMR/79.l0) by pointing out that it was a dooument fooused on the future. Neoessarily it was chiefly oonoerned with the budgetary matters and these were summarized from the tables oontained in the Report. Research funding was not expeoted to grow during the next three years (refer Annex 1) and predictions indicate some possible retraotion. Dr Macfadyen pointed out that no increase was budgeted in the res.aroh oontraot area, and he defended the value of relatively heavy ezpeDditure on meetings; however on this point he oautioned that oritioism oould ooour if it grew further. He gave his personal opinion that one of the best areas in whioh to use WPACMR funds was in institutional strengthening. Professor Nossal oongratulated the Seoretary on an excellent report and on his work during the year. He emphasized that the tabulated budgets in the Report represent only funds under the RPD rubric; hidden resources for rea..rch come from the research components of other Regional Offioe

WPR!ACMR/79.20 Report page 15

programmes and the total is now probably of the order of $ 1 million annually 1. He also recommended that members should not be disappointed in the levels shown for :future budgets; past experience has shown that the Regional Director has managed to find additional money when well presented oases have been brought forward. He asked the Secretary what budgetary provision oould be made for new items now being reoommended for funding, and Dr Macfadyen replied that at leaBt partial provia1on was already made, as listed in Annex 1 of this Report. Progra_ managers however have a responsibility to seek the funds whioh are needed to support researoh aotivities within their own programmes.

Professor Bergstrom was concerned that funds available for meetings of independent scientists were too low. He suggested ways in which other sources of support could augment this - e.g. linking it with large national meetings in the Region. He doubted whether a sizeable research oomponent of other (non-RPD funded) activities should be allowed to build up without WPACMR being kept informed and involved in the evaluation prooess. Professor Nossal reassured him that this would not oocur and the following comment on the budget was drafted and agreed to by all WPACMR members: On examining the budget for 1979-1981 (Annex 1), the Conm1ttee expressed oonoern that the budget for 1980-1981 gave the impression of deolining researoh funds after the peak expenditure of 1979. The Comm1-ttee appreciated that untabulated resouroes for research would be provided within many regional programmes. The Committee therefore requested that the research programme and budget be presented at WPACMR V not only for the RPD programme but also for the priority areas identified by the Committee and its six new subcommittees: in cardiovasoular and metabolic diseases, parasitio diseases, diarrhoeal diseases, other oommunicable diseases, health servioes and oocupational health, and family health.

In short, the WPACMR asks the Regional Director that support extended by the Regional Office for all research, as defined in document DGoI78.2, be put before the Committee at its fifth and subsequent sessions. Another concern was the real decline in resources for promotional meetings. The eommittee felt that the various meetings of task forces, working groups, steering committees, subcommittees, etc., have been a highly successful feature of the regional research programme espeoially in oatalyzing national activities and mobilizing scientific and technical support for regional programmes. I t therefore requested that the Regional Direotor find ways and means to provide the logistic support needed to maintain at least the present number of such meetings and requested the programme managers in the priority areas specified by the suboommittees to report to WPACMR V details of scientific and technical meetings scheduled in 1980-81.

~he actual 1979 figure is $ 1 017 812.

wpn/ACMR/r'l. ;'0 It0POI'\'

I'""'''

Ie.

REPORT OF CONVENOR, WPR FOCAL GROUP ON SPECIAL PROGRAMME FOR RESEARCH

AND TRAINDI} IN TROPICAL DISEASES (Item 9 of the Agenda) Dr R.S. Guinto introduced this item by commending the staff of the Regional Secretariat for their work as members of this Focal Group. 'lbeir two monthly meetings and the range of topics oovered gave evidence of their active involvement in the '!DR programme. Other cooments were provided by the Convenor of the Group, Dr G. Emery, and by the new secretary of the Group, Dr G. Farid, who described some of the practical difficult1es of obtaining TOR support for research projects because of legal and ethical approval procedures. A discussion followed, with a description of the activities of the WHO Secretariat Committee for Research Involving Human Subjects. '!'he intention 1s t.hat new 8thl",,1 guidelines will be prepared soon 1n con.lun"Uon with t.he COImeU of International Organizations of Medical Science. Members were provided with a copy of the TOR special programme report for the period 1 .July 1977 - 30 June 1978, "Action Against Tropical Diseases" and this was co_nded as a readable and valuable report. 'lbe Chairman s\lJMl!lrlzed as follows: 'lbe Committee was pleased to receive document WPRjACMRI79.l2 which describes the activities of the WPR Focal Group for TOR. 'lbe function of the Focal Group is to monitor and coordinate research being conducted within the Region but under the auspices and funds of the Special Progr&llllle. 'lbe Secretariat activities in this regard. with regular meetings of regional office staff members, represents an excellent e~le of the unified corporate effort on the part of the Secretariat to make a success of this UNDP/World Bank/WHO Special programme and is grateful to those who have wOl'ked so hard to bring this about and is also grateful to Dr Macfadyen for rea11zing that he is not the sole arbiter of research within the Region and for achieving interaction between the technical experts within the Regional Office. 'lbe Committee is delighted to endorse the activities of the very able regional office colleagues acting in their capacity of scientists as well as of administrators. There are also a number of prohlemn thllt rortunately ~.n be d&Anrlhed as minor ones. There will alwaYII be problems in obtaining informed consent and ethical clearance for programmes and projects in the Region, which can however be intelligently resolved within the general guidelines which WPACMR III approved, when this topic was disoussed w1th Dr Dunne. '!bere is also a m:Lnor problem concerning facilities for Special Programme trainees when they get back to their own countries and it is hoped that this problem will be resolved by accelerating and extending the principle ot re-entry grants. Finally. this collaboration between the regional Secretariat and headquarters Secretariat illustrates well that there is only one World Health Organization and only one Secretariat and the Committee thanks the Focal Group very much for their work and wishes it well under the new secretary, Dr O. Par1d.

WPR/ACMR/79.20 Report page 17

PROGRESS REPORT ON MALARIA RESEARCH (Item 9.1 of the Agenda) 'll1e COJllllittee welcomed a presentation on this topic (WPR/ACMR/79.l}, WPR/MAI/}O) by Dr Dang Duc ~oh, who soowed slides SUIIIIIII.rizing both the applied field research and other research projects supported by the Regional Antimalaria Programme. Special emphasis was being given to chloroquine-resistant malaria. His coments were amplified by Dr W. van DiJt who stressed also the need for veotor control studies, of which the oomparison of spraying with DDT and fenitrothion was a specific example. During discussion Professor Mao Shou-pai described two new antimalarial drugs currently under investigation at his Institute. One called tripiperaquine (a combination of piperazine and an aminocrine) was proving effective in chloroquine resistance. Another, pyronaridine, was also being studied. He also commented briefly on the possible value of the traditional Chinese herb, Artemesia annua, indioating from his animal studies that this had some antimalarial aotivity Which however was reduced in chloroquineresistant malarial strains. A brief general discussion was sUJIIIISrized by the Chairman, as follows: The WPACMR endorses the broad lines of research outlined by Dr Trach .and Dr van Dijk and noted the gravity of the problem of chloroquineresistant malaria, particularly falciparum malaria. It noted the work being "done in the People's Republic of China conoerning two drugs for the oontrol of chloroquine resistant malaria and weloomed the offer from Professor Mao to collaborate with the Chemotherapy of Malaria Scientific Working Group of "the TDR Special Programe and the Committee also endorsed support for biochemical stUdies on malaria parasites which could lead to a new type of chemotherapeutic intervention. Finally, the WPACMR noted with regret that little work has been done in the area of vector biology and control. It is hoped that the secretariat would attempt to stimulate activities so that proposals for research would come to the TDR Scientific Working Group on vector Biology and Control. FEASmILITY S'ruDY ON STREN!JI'HENING THE WEUCOME VIRUS LABORATORY IN FIJI

(Item 10 of the Agenda, document WPR/ACMR/79.14) In sunrnary, the WPACMR received a report from Dr Hodge of the productive visit of Dr Gust to Fiji in relation to strengthening the Wellcome Virus Laboratory. 'll1e Committee congratulated Dr Gust on an excellent report and strongly endorsed the proposals contained therein. The Committee expects warm relationships with the Wellcome Trust and the

WPR/ACMR/79.20 Report page 18

Government of Fiji in the implementation of this programme and strongly urges the Regional Director to attempt to find the funds for the proposals as sunmarized by Dr Gust. 'lbe upgrading of virus research in the Pacific Basin is considered to be of high priority and the suggestions oontained in the report are realistic and reasonable. 'ltle cost is likely to be substantial at an estiate total capital cost of $ 50 000 spread over a number of years and recurrent costs, chiefly for personnel, of the order of $ 30 000 or thereabouts. In order to be realistic, the Co_ittee doe. not think the Government or FIJi w1l1 be likely to piok up th1. oo.t, it believes that the project 18 important and worthwhile and therefore requests the Regional Director to attempt to find the funds for it. A final co...nt related to a distinguished New Zealand Virologist, Dr Mil.s, who has offered his services as a possible guest professor for the lltarting period to help get thill prograame off the ground. The Co_ittee was pleased to hear froll Dr Hodge that the Fiji Government has wal'lllly " reacted to this suggestion, and there may be a good ohance of the Vellcome Trust actually paying for thill and once again the committee endorses this proposal. RESEARCH ON HEAIIl'H HAZARDS OF WORKnIJ POPULATIONS (Item 11 of the Agenda)

,.....

Introducing this agenda item (WPR/ACMR/79.l5), Professor Kaneko pointed out that bad working environments and the consequent health problems are preventable. Ocoupational environments are changing, new probl.ma are emerging. more chronio industrial h.alth probl• • are appearing. Surveillano• ....-is insurtlcisnt on Hs own, all available ~.chnlqu.fI m"flt he u"ed t.n antioipate and prevent health problema. Employers must be _de to r •• l an increased responsibility in this field and to identify potential health riaka in their work environments. Prof.llsor D.neko supported the reco...ndations in paper WPR/ACMR/79.15 an4 these were then di.culllled, lIupplementary information being provided by Dr Wan Pook Kee. The specific areas in which rellearch was reco_nded (i tellll 2.1 to 2.5 of the document) were noted and the Committee especially noted the proposal to fona a Tallk Foroe and regional Expert Panel in this field. This_II aocepted all a newly-emerging health priority (like cancer and cardiovallcular disealle) which would need increasing emphasis. Financial implioations of occupational health problema to indUlltry were discUllsed. The pap.r _s acoepted in prinCiple, mechani_ for promoting the field being held over for finalization when the subcommittee IItruCture of WPACMR was reviewed. The Chai~ gave the following sunmary: The C~ttee agrees to help acoelerate progrells in this illlportant area by the creation of a lIuitable subcomm1ttee under the reconstructed suboommittee struoture of the WPACMR consid.red under ag.nda item 16.1 WPACMR drew to the new .ubcommittee's attention first of all the great importanoe of this field in oountries whose eoonomio paoe is ohanging

WPR/ACMR/79.20 Report pap 19

rapidly. The Committee decided that the question of regional expert advisory panels. the designation of possible WHO collaborating centres in occupational haalth and the more detailed evaluation and formulation of specific research proposals would be delegated to the appropriate eubco-.1ttae. With the overall instruction froll the WPACMR that it consider this a priority area for further investigation and deyeloplMnt and reporting back to WPACMR V. JACQUES PARISOT FOtlKDATIOH AWARD

(Ttell 12.2 of the Agenda) On the reco_ndation of WPACMR III. Professor M. Bonifacio attended the meeting by invitation and gave a resum~ of his sociological study of urban and rural doctore in the Philippines. for which he has been awarded a grant from the Jacques Pari sot Foundation. A similar presentation would be made to the World Health Assembly in May 1979. at the time of presentation of the award.

Following his presentation. Professor Bonifacio repUed to questions from members of the Co_ittee. He conf'il'llllld thet his saq,le was randomly selected but acknowledged that it was small and incompletely stratified. He had experienced difficulty in persuading urban doctors to participate in the study. He accepted also that the findings represented the opinions of the doctors themselves and that it would be interesting to go on and compare these with opinions from a 'olient' based group. The Chairman thanked Professor Bonifacio for a most interesting presentation. EXECl1l'IVE BOARD STUDY ON WHO EXPERT

ADVISORY PANEIS AND WHO COLLABORATING CENTRES (Item 13 of the Agenda) Assistant Health Ministsr A. Aoosta. Joined the meeting to apeak on documents EB63/24 and EPC/EBWG/l in his capaoity as a member of the WHO Executive Board. He pointed out the usefulness of advisory panels. both to the Executive Board and to Member States in the past. However the need for an in-depth study was aooepted and these documents are the outcome. Three main questions are addressed in the study: these are the quantum and types of expertise needed by WHO. the sources of such expertise and possible ways of bringing it to bear on health problems. The present advisory system lacks balance and. since the development of inter-related global and regional ACMRs. there has been pressure to review the mechanisms used. The Assistant Minister's comments were directed particularly to the role of WHO collaborating centres since these have been the topic of recent discussions. He summarized their current role (from EPC/EBWO/1. p. 29) and identified a number of problem areas. viz. (i) the distribution

WPR/ACMR/79.20 Report page 20

of collaborating centre by fields and by geographical regions is uneven; (ii) the collaboration with WHO is not confined to so-called collaborating centres; (iii) the extent of financial support from WHO varies widely between such centres; (iv) no good review mechanism exists for funding such centres. He identified the following issues for special consideration: (a) the necessity - or otherwise - of a network of WHO collaborat1ng centres; (b) the technical and geographical balance of that network; and

(d) the selection criteria and the prooedure to desiga&tion of the oentresl

followed for the

(e) the rules and practices applicable to the management of collaboration with the centres; (f) the granting, administration and evaluation of contraotual technioal servioes agreements for collaborative research.

Further comment on the documents was given by the ACMR secretary, Dr H. Minners. He pointed out that the two-year study was now a little over half way through and that co_nts from all regional ACMRs would be welcomed by the Executive Board. He pointed out the likelihood that WHO would retein the system of expert panels in modified form, probably with acoeptance of the need for regular rotation of membership.

In opening discussions of this item, the Chairman gave his view of an "ideal" collaborating centre, Which should (i) be a centre of excellence for its field within the nation and be held in high respect by the scientific co~itYJ (ii) be active as a national focal point for its discipline, and (iii) be an effective link in a global researoh network. He approved the conoem of the Executive Board over the role of expert panels and committees as Justifiable, eepeoially tn re~rd to turnover of membership, but pointed out that the record of WHO expert IU'OUP8 1. a proud one and that the various technical report. are respeoted and widely u.ed. He defended the need for re.earch funding deCisions to be mad. by soientific peer groups, as 18 the case with the epeoial programmes, and exhorted the Exeoutive Board to resist pressures for suoh decision to be .ade by the WHO bureaucl'8OY. '!'he opinion of the WHO Secretariat should certainly be oonsidered, but should not be final. 'lhree members (Professors S.S. Ratnam, C.T. Soh, and E. Hyock KWon) spoke of the advantages, from their experience, of designation as a WHO oollabol'8ting centre. For Professor Soh, the experience was very recent and more help was needed. Professor Ratnam also co..-nted generally that the process of designation should involve identifioation of the institution

WPR/ACMR/79.20 Report P... 21

best able to carry out the relevant research. and that desisne4 oentre. should lake their enhanced taailltle. available when appropriate to scientists in adjoining aountries. Dr Minnera indioated taotors taken into account at present When designation is aonsidered. '!bese are: (i) the standing ot the institute at nationsl and international levels, (11) the staft and taailities available. (iii) the prospeotive stability ot the institute. (iv) the oapaoity/abUity to serve one or more WHO prog~s. and (v) the capacity to provide serviaes over a prolonged period. 'l.'tIe Chai~ s~

up the disauesions as follows,

'l'hI Coaa1ttee thanked Dr Aoosta tor the concise and OOIIIprehenaive .-nner in which he desoribed the role ot collaborating oentres and .lIpert panels. It is very iIIportant that the oo-.m1ty of lIOrld soientists in varioua disaip1ines be heavily involved in the central lllis.ion ot WHO. In taat the Coan1ttee felt strongly that such advioe is es.ential to the continued vi tali ty and dynalllisll ot WHO. If there is one .ssage t!'Oll the disoussion, it is that outside e:q,ert. troll acadellio oentres and internal teahnioal e:xpert. troll within WHO, each oontributes _thing to the other. It is troll the oollbination ot these tllO strengths that the Organization w11l get its chiet thrust in the decades betore the year 2000. In general terms, the WPACMR endorses the ooncept ot oollaborating oentres and it is perauacled that. if the pro08ss ot designation is well performed, great benetits will aoorue to the Organization and to world research. through the network of collaborating aentre.. 'Dle WPACMR teels on the other hand that the prooess ot designation JIIWIt be deliberate and have a strong collllponent of obJeotive. peer gro"" evaluation if the right oentres are to be Chosen. '!hit WPACJIIR also felt that WPACMR members and elt-_bers should playa positive role in the designation proaess.

Concerning upert panels, the WPACMR was strongly of the view that these have an illllportant rols in WHO. Of the IIIIJIY roles such panels play, first, they provide valuable information to WHO and to the lIOrld about the state of the art in varioua disaiplines and the doaUMnts produced by Expert Committees are widely used and valued. Partiaularly tlportant are Expert Colllll1ttee reoOllllll8ndations whioh truly represent the very any nations of the world now oontributing to the large volume ot reiSearoh ·and not only the views of the ISO-oalled developed nations. However, many e:xperts and important first rank figures are not being used b7 the Organ1zation. 'lbe seoond role whioh WPACMR endorses very vigorously is the Scientific Working Groups or Task Porces, established for evaluating and reviewing grant proposals. 'lbe Committee felt very strongly that these peer groups should playa very prominent role in resouroe allocation if the Organization is to get -.x1.mum value tor its researob clollar.

WPR/ACMR/79.20 Report page 22

A PROPOSED MEI!:TING

(JfI

NATIONAL MEDICAL RESEARCH COUNCIU!

(Doownent WPR/ACMR/79.19 and a Report prepared by Dr Hodge) (Item 14 of the Agenda)

Dr Hodge introduoed this topio (wpR/ACMR/79.19) by stressing the great illportanoe of the proposed meeting. He noted the baoqround to planning of the meeting and quoted from his 1977 report to the Medical Res.arob Council of New Zealand as followsl "Consideration of the developments in medioal researoh oooperation in Europe leads me to oOlllll8nt that we are a long way behind in this respeot in our own part of the world. Admittedly the orsanizations involved are youn,:.r and enaller. reBburoes are less and distanoes are greater. However, the.e faots inorease rather than deorease the need tor oooperation. Among the likely benefits would be an exchange of general intormation on regional researoh prog~s and speoifio into~tion on projeots and scientists, a mutual approaoh to problems experienced by medioal soientists and administrators in this part of the world, encouragement and advice for newlydeveloped researoh organizatiOns from those whioh have been established for a longer period, development ot Joint researoh prog~s where releVlmt and the coordination of overlapping prOgrammes whioh are ourrently arranged separately, e.g. studies in the Pacific Islands. In addition to the regional reeearoh councils, it will be illportant to involve aleo the medioal diviSion of the South Pacific COmmission ~ the regional office ot WHO, both of which have researoh reepona1blli ties and a ooordinating role.In endorsing the above and the broad thrust of dooument WPR/AcMII/79.19 the' WPACMR did wish, however, to add additional agenda items to the propos.d • •tina and. to rearrange the priority of eome other agenlSa it..... Among the additional it.ms that were approv.d by the Committe. were. 1. On the oOllpilation and sharing of intonation about stl'Uotures and evolution of medical researoh oounolls. Und.r this broad heading ths susgestion arose that the evolution of the New Zealand Medioal Researoh Council might be presented to the meeting as a case study. 2. Meohanilllllll of colllllUl11cation on researob with Mellber govemments and the possible evolution of a single channel of oo..un1oation. }. '!he 1nterfaoe between medioal researoh oouncils and other governmental advisory machineries such as scienoe and teohnology oouncils or even sooial soienoe oouncils might want study in view of the multidisoiplinary nature of health intervent10ns in modern so01eties.

WP!VACMR/79.20 Report page 23

4. The production of biomedical research information in • foI'lll suitable not for scientists but for users of the results of sucoessful scientific research might be addressed by the medical research oouncil directors. 5. One agenda item might deal with the question of whether the grouping of medical research councils or their equivalent in the Region might come to evolve into a more permanent network 80 that a new structure for international collaboration in medical research might develop. '!his would be a -.nifestation of technical cooperation among developing countries. 6. Possibilities for intercountry and even inter-institute research might be brought to the attention of this meeting. In endorsing the broad principles of the meeting and in giving it its highest priority, WPACMR nevertheless realizes that the first meeting will have a certain experimental or exploratory component. In that regard it suggests that the Regional Director might consider even now the probable need for a follow-up meeting in 1981 which would put forth before WPACJIIR VI the fruits of the work accoqll1shed at the meeting in 1980 and the fruits of further ongoing work by subcommittees established by that meeting. '1he 1981 _eting might have then a distinctly high level and political representation so that the importance of medical research in the furtherance of national health goals could be brought to the attention ot the highest decision makers in the Jlllember States. The importance of participation in this venture ot the global ACJIIR and of its sister ACMR in the South East Asia Region was emphasized by the COJIIDittee. The general feeling was developed that as the people that will be invited will be very important people in their own countries, one week might be a little bit long to expect them to maintain their presence in Manila and the suggestion was made that a three-day meeting might be adequate. The WPACMR then appointed a working party under the chairmanship of Dr Hodge and to include Dr Macfadyen and Dean Kwon to refine the preliminary planning so as to bring the 1980 meeting to a successful conclusion. Among the early taaks of this subcoJIIDittee would be to draft a very carefully worded letter of invitation to be prepared for the Regional Director, as it w11l be most important to engage the e.ttmtien of appropriate individuals in the Member States to partiCipate in this venture. However, notWithstanding the importance of drafting this letter, other work will have to be done in order to ensure that the best people from each country participate and the most appropriate people. In that regard, the country programme coordinators will have to be heavily involved and briefed by Dr Macfadyen on the importance that the WPACMR plaoss on this matter.

WPR/ACMR/79.20 Report page 24

Furthermore individual WPACMR memflers, wnen I'EiCUlflliig 'C1:l menMember countries should make personal contact with their health ministries in order to prepare the pathway for the invitation letter and in order to help the health ministry of their nation identify the individual or individuals who would form the most appropriate delegation to this meeting. The possibility was raised that the Regional Director of WHO be asked to refer specifically to this matter when next addressing the Regional Committee. There was a consenaus of opinion in favour of a three-day. rather than a five-day meeti~ and this was accepted. CO-SPONSORSHIP OF RESEARCH MEl!:TINGS

(Item 15 of the Agenda) Discussions of th1sitem, led by the Chairman, centred on the extent to which WHO should lend its name by full co-sponsorship of national meetings and on other ways in which the Organization could assist with promotion of such meetings. While WHO sponsorship was undQubtedly an important factor in persuading some governments to release participants or provide local support, it was sccspted that this mechanism should be used only when certain agreed criteria were met. Most members accepted .during discussions that these criteria should be relatively strict, to maintain the good name of the Organization, but that oth~r means of assistance (e.g., holding sympOSia in conjunction with national scientific meetings, assisting with costs of selected participants or resource people) should be encouraged. It was agreed that each WPACMR subcommittee should be free to identify one such national meeting per year for special help, but that financial and staffing constraint would impose a "ceiling" of six such meetings per year for the immediate future. The Chairman confirmed acceptance by WPACMR of the criteria (as set out in document WPR/AC~9.17) and summarized the disoussion as followsl The WPACMR is aware of the importance of both national and international meetings in the promotion of scientific collaboration and is aware of the difficulties encountered in some countries for funding scientists to go to meetings. It wishes to be helpful in the promotion of international interchange of information amongst medical scientists. However, it believes that full co-sponsorship of a meeting by the World Health Organization should only be undertaken if certain criteria are fulfilled. First, it is important that if the Organization is to be full co-sponsor of the meeting that it be involved wholly and fully in the planning of the scientific programme of that meeting.

WPR/ACMR/79.2O Report page 25

Secondly, it believes that five questions, as set out in document WPR/ACMR/79.l7, should be annered before full co-sponsorship is considered, namely: 1. Is the organization making the request a non-governmental organization in official relation_ with WHO? If not, the type of organization should be specified. 2. Are the purposes, the principal theme and the agenda of the meeting in question directly relevant to WHO's policles and programmes? This should be made explicit.

3. Are there any foreseeable political implications or other considerations that should be especially checked? 4. Is WHO sponsorship Justified in terms of the real impact of its output in WHO's Member States? 5. Exactly what are the technical and/or financial iaplications for WHO in co-sponsoring the meeting? Thirdly, it believes that because of constraints in some resources the total number of meetings per year to which co-sponsorship is given, should be limited. A maximum figure might be six representing the six priority areas of the WPACMR as designated by the six subcommittees. This could be an initial ceiling for a trial period of three years. The Comm1ttee went on to debate other forms of help that the Organization might give to international meetings short of full co-sponsorship. The Committee endorses a variety of such approaches, including the possible holding of symposia within a big congress; the possible siting and timing of WHO workshops to precede or follow major congresses; the possibility of WHO consultants or staff members being brought to a congress in order to represent the WHO position within the meeting; and finally. the possib1lity that WHO may designate a WPACMR member or another senior consultant officially to represent the Organization at the meeting and report back to the Regional Secretariat the most salient features of the meeting so that WHO may be kept fully informed. The WPACMR also commends the efforts that the Organization has already made under this second category of involvement and recognizes that staff resources are a major constraint with respect to fulfillment of these aims.

'""'

WPR/ACMR/T9. 20 Report page 26

OTHER BUSINESS

(Item 16 of the Agenda)

Future subcommittee structure

'!'he WPACMR, under any other business, considered the structure of its task forces or subcommittees. It decided that the WPACMR should replace the present four task forces with a number of subcommittees employing the following principles: 1. Each subcoauittee would comprise two WPACMR members as Chairman and Vice-Chairman. 2. Each subeo_ittee would involve WPRO secretariat (the appropriate regional adviser for the particular discipline most concerned), who would be an integral member of the subcoJl1lllittee.

'lbe appropriate secretariat member from HQ, Geneva would allo be invited to beoome a member of the lubcO/lll11ttee, although his or her attendance at particular meetings may not always be feasible. ,. Each subeollllllittee would have 6 - 10 individuals as stand by resource personnel, who might not in totality attend each meeting of the subcommittee but might. at the discretion of the Chaiman and Vice-Chairman and acting in consultat1on With the secretary of the subc~tt.e. be called upon as the epecif10 taek before the lubcommittee d1ctate •• It 11 further thought that the WHO South Ealt Asia off1ce should be invited to send an appropriate technical officer wherever feasible and des1rable. particularly in those areas where intel'oreg1oll&1 proa:re-s alread;f exist. 'lbe Chairman sUBgested, on the question of an additional WPACMR _mber in the field of lII&JI&gement science, that someone frolll the People's Republic ot' China (which country manages its health system extremely well) be invited to join the collllittee. Once that individual ill ideJltit'ie4, with the help ot' Profell8or xue from the Health Ministry, he would be an exoellent Vice-Chairman ot' tJte WPACMR subcommittee on health service. aDd occupational health. I, I'

i I

WPR/ACMR/79.20 Report page

The proposed new suboo.tttee structure is tabulated belowl WPACMR Proposed Subcommittee Chairman Vice-Chairman

SECRETARIAT WPRO Geneva

Cardiovascular and metabolic diseases Parasitic diseases

J.V. Hodge H. Tanaka D. Rowley Dang-Duc Trach E. Hyock Kwon 5.5. Ratnam

G.J.V. Nossal Mao Shou-pai Chin 'l'hac k Soh Y. Kaneko R.S. Guinto Member from PRe N. I. Chandrasekharan

,..

Appropriate regional adviser - ditto - ditto - ditto - ditto - ditto -

Z. Pi8a* R. Davis* A. Zahra* A. Zahra* E. 'l'arimo* G. SterkY*

3. Diarrhoeal diseases 4. 5. other communicable diseases Health services and occupational health

6. Family health

*or designated representative 2. WPACMR V

The date of the WPACMR would be Monday, 14 April, to Wednesday, 16 April 1980, inclusive. Professor Rowley asked the Committee to consider as an additional feature to the meeting of WPACMR V to have a site visit to one of the important local research institutes. The Chairman suggested that the Secretary explore this. The most likely time for such a site visit would be after lunch on the third day, because the proeramme is pretty heavy. However light arrangements could be appropriately adjusted to take into consideration the pOssibility. It would be fascinating to visit say the Ph111ppine Heart Center for Asia, or the Institute of Public Health. which is being strengthened; or maybe to see the schistosomiasis work at first hand. The suggestion is informal and it is proposed that the Secretary consider this and also think of including a one-hour lecture by a prominent WPACMR member at the institute visited.

Closing remarks were made by the Chairman and the Regional Director responded. The Committee has identified a number of important new activities for the Regional Directqr's consideration and support. The structure

ot the suboo.-1ttee has been drastically altered, the nu.ber ot inoreasing trom 4 to 6 with a distinot change in emphasis Which is largely in response to ohallenges identitied through the dOc~ntation and by the WPACMR ._bers responding to the chall. . .s troJll the Regional Director and the Director-General. At least two new _Jor ettorts are suggested.. en. is the _Jor ettort in clonorchiasis and paraaonill1asis and the other h the 1DIItitute strenathenill8 prog~ in PiJi. 'l'hese are partially pl'O.,ide4 tor in the draft budpt (Annex 1) but the c-1ttee i. a little .ore ambitious and it sugsest. that oonsideration be li.,.n to increaaing the allocation in both th.se areas and thlreby enlars1ng the proposed budaet tor 1980. . Very productive discussions were hsld coneemini better linkage with the medical research endeavours of Me.ber States. TiIl8 and time again the Co_it tee come back to the view that WHO's best rcle is not as initiators of researoh but as catalysts and ooordinators of research. Ths Me.ber States in this Region have very great strengths in their potential tor health research. Often this potential is not used. and the CoDDittee therefore wants WHO to be the catalyst. As part of this catalytio endeayour, the COllllittee proposes conftning, under WHO's guidance and auspices, a meeting of medical research councils, .adical nctions ot scientitic councils, and appropriate individuals tro. countries which do not haft such bodies. Furthermore the CoDDittee accepted the challenge to include a major programme of research on diarrhoeal diseases and Professor Rowley is already aSSigned as Chairman of a subcommittee to give advice in this important area. The Committee would oertainly hope that thl. will be .,ery hard working subco_ittee. The last co_nt relates to one quite extraordinary opportunity facing the Region and that is the faot that China is wilUng to collaborate on research with the World Health Organization to an even greater degree than in the past. I t has been reco_nded that an entirely novel structure of aid for institution strengthening and information exchange be investigated by which WHO would assist China in organizing a meeting to be convened by China of bilateral donor agencies. If this is feasible, Professor Bergstrom, Dr Minners and Dr Wilson have promised to follow this up in Geneva. Dr Macfadyen has offered his services in workill8 very closely with the Regional Direotor and Protessor Mao has also otfered his servioes as a WPACMR member in keeping in very close oontact.

The Regional Director responded by thanking all members for helpill8 WHO. He had no doubt that his successor will respond·to the ohallenge given him. Medioal research is inoreasingly an in.,ortant aspect of WHO's work. Unless this area receives complete .upport,

WPR/ACMR/79.20 Report page 29/~

WHO will just go on the old trail, in a rut, not

i~roving but just repeating. 'Ibe Regional Director undertook to co~ly with all the Committee's recommendations. He had heard the recommendations and accepted them all since he had complete confidence in the Committee; for example, it is possible really to do something about clonorchiaSiS and paragonimiasis and the strengthening of the Virus Laboratory in Fiji. 'Ibe new set-up of the subcolllllittees is very good and the Regional Director is confident that funds for the activities of these subcommittees will be found. The date fixed for the next meeting of the Committee is a good one because every April and November there is a meeting of the WHO Programme Coordinators who could come a little bit early to attend the Committee's fifth session. 'Ibe amount of funds which could be available is proportional to the programmes and packages that are prepared. Finally, the Regional Director expressed the hope that his successor would convene a meeting of potential donors with some members of the COlllllittee, and at this meeting it would be very i~ortant to present good research "packages" to sell.

WPR/ACMlVT9.20 Report page ANNEX 1

PROGJWM: AND BUOOET

RESEARCH PRCMlTION AND DEVEUlPMENr (RPD)

1979-1981

Introductory note At the review of the RPD progranme with the WHO Progranme Coordinators (21-27 November 1978) it was noted that "as major research prograaES developed the funds were gradually being reallocated to the responsible technical programmes. though the medical officer. Research Promotion and Development. was still to act as coordinator". (Note for the Record. 27th meeting with WHO Programme Coordinators. paragraph 12. page 9.) 1.

2. The present programme and budget begins this reallocation process with respect to the regular budget allocations for 1'179 (wpR/RC27/2. page 312, wpR/RC28/2, pap;e 6 and WPR/ACM/V'77.9. pages 18-20) am to the provisional RB allocations for 1980-81 (WPR/WR36/3. pap;e Ij). 3. The reallocated sums. sometimes large and sometimes small, represent a beginning commitment to research within diverse programme areas which is likely to expand in the biennium 1982-53. 4. The reallocation also makes explicit where responn! hf lft.v lies for programme i~lementation. It will be seen that, under the reallocllt.ed budget, the direct responsibility of the RPD programme manager Is restricted to servicing the WPACMR. the Regional Research Centre in Malaysia and small scale collaborative research projects. Half the budget is reallocated between programme managers in communicable diseases. parasitic diseases. cardiovascular diseases. chronic diseases and health services research. 5. Initial experience for 1979 indicates that this division is functioning effectively since all allocated funds for the year are programmed,

WPJl/ACMR/79.20 Report Pace 32 Annex 1

EJlplana'to17 notes Underlining denotes RB allocations as listed in souroe documents referred to in Introductory note, paragraph 2.

FootDote 1: included under general "fellowship" provisions in source doou.ents referred to in Introductory note, paragraph 2, naMl,. a total of uS$ 87 500 in 1979, _ 73 200 in 1980 and US$ 80 500 in 1981. rootnote 2: included under general researoh contract provisions in souroe docu.ent8 referred to 1n Introductory note, paragraph 2, naael,. a total of US$ 155 000 in 1979, _ 200 000 in 1980 and. U8$ 200 000 in 1961. included. under sene",l QOfUlultant prov1l1ofUI 1n souroe docwnenta referred to in Introductory note, paroallraph 2, _1,. a total of US$ 40 500 in 1979, tJS$ 40 5flO in 1980 and US$ 31 500 in 1981. total provision for the centre in 1979 made in source documents referred to 1n Introductory note, paragraph 2, namely a total of US$ 192 600 was reprogr&llllll!d following RPD's visit to Malaysia, 14-22 January 1979 (refer Motes on Dut,. Travel, fCP/RPD/OO1) in order to provide a reduced budget of US$ 150 000 in view of delaJed staff recruit_nt.

Footnote ,.

Footnote 41

WPR/ACMR/79.20

Report page 33

Annex 1

PROGRAlfti: AND BUDGET RESEARCH PROMOTION AND DEVELOPMEm' (RPD) 1979-1981

SERVICING WPACMR

ICP /RPD/OOl Advisory Committee on Medical Research for the western Pacific 1.1 Secretariat Medical officer Clerk stenographer Duty travel Supplies and equ1.pment 1.2 Fourth, fifth and sixth sessions Temporary advisers 1.3 Technical visit People's Hepublic of China 1.4 Seminar Medical research council directors 1.5 Staff development Workshop on organization and management. of medical research l 1. 6 Consultants 1.7 2. 2 000 48 200

000 11 900 1000

49300 4400 6000

50500 4800

6600

15000

24 000

26400

15 HOO

25000

nil

4 ')00

Study mission: modern organization and management of scientific research RESEARCH SUPPORT

66 000 (allocated under project CHN/~D/OOl)

ICP/RPD/003/004 Collaborative research projects 2.1 2.2 Research contracts 2 (ICP/RPD/003) Research trainingl (ICP/RPD/OO4) 7700 25000 nil

25 000 23600

( 29 400 ( 72 800

WP!VACMR/79. 20 . Report page ~ Annex 1

,. '.1 ,,1.1

1m RIOIOIfAL CBWtJiIM ICP/RPD/OO2 Re§10nal Centre for ~esearch and Tra1n1E§ in Trop1cal Diaeases , Xuala Lullpur Internat10nal etaft

1980

l2l!!

?"o.

Ep1demiologist, olin1oal nutrit1onist, b1ostatist1oian '.1.2 Looal staff Seoretary (see also ,.1.6 belOW) '.1.' Consultants' International (2/3/1 man-month) Looal (} 8II-monthe) ,.1.4 Research trainingl 1 x 12 months 2 x , months ,.1.5 Gro!!! tra1ni!!!1i Mosqu1to inooulat1on !!LISA Parasite chemotherapy ,.1.6 Dutl travel Projeot drivers (2) Other staff travel 3.1.7 Supplies and equipment Office supplies Vehicle ICP/BVD/OIO

88 800

l4I 900

121 200

6000

8000 6000

1, 500

-500

2200

sQQ

14 000

12 000

24 200

30 000

30000

6000 1 600

6000 2500

4 000

6000

,000 2IOO

'500

3500

,.2.1

Aoute respiratoEI infeot1ons

,.2.1.1 Internat10nal staff Epidemiolog1st 40

000'2

49 300

50500

WPR/ACMR/79.20 Report page 35 Annex 1

m2 2 3.2.1.2 Research contract Pneumonia unit 3.2.1. 3 Research trainingl 1 x 12 months 1 x 3 months -,3.2.2 Working Gro~ on acute respiratory infections Sentinel unit methodology' 3.2.3 Re§ional advisory I!anel on acute respiratory infections First session Consultants3 2 man/months ICP /M>D/OlO 3.3 Collaborating and national centres for tropical diseases research (People's Republic of China, Republic of Korea, Viet Nam) Research contracts 2 Clonorchiasis, paragonimiasis other 3.3.2 Research trainingl 9. 6. 9 man/months Consultants 3 2.3.3 man/months 4. RESEARCH COII'ONENTS OF 0l'HER PROORAMMES ICP/BVD/0l2 II. 1

1981

85000

20000

19 100 6500 7500

9800

3.2.4

~~ 2 000 9000

2 000

3.3.1

20000 15000 12 500

25000 20000 15 700

20000 22500

~OOO

3.3.3

9000

13500

13200

Ilesearch in dengue haemorrhagic fever Research contracts Philippines Hawaii 2

4.1.1

25000

36400 5 000 25000 25 000

WPIVACMR/79.20 Rep"rt pace ~ Annex 1

Am 11.1.2

~ 24400

ne••arch tra1n1nil 2 :It

24 IIIInth.

12 200 .

12 200

11.1.,

Gro!!!! tra1ning (lIIIequito inoculat1on - see paragreph·'.1.5 above) lCP/ESD/OCR.

11.2 11.2.1

!l!1demio1ol1i1ca1 tra1n1y Consultant 1 x 2

IIIOnthS

9000

4.2.2

Group tra1n1ne; Reg1ona1 oourse on communioab1e and non-oOMUn1oable di.....s ep1dell101og;y lCP/K'D/OO9

'0000

II.' 4.,.1 4.,.2

Sch1stosomiasis control! ra..arob and tra1n1!:!1 Research oontracts2 "'000 Reg10llAl .teer1ng oo_ittee lCP/lll'D/Oll

....... 12 000 10000

16700

4.4 4.11.1 4.11.2

P1lar1as1s research Research contracts2 Working group Brug1an f11ar1as1s ICP/JIPD/012

9000

2 000

900

4.5 4.5.1

Paras1t1c diseases researoh Pirst and second sess10ns of task force 17300 20000

WPR/AcMRn9.20 Report paae ~/38 Annex 1

l212 lCP /CVD/OOl 4.6 4.6.1 4.6.2 Cardiovascular diseases erevention, control and research Fourth session of task force Regional advisory panel rcp /BVO/013

1981

5 000 10000

"".7 4.7.1

3 Tuberculosis research Consultant, 2 man/months rcp /fND/OO6

9000

4.8 4.8.1

Leprosl control and research Consultant, 3 man/months ICP/HSD/017 14 000

4.9 4.9.1 --4.9.2 4.9.3 4.9.4

Health services research Fourth session of task force Regional advisory panel Research contracts Research training Regular budget Other regular budget, CHN/RPD/OOl Voluntary funds 20800 (24 000) 597 100 648 300 601 600 5200 20000

66 000 151 200 79300 70000

(

)

included in non-underlined total in paragraph 2.2 above.

WPR/ACMfl/79.20 Repo1"'t paae '9/40

STUDY GROUPS ON PARASITIC DISEASES While endorsing the Report of Secretary of Task Force on Parasitic Diseases and Leprosy (document WPR/ACMR/79.5). the WPACMR reoeived a proposal to organize study groups on Parasit10 Diseases with the aim of sharing sc1entifio information and field experienoe among soientifio workers in speoifio parasitio diseases oommon to oountries of the Western Paoifio Region. The suggested terms of referenoe for suoh groups are as follows:

(1) To provide first hand information based on their own personal experienoe both in the f1eld and in the laboratory; (2) To disouss advantages and disadvantages of control tools ourrently in use; (3) To suggest ways and means of iq,roving existing oontrol methodology oonsidering looal resouroes available;

(4) To make feasible reoonunendations either directly to the Government oonoerned or through WPACMR; and. (5) To increase and facilitate direct onmmunicatlon hetween workers from various Member 3tates of the Region havlnp; similar public health problems. Priority should be given to the formation of study groups falling under two main headings: 1. Inseot-borne diseases

1.1 Malaria 1. 2 Filariasis 2. Snail-borne diseases

2.1 Sohistosomiasis 2.2 Paragonimiasis 2.3 Clonorchiasis 2.4 Opisthorohiasis Sinoe training and exchange of vital information is a very iq,ortant component of the global programme of TOR. this proposal should be sent to the TDR Director for reaction and comment.

WPR/ACMR/79.2O Report page 41

ANNEX , LIST CF MEMBERS AND Ol'HER PARTICIPAtll'S Professor Sir Gustav Nossal (Chairman) Director The Walter and Eliza Hail Institute of Medical Research Melbourne, Victoria Australia Dr N. I. Chandrasekharan Assooiate Professor Clinical Diagnostic Laboratory Medical center University of Malaya Kuala J:.unpur Malaysia Dr R. S. Guinto American Leprosy Foundation (Leonard Wood Memorial) Cebu Skin ClInIc Cebu City Philippines Professor E. Hyock Kwon Professor Department of Preventive Medicine College of Medicine Seoul Nati.onal University Seoul Republic of Korea Dr J.V. Hodge Director The Medical Research Council of New Zealand Dunedin New Zealand Professor Y. Kaneko Professor of Public Health School of Medicine Toho University

ii- .•

··:;t;;j;i'<I.:~~~'(~,~.

WPR/ACMR/79.20 R"CR;:' page 42

Profe.sor Mao .8be1I-pal Dlreotor Inatltute of Para.ltl0 Die..... AoadM7 of MII410al 801_••

Ch1Jw.. Head

r.:;r.t! Republ10 of' Chlna

Prot•••or S. S. JlatftUI Department of Obstetrio. and G,naeoology unlvere1ty ot Slngapore Slngapore 8 Republl0 of Slngapore Professor D. Rowley. Depart. .nt of Mioroblology aDd T.umlOQ Un1verslty of Adelalde Adelaide South Australia Profe••or H. 1anaka Profe.sor Depart. .nt ot Parasltology Instltute of Nedlcal Sclence l1n1ver.lty of TokJo

TokIO Japan Prote••or Chl~Th&ok Soh Proteellor Department ot Paras1tolo,y CoUege ot Ned10lne Yonsel Uniftrs1t;y Seoul Republic of' ItDrea Dr Dang Duo Traoh '1loe-Dlrector . .tlonal Instltute ot Health &DdBpl~olo87 Hanoi SOOIillst Republl0 of Vlet ...

'l'BII'ORARY ADVISER

Profe.Bor M. Boni taO ' 0

Department of Sociology College of Arts and Sciences

unlverslty of the Phil1ppln. . Dlllman. Quezon Clty Phllippines

WPR/ACMR/79.20 _01"1;

page . ,

Annex' Dr S. BergstrHm Consultant Office of the Deputy Director-General WHO Headquartera Geneva SWitzerland Dr H.A. Minners Responsible Offioer Research Prcmotion and Development WHO Headquarters

WHO STAW

Dr R. Wilson Medical Officer Speoial progre.ane for Research and Training in Tropical D1eeases WHO Headquarters

Dr E.P. MIlch Technical Officer Resource Group Di Vision of Strengthening of Health Services WHO Headquarters Geneva SWitzerland Dr B. Jayaweera Medical Officer Research Prcmotion and Development WHO Regional Office for South East Asia )few Delhi Ind1a Dr J. Hirshman Director. Prcg~ Management WHO Regional Office for the Western Paoif1. Man1la

Philippines Dr G. Emery Direotor Disease Prevention and Research WHO Regional Offioe for the Western Pacifio Manila

philippines

WPR/ACMR/79. 20 lteport page 44 Annex 3

Dr L.R.L. Veratuyf't WHO Prog~ Coordinator KUAla Luapur Malaysia Dr B. Dazo Re810nal Advi.er in Communicable Di.ea.e. WHO Regional Office for the We.tern Paoifio Manila philippines Dr S. Endo Regional Adviser in Chronic Di ....es WHO Regional Office for the Western Pacific Manila Philippine. Dr G. Farid

Medical Officer Intercountry project on Malaria Research WHO Regional Office for the Western Pacific Manila Philippines Dr E. Goon

Regional Adviser in Health Manpower Development WHO Regional Office for the We.tern Pacific Manila Philippines Dr R. Herniman

Regional Adviser in Health ser91ces Development WHO Regional Office for the Western Paoifio Manila Philippines Dr R. Lindner Regional Adviser in Communicable Diseases WHO Regional Office for the Western Pacific Manila Philippines Dr D. Macfadyen Medical Officer Research Promotion and Development WHO Regional Office for the Western Pacific Manila Philippines Dr A. Rll.Jkovic Regional Adviser in Laboratory Technology WHO Regional Office for the Western Pacific ManUa 'ri ] 1"'.. I ...

..,..e'-.::'

WPR/ACMR/79.20

Report pap 45/46 Annex 3

Dr L. Self

Regional Adviser in Vector Biology Control WHO Regional Office for the Western Pacific Manila Philippines Dr W. van Dijk

Regional Malaria Adviser WHO Regional Office for the Western Pacific Manila Philippines Dr Wan Fook Xee

Regional Adviser in Health Services Development WHO Regional Office for the Western Pacific Manila Philippines

,i i

;

WPR/ACMR/79.20 Report paae 47 AMJIEX 4

1 2 )

~en1ng

of the session:

Regional Direotor's address

Adoption of the Agenda (dooument WPR/ACMR/79.1 Rev. 2) Eleotion of offioers: Chairman's address A Plan for the Managelllllnt of Research (dooument DGOtr8.2) 5.1 Regional Research Management Plan (dooument WPR/ACMR/79.2) Vioe-Chairman and Rapporteur

4 5

6 7 8

WHO Global Prog~ on Diarrhoeal Disease Control (dooument WPR/ACMR/79.) IqI1elllllntation of ACMR 20 (dooument ACMR 20/78 Report) IqI1elllllntation ot WPACMR III 8.1 Report ot seoretar:v of Task Porce on Health servioes Research (document WPR/ACMR/79.4)

8.2 Report ot Seoretar:v of Task Porce on Parasi tio Diseases and Leproll7 (doo~nt WPR/ACIIII/19.5) 8.2.1 Report of Task Porce Meeting on Clonorchiasis and Paragonim.asi8 (document WPR/ACMII/79.6) 8.2.2 Awstral1a/WHO selliinar on Tropical I.unolo87 (dooument WPR/ACMR/79.7) 8.) Report of Secretar:v of Task Porce on Coanunicable Diseases and Other Research Areas (document WPR/ACMR/79.8) 8.).1 8.4 Aoute Respirator:v Infections (document WPR/ACMR/79.8)

Report of Seoretar:v of Task Poroe on Cardiovasoular Diseases (dooument WPR/ACMR/79.9) 8.4.1 Epidemiology of non-oommunicable diseases (document WPR/ACMR/79.9)

8.5

Report of WPACMR Beoretar:v (document WPR/ACMR/79.10) 8.5.1 Bi0JDe4ioal Research Inforaation (dooument WPR/ACMR/79.11)

WPR/ACMR/79.2O Report page 48 Annex 4

Report of Convenor, WPR Focal Group on Special Programme for Research and Training in Tropical Diseases (document WPR/ACMR/79. 12) 9.1 Progress report on malaria researoh (document WPR/ACMR/79.13)

10 11

Feasibility sttdy on strengthening the Wellco_ Virus Laboratory in Fiji (doc!ument WPR/ACMR/79.14) Researoh on health hazards of working populations (document wpR/AcMR/79.15) Technical presentations 12.1 12.2 Research on the education of health personnel (document WPR/ACMR/79.16) Jacques Parisot Foundation Award preliminary presentation (document WPR/ACMR/79.18

13 14 15 16

Executive Board Study on WHO EJlpert Advisory Panels and WHO Collaborating Centres (docUMnts EB63/24 and EPCj'EB\o«J/l) Proposed meeting of directors of national medical research councils (document WPR/ACMII/79. 19) Co-sponsorship of research meetings (document WPR/ACMR/79.17) other business

WPR/ACMR/79.20 Report l'Age 49 ANlII!:X 5

Document~eference

JfuJlber WPR/ACMR/79.l 000/78.2 AgeDda

Title

Author

A Plan for the

~nt

of Research

WHO/HQ Dr D. Macfadyen

"""

WPR/ACMR/79.2 WPR/ACMR/79. :5 ACIIIR 20/78 Report

Reg10nal Research JIIuIage. .nt Plan WHO Global Prog"-- on Diarrhoeal D1seaae Control Advisory CoBl1ttee en Med10al Research. Report to the D1recto%'GeDsral Report of Secretary of '!'ask Force on Health Semces Research ",

WHO/HQ

WHO/HQ Dr R. 'Hern1man Dr D. Daze

wpR/ACRR/79.4 WPR/ACMR/79 r5 Ii" ,

Seoretaries' Report on Task Force on Parasitic Diseases and Leprosy Report on the Meet1ng of the '!'ask Foroe on Paras1t10 Diseases: Paragonimias1s and Clonorchiasis (unedited draft) SetI1nar on 'fropical IlBtmology Report of Secretary of Task Force on Communicable D1seases and Other Researoh Areas Report of Secretary of Task Force on Cardiovascular D1seaaes Report of' WPACMR Secretary FiDlLl Report of Working Group of Librarians (unedited draft) Periodical ~tles Proposed by Working Group of Librarians as possible period1oal titles for indexing by the lIat10nal Library of' Medicine f'or Index Medious

Dr S. Endo Dr L. Self WHO/WPRO

WPR/ACMR/79. 6

......., WPR/ACMR/79.7 WPR/ACMR/79.8

WHO/WPRO Dr R. Lindner

WPR/ACMR/79.9 WPR/ACMR/79.l0 WPR/ACMR/79.11 WPR/A911V79.11 Add.. 1

Dr S. Endo Dr D. MacfadJen

WHO/WPRO WHO/WPRO

WPR/AcMR/79. 20 Repert page 50 Annex

WPR/AcMR/79.12

Report of Convenor. WPR Pocal Group on Special Programme for Research and Training in Tropical Diseases Progress Report on JlJalaria Re_rch A Peasibility Study for strengthening the Well come Virus Laboratory in PiJi Proposals for Research in Occupational Health in the western Paoifio Region Research on the Education of Health Personnel Co-apolUlorship of Research MIIetings Rural-urban doctors in some Southern Tagalog areas: a social psychological oomparison (Chapters I and X of a prel1.JD1nary presentation to the Jacques Pari sot Foundation) i!

Dr G.M. Emery

WPR/ACMR/79.13 WPR/~R/79.l4

Dr w. van DiJk Dr I. Gust

WPR/ACMR/79.15 WPR/ACMR/79. 16 WPR/ACMR/79.l7 WPR/ACMR/79.l8

WHO/RQ Dr B.H.T. Goon

Dr D. JlJacfadyen

Dr M.P. Bonifscio

WPR/ACMR/79.18 EB63/24

Proposed Meeting ot' Directors ot' Rational Medical Research Councils

Dr D. JlJact'adyen

Exeoutive Board Organizational study WHO/RQ on the Role on WHO Expert AdT1sory Panels and ColE1ttees and Collaborating Centres in ,meeting the needs< of"WBO res&:N1IIc e:xpert a4v1oe and in oarT7ing out teohnioal aotivities of WHO: Progress report by the Working Group 'n1e Role of WHO Expert Advisory Panels and COnDittees and Collaborating Centres in meetiJIg the needs ot' WHO '}oegard1lJg e:xpert adTioe and in o&rT71ng out technical activities of WHO (Background working document: Organizational studT by the Executive Board) WHO/RQ

EPC/EBlI'G/l

WPR/ACJIIR/Inf ./79.1

Overall SUIIIII&ry and ReCOlllnendations Dr A.C. Re,.s on the epidemiological services and training facilities for epidemiologists in some countries in the Western Pacit'ic Region. WHO (excerpt from the Report on Epidellliological Services and Training Facilities for Epidemiologists)

WPR/ACJIIIR/79.20 Report page 51 Annex 5

WPR/AC~lnf.179.2

Partial S_ry Assignment Report on the National Diarrhoeal Disease Control ProgI'11111118 of some oountries in the Western Paoifio Region Report of the Regional Steering Comadttee (RSC) for the Working Gro1.p on .[:. Japonioum (unedited draft) Supplementary Report on Sexlally Transmitted Diaeasea and Endemio Treponematoses in the Western Paoifio Region Minutes of the Ad Hoc Steering Committee for Re.earch on Dengue ~rrhagic Fever (UMC1ited draft) Report of the Working Group on Aoute Respiratory Infeotions (Sentinel SurveillanoeUOit Methodology) (28 to }O January 1979) Notes on a Visit to the Philippines. Malaysia. Singapore and Rang Kong (11-29 Maroh 1979) Partial SU/IIIJIary of a Report on a Visit to papua New Guinea (study of behavioural faotors assooiated with leprosy control) (FebruaryApril 1979. unedited draft) Final Report of the Working Group on Subperiodic Bancroft:1an Filar1a8is. 1-4 MIly 1978. Apia Report of the 'lhirdMeeting of the Teohnical Advisory Committee on Dengue HaellOrrhagic Fever. Manila. 6-8 December 1978 Report of the third session of the Western Pacific Advisory Committee on Medical Research. Xuala Lumpur. MIllAysia. 24-27 April 1978

Dr J.S. Sumpaioo

WPR/A~lnf·179.}

WHO/wpRO

WPR/ACMRllnf·179.4

Dr B.H.R. Hill

•

WPR/ACMR/lnf. 179. 5

WHO!HQ

WPR/ACMA/lnt. 179. 6

WHO/wpRO

WPR/ACMA/lnf ./79. 7

T. Shi_o

""""

WPR/ACMR/Inf. /79. 8

Dr C. Varkevisser

rcp /M'D/OOl

WHO/WPRO

ICP/BVD/Oll

WHO/WPRO

lCP/RPD/OOl

WHO/wpRO

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date December 31, 1979

Source World Health Organization