WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITI'EE
WP/RC1 /Min/ 3 Rev. 2 li October 1956 ORIGINAL: ENGLISH MINUTES OF THE THmD MEm'ING
Seventh Session Manila 1-13 September 1956
Institute of H~iene Monday, 10 September 19~ at 9:00 a.m. CHAIRMAN: Dr. J. Bierdrager
CONTENTS 1
Opening remarks by the Chairman
.............. . . . .
4 4
2
Draft resolution on the Annual Report of the Regional Director •••••••••••••• Accommodation for the Western Pacific Regional Office .......•...
3 4
......
Malaria eradication Resistance of insects to insecticides
5 6
1
........ Speeches by Representatives of Non-Governmental Organizations in official relations with WHO . .... . Campaigns against smallpox . . . . . . . . . . . . . . . • . . . • . • • . . • • • . . • . •
..
5 6 10 12
13
8
Resolutions of regional interest adopted by the seventeenth and eighteenth sessions by the Executive Board and the. Ninth World Health Assembly
.... .. .
14
WP/RC7 /Min/ 3 Rev. 2 Page 2
Third Meeting MOnday,
10
September
1956
at
9:00
a.m.
PRESENT
I
Representatives of Member States AUSTRALIA CHINA (TAIWAN) Dr. H. E. Downes Miss E. Warren
Dr. L. C. Yen Dr. C. H. Yen Dr. Y. T. Kuo M6decin··Colonel R. Augere M6decin-Colonel Aretas Dr. M. Kusumoto Mr. A. Saita Mr. T. Nakagawa
FRANCE
JAPAN
KOREA LAOS
Dr. C. C. Lee
Dr. C. S. Sayavongs Dr. J. Dierdrager Dr. F. S. Maclean
NETEERLANDS NEW ZEALAND
PHILIPPINES
Dr. R. Tumbokon Dr. E. Agustin Dr. T. Gomez Dr. J. de Paiva Martins
PORTUGAL UNITED KINGDOM
Dr. Dr. Dr. Dr. Dr.
W. Glyn Evans Mohamed Din bin Ahmad M. Doraisingham A. R. Edmonds G. Graham-CUlIJIIling
UNITED STATES
Dr. R. K. C. Lee Dr. K. Dain Dr. II. DeLien Dr. L. K. Quyen Dr. P. G. Can
vmr
NAM
wp/RC7/Min/3 Rev.2 Page 3 II Representatives of the United Nations and Specialized Agencies UNITED NATIONS CHILDREN'S FUND UNITED NATIONS TECHNICAL ASSISTANCE
Mr. S. M. Keeny Mr. Eric Ward
BOARD III R~resentatives
of other Inter-Governmental Organizations Dr. Thoa. C. Lonie
SOUTH PACIFIC COMMISSION IV
Representatives of Non-Governmental Organizations in official relations with WHO INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS INTERNATIONAL PAEDIATRIC ASSOCIATION INTERNATIONAL SOCIEl'Y FOR DLooD TRANSFUSION INTERNATIONAL SOCmry FOR THE WELFARE OF CRIPPLES MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION Mrs. R. Ordiz Dr • A. J3a.ens Dr. F. del Mundo Dr. R. Y. Atienza Dr. J. S. Santillan
Dr. R. Rivera-Ramirez Secretary: Dr. I. C. Fang Regional Director
WP/RC7/Mln/3 Rev. 2 Page
4
1
OPENmG REMARKS BY THE CHAIRMAN
The CHAIRM1\U drew attention to the provisional minutes on the second meeting and stated that the working party assigned to ·consider the question of regionalization would be convened by Dr. F. S. Maclean and not the ViceChairman as stated. 2 DRAFT RESOLUTION ON THE ANNUAL REPORT OF THE REGIONAL DIRECTOR (wp/RC7/3)
The CHAIRMAN submitted for consideration of the Committee the following draft resolution on the annual report of the Regional Director which had been
prepared by the Rapporteurs: ''The Regional Committee, Having reviewed the annual report of the Regional Director on the work of WHO in the western Pacific during the period 1 July 1955 -
30 June 1956 J NOTES with satisfaction the progress made and the emphasis placed
on major activities; EXPRESSES the hope that in the future development of regional
programmes, as large a percentage of available funds as possible shall be devoted to field activities; NOTES with satisfaction the increasing number of fellowships
awarded for training within the Region and hopes that, whenever feaSible, more efforts will be made to facilitate the training of health personnel in their own countries; EXPRESSES satisfaction with the improvement of the public information
service, and reiterates the importance of the dissemination of public information materiaJ..s and their prompt. de~ch
to Member Couutri.es;
WP/RC7/Min/3 Rev.2 Page 5 EXPRESSES satisfaction with the appointment of area representatives, but stresses the importance of keeping the need for such posts under review; NOTES with satisfaction the excellent working relations and good co-ordination of activities with international and other agencies; COMMENDS the efforts to develop efficient and economical regional office operations and expresses the hope that the review of office management will be followed up; CONGRATUIATES the Regional Director and his staff on the preparation of the comprehensive and detailed report; AroPrS the report. II Dr. R. K. C. LEE (USA) asked the Secretary to read the draft
resolution as he felt the Committee had not had time to consider it thoroughly. This was done and the resolution was unanimously approved
by the Committee. Mr. A. SAITA (Japan) asked for improvement in the distribution of
documents in order that the representatives of the Committee might be able to study them thoroughly and referred, in particular 1 the Sub-Committee on the Programme and Budget. to the report of
It was agreed,. therefore,
that the discussion of this item should be deferred until the representatives had time to study the report of the Sub-Committee.
3
ACCOMMODATION FOR THE WESTERN PACIFIC REGIONAL OFFICE (wp/RC7/6) Dr. C. H. YEN (China.) stated that his government greatly appreCiated
the co -opera. tion shown by the people and the Government of the Philippines in providing suitable accommodation for the Regional Office and moved that the draft resolution contained in document WP/RC7/6 be adopted.
wp/RC7/M1n/3 Rev. 2 P~e6
Dr. R. K. C. LEE (USA) expressed his government's appreciation of the generous offer made by the Government of the Philippines and seconded the adoption of the resolution, which was then unanimously approved.
4
MALARIA ERADICATION (wp/RC7/7, WP/RC7/7 Add.l and WP/RC7/7 Add.2) In introducing the item, the SECRETARY referred to the recommendations
of the World Health Assembly with regard to the importance of malariaeradication programmes and the establishment of the Malaria Eradication Special Account. The action taken by the Regional Office in the
implementation of resolution wp/Rc6.Rl3 was described in document wp/RC7/7. Further, the Director-General had been informed of the request of the Sixth Regional Committee to hold an inter-regional malaria conference in 1956 or 1957, and provision had been made by Headquarters for such a conference in 1957.
As far as Addendum 1 to this document was concerned, information had been received from Headquarters that it was proposed to establish an interregional malaria training course in Indonesia and it was felt that participat ion by countries in the Western Pacific Region would be of value in view of the inadequate number of trained malaria workers. Addendum 2 gave details of all the requests for assistance received from governments in the Region. Because of shortage of funds it had, how-
ever, only been possible to include some of these in the Regular Supplemental Budget and as their implementation was uncertain, they had been included in the list of projects which might be financed by the Malaria Eradication Special Account if funds were available.
WP/RC7/Min/ 3 Rev. 2 Page 7 Dr. W. GLYN EVANS (United Kingdom) referred to item 2.1.2 on page 3
of the basic document in connection with the First Borneo Inter-Territorial Malaria Conference held earlier this year. He stated that the three
territories in North Borneo were conducting a very thoroughly planned programme against malaria but they were faced with the problem of a land frontier about 1.500 miles long. For some time now, efforts to co-ordinate
the programme with that of the neighbouring territory had failed and it was hoped that WHO would have taken steps to establish contact with the territory concerned, which was not in the western Pacific Region. The SECRETARY stated that the Regional Office had made representations to the South-East Asia Regional Office on several occasions but the most recent reply indicated that the Government of Indonesia was not yet ready to participate. It was hoped, however, that the situation would improve
and every effort 'WOuld be made to achieve satisfactory contact. Dr. R. TUMBOKON (Philippines) referred to document WP/RC7/7 Add.2 and
in view of the inability of the Organization to finance malaria-eradication programmes entirely from its regular sources of funds proposed the adoption of the follOwing resolution: liThe Regional. Committee, Being aware of the importance of intensifying and accelerating national malaria-control programmes 60
that
the eradication of the disease may be achieved and the regular spraying of insecticides safely terminated before the possible development of resistance of malaria vector species to insectiCides, Realizing that governments of countries in the Region where a malaria problem exists are anxious to intensify
WP/RC7/Mln/3 Rev.2 Page 8 their antimalaria programmes, but that many of the needs of these countries for assistance might not be provided from the Regular budget or Technical Assistance funds because of financial limitation, REQUESTS the Regional Director to ask the Director-General to give priority to assistance to antimalaria projects and to provide for their implementation from the Malaria Eradication Special Account if such projects cannot be financed from the Regular budget or Technical Assistance funds and if sufficient funds are available in the Malaria Eradication Special Account. II Dr. C. H. YEN (China) requested further time to consider this resolution
and suggested that the matter might be included in the discussion of the establishment of an inter-regional training course i~
malaria.
Medecin-Colonel ARETAS (France) fully agreed with the comments of Dr. Evans and Dr. Yen.
The French territorial governments had had difficulty
in their antimalaria programmes in Africa due to the lack of co-operation or co-ordination between the territories concerned. He proposed that a phrase
stressing the importance of co-operation and co-ordination should be added to the resolution as programmes would certainly fail unless these were achieved. Mr. A. SAlTA (Japan) asked for further information on the Special Account.
The SECRETARY stated that the Malaria Eradication Special Account had been established during the Eighth World Health Assembly. Since then
contributions had been received from four governments and during the Ninth World Health Assembly a resolution had been adopted inviting governments and private organizations to contribute to the Special Account. The funds thus There
gathered would be appropriated by authority of the Director-General.
was a tremendous ueed for assistance in this regard as the annual increases
wp/RC7/Mln/3 Rev.2 Page 9 in the WHO and Technical Assistance budgets were limited.
It was hoped,
therefore, that the additional funds required to implement malaria-eradication programmes might be obtained from the Special Account. Mr. A. SAITA (Japan) asked whether the procedure
was to try and fit
requests for assistance in antimalaria or malaria-eradication programmes into the regular or technical assistance budgets first, or. whether they were immediately assigned to the Special Account. normal. procedure was to try and finance to the Organization. The SECRETARY replied that the
them from funds regularly available
Mr. SAITA referred again to the proposed resolution
and was of the opinion that it was the duty of the Organization to spend the money in the Special Account according to the needs of the governments. The
SECRETARY stated that there were for IilOre requests than funds ava.ilable as n1denced by Addendun 2 where there were listed requests which could not be financed from either regular or technical assistance sources. Dr. R.K.C. lEE (USA)
asked whether the Secretary could produce e. comparison table shOwing the need for increased additional funds. The SECRETARY replied that he was not Details of the regional
in a position to inform the Committee on world needs.
requests, however, which could not be financed from regular or Technical Assistance source were given in Addendum 2. understanding as follows. Mr. SAITA summarized his
The allocation of funds for malaria was the
responsibility of the Director-General who reviewed all requests and recommendations submitted by each region and gave percentage allocations to each region. The purpose of the resolution proposed by the Philippine
delegation seemed to be to call the attention of the Director-General to the importance of progr~s
in the Region and to request special If this were the case he was
consideration for activities in this field.
WP/RC7/M1n/J"Rev.2 Page 10
. in full agreement with the spirit expressed in the resolution but suggested it should not only refer to the Special Account but also to other financial resources available to WHO. Dr. TUMBOKON thanked Mr. Saito. for his suggestion
and expressed willingness to re-word the resolution accordingly.
It was
agreed that the two representatives concerned should prepare a re-wording of the resolution. The ~l then submitted the resolution contained in document WP/RC7/7 for consideration of the Committee. following phrase should be added: Medecin-Colonel ARETAS proposed that the "to co-ordinate the antimalaria progrannnes Dr. EVANS
of all countries irrespective of the Region to which they belonged."
suggested that the co-ordination mentioned by Medecin-Colonel Aretae should not only cover the Region but co-ordination between regions. In the case
previously presented, a territory outside of the Western Pacific Region was involved and it would, therefore, be of particular importance to mention it. Dr. LEE proposed that a working party composed of the representatives from
France, Japan, the Philippines and the United Kingdom be established to prepare a suitable resolution on the subject. unanimously agreed. There being no objection, this was
The CHAIRMAN suggested that the working party might be
attended by any representative who wished to take part in its deliberations.
5
RESISTANCE OF INSECTS TO INSECTICIDES (wp/RC7/8) The SECRETARY, in introdUCing the item, stated that while the control and
eradication of malaria was economically feasible in most areas by the use of residual insecticides, the cost would be considerably increased if such a method were rendered inadequate by the development of resistance in the malaria vectors. Un:f'ortunately, reeearch work in this field had been Ibcument WP/RC7/8 had been prepared to give
restricted and unco-ordinated.
a brief statement of the magnitude and importance of this problem and also summarized WHO's main objectives in the global problem of insect resistance.
wp/RC7/Mln/3 Rev.2 Page I I
Dr. C. H. YEN (China) stated that the danger existed in Taiwan, although
the actual magnitude of the resistance had not been determined, and the population as a 'Whole had asked for much more effective insecticides to control, not only anopheles mosquitoes, but also culex mosquitoes, fleas and other insects. He agreed that a symposium along the lines suggested in the draft resolution was desirable and proposed that the resolution be adopted. M6decin-Colonel
.ARErAS supported the adoption of the resolution and informed the Committee of the malaria-control mass campaigns in French West Africa and the Cameroons. The caottpaigns in French West .Africa were being carried out by national teams with supplies provided by UNICEF. In the Cameroons, there were international
pilot areas with international experts and a.:Nier three years, much to the disappointment of UNICEF and the WHO experts, there had practically been no progress made in malaria control although no resistance of the anopheles to insecticides had yet occurred. It had, therefore, been suggested that it
was useless to spend money on unsuccessful campaigns and that before planning an eradication programme in Africa, the follOwing should be carried out: (a) the establishment of a malaria institute, (b) the training of malariologists in the clinical fields and of chemists to be in charge of the preparation of dosages of residual insecticides in the areas which had been sprayed, with a view to seeing whether the action of the insecticides remained. as long as cases occurred., and ( c) the assignment of an entomologist to deal with the biological aspects. Mbdecin-Colonel ARETAS also mentioned that after the sp~ng
campaigns, it
had been found that the Anopheles gambiae, instead of keeping its endophilic characteristics had developed exophilic characteristics and in his opinion it 'WOuld now be very difficult to control maJ.aria only through spraying. This might, however, be possible in the future, perhgps a.fter the
WP/RC7/Min/ 3 Rev. 2 Page 12 decisions of the Malariolog1sts' Conference in the African Region held last year had been made known. It might then be possible to launch inter-govern-
mental projects with a view to studying the biology of the anopheles, its resistance to insecticides and to find means to attack the vectors. In this
connection two facts should be considered: (a) the parasite reservoir, usually the result of synthetic antimalaria drugs and (b) the vectors themselves, on which two studies were at the moment in progress. He was fully in favour of
the resolution proposed because such a symposium was most desirable and would like to suggest the attendance of the French entomologist in New Caledonia. Dr. R. K. C. lEE (USA) asked whether the symposium planned for 1958
had been included in the regional budget, as he wondered whether this was not a subject which was the concern not only of the Region but Headquarters also. Had WHO Headquarters planned any symposium where specialists from all parts of the 'WOrld could be brought together or was it limited to one or two regions? The SECRETARY stated that this was a combined Headquarters/inter-regional project and would be arranged by Headquarters. The resolution was then put to the vote and unanimously adopted.
6
SPEECHES BY REPRESENTATIVES OF NON ~OVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO Dr. F. del Mundo (International Paediatric Association) Dr. DEL MIJNIX)
conveyed the greetings of the International Paediatric This year the Association had been favoured
Association to the Committee.
by the Organization by making it possible for an expert group to be convened in Stockholm to discuss and determine standards and recommendations for adequate and up-to -date paediatric education. There was no doubt that
the changes in the causes of morbidity and mortality, as well as present trends and present-day living had required a change in paediatric training.
wp/RC7/Min/3 Rev.2 Page 13 At the meeting, circumstances and conditions in both under- and well-developed countries had been carefully considered and recommendations had been made 'Which were suitable to any region. Representatives from the South-East Asia
and Western Pacific Regions attending the Eighth International Congress of Paediatrics in Copenhagen last month had decided to hold a regional meeting in Singapore in 1958. It was hoped that WHO would assure the success of
such a meeting by giving it assistance. Dr. J. S. Santillan (International Society for the Welfare of Cripples) Dr. SANTILLAN stated that in a recent survey made by Dr. H. H. Kessler,
United Nations consultant, on the rehabilitation of the disabled, it had been found that no less than one million of the population were disabled in one form or another. A considerable proportion were children from one to six
years • Rehabilitation of the disabled in the Philippines was in its infancy and he was pleased to note that provision had been made in 1957 for two fellowships of six months duration each to enable two technicians to study brace appliances and boot prosthetics. According to recent surveys,
twenty-fi ve per cent of the world population was handicapped and if this was the case more attention should be paid to this problem by bodies such as the World Health Organization. 7 CAMPAIGNS AGAINST SMALLPOX (WP/RC7/9, wp/RC7/9 Add.l) The SECRETARY stated that this i tern had been placed on the agenda in implementation of the resolution adopted at the last session of the Committee. As no comments were received from the Committee regarding the document, it
was agreed that the Rapporteurs should be asked to prepare a draft resolution taking note of the reports made.
WP/RC7l'Min/ 3 Rev. 2 Page 14
8
RESOWTIONS OF RIDIONAL lNTEREST ADOPl'ED BY THE SEVENTEENTH AND EIGHTEENTH SESSIONS OF THE EXECUTIVE BOARD AND THE NINTH WORLD HEALTH ASSEMBLY
Leprosy control (WP/RC7/l0) The SECRETARY stated that the item had. been placed on the agenda as it was felt that it would be of interest to the Committee to hear of the resolution adopted by the Ninth World Health Assembly on leprosy control and of the proposed conference should fUnds become available. As there were no
comments, Dr. R. K. C. LEE (USA) moved the adoption of the draft resolution contained in the document, this was seconded by Dr. C. C. LEE (KOrea) and unanimously adopted. Sessions of Regional Committees outside of Regional Headquarters (WP/RC7!11) The SECRETARY stated that the resolutions of the Executive Board and the World Health Assembly concerning sessions of regional committees outside of the regional headquarters had been submitted for information of the Committee only, as it had been the practice in this region for meetings to be held in alternate years at the regional headquarters and the increased costs had been met by the host governments. As there were no comments, it
was agreed that no further action was necessary. The CHAIRMAN invited the Working Party on Malaria to meet after the adjournment of the meeting in order to discuss the resolution on malaria eradication. The meeting rose at 11:39 a.m.