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139
Fourth Meeting Tuesday, 5 September 1961 at 9.00 a.m. PRESENT
I
Representatives of Member States AUSTRALIA CAMBODIA CHINA FRANCE Mr R.
Dr H.E. Downes Harris
Dr Thor peng Thong Mr Sum- Vad.hanayu
Dr C .K. Chang Dr C.H. yen Medecin-Colonel L. Caillard Dr N. Nagatomo Mr K. Watanabe Dr S.W. Yun Dr W.J. Jesudason Inche Ibrahim bin Haji Yasin Dr O.J.M. Kranendonk Dr H.B. Dr D.P. Dr J.C. Colonel Turbott Kennedy Thieme J. Ferris Fuller
JAPAN KOREA MALAYA
NETHERLANDS NEW ZEALAND
PHILIPPINES
Dr E. Valencia Dr E.L. Villegas Dr E. Sison Dr P.W. Dill-Russell Dr Abdul Wahab bin Md. Ariff Dr D.A. Baird Mr W.H. Burndred Dr L.J. Clapham Mr D.M. Ellerton Mr Kwong Sea yoong AMERICA Dr A.S. Osborne Dr R.A. Phillips Dr I.e -Cuu-Truong
UNITED KINGDOM
UNITED STATES VIET NAM
OF
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II
Representatives of other inter-governmental organizations and of non-governmental organizations INrERNATIONAL COUNCIL OF NURSES
Miss F.J. Cameron Sir John P. walsh Dr C.N. Derek Taylor Mr M. S. Galloway
INl'ERNATIONAL DENrAL FEDERATION INrERNATIONAL UN! ON FOR HEAIJrH EDUCATI ON LEAGUE OF RED CROSS SOCIETIES WORLD CONFEDERATION FOR PHYSICAL THERAPY WORLD FEDERATION OF OCCUPATIONAL THERAPISTS WORLD FEDERATION OF SOCIETIES OF ANAESTHESIOr.oorsrS WORLD FEDERATION OF UNITED NATIONS ASSOCIATIONS WORLD MEmCAL ASSOCIATION WORLD VETERINARY ASSOCIATION III WHO Secretariat REPRESENTATIVE OF THE mREOl'OR-GENERAL SECRETARY
Miss J.C. MCGrath Miss F. Rutherford Dr A.A. Tennent Sir John P. Walsh Dr C.J. Ross-Smith Dr I. J. Cunningham
Dr P.M. KauJ. Assistant Director-General Dr I.C. Fang Regional Director
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141
1
CONSIDERATION OF DR.AF.r RESOLUTIONS The Committee considered the following draft resolutions presented by
Dr YUN (Korea), Rapporteur.
1.1
Regional Director (continued from
Dr THOR PENG THONG (Cambodia) and Dr TRUONG (Viet Nam) seconded that, in the interests of greater force and clarity, paragraph 2, sub-paragraph 1 be amended as follows: "2. EMPHASIZES the iIllJ?ortance of: (1) preparing and implementing the programmes with all the necessary flexibility, taking into account the socioeconomic difficulties particular to each country in the Region;" Dr DILL-RUSSELL (united Kingdom) stated that, in the opinion of his delegation, the proposed amendment did not affect the sense of the draft resolution. His delegation would, however, allow that there could be
differences in the French version which had motivated the proposed amendment. He suggested that the draft resolution be referred back for further review of the.French text. The CHAIRMAN agreed that this should be done and submitted to the Committee later that morning. below. ) (For resumption of discussion, see section 1.3
1.2
~~~~__~~__~~~___ i_n_p~ro~r_amm~~e
(continued from the second
The CHAIRMAN asked whether the Committee agreed to the adoption of the
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REGIONAL COMMI'l'.rEE: TWELFTH SESSION
proposed resolution. was put to the vote.
There being no further comments, the draft resolution
Dr VILLEGAS (Philippines) moved the adoption of the resolution. Decision: The draft resolution was adopted (see resolution WP/RC12.Rl).
1.3
ort of the Re ional Director (resumed from
The CHAIRMAN referred to the amendment proposed by the representative from Cambodia, which had been distributed, and stated that he believed that the main point of the amendment was to cover planning and implementation. He asked the Secretary to comment. The SECRETARY stated that, while he fully appreciated the spirit behind the proposed amendment, he would like the Committee to appreciate the difficulties of the Regional Office when flexibility in implementation was concerned. In
the preparatory stage, the approach must be flexible and full conSideration must be given to socio-economic difficulties. However, if flexibility were
demanded when implementing an agreed plan of operations this would mean that there would be no plan at all. He would, therefore, find it difficult to
accept the mandate from the Committee. Medecin-Colonel CAILLARD (France) stated that having compared the two texts there was, apart from the point made in connection with implementation, no great fundamental difference in content. However, the part of the proposed
amendment covering "the socio-economic difficulties particular to each country" was phrased in rather more specific a manner than the text in the original resolution.
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The CHAIRMAN then put the proposed amendment to the vote. Decision: The amendment was rejected.
The CHAIRMAN then put the original draft resolution to the vote. Decision: The draft resolution was adopted (see resolution WP/RC12.R2).
1.4 WP/RCl2/WP/3 - Malaria eradication programme (continued from the second and third meetings, sections 5 and 1 respectively) Dr DILL-RUSSELL (united KinGdom) stated that his delegation would like the deletion of the second part of paragraph 1 of the resolution, which referred to the malaria programme in North Kalimantan. HiS delegation was very grateful
to the Regional Director for the action taken but it ",ould seem that as the matter was still under consideration and not yet brought to finality, this statement was a little premature. The matter was in fact raised as a question
by the united Kingdom delegation, most adequately answered by the Regional Director, and it was felt that at this stage it 'vas better left as a note in the minutes rather than part of the resolution. It was so agreed. Dr TRUONG (Viet Nam) proposed that the resolution be further amended by the addition of the following ",ords which would constitute a new paragraph 5:
"5.
REQUESTS the Regional Director to continue to give full attention to the planning and implementation of malaria eradication programmes in the Region, taking into account the problems particular to each country, and to continue the necessary support until the completion of the programmes."
The CHAIRMAN suggested that the Committee proceed to the discussion of the next resolution while the Secretariat arranged for the proposed amendment
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to be prepared and distributed in both languages. see section 1.7 below.)
(For resumption of discussion,
1.5 ~~~~~~__~~~~~~~~~~o~s~t~a~g~e~st~am~~s (continued from the
Dr DILL-RUSSELL (united Kingdom) suggested that an addition be made to paragraph 2 of the draft resolution, as all countries did not feel that they could produce a special postage stamp for reasons of difficulty, policy of issue and because in certain areas there never had been any malaria. that paragraph 2 be amended by the addition of the following: "either in the form of a special stamp or the use of a cancellation stamp on letters and postcards." Dr VILLEGAS (Philippines) asked whether the original project as presented in the World Health Assembly included the use of cancellation stamps, otherwise the Committee might be out of place in proposing something which had not been approved by the World Health Assembly. Dr KAUL (Assistant Director-General) believed that the original proposal had referred only to postage stamps and the use of special cancellation stamps had not been planned. He would, however, refer to the resolution of the He proposed
Executive Board which had initiated this proposal. It was agreed that the Committee would proceed to the consideration of the next item while the documentation referred to was obtained. of discussion, see section 1.8 below.) (For resumption
1.6 continued from The CHAIRMAN asked whether the Committee agreed to the adoption of the
MINUTES
OF THE FotJRrH
MEEnNG
proposed resolution. was put to the vote.
There being no further comments, the draft resolution
Decision: The draft resolution was adopted. amendment, see section 1.10 below.)
(For further drafting
1.7
3 - Malaria eradication pro ramme (resumed from section 1.4
The CHAIRMAN referred to the amendment proposed by the representative from Viet Nam which had now been distributed. Dr VILLEGAS (Philippines) suggested, that as the Regional Director's ability to undertake a malaria eradication programme depended on resources available to him, the words "as resources are available" might be inserted in the amendment after lithe necessary support". The SECRETARY stated that the spirit behind the resolution involved more than a question of finance and that in implementing a malaria eradication project a great deal of precision vlaS
required.
There 'Were certain minimum
standards and requirements without which a malaria eradication programme could not be effectively carried out. The suggestion made would, therefore,
nullify all the standards and requirements which the Regional Director had to follow. He did not believe that vlHO could agree to this suggestion because
through the EXecutive Board and the '\Vorld Health Assembly it had always been emphasized that malaria eradication must be carried out in a precise way. this proposal were accepted it would mean that standards and requirements could be changed to fit socio-economic conditions. to say a few words. Dr KAUL (ASSistant Director-General) stated that it was fully recognized Dr Kaul might perhaps wish If
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that there were many difficulties at the national level in establishing an eradication programme; difficulties of organization, limitations of financial resources, difficulties in obtaining technical personnel and local supplies. It was, however, absolutely essential that a plan was adopted which would lead to eradication. There were no two ways of undertaking eradication. Eradication
had to take account of the vectors of transmission and unless those vectors of transmission were broken eradication would not be achieved. standards and certain basic re~uirements
certain basic The
were, therefore, necessary. M~ia,
Organization and the Expert Committee on
recognizing that economic
and social conditions were not the same in all parts of the world, had not suggested that the whole world should eradicate malaria Simultaneously starting on a particular date and ending on a particular date. They had recognized
that there might be stages in the eradication programme and that preparatory work might be necessary. Certain pre-eradication programmes, certain prere~uirements
eradication surveys and certain pre-eradication
before a plan of
eradication was prepared had, therefore, been suggested.
It was possible for
WHO to assist countries in developing their plans leading up to eradication and to that extent the Organization was fully prepared to continue to support each country where malaria is prevalent to attempt to develop the programme to the stage of eradication. However, when once a programme of either pre-
eradication, a pre-eradication surveyor eradication itself was undertaken commitments had to be met, otherwise it would not be possible to see any progress. It would entail at this stage resources and funds and under the
terms of the Expert Committee and under the instructions of the Executive Board and the World Health Assembly certain very stringent to be followed. re~uirements
had ,.
The Organization and the Director-General did not expect to
.
refuse to give assistance to any country needing it but the assistance was
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to be given to the stage of development and the stage of the plans made, recognizing that once a country had accepted those conditions it had to attempt to fUlfil those conditions. The CHAIRMAN suggested that the Committee might like to consider breaking the sentence at the word IfRegionll. Dr OSBORNE (United states of America), wondered whether this was the best place to break the sentence. The Regj..onal Director, in the planning and
implementation of malaria eradication programmes, vlas bound to take into account the problems particular to each country. He wondered if instead of breaking it
at that pOint, it could be broken at the word "country". The CHAIRMAN did not think that this could be done because implementation was determined by set principles 'which could not be varied. The planning could
be flexible according to the needs of the country but not the implementation. Dr TRUONG (Viet Nam) stated that he had asked for the amendment because he believed that in the light of the discussion on the malaria eradication programme which had taken place earlier, his proposal was rather important and not contrary to the spirit of villO. He thanked the Regional Director and the
'-
Assistant Director-General for their explanations on the guiding principles of WHO on matters of assistance to malaria eradication programmes. Like draft
resolution WP/RC12/WP/l, which had just been approved by the Committee and which mentioned that programme planning should be done With the necessary flexibility, taking into account the socio-economic differences, he thought that this statement on flexibility could also refer to malaria eradication. ,. -".
One had to know the socio-economic differences in the countries, otherwise WHO assistance would not have as much value. The Regional Director was being
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asked to give his full attention to the planning aspects.
When it came to
implementation, he was aware of the basic requirements 'Which were imposed by WHO, without which no proper results would be obtained.
However, some countries
had their difficulties, their own problems and if the Regional Committee asked the Regional Director to take those difficulties and problems into account, he did not think. this was against the spirit of WHO. As to the last portion of
the phrase "to continue the necessary support until the completion of the programmes", this was also important in the preparation of each country programme for which every country made tremendous efforts. moral support were required from \VIIO. Both technical and
He hoped his fellow delegates would
study the amendment again and if it was in the spirit of WHO, take a deCision on it. Dr YEN (China) wondered whether the amendment would be more acceptable if it were modified as follows: " • •• malaria pre-eradication programmes in
the Region, ••• " • As the pre-eradication programme was the preliminary step, attention could then be given to the problems particular to each country. The SECRETARY stated that there would be no difference 'Whether it was a pre-eradication or eradication programme. If certain requirements necessary
to carry out a pre-eradication or an eradication programme had been agreed upon, the Government and WHO would be expected to fulfil these commitments. If these
commitments were not met, it vnas utterly impossible to carry out either a preeradication or eradication programme. The CHAIRMAN put the proposed amendment to the vote. Decision: The amendment was rejected by nine to two, with two abstentions.
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· MINlJrES OF TEE FOURI'H MEEI'ING
The CHAIRMAN then put the original draft resolution to the vote. Decision: The draft resolution was adopted with the amendment proposed by Dr Dill-Russell (see resolution WP/RC12.R3).
1.8
Dr THOR PENG THONG (Cambodia) wished to know if Dr Kaul could inform the Committee of the decision made by the World Health Assembly in regard to the implementation of the resolution. Dr KAUL (Assistant Director.General) stated that the proposal for the issue of the special postage stamps had been submitted by the Director-General to the twenty-sixth session of the Executive Board and later to the Fourteenth World Health Assembly. In brief the plan was that a simultaneous issue by
Member governments of postage stamps devoted to the malaria eradication programme would help spread information and stimulate interest in the battle against malaria. Increased world.wide publicity was therefore the main purpose In addition to their informative value, they
for the issue of such stamps.
would also develop an additional source of income for the world malaria eradication programme. The participating Member governments might either
contribute a percentage of the proceeds from the sale of such stamps to the World Health Organization or donate quantities of stamps which would be sold on the philatelic market at their face value. The proposal and the plan did
not indicate the inclusion of cancellation stamps. Dr DILL-RUSSELL (united Kingdom) stated that, in view of the Assistant Director-General's statement, he itished to withdraw his amendment. The CHAIRMAN announced that the amendment had been withdrawn and the
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REGIONAL COMMITTEE: TWELFTH SESSION
draft resolution in its original form was put to the vote. Decision: The draft resolution was adopted with two abstentions (see resolution vlP/RC12.R4).
1.9
6) The CHAIRMAN asked whether the Committee agreed to the adoption of the proposed resolution. was put to the vote. Decision: The draft resolution was unanimously adopted (see resolution WP/RCl2.R5). There being no further comments, the draft resolutions
1.10
Wp /RC12/WP /5
- The isolation of the trachoma virus, production of trachoma vaccine and relimin results of the clinical trials resumed from section 1.5 above
Dr OSBORNE (United states of America) referred again to the draft resolution WP/RC12/WP/5, and stated that Captain Phillips wished to propose an amendment. captain PHILLIPS (united States of America) stated that, as he had mentioned during the discussion of the item, the project was a joint venture by American and Chinese scientists and he therefore believed that both governments should be mentioned and not only one. The following amendment was then proposed:
"EXPRESSES its appreCiation to the Governments of the United states of America and of China for having made this information available." Decision: The draft resolution, as amended, v18.s unanimously adopted (see resolution WP/RCl2.R6).
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151
2
CONSIDERATION OF THE REPORr PRESENTED BY THE SUB-COMMITTEE ON PROGRAMME AND BUDGET: Item 19 of the Agenda (Document WP /RC12/13) (continued from the first meeting, item 9) The CHAIRMAN presented the report of the sub-Committee on programme and
Budget. Decision: There being no discussion, draft resolution WP/RC12/P&J3/WP/l on "Modifications to the 1962 regular programme and budget" was adopted unanimously (see resolution vIP /RC12 .R?) •
Dr OSBORNE (united States of America) wondered whether the last paragraph of the draft resolution did not refer to the whole proposed programme and budget for 1963 and not merely the supplementary list of projects. The CHAIRMAN agreed that the last paragraph should become a new heading under III. Decision: The draft resolution, as amended, was unanimously adopted (see resolution WP/RC12.R8). 3 mATEMEN!' BY THE REPRESENTATIVE OF THE WORLD FEDERATION FOR MENTAL EEALTH (continued from the first and third meetings, sections 12 and 5 respectively) Dr TAYLOR, representative from the International union for Health Education, read to the Committee a statement prepared by Dr Stoller, representative from the World Federation for Mental Health. In his statement, Dr mOLLER emphasized certain points which had emerged during the Technical Discussions and which concerned social scientists and their disciplines. The successful introduction of any public health measure
must be related to the values and the attitudes of the community being approached.
\ ~.
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REGIONAL COMMrT'rEE: TWELFTH SESSION r'
On Sunday, the group had heard something of the way in 'Which the state of mental
health of indiViduals could hold up the introduction of a necessary and scientifically supported measure, i.e., fluoridation, in a highly developed society subjected to a democratic voting procedure, as well as ways by which, with careful thought and understanding of the socially disruptive phenomenon, this problem could be overcome. He believed that the process of introduction
could have been greatly facilitated if an initial sampling survey had demonstrated - as was determined only after two years _ that the vast majority of the population were not averse to fluoridation. The group had heard that
in developing countries, there were grave dangers that changing food habits involving the use of processed and refrigerated foods could magnify considerably the problems of dental ill health. In the light of what had been said before
and the preventive implications involved, it seemed important for public health authorities to utilize the skills of several SCientists, through known methods of sampling surveys, especially in regard to attitudes and values, as part of any public dental health programme. This was essential since mention had been
made of the importance of customs and beliefs in influencing changing patterns of diet and the acceptance of new procedures. Dr Stoller stressed the need for building evaluation programmes into any
health education programme and strongly supported the statement that it be an indigenous one. He was sure that the World Federation for Mental Health would
seriously consider helping with the development of social sciences methodology appropriate to the introduction and continuation of dental health programmes.
4
CONSIDERATION OF THE REFORI' PRESENTED BY THE TECHNICAL DISCUSSION GROUP: Item 20 of the Agenda (Document wp jRC12j14) (continued from the first meeting, section 7) Colonel FULLER (New Zealand).1 Chairman of the Technical Discussions,
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153
presented the report prepared by the Technical Discussions group.
He read,
in particular, the paragraph covering the discussion and conclusions given on pages 9-11. Referring to the suggestion concerning the appOintment of a
dental consultant to the Regional Office, he said that the group felt that the dental health problem in the Region could be best assessed and determined with the assistance of a dental epidemiologist. Once the problem had been
determined, it would then be appropriate, if necessary, to appoint someone on the administrative and planning side. epidemiologist should come first. Medecin-Colonel CAILLARD (France) wished to kn01v ,'That type of specialist Colonel Fuller envisaged for the epidemiologist's post. In France there were However, the appointment of a dental
a number of epidemiologists, but it was not certain ,·rhether any of them were specialists in dental problems. Colonel FULLER (New zealand) said that the point would be clearly demonstrated if he mentioned the name of a typical dental epidemiologist who could fulfil the requirements of the post very adequately, i.e., Professor Davies. He pOinted out that, of course, there might be others in other
countries with similar knowledge and qualifications. Dr OSBORNE (united States of America) commented that the Technical Discussions report was a very good one. However, it only reflected the He
excellent, serious and thoughtful deliberations held on the subject.
had been very much impressed with the opening panel presentations, which had brought about provocative discussion, and wondered whether it would be possible for the opening statements to be reproduced from the tape and given .vide distribution.
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REGIONAL COMMrTrEE: TWELFTH SESSION
The SECRErARY remarked that Dr Osborne t s statement was very timely and well taken. The statements of the members of the panel would be obtained and
distributed later to all representatives. Decision: The Committee adopted the report presented by the Technical Discussion group and agreed that liThe role of health services in the improvement of community water supplies" be the subject of next year's Technical Discussions. (For adoption of resolution, see section 6.2 below. )
5
TIME, PLACE AND DURATION OF THIRrEENTH, FOURrEENTH AND ~H SESSIONS OF THE REGIONAL COMMI'l'TEE: Item 21 of the Agenda (Document WP/RC12/10) The SECRETARY drew attention to document WP/RC12/10 which contained the
text of a letter from the Government of Korea withdrawing its invitation to the Committee to hold the thirteenth session in Korea and inviting the Committee to hold its sixteenth session there instead. Unless the Committee decided
otherwise, the thirteenth session would be held in Manila, in accordance with the past procedure that every second year the meeting would be held at regional headquarters. As decided by the Regional Committee at its tenth session, the
fourteenth session would take place in Port Moresby, Papua and New Guinea. Dr VILLEGAS (Philippines) extended to the Committee the offer of the Government of the Republic of the Philippines to act as host for the thirteenth session in Manila in 1962. Dr YON (Korea) recalled that at the last Regional Committee meeting held in Manila his Government had offered Seoul as a venue for the thirteenth Regional Connnittee meeting in 1962. However, his Government, after giving
further consideration to the matter, had reached the conclusion that it would be more appropriate for the meeting to be held in Manila and now offered to act as the host country for the sixteenth session (1965) to be held in Seoul, Korea.
MINUI'ES OF THE FOURrH MEETING
155
Dr VILLEGAS (Philippines) acknowledged the kind invitation of the Korean Government and proposed that the invitation be accepted. Dr YEN (China) seconded the proposal. Dr THOR PENG THONG (Cambodia) and Dr TRUONG (Viet Nam) thanked the Governments of the Philippines and Korea for their invitations. Decision: It was agreed that the intitations of the Governments of' Korea and the Philippines should be accepted. (For adoption of resolution, see section 6.2 below.)
6
arHER BUSINESS: Item 22 of' the Agenda
6.1 Resolution of appreciation Dr SISON (Philippines) sponsored a resolution of appreciation. Dr DOWNES (Australia) seconded the resolution. Dr CHANG (China) endorsed the sentiments expressed but wished to add by way of amendment the follovTing: " ( 6) .M.r P. Dowse, Mayor, Lower Hutt City, and members of his staff for kindly arranging the most instructive visit to the fluoridation plant j " Dr SISON (Philippines) accepted that amendment. Decision: The draft resolution, as amended, was adopted (see resolution WP/RC12.R9).
6.2 Consideration of other draft resolutions (resumed from sections 4 and 5 above) -<
The
follo~ng
draft resolutions were then considered:
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REGIONAL COMMITTEE: TWELFTH SESSI ON
wp/RC12/wp/7 - Technical Discussions (resumed from section 4 above) lace and duration of thirteenth fourteenth
Decision: Both resolutions were unanimously adopted (see resolutions WP!RC12.RlO and WP/RC12.R11).
7
ACKNOWLEOOEMENT BY THE CHAIRMAN OF BRIEF REPORrS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH AOl'IVITIES: Item 8 of the Agenda (continued from the first and second meetings, sections 10 and 6 respectively) The CHAIRMAN announced receipt of a progress report relating to health
services in the Territory of Papua, New Guinea.
The meeting adjourned at 11.39 a.m.