Joint Coordinating Committee fourth session, Kuwait, 5-7 December 1977: independent chairman's report of proceedings

IJOINT COORDINATING COMMITTEE ONCHOCERCIASIS CONTROL PROGRAMME IN THE VOLTA RIVER BASIN ARXA Fourth session Kuwait 5-7 Decenber L977 INDEPENDENT CHAIR}TAN IS REPORT OF PROCEEDINGS 1. INTRODUCTION: Agenda iten I 1.1 The fourth session of the Joint Coordinating Comittee for the Onchocerciasis Control Programe in the Volta River Basin Area was held at. the headquarters of the Kuwait Fund for Arab Economic DevelopEent, Kuwait City, Kuwait, fron 5 to 7 Decernber 1977. The session rras attended by representatives of the Governments of Belgium, Benin, Canada, France, Federal Republic of Gernany, Ghana, Ivory Coast, Japan, Kuwait, Mali, Netherlands, Niger, Togo, United Kingdon of Great Britain and Northern Ireland, United States of America, Upper Vo1ta, the United Nations Development Progrmme (UNDP), the Food and Agriculture Organization of the United Nations (FAO), the World Bank (IBRD), and rhe World Iteatth Organization (WttO). Observers from Guinea, Nigeria and Senegal were present at Ehe invitation of the Independent Chairnan. The session was also attended by the representative of the Economi,c Development Advisory Panel and observers from the Organisation de Coordination eE de Coop6ration pour la Lutte contre les Grandes End6mies (OCCGE) and Ehe Office pour 1a Recherche scientifique et technique outre-mer (ORSTOM) of the French Government. A list of participants is.attached as Annex 2. 1.2 The session was opened by His Excellency Dr Abdel Rahman Al-Awadhi, Minist.er of public Health of Kuwait, who welconed the parEicipants to his country. 1.3 In his opening address (attached as Annex 3), Dr Al-Awadhi said that the JCCts presence in Kuwait underlined the strong feeling of solidarity and cooperation betr"reen Kuwait and the rest of the world for the alleviation of hunan suffering. It also provided an opportunity to make the Programers aims and successes knorm to a wider public, especially in the Eastern Mediterranean Region. Moreover, it exenplified the strong ties of friendship and solidarity betlreen African and Arab nations. Kuwait wished the Progrartrtre success, not only because of its humanitarian and economic objectives, but also because some Arab countries were affected by the disease; he hoped that activities would event.ually be extended to them. Dr Al-Awadhi paid tribute to the devotion and skill of the field staff of the progranrme, which had made impressive progress since it.s inception Ln L974. He particularly noted the strides made in research, which he considered viEal for future success in controlling the disease. The Progralme was an excellent example of international cooperation, and he hoped that more countries and organizations would contribute to its work. L.4 A message (attached as Annex 4) from the Director-General of WHO, Dr H. Mahler, vras read to the Comnittee. Dr Mahler said that the holding of the JCCrs session in Kuwait, withparticipants from various regions, demonstrated that some major health problems could only be tackled through concerted efforts on a broader than regional scale. In turn, the programe would Senerate results and experience of much wi.der than regional significance. He stressedhis comitEent, and that of WHO Regional Director for Africa, to the success of OCp. The Prograrmne had inaugurated a ner., type of international cooperation, with such encouraging results that the model was already being reproduced in other technical cooperation prograrmes such as the wlfO^NDP Special Programne for Research and Training in Tropical Diseases. The technical efficiency and enthuslasm of the Programre staff, the guidance of the OCpts advisory bodies and the constructive spirit in the JCC and Steering Cormittee had been a constant encouragement Eo WllO as Executing Agency. He expressed his warm grati-tude to all countries and agencies taking part in the Programme. _., 1.5 The Independent Chairman, Dr M. G. Candau, Ehanked Dr Al-Awadhi for honouring the Conrnittee by presiding over its inaugural meeting. In his introductory statement (attached as Annex 5), Dr Candau said thaE in L977 the Prograrune had Eaken a significant step forward through the extension of spraying operations to the entire OCP area. The experience of the first four years of operations indicated that progress was good and that the social and economic development of the areas liberated from onchocerciasis would rapidly gain momentum. Ilis recent visiE to the seven Participating Countries had shown that Governments were in general sat.isfied with the Programne and had welcomed the opportunity for frank di-scussion provided by the first joinE meeting of National Onchocerciasis CommitEees, held in Abidjan in June. The extension of the OCP area remained of great interest to many Participating Countries, and he hoped that an agreement on the principle of extensi.on could be reached during the session. The problem of extension to neighbouring countri-es also meriEed study. He welcomed the Steering Coumitteers proposal that the Sponsoring Agencies should field a high-level mission in 1978 to review the Prograrmel the results of this study would be important for Ehe decisions to be taken by the JCC at its fifth session on the fuEure development of the Progranrne. He called for a still greater research effort in all fields for which OCP count.ed on the cooperaEion of the international scientific corununiEy. In conclusion, he underlined Lhe need to establish a sound and locally adapted health infra- structure in the areas liberated from onchocerciasis and Eo promote the peoplers education so thaL they could take part in all phases of socioeconomic development. I.6 At the conclusion of the inaugural addresses, the meeting was briefly suspended Independent Chairman then took the Chair. The 2. ELECTION OF TIIE VICE-CHAIRMAN OF THE SESSION: Agenda item 2 2.1 Recalling the procedure adopted at the Comrnitteers previous sessions, the Independent Chairman proposed His Excellency Dr Abdel Rahman Al-Awadhi, Minister of Public Health, Kuwait, as the Vice-Chairman for the duration of the session. This proposal was approved by acc lamat ion. 3. ADOPTION OF THE AGENDA: Agenda item 3 3.1 The provisional agenda (document JCC4.1) was adopted withouE amendment. It was agreed that questions relating to the second stage of the Progrartrne, starting in 1980, would be discussed under agenda item 1O. 4. PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATTON FOR 1977: Agenda irem 4 4.L WHOrs progress report for 1977 (document JCC4.2) \^7as presented by the Progranmre Director, Mr M. Ls. Bazin, who began by ouLlining OCPrs activities from 1974 to 1976 and che situation prevailing ac the start of. 1977. 4.2 During L977, operational activities in entomology came under four main headings: the installation of the new aerial spraying contracEor; the start of larviciding operations under Phase III; the continuation of evaluation; and a study of reinvasion. The t.ransition from Evergreen to Viking Helicopters had been relatively smooth. Since mid-April 1977, Viking had had 17 staff, nine helicopters and three fixed-wing aircraft in the Progranrne area. The equipment had functioned wel1, and problems of liaison between Vikingrs headquarters and the field had been ironed out in meetings between WHO and the Canadian Conrnercial Corporation, the main contractor, which had entered into a three-year contract totalling $ 6 L4L 745. 4.3 Phase III larviciding operations had begun on 22 l(arch in rhe eastern secEion and 29 March in the west. Entomological evaluation had continued. Because of the good results previously obEained in vector control, treatment had been interrupted for periods of 5-17 weeks in some part.s of the Phase I area. The natural reduction in breeding sites in the dry season had permitted treatment to be spaced o.ut in Phase II. Thus the SOOO kny'week sprayed in December L976 inad been reduced to 1OOO krn/week in March 1977. t t3- 4.4 The phenomenon of reinvasion had reappeared on the LSraba, the Bandama, and in Ehe souEh of Mali. The operation mounted to investigate it had cost a little over $ lO0 O0O. 4.5 The Epidemiological Evaluation UniE had carried out 21 OOO simple evaluations in 85 vi1lages, and 28OO detailed examinations in 15 vil1ages. It had also studied the efficacy of nodulectomy under conditions of 1ow transmission, the frequency of in utero transmission, and the relation between the degree of parasitism of the anterior sepent of the eye and Ehe risk of severe eye lesions. It had participaEed in drug trials at the Centre Muraz, Bobo-Dioulasso, Upper Vo1ta, and the Chemotherapeutic Research Centre at Tamale, Ghana. 4.6 In economic development, the Programmers role was first to provide information for a1l inEerested in its activities; secondly, to act as a link between Participating Countries and between these countries and other parties, in order to help coordinate policies and avoid duplication; lastIy, on request, to advise on project, identification, preparation and sources of financing. The report on soci.oeconomic aspect.s of the Programe, prepared by OCP for t.he first time, was an attempt to provide the necessary information on development projects in the area. This had entailed strengthening the staff of the Economi.c Development Unit and tapping all sources of information. The response had been encouraging. The report described planning institutions in the OCP area, listed development projecEs by country, dealt with the financing of certain sEudies and examined the sit.uation with regard to the FAO/IBRD planning methodology, for which sone $ 7 nillion had been eannarked. OCPts present estimate of the sum to be invested in the area in the coming 10 years was about 8OO billion CFA francs, and the projects involved would raise complex economic and social problems. The need for a concerted, though f1exib1e, approach was clear. 4.7 In the field of research La L977, the Prograrune had drawn up, negotiated and signed 21 Agreements for a toEal of over $ 5OO OOO, including seven on vector ecology ($ 154 OOO), four on insecticides ($ 60 5OO), seven on medical aspects ($ 2OO OOO), and three on the environment($ 117 OO0). A paper on research appeared as an annex to the Plan of AcEion and Budget for L978. 4.8 A documenE on Eraining had also been annexed to the Plan of Action. The Eraining Prograrme was aimed aE upgrading the qualifications of existing OCP staff, training new staff, and teaching OCPrs methods to workers from countries outside the Programe. For the time being, virtually all authorized posts were fi11ed, though naEurally Programe structures would change and staff would leave. For budgetary reasons, however, the Prograruue could not take on extra staff to train on the job and then hold in reserve to fitl vacancies or until Eheir countries needed then. In any case, nothing could be done in that direction without first rnaking an accurate evaluation of countriesr professional staff needs, which would depend on the priority Ehey gave to onchocerciasis control within their health budgets and the career opportunities they offered scientists and adninistrators who wished to specialize in onchocerciasis. 4.9 The Prograrmnets liaison and coordination activities had centred on monitoring or sErengthening contacEs with the Participating Countries, oEher members of the JCC, OCpts statuEory bodies, and the public. Of special interest had been the first joint meeting of the National Onchocerciasis Comittees, held at Abidjan fron 15 to 17 June. The meeting had dealt particularly with extension of the Programe area, research, training, and the contributions of the Participating Countries tohrards a part of Progranrne costs. The nexL such meeting \^ras planned for Cotonou in 1978. The Prograrrme had also arranged eight meetings of its statutory bodies, for which it had prepared the agenda, background documentation and rePorts. 4.10 Following a seminar held at Ouagadougou under the auspices of the Union des Radios et T6l6visions nationales drAfrique for rural radio staff from the Participating Countries, a Permanent unit had been set up in the Rural Radio of Upper Volta to transmit informaEion on OCP activities to the other rural radio services. Various broadcasting stations from outside the area made recordings, and the Programe had received numerous journalists and visitors. New films on the Programne had been made during the year, one of them by the BBC, and a sequence had been shot by the French TV. 44' ll lv1uch time had also been spenE in the management of the programmers 7oo staff incountries, buildings, 225 vehicles, and supplies and equipment. s even on the budget pro gre s s 4'L2 In conclusion, the latest calculations indicated thaE the savings in 1977 estimates approved in December 1976 would exceed the g 2 million indicated in thereport on the basis of June 1977 figures. 4'13 The JCC congratulated the Programme Director and his staff, the Executing Agency andGovernments on the success of oCPts operations in 1977. rt noted the smooth completion ofthe transfer of ocPrs Geneva support unit. to ouagadougou, and of wHo,s supervisory responsi-bilities from Geneva to the wllo Regional office for Africa in Brazzaville. Satisfaction was expressed rrith the Abidjan meeting of the National onchocerci-asis Committees, which had givenpriority to economic development and the intensification of training of nationals. 4.14 The Committee corulended oCPts management for the very substantial savings on the estimated expenditure for the year. It stressed, however, that such savings should not be made to the detriment of the Progrannne, Reductions in spraying should be carefully watchedso that the efficiency of operations was not endangered. The results would have a considerable bearing on the determination of requirements for the second stage starting in1980. The level of surveillance needed after the vector population was reduced also merited study; it was suggested that reductions in surveillance should be approached with greaL caution and be decided only after examination by the Scientific and Technical Advisory cormnittee (STAC). The Committee decided to discuss the question of reinvasion under agendaitem 5. 4-15 In the field of research, it was considered that Ehe responsibilities of oCp and the WHo Special Progrannne for Research and Training in Tropical Diseases (ton) shoutd be clearlydefined. oCPrs own research should be directly related to its activities, on such topics as reinvasion, environmental protection, and larvicides to replace Abate; it should collaborate with TDR on chemotherapy. 4.L6 A representative said that his Government had received little documentation during theyear, and that the quarterly report had appeared belatedly and irregularly. It was suggested that all countries would be interested in the report of the OCp consultant from theLiverpool School of Tropical Medicine who had visited Ghana and lvory Coast Eo advise on ruralhealth services and the training of auxiliaries (paragraph 51 of the progress report). The PrompE PreParation of reports on training and transport (Plan of Action and Budget, Annexes B and C) was connnended. 4.17 The representative of the Federal Republic of Germany said that his Government had helddiscussions with the Programre Director and the Wor1d Bank in autumn 1977 it order to learn more about OCP. Io 1977, it had disbursed the final DM 4 million segment of its first-stage contribution of DM 13 78O OOO, or roughly $ 6 million. A mission of Lhe Ministry of Economic Cooperation would visit the OCP area in 1978 to consider further support for stage 2beginning in 1980. The mission would bear in mind the results of the JCCrs session and coordinate its work with that of the WHO/nank evaluation mission. He was convinced that the Programme could make a great contribution to the economic development of the area, and iLsgoals deserved full support. 4. I8 The WHO representative thanked representatives for their encouraging comments. Every effort would be made to continue in the same vein. 4.L9 With regard co the potential effects of savings on operations, the Conmittee was informedthat the interruptions in spraying in L977, as in L976, foLlowed the excellent results obtained in certain rivers or basins. They were decided on by the Vector Control Unit only after a sufficiently long period of zero results, i.e., complete absence of blackflies, and after thorough analysis of each case. When treatment was reduced, however, surveillance was continued or even strengthened. It was only curtailed when nearby catching points gave the same results; it was possible that furLher catching points could be cut. Again, such decisions were not taken lightly. t -5- 4.2O The Comittee was to1d, in answer to a question, that the control of stages of blackfly other than lhe larvae had long been contemplated, and that experiments on the control of adults were now under consideration. 4.2L With reference to coordination between OCP and TDR on research, the [JttO representative said that high priority had been accorded to onchocerciasis in the Special Prograrrne. The TDR Scientific Working Group which met in early 1977 had approved many research proposals, amounting to a total of $ 702 OOO, for all filarial infections including onchocerciasis. The disease was also on the priority list of the African Regional Advisory Committee for Medical Research. Two years earlier WIIO had established a Research Coordinating Cormi,ttee on Onchocerciasis, chaired by the Director of OCP. Of the research projects approved for 197.7, half were in the field of chemotherapy, including the testing of compounds known to be active against other parasites and investigations of the use of known filaricides with changed dosages and regimens. To support research on chemotherapy, further studies were needed on in vitro cultivation of the parasite and for the development of suitable animal models. Other aspects of research covered the imune response, purification of antigens and development of sero- logical tests, including biochemical methods for the differentiation of strains of Onchocerca volvulus. In a number of laboratories research continued on the vector and its genetics. The fact that some savings had been mede under the heading of research reflected the limited pool of workers available in the field of onchocerciasis and the effect of coordination in reducing expenditure. 4.22 Speaking at the invitation of the Independent Chairman, the observer from OCCGE said that as he understood it, TDR was prepared Eo finance research and training at centres that met certain criEeria. However, since one of those criEeria was that pilot centres should have a national structure, interstaEe organizaEions such as OCCGE were excluded. He therefore proposed that financial arrangements be worked out with oCP to enable OCCGE to assist the Prograrmre, particularly through training. 4.23 Two representatives expressed concern Ehat the credits available for education and training had not been fu1ly utilized it L977 and asked for an explanation. 4.24 The WHO representative replied that Ehe savings had arisen because the funds, provided by UNDP, were intended for the training of personnel from the Participating Countries, buE they had not proPosed candidates. They had been notified earlier in the year of Ehe situation but only Togo had proposed one physician for ophthalnological training. Ihe Prograrme wished to use the money for the countriesr benefit but the 1ittle that had been ut.ilized was to train personnel for itself as in previous years. 4.25 OCP had now trained the personnel it required. Ihere was a general shortage of staff in national service and there was a need for the countries to build up a cadre of specialisEs to play a greater role in onchocerciasis control in future. Among the Participating Countries, he believed only Ghana had established post.s for scientists Eo work on onchocerciasis, and two Ghanaians had been E.rained accordingly. OCP knew of at least four entomologists, Ewo trained in Canada and Ewo by ORSTOM, who were now available but without posts in Eheir countries. 4.26 From the discussions that followed it was evident that some misunderstanding had arisen concerning the type of training that could be provided under the auspices of OCP. Speakers repeatedly stressed the importance of education and trai-ning and representatives of several Participating Countries outlined action Eaken since the Abidjan meeting of the National Onchocerciasis Commit tees. 4.27 fhe Participating Countries, appreciating that Ehey would eventually take over OCPts control operations, realLzed Ehat Ehey needed to train nationals to replace the present international staff. They considered that the immediate utilization of trained sEaff was not necessarily vita1. As nat.ional progra*es developed, countries could propose staff for training ln particular disciplines. 6- 4.28 Although all OCP posts were full, the Prograrrne should be prepared to Erain national staff in its unique techniques. Often supplementary in-service training was needed for specialists possessing the necessary theoretical knowledge. However, iE was pointed out that technical training was often pointless if no post was available in OCP or nationally. 4.29 The WHO representative, regretting the situation, explained that OCP could never be a training institute. If onchocerciasis was rea1ly a priority problem, countries must muster funds to fight it and set up a career structure; OCP could then fund the training required by governments. He stressed that, with its limited budget, OCP could not employ every trained person. 4.30 The Participating Countries welcomed a proposal that OCP hold discussions with each country early in 1978 to review the situation. Representatives expressed the conviction that following Ehe JCCrs review and with adequate j-nfomation, education and training funds would not be underutilized in 1978. The next meeting of National Onchocerciasis Committees in 1978 would consider plans for national structures. The Progr:me wished to give as much help as possible and it was confirmed that t.he UNDP funds could be used in a flexible manner. 5. ANNUAL REPORT OF THE SCIENTIFIC AND TECHNICAL ADVISORY C0MMITTEE: Agenda item 5 5.1 In Ehe absence of the Chairman of the Scientific and Technical Advisory Committee (STAC), the reporE on the Comitteers fourth and fifEh sessions (document JCC4.3) was introduced by a member, Dr P. Haskell, who also reported on the sixth session held in November L977. The problem of overlapping interests with other bodies had been solved by holding joint meetings with the Ecological Panel and inviting members of the Economic Development Advisory Panel(SnAp) to the STACTs sessions. To tackle a wide variety of subjects, the STAC had started the practice of setting up working groups of the Scientific Advisory Panel (Sa.P) to study specific topics and report back to it. He noted that TDRrs relationship with OCP was not yet settled; certainly TDR would take up some aspects of research that OCP could drop. He drew attention Lo the definition of OCPts object.ive in section 2 of the report. 5.2 Gratifying progress had been made in understanding the problem of reinvasion. As the migrations were a normal phenomenon, and governed by the wind, reappearances would happen, and in fact were being detecced efficiently. The VecEor Control Unit studies had shor,m that the problem did not necessarily require enormous extensions of the OCP area or vast expense; to avoid misuse of scarce funds and manpower, pending further study, precision and select.ivity were the essentials. 5.3 Research had produced techniques for finding which blackfly cytotypes transmitted onchocerciasis. At its sixth session, the STAC had again suggested stepping up work on a back-up insecticide for Abate. Synthetic pyrethroids uere being considered for Ehe treatment of adult fLies, possibly in the zones of arrival of the invading females. 5.4 The STAC had concluded that entomological operations were being carried out very effectively. It warned that the professional staff was now sEretched to the lirnit, and it would be very unwise to reduce t.he vector control staff or extend the Prograrme area wit.h the existing staff. Training might be important in that connexion. 5.5 The Epiderniological Evaluation Unit had produced essential data. Sociological factors in its work were discussed on page 1I of rhe reporE. The STAC had voiced concern that data were stored on computer, but not always in a form that permitted the right questions to be asked. In chemotherapy, drug Erials could now be carried out at the research centre at Tamale, Ghana. To its regret, the Epidemiological Evaluation Unit was not able to give medical treatment on the spot; perhaps a mobile dispensary, especially for eye infections, could work in conjunction with the Unit. 7- 5.6 The JCC had asked for criteria to determine an accepEable level of transmission for resettlement. A working party set up by the STAC on this difficult question had suggested an annual transmission potential (ATP) of lOO and an annual biting rate (ABR) of 1OOO as provisionally acceptable levets Eo enable populations to live reasonably free of the fear of onchocerciasis, on the assumption that vector control continued at the existing level. 5.7 OCPrs research effort had been reduced, partly because of TDR. The STAC had expressed some concern at this reduction. The amount of relevant research being done in Ehe world was small, and OCP was trying to harness it. Clearly, as an operational programre, OCP was limited to applied research. 5.8 At its most recent session, the STAC had discussed Eraining. Its view was, as Ehe Programre Director had said earlier, that OCP was not a training organization and should only train staff for its ovrn work. The Participating Countries needed nati.onal career structures, \.rith adequate training programmes. The STAC had also concluded that Ehe Vector Control and Epidemiological Evaluation Units should be reinforced. It had recomended that OCP start to study Ehe possible effects on economic development of trypanosomiasis and schisEosomiasis in areas freed from onchocerciasis. This fitted in well wiE.h the 1978 review mi-ssion, which must take inEo account the effect that other diseases might have on economic development. 5.9 Adding to Dr Haskell's remarks, the Chief of the Vector Control Unit drew attention to a display in the lobby of the Kuwait Fund building which illustrated the annual transmission potential (etp) in different parts of the OCP area at different daEes. In the centre of the area, where the ATP was below lOO infective larvae a year, spraying could be interrupted as soon as the situation permitted and people resettled. In other parts, the situation was as yet less satisfactory. 5.10 The Chief of VCU agreed that reinvasion was a normal phenomenon. A map on page 19 ofthe Progrartrne's Progress rePort (document JCC4.2) showed the areas subject to reinvasion inL977, or.e in south-west Mali and north-west Ivory Coast, a second on the Ivory Coast/Ctanaborder, and a third on the Togo/nenin border. Studies in 1975-1977 nad shown that theinvading females were of the Sinulium dannosum and S sirbanum savanna species; that they were o1d, had taken bloodmea Is, and might carry O. volvulus ; and that they were carried bythe prevailing monsoon winds. Experimental spraying of the Marahou6 and upper Sassandra rivers ia L977 had shown that spraying the Ma rahou6 protected the L6raba and Bandama, wheretransmission had fallen below the critical leve1, while spraying the upper Sassandra protectedthe upstream Bagots. The direction of re invasion, favoured by the monsoon was from south-westto north-easE. With the wind, females could fly over 25O km. Thus any area less than 2OO km downwind from savanna Simulium damnosum s.1. breed ing zones could be reinvaded byinfective females; Ehis conclusion had been submitted to the STAC at its session in NovemberIn his view, the present conErol strategy was sound, andlimited in space or Eime. the campaign should not be too 5.11 The JCC welcomed the STACTs increasingly evaluative report. The STACTs important parE in the Progranrne could be expected to increase. The tasks it set itself at the foot of page 1 of the rePort appeared reasonable. However, it was not clear what audience its reconrmendations were aimed at or how they were followed up. The definition of OCpts objective on Page 3 represented a considerable change from the November 1973 Agreement, where the objective was stated as the elimination of onchocerciasis, wit.h interruption of transmis- sion by the elimination of the vector as an intermediate stage. While the new objective appeared reasonable, OCP should sti1l do all it could to achieve interrupEion of transmission. The change had obvious implications for planning for stage 2. It was suggested E.hat STAC reports should be circulated to the JCC as soon as ready during the year. The STAC had encouraged OCPrs scientists to prepare data for publication. At the same time, many other rePorts had Eo be drafted; it was hoped that this burden would not interfere with the operational work. 85.12 Representativesr concern regarding the reinvasion of treated areas persisted. The STACTs cautious approach to extension in order to combat reinvasion seemed at variance with the view that the control campaign should not be limited in time and space. The need to treat certain zones outside the OCP area was a strong argument for extension, and not only to the Marahou6 and Sassandra. other sources of invading females might still be found. perhaps all Simulium zones wi-thin 2OO km of the OCP area should be included; otherwise, control could only be on a short-term basis. The Vector Control Unit could not do the extra work with its present staff and resources; on the other hand, the programme reported a saving of$ 3 million in I977, which hardly corresponded to realities. Meanwhile, apart from treati-ng reinvaded areas, the STAC haC suggested a study of resting places with a view to the control of adult flies. 5.13 The absence of a back-up insecticide for use if resistance to Abate developed continued to preoccupy the CommitEee. IE was suggested that high priority in research should go to the discovery of one or more insecticides outside the organophosphorus group; underutilization of funds should not prejudice chis work. The Courmittee was reminded again that resistance to Abate, if:-t appeared, was likely to spread slowly, so that Ehere would be time to continue stuCies on other promising chemicals. The STAC had asked for a meeting of specialisEs to plan the work on new insecticides. Another possible approach was the use of insect growth control compounds, which had shown promise experimentally at very Iow dosages. Increasing the dose of Abate would also give some yearsrrespite. It was objected, however, that that would endanger the river flora and fauna, and Ghana, which received much of the residue, would require notice of any such decision. 5.74 The STAC report noted on page 7 that a SAP working group had decided to convert the cytotypes of the S. damnosum complex into species. A representative asked in what way the working group was qualified to make such a decision, and why the STAC judged it premature. Dr Haskell explained that the working group, composed of international experLs, had been called to examine the nomenclaLure of S, damnosum. Despite the wording of the report, the STAC had in fact agreed Ehat the timing of the decision was appropriate. The Chief of the Vector Control Unit added that species had to be declared as such once specific criteria vrere satisfied. There were six or seven species of the S. damnosum complex in West Africa. The decision made 1ittle difference for control purposes. 5.15 A representative expressed the view that it would be unrealistic, and outsideOCPts terms of reference, to try to deal with trypanosomiasis and schisLosomiasis. He suggesEed that the question should be referred to TDR, which covered both onchocerciasis and these two diseases. Another representative agreed, however, that a STAC working group should look into Ehese and perhaps other diseases, If feasible without detriment to onchocerciasis control, some OCP field staff might gather data for trypanosomiasis control as the densiEy of Simulium fe1l. It was noted that FAO vras supporting a large-scale prograume for the control of trypanosomiasis and eradication of Glossina in Africal because the country by country approach had not proved satisfactory, it was now planning an international campaign in collaboration with WHO. Other inEerested organizations included the Organization of African Unity and IAEA, which was working on the breeding of sterile f1ies. This new programme for the control of African animal trypanosomiasis was being discussed in December 1977 at a meeting in Rome. 5.16 The STACTs views on training were noted. A representative considered that OCp should continue to seek the best way of assisting the Participating Countries to increase theirtrained staff, perhaps through a special fund for training. In any case, Eraining of onchocerciasis specialists should not be fragmented, but must fit into the overall nationaltraining prograrune. 5.L7 Replying to poinEs raised, the trIHO representative said that the STAC was expected toprepare an annual report for the JCC, which went first to WHO and then the Steering Committeefor their comments. wHO saw the STAC as its adviser on scientific and technical matters, and had been verv satisfied with its contribution so far, as the many measures taken in responseto its recommendations bore witness. Within budgetary lirnitations, it would continue to -9- fo1low these recomendations, €.8. to convene working groups on trypanosomiasis and schistosomiasis and on alternative insecticides. Ihe report of the SAP working group on criteria for resettlement had not yet been circulated, as it had only just been examined by the STAC. 5.18 A representative had noted Ehat a seven-day cycle for larviciding breeding sites had originally been selected, since larval maturation took not less than eight days, and asked if an 8-10 day periodicity was safe. The WHO representative said that the Ereatment rate depended on the rate of larval development, which in turn depended on water temperature and the amount of food available. In the colder seasons and in colder parts of the OCP area, the larvae were found to develop more slowly and thus less frequent spraying became possible. However, the Progiamers calculations showed that the potential gains to be derived from these variations by lengthening the treatnent cycle Eo eight, nine or even 10 days would be more than offseE by the logistic disadvantages. Not only would spraying on non-working days pose problems, but i.E would not be possible to keep to the longer cycle throughout the year, and a helicopter could not operate on a lO-day cycle in one area and a seven-day cycle in another. 5.19 Further questions had related to the doubling of the epidemiological sampling rate recorunended by the PAG Mission and the change in composition to attlogicaltt, and notrrrandomrr, sample. The WIIO representative explained that the PAG Missionrs figures were theoretical estimates proposed by statisticians unfamiliar with the disease or the areal they would have served for an evenly distributed condiEion, but were inadequate for a focal disease that varied greatly in prevalence within localities. fhe sanpling was logical ln the sense Ehat it was related to vector control operations in order to show their epidemiological effect near and at some distance from rivers. Because the situation changed as soon as larviciding began, the Epideniological Evaluation Uni.t was trying to work in as many localities as possible and Eo carry out a whole series of studies. 6. STUDY OF THE GEOGRAPHICAL EKTENSION OF THE PROGRAI.TME AREA REQUESTED BY THE @VERNMENTS OF BENIN, GHANA, IVORY COAST, MALI AND TOGO: Agenda item 6 6.L The Chief of the Vector Control Unit introduced a report (document JCC4.4) prepared in accordance with the JCCrs request for a study of the implications of extending the OCP area. The criteria applied in the report were those discussed at the ComitEeers third session: contiguity with the present OCP areal maintenance of t.he balance of the Prograrmre; relationship with reinvasion; and the susceptibility of proposed new areas to reinvasi,on. For each country, the report dealt rdith the entomological, epidemiological and economi-c aspects, Baps in present knowledge, and a plan of action with cost estimaEes and a time schedule where relevant. The information had been obtained from the countries concerned, from international and regional organizations, and through visits by OCP staff. 6.2 The JCC expressed general saE.isfaction with the report. The representaEives of Contri- buting Parties were prepared to consider the extension of the Prografl[ne area provided that the present OCP project was in no way prejudiced and provided that adequaEe human and financial resources were available. One representative proposed five criteria by which requests for extension night be judged: (1) ttre need to prot.ect the existing area against reinvasion;(2) the priority accorded to onchocerciasis in the proposed area; (3) the possibility of applying present systems and techniques; (4) the economic development and potential of the area; (5) reasonable cost and availability of financing. The importance of health considerations and of freeing additional areas for economic development was sEressed by a number of speakers. 6.3 Where studies of extension areas were proposed, representatives r^rere concerned that OCP did not have the necessary manpower for such studies without interfering with present work. Even if funds were available, the worldts pool of experienced ophthalnologists and epidemiologists for evaluation of the disease was limited. To ensure that staff were available in the short and long Eerm, countries would have to press ahead with training of national personnel. 10- 6.4 The ParticiPating Countries requesting extensions sumarized the main considerations leading to Eheir requests. They stressed that the principle of exEension should be accepted equally for all the countries, and the proposals should be taken as a whole. The areas concerned satisfied all objective health and economic criteria, and acceptance should not be related to countriest ability to finance the additional work. 6.5 The representative of Benin said that the proposed extension area in his country was rich agricultural land, but so. heavily infested with onchocerciasis that plans for development had had to be abandoned. He drew attention to errors in the report; for example, there were 10 hydrological stations in the area, not two. Benin was prepared to provide national specialists to assist in the medical survey as OCP consultants. The extensions in Benin and Togo should extend south to the same latitude in order to avoid dangerous gaps. The necessary studies could be completed in the first year and spraying begun in the second. He suggestedthat a study group should visit the country and draw up a two-year progranme. 6.6 The representative of Ghana pointed out that Ehe proposed extension zone included not only the Brong-Ahafo region, but also the Ashanti and eastern regions. These were important cocoa, timber and food-producing areas. He accepted Ehe plan of action outlined in the report, and proposed that Ghanaian scientists, especially entomologists, be attached as counterParts to OCP headquarters and the Tamale subsector to gain experience. 6.7 The representaEive of Togo said that his Government had requested extension to the whole of the Mono basin. Studies had shor,m this fertile area, which was favourable for agricultural development, to be a serious focus of onchocerciasis. He accepted the plan of action put forward in the report, although it did noE cover the whole of the area requested. 6.8 The representative of Ivory CoasE said that his Government attached absolute priorityto its proposed extension area, in which very large investments had been made and where a big sugar complex was to begin operations in 1978. A joinr wHo/ocCGE mission in May 1977 had revealed a serious health situation, with a very high prevalence of onchocerciasis and highblindness rates- The entomological argumenEs, to prevent reinvasion of the present oCp area, were equally compelling. Because of the financial implications of its request, his Governmenthad decided to make a voluntary contribution of $ 2 345 OOO over two years to cover the additional cost to OCP. 6-9 The representative of Upper Volta recognized that his country was in a special situation as iE was already fully covered by ocP. rt was in favour of the proposed extensions providedthey did not impair the progress of Ehe present Prograrme. The extension Eo the upper Sassandra and Marahou6 was justified, because the persistence of these foci would jeopardize all OCPrs work. 6.10 Ihe representative of MaIi said that of his countryts L 24O OOO km2, nearly gOO 006 km2 were in the Sahel; at least 225 OOO km2 of the remainder was infested, but less Ehanloo ooo km' was covered by oCP. He pointed out that the Ewo separate onchocerciasis zones shown in Mali on the maP on Page 2 of the report were in fact one continuous zone stretchingfrom Bamako on the edge of the OCP area to the Guinea and Senegal borders. Mali had fulltechnical information and could produce hydrological data in less than a year. He proposedthat studies be made to pinpoint the extension, estimate costs and draw up a timetable. The criEeria for extension, and particularly the need to protect the present oCp area, should be applied t.o all countries, and studies should begin. 6.11 He reasons, Meetings with thejoin OCP informed the Committee that Guinea and Senegal wished to join OCp. For entomologicalit was desirable that the Mali extension should reach also into these two countries.to coordinate requirenents had been held between the three countries, in accordance suggestion in the rePort. He proposed that Guinea and Senegal should be invited to and that extension to the three countries should be approved as a whole. 11 - 6.L2 It was the general view that the extension area in Ivory Coast satisfied the suggested criteria. It was a proved source of reinvasion, the results of prelininary spraying had been encouraging, economic investoent in the area was large, technical data were available, and the burden on the Prograrme would be greatly reduced by the Governmentrs offer to finance the work. The area should perhaps have been parE of OCP from the start, and iE was considered that the Programne should be authorized to begin operations there in 1978. 6.13 For the extensions Eo the south, in Ghana, Togo and Benin, the report indicated that the technical data were not yet complete and suggesEed furt.her studies in 1978 and L979. The ConEributing Parties considered lhat work should proceed on Ehe studies in line with the plans of action proposed in the report, without commitment as to a final decision on extension Eo the new areas, which would depend on the outcome of the studles. The eventual proposals should be reviewed by the STAC before coming to the JCC, which would no doubt also take the 1978 review missionrs report into account. IE was hoped that the Participating Countries concerned would contribute to all phases of the work. 6.14 The proposed extension in Mali was a separate case to the ext.ent that it involved two counEries that were not members of OCP and related to the Senegal rather than the Volta Basin. Support was expressed for an independent technical review by WHO of the requirements of the area. 6.15 With regard Eo the financing of the proposals in the report, the estimated cost was $ 3.5 million over the coming Ewo years. The Netherlands representative said that his Government would make an additional contribution of $ 5OO OOO towards that total. The United States representative announced a contribution of $ 3OO OOO for the additional studies. The United Kingdom representative said that his country, which contributed LO"/" of WHOts annual drawings on the Onchocerciasis Fund, was ready to bear LO% of the additional expenditure. The World Bank representative considered that together with Ivory CoasErs contributi-on of $ 2 345 OOO, sufficient funds would be available to carry out the proposals. 6.L6 RepresentaEives pointed out that OCPrs operational staff was already heavily burdened and that the extra work could not be done without detriment to present activiEies. The Progranrne Director should be given a clear mandaEe to increase his staff accordingly. 6.L7 The Independent Chairman said that after consulEations with the Government of Mali he had invited the Governments of Guinea and Senegal to be representated at the session. He read out the text of a cable from the President of the Republic of Guinea informing him of thaE countryrs wlsh to join OCP and seeking his support for it.s request, which had already been submitted to the WHO Regional Office for Africa. He had also received a cable from the Government of Senegal, followed by a letter embodying iEs formal application for membership. In addition he had been informed by WHO Ehat Nigeria was interested in learning more about OCP, and he had invited the Government to be represented at the session. He welcomed the observers of the three countries on behalf of the JCC. 6.18 The UNDP representative said that his Organization had received a cable from the President of the Republic of Guinea and that the Adrninistrator of UNDp had requested him to support Guinears admission to the Prograumre. The FAO representative said that the Di.rector- General of FAO had also received a cable from the President of Guinea asking support for the Guinean case. 6.19 The observer from Guinea reaffirmed his countryts wish to join the prograrmre. Only concerted international action in all endemic areas over an extended period could be effective against onchocerciasis in West Africa. He described the history of attempEs to study and control the disease in Guinea, where the epidemiological situation was ser1ous and economic development was considerably hampered. With the help of a map, he demonstrated thefoci of onchocerciasis in Guinea, which would continue to reinvade the OCp area in Mali andIvory Coast unless also treaEed. Following his countryrs request to WHO in November L975 f.or membership in the Programe, the Organization had proposed various studies which had since t2- been carl'ied out. Requests for training fellowships had also been addressed to the WHO Regional Office. He asked the Conrnittee to accept Guineats application for membership and Eoplan for its participation in the second stage of OCP. Guinea would meet all necessary condit ions . 6.2O The observer from Senegal said that onchocerciasis was a serious health problem in one clearly defined section of eastern Senegal, an area with a high economic potential. Epidemiological surveys had been carried out by the Government and OCCGE since 1951, and a special onchocerciasis unit had been set up at K6dougou in 1971. Virtually complete epidemiological and entomological data were available. However, Ehe Government's long- standing request that OCP should be extended Eo the Mali/Senegal/Guinea subregion had not so far been met. Environmental and health studies had begun as part of che OMVS progranrne for the integrated development of the Senegal River Basin. OCCGE was associated with this work, which was directed by USAID. Similar studies had been undertaken in the Gambia River Basin as part of the OMVG prograrmne. Eastern Senegal was also the site of the World Bank "new lands" project, which had taken the onchocerciasis problem into account in its surveys. Financing for onchocerci-asis studies was provided for in the fourth and fifth national economic development plans; the Government had done all it could. Finally, as far as health coopera- tion lsas concerned, political problems with neighbouring States had now been overcome. 6.2L The observer from Nigeria said that all except two of the 19 states in his country reported onchocerciasis, and the disease was a priority in the current five-year plan. As it had done since the Progra-uuners inception, his Government wished to join OCp for the whole of the country, with intensive operations in the severely affected areas, which covered about 7Oo OOO km' out of the total of 923 773 ktrz. Adequate epidemiological information was available to justify a control campaign, with prevalences of 40-80% reported. Blindness rates reached 5.6% or more, and in 1973 there were estimated to be 5OO OOO blind people in Northern Nigeria. The economic effects had been serious; farms and villages had been abandoned and tin mining was adversely affected. EnEomological informaLion was as yet incomplete and Nigerian entomologi-sts working on the vectors could benefit from visits to OCP. Hydrological data might need to be supplemented. When Nigeria is admitted to the Programme, a detailed plan of action should be prepared. OCP could assist particularly with training, though a Eraining centre would be needed in the counEry. He hoped that Nigeria would be able to join the Prograrme. 6.22 The UNDP representative believed that the Committee should accept the principle of extension, both within and outside the present Participating Countries, and then deal with the lega1, logistic and financial aspects. As to the proposals before rhe JCC, a decision could be reached imnediately on the start of operations in Ivory Coast and the studies to the south of the present area. Mali had been told that studies should also cover Senegal and Guinea; it had therefore begun vork in cooperation with its two neighbours. The problem was that OCP funds could not be used for nonmember countries, while the studies in Mali outlined\ in the document might not bp entomologically valid if carried out alone. The JCC mighr set a date within which extension to cover the three countries would be reviewed. 6.23 In a message to the JCC, the WHO Regional Director for Africa said that for the past two years five Participating Countries had requested extensions in their terriEories, while other countries in the area had also asked for help in controlling the disease. In September L977, the WHO Regional Corrnittee for Africa had asked the Regional Director to 'rreview the possibility of exrending the Onchocerciasis Control Prograrmne in the Volta River Basin Area to neighbouring countries affected by onchocerciasisr', The requests of those countries should be met, both on humanitari.an grounds and also because of the reinvasion of freed areas by blackflies from outside the area. Since it would be practicaLly impossible to prevent reinvasion of the west of che OCP area unless control activities were carried out simultaneously in the contiguous parts of Mali, Guinea and Senegal, WHO would initiate discussions among the three countries so Ehat a coordinated prograrrne of onchocerciasis control could be organized there. He welcomed the presence of observers from Guinea and Senegal at the session, and expressed the hope that the JCC would reach a favourable decision on their requests. 13 - 6.24 A number of representatives considered that Guinea and Senegal should be admitted to OCP so that studies could begin in those countries and Mali on a sound entomological basis and in order to Protect the west flank of the Programe area. The interest of Nigeria inthe Progranrne was welcomed. However, the JCC considered that since the onchocerciasis zone in that country was as large as the whole of the present Prograrme area, further consultations would be advisable to investigate what was the best way of associating the Nigerian programe\,rith OCP. Nigeria could possibly join the Programe, either as a Participating Country or aContributing Party; alternatively, it could run a separate programe closely coordinated with OCP. 6.25 Several rePresentatives pointed out that the agenda item related to extension 1n Present Participating Countries on1y. They had not been informed in advance of the applications of the three additional countries, and they had no mandate to discuss thequestion. The admiesion of new nembers would entail amendments to the prograrmers basicAgreement. It was noted from the Regional Dlrectorrs message that WHO was prepared toinitiate studies with regard to the requests of Senegal, Guinea and Mali. Similar discussions might also be held with the Government of Nigeria. The IJHO Regional Committee for Africa had requested the Regional Director to a6sist in wldening the prograrme area. If the Regional Office could not itsetf undertake the necessary studies, it could calI on the resources of WHO as a whole, and thus avoid overburdening OCP, the funds of which could not in any case be used outside t.he Programers member countries. 6.26 The Independent Chairman considered that the JCCrs conclusions with regard to the report could be suffined up as follows. The Cormnittee agreed with the proposals for an extension in Ivory Coast as from 1978 and for studies over the next two years in Benin, Ghana, Mali and Togo as outlined in the report. WHO should be asked to conduct joint studies in Guinea, SenegaL and western Mali where technical considerations indicated a combined approach. The JCC noted with satisfaction the Regional Directorrs offer to carry out these joint studies and expressed Ehe hope that WHO would find the additional resources as soon as possible. In that r^7ay, the necessary inforuation would be available for the JCCrs next session, and no time would have been wasted. In the case of Nigeria, if it wished to become a Contributing Party, it should be invited to consult the World Bank. If it r.Tished to be a Participating Country, much more information would be required, the major technical consideration being whether it should join OCP or operate its own separate programe. WHO should be invited to discuss with Nigeria r^lhat its relationship, to OCP should be. 6.27 The JCC accepted thosg proposals. It further noted that the Prograrme Director would have to increase OCPrs sEaff in order to carry out the extensi.on work and studies it had approved without sacrificing the efficiency of existing Prograrmre activities. 6.28 The United States representative said that if IJHO wished to carry out the joint studies in Ehe Senegal River Basin, hi-s Governnent woutd be willing, entirely outside the Prograrune, to consider making a contribution in the fora of consultants or other assistance that might be nee de d. 7. RXPORT OF THE ECOIOGICAL PANEL: Agenda item 7 7.1 In the absence of the Chairnan of the Ecological Panel, t,he item was introduced by the FAO representative. The report (document JCC4.5) covered the Panelts activities for the first half of 1977, incLuding its sixth session, which had been held at Ouagadougou jointly with the STACTs sessi-on. It dealt specifically with: ecological aspects of the aquatic monitoring activities, in which the Panel concluded that the nuurber, type and frequency of observations were satisfactory; the im'plications of settlemenE for the natural and human ecology, for which the Panel proposed a number of points to be taken into account in establishing settlement policies and planning human settlemenEs; and land resettlement. In April L977, it accordance with the Panelrs recomendation, the Chairman had visited the OCP area for consultations with the Progratrme's hydrobiologists. Monitoring work on the BagoE and Oti rivers, under pre- Ereatment surveillance but now in the treatment phase, was of particular interest. Initial 74- treatment had caused a catastrophic kill of the river benthos, but not of the fish. As observed in the Phase I rivers, however, the invertebrate fauna and microflora had soon re-established themselves at abott 70% of the initial biomass. 7.2 At its seventh session, in Novernber L977, the Panel had noted that its recomnendation on the collection of invertebrate specimens had been carried out and hoped that similar collections would also be made in the east of the OCP area. It felt that OCP should be very clear vrhaE questions it intended t.o resolve through the analysis of the comput erized. aquatic monitoring data; a SAP Working Group might be useful to clarify that question. The Panel had asked FAO to prepare a draft outline for a study on the ecological change caused by settling human migrant.s. 7.3 The Panel concluded that mechanical removal of existing breeding sites might well create more difficult breeding sites to control. Mechanical control night be justified if linked with the economic use of the water for irrigation or power. The Panel noted that a pilot Project to ascertain the side-effects of mechanical conErol measures was included in che 1978 proSralltrne. 7.4 The Panel cormended OCPts handling of the complex problem of reinvasion, and strongly supported Ehe proposal to study the resting places of invading adult flies with a view tokilling Ehe females before they laid their eggs. Care should be taken not to ki11 naturalpredators andfor valuable pollinators. 7.5 The Panel recognized thaE if money was to be spent on land settlement, this would have to be based on a cash-crop economy. That. meant, not large-scale plantation agriculture, but rather improved sma1l-sca1e farming. IE proposed that the OCP Economic Development Unit(tOU) tollow up its work on economi.c development projects in the prograrure area byidentifying the crop rotations and farming practices being used. 7.6 The Panel had discussed the ecological dangers to rivers in Ehe OCp area associated with agricultural cheuicals, agro-industrial waste and human pollution. The assessment of acceptable ecological change during land settlement would be a main issue at the panelrs nexE session. The Panel underlined the importance of agricultural research and extension servicesin controlling undesirable ecological changes. As 1itt1e appropriate research was being donein this field in the Progrartrne area, the Panel recormended that an inventory of research and extension facilities and prograrnrnes be compiled. 7.7 With regard to aquaEic monitoring, the Panel proposed that monthly sampling ofinvertebrates and quarterly sampling of fish should start 12 months before treatment and thar on the first three applications of larvicide 48-hour drift-net samplings should be taken. The sampling frequency could be reduced when a new equilibrium was reached. 7.8 While some rePresentatives considered that the Panelrs report highlighted the main ecological points that countries needed to rake inEo account, others found it too schematic; they would have preferred a more detailed scientific presentation, not just a suurmary of conclusions. If national rural development services were to follow the panelts guidance, they must be given clear and accurate information. It was little help to refer to ecological dangers of, for example, agricultural insecticides or dam construction, without specifying what measures should be taken against them. A representative pointed out that despite such dangersthe ParEicipating Countries must go ahead wiEh development project.s. They were fu11y aware of the principles outlined by Ehe Pane1, but found that because of economic constraints theyhad little choice. He hoped that future reports would better meet the requirements of allinvolved in the Progranme. The Panel was asked to work more closely with the countries;particiPants in its meetings should include not only research workers, but also government staff working on economic development. 15- 7.9 The Corrnittee was not clear what readership the report was aimed at - the ParticipaEing Countries, the ConEributing Parties, or OCP itself - or whether its reconrmendations were intended for the Steering Comittee, the countries, or the world at large. Indeed, the Panel seemed still to be feeling ics way. Annex II of the report appeared to widen its terms of reference, and the Panelrs conclusions stretched them still wider, so that they overlapped the activities of other groups. The items mentioned at the end of Annex II even suggested thaE the Panel was enEering new sectors. 7.LO More deEails were requested on the conclusions of the meeting of hydrobiologists mentioned in paragraph 6 of the report. A speaker expressed his agreement in principle with the monitoring protocol outlined by the FAO representative. The Progranme was asked to make its monitoring findings available to counEries so that they could arrive at their own assessments of Ehe situation; some scienti-sts sti11 considered that the effect of Abate on the environmenE was susPect. If the slight biological effecEs of larviciding EreatmenE were negative and required further study, that should be made clear. A representative felE thaE more should be knoun of the fal1 and then recovery in the biouass afEer first application of Abate. 7.LL Referring to paragraph 12, a representative did noE agree that resi.stance Eo Abate would spread very quickly. Resistance was a possibility, but would start loca11y and not spread fast. Another speaker expressed concern that the Panelrs conclusion on this point differed from that of the STAC. 7.L2 The proposal to study the resting habits of adult blackflies was welcomed. It was suggested that isotopic marking techniques should be used in these studies. Among possible adulticides, pyrethrins and pyrethroids yrere effective against biting flies aE very low concenErations, and so were less of a danger to fish Ehan earlier compounds. RepresentaEives asked for clarification of the reference in paragraph 37 to Ehe use of ttspecially designed" smal1 dams in mechanical control of breeding sites. Dam flumes were often highly productive of S. damnosum. 7.L3 The Panelrs conclusions on the implications of settlement for the natural ecology were considered barely relevant in Ehe light of the present leve1 of farmers in the OCp area. Paragraph 16 might be based on scientific observations, but it was not easy to apply in countries trying to increase crop and livesEock production. Applied research was needed to establish precise limiEs to livestock carrying capacity. As to paragraph 17, obviously dams and irrigation ditches could provide breeding sites and spread disease, but since water could not be stored and distributed in any other way, they were a necessary evil. 7.14 Responding to coments and questions, the FAO represenEative said that the panelrs Purpose was to act as the independent conscience of the Steering Committee and the JCC. Thusit had a responsibility to highlight the dangers all knew existed, and to be idealistic in approach. The report of the sixth session was general in nature because the panel had tried to assemble a framework of ecological points to be watched in OCPrs work and in the economic development of freed areas. The report of the recent seventh session was more specific. 7.L5 As to the rapidity of the spread of resistance to Abate, the panelts differing conclusions tere probably due to the environmentalistsr different Eime-frame and habit of becoming concerned at. an early stage. The proposed Ehree 48-hour drift-net samples after spraying should shed more light on the phenomenon of kil1 and subsequent rapid recovery. Thebiological effects of larviciding, though slight, were indeed negaEive; for that reason the Pane1 had noted the need for fo1low-up sEudies. . The Panelrs reference Eo the protection of natural predaEors in adulticiding did noE relate specifically to predators of S. damnosum; it seemed unlikely that important blackf ly predators existed. The mentio.r of "pEEi.llyEignedsmall dams was inLended to underline the need to avoid creaEing breeding sites in spillways; much could be done to reduce this hazard. The Panel had no intention of limiting the construction of dams or producEion of livestock. It simply pointed to the irnplications forthe environment, so that due precautions could be taken. In agricultural research, one approach would be to draw information from institutions in similar agroclimatic zones anddisseninate iE through OCp. 16 - 7-16 The wHo rePresentati-ve agreed that it was important to be clear as to the purpose ofthe Pane1. When the Prograurme began, its role had been to ensure that activities did not damage the environment; that check had been useful, and in fact there had been no serious ecological problem. The Panelrs reports were addressed Eo the Steering Committee. Governments could accept or reject its guidelines, as they wished. OCp, however, had to takeits advice into consideraEion. 7 -17 The Committee was informed that when rivers were first treated \dith larvicide, a large number of non-target organisms became detached, and might die, but within thTo to three months the population was restored to some 70% of its former leve1, with few species lost. There\ras no detectable effect on the fish population. Fu11 aquatic monitoring reports were already available in the countries. The collection of specimens vras necessary because many of the organisms found were new to science and taxonomical studies \^rere necessary to ensure that work was comparable. In answer to a question, the representative of Benin was informed that a Canadian hydrobiologist had visited his country with the Governmentrs permission to make apreliminary survey of water organisms. It was noEed that resistance of insects to organophosphates, of which Abate was one, was acquired slowly, if at all. In a zone treated \'rith Abate since 1972, the level of sensitivity of Simulium larvae when spraying was resumed after interruption \4ras the same as before the initial Ereatment. However, work on other larvicides of other chemical groups would continue. In conclusion, WHOrs approach to the building of dams was not to attempt to stop them, but to cooperate with the departments concerned in the health aspects. 7.18 The Independent Chairman suggested Ehat the SE.eering Conmittee should take the JCCts comments into account in planning the Panelrs future work. 8. ANNUAL REPORT OF THE ECONOMIC DEVELOPI,IENT ADVISORY PANEL: Agenda item 8 8.1 In the absence of the Chairman of the Economic Development Advisory Panel (EDAP), annual report for L977 (document JCC4.6) was introduced by the Panelrs representative, Mr W. de Souza. During the year the Panel had met twice, in Ouagadougou in March and Rome in August. its 1n 8.2 At its third session, Ln L976, the JCC had expressed the wish that the EDAP should direct its attenEion to the analysis of specific projects as well as general development problems. That wish had been taken into account. The report was divided into three sections: the first dealt with the Volta Va1ley Development (AVV) project; rhe second wirh specific problems discussed during the year; and the third with a surtrnary of the Panelrs opinions and reconrnendations. 8.3 The Panel had had an opportunity to pay a field visit to the AVV project - the best-knovm development project in the zone freed from onchocerciasis - and to hold discussions with the authorities responsible. It had concluded that while much remained to be done, especially in the health field, the project was an extremely interesting one. 8.4 Of the specific problems discussed, the first was the question of methodological approach to development. Here the Panel recormended flexibility in the application of the WorId Bankf FAO/UNDP methodology, in view of the differences from country Eo country. Certainly current development operations should not be delayed. 8.5 In its discussion of migration to disinf,ested areas, the Panel had concluded that, although it requi-red a substantial outlay, di-rected mi,gration gave the best chance of tackling problems successfully. However, since spontaneous migration could noE be prevented, it should be channelled to ensure that it did the least possible harm to the ecology and brought the greatest possible benefits. L7- 8.6 Another topic tackled was that of health organization. The Panel noted that shortages of health personnel and drugs might be alleviated by using auxiliaries trained on the job in the country concerned and by exploiting all the possibilities of the local pharmacopoeia. Health education would be important, and populations night have Eo contribute to their or^,n health costs. In any case, the freed areas would have to continue under special health survei 1 lanc e. 8.7 The Panel had discussed the question of agricultural credit as a catalyst for development. In the absence of adequate credit. systens, it had suggested the convening of an intercountry meeting of central, development and agricultural banks to create suitable financial structures. Present loan systems ldere directed to cash crops, and attenEion to food crops was also needed.Credit institutions could also assist in the training of farmers. The introduction of agricultural credit should be accompanied by suitable measures with regard to infrastructure, food storage, marketing, and price policies. 8.8 In the development of agro-industries, on a large or small scale, the processing of food products was particularly important. In introducing new technologies, care should be taken not to deprive women of functions that had always been their province. The panel had suggested studies of two major constraints on agro-industrial development - the cost of energy and of transport. 8.9 Discussing the role of women and youth in the development of oncho-freed zones, the panel had pointed to the danger that in the upheavals resulting from migration the women and youngpeople might be the principal sufferers; they should benefit from training and other services Eo enable them to make a real contribution. 8.10 In section III of its report, the Panel had endorsed the proposals for studies listed in section VI of the Economic Developtrent Unitrs annual report. Pending Ehose studies, the Panel had sumarized its conclusions in a number of recomendations. Notr7 that vector control oPeraEions were yielding substantial results, the problems of economic development were crucial. The studies recormended should give added momentum Eo the development process. The Panel welcomed the Steering Comitteers proposal for a mission to review the programre in 1978, and hoped that it could be associated in that study. 9. socroEcoNoMrc DEVEIOPI,IENT ASPEcrs oF THE PROGRAIIME: Agenda iren 9 9.1 The Chief of the Economic Development Unit presented the annual report on socioeconomic development aspects of the Progr:me (document JCC4.7). The report, the first Eo be producedby the Progranme, followed a pattern that would pernit future reporting on a comparativebasis. It resulted from a collaborative effort by ParEicipating Countries and bilateral andinternational aid agencies, which he thanked for their cooperation; he atso appealed to them to provide further information as soon as available. Some difficulEy had been met indistinguishing development projects that were sti11 in Ehe preliminary stages from those that had already reached the execution st.age or been completed. In order to improve reporting,five caEegories of classification had been proposed in section IV (page 10 of the documenE). If suppliers of infornation would observe that classification, the scope and quality of future reporEs could be considerably improved. 9.2 AparE from recording the activities of the EDU for L977 and describing the planning institutions and project.s of interest to the development of the OCP area, the report discussed a number of important issues bearing on this development. It also proposed a list of special topics Ehat required investigation in order to anticipate future development problems and deal with them as they arose. 18- 10. DISCUSSION OF AGENDA ITEX.,TS 8 AND 9 10.1 Representatives agreed that the EDAPts report was too general and unanalytical. Of the problems raised, some were secondary, and more social than economic in naEure. There was a lack of specific proposals - for example, how was appropriate technology to be applied, and in what fields? - and some of the studies suggested might already have been done, by such bodies as the Club des Amis du Sahel. The EDU could well investigate thaE possibility. An indication of crop or soil research needs, an analysis of possible models to be applied to the OCP area, and recormendations on exisEing or needed research institutions would all have been welcome. It was acknowledged that economic questions were more difficult Ehan scientific ones because they touched upon national sovereignty. LO.z A representative pointed out that many of the EDAPTs recomendations entailed extra expense for the Participating Countries. He considered Ehat some of the reportrs shortcomings could be overcome through stronger links between the Panel and Ehose countries. Much of its advice rras not applicable to all countries, because they had already taken the measures recomended. The proposal to establish special agricultural crediE structures for the areas freed from onchocerciasis ran counter to the principle of integrated nati-ona1 development; what was more, the document omitted all reference Eo school educaEion, though it was at least as important as the eradication of onchocerciasis. It was suggested that the possibility of financing projects in the OCP area through the new InternaEional Fund for Agricultural Development night be invesEigated. A representative disagreed with the Panelrs conclusions on the disadvantages of spontaneous migration. lO.3 Two representatives expressed satisfaction with the joinE FAO/IBRD methodology for the planning of economic development in freed areas, provided that developmenE acEivities went ahead without waiting for preliminary studies to be completed. On the other hand, another representative had the impression Ehat the meEhodology was being imposed on countries, which was an infringement of their prerogative to establish their own plans. 10.4 With regard to health matters, it was pointed out Ehat the estimate of $ 2 per person per year for health expenditure in freed areas (section II, paragraph 3.5 of the EDAP report) was based on a conventional health services approach, which appeared to contradict the reconrnendation to exploit the local pharmacopoeia in the previous paragraph of that rePort. The JCt was reminded that the Programtrers goal was not so much to control onchocerciasis as to free some 65 OOO-70 OOO km2 of valley land for development; it should therefore give its attention to trypanosomiasis, which could be as serious as onchocerciasis if epidemics occurred in resettled areas, 1O.5 Some of the topics proposed for study r^rere not specific to the OCP area, for example the integration of r^romen and youth in the development process, and the establishment of agricultural credit sEructures, which were needed everywhere. What was more, women and children should not be treated as a single topic; vromen shared menrs work and were playing an increasing part in decision-making. As to the second subject, the justification for special credit structures for the freed areas hTas not clear, and the proposed meeting should not be heId. If agricultural credit was to be a success, it must also cover such aspects as marketing; USAID had done a successful study with the Ivory Coast that might be useful to OCP The FAO representative said that. in his Organizati.olts view, agricultural credit facilities should be extended to even the most remote areas within each country. However, a start on creating the necessary infrasEructure could be made within the OCP area provided that the ultimate structure would be countrywide. He noted that the inaugural meeting of the African Regional Agricultural Credit Association was being held in Nairobi. That Association would help development banks to create the necessary infrastructure and adopt suitable procedures to bring credlt to the sma11 farmers. 10.6 Representatives expressed their satisfaction E.hat in its first report, and despite some inaccuracies, the EDU had produced a useful catalogue of econoxoic developments in the OCP area. It was suggested that information should continue to be the EDUrs first priorlty' and thaE, at the request of Participating Countries and donors, it night give fuller details of certain _19_ projects in order to assist in financing. One representative doubted if OCP could make a bigger contribution to economic development; vector control operations were reBional and could be determined solely by the Participating Countries, but economic development projects were national and depended on many bodies and organizations outside the Programne. Another view was that the EDU should expand the basic functions shown on page 2 of its report in order Eo carry out studies, seek financing, provide consultants, or give governments specific advice on the action they should take in relation to onchocerciasis control. However, it was poinEed out that such an advisory role was impossible without more staff; even obcaining informatlon was difficult when countri.es lacked highly developed stati.stical services. The EDU was also considered to have a role ln the Sahel, particularly through CIISS; close coordination with this body at the project planning stage would ensure that financing bodies were aware of OCP. LO.7 One representative believed that some of the topics for invesEigation described in section VI of the nDUrs report were not of prime i,mportance for OCP, e.g., the integration of women into the development process and the efficacy of appropriate technologies and protective clothing in reducing the incidence of onchocerciasis. Another speaker regretted that in section III the report did not refer to the part being played by the African Development Bank in the land satellite studies under USAIDTs Regional Onchocerciasis Area Planning (ROAP) proj ec t . 10.8 A number of representatives broached the more general quesEion of OCPrs role in economic developmenE activities and the besE structure to carry out that role. The JCC was warned against encouraging duplication in the institutions it had established. fhe reports of the STAC, the Ecological Panel, the EDAP and Ehe EDU all contained errors and repetiEions; it seemed that different bodies were discussing the same matters in the same way. The fact that advisory groups felt the need for joint meetings to coordinate their views, but then produced seParate reports, poinEed plainly to Ehe need for fewer major groups, the necessary subgroups being appointed as required. 10.9 Moreover, it was possible that a different framework should be envisaged for the socioeconomic aspects of OCPrs work. The Programme might sinply be duplicating the work of other bodies. It r"ras proposed that the Comittee should devote aE least one day to a thorough discussion of economic developnent problems at its 1978 session. By that time, the EDAP would have examined t.he report of the proposed review mission, and the JCC would have before it the next annual report of the EDU as well as the missionrs report and the EDAPts cotrunents. As the socioeconomic aspects of the Prograrune became more important, the extension studies progressed, and the need for second-stage financing drew near, the JCC should be ready to give OCP precise recormendations as Eo its role in economic development activities. 10.10 Responding to Lhe discussion, the representative of the EDAP welcomed the JCCrs interest in economic development. It was true Ehat in the short time available the Panel had not been able to discuss some questions in depth. He agreed that t.he possibility that the Club des Amis du Sahel had already done some of the proposed studies should be investigated. The Panelrs report made it clear that development projects should not be delayed while waiting for the comrnon planning methodology to be compleEed; in any case, the methodology was always subject to national wishes, in keepi,ng with the principles of sovereignty. The introduction of agricultural credit had been stressed because the Panel believed that the ParEicipating Countries had special hopes for the freed areas that justified special efforts. Obviousty, if possible, credit should be available to the smallest farmer. As to the cost of health services, the Panel had mentioned an ideal figure, but had also said that local met.hods should be used where funds were lacking, and indeed were already being used. It had encouraged such simple approaches as the use of health auxiliaries. The panel had not merged nomen and youth;it had stressed the inportance of education of both groups, and Ehis implicitly included school education. In the Past., the JCC had found difficulty in giving time to economic development problems, and he welcomed the proposal to devote a whole day to the subject at the next session. 10.11 The World Bank representative said that he would welcome a comprehensive debate on economic development at JCCrs next session. He had noted the Comitteers views on thepotential overlap between the various advisory groups, and in 1978 he hoped to present proposals 20- to the SEeering Connnittee and Ehe JCC on the EDAPTs role. He recalled that the common FAO/IBRD methodologv was intended for data-gathering. It was made available to Governments to help the Bank to assess the problems and give advice, but no attempt was made to impose i.t on countries. Certainly development projects should not be halted while the exercise was in progress. He looked forward to the assistance of the Participating Countries for the forth- coming review mission. 11. REVIEW OF TIiE PLAN OF ACTION AND BUDGET OF THE PROGRAMI'IE FOR 1978: Agenda item IO 11.1 Tntroducing the Plan of Action and Budget Estimates for 1978 (documenc JCC4.8), the Programme Director said that the 1978 budget \^7as an adjustment budget. The revised 1978 estimate of US$ 12 885 OOO, based on the experience of L977 - the first year of operations over the whole OCP area - compared with the Eotal of $ 13.5 million originally estimated fbr 1978 in December 1976. Activities for L977 had cost some $ 2 7OO OOO less than the approved budget figure of $ 13 L37 2OO. Lower than anticipated costs for personnel, travel, air operations and maintenance i-n 1977 had prompted readjustments in the 1978 estimates, which were listed by Programme acriviry in Table I. Of rhe total of $ 12 885 OOO, g 12 loo ooo was expected to be financed frorn the Onchocerciasis Fund, $ 465 OOO by UNDP, and $ 320 0OO1 by the Participating Countries. The revised estimated cost for the first-sEage period L974-L979 was no\, $ 57 320 OOO, as compared with the total of about $ 61 nillion forecast in December 197 6. LL.2 A definition of each category of expenditure appeared on page 13 of the budget document. To help in the comparison of costs, the detailed estimates by activity in Tables IV-XI included original and revised figures side by side for the years 1977-1979. New tables included Annex V (number of posts authorized and fi11ed) and Annex VI (distribution of professional staff by grade and nationality). The document also contai.ned annexes on research, training and transport. 11.3 Activities not provided for in the Plan of Action included the evaluation and reappraisal of OCP to be carried out with a view to planning for Ehe second stage (1980-1985), and the study of the effects of trypanosomiasis and schistosomiasis on development in freed areas suggested by STAC. LL.4 The JCC, in reviewing the Plan of Action and Budget, congratulated the Programme Director and his staff on the very clear and precise presentation in the document. Represen- tatives also welcomed the reductions in the cost estimates for 1978 and 1979, and expressed satisfaction with the detailed annexes on research, training and transport. 1I.5 In response to quest.ions, the JCC was informed that the June 1977 estimated overall total for 1978 of $ 12 885 OOO still held good. The consequence of any savings foreseen in the revised 1978 budget would be to reduce the overall requirement for the Progranrne for L97 4-L97 9. f1.6 The increase of $ 869 OOO for the Office of the Programne Director and administrative support at OCP headquarters in the revised as compared Eo Lhe original budget estimales for 1978 was accounted for by transfers of posts from Geneva to Ouagadougou and from other OCP Units. Part of Ehe increase over L977 was attributable to full provision being made in 1978 for posts vacant tn L977. The post of liaison officer at the WHO Regional Office for Africa in Brazzaville had been created to permit appropriate supervision of the Progrannne by the Regional Director. The transfer of responsibility for OCP from WHO headquarters to the Regional 0ffice had been carried out successfully. The suggestion that WHO Representatives in the Participating Countries might act for OCP in supervising staff and maintaining discipline was noted. However, the Prograrnme Director expressed his saEisfaction with the behaviour of Programme workers at present; he preferred the relationship of trust to continue. Ll.7 No agreement had yet been reached with the Programners air operations contractor on the definition of "flying hours" despite a meeting at the end of October 1977, and further talks would be held in Ottawa in January 1978. The question $/as important for OCP, as it 2L- determined how the aircraft were used operationally. Ihe JCC was assured that the reduction of some $ 4OO OOO for aerial operations in the revised 1978 estinates (Table V) would not be to the detriment of rivers being treated in 1978; spraying would continue, as in 1977, unless scientific considerations dictated otherwise. 11.8 A representative pointed out Ehat the budget estimates did not provide for the extra cosrs of $ 1 548 8OO for year 1 and $ 1 978 9OO for year 2 indicaEed in the study on geographical extension (documenE JCC4.4). Adding in those figures would give revised figures of g 14.4 million in 1978 and $ 16.3 nillion in 1979. fhe WHO rePresenEative confirmed those figures; according to the World Bankrs calculations, the additional sr:ms could be covered from exEra income. 11.9 The Comittee was inforned that the figure of $ 320 OOO, shown as the contribution of the parEicipating Countries for 1978, represented those countriesr undertakings at the joint meeting of National Onchocerciasis Comittees held at Abidjan in June 1977. The representatives of Benin, Ivory Coast, Mali, Niger and Upper Volta confitmed their undertakings to provide counterpart funds for the financing of their nationals in OCP. 11.1O A representaEive suggested that the Programe Directorrs reference to a study on trypanosomiasis and schistosmiasis needed clarification in the light of TDRrs responsibility for these two diseases and OCPrs mandate t.o deal only with onchocerciasis. The WHO representaEive said that members of the STAC had expressed concern regarding the risk of other diseases in areas freed of onchocerciasis. One possibility was to use OCP staff in the detection of human and animal trypanosoniasis. He could say little more until the proposed STAC working Broup had met. 11.11 As at its third session, the JCC stressed the need for more research on neT^, drugs for the treatment of onchocerciasis. A represenEative suggested that the Independent Chairoan might write to TDR to encourage it to do more in this area. As pharuaceutical companies were reluctant to invest in such research (Annex A, page 7), WHO should consider giving grants for the purpose. Another representative noted that WHO had recently made contact with the principal companies, and that TDR was supporting drug screening studies; clearly OCPrs research activities should be closely coordinated with those of TDR. LL.L2 In reply, Ehe WHO representative outlined drug development activities in 1977. In February a scientific working group on filarial infections, including onchocerciasis, had made a provision of $ 354 OOO for chemotherapeutic research, and of 32 Research Agreements 16 relaEed to chemotherapy. An Agreement had been made with an instiEution in the United States for the screening of 4OO compounds Ln L977 and 1978. Tests were also being carried out on the use of 4-aminoquinolines as microfilaricides and on maintenance of serum levels of suramin that could lead Eo better utilizatlon of this drug, In 1978, the sEeering cormittee of the scientific working group on filarial infections would decide on further work on potentially useful drugs, with particular reference to O. volvu1us. Practicable animal models were urgently needed. so far sma11 rodents had been used; chi'mPanzees r^rere suitable but very expensive, and other primates vere being Eested. TDR would welcome OCPrs moral suPPort in this work, but in any case all concerned in WHO were very conscious of the importance of chemotherapy of onchocerciasis. Unfortunately, develoPments were 1ikely to be s1ow. 11.13 The IINDP representative drew attention to the relaEively high 1977 saving of some g 225 OOO in research and training, the fields to which IINDP financing was devoted. It was suggested that the inability of the Participating Countries to produce qualified staff for training, to which attenEion had been drawn by the STAC, was one reason for the underutili- zation of UNDP credits; that in turn was related to the absence of a suitable career structure for trained staff in those countries. A representative considered Ehat it was noE clear from Annex B (Training) whether OCP training funds were intended only to train Prograrune staff members or whether fellowships were also open to national staff who would work in their own countries. It r^ras pointed out that the revised estimates for education and trai.ning in 1978 and 1979 were higher than the original figures. The Progranrme Director reiterated that in order to clarify the training situat.ion, in which the JCC had shown great interest, he proposed ro visit each participating Country personally in order to discuss national onchocerciasis policies, obtain names of candidates for fellowships, and arrange training Programnes. -22- 11. 14 Referring to Annex C (Transport), the represenEative of Belgium, cormending the efforts of the Programae staff at all levels, offered her countryrs assistance for the further training of drivers and other transport staff. The WHO representative welcomed that offer particularly since the Programne had so far failed to find an agency that could provide the training needed. Asked hrhether the present total of 222 vehicles was considered optimal, he said that the number was determined by the plans of operation of the Vector Control and Epideruiological Evaluation Units, and that it would be difficult to reduce the number further if the operational approach rqained the same; he noted that the total included a 20% reserve for repairs. 11.15 The Plan of Action and Budget of the Programne for 1978 were accepted by consensus 12. FINANCING OF THE ONCHOCERCIASIS CONTROL PROGRAMME: Agenda iEem 11 L2.l For the discussion of chis item, Ehe Comittee had before it a tabular statement of theposition of the Onchocerciasis Fund, prepared by Ehe World Bank as administrator, showing receipts and disbursements for the period L974-L976, actual or estimated receipts for L977, and actual or forecast disbursements f.or L977-L979. Coruuenting on the sEatenenE, the Ialorld Bank representative said that of the $ 2 million contribution expected from Kuwait in L977 ,$ 1 million had now been paid and the rernaining $ 1 million would be paid shorrly. Belgium \ras on Ehe point of paying i-ts L977 contribuEion, estimated in the table at US$ 410 OOO. As already noted, the total expenditure of $ 57.3 million nor^7 estimated for I974-1979 was considerably below the December 1976 esEimate of $ 61 million. The cost of activities relating to Proposed extensions of the Programme area was expected Eo raise requirements from the Onchocerciasis Fund by some g 1.5 million in 1978. L2.2 The United Kingdom representative said Ehat his Government would be happy, subject toparliamentary apProval, to continue to provide lO% of WHOrs drawings on the Fund in 1978. 12.3 The Canadian representative said that Lt L974 his Government had pledged up to CAN$ 3 million for the first stage, subject to parliamentary approval. It now proposed to increase that total for the six-year period to CAN$ 3.5 million; subject to ministerial andparliamentary approval, it would contribute CAN$ 75O OOO a year in L978 and L979. 12.4 The Netherlands representative expressed his Governmentrs satisfaction with the Prograrnmers results. In L974, the Netherlands had cournitted $ 6 million for the first stage.Of Ehat total, it had so far transferred $ 4 million, and had contacted the World Bank to find out when and how the balance of $ 2 million should be provided. In addition to that total, and to support necessary exEension activities, his Government was willing to transfer an additional $ 5OO OOO to rhe Fund for rhe first stage. 12.5 The representative of France said that his Government had so far contri-buted FF 17 million of its total pledge of FF 26 million. Of the balance, ir proposed to pay FF 4 million i-n 1978 and FF 5 roillion in 1979. 12.6 The representative of Kuwait said that of his Governmentrs first-stage corunitment of US$ 6 million, US$ 2 million had been paid by the end of 1976. Up ro rhe end of 1977, Kuwair had been asked to give a further US$ 2 million instead of the US$ 1 million originallyplanned; US$ 1 million had been paid so far and the second US$ 1 million would be transferred before the end of the year. Of the balance of US$ 2 million, his Government would give US$ I million in 1978, whenever the World Bank wished. L2.7 The United States representative said that in the period Lg74-L977 his Government had disbursed US$ 4 million of iEs US$ 6 million first-stage pledge. While the prograrmne had made commendable savings, costs were sti1l increasing because of inflation. His country had therefore decided to pledge US$ 1.7 rnillion for the present progranme in 1978, an increase of US$ 7OO OOO; it would also provide a further USg 3OO OOO for data collection relared ro rhe proposed geographical exEensions. -23- L2.8 The representati-ve of the Federal Republic of Germany pointed out that the financial statement circulated to the JCC contained an error. In fact, in January 1977 his country had cornpleted its promised first-stage contribution by paying for L977 the sum of DM 4 million, bringing its Eotal payment to DM 13 780 OOO, or approximately US$ 6 mi1lion. The World Bank representative replied that the table was not incorrect; the apparent error was explained by the application of different exchange rates. L2.9 The Belgian representative said that her countryts 1977 paynent should now have been received by the World Bank. Its 1978 payment would not be lower than that for L977; indeed, she hoped that it would be both slightly higher and more prompt. L2.LO The representative of Ghana conrmended the Programe for t.he savings made. On the Programers inception in 1974, his Government had pledged a contribution of f ZOO OOO, and hadpromised a further lump-sum payment in course of time. The Government was now considering that increase in its contribution, and the Progranme would be informed once a deci-sion was made. L2.LL Sumning up the discussion, the World Bank representative said that original pledges for the first stage as a whole had totalled US$ 34 milIion, while oEher donors had indicated annual contributions totalling some US$ 13 ni11ion. The World Bank group had promised about US$ 6 million for the six-year period, UNDP would contribute some USg 2 million for research and training, and the Participating Countries had pledged some US$ 650 OOO. L2.L2. In addition to the conEributions so far announced for 1978, Japan could be expected to maintain or increase iEs support, Norr^ray would presumably give half of its US$ 1 million pledge in 1978 and half in 1979, and the African Development Bank would confirm its yearly contribution of some US$ 18O OOO. The World Bank would contribute US$ 1.5 nillion in 1978. Several countries had promised additional funds, totalling about US$ 3.5 ni1lion, for extension oPerations and studies. This figure included the contribution of US$ 2 345 OOO for the coming two years announced by Ivory Coast under agenda item 6. L2.L3 During 1978, the Bank proposed Eo pay quarterly advances totalling US$ 13.5 million Eo l,lHO as the Executing Agency. That sum should be amply covered by contributions pledged for 1978 and by carry-over of cash and investment income from the previous year €rmounting to soEe$ 3 rnillion. L2.L4 The second stage of the Programe would begin in 1980. AgainsE a background of cost increases and possible extensions of the OCP area, the Eirne had come to begin to reflect on suitable financing arrangenents. The World Bank had started to make the necessary concacts, which it would pursue when firaer cost estimates for the second stage were available. L2.L5 RePresentatives proposed that financing of the second stage should be discussed at the JCCrs fifth session in 1978, though countries could not necessarily be expecEed to announce firm figures unEil they had had time to examine the studies to be submitted to the JCC in 1978 and the reactions to them by both Participating Countries and Contributing parties during the nexE session. It was suggested that the World Bank should arrange a pledging meeting some time in 1979. The Independent Chairman confiraed that at least a preliminary discussion of second-stage financing would be held at the JCCts fifth session. 13. SELECTION OF THE INDEPENDENT CHAIRITAN: Agenda irer 12 13.1 The ConrniEtee held a restricted meeting, under Ehe chairmanship of the Vice-Chairman to discuss the selection of the Independent Chairman. 13.2 On the resumPtion of the JCCts regular meeting, the Vice-Chairman announced that the Cormnittee had decided unanlmously to select Dr M. G. Candau, Director-General Emeritus of the World Healch Organization and Independent Chairman of the JCC since its first session in 24- February 1975, to serve for a further period. The conrnittee thanked Dr candau for hisinvaluable services in the Past and expressed its gratification that he vias prepared to servefor a further term. In repIy, Dr Candau thanked the conmitEee for its continued confidencein him. L4. OTHER },IATTERS Agenda itern 13 fifth session of the JCCArraneement s for the L4'l The committee accepted with gratitude the invitaEion of the Government of Togo to holdits fifth session in Lom6 in early December 1978, the precise date to be arranged by the rndependent chairman in consultation with the Government. Because a heavy agenda wasanticiPated, and in the light of the Committeers earlier decision to devote a whore day toquestions related to socioeconomic development, it was agreed that four days should be providedfor the session. Documentat ion 14.2 A representati-ve observed that many documents were distributed together in the weeks before the JCC's sessions, some of them rel-ating to meetings held six months or more earlier. It was suggested that reports of advisory meetings should be sent out as soon as they were ready, to enable countries to keep abreast of developments and to allow time for reading and circulation to National Onchocerciasis Cornrnittees before sessions. If full reports Trere available only for the JCC, at least minutes could be circulated in advance. Another representative stressed the value of Oncho Flash and the OCP quarterly reports, whi.ch he consi.dered should be distributed regularly and promptly. 14.3 The Independent Chairman pointed out that the reports of the JCCts statutory bodies had to go through established channels and then to the Steering Comittee. The Steering Qomnittee could be asked to forward reporEs to him as soon as possible for translation, reproduction and distribution. He observed that all but one of the documents for the fourth session had been distributed in advance of the statutory requirements. Fi 1ms L4.4 A representative proposed that a copy of each film made on OCP should be supplied to each member country, to enable them to keep their own public informed. Film makers should only be permitted to make films if they promised to provide the necessary copies. The WHO represenLative said thaE it would not be feasible to give a copy to each count.ry; however, a national showing of each film could be arranged. Contributing Parties L4.5 A representative observed that the list of contributors to OCP had remained unchanged for some time. Financing rqould be particularly important to fund possible exEensions to the Programme area and to plan for the second stage starting in 198O. Some Arab countries might be able to help, and he wondered if enough had been done to acquaint them with OCPts work. 14.6 The LIoTIC Bank represeatative agreed that it would be useful to find new contributors. The Bank would renew its efforts in that direction, and would welcome representativest support and suggestions. 15. CLOSURE OF THE FOURTH SESSION: Agenda item 14 15.1 The Independent Chainnan expressed his gratitude to the Vice-Chairman for his support during the session and to the Government of Kuwait for its ouEstanding hospitality and the excellent facilities it had provided. He thanked all the participants for their cooperation in the exercise of his functions. _25_ 15.2 Ttre Vice-Chairman said that the JCCrs session had enabled hi-n to gain a closer under- standing of the working of internatlonal cooperation and brotherhood through the Programme. KuvaiE itself had known poverty as recently as 20 years ago, and it welcomed the opportunity to join other countries, however far apart geographically, in working for human bettement. 15.3 The Independent Chairman thanked the Vice-Chalrman for his inspiring words. declared the fourth sesslon of the JCC closed. He then 16. EXCIJRSIONS ARRANGED BY THE GOVERNMENT OF KTIWAIT 16.1 On Wednesday 7 Decenber, at the invitation of the host Government, participants visited desalination and petrochemlcal plants at the Shuaibah industrial area and the oi1 installations at Ahmadi. Particlpants also had an opportunity to visit the Kuwait Towers. -26- ANNEX 1 ONCHOCERCIASIS CONTROL PROGRAI''ME IN TIIE VOLTA RIVER BASIN AREA JOINT COORDINATING COMMITTEE Fourth session Kuwait, 5-7 December 1977 JCC4.L I 2 3 4 5 6 AGENDA Opening of the session Election of the Vice-Chairnan of the session Adoption of the agenda Progress Report of the World Health Organization for L977 Annual Report of the scientific and Technical Advisory comrnlttee Study of the geographical extension of the Programe area requested by the Governments of Benin, Ghana, Ivory Coast, Mali and Togo Report of the Ecological panel Annual Report of the Chairman of the Economic Development Advisory panel Socioeconomic development aspects of the programe Review of the Plan of Action and Budget of the prograume for L97g r Financing of the onchocerciasis control programre Selection of the Independent Chairman Other matters Closure of the fourth session 7. 8. 9. 10. 11. L2. 13. L4. 27- JOINT COORDINATING COMMITTEE Kuwait 5-7 Decenbet 1977 LIST OF PARTICIPANTS Dr M.G. Candau Independent Chairman Joint Coordinating Committee (JCC) PARTIC IPATING GOVERNMEX{TS People's Bepublic of Benin Son Excellence Monsieur Issifou Bouraima Ministre de Ia Sant6 publique Ur Nicolas Ahouansou Conseiller permanent du Projet D6veloppement 6conomique des Zones tib6r6es de I'Onchocercose Ministdre du Plan, de Ia Statistique et de Ia Coordlnation des Aides ext6ri.eures Ghana ColoneI Dr J.B.B. Asafu-Adjaye Executive Director National Onchocerciasis Secretariat Ministry of Economic Planning Dr K. Ward-Brew A.G. Deputy Director of Medical Services Ministry of Hea1th Mr N.S. Belo-Giwa Secretary National Onchocerciasis Committee National Onchocerci.asis Secretariat Ministry of Economic Planning Ivory Coast Dr I. Kone Directeur des Relati.ons r6gionales et internationales MinistBre de Ia Sant6 publique, de Ia Population et des Affaires sociales MaIi Son Excellence Monsieur Mamadi. Keita Ministre de la Sant6 publique et des Affaires sociales MinistBre de Ia Sant6 publique et des Affaires sociaLes Dr Souleymane Sow Mideci-n-Chef du Service des Grandes End6miesDivislon de 1a M6deci.ne socj.o-pr6ventive et des Maladies transmissibles Ministdre de la Sant6 publique et des Affaires sociales ANNEX 2 28- Annex 2 Mr Ousmane Niar6 Ing6nj-eur des Travaux agricoles Direction nationale de lrAgriculture Minist6re du D6veloppement rural Niger Dr Ibrahim Alfa Ciss6 Dj-recteur Hygi6ne et M6decine mobile Ministbre de la Sant6 publique et des Affaires sociafes Mr Boukari Yonli Chef du Secteur Infrastructures et programmes sociaux IVIini st 6re du Pt an Togo Dr Ad;ete Prince Agbod;an M6decin Chef du Service de.s Grandes End6mies du Togo Ministdre de ra Sant6 publique, des Affaires sociares et de fa promotion feminrne Upper VoIta Son Excelfence Monsieur Tinga Douamba Ministre de Ia Sant6 publique et des Affaires sociales vice-Pr6sident du comit6 national de Lutte contre r'onchocercose Mr Sim6on Sorgho Directeur g6n6raI et Secr6talre permanent du Comit6 national voltaique de Lutte contre I rOnchocercose Autorite des Am6nagements des VaIl6es des Voltas CONTRIBUTING PARTIES 4frican Development Bank (ADB ) Be I gium Mrs Suzanne Vervalcke Drrecteur d'Admrnistration, Direction de la coop6ration multilati'ra1e MinistEre des Affaires etrangEres, du Commerce ext6rieur et de Ia Cooperation au Di'veloppement Canada Dr Paul Ladouceur Sectj-on Chief, UN Programmes Dlvision Canadian Internatlonal Development Agency -ro- Annex 2 Mr Ian Lindsay Scientific Adviser, Research Establishment, Ottawa Mr Michel Roy First Secretary Canadian International Development Agency Office of the Embassy of Canada in Ouagadougou, Upper Volta Federal Republic of Ge rmany Dr Wilfried hrlst Federal Ministry for Economic Cooperation France Ivlr R. Thi I Sous-Directeur des Affaires financidres et g6n6rafes i la Direction de la Coop6ration culturelle et technique Minist6re de Ia Coop6ration Dr H. H61ils charg6 de Mission, Direction de ta sant6 publique et de I'Action sociare Ministbre de Ia Coop6ration Japan Mr Koichi Mukai First Secretary, Embassy of Japan in Kuwalt Kuwai t His Bxcellency Dr Abdel Rahman AI-Awadhi Mini-ster of Public Health Dr Galal Amin Economic Adviser, Kuwait Fund for Arab Economic Development Dr Gafar Ezzat Head of Department of Preventive Medicine, Ministry of public Health Dr Talaat Zaghloul Entomologj-st, Ministry of Public Health Dr Yahia Hamdan Ophthalmologist, Head of Eye Unit, Ministry of hrblic Health The Netherlands His Excellency Mr H.E.G.W. Bendien Ambassador of the Netherlands in Kuwait Mr Jacques Van Hellenberg Hubar Second Secretary, RoyaI Netherfands Embassy in Kuwait 30 Annex 2 Mr W.D. Maniece Ass istant-Secretary Ministry of Overseas Development Dr M. Baker Medical Adviser Mi-nistry of Overseas Development Dr P.T. Haskell Chief Adviser on Pest Management l\4inistry of Overseas Development United States of America Mr E. Dennis Conroy Director, Office of Regional Affairs Bureau for Africa Agency for International Development Dr Joe L. Stockard Tropical Medicine Specialist Office of Health Bureau for Technical Assistance Agency for International Development SPONSORING AGENCIES Food and Agriculture Organization of the United Nations (FAO) Mr T.S.B. Aribisala Director, Agricultural Services Division Mr C.G. Groom Senior Officer, PoIicy and Planning Unit Agricultural Services Division FAO Technical Secretariat to Steering Committee World Bank (IBRD) Mr Andri' Gu6 Director, Programmes I Wcstern Africa Region Mr Stephen Denning Division Chief, Programmes I Western Africa Region Mr Hjalte Sederlof Loan Officer, Programmes I Western Africa Region United Kingdom -31 - Annex 2 United Nations Development Programme (UNDP) Mr Salif N'Diaye Chief of the Division for Regional Projects Regional Bureau for Africa WorId Heatth Organization (WHO) Mr Marc Ls. Bazin Director of the Onchocerciasis Control Programme WHO Secretariat Dr T. Lepes Director, Divi-slon of Malaria and Other Parasitic Diseases, WHO HQ Dr J.A. Mahoney Director, Disease Control and Environmental Health Regional Office for Africa Dr F. Grant Medical Officer Onchocerciasis Control Programme, Regionat Office for Africa Dr C.-H. Vignes Chief, Constituti-onal and LegaI Matters, WHO HQ Dr R. Le Berre Chief, Vector Control Unit, Onchocerciasis Control Programme Dr D. Carney Chief, Economic Development Unit, Onchocerciasis Control programme Mr R.C. Helmholz Chief , Administrative Services, Onchocerciasis Control programme Dr A.M.E. Prost Epidemiologist, Onchocerciasis Control Programme Mr J.D.M. Marr Entomologist/Aiofogist, Onchocerciasis Control programme Mr J.F. WaIsh Scientist, Onchocerciasis Control Programme Miss M. Desbois Administrative Officer, Onchocerciasis Control prograrune Mi.ss R. Villars Administrative Officer, Onchocerciasi.s Control programme 32 Annex 2 EX OFFICIO PARTICIPANTS Mr Wilfrid de Souza Representative of the Economic Development Advisory panel OBSERVERS Guinea Dr Gabriel SuItan Directeur national des Services de Pr6vention Ministbre de La Sant6 Nigeria Dr Emmanuel Ademola Smith A.G. Director of Public Health Services Federal Ministry of Health Dr Akanni Olufomi Olakunle Sorungbe Consultant Epidemiologist Federal Ministry of Health Senegal Dr Alassane M'Baye Directeur adjoi-nt de Ia Sant6 publique Mirdecin Chef du Servicc des Grandes End6mies Minist6re de la Santi'publique et de liAction sociale de la Rdpublique du Scni'gal Organisation de Coordrnation et de Coop6ration pour Ia Lutte contre Ies Grandcs Endi'mies (OCCGE ) Dr Cheick Sow Secri'ta r re g('nf'ra I Officc de la Recherche scientifj-que et technique Outre-Mer (ORSTOM) Dr Jean Mouchet Inspecteur gi'nr':ra I Directeur des Services scientifiques centraux 33- AIIMX 3 OPENING ADDRESS by His Excellency Dr Abdel Rahman Al-Awadhi Minister of Health, Kuwait Mr Chairman, distinguished delegates, It gives me Sreat pleasure to welcome you to Ehe fourth session of the Joint Coordinating Comnittee of the Onchocerciasis Control Prograrune in the Volta River Basin Area. May I exPress my gratitude for your presence and participation in this meeting, and extend to you our best wishes for a pleasant stay in Kuwait and our hopes for the success of such an important funcEion. Ladies and gentlemen, The aim of extending the invitation to hold the meeting of the Joint Coordinating Cornnittee for the first time in Kuwait was in fact to confirm the strong feeling of solidariEy and cooperation between Kuwait and the rest of Ehe world for the benefit of humanity and the Protection of man againsE devastating diseases in general and for the protection of the inhabitants of the Volta River Basin area from onchocerciasis in particular. IE is worth noting here that the great concern shown by Ehe SEate of Kuwait in contri-buting to this Progranrne stems from the firm belief adopted by Kuwait that she should extend all possible assistance that could contribute Eo the greater happiness and welfare of man everywhere. And this was the main motivation for the participation of Kuwait in this Prograrnrne and for inviting the Joint Coordinating CommitEee to hold its fourth session here in Kuwait in spite of the fact that Kuwait falls outside the area affected by the disease. This indeed should give our meeting here today a new significance in which it differs from previous meeEings. During the past few years there have been conrnendable and concerted efforts Eo acquainE the international public opinion of this Progranrne through the various means of publiciEy and mass media. Nevertheless I sti11 feel that there is scope for increasing our efforts in thisfield. This is another purpose which could be fu1filled by holding the JCC meeting rhis yearin Kuwait, which constitutes a new opportunity for acquainting a wider public of the noble aims of this Programme and of the success which has been achieved so far, especially in thispart of the world. It will also allow for the opporEunity for urging new contribuEors tojoin the countries and organizations which have already contributed to the programne. I would also like to mention that to hold this meeting in Kuwait should be taken as a new confirmation of the strong ties of friendship and solidarity between the African and Arab nations, and of Kuwaitrs support and comrnitment to this Prograrmne. I would also like to add in this connexion that Kuwait as part of the larger Arab nation is particularly keen that this Progranrne should achieve the highest degree of success not only because of its noble humani- tarian and economic objectives of which we are a1l aware but also because some Arab countries are Ehemselves affected by the disease. And I sincerely hope that Ehe success of the Progranrne in Western Africa will lead to its extension to cover other parts of the world including those parts of Arab countries. Mr Chairman, distinguished delegates, allow me to take this opportuni-ty to pay our highest tribute Eo those people working in the field. I indeed regret Ehat I cannot single them out individually but. I want to st.ress our great appreciation of their devotion to the work in their various fields, and to commend their contribution to this most difficulE under taking. 34- Annex 3 I am not going, at this point, to speak at any length on the technicalities of the Progranrne or on the progress achieved so far, but I would like here, on behalf of the Kuwait Government, to say how impressed we are with the progress made so far under the able leader- ship of Dr Candau, the Independent Chairman of this Cormnittee. We have noted with interest the strides made in research, covering the ecology of the blackfly vector, the clinical atd ophthalmological aspects of the disease and the testing of alternative insecticides towards the destruction of the fly. As we all realize, this is the vital ground work for the future success in controlling the disease. May I end by expressing my hope that the next tiTo years which are the last two years of the first stage of this Prograrmne will witness a similar success to that achieved during the past four years since its inception in 1974. In fact this Progranrne which brings together such a large number of countries and international organizations should be seen as an example of international cooperation in combating a coflrmon problem, with no other moti.ve than the alleviation of human suffering and improving the lot of millions of people. It is with the hope to see this cooperation further strengthened, and to see more countries and organizations joining us in this effort, that I wish you every success in y deliberations. Jut -35- ANNEX 4 ONCHOCERCIASIS CONTROL PROGRA}'ME IN THE VOLTA RIVER BASIN AREA JOINT COORDINATING COMMITTEE Fourth session Kuwait, 5-7 Decembet 1977 MESSAGE OF DR H. MAHLER, DTRECTOR-GENERAL WORLD HEALTH ORGANIZATION It is for me a matter of sincere regret that I have been unable so far to attend a session of the Joint Coordinating Comnittee of the Onchocerciasis Control Prograrutre and address personally the representatives of governments and agencies participating in this unique endeavour. I deplore it all the more as this session will tackle issues of crucial importance for the future of the Prograrnme, that is, for the ultimate welfare and productivity of the people in Ehe area concerned. The fact that the sesslon is being held in Kuwait, at the generous invitation of the Government of this country, with the participation of many countries and agencies from various regions of the world, symbolically dernonstrates that in our time a situation such as the one created by onchocerciasis in the VolEa River Basin can be effectively dealt with only through concerted efforts on a broader than regional sca1e. The Prograrune will in turn generate through its health, social and economlc outputs an important fall-out of findings and experience which will prove, I am sure, of much wider than regional significance. I have fotlowed closely E.he developnent of the Programe since I assumed directorship of its Executing Agency. I feel deeply comitted to its ultimate success for the disease- stricken peoples in the area, for the governments of the seven nations who are placing so much hope in it and giving it so much genuine support, for the governments and agencies - inside and outside the African Region - who have generously agreed to bind themselves to long-term technical and financial contributions. The Progranmre forms part of the activities of WHO in its African Region. I know that. the WHO Regional Director, Dr Comlan A. A. Quenum, is as conmitted as I am to its success andgives it his constant and personal attention. We are both confidenE that the Prograrrne Director, Mr Marc Ls. Bazin, who shoulders thedirecE heavy responsibility of operating the Progranrne, will ensure its technical efficlency and sound administrative and financial management with a view to achieving optimal cost/ effectiveness ratios. I do not wish to expand on specific aspects of the Prograuuoe, however important I consider them, because I believe that the Prograrme Director and his staff will do so much betEer, withtheir first-hand knowledge and direct operational responsibility for the progranrme. They will at all events be speaking for Dr Quenum and for rnyself. This Progranrne has indeed inaugurated a new type of international cooperation founded onthe intimate association of Ehe participating countries and the Executing Agency, on theinvolvement of the scientlfic and technical conmunity at 1arge, on a closer interrelationship between the global, regional and naEional levels of responsibility, each level playing its Proper role in suPPort of field activities. The results so far achieved are so encouragingthat the model is already being reproduced in other technical cooperation progranmes, such as Ehe Special Progranrne for Research and rraining in Tropical Diseases. 36- Annex 4 The Programme staff has displayed, under often difficult field conditions, remarkabletechnical efficiency and unfailing devotion to, and enthusiasm for, their work. TheScientific and Technical Advisory Cormit.tee, the Scientific Advisory panel and its workinggrouPs and the Ecological Panel have provided the Executing Agency with invaluable advice and,perhaps even more importantly, with the continuous independent assessment of activities itdemands. The climate in the Steering Comlittee has constantly been one of true constructivepartnership. This spirit of cooperation which, I know, also pervades the deliberations of the JointCoordinating Comnittee, is a constant encouragement for the Executing Agency in the disch4rge of its heavy responsibilities. For this, I wish to extend to all representatives of theparties participating in the Programne my r^Tarmest thanks, together with my confident hopeithat this session of the Joint Coordinating Conrnittee will mark a further successful step in our comnon endeavour. -37- A}TNEX 5 ADDRESS BY THE INDEPENDENT CHAIRMAN Your Excellency the Minister of Health of Kuwait, Members of the Joint Coordinating Comittee, Your Excellencies, Ladies and Gentlemen, Atlow me, Excellency, in ny capacity as Independent Chairman, to express our appreciation of the honour you are doing us by presiding over this inaugural meeting of the fourth session of the Joint Coordinating Comittee of the Onchocerciasis Control Programe in the Volta River Basin Area. The interest that your Government takes in this Programe is a source of encouragement to all of us. It is in response to your countryrs invitation that we are meeting today in this most impressive city of Kuwait, and I know that I am expressing the feelings of all of us here when I ask you to accept our thanks and Eo convey to your Government our gratitude for the generous hospitality extended to the Conrmittee. The year of L977 witnessed a significant step in the life of the Prograume: this was the exEension of spraying operations to the entire Prograrme area as established in the 1973 report of the Preparatory Assistance Mission to the Governments of the seven Participating Countries. VecEor control operati-ons by aerial treatment with insecticide now cover some 14 OOO kn of watercourses that drain the 7OO OOO km2 of land embraced by the Prograrmre. I believe it is true Eo say that this difficult and ambitious Programre has developed according to the original Plan of Operation in a very reasonable span of time. Many other examples of the progress made could be mentioned, such as Ehe completion of the first round of prelininary epidemiological evaluation, the coming into operation of the Chemotherapeutic Research Centre at Tamale in Ghana, the field trials of an alternative insecticide, and the study carried out on the reinvasion of the Prograrme area by female blackflies. The experience of the first four years of operations and the resulEs obtained, together wiEh the knowledge acquired concerning the disease and its vector, give us reason to believe that the onchocerciasis control activities are progressing well and that the social and economi.c development of the areas liberated from the disease - the real objective of the Programne - will rapidly gain momentum. As in previous years, I recently visited the seven Participating Countries for discussions with each Government on the developnent of Programme activities and for an exchange of views on the agenda for our present session. I was able at the same time to visit Progranme Headquarters and obtain first-hand information on the workrs progress. First of all, I found that the general reaction in all Participating Countries is Ehat the Prograurme is progressing smoothly, in accordance with the time-table established in the Plan of Operations, and that the results are in general good. In several countries I was invited to aEtend meetings of the National Onchocerciasis Control Comnittees, which play a very important role in the coordination of the Prograrune at the government leve1. It was the general feeling that the first joint meeting of these national corrnittees, held in Abidjan in June of this year, provided an excellent and unique opportunity for a frank discussion of matters of concern to all Participating Countries. The need for information materials such as films, pamphlets, IIONCHO FLASHT'and the Progranmers quarterly reports was emphasj-zed at all the meetings in which I took part. Several countries Eook the opportunity of my visit to discuss the extension of the area of the Prograrune. This is a matter of concern and great interest to a number of these count.ries. As you will recall, the question was discussed at the third session of the JCC last year in Ouagadougou, although no decision on the principle of extension was taken at that stage, a 38- Annex 5 request was made for a study to determine how other infested zones outside the present boundaries could be included in the Prograrmne area. It was emphasized that the extension should be judged on its own merits, whether entomological or economic; if extension to a1l onchocerciasis areas in the Participating Countries was impracticable, at least all areas which constituted possible sources of reinvading flies, and areas scheduled for development, should be included. This study is now before the Comittee and will be discussed under agenda itern 6. It is hoped that an agreement can be achieved on the principle of extension and also its financing. The problem of extension to include areas in neighbouring countrles which constitute known sources of blackflies that are reinvading the present Prograrmne area is another question that deserves consideration and study. Looking forward into the future, I should like to make a few additional remarks At its last session, in September of this year, the Steering Coumittee concluded that the rrSponsoring Agencies should field a high leve1 mission to carry out a comprehensive review of the Onchocerciasis Control Prograrune in order to lay a proper basis for the next six years phase of the Programmerr. I belleve that this decision is very timely. There can be no doubt of the value of an analysis of Ehe present siEuation, a study of the results so far achieved and the knowledge and experience acquired in the control of the vector and of the disease, and review of the information available on action and plans for socioeconomic development of the areas liberated from onchocerciasis, when compared with the baseline data contained in the PAG report of 1973. The results of this re-examination will be of great importance for the discussions to be held and decisions to be taken by the JCC at its fift.h session, next year, on the future development of the Progrannne. Furthermore, if the Prograrme is going to be a real success, we have to look for knowledge to solve old problems and prevent ner., ones from arising. We need, for inst.ance, to have an alternaEive insecticide available to replace Abate if and when necessaryl Eo intensify taxonomic and ecological studies in order to learn more about the distribution, the season4l variat.ion and the epidemiological role of the different spe cies of the Simulium damnosum complex, and Eo acquire a better understanding of the behaviour of the invading adult flies, including their migratory movements and resting sites; to stimulate the study of existing drugs and Ehe finding of new ones for the treatment of onchocerciasis that will be effecti and suitable for mass therapy. Certainly, a stil1 greater research effort has to be made, and we count on the generous and invaluable cooperation of the international scientific cormnunity to find the ansh,er to many of the problems we are facing today. Of the numerous tasks to be undertaken for the social and economic development of thei areas liberated, or to be liberated, from onchocerciasis, one of the most important is thei establishment of an appropriate health infrastructure. This should be specifically adapt{d Eo the rural conditions of the countries concerned; that is to say, it should be simple, Practical and effective, with prevention as the first priority. Here I should like to stfess that the local population should be associated in the process of improving its own health i conditions. I realize that no doubt there will be other important parasitic diseases that may have to be dealt with by special campaigns, but this does not replace the need for a Permanent health infrastructure. It is difficult to imagine how the hurnan, social and economic development of a region can be started and make worthwhile progress when nutritional deficiencies and disease are rife. Indeed, for rational developmenL we need to give priority to the whole question of education of the people so that they can participate fully and consciously in all phases of socioeconomic development. ,l ve The Onchocerciasis Control Prograrune in the Volta River Basin Area has proved iEself an excellent example of international cooperation for development. The results so far obtained justify our belief that we should persist in our efforts to attain the goals set the Progra[trne rdas conceived. 4s I Ighen t' -39- Annex 5 Excellency, allow me in conclusi.on, to reiterate our thanks to you for presiding over this inaugural meeting and to assure you that your presence and the continuing support of your Government are a great incentive to all concerned to continue the fight for the final success of our Prograrmle. I should like also to express my thanks to Mr Abdlatif Al-Hanad, the Director-General of the Kuwait Fund for Arab Econouic Development, and his staff for their precious help and the facilities they have provided for the holding of this session. May I also be allowed to thank the authorities, the observers and guests who have honoured this inaugural meeting with their presence. * t