WPRlRC55/SRl3 SUMMARY RECORD OF THE THIRD MEETING (Mandarin Hall, Shanghai International Convention Centre) Tuesday, 14 September 2004 at 14:10) CHAIRPERSON: Mr GAO Qiang (China) CONTENTS page I.
Proposed programme budget, 200~-2007 and the eleventh general programme of work, 2006-2015 (continued) ............................. .. Outbreak response, including severe acute respiratory syndrome (SARS), influenza and a progress report on the revision of the International Health Regulations ........................................................................... .
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PROPOSED PROGRAMME BUDGET, 2006-2007 AND THE ELEVENTH GENERAL PROGRAMME OF WORK, 2006-2015: Item 10 of the Agenda (Document WPRJRC55i4) (continued) Dr VUI (Samoa) pointed out that his Government gave priority to health: it allocated 25% Of
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budget to health development, which indicated its level of commitment. Analysing the proposed budget. it appeared that WHO allocated most of its resources to the major diseases and to countries where millions of people were affected; little attention seemed to be paid to the concerns of small developing countries. However, even though the numbers might be low in absolute terms, the
percentage of the population affected by major diseases in those countries could be high. He urged the Regional Director to make a strong request to the Executive Board for more emphasis on prevention, especially in the small countries of the Pacific. because of their diverSIty. vast geographical areas and limited resources, which hampered their efforts to achieve equality in health. Greater attention should be given to their needs. and a larger share of the budget should be allocated to the Western Pacific and South-East Asia regions. Mrs PIERANTOZZI (Palau) noted that the increase proposed for the overall budget 2006-2007 was 12.8%, whereas that proposed for the regional allocation was only 0.3%, the smallest increase of all regional allocations. She commended the reduction of the allocation for WHO Headquarters, yet did the minimal increase for the Western Pacific mean that the Region was the poorest performer? How did such a small amount correlate with Organization-viide results-based budgeting? The Western Pacific Region, with its numerous small island countries spread over vast areas, and with hmited resources. had to face many challenges to health. Yet it appeared that the RegIOn was being penalized for its good work. when in fact more funding was needed to sustain the progress already achIeved. The burden of noncommunicable diseases was heavy: more resources were needed for preventIOn now In
order to avoid massive costs in the future. The incidence of HIV/AIDS was
rising fastest in the Western Pacific and South-East Asia regions: if no action was taken immediately, by 2010 the burden of disease would be very great. All those reasons argued for a larger allocation to the Region. Mr HOU (China) endorsed in principle the draft proposed programme budget 2006-2007. Several observations should, however. be made. First, with regard to method. preparation of future programme budgets should be more transparent and results-based. with fairer resource allocatIOn. Performance indicators should be clearly related to implementation so as to improve efficiency and promote health activities. Issues and challenges should ret1ect the situation in the Region as well as the main health problems. The goals and targets should be related to them and should be quantified as far as possible. Strategic approaches should be geared to implementation.
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Second, he concurred with the five priority areas identified, but noted that HIV/AIDS, tuberculosis and malaria, all of concern to the international community, had not been included. He trusted that those diseases would nonetheless receive appropriate attention. Similarly, adequate
consideration should be given to management and organization of health systems in order to improve the efficiency of both health personnel and services. In that way local communities and the general public would benefit from reasonably priced, high-quality care, within the broader context of raising the health status of the population. Third, with regard to global health security, he hoped that technical support and cooperation in the Region would be strengthened in order to tackle potential outbreaks of SARS, avian influenza or other infections effectively. Fourth, he noted the approaches adopted by WHO with a view to reducing poverty and promoting development. China was a developing country with a large population, but socioeconomic development had been uneven, and millions of people lived below the poverty line. The Government was making efforts to improve the social security network and had adopted a series of poverty alleviation measures. It had established special funds to provide support to poor regions and to set up urban and rural medical assistance schemes. In that respect he would welcome strengthened support and cooperation from WHO. Fifth, he hoped that WHO would continue to play a leading role in control of noncommunicable diseases, in particular in the reduction of those related to tobacco consumption. Sixth, he understood the reasons for the proposed increased budget and agreed to a moderate rise in the overall level. Nonetheless, a rise in assessed contributions would pose difficulties for some developing countries. The percentage by which the budget would be increased should be agreed upon through a process of consultation with Member States. The General Programme of Work played an important role in orienting WHO's future activities. The final version should stem from a process of extensive consultation with all parties concerned, starting with meetings of internationally reputed experts in the appropriate fields. Mr NAKAZAW A (Japan) said that he fully supported the Director-General's commitment to allocate more resources to regions and countries. Although the process of decentralization had started only recently, more efforts were required to improve both effectiveness, particularly at country level, and efficiency, especially of the Organization itself. The Fifty-seventh World Health Assembly had requested the Director-General to review the criteria for establishing budgetary allocations to the regions, in consultation with the regions and with Member States. That decision had stemmed from
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appeals by Member States of the Western Pacific to halt further decreases in the regional allocation. He asked whether the Regional Director could provide infonnation on that consultative process. Dr KING (New Zealand) noted that, in the previous decade, the budget had not kept pace with the level of funding needed. However, the global economy was now stronger and, in view of current health challenges, it was not the time to cut back, but rather to rise to meet them. Indeed,
interventions from nongovernmental organizations had pointed out public health problems that were scarcely being tackled by WHO, and that needed to be addressed, together with many others. A cogent argument had been put forward to increase the overall level of the budget. The problem was more one of distribution: how would additional funding be allocated? On the basis of the programme proposed, the budgetary allocation to the Region was clearly insufficient. The new fonnula for regional allocations that was being elaborated needed to be fair, but also to take account of results, which should fonn the basis for funding decisions. The Region had produced some very good results and could expect to be rewarded for them; that would provide an incentive to do even better. The Executive Board needed to examine carefully the way in which funding was to be divided up in order to ensure that each region, and the Western Pacific in particular, was receiving its fair share. ~rs
BLACKWOOD (United States of America) appreciated the clear presentation and results-
based approach of the budget documents, which would lead to better perfonnance, greater accountability and better management within and between areas of work. The Organization had succeeded in increasing extrabudgetary funding. which showed donor confidence. The DirectorGeneral had proposed a significant increase in the overall budget. The proposed budget also showed a move towards integration of regular and extrabudgetary funding. which her country agreed with. Her country did not support the proposed 9% increase in the regular budget. The United States of America continued to call for budget discipline, accountability, efficiencies and prioritIzation in international organizations and therefore favoured maintaining the budget for assessed contributions at the 2004-2005 level of approximately CS$ 858 million. \\-'bile she noted that the United States of America agreed that intensified action was needed in areas identified in the proposal, she felt the budget presented had not answered the hard questions, such as identifYing activities to be downgraded. Annex 3, appendix 2 on p. 27 showed that, since the 1998-1999 biennium, the Western Pacific Region had distributed 55% of the regular budget to countries and 45% to regional and intercountry activities. That remained virtually unchanged in the new budget and she asked the Regional Director whether more funding would be moved to country activlties.
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Much had been done on areas of work in the programme budget, but it was difficult to evaluate proposed baselines and targets when context was lacking; in a number of places, percentage rates were given without delineation, and numbers without context. The budget should clearly indicate baselines and targets, and state whether they were global or regional. the Organization's continued efforts to increase accountability. Mr KIRAT A (Kiribati) noted the proposed increases in the global and regional budgets. He also noted the increase in the allocation for epidemic alert and response, which would be needed in future. Although most countries in the Region had better health indicators than those in other regions, other factors had to be kept in mind when deciding on regional allocations. Even while communicable diseases were still common in some countries, noncommunicable diseases were a growing problem, in spite of considerable progress. Obesity, diabetes, high blood pressure and heart disease were widespread, and significant resources and funding would be needed to deal with them. HN / AIDS, as the Regional Director had said, was a time bomb. Time was running out. All
She concluded by endorsing
available resources should be mobilized to avert a catastrophe such as that afflicting Africa. WHO would have to provide considerable extra resources for that purpose.
On matters of detail, the speaker noted that the use of "blindness and deafuess" as indicators of noncommunicable diseases appeared to shift interest away from traditional NCD risk factors and complications. He also suggested that in annex I on p. 36 the term "mental health, tobacco and/or alcohol and substance abuse" would be more useful than "mental health and substance abuse". Mr CHOr (Republic of Korea) agreed with the general lines of the 2006-2007 proposed programme budget; the increase, though not sufficient, would be welcome. In his view, the budgetary allocation for noncommunicable diseases should be gradually increased. More resources should also be allotted to epidemic alert and response, and to pandemic preparedness, especially speedy information gathering, analysis and dissemination. He favoured an increase in funding for interregional activities, noting that the South-East Asia and Western Pacific regions were closely linked in terms of disease outbreak and transmission. On the subject of disease outbreaks, he hoped the Regional Office would facilitate information exchange, particularly on isolated pathogens, among national reference laboratories. That would require some provision in the programme budget. His Government would fully support WHO's strategies on disease control and health promotion.
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Dr TANG I (Tonga) said he had listened with interest to Japan and the United States of
America, the major donors to the budget. The programme budget as presented was only a proposal, and although it stated that the Region would have an increase, that depended on it being accepted, and the United States of America had said that it did not accept it. He hoped that, if the proposed programme budget were not approved, the Western Pacific Region would not continue to suffer as a result. As a member of the Executive Board, he would monitor the process of decentralization. He had already asked whether WHO Headquarters was doing enough. It was a golden opportunity to devolve more of the 36 areas of work, many of which were retained by WHO Headquarters. to regional and country levels. While in Geneva he had asked WHO Headquarters what was being shifted; were people being moved, or funds? He had not received an explicit answer to his question. At the previous World Health Assembly the Director-General had been asked to draw up guidelines for allocation of funding to the regions. Like the representative of Japan, he asked for the Regional Director's view on the subject. Dr SONG (Vanuatu) welcomed the proposed programme budget 2006-2007 and the outline for
development of the eleventh general programme of work, 2006-2015. Vanuatu also supported the policies and priorities on regional health issues, which echoed his country's corporate strategic plan for 2004-2006. He looked forward to worJang with the Regional Office on development of the 10-year programme of work, in order to improve the country's provision of health services. Mrs ARTHUR (France) welcomed the proposed programme budget and the draft outline of the general programme of work, 2006-2015. The budget complied with the resolutions of the Health Assembly and reflected current priorities in public health. She agreed that the risk of a pandemic was more acute than ever. France agreed with the pnorities identified in the budget: namely. the Millennium Development Goals. HIV /AIDS, promotion of maternal and child health, access to essential drugs. control of noncommunicable diseases, and the strengthening of health systems, progress on all these fronts was necessary if poverty was to be reduced. She observed that 70% or more of the budget consisted of voluntary contributions. She was not pleased to see items such as food safety depend essentially on contributions which could not be relied upon to continue. She also queried the wisdom of reducing the budget for poliomyelitis eradication. when an epidemic could yet occur in Africa. Even the Western Pacific Region was not safe from that
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threat; and yet it seemed that immunization activities for 2005 might be jeopardized by lack of funding. Mrs LE THI THU HA (Viet Nam) understood that the Western Pacific Region would receive an increased allocation if the World Health Assembly approved the budget increase. If not, she hoped the Region would not suffer too much, as it had done in the past. She noted that WHO expected an increase in extrabudgetary resources and asked how countries would benefit fbm that. Dr SELUKA (Tuvalu) remarked that the general programme of work, 2006-2015 could be seen
as WHO's response to the globalization of the world economy. He hoped that it would lead to the achievement of the Millennium Development Goals in the coming decade. With regard to disease control, he asked WHO to provide emergency facilities close to Pacific island countries, with laboratories and technical specialists. He supported the proposed increase of 9% in the budget. Mr UNA (Solomon Islands) said that his country was going through the epidemiological transition, and needed special attention. Recently, Australia had provided major support, for which his country was grateful, as it had helped defend the gains of the previous 50 years. Respiratory illnesses remained the major cause of mortality, followed by diarrhoeal diseases and malaria. Intestinal worm infestation and skin disease were so rife that they were not even regarded as priority problems. Diabetes, hypertension and stroke were receiving more attention. The Ministry of Health, the WHO Country Liaison Office in Honiara and the Australian Agency for International Development (AusAID) were reviewing the post-conflict health situation. SARS, avian influenza and the first case of AIDS in his country had shown the need to improve control of infections in health facilities and blood transfusion services, and the importance of food safety and public health regulations. Tuberculosis and leprosy remained major public health programmes, and prevalence of those diseases had been kept below I %. The signing of the WHO Framework Convention on Tobacco Control addressed public health problems at community and government levels. Solomon Islands was trying hard to overcome its problems, and it was grateful for the support it had received from its neighbours. He concluded by expressing his support for the proposed programme budget. Ms LANGIDRIK (Marshall Islands) endorsed the views expressed by other speakers from Pacific island countries and supported an increase in allocations to the Western Pacific Region. The representative of Tonga had asked whether enough was being done. However, it was difficult to define what could be considered as "enough" in terms of action to combat the many public health concerns in the Region. In addition to the major disease burdens, Member States were often prone to
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natural disasters. increasing the likelihood of diarrhoeal disease outbreaks. Moreover. the world was constantly changing, bringing new problems such as SARS and avian influenza. There would
therefore always be room for further efforts. She hoped that the Regional Director and the Executive Board would take into account the specific needs of the Pacific island countries when determining regional allocations. Despite their differences, those countries were all aiming for the same goals, which included the Millennium Development Goals. Human resources development was a particular priority, given the lack of skilled health personnel and the migration of existing staff. High rates of diabetes in her country necessitated an emphasis on healthy diets, but it was difficult to grow the vegetables and fruit needed when land was limited. Ms HALTON (Australia) welcomed WHO's strong commitment to administrative reform and its efforts to develop and improve the results-based management framework. The high level of
consultation in developing the budget proposals gave Member States confidence that questions raised by them would be addressed prior to the World Health Assembly III
May 200S. However, the current
proposals assumed a significant increase in the regular budget and an even greater one in voluntary contributions. The former would be difficult for many countries to accept in the current climate of restraint, when few governments could provide such a level of growth for national health services. The anticipated increase in voluntary contributions was optimistic, especially given the significant increase in the current biennium to fund the "3 by 5" Initiative to increase access to antiretrovirals. The proposed programme budget would be the subject of close scrutiny in the lead-up to the next Health Assembly to ensure that the proposals and any savings made to offset spending increases provided optimum value. Her Government would take particular interest in identifYing all possible efficiencies, for example, through economies of scale at country level achieved by better integration of WHO actlVities in national programmes and improved collaboration with other United Nations organizations in support services. Greater use should be made of country allocations to promote increased efforts by governments to improve infrastructure and capacity, rather than to take over activities formerly undertaken by other funding agencies. She endorsed the comments of previous speakers regarding the specificity of the budget. There was considerable room to improve
transparency in the use of voluntary contributions, especially those that were tied to specific activities. The proposed general programme of work, 2006-2015 indicated the maintenance of immunization and vaccine development. but at a lower level in anticipation of success in eradicating poliomyelitis in 2005. essential activities. Any reductions must be carefully managed to avoid adverse effects on
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The Director-Genera1's proposed increase in the programme budget for 2006--2007 represented an attempt to respond to new priorities identified by Member States. Prompted by the outbreaks of SARS and avian influenza, Western Pacific countries had rightly called for WHO to develop and maintain improved mechanisms for rapid and effective responses to potential communicable disease crises. Further, Australia and others in the Region had called for more support to countries trying to develop the good governance principles and sound economic practices needed to deliver health services effectively on a sustainable basis. At the Fifty-seventh World Health Assembly, WHO had been requested to give greater priority to noncommunicable diseases, diet and physical activity. The Western Pacific Regional Committee had consistently called for an increased regional allocation to enable the Region to continue its significant public health achievements. It had also asked for savings and efficiency gains to enable increased support for programme activities. The proposed increase in the regional allocation of US$ 37 million was significant, especially in view of the reductions in the two previous bienniums. Importantly, it reflected a reallocation of resources from Headquarters to regional and country offices, fulfilling the Director-General's commitment to reorient WHO's priorities to services that would make a difference in people's lives. She looked forward to further discussions on the proposed programme budget in other forums. A clear focus on expected outcomes and performance as well as financial restraint would deliver good results. However, there was also a need to be able to respond quickly and flexibly to emerging health threats. Dr DAYRIT (Philippines) expressed appreciation for the efforts made to implement resultsbased budgeting. He pointed out that the proposed US$ 361 million increase (12.8%) in the
programme budget for 2006--2007 was small in comparison to the US$ 27 billion per year in voluntary contributions called for in the report of the Commission on Macroeconomics and Health. The proposed increase in assessed contributions was only US$ 77.3 million (9%). The greater part of the increase. USS 290 million (14.9%), was expected to come from voluntary contributions. Table 2 in Annex 2 of the report before the Committee showed an increase ofUS$ 39.3 million (20.3%) III
the
allocation to the Region. The Executive Board and the Health Assembly, perhaps with the help (" . management experts, would need to determine whether the proposed increases were justified in light of what the Organization was being requested to undertake, or whether it would be possible to keep the programme budget at the same level as for the previous biennium, while requesting further cost savings and efficiencies so that activities could be increased. The decision would be facilitated if the information provided on proposed programme activities indicated strategic directions and showed any proposed increases and decreases. It would also be useful to indicate what the proposed increases would mean for individual Member States.
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Mr NETH (Federated States of Micronesia) commended the Regional Director and his staff on their efforts and expressed a willingness to cooperate with WHO and with other Pacific island countries. Budget proposals were a sensitive issue, but he feared that those who said nothing might gain nothing. The Federated States of Micronesia therefore called for as much support as possible from WHO. As in the Marshall Islands, there was a great need, inter alia, for human resources development and capacity-building. His country would make good use of any funding provided and would ensure full accountability and transparency. The REGIONAL DIRECTOR said that the comments and suggestions from speakers had indicated a consensus among Member States that the Western Pacific Region deserved an increased allocation for the 2006-2007 biennium. Before responding to individual questions. he wished to explain how the budgeting exercise in WHO had evolved. In earlier years, regional allocations had been made on the basis of precedent, with no application of objective or philosophical criteria; what had been the case in one biennium had been repeated in the next. Resolution WHA51.31, adopted in 1998, had called for the application of a formula based on the UNDP Human Development Index, which included indicators such as life expectancy, gross national product and literacy rate. The formula also took some account of popUlation size, but it did not include disease burden or efficiency and performance III
delivery of health services. It did not therefore reflect the reality in countries, and
some Member States that had improved health indicators experienced reductions in allocations, despite continuing health problems. The Director-General had therefore been requested to develop more objective cnteria for determining regional and country allocations. He was currently
considering the matter and had already given a commitment to ensure that, in the 2006-2007 blenmum, 75% of overall funds, regular budget plus voluntary contnbutions, would go to regIOns and countries. The target for 2008-2009 was 80%. Responding to the concern expressed by several speakers regarding the proposed increase in assessed contributions. he said that, while extrabudgetary contributions had been increasing over the years. regular budget funding had remained virtually static. However. a large proportion of
extrabudgetary funds was earmarked for specific programmes. Such funds were also usually timelimited and depended on the priorities of donors. The Director-General had therefore called for a regular budget increase in order to ensure sustainability of funding for WHO's core priority programmes. The representatives of Australia, Japan, New Zealand and Tonga had asked about the status of discussions on the guiding principles behind determinatIOn of allocations to countries and regions. By mid-October, the Secretariat's view on the issue would be posted on the website, for input from Member States. In that way. the views of the countries of the Western Pacific Region would be
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transmitted to the Executive Board, four of whose members were from countries in the Region. The perception of many Member States that the Region was being penalized for good performance should encourage them to enter the discussion, to ensure a more equitable, more realistic distribution of resources, on the basis of consideration of all aspects of needs and health delivery. Decentralization was important, but what was needed was a guiding principle for budget allocation. WHO had a unique organizational structure, with governing bodies at global and regional level, and staff at Headquarters, regional and country levels. He considered that efficiency and effectiveness could be increased by ensuring that there was no duplication of effort among those levels. In order to do so, it would be necessary to define their roles clearly. Headquarters should exercise a normative function and set global policies. Some programmes and initiatives should therefore remain at Headquarters, such as negotiating with the pharmaceutical industry to obtain drugs at equitable prices. Technical cooperation, to train personnel for instance, should, however, be maintained at regional and country levels, with support from the regional offices. Regional offices should be responsible for developing policies specific to their regions. The representatives of the United States of America and Viet Nam had asked about the percentage of the regional budget that countries were to receive. They had received 55.6% of the regular budget for the current biennium, and he proposed that they receive 55.85% in the next biennium. He was confident that the extrabudgetary resources would increase, as they had in the preceding bienniums, and countries would receive more than 50% of that portion of the budget in the 2006-2007 biennium. He agreed with the representative of the Republic of Korea that both information exchange and resources should be increased for noncommunicable diseases. In response to the representative of France, he said that the allocation for eradication of poliomyelitis had been decreased globally, but the regional allocation had remained stable in order to maintain polio-free status. Only a few small foci remained, in regions other than the Western Pacific In response to the request from the representative of the Philippines for a comparison of
allocations to each programme across bienniums, he referred the representative to the table in annex 3, appendix 1. The DIRECTOR, PROGRAMME MANAGEMENT, replying to a question from the representative of Kiribati, said that blindness and deafuess were addressed in very small programmes within the WHO structure and were not considered a separate area of work. The term 'substance abuse' covered, not only alcoholism and tobacco smoking, but also the use of psychoactive
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substances, which unfortunately was on the increase in the Region. He therefore considered that the term should be retained. The DIRECTOR, PLANNING, RESOURCE COORDINATION AND PERFORMANCE MONITORING, WHO HEADQUARTERS described how regional allocations had been made to different areas of work in the current budget. For the first time, results-based budgeting had been used with no preconceived baseline figures. Thus, goals, targets, issues and chaJlenges had been formulated, and then the regions had been asked to estimate the costs of implementation, in consultation with Headquarters. On the understanding that it would be impossible to obtain all the necessary resources to meet the stated objectives, the estimated costs had been scaled down slightly, mostly for allocations to Headquarters. A number of initiatives had been implemented to increase efficiency in administrative sectors of WHO. Nevertheless, the 70% of the budget represented by voluntary contributions did not include funds for administration, planning and management. Programme support was inadequate. Thus, over the past six bienniums, during which there had been zero nominal growth, the regular budget had been used to 'subsidize' programmes financed by voluntary resources. She confirmed the fear expressed that, if the Health Assembly did not approve the proposed increase in assessed contributions. all parts of the WHO budget would be affected, including regional allocations. There being no further comments, the CHAIRPERSON requested the Rapporteurs to prepare an appropriate draft resolution for consideration later in the session. 2. OUTBREAK RESPONSE, INCLUDING SEVERE ACUTE RESPIRATORY SYNDROME (SARS). INFLUENZA AND A PROGRESS REPORT ON THE REVISION OF THE INTERNATIONAL HEALTH REGULATIONS: Item 11 of the Agenda (Document WPRlRC55/5) The REGIONAL DIRECTOR. introducing the item, said that, in July 2003, when the World Health Organization had finally declared that the last chain of transmission of SARS had been broken. one question had been on many peoples' minds: would it return? Since then, there had been three separate incidents of SARS infection that had been acquired in laboratories, all in the Western Pacific Region. In addition, between December 2003 and January 2004, four cases of SARS in the general community had been reported from Guangdong Province, China. On only one occasion had any of those incidents resulted in onwards transmission of the virus: in the case of a small outbreak that had started in a laboratory in Beijing. As soon as the diagnosis had been made, the public health response
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had been swift and highly effective. No further cases had been seen and the outbreak had been rapidly contained. In December 2003, an outbreak of avian influenza in poultry had been reported in the Republic of Korea. By the end of February 2004, eight Asian countries had confinned outbreaks of infection with H5NI in pOUltry, and more than 100 million chickens and ducks had died or been culled. Nine countries had now reported outbreaks of avian influenza in pOUltry. More significantly, human deaths from infection with the same virus had been reported in Thailand and Viet Nam. The outbreak had been historically unprecedented. Many national governments had been optimistic that the outbreak had been controlled by application of the necessary control measures; however, in July, the optimism of some countries had been shattered by a resurgence of the disease in poultry. So far in 2004, the virus had caused 39 recognized human cases in Asia, with 28 deaths. The events had raised many issues, both for countries in the Region and for WHO. More needed to be understood about the ecology of the infectious agents. It was also essential to be sure that laboratory experts and people employed in animal markets and fanns were working in a safe environment. Every nation, without exception, should be as well equipped as possible to detect and respond to any event of public health significance. Perhaps more than any other event in recent history, the outbreak of SARS in the past year had clearly shown that infectious agents did not respect international boundaries. It was crucial that WHO and its Member States work together to ensure that the new International Health Regulations, which would provide a legal and operational framework for cross-country collaboration in the event of any similar threat, were universally adopted. It was also important to strengthen the Region's collaboration with the neighbouring South-East Asia Region, as the SARS and avian influenza outbreaks had demonstrated the advantages of seeing Asia as one epidemiological block. The REGIONAL ADVISER IN COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE provided further details of the confinned cases of SARS that had occurred after global containment. There had been one case in Singapore in August 2003, one in Taiwan (China) In
December 2003, four cases in Guangdong (China) between December 2003 and January 2004, and nine cases in Beijing and Anhui (China) in June 2004. Except for one of the cases in Guangdong, all had been associated with laboratory accidents. Avian influenza associated with H5Nl virus had been found in pOUltry in eight Asian countries, with 35 confinned human cases in Thailand and Viet Nam. The outbreak had been reported as contained by the end of March 2004, but a new case had since been reported in Malaysia, as well as additional cases in Viet Nam in August and one in Thailand during the past week.
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Several main issues had to be addressed in relation to emerging zoonoses. With respect to animal-to-human transmission, more studies were required on the ecology of the virus in the environment. There should be regulatory control of animal husbandry practices, including live animal markets, which had been implicated as a source of some emerging diseases. Closer collaboration should be instituted between the health and the agriculture sectors at national, regional and global level. The emergence of laboratory-acquired cases highlighted the importance of strengthening national and regional biosafety programmes. The potential for an H5Nl influenza pandemic implied a need to strengthen surveillance of humans and animals to detect possible cases early enough for effective intervention. In order to face a 'worst case scenario', national pandemic preparedness plans should be made, including the development of vaccines. The way forward included revision of the International Health Regulations, with input from the regional offices, and formulation of a strategy for capacity-building in both the Western Pacific and the South-East Asia regions. Dr ARIF (Malaysia) reported that, smce the SARS outbreak, Malaysia had strengthened
infectious disease surveillance, prepared a manual on rapid response, and developed standard operating procedures for outbreak management. He proposed that WHO should formulate a
framework for the development of national plans of action for pandemic preparedness, and recommended the use of the ASEAN Disease Surveillance Net for exchange of information with WHO and :v1ember States, includmg non-members of the Association of Southeast Asian Nations. He welcomed the inclusion in the revised International Health Regulations of Article 38, clearly stating there should be no exemption for those with diplomatic status. He would welcome the expansion of Article 39 to include import and export of all pathogenic organisms since those were potential sources of disease outbreaks. He requested WHO to develop minimum criteria for assessing compliance with the revised regulations and to play an active role in ensuring their implementation by Member States. Dr CHEW (Smgapore) recognized the exceptional leadership shown by WHO in the Western Pacific Region during the crises brought by outbreaks of SARS and avian influenza. He stressed that the potential for an outbreak of avian influenza to be more catastrophic than SARS could not be ignored. In the absence of natural immunity to H5Nl, he considered that rapid vaccine development was necessary. He proposed that WHO should seriously consider pre-pandemic vaccination
programmes with seasonal influenza vaccines that incorporated the H5Nl component for populations at risk. Dr MATSUTANI (Japan) supported the actions that had been proposed to strengthen infectious disease surveillance and response to outbreaks of infectious diseases. In Japan, revision of legislation
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for infectious disease control and quarantine measures, development of appropriate plans of action, skills training and research on the SARS coronavirus, particularly the development of anti-SARS vaccine, were ongoing. He emphasized the importance of sectorwide and interregional collaboration in outbreak response and WHO's role in maintaining international cooperation, including the establishment of regulations on the trade in live and processed poultry. He recognized the importance of collaborating in the revision of the International Health Regulations. DR RADFORD (United Kingdom of Great Britain and Northern Ireland) supported the actions that had been proposed for consideration. She stressed the importance of rapid response, not only for surveillance, but also in the management of outbreaks. She said that communicable diseases had become global issues in view of their potential to develop into pandemics. She requested further elaboration on the proposed biregional strategy on outbreak-prone diseases and the timeframe for its development. The meeting rose at 16:40.