(WPR/RC19/sR/2 )
SUMMARY RECORD OF THE SECOND MEEl'ING WHO Conference Hall Wednesday. 2 October 1968 at 9.00 a.m. CP.AlRMAN: Dr
C.S. Gatmaitan (Philippines) CONl'ENI'S
1
Address by incoming Chairman ......................................
135 1.36 136 137 138
2
Adoption of the Agenda ........................................
3 4
statement by the Chairman of the Technical Discussions ••• statement by the Regional Director
....................................
5
Establishment of the Sub-Committee on Programme and Budget
6
Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities 138 Report of the Regional Director •••••••••••••••••••••••••• 138
7
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1:32
REGIONAL COMMITI'EE: NINETEENTH SESSION
SECOND MEmING
Wednesday, 2 October 1968 at 9.00. a.m. PRESENT
I.
£l.epresentatives of' ME"..!llber States AUSTRALIA Dr H.M. Franklands
~
~
Mr Tore Lokoloko Dr R.F.R. Scragg Mr P.A. Jackson
Dr R.H. MacDonald CAMBODIA CHINA. Dr Thor Peng Thong Dr C.K. Chang Dr Y.T. Wang
•
Dr L.P. Chow FRANCE JAPAN Medecin-General J. Rondet Dr T. Muranaka Mr K. Watanabe Mr N. Maekawa
Mr Y. Masuko LAOS MALAYSIA Dr Tiao Jaisvasd Visouthiphongs
Tan Sri (Dr) Mohamed Din bin Ahmad Dr Chong Chun Hian Dr Fang Ung Seng Dr K.S. Jap Dr C.N.D. Ta\y"lor Dr C.S. Gatmaitan
>.~
NEW ZEALAND
PHILIPPINES
J. J. G. E. F. J. V. Mr T. POR'lUGAL
Dr Dr Dr Dr Dr Dr Mr
Dizon Navarro Balbin Perez Nepomuceno Sumpaico Flores Carreon
-'
Dr N.C. de Andrade ~
SUMMARY RECORD OF THE SECOND MEETING
133
REPUBLIC OF KOREA
Mr Sang Yung Soh Dr K. S •. Chang Mr Lye Thim Fatt Dr P.H. Teng Dr C.H. Gurd Dr R. K. C. Lee Dr J. K. Shafer Dr H. DeLien Dr LEl
SINGAPORE UNITED KINGDOM
UNITED STATES OF AMERICA
~ VIET-NAM
Nhan
Thuan
WESTERN SAMOA
Mr Luam.a.nuvae Eti
II.
Representatives of the United Nations and Specialized Agencies UNITED NATIONS DEVELOPMENT PROGRAMME
Mr G. Hamdy
III. Representatives of other intergovernmental organizations INTERNATIOlfAL COMMl'I'orEE OF MILITARY MEDICINE AND PHARMACY SOUTH PACIFIC COMMISSION Colonel P.J. Barcelona, Me
Dr A. Guinea
,.
rv . .c
Representatives
O!~~B-~overnmental
organizations Mr J. E. Nifialga
INTERNATIONAL UNION OF ARCHITECTS $
INTERNATIONAL DENTAL FEDERATION INTERNATIONAL UNION :roR HEALTH EDUCATION MEDICAL WOMEN'S INTERNATIONAL ASSOCIATIOlf INTERNATIONAL COMMITTEE OF CATHOLIC NURSES
Dr F. Rojas
Miss C. del Rosario
Dr Fe del Mundo
Mrs M. Ordonez
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";/
'.
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REGIONAL COMMITl'EE: NINEI'EENI'H SESSION
WORLD FEDERATION OF
Mrs
C. M.
Abad
OCCUPAT:-()NAL THERAPISTS INTERNATIONAL PLANNED PARENTHOOD FEDERATION
Professor D. Chun Dr H.M.C. Poortman
V.
Observers RYUKYU ISLANDS Captain D.A. Sebahar
VI.
WHO Secretariat DIRECTOR-GENERAL SECRETARY Dr M.G. Candau
Dr Francisco J. Dy Regional Director
...
SUMMARy RECORD OF lliE SECOND MEETING
The CHAIRMAN welcomed l-1edecin-General Rondet, Representative of France. Medecin-General RONDET (France) apologized for his delayed arrival \m.ich was due to a sudden change in airline schedule. both to him and the country he represented. 1 ADDRESS BY INCOMING CHAIRMAN: Item 6 of the Provisional Agenda He thanked the Commi ttee for having elected him as Vice-Chairman Hhich was an honour
-.
The CHAIRMAN stated that health conditions in most countries had improved during the last two decades. In the more developed and This advanced countries, communicable diseases and diseases related to poor environmental sanitation \'lere in their final stages of control. several factors: health progress was attributed by people in the public health field to the existence of well-functioning health departments with adequate and well-equipped health and medical facilities; a sufficient number of trained health, medical and paramedical personnel; improved environmental sanitation and a health-minded and educated citizenry. In the Regional Director's Report, it Has mentioned that health conditions in the developing and underdeveloped countries had changed very little. Many governments were still faced with the problem of combatting a high incidence of communicable diseases. Improved communications had brought countries closer together. This meant economic and educational progress for the peoples concerned. However, epidemiologically speaking, this might also result in the spread or introduction of communicable disease from one country to another. He suggested that the various epidemiological methods for the identification of the means of spread and. the control or eradication of communicable disease in the Region should be reviewed jointly by countries, and that governments, leaders, health administrators, and others should analyze whether they had done their share in
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REGIONAL COMMITTEE: NINEl'EENTH SESSION
improving the state of health and sanitation in accordance with the standards set by WHO. This would mean making an inventory of the nUlilber of properly equipped health and medical facilities, such as rural health units, dispensaries, health centres, hospitals and medical centres; of the number of staff that medical, nursing, paramedical and post-graduate schools could turn out yearly for preventive and curative work; of determining whether sufficient funds had been allocated to sanitation, nutrition and the various fields of health. All these and other questions could be summed up in three words - national health planning, which was the subject of this session's technical discussions. The Chairman hoped that representatives would actively partiCipate in the deliberations and share their experiences, knowledge and methods so that the task of health building in the Region might be successfully accomplished. The agenda of the meeting \~as
\'1611 balanced and he hoped
that the discussions would be fruitful and successful. 2 ADOPTION OF THE AGENDA: Item (Document WPR/RC19/1 Rev.l)
7 of the Provisional Agenda
Dr F'RANKIJU"l])S (Australia) r:toved and Dr TAYLOR (New Zealand) seconded the adoption of the agenda. Decision: In the absence of any comments, the agenda was adopted.
3
STATEMENT BY THE CHAIRMAN OF THE TECHNICAL DISCUSSIONS: Item 8 of the Agenda The CHAIRMAN announced that, in accordance with the resolution
adopted by the Regional Committee at its eleventh session, the Chairman of the technical discussions was selected by the Regional Director, in consultation with the Chairman of the Regional Committee. Tan Sri (Dr) Mohamed Din bin Ahmad, Director of Medical Services (West Malaysia) and Permanent Secretary, Ministry of Health. Malaysia. had been selected to serve in this capacity.
.-
SUMMARY RECORD OF THE SECOND MEETING
137
The Chairman then invited Dr Din to speak. Dr DIN (Malaysia) informed the Committee of the arrangements made for the technical discussions, the topic of which was "Health Planning as an Administrative Tooll!. sions". The purpose of the discussion was outlined in document WPR/RC19/TD5 entitled "Guidelines for the Technical DiscusFour working papers had been distributed. To facilitate the discussions, the participants would be divided into three groups, t\'IO of which would be English-speaking; the third would be in French and English. interpretation facilities. There would be three sessions in all: the afternoon of Friday, 4 October, \'lhich would consist of a plenary meeting followed by group meetings; Saturday morning, 5 October, continuation of the group meetings; and Monday morning, 7 October, when the draft report of the technical discussions would be discussed in a second plenary meeting. Dr
The last group would be provided with
Arne Barkhuus, formerly Chief of the National Health Planning
Unit at 1.rffiO Headquarters and now a \'ffiO consultant, and Dr Hernan Duran, Chief of the Training Division, Pan American Program for Health Planning, Pan American Health Organization, would speak at the first plenary session. (For consideration of the report of the technical discussions. see the sixth meeting, section 3.) 4 STATEMENT BY THE REGIONAL DIRECTOR The REGIONAL DIRECTOR thanked the Representatives for the kind remarks they had made about him during the celebration of the Twentieth Anniversary of WHO. He was fortunate to have a competent staff both in the Regional Office and in the field, and they all worked as a team. He was also fortunate to be associated with governments whose understanding made the work pleasant and rewarding. the health of all peoples. He looked forward to continued co-operation with governments in their partnership to improve
138
REGIONAL COMMI'l'l'EE: NINEl'EENTH SESSION
5
ESTABLISHMENT OF THE SUB-COMMI'l'l'EE ON PROGRAMME AND BUDGEI': Item 9.1 of the Agenda In accordance with the principle of rotation, it was agreed that
the membership should be composed of the Representatives of Cambodia, France, Laos, Malaysia. Philippines. Portugal. Singapore. the United States of America and Western Samoa. It was also agreed that the SubCommittee would meet at 2.30 p.m. on Thursday. 3 October. and that a further meeting would be held on the afternoon of Monday. 7 October. to review the draft report of the Sub-Committee. (For consideration of the report of the Sub-Committee. see the sixth meeting. section
5.)
,..
6
ACKNCMLEDGEMENT BY THE CHAIRMAN OF BRIEF REPORTS RECEIVED FR0r<l GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIES: Item 10 of the Agenda The CHAIRMAN acknowledged reports received from governments on
the progress of health activities in the following countries and territories: ~acao.
Australia, Cambodia. China. Hong Kong. Japan, Laos, In addition.
Malaysia. New Caledonia and its Dependencies, New Zealand,
Philippines. Republic of Korea, Timor and Western Samoa.
the Government of Japan had submitted "A Brief Report on Public Health Administration in Japan". covering the period from January 1967 to August 1968. (For further reports acknowledged. see the fourth and fifth meetings. section 1.) 7 REPORT OF THE REGIONAL DIRECTOR: Item 11 of the Agenda (Document WPR/RC19/3) The REGIONAL DIRECTOR. in introducing the Report, stated that in the field of communicable diseases control priority had been given to the fight against malaria. The malaria eradication programmes in Sabah and Sarawak had been strengthened as a result of the recommendations made by the WHO independent assessment teams which had visited these countries. Malaysia. A malaria eradication programme had started in West In Korea. the The administrative management and the operational practices
in the programme in the Philippines had been improved.
status and functions of the basic health services and their possible
SUMMARY RECORD OF THE SECOND MEETING
139
participation in the future malaria eradication programme were being assessed. As pointed out in the Report, the global strategy of malaria The Governments of Malaysia and the eradication was being re-examined.
Philippines had agreed to WHO's proposal that consultant teams might carry out studies in their countries. Although no cases of smallpox had been reported in the Region during the period under review, Cambodia and Laos were undertaking intensive smallpox vaccination campaigns. being produced in a number of countries. fello\-lships to train the staff concerned. Last year a fairly extensive focus of human schistosomiasis had been discovered in Laos. Cases had now been found in Cambodia. C~~bodia
Freeze-dried vaccine was WHO had provided consultants
to advise on the maintenance and operation of the production units and
A WHO team, conSisting of a paraSitologist and a malacologist, would carry out extensive surveys in and Laos later this year. In the filariasis control pilot project in Western Samoa mass drug distribution had resulted in a marked reduction in the microfilarial rate, in the average filarial count per infected person, and in infection rates in mosquitoes. BeG vaccination campaigns \~ere
being steadily expanded.
WHO
recommended that in countries where a BCG vaccination programme was indicated, at least 75% of the eliGible popUlation should be protected. This requirement had been met in the New Hebrides and Western Samoa. The effectiveness of direct BeG vaccination of infants and young children \~thout
preliminary testing had been demonstrated by the
increasing proportion of children under five years of age now being vaccinated. A programme of training in health planning had been established in collaboration with the University of the Philippines. The annual three-month course would consist of an introduction to the required basic disciplines (e.g., economics, public administration, demography, sociology), a theoretical presentation of the various aspects of planning (e.g., economic development, phYSical, social) with emphasis
•
,
140
REGIONAL COMMITI'EE: NINETEENTH SESSION
on national health and manpower planning, followed health planning.
by
field practice in
As a consequence of the interest shown in national health planning, renewed attention was being given to the integrated content and purpose of the communi ty health service in the hierarchy of the general health services. Various patterns for the organization of general health and
services and their delivery to the community were being evolved. Additional studies operational research were being undertaken in some countries so that the most rational use could be made of available resources in the field of health. The pattern for local health services development which had been tried out in a demonstration project in Korea tms now being extended to other provinces. In vlest Malaysia, 40% of the rural health units A WHO team originally scheduled for establishment had been completed.
had just completed an evaluation of what had been done and operational studies of local health services in districts were under consideration. In Laos, it had been decided to redefine and expand the coverage of assistance previously provided by WHO under the rural health development project. The new project had as its long-term objectives the strengthening of facilities for the training of health personnel and the development of health services at all levels, including the establishment of better co-ordination between special and general health programmes. the Vientiane Plain being built. In the New Hebrides, where the tuberculosis control programme had been so successful, a broadening of the project to cover the development of the basic health services was under study so that the achievements of this mass campaign would be maintained. In Western Samoa, the WHO public health team had already assessed the rural health services with particular attention to their actual activities. was under way. A reorganization of the Health Department In keeping with the Government's five-year and
development plan, the project's activities would be concentrated in in the area where the first large dam tms
SUMMARY RECORD OF THE SECOND MEETING
141
The health survey in the four riparian countries of the Lower Mekong Basin had been completed at the end of 1967. in the Mekong Committee Secretariat. One of the recommendations made by the team was the creation of a public health desk A vlHO public health administrator and a sanitary engineer "(Quld, therefore, be appointed to ensure that health reqUirements were given adequate attention throughout the planning and execution of all Mekong Committee projects, which would result in important movements of population. This team would operate in close co-operation \'lith the WHO representative in each country and through them with the national Mekong Committees and the health authorities. One of the concerns of the nursing and allied health professions in most countries of the Region had continued to be how to provide enough nursing and midwifery personnel to meet the needs of rapidly growing popUlations. In some countries, nursing skills were still being Nasted as a result of the poor utilization of nursing time, the rate of turnover of employed staff and the emigration of the best qualified nurses to other countries. were to be met. Nutritional problems in the Region mainly affected mothers and young children. gro,,~h
This situation would have to be
improved if the nursing requirements of the expanding health services
Frank malnutrition was sometimes seen.
A degree of
retardation was common, especially from six months to two The Regional Office's general approach to these problems
years of age.
was by nutrition education, through maternal and child health programmes and applied nutrition programmes which involved other agencies (FAO and UNICEF) and diSCiplines (education, agriculture and community development). There had been increasing contact with the World Food New Programme, whose resources had recently been greatly increased. being developed. The number of countries in the Region where family planning had been adopted as an official policy was increaSing. The importance of integrating family planning as well as maternal and child health
policies in favour of supplementary feeding for vulnerable groups were
142
REGIONAL COMMI'!'l'EE: NINE1'EENTH SESSION
services into the basic health services was understood, but in some countries this procedure was not being followed. which more attention \'lould have to be given. Activities in the field of environmental health had continued to expand. Important strides had been made in planning for sewerage and The United Nations the disposal of other wastes, in the control of environmental pollution and in establishing environmental health standards. Development Programme had approved Special Fund assistance to China (Taiwan) in connexion with a sewerage planning project for Taipei. This was the second major project in the Region which had qualified for this type of assistance. Despite all the efforts of governments there still existed a widespread shortage of medical and paramedical personnel. be one of the priorities in the regional programme. The strengthening of national training centres continued, therefore, to A major development during the period under review was the decision of the Government of Viet-Nam to set up a national institute of public health to train various categories of health workers. The United States of America ~lould
This was an area to
had pledged a contribution of one million US dollars and the Kingdom of the Netherlands had pledged 500 000 US dollars, which of which had already been received. project. Increased emphasis had been placed by the Regional Office on the need for evaluation of its programmes of assistance. outline had been prepared for plans of operation. A new This included be paid in five yearly installments of 100 000 US dollars each, the first He understood that some other countries were also considering making contributions to support this
built-in methods of evaluation which would permit the Organization to assess, in consultation with governments, the progress that was being made yearly and to determine whether the assistance being given should be continued, redefined or withdrawn. In closing, the Regional Director stated that he was fully aware that the work done by vntO in the Region represented only a small part of the efforts being made by all governments to improve the
SUMMARY RECORD OF THE SECOND MEETING
health of their peoples.
The problems facing the developing countries
were enormous but governments were showing an increasing capacity to absorb WHO assistance effectively. On the suggestion of the CHAIRMAN, the Report was discussed
section by section. Introduction (pages vii-xv)
Dr DIZON (Philippines) stated that he was particularly appreciative of the skill with which priorities had been established to meet the needs of Member countries. The problem of communicable disease control was The Philippine delegation noted with pleasure \~s
important and he was pleased to note that emphasis was being given to this aspect of the programme. that increased attention being b~ven
to evaluation.
Assistance must
be evaluated in terms of the problems and needs of a particular situation.
Dr THOR PENG THONG (Cambodia) was happy to note the progress being "
made and the fact that the activities being carried out by the Regional Office had become more numerous. solve many health problems. Dr LEE (United States of America) recalled that last year the Regional Director had discussed bankable projects for the funding community water supplies. of Reference was made in the Introduction to furthe~
His country had received a tremendous
amount of assistance from WHO and, as a result, it had been possible to
.. r-
assistance being given to governments in preparing bankable projects of this type and he would like to have information. He also asked if Western Samoa had been able to get support for its community water supply project from the Asian Development Bank. The REGIONAL DIRECTOR said that there were two projects in the Region financed under the Special Fund component of the United Nations Development Programme, the Development of a Master Plan for the Sewerage of Greater Manila Area (Philippines) and the Development of a Plan for
~
Sewerage in Taipei City.
He hoped that when these plans were developed,
further assistance could be given to the governments concerned in making
i44
REGIONAL COMMITl'EE: NINETEENTH SESSION
the projects bankable so that funds could be borrowed from external sources to carry them out. Assistance was being given to Western Samoa in develop:ing feasibility studies for a water supply programme. Dr FRANKLANDS (Australia) stated that he was particularly interested in the quarantinable diseases. He was pleased to note, therefore, that Any· the attention of governments cont:inued to be drawn to this problem. were endemic to countries free of them deserved support.
measures to prevent the spread of disease from countries in which they
Dr DIN (Malaysia) said that the Regional Office
had continued to
weigh and balance with great care the needs of countries in the Region, and at the same time had given full attention to those subjects of regional
interest.
He had noted that the Regional Director had made no reference
to health laboratory services in his introductory remarks and asked what priority would be given to this aspect of the programme in the future. The REGIONAL DIREaI'OR stated that for some time now it had been realized that communicable disease control programmes were very weak on the laboratory side. For this reason, a post of regional adviser in The health laboratory services had been included in the 1969 budget. when the new adviser assumed his post.
assistance which WHO could provide in this field would be strengthened
Dr TENG (United Kingdom) was particularly pleased to see that the Regional Office had appointed an adviser in the organization of medical care. This was one area which should always be kept under constant The other problem which had been emphasized The Regional Director should be review in view of the changing pattern of diseases - the long-term cases and the aging population.
was the health manpower requirement.
congratulated for having pin-pointed the problem of shortage of qualified teaching staff and also the "brain drain".
Dr LEE (United States of America) asked about the qualifications of the regional adviser in health laboratory services, because public health laboratory services in the Region must vary considerably.
SUMMARY RECORD OF THE SECOND MEETING
The REGIONAL DIRECTOR said that he had asked the Director-General to permit the Chief of Health Laboratory Services at WHO Headquarters to Join the regional office staff. would agree to this proposal. Dr CHOW (China) referred to the remarks made by the Regional j
He hoped that the Director-General
'-
Director in connexion with family planning. the Region.
He felt this ''las an
important area which was a growing health need in many countries in He hoped that with the assistance, guidance and encouragement of WHO, activities in this area could be strengthened and integrated with the general health services. Part I, section 1: Malaria (pages 3-11) ,,~as
Dr CHONG (Malaysia) stated that progress
being made in the
malaria eradication programme in Sarawak and, depending on the availability of funds, it was hoped to reach a version of the consolidation phase by 1972 or 1974. He stressed "version of the consolidation phase" because it would be a consolidation phase with a high maintenance cost as the country shared a long border with Indonesian Borneo, which had not yet started an eradication project. assisting in two specific respects: Recently, WHO had been by supporting the inter-country
co-ordination conference in Borneo, dUring which good relationships had been established with the Indonesian representative; and by the visit of the independent malaria assessment team. Follovang this visit, It had the Government had worked out a new strategy for eradication. would be reached by 1971. and
been hoped that if this could be followed, the consolidation phase It had been discovered, however, that the plans made were not practical, firstly because of shortage of funds, secondly, because it would involve the hiring of short-term workers. New plans had been This was not politically acceptable to the State.
made confirming the recommendations of the independent malaria assessment team but adapting them to the particular needs of the country. It was now hoped that a smaller number of people could be hired,
146
REGIONAL COMMITrEE: N:INErE£mrH
SESSI~,!.-_ _ _ _ __
-
trained and kept.
The budget would thus be smaller and there would be
greater state partioipation, so that the people in Sarawak would regard malaria eradication as their own work. Referring to the Regional Director's statement that the work of WHO represented only a portion of the many other health activities being carried out, Dr Chong said that his country had received generous aid from Great Brita.:!.n, Canaca, Australia, New Zealand and the United States of America. He wished to single out Canada since it had no There were presently twenty medical representative at the meeting.
students from Sarawak undertaking various types of training in Canada. five of them had already returned home and six of the trainees were natives of Sarawak. Speaking of WHO assistance in general. Dr Chong said that although Sarawak needed more aid, the amount it was presently receiving was about all that could be usefully absorbed. Counterparts were now available He hoped that WHO would for all WHO personnel assigned to his country.
make more use of the economic approach as this was particularly essential when obtaining the approval of his Government for the various projects that the health authorities in Sarawak hoped to undertake. who could be absorbed into the permanent service. The REGIONAL DIRECTOR referred to the national health planning course which had recently been started in Manila and which would be an annual event. The Organization fully appreciated the importance of health workers being able to speak the language of the economists and this aspect was \11e11 covered in the course. Dr ANDRADE (Portugal) stated that his Government was deeply concerned with the problem of malaria in Portuguese Timor and that it would do its best not only to improve the basic health services so as to provide a suitable infrastructure for the implementation of a malaria eradication programme but also to hasten the necessary epidemiological enquiry already begun. Another maj or need in Sarawak was the local training of multi-skilled health workers
SUMMARY RECORD OF THE SECOND MEETING
147
Section 2.3.4:
Japanese encephalitis (page 15)
Mr WATANABE (Japan) referred to section 2.3.4 (page 15) and stated
that the figures provided in connexion with cases and deaths of Japanese encephalitis in Japan should be corrected as follows: and 659 deaths; 1966 - 2301 cases and l4JJ.2 deaths.
1967 - 1028 cases
Between 1 January
and 16 September 1968, there had only been 462 cases· and 156 deaths.
These figures were considerably lower than those reported in the corresponding period in 1967.
The reasons for the considerable decrease were
not kno\'m although it was presumed that this was due, first, to the completion of the encephalitis vaccination campaign, which had covered almost thirty million people, and second, to the decrease in the mosquito population and the general improvement of environmental sanitation, as a result of the very extensive activities of the community health organizations in which the people themselves had participated. In 1967, a field research project had been started with a view to finding
out other ways of preventing the disease.
In Nagasaki prefecture
of Kyushu Island, where the outbreak usually occurred first, twenty thousand young pigs had been immunized with attenuated live vaccines. This had also been done in Osaka in 1968. ~lould
The idea was that
the vector mosquito vaccinated pigs. years.
not be infected with the virus if it bit the
This study would be continued for another two or three
Mr SOH (Republic of Korea) stated that there ~lere many cases of
Japanese encephalitis in Korea every year. this year.
In 1967, 2688 cases and
789 deaths had been reported: 1200 cases had already been reported He understood that WHO was not yet in a pOSition to state He asked WHO to undertake studies, not only that the vaccine available in some countries was effective against Japanese encephalitis. on vector biology research, but vaccine trial and vector control studies in the hope of finding a solution to the problem.
148
,_ _ _ _..;;.RE""• .;;;GI:;;.,;O;,;;:.N;;.c;A.::,.LCOMMITI'EE! NINErEENTII::.....::;SES=S;:=I;::.;DN:.:.-_ _ _ _ _ __
Dr CHOW (China) said that the health authorities and the public in
Taiwan had become more aware of the need to do something to control Japanese encephalitis. In 1965, a study using mouse brain encephalitis The vaccine with diphtheria toxoid as placebo had been undertaken. about 80%.
results had indicated that the efficacy of mouse brain vaccine was His Government was now producing mouse brain vaccine and was very grateful to WHO for providing a short-term consultant to help in the production aspects and to undertake other epidemiological studies. Studies had also been undertaken on the conversion rate of peak titres and the bionomics of the vector. Dr Chow requested WHO to assign a research team to assist his Government to study the epidemiology and other features of There were a few entomologists and tp~s
disease, in particular, the biological control of the vector mosquito. epidemiologists ~lho
could serve as
counterparts of the WHO experts who would undertake the. studies, and other resourcE'S, such as NAMRU II, which could provide technical assistance in co-operation with the WHO team. The REGIONAL DIRECTOR pointed out that the interest of WHO in this disease was not confined to the control of the vector. of Japanese encephalitis vaccine. WHO had sent an epidemiologist to Korea to discuss the question of the production The question of a field trial had been discussed by the Representative of Korea to the World Health Assembly last May wi th the Chief of the Virus Diseases Unit at WHO Headquarters, and he (the Regional Director) had been present during this discussion. He recalled that WHO had agreed to provide a consultant should the Government decide to , undertake this trial. The Regional Director emphasized that the results of a field trial in China (Taiwan) might not be applicable to Korea and vice versa. 1he DIRECTOR-GENERAL stated that the request made by the Representat,ive of China for a team to carry out insect biology stUdies and epidemiology on Japanese encephalitis came under the
SUMMARY RECORD OF THE SECOND MEEl'ING
149
Headquarters Research Progranme. the 1970 budget some three posts:
He had been requested to put into an epidemiologist. an entomologist He could
and an ecologist. to undertake this work in China (Taiwan).
not state today if he would be able to do this in view of the limitation imposed on the total of the budget. Section 2.3.5: Dengue-haemorrhagic fever (page 16)
Mr LYE (Singapore) referred to the subject of haemorrhagic fever. In Singapore, it was considered that mosquito-borne diseases of this
nature were best tackled in an urban environment by sanitation improvement rather than chemical therapy. Control had not been adequate and With the rising number a health education campaign had been organized to induce the population to co-operate; the reaction had been very poor. of cases of haemorrhagic fever in the last few years, it was felt that it was time to tackle the problem of mosquito control generally "Iith legal backing. Legislation had been passed Whereby mass partiCipation ~
was induced, especially in the eradication of water-bearing receptacles and the breeding places of
mosquitoes.
It was too early to say
what effect this would have but the preliminary results that had been obtained by the Vector Control Unit were encouraging and this might be a solution to the problem under urban conditions. Section 2.4.2: Filariasis (pages 17-18)
Mr ETr (Western Samoa) stated that the control project in Western Samoa had been established in 1965. completed in October 1966. The first mass campaign was WHO had assigned an epidemiologist to A
assess the results of the campaign and, as pointed out in the Regional Director's Annual Report, encouraging results had been achieved. follow-up programme was in progress. A trial study on vector control
methods was now being carried out by a WHO consultant in entomology. \-lestern Samoa was fortunate to have been host to the World Health Organization/South Pacific Commission joint seminar on filariasis
., 150 REGIONAL COMMI'I'I'EE: NINEl'EE:::.:~=. :!-:::S:::::ES~S;:;:I::;::O!.:.N_________
which had been held in Apia from 6 to 12 August. filariasis control project.
The seminar had beert
well attended and the participants had sho\'m a keen interest in the It had been reported that following drug therapy. the residual infection rate had a tendency to rise again after the initial fall. and a second round of mass drug administration and a vector control programme were. therefore. recommended. It was hoped to carry out the second round of mass treatment in the early part of 1969. continue to assist and ~~e
•
It was also hoped that WHO and UNICEF would project. Substantial progress had been made The continuing
he did not wish to see this progress deteriorate.
support of WHO and UNICEF was essential to prevent this happening. The REGIONAL DIRECTOR stated that provision had been included in the proposed programme and budget estimates for 1970 for the continuation of the filariasis project in Western Samoa. In view of the many requests received for advice in connexion with arthropod-borne infections such as haemorrhagic fever. Japanese encephalitis, filariasis and plague. provision had also been made in 1970 for an inter-country vector control advisory services project. Section 2.8.1: Cholera (page 25)
•
Dr DIN (Malaysia) referred to the Joint cholera study being carried out by the Governments of the Philippines and Japan in co-operation with WHO. Be noted that the findings of the team would be published shortly and asked if the Committee could be given a preview of the report. particularly on the bacteriological aspects of the use of clasSical vaccines or their alternatives. Dr DIZON (Philippines) stated that this programme was an example of collaboration in the study of diseases. three aspects: The study consisted of field cholera vaccine trials, which were being carried An issue of
out in Negros Occidental, carrier studies. and laboratory studies on the viability and other characteristics of the vibrio.
..
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SUMMARY RECORD OF THE SECOND MEETING
151
the WHO Bulletin had been devoted to a preliminary report on the findings and this was the only published report so far.
Dr YEN, Regional Adviser in Communicable Diseases, said that the team was now in Bacolod and
was carrying out studies on the treatment
of contacts and carriers.
Information on the most recent findings was
not yet available in the Regional Office. Section 2.4.1: Schistosomiasis (pages 16-17)
Dr VISOUTHIPHONGS (Laos) stated that last year a survey team had detected some cases of schistosomiasis in Khong Island in the southern part of Laos. The parasite had spread to other parts of the country, It was hoped that the WHO This could possibly be but specific figures could not be given.
survey team would be able to collect detailed information and establish a programme for the control of the disease. Basin. The REGIONAL DIRECTOR informed the Comrni ttee that some years ago, WHO had suggested to the Mekong Committee that surveys should be made in Laos and Cambodia to determine whether schistosomiasis existed. was felt this would be useful in view of the extensive development projects being planned in the Lower Mekong River Basin. of infection. '!he earlier surveys conducted by the WHO team had not revealed any snails or foci As pointed out in the Report, a fairly extensive focus of human schistosomiasis had been found last year in Laos, and in Cambodia schistosomiasis eggs had been found during an operation of a patient. A search had been made for the intermediate host but this It was hoped that the team which would be sent had been unsuccessful. It included in the project for the development of the Lower Mekong River
to Cambodia and Laos would provide further information on these rather interesting parasitological findings.
152
REGIONAL COMMI'lTEE: NINEI'EENTH SESSION
Section 2.7:
Leprosy (page 25)
Medecin-Colonel RONDET (France) suggested that more attention should be given to leprosy. This disease was highly endemic in New Caledonia '(mere there was a high percentage of lepromatous cases. The REGIONAL DIRECTOR informed the Committee that in 1970 provision had been made under inter-countr,rprojects for an adviser to provide assistance in this field. Dr THOR PENG THONG (Cambodia) referred to the schistosomiasis
problem in Cambodia.
Pending the arrival of the WHO team, the Ministry· They had
of Health had decided to send communicable disease teams to conduct a systematic preliminary survey. around Kratie. Section 2.6: Tuberculosis (pages 18-25) been able to find a rather disquieting percentage of positive cases in a group of population
Dr THOR PENG THONG (Cambodia) agreed with the statement in the Regional Director's report that the use of photofluorography in the control of tuberculosis was costly and that it was difficult to use this method in countries with limited resources. case detection in the developing countries. infectious cases. He noted that WHO recommended the adoption of sputum microscopy as the primary means of It was recognized that even in very sputum examination did not always reveal the bacilli,
If the presence of bacilli \-las chosen as the
criterion for treatment, many infectious cases would not be treated. The patients who came to the tuberculosis control service were usually those who knew that they were sick. If they were not treated owing to the absence of bacilli, the population might obtain an unfavourable impression of the tuberculosis control programme. Dr TAO, Regional Adviser in Tuberculosis, explained that every patient was entitled to treatment but before diagnosis was made it
SUMMARY RECORD OF THE SECOND MEEl'ING
153
was impossible to initiate treatment.
In many developing countries, In Cambodia, for instance,
the number of available X-ray units was limited and it was not possible to extend the X-ray service to many areas. two in Battambang. facility microscopy. there were only four photofluorographic units, two in Phnom-Penh and In all the other provinces, the only diagnostic If there were microscopic
that could be expected within the next few years would be This was a question of priority.
facilities for the diagnosis of tuberculosis in every province and ample treatment facilities, the provision of X-ray facilities could be discussed. It was not intended that patients with X-ray shadows without bacteriological proof should not be treated. The matter was only a question of the availability of diagnostic facilities. Dr SCRAGG (Australia) referred to the remarks made on leprosy
by the Representative of France. ~~s
Leprosy in the South Pacific area The proposed appointment of
quite an important problem and considerable assistance in this He then drew the Committee's attention to It appeared from the work done in an
field had already been received from WHO. a leprologist waS welcome. now under evaluation by WHO.
the study which had been undertaken on BeG vaccination and which was isolated area in New Guinea that this vaccination was about effective in the prevention of the development of leprosy. still ~
50% This was
judice and the results might not be as good but it appeared
that BeG vaccination gave some measurable protection against leprosy. This work had started in New Caledonia some ten or more years ago. A new preparation of sulfone drugs, a 75-day injection, was also being used in New Guinea. This had been most effective and had caused the It appeared that tremendous advances disappearance of lepra bacillus.
were being made in the control of this infection. Dr LEE (United States of America) referred to the statement on
page 25 that "emphasis has been placed on the importance of releasing the arrested and non-infectious patients from sanitaria ••• " and asked
154
what the criteria were today for the eValuation of the laboratory diagnosis of the acid-fast organism. and
He understood from the authorities in Hawaii
that Dr Robert Worth had been doing some work of this kind in Hong Kong that the findings of acid-fast organism did not mean that the patient was infectious. It was agreed that discussion on this point would be continued in the afternoon. (For continuation of discussion. see the third meeting, section 1.)
The meeting rose at 12.00 noon.