(WP/RC15/Mln/3 Rev.1)
MINUTES OF THE THIRD MEETING vTHO Conference Hall Friday, 18 September 1964 at 9.00 a.m.
CHAIRMAN:
Dr L. W. Jayesuria CONTENTS
I" .....
1.
Report of the Regional Director (continued) .•••••••••••••.•• Consideration of draft resolution on General programme of work covering a specific period ...•••••...••..• Cholera .................................................... .
127 130 131
2.
3.
4. 5·
Address by incoming Chairman •....••.•••••.•...•••.....•••••• Procedure for the nomination of Regional Directors ••••••••••
139 141
-123-
324
Third Meeting Friday, 18 september 1964 at 9.00 a.m. PRESENT I. Representatives of Member States AUSl'RALIA Dr H.E. Downes Dr R.F.R. Scragg Dr C.J. Ross-Smith His Highness Prince Norodom Monissara Dr C.K. Chang Dr T.C. Hsu M6decin Colonel M. Orsini Medecin Commandant J.L. Rigaud Dr Y. Ozaki Mr K. watanabe Mr Y. Matsuda
..
CAMBODIA CHINA FRANCE JAPAN
KOREA lAOS MAlAYSIA
Mr
Dr Sang Tae Han Kuan Seop Jin Dr Phouy Phouttasak Dr Dr Dr Dr L.W. Jayesuria D.M. Cameron R. Dickie V. Thevathasan
NEW ZEAlAND
Dr D.P. Kennedy Dr Dr Dr Dr Dr A.H. Cruz J.J. Dizon V. Mauricio E.L. Villegas A. San Juan
PHILIPPINES
..
PORl'UGAL UNITED KINGDOM
Dr N.C. de Andrade Dr A.C. Guerra Dr P.H. Teng Dr J.D. MacGregor Dr D.W. Bookless
•
MINUTES OF THE THIRD MEErING (
125
UNITED STATES OF AMERICA
Dr R.K.C. Lee Dr E.J. O'Rourke Dr J. ~l. Salllpson Colonel E.J. Dehne Dr Nghiem Xuan Tho Dr J .C. Thieme
VIl'T-NAM vlESTERN SAMOA II.
Representatives of the United Nations and Specialized Agencies INTERNATIONAL LABOUR ORGANISATION Dr R. Goldsmith
III. Representatives of other intergovernmental organizations INT~RNATIONAL COMMITTEE OF MILITARY MEDICINE & PHARMACY
Colonel V.C. Javier Medecin Colonel M. Orsini
SOUTH PACIFIC COMMISSION IV.
Representatives of non-governmental organizations INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS INTERNATIONAL COUNCIL OF NURSES Dr S.P. Lopez Mrs L.A. Alvarez Dr A. Ursua Dr D. Valenzuela Dr Fe del Mundo Dr G.C. Ca.ridad Dr D.J. Tablan Mr A.S. D1malanta Dr F.M. Herrera
/~
-
INTERNATIONAL DENTAL FEDERATION INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS INTERNATIONAL PAEDLA.TRIC ASSOCIATION INTERNATIONAL SOCIETY OF BLOOD TRANSFUSION INTERNATIONAL SOCIETY FOR REHABILITATION OF THE DISABLED INTERNATIONAL UNION OF ARCHITECTS ~H
INTERNATIONAL UNION FOR EDUCATION
•
126
A
.. INTERNATIONAL UNION FOR CHILD WELFARE LEAGUE 0]' RED CROSS SOCIETIES MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION WORLD FEDERATION 0]' OCCUPATIONAL THERAPISTS WORLD FEDERATION OF SOCIETIES 0]' ANAESTHESIOLOGISTS V. Others ROCKEFELLER FOUNDATI9N VI.
Dr E.L. Villegas Dr G. C. Caridad. Dr Fe del Mmdo Mrs C. Abad Dr B.A. de Castro, Jr.
'.
.
.-< Dr L.A. Gregg
WHO Secretariat REPRESENTATIVE 0]' THE DIRECTOR-GENERAL SECRETARY Dr P. M. Dorolle Deputy Director-General Dr I.C. Fang Regional Director
MINUTES OF THE THIRD MEEI'Dl'G
127
., 1.
REPORT OF THE: REGIONAL DIRECTOR: Item 10 of the Agenda (Document WP/RC15/3 and Cerr.1) (continued from the second meeting) Part III Section 3 Tuberculosis Control Pro ect Western Samoa pages 55-5 Dr TIiIEMl5 (Western Samoa) informed the Committe.e that the WHO regional.
tuberculosis adv:!.sory team had recently v:!.sited Western Samoa to eval.uate the results of the tuberculosis campaign. It appeared that tuberculin
reactors had increased in the juvenile group slightly, which was an indica!
tion that BeG should be included in the control measures.
Probably because
of the high rate of migration of Samoans from one area to another, it was not possible to supervise domiciliary treatment as completely as desired. With the inclusion of BCG vaccination in the programme it was believed that the second phase of the project, which would start in 1966, would be more successful and would make tuberculosis a minor problem in his country. There being no further discussion, the CHAIRMAN asked the Rapporteurs to consult the Secretariat about the preparation of an appropriate resolution. Draft resolution on poliOmyelitis Dr CHANG (China) stated that at the last session his delegation had commented on the question of the prevention of poliomyelitis. It wished
to propose that the Organization should encourage and assist with stUdies on the problem of poliomyelitis and its control. Further, that the diffiHe then
culties in obtaining supplies of vaccine should al.so be stUdied.
read to the Committee a draft text for inclusion in the resolution on the Annual. Report of the Regional Director. Dr LEE (United States of America) stated that his delegation would like to support the resolution submitted by the Representative of the Republic of China. He hoped that it would be considered as a separate
resolution and not included in the one on the report of the Regional
•
Director as it covered an important subject.
~28
REGIONAL COMMI'I'I'EE: FIFTEENTH SESSION
Dr CHANG said that his delegation would, of course, prefer to have a separate reso~ution.
Mr WATANABE (Japan) asked whether the draft reso~ution proposed by the
Bepresentative of the
Repub~ic
of China and supported by the Representative
of the United states of America would be discussed again by the Committee. The CHAIRMAN confirmed that the reso~ution propos~
would be prepared as a draft (For
and presented to the Committee for further discussion. reso~ution,
consideration of draft section 8.2.)
see minutes of the fifth meeting,
Draft resolution on
He~th
in Relation to DemOgraphic Questions
Dr LEE (United States of America) stated that the Bepresentatives of the United States, Korea and the Republic of China, would like to propose the following draft resolution on population and demography: 'Notes that research in the field of human reproduction is being conducted by the World He~th Organization, Notes further that a number of countries are conducting field population stUdies and programmes and that many institutions of training in other he~th sciences are beginning to provide programmes in this field, Considers: (1) that more studies are required on human population in a demographic sense; (2) that these should be conducted in large and ~ population groups to determine the optimum. levels of he~th for given communities; (3) that properly trained he~th profession~s must be provided to conduct ecologic studies in the field;
."
(4) that information on population programmes should be free~y interchanged between countries; Requests the Region~ Director and his staff to implement a programme of population studies, training and free exchange of information and submit a report on these activities to the sixteenth session of the Committee."
MlNUTES OF THE THIRD MEEl'lNG j
129
The REGIONAL DIRECTOR remarked that the United Nations was already undertaking a population study and this would mean duplication
or
work.
Dr LEE stated that he had discussed the proposed drart resolution with members of the Secretariat and had been told that the United Nations was concerned with demography and population statistics. The proposed
resolution was intended to emphasize the health aspects as would be noted from paragraph 3.(2). Health leaders should. be interested in and concerned
with the health aspects of demography and population. The REGIONAL DIRECTOR suggested that ir the Representative of the
United states of America wished to emphasize the health aspects of the subject, this should be expressed. clearly. As presented, the proposed
resolution did not appear to reflect this attitude. Dr DOROLLE, Deputy Director-General, shared the Regional Director's concern. As read, the proposed resolution gave him the impression that He was sure,
the Committee would step into the United Nations field. -:;:ho~ver,
that this was not the case and that Dr Lee's intentions ,rere to
make health workers conscious of demographic and population problems, to promote a better understanding of their relationship with health problems, and to provide training facilities for the purpose. only be a matter of wording. Dr LEE agreed that it was very difficult to understand the intention of the resolution when it had only been read to the Committee. He
It might
confirmed that the resolution aimed at stressing the health aspects of the subject and that it was directed to health administrators and health teachers. It was not intended to duplicate the work of any other
130
ROOICBAL COMMI'l'l'EB: FIF'xEENTH SESSION
'. 'T
organization.
Dr Lee suggested that copies of the resolution should be
distributed to the Committee for consideration. The CHAIRMAN asked that the necessary arrangements should be made
to have this done.
(For consideration of draft resolution, see minutes
of the fifth meeting, section 8.1.) Section
7 Health statistics and Hospital Records
The CHAIRMAN asked the Regional Director to reply to the questions ~
.,
previously raised by the Representative of the United states of America. The REGIONAL DIRECTOR explained that the statistical information on
health and social conditions of countries and territories referred to in the report was being collected to meet requests from governments and nongovernmental agencies in the Region and also for the use of the regional office staff. There was no intention to publish this information, since
most of it could be found in Headquarters' publications, such as the Weekly Epidemiological Records, M:>nthly Epidemiological and Vital statistics Reports,
Annual Epidemiological and Vital statistics, and
Reports on the World Health Situation. The CHAIRMAN thanked the Regional Director for his statemnt and !!ongratulated him on his lucid and comprehensive report. (For considera-
tion of draft resolution, see minutes of the fifth meeting, section 8.3.)
2.
CONSIDERATION OF DRAFT RESOLUTION ON GENERAL PROORAmE OF WORK COVERING A SPECIFIC PERIOD (Draft resolution WPjRC1 5jWPjl) (continued from the first meeting, section 11) Dr DOWNES (Australia), Rapporteur, read draft resolution
WP/RC15/wpjl to the Committee.
MINUTES OF THE THIRD MEE.'I'ING
131
Decision: There being no comments; the draft resolution was adopted (see resolution WP/RC15.Rl).
3.
CHOLERA: Item 14 of the Agenda (Docuzrent WP/RC15/5) The REGIONAL DIRECTOR stated that the Committee at its fourteenth
session had made recommendations covering the problem of adequate vaccination of the personnel of fishing boats and similar ships moving casually from country to country, the encouragement and co-ordination of further studies on the problem of carriers, and the need for closer co-ordination of anti cholera l-FOrk in the vTestern Pacific, South-East Asia and Eastern Mediterranean Regions. The document presented. to the Committee summarized
the action taken in connection with these recommendations. Dr TENG (United Kingdom) informed the Committee of the results of the experiences which Hong Kong had had during the past four years. Cholera had strucl~
Hong Kong in 1961, after having been absent since 1946.
In 1961 there had been
77 cases of cholera El Tor with 15 deaths; in 1962,
11 cases ,·lith 1 d.eath; in 196-'5, 115 cases .lith 4 deaths, and in 1964 up to 30 June (since when it had been free), 34 cases ;'lith 4 deaths. As a
result of these experiences, an intensive year-round monitoring organization had been built up, designed not only to gain as much epidemiological knowledge as possible during the course of an outbreak, but also to give information on the course of events when cases were not appearing. All
cases of gastro-enteritis seen at government dispensaries, clinics and institutions were thoroughly investigated and stool specimens or rectal swabs were sent for bacteriological examination throughout the year,
132
REGIOOAL COMMITTEE: FIFTEENTH SESSION "
whether there were suspected cases or not. taken every night and cultured.
SaJl!Ples of nightsoil were
•
Widesp:read saJI!Pling was al.so undertaken
of sea water, well water and foodstuffs, including fruits and vegetables liable to be sources of contamination with vibrios, for examination. When a case was found, the immediate family contacts were isolated in a quarantine camp and the occu;pants of the bouse were subject to widespread swabbing for bacteriological examination, in order to obtain as much information as possible on the source and d.istribution of the vibrio in the household. Occasional surveys of persons in the lower
income grou;ps were also conducted to obtain information on the prevalence of vibrio in this population. Furthermore, a year-round intensive food
hygiene campaign was conducted and last, but not least, a mass cholera inoculation campaign undertaken. During 1963 and 1964, a total of 149 cases of cholera El Tor had been reported in Hong Kong, of which only 39.6 per cent. could be classified as severe clinical cholera; 38.9 per cent. showed mild gastro-intestinal symptoms, and the remaining 21.5 per cent. were classified as moderately severe. A total. of 2276 immediate contacts had been isolated in the quarantine centre and 129 had been found to be symptomless excretors of the vibrio. every case there had been a number of symptomless carriers. Thus for In the 1963
•
outbreak, there had been a lot of cases who had reported at the clinics suffering from mild attacks of gastro-enteritis, from which they had recovered completely af'ter taking some stock mixture. They had been
discovered to be cases of cholera on bacterial examination of rectal. swabs taken as a routine. had been cholera. They had been unaware that their infection
Widespread infection of nightsoil routes had been
discovered and a very rigid system of sampling and culture of the
MINUTES OF THE THIRD MEEI'ING
133
nightsoil had been done.
The most interesting fact that had emerged from
this was that to date no infection of nightsoil had preceded the appearance of a. case. Further, it had been discovered that NAG vibrios '</ere being
found in the nightsoil instead of El Tor haemolytic strain of vibrio.
.......
Sixty-four per cent. of the homes of patients had showed positive results on routine investigation with the vibrio in latrine pans, drainage outlets, surface channels, dust bins and food chopping blocks. The most
important finding had been that in almost all the cases of cholera investigated so far, the vibrio had been recovered from the food chopping blocks, which are used for cooked and uncooked food and therefore could be the medium of transmission of the vibrios. In spite of the wide-
spread dissemination of the vibrio throughout the colony of Hong Kong, as indicated by the nightsoil sampling, routine investigations of foodstuff and water and the various groups of persons not connected with cases had been in general negative. One positive sample of sea water
had been obtained in 1963 from a very heavily polluted boat anchorage in Kowloon and one sample of spotted crabs. During 1963, more than
3400 individuals, short-term prisoners and all illegal and other immigrants had been examined and found to be negative. Of' the 950 labourers
handling nightsoil which had been found contaminated with the vibrio only one case had been found positive. Hong Kong had been free from cholera since 30 June this year and in spite of the very intensive investigations into cases of gastroenteritis and the search for the vibrio in the nightsoil, only NAG vibrios had. been found to be present in the nightsoil. Type 1, but Ty:pes 2 and 3 were beginning to appear. These ,;ere
134
REDIONAL COHUi'fEE: Ji'li"l!EEN'I'H SESSION
The United Kingdom delegation welcomed the news that an inter-
regional seminar was to be conducted in Manila in November to go into the various problems connected with cholera control. It was hoped that
fruitful discussions would take place that wuld give a lead to the prevention and control. of this rather compl.icated disease. Dr HAN (Korea) reported that since l.946 when there had been about 15 000 cases of cholera with 10 000 deaths, Korea had been free from chol.era until 1963 when there had been 415 confirmed cases with 38 deaths. Including S11Spects, there had been 1007 cases with 70 deaths The Government estimated that
within about forty days of the epidemic.
it had lost about $3 000 000, partly because of' the cost of' the control measures and partly because of the tall in exports as other countries did not wish to receive commodities coming from Korea. At the beginning
of the outbreak only 1 000 000 doses of vaccine had been available. Vaccines had been donated by the Governments of Japan, China, Thailand, Hong Kong, the United states of .America, Viet-Ham, Australia, and India. Assistance had also been given by WHO and UNICEF. Dr Han expressed the
gratitude of his Government to those countries and organizations which had provided assistance during the recent epidemic. At the beginning of this year, the Korean Government had started an anticholera c8ll!Paign.
Quarantine measures had been strengthened and There were still
up to now about 9 000 000 persons had been inoculated.
about 5 000 000 doses of the vaccine on hand to meet f1Iture emergencies. Diarrhoeal centres had been established throughout the country with laboratory facilities for easy case-finding. Cases with diarrhoea
were encouraged to go to these centres for laboratory examinations and trea.tment.
MrNUTES OF THE THIRD MEm'ING
135
With the assistance of captain Phillips of NAMRU-II, the training of physicians, including private practitioners and laboratory personnel, had commenced at three major points. The Government bad established
rehydration centres in the provinces so that it was possible for patients to reach a treatment centre within three hours of the onset of the <. ~
disease.
SUfficient amounts of saline solutions to treat more than 1000 In addition, personnel, equipment
cases of cholera El Tor were on hand.
and other facilities required in case of another outbreak were being
. ...
mobilized. In view of the inability of the Government to detect the source of
infection in last year's epidemic, and the belief that the introduction of cholera El Tor last year might hav~
been due to a carrier who had been
undetected by the quarantine services, it was hoped that the early conclusion of the studies of the role of carriers in the transmission of cholera might yield the information required for the effective iIqplementation of cholera control programmes. Dr CRUZ (Philippines) fully supported the recommendations and the basic paper submitted by the Regional Director. been cholera-free from 1938 to 1960. The Philippines bad
Then in 1961, following the out-
breaks in various parts of South-East Asia, the country had been seeded with cholera. Since then epidemics bad been experienced from
time to Ume and from place to place although follOwing a definite seasonal pattern. The joint Japan/Philippine/WHO chOlera vaccine
controlled field trials, mentioned by the Regional Director, were being carried out in Negros Occidental province; between 17 May and
4 July, 584 000 people haa. been vaccinated '\-lith the three test vaccines and the placebo. The
results of the surveillance being undertaken '\>/ere
136
still to be analyzed.
Since it was suspected that carriers played an
important role in the dissemination of. the disease , and this was confirmed by the findings in Bacolod, the Department of Health had issued a Department Circular No. 152 dated 16 JUly 1963, giving instructions to the health officers regarding the treatmmt of carriers. consisted of three phases: The joint studies
(1) controlled field trial of cholera
vaccines; (2) cholera carriers study, and (3) bacteriology of cholera El Tor. The CHAIRMAN reported that Malaya. had been free from cholera for
quite a number of years and it had only been about May 1963 that an outbreak had occurred Which lasted until the latter part of June. During this period there had been 112 confi:rned cases, nine of which had died. Through extensive and expensive measures of prevention, this
outbreak had been brought under control.
In November of the same year,
one isolated case had occurred in the state of Ferak about 250 miles away. This case had been fatal, but strange to say, no other case had Towards the latter part of November of the same year, there Again, with Cases had
occurred.
had been two iSOlated cases in the suburbs of Kuala Lumpur.
prompt measures, the disease had been brought under control.
appeared in the states of Ferlis and Kedah, which border the southern territories of Thailand., where rural sanitation is poor and the waterways are used. as the water supply for drinking, cooking and washing. As these water-ways were found to be contaminated with cholera vibrios, the people had been advised to cook their food and boil their water. The Government had also taken measures to provide pure water through
the extension of the piped water supply, by bringing water carts to the affected villages and assisting in the construction of wells where this
MINUTES OF THE THIRD MERl'ING
J.37
was feasi.bJ.e.
This outbreak had subsided to a certain extent, but broke
out again in April/May this year; at t.he same time cases had appeared in the east coast states of KeJ.antan, Trengganu and Pahang. From November
of last year to 5 September J.964, there had been a total number of 470 cases; 127 of these had died and 175 carriers had. been isolated. Ninety
of the 127 deaths had taken place outside of the hospitals, mainly because of the reluctance of certain groups of people in the affected areas to seek hospital treatment, partly through fear. Apuzzling
•
feature in the MaJ.acca epidemic had been the fact that although rectal swabbings had been made of a large number of contacts no carriers had been detected. After the intensified country-wide inoculation campaign, It
it seemed that the number of carriers had been rather remarkable.
was difficult to know why they had. not been detected. before or whether this carrier state was the result of inoculations. It had also been
found. in many instances when checking against the histories of the patients, that they had received inoculations against cholera two weeks to three or four months previously. He hoped the results of the joint
studies mentioned would help solve the problem of carriers and the efficacy of the vaccines used. The Government had established mobile teams to deal with the epidemic and treat patients in isolated villages. Personnel in infected
areas had been reinforced through the assignment of additional physiCians, nursing staff ~~d
public health inspectors.
Large quantities of infusion ~'1d
flUids, which could be moved rapidly by road, rail or air,
a. reserve
of at least one million doses of vaccine 'Were available to meet any emergency. He expressed his gratitude to the countries which had given
prompt assistance by sending supplies of cholera vaccine during the epidemic.
138
REGIONAL COMMITl'EE: FIFTEENTH SESSICli
The Government had not restricted the movement stuf~
o~
persons and
~ood-
because it was thought that this 'WOuld cause inconvenience and It was ~elt
result in economic loss to the country.
that with intensified
health education and improved environmental sanitation, much could be done to control such epidemics. He did not think that inoculation was
the chief answr to the control of cholera. by other sanitary measures.
This must be supplemented
It was felt that the disease 'WOuld probably
remain for some time and might appear in the most unlikely places and possibly at the most unlikely times. Dr TENG remarked that when checking into the immediate host contacts
.<•
isolated in quarantine camps, daily rectal swabbing had been done to find the carrier. In some cases cholera vibrios had been isola.ted only ai'ter
the fifth, sixth or seventh swabbing, which meant that one had to be :persistent to find the carrier with the same technique administered by the same person. It was believed that cases of cholera occurred in
persons who were susceptible to the disease and who were also contacts of carriers or o~
a case.
Dr LEE (United states o~ America) commended Dr Teng on his presenta-
tion
o~
the epidemiological investigations of the cholera outbreaks in He congratulated the Organization on the steps taken to arran~
Hong Kong.
a cholera seminar and supported the statement of the Representative France on the need ~or
o~
rapid epidemiological information. ~mber
He urged the "
Organization to invite as large a group of to the seminar. The United states o~
countries as possible
America was very interested in
cholera and had invested considerable sums in studies in other regions. A symposium on cholera research was planned for
1965
in Hawaii and he
hoped that the countries invited 'WOuld all attend.
MrNUrES OF THE THIRD MEm'ING
139
There being no other cOlllllll:lnts, the CHAIm1AN proposed that the Committee take note of the report presented. It was so agreed.
4.
ADDRESS BY INCOMING CHAIRMAN: Item 5 of the Agenda
The CHAIRMAN stated that it was indeed rather a remarkable coincidence that within a few days of the first anniversar,y of the formation of Malaysia, the Chief Representative of Malaysia to the fifteenth session of the Regional Committee for the lvestern Pacific, should have been deemed worthy of the honour of being elected its Chairman. It was
difficult to find words suitable enough to indicate his country's appreciation of this most generous and kindly act. The simpler the words,
the more sincere they -were, and therefore, he would say, on behalf of his country, "thank you fl. The Western Pacific Region covered a vast area and its health
--
problems ranged over a wide field..
In his Fourteent.h Annual Report,
the Regional Director had outlined the many problems which existed, and the efforts being made, with the help of' international agencies, to find a solution to these problems, so that a better state of health could be achieved. Malaysia faced a cross-section of the problems found in the Region. There were problems connected with environment oJ. sanitati.on in the rural areas, problems arising out of a growing industrial and urban population, problems associated with illiteracy, conservatism, superstition, adherence to age-old customs and traditions, hard to resolve and even harder
'.-..>-
to break, and last but not least, the problems that seemed to follow
140
in the wake of modern civilization and the migration of a rural population into urban areas. In his report the Regional Director had emphasized certain out-
standing problems that were present in most of the countries in the Region. One of them -was cholera El. Tor which, within recent years, had afflicted and was continuing to afflict quite a few countries. It -was encouraging to note the progress being made in the fight against malaria. China (Tai-wan) -was to be congratulated on the fact
that it -was the first country in the Region whose malaria eradication programme had reached a stage when it was expected that its government would request WHO to certify eradication of malaria before the end of 1964. In Malaysia, a pre-erail.ication campaign 'Was starting in the states
of Malaya, and continued progress towards eradication -was being made in the states of Sabah and Sarawak. with the help of WHO and UNICEF. He
hoped that the success achieved in the fight against malaria would encourage all countries in the Region to intensify not only this fight, but also to make plans now for an assault against other communicable diseases such as tuberculosis, leprosy and the virus infections.
Two other subjects which merited deep and earnest consideration were nutrition and health education. He also wished to associate him-
self with the emphasis that the Regional Director bed placed upon intraregional training. Facilities for the training of medical and. para-
.-
medical personnel should be expanded within the Region, so that it would not be necessary to send persons to other regions, or from one country to another within the same region, where perhaps the training for wh:i.~h
they had been sent might not equip them to deal adequately with the special problems they would encounter in their own country. He did not
"0
MINUTES OF THE THIRD MEE.'l'ING
141
deny that the more developed. countries in the Region had generously assisted their less developed neighbours in the training of personnel. He 'Wished to suggest, however, that they consider the feasibility of sending thos3 concerned 'With training programmes to study the conditions that eY.isted in the less developed countries, so that they could speak with first-hand knowledge and could adopt their curricula to meet the needs of their overseas students.
5·
PROCEDURE FOR THE NOMINATION OF REGIONAL DIRECTORS: Item 14 of the Agenda (Document WP/RC15/7) The REGIONAL DIRECTOR said that the question of introducing a new
procedure for the nomination of the Regional Directors had been discussed by the WHO Regional Committee for Europe at its twelfth session in August 1962. The proposal of the Committee had been referred to the thirtyThe Board had
first session of the Executive Board in January 1963.
requested the Director-General to study this question and to report to the Executive Board at a future session. The report of the DirectorFollowing a review of this
General was attached to document WP/RC15/7.
report, the Executive Board had invited the Regional Committees to study the suggestions contained therein. The Regional Director then outlined
the present procedure in effect in the Western Pacific Region and summarized the new proposals. The CHAIRMAN invited the Committee to consider the proposals made. Mr WATANABE (Japan) observed that although the new proposal had.
been made by WHO Headquarters, Article 49 of the WHO Constitution clearly stated that each Regional Committee should adopt its own rules
~42 '-
of procedure.
The change bad first been proposed by the Regional
Committee for Europe and. it was, therefore, presumed that the Regional Committee for Europe would adopt the new procedure. Should the Regional
Committee for the Western Pacific decide to adopt a different procedure, or maintain its present one, this might conflict with whatever was adopted by the Regional Office for Europe. The proposal from Head-
..
~
quarters seemed to suggest that each Regional Committee should adopt the new procedure. Dr DOROLLE, Deputy Director-General, stated that the Representative of Japan was right when he referred to Article
49 of the Constitution by
which Regional Committees Vlere responsible for the adoption of their rules of procedure. However, on the other hand, Article 52 of the same
Constitution made the Board responsible for the appointment of the Regional Director "in agreement with" the Regional Committee. In the
case of the procedure for the appointment of Regional Directors, there could be a conflict betVleen these tv.> rules. It was why, when a change ~'
in the procedure had been suggested in the Regional Committee f'or Europe, the latter realized that it should first refer the mat'cer to the Board, in order to ensure some co-ordination betVleen the diff'erent regions. The
Board, in the resolution which could be found on page one of' document WP/RC~5/1, bad invited the Regional (bmmittees to consider the suggestion
"-
--
contained in the relevant report from the Director-General (document EB33/32). The time had, therefore, come for this Committee to take a
decision with regard to its own procedure.
Any adJustments -which might
be suggested by the Board could be considered at a future session. Regarding another point made by the ~presentative
of' Japan, it was
true that the proposal of' the Regional Committee for Europe was only
•
" :;i
MINUTES OF THE THIRD MEETlliG
concerned with the procedure for the proposals for candidates to the Regional Committee. Ifuen the Board had decided to put the matter. on its
agenda, the Director-General felt that the time had. come to give new consideration to the whole matter. In this respect, it might be of inte-
rest to refer to the discussion at the International Health Conference in 1946 (Annex 3 of document EB33/32, page 7, which was itself an annex to document WP/RC15/7). When what became Article 52 of the
Constitution had been discussed, the original proposal had been to the effect that the Regional Director should be "appointed by the regional committee subject to the approval of the Executive Board". Eventually
after a long discussion, the Assembly had adopted a different proposal moved by the delegation of the United States providing that the Regional Director should be "appointed by the Executive Board in agreement with the regional committee". This was Article 52. In practice, a tradition
had been established which did not follow the sense of Article 52 but,
in fact, reflected the proposal which the International Health Conference had not adopted. What was being done now was that the Regional Committee
proceeded to an election of one person and submitted this name to the Board for approval, which meant practically an appointment by the Regional Committee with the approval of the Board, instead of an agreed decision, as provided by the Constitution. The Director-General felt
that he should draw attention to this matter to see whether the Board and the Regional Committees would wish to go back to a more fruitful interpretation of the intention of the Constituents. As indicated on
page 3 of document IVP/RC15/7, it was suggested that the Regional Committee should submit to the Board more than Olle name except in exceptional circumstances where, for instance, there was only one
REGIONAL CCHn'TTEE: FD'TEEm'H smsIOO ~
..
candidate or when the Regional Committee had unanimously decided that it would like to reappoint the existing Regional Director. Normally, in
the opinion of the Director-General, the Regional Committee should submit three names so as to leave the Board the full responsibility of appointing the Regional Director amongst candidates agreeable to the Regional Committee. This suggestion of the Director-General was put before the
Regional Committee for its decision. Another point of lesser iJr!portance was the procedure for proposals in the establishment of the list of candidates. In the Regional Committee
for Europe in 1962 it had been suggested that governments should propose candidates and. that among the representatives at the Regional COmmittee, a person would be selected to receive these nominations. The Director-
General, though in favour of the system of proposals by governments, believed that the designation of a nominations officer was an unnecessary complication, and that the Director-General was ex-officio qualified to receive the proposals and circulate them to !embers of the regions. The Director-General had, therefore, suggested that this Committee
should adopt a system of proposals by governments three months in advance with circulation of the curriculum vitae through the DirectorGeneral. Dr SCRAGG (Australia) noted that one of the main variations in the
new proposal was that instead of making one nomination to the Executive Board, there would be a panel of nominations. The present procedure was If the intention of
that one name was proposed, accepted or otherwise.
the Conference that drew up the Constitution was to be abided by, he felt that the establishment of a panel of names was wving away from the original intention. If the Committee submitted two names, then
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MINUTES OF THE Tlf.mD MEErING .'
obviously there was no real agreement on the second name.
The
Committee,
therefore, would have to be sure in its mind that it would agree to either of the two persons proposed. for under the new proposals. be agreed to by the Committee. e. 0-
This, he thouglrt, was not provided
It was essential that any proposal should
A ballot might give one person first and
another second place and yet, the Executive Board might in its wisdom decide that the second person would be the best person to appoint as Regional Director, If there was some provision to cover this possibility,
.. ----
then the proposal had considerable merits, Mt'
WATANABE considered that the new proposal had IllUch more merit It would be of advantage if' the
than the existing rules of procedure,
names of candidates, with their qualifications, could be distributed in advance to all Member goverru:rents. Another advantage to be gained was
that the Executive Board, with its full authority, could select from among the two or three names submitted by the Committee. It would,
however, be desirable if an indication of preference or choice could be made by the Regional Committee which was cOmposed of representatives of governments in the Region. He appreciated the idea contained in
Article 52 of the Constitution that the Executive Board had the right or authority to appoint the Regional Director in agreement with the Regional Committee. He fully subscribed, however, to the idea of the
Regional Committee indicating its choice or preference should more than one name be submitted to the Executive Board for its consideration. Dr ORSINI (France) stated that it would be logical for the Regional Committee to exercise its authority by submitting a list of .. ~
names of' candidates f'rom which the Executive Board would make a choice
11!.6
RIDIONAL COMMITTEE:· FU"l'lSENTH SESSION
... '.
in selecting the Regional Director.
However, he did not believe that it
would be very profitable 11' the Regional Committee should establish'this list in order of preference. He supported the idea that the Regional
Committee should propose two or three names f'rcm which the Board could choose, but without any indic:ation as to preference, which he considered to be a delicate matter. their opinion. Dr SCRAGG remarked that a1'ter having read the proposals in Annex 1,
He suggested other representatives should give
under clause 5( d),
he believed that the Committee could decide to el1m:l.-
-.
nate certain proposed. names entirely from any documentation submitted to the Executive Board. The only question, therefore, vas whether the
Committee should indicate a preference.
He felt that the RegionaJ.
Committee should have the right to indicate its views, which would be determined by ball.ot, and if' it did prefer a candidate it should indicate that preference. Dr DOROLLE supported the statement of the Representative of France
that it would be very useful if the opinion of the other M2mbers of the Committee could be obtained. However, for purposes of clarification,
he would like to point out that there were t'WO different aspects of the proposal. The first dealt with the establishment of the list of candi-
dates and the manner in which it should be notified to govel'IllEnts. This could apply to any system for the submission of nominations to the Board.
The Committee could, for instance, keep the present system of
nominations to the Board but change the vay in which the Committee received information on the candidates proposed. According to the
present practice, nomination papers were placed in a ball.ot box,
, <:3"
Mnlt.JTES OF THE THIRD ME:E!I'ING
147
following which a list of names suggested would be prepared. in an alphabetical order without any indication of the· number of times an individual's name was found in the box. would then follow. The suggestion made by the Regional Committee for Europe, which had the support of the Director-General, was that the list of candidates should be prepared in advance through proposals from the Region. ~mber
The discussion and election
States in
The list 'WOuld be accompanied by a resume of the career
and qualifications of each candidate and circulated to governments so that each representative 'WOuld come to the Regional Committee Meeting with a well-documented opinion on t:b.e various candidates. The second aspect of the proposal was even more important and more delicate. The Committee had to decide whether it wished to continu~
to
submit one name only to the Board, or whether it wished to submit more than one name. If the latter procedure were adopted, a second decision
had to be made as to whet.her or not the names would be submitted in alphabetical order or with an indication of an order of preference. The first aspect could be dealt with relativdy easily.
AD. that
was needed was a deCision on whether the nominations should be made in advance, and whether the Committee wished the Director-General to be responsible for seeking nominations and circulating the information to Governments. Once this had been decided upon, the Committee could deal
with the more difficult point already discussed by the Representatives of France, Japan and Australia . . Dr O'RO"lIRKE (United states of America) stated that his delegation considered that the proposed resolution 'WOuld give the Executive Board a more active role in the selection of the Regional Director. At the
148
'. moment it merely rubber-sta.!lij?ed the Regional Committee's choice and had no opportunity to review in advance the various candidates and their qualifications. The Executive Board should be allowed to consider the
best qualified candidates for the Regional Director's post and should p1ay a part in the final se1ection. The United states delegation agreed
that the submission of more than one name would be in accordance with Artic1e 52 of the WHO Constitution. He also felt that the suggestion of
the Representative of Japan that priorities should be estabJ.ished wou1d give the Board the sense of the fee1ing of the COmmittee. It would on1y
be in unusual circumstances that the Board would not accede to the wish of the Regional CPmmi ttee. In this way the views of the Executive Board
would be included in the decision taken. Dr THIEME (Western Samoa) feU that the statement made by the Representative of the United States of America did not seem to answer the question of whether there should be advance notification of candidatures. He believed this was a useful procedure as it Y10uld offer an
opportunity to governments to review the candidates' qualifications. He agreed to the suggestion that when forwarding names to the Executive
Board, the COmmittee should indicate its preference. Dr O'ROURKE
stated that his delegation was very much in favour of
advance notification and Y10uld certain1y support this proposal. Dr SCRAGG suggested that the Papporteurs should be asked to present a motion for consideration by the Committee. He thought that there had
been more speakers in favour of some preference being indicated.
If
the Committee could have a motion from the Papporteurs on the matter it could proceed to some form of finality.
MINUTES OF THE THIRD MEETING
149
Dr DOWNES (Australia), Rapporteur, reQ.uested some clarification from the Committee in order that he might interpret their wishes adequately. It would appear that 'che Committee was in favour of advance
notification of the candidates proposed, and that the consensus of the group was that the Executive Board should have the executive authority to select the RegionaJ. Director from a panel of names submitted by the Committee through the Director-General. On
the other hand, as Rapporteur, he had doubts in his mind as to
whether or not the Committee wished to indicate priorities in the names submitted to the Board. After balloting, the Regional Committee might If the voting on the three
reduce the number of nominations to three.
names resulted in a ratio of 5:4: 5, it would indicate that there was no particular preference. On the other hand, if the ratio were
6:5:3 or
even 7:6:1 it would surely indicate the preferences of the Committee.
If, therefore, the Committee presented two candidates to the Board with information on the result of the voting, this wouJ.d guide the Board in its selection of a candidate. If the voting resulted in a ratio of 13:1
or 12:2 the Regional Committee would surely indicate its priority.
He
suggested that the Committee should decide on the number of names to be submitted to the Board and whether it wished to indicate a preference. The REGIONAL DIRECTOR referred to Rule
53 of the Rules of Procedure
wherein it was stated that amendments of, or additions to, the Rules might be adopted. by the COmmittee, provided that it had received and considered a report thereon by an appropriate sub-committee. The CHAIR¥AN proposed that a sub-committee be appointed to consider the proposals further. Its terms of reference 1fould be to re-draft
150
REGIOOAL COMMITrEE: FIFTEENTH SESSlOO
'. Rule 51 af the Rules of Procedure in accordance with the discussions. The Committee would review the report of the sub-committee on Tuesday
mrning.
It could then make a final decision and a resolution could
be adopted. It was so agreed. The CHAIRMAN designated the Representatives (chief or alternate)
of Australia, China, France, Japan, United states of .AIlerica and Western Samoa as members of the sub-committee. was designated Convenor. proposals in its report. The Vice-Chairman (Dr Kennedy)
The sub-co!lllllittee could propose alternative
It was suggested that it should meet on
saturday, 19 September at 8.30 a.m. in the Committee Room above the Conference Hall. It was so agreed. (For consideration of the report of the Sub-
Committee on Amendments to the Rules of Procedure and the draft resolution, see minutes of the fifth meeting, section
3.)
The meeting adjourned at 12.10 p. m.
ad