Report to the Regional Director: WHO South-East Asia, Advisory Committee on Health Research twenty-ninth session, Yangon Myanmar, 14-16 June 2004

World Health Organization Regional Office for South-East Asia New Delhi 2004 Report to the Regional Director WHO South-East Asia on Health Research Advisory Committee World Health Organization Regional Office for South-East Asia New Delhi 2004 Twe nty -ni nth Se ssio n, Y ang on, My anm ar, 14- 16 Jun e 2 004 SEA-ACHR-30 Distribution: General WHO South-East Asia Advisory Committee on Health Research Report to the Regional Director WHO Project: ICP RPC 001 World Health Organization Regional Office for South-East Asia New Delhi 2004 Twenty -ninth Session, Yangon, Myanmar, 1 4-16 June 2004 © World Health Organization (2004) This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. Page iii CONTENTS 1. INAUGURAL SESSION.....................................................................................1 2. BUSINESS SESSION..........................................................................................3 2.1 Review of the Work of WHO on Health Research................................6 2.2 Regional Health Research Priorities on Emerging Infectious Diseases..................................................................................15 2.3 Work Plan for Health Research Priorities on Emerging Infectious Diseases..................................................................................25 3. CONCLUSION AND RECOMMENDATIONS..............................................31 4 CLOSING SESSION ........................................................................................32 Annexes 1. Terms of Reference of SEA-ACHR .................................................................35 2. List of Participants...........................................................................................36 3. Agenda.............................................................................................................39 4. Health Research Priorities on EID for the SEA Region .................................42 5. List of Working Documents............................................................................44 Page 1 1. INAUGURAL SESSION The WHO South-East Asia Advisory Committee on Health Research (ACHR) held its Twenty-ninth session at Hotel Sedona, Yangon, Myanmar from 14 to 16 June 2004. At the inauguration session, H.E. Professor Kyaw Myint, Minister of Health of Myanmar, while welcoming the Regional Director, the members of SEA-ACHR and special invitees, expressed deep satisfaction for Myanmar being hosting the meeting of SEA-ACHR for the third time. He stated that rapid globalization and advancement in technology had compelled nations to review their strategies for health research development. He said that there were mismatches between the burden of illness overwhelming the poor, and the investments in health research concentrating on the problems of rich and developed nations. This required the health research community both at national and international level to intensify their collaboration in policy analysis, capacity-building, knowledge-sharing and management. Professor Myint said that many important health determinants lay beyond the domain of health sector, and thus, intensive health advocacy, using evidence-based information, was needed. Developing countries had to be dependent upon the health research and scientific breakthroughs for effective development of health interventions, such as new and effective antimicrobial medicines and vaccines. Changes in lifestyles had led people towards adopting unhealthy bahaviour and exposing themselves to many high-risk factors, and this enhanced the prevalence of noncommunicable diseases. Professor Myint stressed that development of national health research systems should be part of national health systems development, since health research was the brain behind health systems. Professor Kyaw Myint elaborated on Myanmar's health research development. Myanmar had focused its health research on both infectious diseases like TB, malaria, HIV/AIDS and diarrhoreal diseases, and noncommunicable conditions like diabetes and hypertension. A larger proportion of health research funds had been used for basic, biomedical, and clinical research on traditional medicine. He appreciated WHO for designating the Department of Medical Research (Lower Myanmar), Yangon, as a WHO Collaborating Centre (WHOCC) for Research and Training on Report of the Twenty-ninth Session Page 2 Malaria. The Department had been concentrating on basic and applied health research, clinical management, drug-resistance studies, development of diagnostic kits, and training. He urged WHO to assist similar national centres of excellence which were working on other subject areas, including traditional medicine research and programme development, and also to facilitate their designation as WHOCC. Professor Kyaw Myint said that health research development was an increasingly important area which enabled a more pragmatic exploration of health and health-related science and technology, and also in improving health systems, planning and management. He felt happy to note the significant growth in health research development at national, regional and global levels, leading towards effective health promotion and protection. Emphasizing the need for intercountry collaboration in view of the increasing risk of rapid transmission of emerging infectious diseases that kept crossing national boundaries, he said that eminent scientists representing all countries of the Region, with varied experiences in different aspects of health research development, would be able to provide clear and consistent advice for promotion and development of health research in the Region. In conclusion, Prof Myint wished ACHR members a pleasant stay in Myanmar. Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia, in his opening address, thanked the Minister of Health and the Government of the Union of Myanmar for hosting the meeting in Yangon for the third time. He stated that the Regional ACHR was an important policy advisory body, appointed by him, to provide advice on health research policy and strategy relevant to countries and the Region as a whole. He also appreciated the significant contributions made by ACHR in the past, as per the terms of reference as agreed earlier (See Annex 1). Dr Samlee said that health research was an indispensable function which was crucial to generating evidence-based knowledge for the Organization to collaborate effectively with its Member States. He highlighted the reasons for choosing this year’s theme "Health Research on Emerging Infectious Diseases". He said that excellent progress had been made to tackle infectious diseases like tuberculosis, malaria, leprosy, dengue and dengue haemorrhagic fever, which were still affecting large numbers of populations. At the same time, a few new diseases caused by Severe Acute Respiratory Syndrome (SARS) and new strain of avian influenza had emerged in recent years and caused enormous socio-economic and psychological impact on populations. In addition, the burden of illness WHO South-East Asia Advisory Committee on Health Research Page 3 due to noncommunicable diseases was increasing steadily. New pathogens, particularly viruses, remained unpredictable and continued to emerge and spread across countries. Dr Samlee briefly informed the ACHR that a Regional Task Force on Emerging Infectious Diseases (EID) had been established to develop a vision document, containing the regional framework to guide actions in Member States of the Region. The outcome of the present session of ACHR would complement the concepts and strategies to be enunciated in the Regional Vision paper, especially on building research capacity and generating new knowledge, to respond to the challenges of EID. In order to effectively control emerging diseases, the Regional Director advised countries to promote and develop health research as an integral part of health systems. There was need to develop strategies on how countries organized and managed health research, how knowledge was produced and synthesized, how the demand for relevant knowledge was cultivated and how and where countries used that knowledge in order to improve efficiency and effectiveness of health systems. In order for a health research system to function effectively and efficiently in each country, continuous capacity-building of researchers and research managers, as well as extensive support to health research were crucial. It was important that funds were dedicated to health research as an investment. The strong link between health outcomes and research outputs is a vital step for the sustenance and growth of national health research systems. In most cases, the health research agenda was restricted and confined to only a few institutions and to the ivory towers of the academia, with most of health research having no relevance to the health of the common man. To deal with this issue, he urged SEA-ACHR to be proactive in bringing together national and international health policy-makers and researchers to develop a strategic framework for narrowing the "know-do” gaps, and assume the leadership role to make it happen. Dr Samlee also appreciated the commendable achievement made by the health and health-related research institutions in Myanmar, especially the Department of Medical Research. 2. BUSINESS SESSION A total of 13 SEA-ACHR members, 10 special invitees, including two Regional Directors Emeriti, and one former Executive Director of WHO/HQ, and the WHO Secretariat led by the Regional Director, attended the 29th session of SEA-ACHR (See Annex 2 for List of Participants). Report of the Twenty-ninth Session Page 4 At the outset, the Chairman of ACHR, Professor NK Ganguly, Director- General, Indian Council of Medical Research, while welcoming the participants, stated that the ACHR members had many opportunities to have stronger linkages and interactions among themselves and through them, with other scientists. Close proximity and focused approaches had greatly facilitated this process. In recent years, the Member States and their neighbours had suffered major calamities caused by: (1) micro-organisms that had never been known before, affecting either humans or any other species, like SARS; (2) micro-organisms which were known to affect other species, but which affected humans for the first time, like the human cases due to Influenza A(H5N1), and (3) micro-organisms known to affect humans, but now having a different antigenic structure, such as Vibrio cholerae, Serogroup O139. These epidemics had a great impact on social status and economy. Professor Ganguly endorsed the Regional Director's initiative of establishing appropriate technical advisory teams and task forces, including the work to develop a regional vision paper, outlining a strategic framework for effective control of EID. He urged the ACHR members to deliberate this year's theme by identifying key areas of health research and developing a workable plan. He assured the participants that he would take up this plan with policy- makers and get concrete results. Professor Ganguly highlighted the fact that the SEA-ACHR had facilitated a series of health research development activities in the Region over the last few years. The priority activities included: (i) adoption of regional framework and strategies for health research systems development; (ii) development of modules for health research management training; (iii) production of CD- ROM and documentation on the compendium of case studies for training on health research ethics in reviewing proposals involving human subjects, and (iv) facilitation of national forums for research ethics, and production of regional vaccine policy and strategies. With WHO-TDR support, India conducted the clinical trial of miltefosine for control of kala-azar. The 20th session of SEA-ACHR held in Maldives in 2003 provided directions for the Region on health research priorities on the single-gene disease, thalassaemia in order to enhance effective community control of the disease. WHO South-East Asia Advisory Committee on Health Research Page 5 The ACHR Chairman also shared the wish list that came out during the 42nd Global ACHR in May 2004. The Chairs of ACHR from all Regions expressed the strong desire for greater inter-regional collaborative works on common health research problems, and sharing their experiences in development and implementation of health research policies. They also requested WHO-RPC/HQ to develop generic models for collaboration between HQ and regions and also amongst regions, to encourage cluster systems of stakeholders, and to establish communication networks for capacity-building within countries of the South. There are many examples: (i) Thailand's expertise on dengue haemorrhagic fever; (ii) Bangladesh's expertise on arsenic research; (iii) capacity-building in writing of research proposals for mobilizing research grants from extra-budgetary resources (e.g. the NIH model); (iv) prioritization of key regional and inter-regional health issues; (v) strengthening of the stewardship role of government and development of national health research systems; (vi) enhancing cooperation towards moving the research products to needy people; (vii) sharing information on research in vulnerable diseases such as diabetes in children; (viii) development of the means on how to access evidence-based information; (ix) learning from experiences of countries with accelerated economic growth, on how they reduced mortality, and (x) discussion and debates on the misuse of technology for diagnostic and prevention purposes. Dr Bjorn Melgaard, Director, Programme Management, WHO/SEARO, while welcoming the ACHR members and all invitees, conveyed his great pleasure in participating in the ACHR meeting for the first time. The programme of work for this year's ACHR session had been discussed extensively prior to the start of the meeting in Myanmar, on how best to organize the session. In recent years, the world had been witness to outbreaks of many EID that had an impact beyond the area of health. Dr Melgaard highlighted the importance of identifying health research priorities that could be funded by development partners. The evidence produced from these health research studies will enable WHO to guide and assist Member States in putting efficient outbreak alert and response mechanisms in respect of EID. The impact of EID beyond health was expected to be tremendous in the near future. A broader and wider thinking on the technical context of the diseases was very much needed, such as how to link the existing laboratories for diagnosis and surveillance, how the tools which had been developed could be made widely available, and how more Report of the Twenty-ninth Session Page 6 knowledge could be collected on the socio-behavioural and economic aspects of the disease. Recent epidemics of SARS and Avian influenza had found the place on the political agenda. A month from now, the Heads of States would be meeting to discuss the economic impact caused by SARS and avian flu. There was also the need to focus on risk perception and risk communication in view of the fact that the public reaction to the outbreak of recent EID had been more than was expected. The ACHR members and other invitees who are attending this session were then introduced. Professor U Paing Soe, Director-General, Department of Medical Research (Lower Myanmar), was nominated as Vice-Chairman. The Chairman, Professor NK Ganguly requested the ACHR members - Professor Dulitha Fernando, Dr Agus Suwandono and Dr Somsak Chunharas to act as Rapporteurs and assist him and the Secretariat in finalizing the report. After a brief discussion, the ACHR adopted the agenda for the 29th session of the SEA-ACHR. (Annex 3) 2.1 Review of the Work of WHO on Health Research Dr Tikki Pang, Director, Department of Research Policy and Cooperation (RPC), WHO/HQ, presented a summary of the series of global initiatives in health, which had emerged in recent years, both within and outside the Organization. These included the adoption of Millennium Development Goals (MDG); the establishment of the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria (Global Fund); the Global Alliance for Vaccines Initiative (GAVI); the Global Alliance for Improved Nutrition (GAIN), and the latest WHO/UNAIDS initiative- "3x5" for control of HIV/AIDS. He said that there was an urgent need for turning scientific knowledge into effective action for people’s health. He mentioned three critical gaps, the first being related to the transfer of products of research and development involving new tools and interventions, for use to solve priority health problems. As a consequence, the research results that came out late would not attract any political interest, and thus, they would not be used for decision-making. The second gap was the bias of knowledge and the access to such knowledge. Evidence had shown that bias existed in the knowledge itself, which led to a serious misconception. Access to knowledge had been shown to be high in Europe (42%), Canada and the USA region (31%), and the Asia-Pacific region (31%), as compared to Africa (3%) and the Middle East (4%). The third critical gap was the “Know-do WHO South-East Asia Advisory Committee on Health Research Page 7 gap”, which was the gap between what we knew and what we did concerning which there were at least two major issues. Firstly, it was the gap between producing knowledge and translating knowledge into health decision-making. Secondly, there was a gap between decision-making and the utilization of new knowledge in clinical and public health practices. Creation of an enabling environment, social movement and political involvement were important factors to bridge this gap. One key element to solve the “know-do gap” was the strengthening and enhancing of the work of national health research systems (HRS) in all countries. To review and assess the development of HRS globally, a framework and related instruments had been developed and pilot-tested in 13 low- and middle -income countries. The results will be used as inputs for the "World Report on Knowledge for Better Health, 2004" that would be launched at the Mexico Ministerial Summit on Health Research, to be held from 16-20 November 2004. Regional consultations that had been organized over the past few months had agreed upon eight deliverables for the Summit. A few of them were: (i) the Global Clinical Trials Register; (ii) Improving Access to Health Information in the Developing World; (iii) Global Observatory for Knowledge Transfer; (iv) Core priorities for health systems research, and (v) Special Programme in Research for Health Systems Development. Observations and recommendations of the Mexico Summit will be reported to the WHO Executive Board in January 2005 and to the World Health Assembly in May 2005. Dr U Than Sein, Director, Health Systems Development, WHO-SEARO, in his presentation, stressed that the health research system was the “brain” behind the health system. A well-functioning health research system dealt with strategic areas such as: ensuring good governance for research and development; capacity-strengthening for managing and conducting health research; development of tools and methodologies; knowledge-sharing and management, and advocacy. Accomplishments in the area of health research were an accumulation of the work and achievements of both the Member States and the Regional Office. At the country level, the national health/medical research councils or similar analogous bodies, the national health research forums and the national health research policies had contributed towards the directions and stewardship of the development of health research. The national capacity strengthening was a critical strategy to enhance knowledge and skills in health research, not only targeting health Report of the Twenty-ninth Session Page 8 researchers but also other parties who played a role in health research system. These are health research managers; policy-makers of health research, and research funding agencies. The least-developed countries like Bhutan, Maldives, Myanmar, and Nepal were currently enjoying the benefits of the global project, called "Health InterNetwork Access to Research Initiative (HINARI)", which allowed free access for around 15 000 journals, both online and in full text. As regards knowledge-sharing and dissemination, the Regional Office had supported Member States with Health Literature, Library and Information Services (HELLIS) network; and in helping countries with pooled subscriptions of required journals. The pooled subscriptions had reduced the costs tremendously. The Global Information Network (GIFT) programme installed at WHO country offices, enhanced access for scientific information. Advocacy was directed towards contribution of regional research work to national, regional and global development of health research and health systems. The existing mechanisms for advocacy were the subject of debate at inter-regional forums (such as those of SEAR/WPR and SEAR/EMR), towards building partnerships with international donor agencies [e.g. SEARO and the National Institute of Health (NIH), USA, for strengthening capacity on ethical and legal aspects of international health research] and for making effective use of WHO collaborating centres (WHOCC) and national experts. Professor Dr U Ko Ko, WHO Regional Director Emeritus and President of Myanmar Academy of Medical Science, in his short presentation on the development of health research in South-East Asia, started with quotation from quoting Dr Halfden Mahler, the then Director-General of WHO. The essence of Dr Mahler’s words was that in order to look forward with vision, one should learn from the lessons of the past in order to build a more stable and a healthier future. Dr Ko Ko shared with members and participants the historical development of research policy and cooperation in the SEA Region, especially how regional ACHR was established more than two decades ago, how regional health research programme was given high priority and how this had strengthened national health research capability. He briefly highlighted how vaccine research, nutrition-related health and biomedical research, health services research areas have been developed and strengthened in the countries of the Region. Dr Mohamed Abdur-Rab, RA-RPC, WHO/EMRO articulated his inspiration in joining the ACHR meeting of the SEA Region for the second WHO South-East Asia Advisory Committee on Health Research Page 9 time, the first time being in Maldives last year. The bi-regional SEA/EMR meeting held in Maldives in 2003 had resulted in adding values to collaboration among the two regions. The Eastern Mediterranean Region (EMR) was also carrying out an analysis of the performance of national health research system in five countries. The objectives were to identify the present modalities in order to move forward. The findings showed that challenges faced by the five countries in health research systems were common. The key issue in Pakistan was capacity-building, and braindrain. In Iran, it was the quality of health research, while Sudan faced financial problems for health research and Morocco was still struggling with basic research. The Regional Committee of the Eastern Mediterranean had endorsed the recommendation for 2% of Regular budget being devoted for research, besides the receipt of financial support from TDR-WHO/HQ to carry out small-grant research projects. Discussion The Chairman praised the achievements made in health research both at the country and regional level. The strategies for national health research system in the SEA Region, which were developed by the expert group of senior health researchers in 2001, had provided a more conducive environment for enhancing proactive collaboration between Member States and the WHO Regional Office. With regard to knowledge-sharing and managing knowledge, India was involved in Health InterNetwork Access to Research Initiative (INARI), a specific project of WHO. The Chairman thanked Professor U Ko Ko for his enlightening presentation which was an invaluable heritage for ACHR members. It provided the historical background of ACHR; the trend of funding for health research, and the emergence of health and bio-medical research institutions. The Regional Director congratulated Dr U Ko Ko on his presentation, for bringing about tremendous development in the Region over the past several years. Dr Samlee reiterated the importance of Dr Mahler’s words, and stated that WHO could not afford to look forward without looking back at the past, as future of WHO’s work had to be built on the successes that have been achieved and the lessons learnt in the past. WHO collectively stood for Member States, its Governing Bodies and the WHO Secretariat. Together he said, “WHO has been working in a collaborative manner through a good mechanism of work, in building technical capacity and by involving members of the WHO Expert Advisory Panels, the WHOCCs and scientific working Report of the Twenty-ninth Session Page 10 groups”. Such collaboration provided a comparative advantage to WHO and enabled it to work more efficiently and effectively. One important area was research information management where the challenge was to make it conducive for the consumption of both the public and the policy-makers. Another challenge dealt with the content of information in terms of research results, which was usually overlooked. The issue was to make health research information understood by the target audience, by using simple language. Dr Bjorn Melgaard, DPM-SEARO, also highlighted new ways of working of the ACHR. The research agenda for ACHR had been developed, to deal with a particular thematic technical subject. The ACHR members could further assist in better use of national expertise and WHOCCs. The WHO country office in Thailand had initiated creation of database of national expertise to enable them to share their experience on international work. It had also established the Secretariat and the Charter for networking of national centres of expertise and WHOCCs. These initiatives were to be expanded to other Member States. The Regional Director had started the process of decentralization, whereby greater authority had been delegated to the WHO Representatives. They could now approve bilateral or horizontal collaboration, such as working across borders (e.g. the Myanmar and Thailand joint proposal on border health issues). The ACHR members discussed the critical issue of why few decision- makers used research results as evidence for developing health policies, which was a big and continuing challenge. Many health researchers conducted studies without linking them to the needs of health systems. Many countries had not yet adopted the national health research agenda. Researchers tended to stay away from policy-makers and hardly any dialogue existed between the two parties. Research results were mostly discussed among researchers. Conducive environment does not exist in which researchers and policy makers could not share and express their perception and needs. WHO and its partners were planning to have a Ministerial Summit on Health Research in November 2004 at Mexico, at which 20-30 ministers of health, science and technology would be attending to share their health research development. In order to prepare a smooth dialogue at Mexico, senior policy-makers from selected countries would meet in Kuala Lumpur, Malaysia in September 2004. The ACHR members felt the urgent need to revisit primary health care (PHC) and health-for-all (HFA) approaches which brought success on improved health status in many countries. Countries had adopted and WHO South-East Asia Advisory Committee on Health Research Page 11 accelerated the implementation of the concept, approaches and programmes of PHC/HFA, to narrow the health gaps and to increase the use of knowledge. Simple technology such as oral rehydration therapy (ORT) was invented and made widely available and easily accessible for people, with strong political support and commitment. Despite such successes, large proportions of people were still left behind for health development, the main reason being political and systemic constraints. This highlighted the need for organizing seminars, forums, discussions and debates for effective interaction and exchange of ideas and findings between researchers and policy-makers, and also between researchers and the general public. The experience of effective control of SARS and Avian Flu recently highlighted the need for health research with stronger political support. High- level policy-makers including Heads of States of both affected countries and countries that could potentially be affected, were able to meet and discuss on why such epidemics of emerging infections diseases occurred, and how they could be controlled as fast as possible. Urgent response by health research institutions at global, regional and national levels, to identify the causal organism, make appropriate diagnosis, and contain them, became important. Health and biomedical research needs to be carried out in a coordinated manner among all research institutions. In the case of SARS, for example, it took two months to identify the causative agent. All new health initiatives needed strong health systems, and therefore, health systems research, operational research, and policy research had become more important than before. Health systems research would bring evidence to strengthen health systems. Health research on health systems was complex and difficult, and moreover, did not involve any urgency. Health systems research needed new approaches to encourage countries to carry out more studies, especially to elicit tacit knowledge. The ACHR members congratulated RPC/HQ for assisting countries with the framework for health research systems, and providing analytical tools and instruments for assessing the performance of national health research systems. The tools on health research system's performance had been pilot-tested in 13 countries globally (two –Thailand and Indonesia from the Region), and soon there would be workshops and training for study teams to enable them to conduct analysis based on country needs. Data on individual and institutional survey had been submitted to WHO/HQ. The ACHR members proposed that WHO-RPC/HQ should strengthen capacity-building for country teams to enable them to analyse their data. The findings would be utilized as input for Report of the Twenty-ninth Session Page 12 the "World Report on Knowledge for Better Health" to be launched at the Mexico Summit. A session on the global project of national health research systems' assessment was scheduled at the eighth session of the Global Forum for Health Research, to be held in Mexico City, back to back with the Ministerial Summit for Health Research, in November 2004. As countries were already familiar with the quantitative method, they needed to build capacity on qualitative method. This could be in the form of training consisting of a comprehensive packet on qualitative methods: the concept and designing of questionnaires; and analysing and interpreting the data gathered from study using qualitative method. Qualitative tools for assessing NHRSA, which is globally developed, should be further adapted to each country’s context, especially if periodic assessment is needed to assess the performance. Furthermore, these tools could draw on more in-depth observations to make them more user-friendly and un-complicated. The next effort should be to study strategies and mechanisms in order to find out how the performance of national health research system can contribute to effective health system development. It is recommended that an analysis be made in this regard. In order for countries to be instrumental in carrying out health system research, they had to develop a strong health research system. Even in a small developing country like Bhutan and Maldives, health research systems' development played pertinent roles. It was proposed to make use of high-level political forums of the Region for further commitment in bringing knowledge into action. Research had to be used as a basic tool to develop appropriate health care systems, in order to reach large segments of population who lived in difficult places. The ACHR members who were chairs of health/medical research councils shared the updates on the progress on health research. The Bangladesh Medical Research Council (BMRC) had provided ethics research training in collaboration with the National Institute of Health (NIH) under the Fogarty grant and had expanded the participation of Kazakhstan scientists. It was imperative for Bangladesh to strengthen the Ethical Review Boards (ERBs). In Maldives though commitment to health research was high, the only formal institution of research was under the Ministry of Health. Concerns were expressed that research results must reach the people. The Chair of National Health Research Council (NHRC) also raised concerns on the issue of misuse of medicines. WHO South-East Asia Advisory Committee on Health Research Page 13 The ACHR member from Bhutan noted the different stages of health research development in countries of the SEA Region, and that Bhutan was among countries in the early stage of development. Much was still needed to build national health research in Bhutan. With the existing status, the member viewed advocacy as the appropriate strategy to lead Bhutan to rapid progress on the development of national health research system. Capacity-building on development of good research proposals that could meet the expectations of donors was a continuous effort of Medical Research Councils of Bangladesh and India, and of the Nepal Health Research Council. Much of the work being done in collaboration with international agencies and institutions in Bangladesh was focused on arsenic, the biggest health problem of the country. The emerging infectious diseases or EID, chosen as the topic for the current meeting of ACHR, was very much relevant to Bangladesh, which like Malaysia, was hit by the outbreak of Nipah virus recently. Kala-azar and dengue also continued to be high-disease burdens for Bangladesh. With health problems becoming increasingly complex these days, the challenge was to work on developing a more integrated approach. Health and non-health disciplines had become more intertwined. The SARS outbreak provided evidence of the close relationship between medical and health problems, and economic and social problems. The ACHR stressed the need for more attention to be given to non-medical and non-health research, involving research on the cause-effect relationship between a certain health problem and the non-health factors such as economy, education, and the social and gender factors. In recent years, much had been done to build the database for health research such as “SHARED”, which enabled researchers to share and obtain inputs on their research work. Further efforts should be carried out beyond the use of the database for research, such as for resource mobilization, and for building network and collaboration among researchers with common interests. This issue was related to knowledge management in which WHO could play a catalytic role. The discussion among ACHR members concluded by highlighting several key issues as follows: � The Regional Office should allocate a certain percentage of the Regional budget to promote health research of regional importance. However, this should take into account the country budget as well. Report of the Twenty-ninth Session Page 14 Regional budget should be used primarily for coordination and catalytic purposes, whereas country budget should be used more for funding direct research costs. A proper management set-up will help ensure achievement of the objectives of these collaborative research efforts. � WHO should help create better international collaboration (between developed and developing countries) with the view to addressing priority country issues; achieving better balance and use of available resources; sharing and management of research data and materials, and sustainable capacity-strengthening of developing countries. This may require WHO to play the negotiating role rather than just the advocacy role through formulating principles and code of good practices. � WHO and countries should pay more attention to the need for capacity-building in research management. Such capacity-building is needed not only for researchers but for research users, especially the policy-makers. � Countries should establish mechanisms that will help ensure better involvement and integration of non-medical health research disciplines into the priority health research setting as well as other research planning and granting mechanisms. The mere existence of medical research councils in many countries may not be adequate to integrate non-medical health research needs into the priority health research agenda. The effort to create national health research forum as a regular mechanism for exchange and decision-making in health research policies and planning may be a good example worth trying. � Besides working to develop international database or access to existing research information, WHO and countries should work together to develop mechanisms in countries towards proper knowledge management in order to ensure the transfer of research knowledge to relevant and appropriate groups of research users such as policy-makers. Such mechanisms will help digest research information (both emanating in countries as well as being retrieved from other sources) so that it becomes usable by various groups of research users. WHO South-East Asia Advisory Committee on Health Research Page 15 � Countries should carry out exercises on health research system assessments that would help them to focus on and identify priority issues that need be to be addressed and improved. 2.2 Regional Health Research Priorities on Emerging Infectious Diseases 2.2.1 Situation Analysis of Emerging Infectious Diseases The Chairman, Dr NK Ganguly stated that emerging infectious diseases (EID) are making difficult challenges ahead, since they were linked with environmental, developmental and socio-cultural aspects, and, often, contributed a significant impact on national economy. Combating these EID required strengthening surveillance as part of public health systems, and also better understanding of epidemiology and transmission patterns. Dr David Heymann, Representative to Director-General, WHO/HQ, in his presentation, started with the global experiences with recent epidemics of SARS, Avian influenza, Dengue and dengue haemorrhagic fever (DHF) and Nipah infection. He also identified possible research priorities and areas for strengthening at global and the Regional Office level. He gave examples on three pandemics of influenza that had historically been recorded, in 1918, 1957 and 1968. The antigenic drift that occurred continuously and uninterruptedly mandated that a new vaccine had to be developed almost yearly. WHO had maintained a global network of influenza laboratories, to continuously monitor flu epidemics around the world. There is an impending danger that the influenza virus may jump the specific barriers, and it could cause epidemics leading to human-to-human transmission. The Avian flu epidemics which occurred earlier this year, besides its health impact, also led to culling of millions of chicken, with an extremely adverse economic impact. While appropriate vaccine could be made available, the issue of inequitable distribution was yet to be overcome. The research priorities regarding avian flu included: (i) better understanding of animal and human influenza molecular biology and epidemiology; (ii) vaccine and antiviral drug development; (iii) enhancing the capacity for outbreak containment; (4) assessment of economic impact, and (v) research relating to behavioural interventions and risk communication. Dengue/DHF occurred frequently in the Region in epidemic forms for a few decades. The virus was now shifting to newer geographical areas and population groups, becoming more virulent. Research priorities included Report of the Twenty-ninth Session Page 16 dengue epidemiology and new methods of vector control; development and delivery of vaccine and antiviral drugs, case management of dengue/DHF patients; the assessment of economic impact, and risk communication. The SARS epidemic in China during 2002-2003 also underlined the importance of international travel in disease transmission, the need for global alert and containment, and informing the occurrence of disease transparently and openly, and sharing information during outbreaks among countries. The SARS epidemic had devastating economic effect and was responsible for reducing Asia’s GDP by US$ 18 billion, and nearly US$ 60 billion in lost demand and revenues. Areas where countries of the SEA Region could make contribution to SARS research included understanding epidemiology; contributing to vaccine and antiviral development, and in the areas of patient management, laboratory safety and infection control, and risk communication. In summary, three broad areas for research and development were identified: (i) obtaining complete epidemiological information, (ii) developing new and improved tools, and (iii) identifying cost-effective strategies. It was recognized that Asia will have to play an increasingly vital role in development of new drugs and vaccines – and that it should be prepared to take up this global role. Dr Chantapong Wasi of Mahidol University, Thailand, made a short presentation on the experience of social, behavioural and economic impact of emerging infectious diseases. Following the prevention and control of epidemics of SARS and Avian flu, Thailand now had a national preparedness plan for management of emerging diseases. Between 1 December 2003 and 25 March 2004, Thailand had 21 probable cases of Avian flu with eight deaths. In addition, various types of animals such as chicken, ducks, ostrich, and tigers were affected. Besides agriculture and animal husbandry industries, the outbreak had significant impact on other industries, construction and hotels, etc. leading to great economic losses. Thailand now prepared its response which included surveillance, patient care, laboratory facilities and public information and dissemination. In order to better characterize the epidemic, the emerging infectious diseases surveillance should cover clinical aspects, i.e. case definition, etiological diagnosis, zoonotic and vector surveillance. A network should be established consisting of both international and national linkages, including the full use of WHO CCs and centres of excellence. Besides a technical working group at national level, advocacy and WHO South-East Asia Advisory Committee on Health Research Page 17 policy-making groups also need to be established. Laboratory preparedness in Thailand consisted of strengthening the capacity of diagnostic laboratories, training, technology transfer and partnership and close linkages between clinical and veterinary information. It had also developed a food safety policy to ensure hygienic behaviour among food handlers, proper cooking, and good animal husbandry practices. Public information on correct personal safety practices and handling of birds were identified as important issues to be handled during the outbreak. Professor Ascobat Gani, Faculty of Public Health, Indonesia, in his presentation on policy and managerial issues in emerging infectious diseases prevention and control, emphasized the importance of international collaboration. At the outset, he emphasized that policy and its management must be based on evidence. It was clear from the SARS and Avian flu outbreaks that emergence of new pathogens could create substantial losses in terms of human lives as well as severe economic consequences, and that system research on epidemiology, its mode of transmission and risk factors were necessary to control the outbreak. Four policy and managerial issues were relevant: (i) beyond-health policy issues, (ii) financing the policy; (iii) delivery system, and (iv) research policy. Dr Ascobat highlighted the beyond- health policy issues such as the need for advocacy, emphasizing the centrality of EID in economic development. This would require assessment of economic impacts of EID, analysis on the costs of preventing and controlling these diseases versus benefits foregone due to such diseases. Recognizing that destruction of animals and trade embargo would cost local farmers/animal husbandry the enormous amounts of money, a system of compensation should be considered. The economic impact often led countries to adopt a multi-sectoral approach, involving sectors such as health, agriculture, immigration, trade and tourism, etc. The issue of financing the policy required an understanding that interventions used to combat emerging diseases were the public goods with large externalities. These included surveillance, health promotion, and environmental sanitation. Hence, interventions for EID should be supported through the government action as public goods, unlike interventions for noncommunicable diseases which are based on individual action. The responses needed should be shared by the government at various levels as well as by international donors. This was linked with the national health care delivery systems, such as surveillance capacity at all levels, use of information Report of the Twenty-ninth Session Page 18 technology, laboratory capacity and logistics management. Human resources training and networking, and having an epidemiological surveillance team at local level were needed. Dr Ascobat also stated that the health research policy for EID covered biomedical and clinical research required mapping of capacity at various levels. Assessment of risk was needed to develop and implement local specific interventions. In order to mobilize policy-makers through advocacy, analysis of economic impact would be required. The Chairman, Dr NK Ganguly, also outlined the successes achieved in tackling EID in Asia, while indicating the vulnerability of the Region, due to most outbreaks being originated from Asia. When classifying EID into different types, it was clear that an effective response to EID required early detection, identification of the organism using available tools, approaches to case management and defining of susceptible populations, and institution of control measures. Historically, research had played an important role in identifying the cause of outbreaks, for example, plague and viral encaphalaitis in India. The Chair also identified health research priorities, in the area of surveillance of existing and emerging diseases, impact of environmental factors such as developmental projects, and policy-related research. Environmental factors, those are to be studied, included impact of dam construction, natural calamities such as earthquakes and effects of global warning etc. Most factors such as migration within and outside the country, irrational use of drugs, impact of social inequities and poverty, and the role of customs and behaviour in disease transmission also formed areas for research. Other research priorities included development and use of tools (i.e. diagnostic tests, development of animal models, GIS and satellite imaging and remote sensing). These areas either led to policy formulation (documenting, research-based evidence, and economic impact analysis) or were linked to infrastructure development i.e. research training, laboratories, setting up repositories and sharing of infrastructure, facilities and products among countries. Research also helped in building and strengthening international collaboration through the use of internationally-accepted definitions during outbreaks, establishing mechanisms for flow of information, and developing of tools by WHO CCs or by centres of excellence at country level. WHO South-East Asia Advisory Committee on Health Research Page 19 Discussion Ensuring access to vaccine by developing counties needed to be tackled through a system of developing high volumes at low cost. Since the private sector was involved in vaccine development while government’s role was to facilitate the process, it may be useful for WHO to engage all partners in discussions on this issue. Regarding the issue of transportation of laboratory specimens, guidelines were available on packaging of specimens according to bio-safety requirements on the basis of which WHO can facilitate transport of samples to any country. These guidelines were also available with WHO country offices. Networking and linkage among countries were required to ensure that samples from smaller countries which did not have the required level of expertise were sent to other countries for processing. With a view to facilitate intercountry and inter-regional collaboration, discussions were presently in progress with the Western Pacific Regional Office to develop a bi-regional strategy on emerging diseases. Based on the presentations and ensuing discussions, the following areas of research in EID were identified: (1) General � Assessment of vulnerability of specific countries to emerging infectious diseases; � Evaluating the existing gaps in current surveillance system; � Assessing national epidemiological and laboratory capacities in outbreak containment; � Facilitation of additional resources for building health system capacity; � How can partnerships be developed with the private sector, civil society and policy-makers; � Identifying cost-effective strategies and policies and how to advocate their use in Member countries, and � Using modern technology for information management and dissemination. Report of the Twenty-ninth Session Page 20 (2) SARS and Avian Influenza � Better understanding of molecular characteristics of the virus; the transmission pattern including link with animals in terms of degree of exposure; and risk factors responsible for the spread of these new pathogens; � Evaluating the effectiveness of existing tools (vaccines and antiviral drugs), specifically the role of vaccination of chicken in preventing transmission; the role of antiviral drugs in preventing epidemics, and methods of enhancing access to vaccines and antivirals for the poor and the marginalized, and � Developing new vaccines, drugs and diagnostics (participating in clinical trials); system of delivery to where needed most. (3) Dengue and Dengue Haemorrhagic Fever � Mechanisms for dengue vaccine development and licensing, and � Documenting trends in dengue case fatality rate following implementation of case management guidelines for advocacy, programme planning, and evaluating the impact of this intervention. 2.2.2 Health research priorities on emerging infectious diseases Professor U Paing Soe, Director-General, Department of Medical Research (Lower Myanmar), moderated this session. The participants were divided into three Groups - A, B and C to identify health research priorities, to be derived by analyzing the factors of disease burden, such as seriousness, persistence, what had been done, and how effectively interventions had been carried out so far. The following paragraphs described the summary of the presentation of the groups. Group A Group A came up with an agreement on the health research priorities related to areas of epidemiology, laboratory, and prevention and control of EID, particularly, Avian influenza and other types of flu, SARS, Dengue/ Dengue Haemorrhagic Fever, TB, malaria, HIV/AIDS, diarrhoeal diseases, leptospirosis and Nipah virus. For each of the diseases, the research priorities are: WHO South-East Asia Advisory Committee on Health Research Page 21 Avian Influenza � Operations research on clinical and laboratory clinical system (e.g. the Flu net), � Basic research: diagnostic tool development, and � Bio-molecular characterization of agent. SARS � Epidemiological research; � Operations research on clinical as well as laboratory clinical system, and � Basic research. Dengue and Dengue Haemorrhagic Fever � Operations research on clinical as well as laboratory clinical system e.g. Dengue Net, and � Basic research: diagnostic tool development, � Bio-molecular characterization of agent. Tuberculosis � Operations research on Multi-drug resistance of TB (MDRTB); � Basic research on epidemiology, and � Clinical trial for MDRTB as well as for traditional medicine for MDRTB. Malaria � Operations research on community-based surveillance for early detection of outbreak; � Clinical trial (efficacy trial on drugs and vaccines); � GIS (Field-action research), and � Basic research: diagnostic tool development, bio-molecular characterization of agent. HIV/AIDS � Surveillance; � Operations research on high-risk group identification; Report of the Twenty-ninth Session Page 22 � Efficacy trial on drugs and vaccines; � Antiviral drug resistance monitoring, and � HIV/AIDS biomedical characterization of virus. Diarrhoeal Diseases � Clinical trial for vaccine research (cholera and rota virus). Leptospirosis � Development of rapid diagnostic tools. Nipah � Research on ecology and transmission (in collaboration with WPRO), and � Development of diagnostic tools. Group B Group B identified health priorities in the areas of social, behavioural and economic aspects of EID, which were generic and applicable to any disease under EID. Knowledge � At household level: risk perception of communities, health-seeking behaviour, and � Lay public and society: what messages to be delivered, and how? Role of other sectors � Development of inventory of rules and regulations, and � Barriers to the implementation of rules. Infrastructure � Defective health systems: interventions of health systems – hospital, health centre and KAP studies of health workers. WHO South-East Asia Advisory Committee on Health Research Page 23 Interventions � Identification of appropriate key holders (stakeholder analysis); � Barriers to best practices of health workers, how to sustain interventions; � Management of health systems (management of health managers); � Evaluation of existing interventions; � Social factors contributing to effectiveness; � Costing of interventions, and � Cost-effectiveness of alternative interventions. Documentation of regional best practices � Political and economic aspects of decision-making. Group C The Group identified the health research priorities in the area of public health management for prevention and control of EID including policy research. The Group identified the EID based on syndromic approach, and grouped the diseases into: vector-borne diseases such as malaria, JE; respiratory diseases; encephalitis; haemorrhagic fever and other diseases. (a) Research on pathogens based on syndromic approach for: � Malaria and Japanese encephalitis: � Drug resistance- new medicines -drug policy; � Insecticide resistance (impregnated bed net; environ- mental situation); � Local-level management (intervention packages); � Respiratory diseases: alternative drugs; vaccines; � Encephalitis: antiviral drugs; vaccines; � Haemorrhagic fever; antiviral drugs; vaccines, and � Other VB diseases. Report of the Twenty-ninth Session Page 24 (b) Systemic issues � Global policies: international; � National public policies: decentralization; public health regulation; � Surveillance: human diseases; animal diseases; zoonotic diseases; laboratory infrastructure, and � Lack of human resources: veterinary epidemiologist; field epidemio- logist. (c) Control issues Technology: � Available and new technology (vaccines; medicines, diagnostics; insecticides; protective gears); and, � Predictive epidemiology: modelling-control-dry run; tools/ methods Transmission interruption: � Quarantine/ isolation; facilities, staff; � Case management; hospital care; transfer of infected material; � Contact tracing; animal culling and related issues: surveillance; vaccination; � Integrated vector control; � Integrated human disease surveillance: surveillance sites; information-sharing, and � Management of emergency response: emergency response teams; supplies management. (d) Coordination � Animal husbandry; OIE; � Other sectors: tourism (port-health); trade (ban - SPS/TBT, Standards for IHR travel advisory); transportation (migration), and � Work with the private sector: subsidy; tourist destinations. (e) Intercountry collaboration for Regional surveillance: � Network of laboratories [Regional Laboratory (Lyon Model)]; sentinel sites; Epidemic Intelligence Networks; Epidemic Alert and Response Teams; WHO South-East Asia Advisory Committee on Health Research Page 25 � Cross-border control: Cross-border points; Information-sharing; � Multi-centre research collaboration; Access to research information; exchange of faculties; capacity-building; intellectual property; material-sharing/ transfer, and � Reducing the economic impact on affected countries: working with countries; working among UN Agencies, WB and WTO. (f) Information-sharing � Use of public media: access to information-translating into policies; � Packaging of messages: understanding stakeholders' languages; � Open access to surveillance: sharing information across sectors; sharing across borders-global network-regional network, and � Information on supplies- source of supplies: vaccines; laboratory supplies; protective materials. 2.3 Work Plan for Health Research Priorities on Emerging Infectious Diseases Dr Adik Wibowo, Regional Adviser for Research Policy Cooperation, SEARO introduced briefly the group works on the development of work plans for health research in EID. Based on results of the previous group works, each had to select five priority research areas, and to elaborate and develop a work plan based on the matrix comprising the following components: � What would be the outcome by 2007? � What would be the benefit? Whether it will benefit at all: � New basic knowledge; � New and improved tools; � New and improved intervention methods, and � New and improved policy/strategy. � Who will take the lead? � How many countries/centres were involved? � What kind of partners were to be involved? The matrix to develop the work plan was as under: Report of the Twenty-ninth Session Page 26 SN Health research priorities, types of research Expected Outcomes; 2004- 2007 Benefit of research Actors involved, who will take the lead; countries involved Other mechanisms and other remarks All three Groups deliberated and came up with the following: Group A (1) Operations research on integrated disease surveillance system (including GIS); (2) New rapid diagnostic test for MDRTB; (3) Clinical trial of combined TRM for MDRTB (India and Myanmar); (4) New rapid diagnostic test for dengue, avian flu, leptospirosis, SARS; (India, Indonesia and Thailand), and (5) Screening of "new" drugs for malaria and HIV (India, Indonesia and Thailand) for new drug discovery. Group B (1) Economic cost of EID prevention and control; (2) Health-seeking behaviour; (3) Barriers to effective health care delivery, KAP of health care workers; (4) Outcome evaluation of selected interventions on EID, and (5) Regional experience on responses to EID, including multi-sectoral responses. Group C (1) Analysis of existing disease surveillance systems, and model development to incorporate EID: (with special emphasis to study details in countries with decentralized structure; integrating these systems into national health systems); (2) Feasibility study on setting up of regional epidemic rapid alert and response centre, with full support of laboratory and epidemiological WHO South-East Asia Advisory Committee on Health Research Page 27 analysis [active search and validation of epidemics and mobilizing response teams, within the framework of IHR for the Region]; (3) Capacity assessment of public health laboratories, with bio-safety infrastructure, in the Region, followed by capacity-building plan; (4) Public-private partnership for research and development (R&D) networks for vaccines, medicines and diagnostic tools: Inventory of public and private R&D institutions, including molecular and biotechnology institutes and their networks [Regional Vaccines Policy and Regional Essential Medicines Policy], and (5) Economic studies on EID impact and related public policies, including choosing of interventions and policy options. Discussion Research priorities on emerging infectious diseases Research priorities on EID could not be formulated in a fragmented manner. Rather, they should lead to an integrated "systems development" towards the prevention and control of EID. The group members characterized the following areas of research as priorities on EID: (i) Studies on molecular characterization of pathogenic infectious agents: Research in this area should focus on the evolution of pathogenic agents, which lead to changes in pathogenicity, transmissibility and host- adaptation. In technology-advanced laboratories, the genetic characterization of such infective microorganisms can be undertaken to identify and facilitate development of new treatments and vaccines. Studies should also be undertaken to assist in developing novel strategies to overcome drug resistance phenomena. Molecular epidemiology to trace the transmission pattern of diseases across national boundaries and ascertain their sources of infections can support disease control activities. (ii) Policy analysis: Recent outbreaks of SARS and Avian influenza have demonstrated the wide impact of EID on socioeconomic aspect, which warrants the need for a concrete national policy on EID including practical strategies for immediate and appropriate actions. In order to build up a comprehensive national policy on EID, studies should be carried out in the area beyond health sector, such as social and economic, trade and commerce sectors, in order to analyze the policy towards EID. Policy analysis needs to be Report of the Twenty-ninth Session Page 28 conducted to review the existing policy and to identify the constraints in implementing the policy on EID. (iii) Behavioural studies: Research in this area should cover studies on (i) knowledge and behaviour of the general public in response to EID, (ii) generating public awareness to avoid panic, and alarming reactions when dealing with outbreaks of emerging infectious diseases, and (iii) media perception and response to the dissemination of information on EID. The study results will form inputs to the development of guidelines for the general public to prepare themselves against EID. (iv) Studies on the economic impact of EID: These studies should uncover the magnitude of loss in monetary terms, as well as identify the sector or economic activity that is mostly affected by the EID. The economic impact studies should also focus on the impact of interventions, though the cost- benefit analysis is difficult to perform due to the complexity of calculating the loss of human lives in monetary terms. Studies need to be undertaken on financing in order to identify the flow of costs and efficient utilization of available resources. The economic cost of social behaviour in response to EID is another area for research. This is to understand better the various social phenomena in responding to EID and to compare the economic loss caused by various social phenomena. (v) Strengthening public health laboratories: Laboratories are important facilities for ascertaining the aetiology of EID. An inventory of microbiology and biotechnology laboratories available in the countries of the Region should be developed as soon as possible, classifying them into different quality and capacity. The compendium would help identify potential laboratories which could be designated as the centres of excellence for EID prevention and control. Strengthening of laboratories requires building the capacity in human resources, providing financial support, and integrating them into a quality health system. (vi) Situation analysis on existing modalities: Many countries either with the help of their own budget or with the assistance of development partners, have built their infrastructure. They also made them functional to carry out useful programmes to support research activities on EID. Indian Government with the additional assistance from the World Bank is able to establish national disease surveillance system. The Asian Development Bank particularly WHO South-East Asia Advisory Committee on Health Research Page 29 supported Indonesia with the project on promotion and utilization of GIS and CTN (computerized telecommunication network) at the district level for strengthening surveillance. Various anthropological and social studies have covered issues of health-seeking behaviour. The Early Warning Outbreak Recognition System (EWORS) is a system developed at NAMRU, Indonesia, which has been used by many countries in South-East Asia. This has now been upgraded as ASEAN Infectious Diseases Network (SEANET) that facilitates information and institutional exchanges by creating linkages via the web. The polio/measles laboratories in Indonesia are an example of good networking, not only for specific diseases but also for all emerging diseases. Strengthening laboratories and surveillance system Public health laboratory services are mandatory for early diagnosis, tracing the spread of infection, ascertaining antimicrobial susceptibility and supporting epidemiological studies to understand the disease profile in the community. Accurate and timely analysis by laboratories is critical to identifying, tracking and limiting public health threats. The laboratories in the Region need to work and collaborate in a concerted manner in order to build an efficient national network of public health laboratories. A good surveillance system is the backbone of efforts against EID as it is an essential element for any disease control and eradication effort. Timely recognition of EID requires early warning systems to detect these diseases and to come up with quick measures to control the spread of disease. Surveillance of the host factors of EID should also be strengthened and be integrated into the systems network. Coordination, collaboration and networking EID, being a multi-sectoral issue, needs to be reviewed from various perspectives in order to obtain as much information and evidence as are needed. The origin of a few deadly EID like SARS and avian flu was in countries of Asia; however the spread of these diseases encompassed countries outside Asia as well. Since the most vulnerable population is in Asia, the research priorities on EID should focus on countries in Asia. Due to uncertainty in emergence of a disease, there is great need for WHO to work Report of the Twenty-ninth Session Page 30 through bi-regional contacts in coordination with its headquarters in Geneva. The WHO regional offices for the Eastern Mediterranean and the Western Pacific regions could work together with the South-East Asia Regional Office to strengthen support to countries. Strengthening health systems and health research systems Occurrence of outbreaks can be seen as an indicator of an ill-prepared health system. An efficient health system can not only quickly detect and respond to the outbreak during its earliest stage but is also sensitive and alert enough to spot a new and unidentified infection. The poor performance of health systems is strongly related to inadequate funding. There is need therefore to mobilize and allocate adequate financial resources to build and strengthen appropriate infrastructure to implement national plan for the prevention and control of diseases, develop adequate human resources, and to respond on time to outbreaks. There is also the need to strengthen the components of the health research system (improving knowledge and skills of researchers; mobilizing resources for research, and advocating to policy-makers to use the evidence) to enable it to carry out research on EID effectively and efficiently. Diseases categorized as emerging infectious diseases The ACHR members further discussed the scope of the definition of EID, for determining which diseases could be categorized under EID. Some members were in agreement with the framework proposed which tended to put all diseases under EID with the notion that EID in practice did not come in isolation. Malaria, TB, or leprosy may also be included later. The Group C members selected EID based on the syndromic approach. Members also discussed whether the list of EID should be limited to diseases, which already existed and persisted only in countries of the SEA Region or whether the list should be broadened to include those affecting the neighbouring regions. The discussion also traced the origins of EID to the years 1995, 1996 and 1997, when the subject was debated at the World Health Assembly intensively under emerging and re-emerging diseases. It was highlighted the link between research and development, and research led to development. Resources were needed for research. However, development was more complex and needed involvement of many other stakeholders. WHO South-East Asia Advisory Committee on Health Research Page 31 Follow-up of the work plan A regional task force consisting of country experts and relevant staff of the Regional Office would carry out further refining and transforming the broad activities of the work plan agreed upon during this ACHR session. The refinement of EID research proposals should be aimed at making the work plan tangible and crisp so as to allow its implementation by WHO and its Member States. For making the work plan functional, financial support was very much needed. The work plan should also aim to build linkages with other global programmes such as the “3x5” initiative, the polio campaign, and should seek ways of collaboration. WHO will provide technical support for reviewing, implementing and evaluating the research studies. In order for WHO to take the work plan forward, both country and the regional budget should be reviewed together in order to use identified funds in an integrated manner towards supporting the conduct of priority research on EID. 3. CONCLUSION AND RECOMMENDATIONS Professor Ganguly summarized and recapitulated the highlights of the meeting and the ACHR members adopted the following recommendations to the Regional Director and Member States. Recommendations The SEA-ACHR: (1) Strongly endorses the view that health research is an indispensable means to effective development of health systems, and urges Member States to develop and strengthen the capacity for health systems research, in order to address the challenges in reaching the MDGs; (2) Recommends that the Regional Office for the SEA Region facilitates the use of the new framework and cutting-edge instruments in implementing effective and efficient health research systems; (3) Recommends that WHO, especially WHO-RPC/HQ, promotes and supports the development and dissemination of tools and methodologies (both qualitative and quantitative) that are crucial for extending health research systems beyond conventional approaches. Priority-setting tools should address how to organize a good priority- setting process and how to involve stakeholders rather than how just Report of the Twenty-ninth Session Page 32 to rank problems. Knowledge-sharing should address not only knowledge management, but also the question of how researchers could better present their data and research findings; (4) Recommends that health research on EID should lead to strengthening and development of effective integrated disease surveillance systems, which would include strengthening of human resources; networking of public health and biomedical laboratories; capacity-building and budgetary and financial support; (5) Recommends that the Regional Office facilitates and supports the public policy analysis including economic analysis, in relation to the prevention and control of EID; (6) Recommends that the Regional Office facilitates health research focusing on public and media perception on the prevention and control of EID, as well as public responses to EID; (7) Recommends the Regional Office to establish a coordinating centre (within WHO) to coordinate the work of the existing disease surveillance network, facilitate capacity-building, and to conduct situation analysis (risk and vulnerable assessment), as well as to provide necessary support for strengthening the capacity for disease surveillance and health research, including epidemic alert and response by Member States, and (8) Requests the Regional Director to develop the work plan comprising health research priorities for the prevention and control of EID in the Region as proposed by this ACHR session (Annex 4), within the framework of Asia-wide disease surveillance strengthening. WHO should also follow up on resource mobilization and immediate implementation, in collaboration with country offices, regional offices and headquarters, as well as with other development partners. 4. CLOSING SESSION The Chairman invited Professor Chitr Sitthi-amorn and the Regional Director, Dr Samlee Plianbangchang, to say a few words in memory of the late Professpr Natth Bhamarapravati, having served as ACHR member for many years and also as Emeritus Professor, Centre for Vaccine Development, Mahidol University, Thailand, who passed away recently. WHO South-East Asia Advisory Committee on Health Research Page 33 Professor Chitr remarked that Professor Natth was very much dedicated to the health research work on infectious diseases, especially genomes. His long-time commitment to the work on prevention and control of Dengue/DHF, and to the development of relevant technology and its application shall always be remembered. Dr Samlee remembered Professor Natth as a humble scientist with a remarkable international reputation. He was the President of Mahidol University, Founder of the Asian Institute of Health Development, and was engaged in international and intercountry cooperation for health development, especially in infectious disease and health and biomedical research. Professor Natth was a scientist with a human face and his death was a great loss for Thailand. Dr Samlee Plianbangchang, in his closing remarks to the 29th session of the SEA-ACHR, appreciated the hard work put in by ACHR members and invitees. Though the work plans developed during the three-days session were broad, it was felt that the ACHR members and relevant national experts in EID could further develop through establishment of specific scientific working groups or technical task forces to refine and finalize these work plans. In order to facilitate the task of expert working groups, a network should be built among ACHR members and national focal points on health research, which should help establish regular consultations towards refining and implementing the work plans. The network should also make use of electronic communication to further facilitating its work. The Regional Office would be responsible for taking follow-up actions on implementing the recommendations of the 29th session of SEA-ACHR. In order to ensure implementation, it was important to assign relevant Areas of Work in the Regional Office, to revisit the respective work plan and activities, and to accommodate the work plans on health research in EID produced by the 29th ACHR session. The Regional Director stated that the mechanism that was set up for the 29 th session of SEA-ACHR was aimed at focusing the discussion on a specific health topic, with a view to ensure that research in the specific area was appropriately carried out and that the research results were utilized maximally. This focused approach would also be followed for the future meetings of SEA-ACHR with a specific theme or topic being chosen for each meeting. Report of the Twenty-ninth Session Page 34 Dr Samlee used the opportunity to thank the Government of Myanmar and H.E. Professor Kyaw Myint for inaugurating the meeting and providing full support to the conduct of the 29th session of SEA-ACHR in Yangon. The proposal of ACHR member from Indonesia for hosting the next session in Indonesia was noted. The Chairman then closed the session. WHO South-East Asia Advisory Committee on Health Research Page 35 Annex 1 TERMS OF REFERENCE OF SEA-ACHR To advise the Regional Director in the following areas: (1) Formulation and implementation of health research policies and health research agenda in the Region in line with the resolutions and policy guidance of the World Health Assembly, Executive Board and the Regional Committee, and also within the overall framework of the global WHO research policy. (2) Coordination and harmonization of health research activities of various national health research bodies/councils/departments, institutions with those of WHO, with the purpose of strengthening of national research capability and research management for health development. (3) Development, management and improvement of the health research information system, including research monitoring and evaluation, for evidence-based decision making. (4) Collection, analysis, and dissemination of existing health research findings on emerging scientific knowledge and technology, with a view to promote and foster research application and practices at the national and institutional levels. Report of the Twenty-ninth Session Page 36 Annex 2 LIST OF PARTICIPANTS ACHR Members Dr Harun-ar-Rashid Director, Bangladesh Medical Research Council Mohakhali, Dhaka Bangladesh Tel. 880-2-8828396 & 8811395 (O) Fax. 880-2-8828820 E-mail: bmrc@citechco.net Dr Sangay Thinley Secretary, Ministry of Health Royal Government of Bhutan Thimphu Bhutan Tel. 00975-2-326627; Fax: 00975-2-324649 E-mail: Sangaythinley@health.gov.bt Professor N.K. Ganguly ??? Director-General Indian Council of Medical Research Ansari Nagar, New Delhi 110 029 India Tel. 91-11-265896204 (O) and 91-11-26493145 (R); Fax: 91-11-26588381 E-mail: gangulynk@icmr.delhi.nic.in; icmrhqds@sansad.nic.in Dr Indrani Gupta Head, Health Policy Research Unit Institute of Economic Growth Health Policy Research Centre University Enclave Delhi-110 007 India Tel. 27667288; 27667570; 27667101 E-mail: indrani@ieg.ernet.in Dr Dini Latief Director-General, National Institute of Health Research and Development Ministry of Health, Jl. Percetakan Negar 29 Jakarta 10560 Indonesia Tel. 62-21-42645214; Fax: 62-21-4243933 E-mail: dini_latief@litbang.depkes.go.id Dr Agus Suwandono Director, Centre for Research and Programme Development on Disease Control National Institute of Health Research and Development Ministry of Health, Jl. Percetakan Negara 29 Jakarta 10560 Indonesia Tel. 62-21-4244375; Fax: 62-21-4248653 E-mail: dragus@indosat.net.id; selitbang@litbang.depkes.id Professor Sudigdo Sastroasmoro Department of Child Health Medical Faculty, University of Indonesia Jalan Salemba 6, Jakarta-10430 Indonesia Tel: 62-21-3147342; Fax: 62-21-3907743 E-mail: sudigdo_s@yahoo.com Professor Paing Soe Director-General Department of Medical Research (Lower Myanmar), Yangon, Myanmar Tel: 095-01-284419 Fax: 095-01-251514 E-mail: dmrlowerm@mptmail.net.mm Dr Sachey Kumar Pahari Chairman, Nepal Health Research Council Ram Shah Path, PO Box 2767 Kathmandu Nepal Tel: 977-1-254220; Res:977-1-4370406 4371225; Fax: 977-1-262469 E-mail: nhrc@healthnet.org.np Professor Dulitha N. Fernando ??? Professor of Community Medicine Faculty of Medicine, University of Colombo Colombo Sri Lanka Tel: 94-1-695300, 696243; Fax: 94-1-691581 E-mail: dulithafernando@hotmail.com; sunithf@sltnet.lk WHO South-East Asia Advisory Committee on Health Research Page 37 Professor Chitr Sitthi-amorn Director, Institute of Health Research Chulalongkorn University Bangkok Thailand Tel: 66-2-2188152;, 2188141 Fax: 66-2-2532395, 2552177 E-mail: chitr@md2.md.chula.ac.th; sunitra.p@chula.ac.th Professor Chantapong Wasi Department of Microbiology Faculty of Medicine, Siriraj Hospital Mahidol University, Bangkok Thailand Tel: 662-4197053-4; Fax: 662-4184148, 4113106 E-mail: sicws@mahidol.ac.th Dr Somsak Chunharas Secretary-General National Health Foundation 1168 Phaholyothin 22 Jatujak, Bangkok 10900 Thailand Tel: (662)5115855; Fax: (662) 939-2122; Mobile 01-8601704, E-mail: somsak@thainhf.org; somsak@health.moph.go.th Special Invitees Dr U Ko Ko Regional Director Emeritus and President, Myanmar Academy of Medical Sciences No. 27, Pyidaungsu Yeik Tha Road Dagon Township Yangon, Myanmar Tel: 95-1-538908 Professor Uton Muchtar Rafei Regional Director Emeritus and Professor of Public Health, University of Padjadjaran (UNPAD) 35 Dipati Ukur Street, Bandung, West Jawa 40132 Indonesia Tel/Fax: 00-62-22-2503275 Email: rafeiu@hotmail.com Professor Md Abdul Khalique BarBhuiya Acting Director, NIPSOM and Professor of Occupational and Environmental Health, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka 1212 Bangladesh Tel: 880-2-8821236 Dr U Htun Naing Oo Director-General Department of Medical Research (Central Myanmar), Pyinmana Myanmar E-mail: dg-dmrp@moh.gov.mm Dr U Thein Tun Director-General (a.i.) Department of Medical Research (Upper Myanmar) Mandalay, Myanmar E-mail: dg-dmrm@moh.gov.mm Professor Ascobat Gani Faculty of Public Health University of Indonesia Jakarta, Indonesia Fax: 0062-21-7863472 E-mail: asco@cbn.net.id Ms Maimoona Aboobakuru Deputy Director Ministry of Health Male Maldives E-mail: maimoona@health.gov.m. Dr Stanley de Silva Deputy Director-General (ET&R) Ministry of Healthcare, Nutrition and Ulva Wellassa Development Colombo Sri Lanka Tel: 94-11-2692213(O); 94-11-2731314 (R); Fax: 94-11-2679162 E-mail: stanley@health.gov.lk; sodesilva@hotmail.com Report of the Twenty-ninth Session Page 38 Other WHO Regions and Global Organizations Dr Abdul Ghaffar Health Policy and Systems Specialist Global Forum on Health Research (GFHR) 1-5 Route des Morillous 1211 Geneva 2, Switzerland Tel: 00-41-22-791-1606 Fax: 0041-22791-4394 E-mail: ghaffara@who.int Dr Mohamed Abdur Rab Regional Adviser Research Policy and Cooperation WHO Eastern Mediterranean Regional Office (EMRO), WHO Post Office, Abdul Razzak Al Sanhouri Street, Opposite Children’s Library, Nasr City, PO Box 7608, Cairo 11371, Egypt E-mail: abdurrabm@emro.who.int WHO Secretariat WHO/HQ Dr David L. Heymann, Representative of the Director-General (Polio Programme) and Former Executive Director, Communicable Diseases Dr Tikki Pang, Director, Research Policy and Cooperation (RPC) Dr Juntra Karbwang-Laothavorn, Special Programme for Research, Development and Tropical Diseases (TDR), Geneva karbwangj@who.int WHO/SEARO Dr Samlee Plianbangchang Regional Director Dr Bjorn Melgaard Director, Programme Management melgaardb@whosea.org Dr U Than Sein Director, Department of Health Systems Development Tel: 91-11-23370804; Fax: 91-11-23379507 thansein@whosea.org Dr Jai P. Narain Acting Director, Department of Communicable Diseases Tel: 91-11-23370804; Fax: 91-11-23379507,: narainj@whosea.org Dr U Myint Htwe Chief, Internal Review and Technical Assessment htwem@whosea.org Dr Adik Wibowo, Regional Adviser, Research Policy and Cooperation Tel: 91-11-23370804; Fax: 91-11-23379507: wibowoa@whosea.org Mr S.K. Bajaj Senior Secretary-RPC Tel: 91-11-23370804; Fax: 91-11-23379507: bajajs@whosea.org WHO Country Office, Myanmar Dr Stephan Paul Jost, Acting WHO Representative to Myanmar Mr P.P. Singh Programme and Administrative Officer Dr U Myo Paing National Professional Officer U Htay Win National Programme Officer National Organizing Committee Dr U Than Tun Sein Director for Socio-Medical Research Department of Medical Research (Lower Myanmar) 5 Ziwaka Road, Dagon PO Yangon 11191, Myanmar E-mail: ttsein@mail4u.com.mm Dr U Kyaw Min Director (Admin.) Department of Medical Research (Lower Myanmar) 5 Ziwaka Road, Dagon PO Yangon 11191, Myanmar E-mail: dmrblood@mptmail.net.mm Dr Daw Mon Mon Research Scientist/Head Medical Statistics Division Department of Medical Research (Lower Myanmar) 5 Ziwaka Road, Dagon PO Yangon 11191, Myanmar E-mail: lwinthiri@mail4u.com.mm WHO South-East Asia Advisory Committee on Health Research Page 39 Annex 3 AGENDA 1. Inaugural Session 2. Business Session 2.1 Review of the work of WHO on health research 2.1.1 Global work 2.1.2 Regional work 2.2 Regional health research priorities on emerging infectious diseases 2.2.1 Situation analysis 2.2.2 Health research priorities on emerging infectious diseases 2.3 Work plans for health research priorities on emerging infectious diseases for South-East Asia (2004-2007) 2.4 Conclusions and recommendations 3. Closing Session Annex 4 HEALTH RESEARCH PRIORITIES ON EID FOR THE SEA REGION 1. Surveillance Health Research Priorities Types of studies Expected Outcomes for Time Frame:2004-2007 Benefits Actors and countries involved Mechanisms Surveillance system - Situation analysis of existing surveillance system - Operational research - Modelling for integrated surveillance system of EID (including GIS), taking into account different types of national health systems. - Situation Report on strengths, weaknesses of surveillance system - Improved and harmonized surveillance for EIDs - Model development of integrated surveillance system - Prepar e an inventory of expertise and institutions on emerging infectious diseases. - Strengthen early warning signs of outbreak - Improve national surveillance systems - Develop effective integrated surveillance system - Establishment of regional surveillance network - WHO SEARO - High-burdened countries in SEAR/WPR - The ASEAN Disease Surveillance - Singapore Disease Surveillance centre - Mekkong Disease Surveillance - Communicable Diseases Centres/US Naval Medical Research Unit (NAMRU) - WHO/SEAR and WPR - ASEAN countries - Regional Forums: APHRF, INCLEN and others - Meeting with national/regional partners 2. Development of New Diagnostic and Tools: Discovery of New Vaccines and Drugs Health Research Priorities Types of studies Expected Outcomes for Time Frame:2004-2007 Benefits Actors and countries involved Mechanisms Development of new diagnostic tools; discovery of new vaccines and drugs - Clinical trials - Invention of new rapid diagnostic tools for selected EID (Multi-drug Resistnace TB, Dengue, Avian Influenza, Leptospirosis, SARS) - Drug screening for Malaria and HIV/AIDS - Mapping and inventory for vaccines, drugs, diagnostics in public, private sectors including NGOs - New diagnostic tools - New drugs - Cost-effective, alternative treatment regimen - Establishment of a clinical outcome trial network e.g. Dengue/Dengue Hemorrhagic Fever case fatality rates. - Improved care, prevention and control - Improved correct diagnosis - Thailand, Indonesia, India - WHO - Drug companies - Global Funds for Fight of AIDS, TB and Malaria (GFATM) - Global Alliance for Vaccine Initiative (GAVI) - Endemic countries, individual countries - National Science and Technology Institutes, R&D (Biotechnology laboratories and Private Industries) - All SEAR countries, WHO/SEARO, and other partners; - For TB: Myanmar, India Traditional Medicine Departments, Clinical Centres - In collaboration with Public Private Partnership - WHO Special Programme for Research and Training in Tropical Diseases (TDR) 3. Studies to Strengthen Laboratories Health Research Priorities Types of studies Expected Outcomes for Time Frame:2004-2007 Benefits Actors and countries involved Mechanisms Studies to strengthen laboratories - Feasibility study with full support of laboratory and epidemiolgical analysis [active search and validation of epidemics and mobilizing response teams, within the framework of Internatinal Health Regulations for the Region] - Assessment and analysis study - Feasibility report - Mapping of expertise and centres - Inventory of public and private Research and Development institutions, including molecular and biotechnology institutes and their networks - Regional vaccine policy - Regional essential medicines policy - Capacity of public health laboratories assessed - Plan for capacity-building developed - Early and rapid alert and response, for possible control of outbreaks - Network of capable public health laboratories to support surveillance and quality assurance in place - WHO SEARO - Indonesia, India, Thailand - FETP units - Other selected countries. - WHO national laboratory networks, - Health Ministers' Forum 4. Health Systems & Socio Economic Impact Analysis Health Research Priorities Types of studies Expected Outcomes for Time Frame:2004-2007 Benefits Actors and countries involved Mechanisms Health Systems and Socio- economic impact analysis of 3-4 recent EID in South- East Asia Member Countries - Health system analysis: human resources, public- private partnership studies - Outcome /impact analysis: Evaluative studies, Economic, Market, Public policy, Behavioral studies - Analysis of barriers to effective health care delivery; Knowledge attitude practice of health care workers - Report on regional experiences in response to selected EID - Understanding health- seeking behavior and public, communities and media perceptions on risks of EID - Strategic plans for human resources , for budgeting, for advocacy, for choosing interventions and policy options, for planning risk communication on EID - For reallocate resources if necessary (including multi- sectoral response to EID, public- private partnerships) - Identification of appropriate interventions - Effective use of resources - Advocacy tool for sensitizing national governments, development planners, donors - Healthy public policy options - Appropriate interventions identified - Tools for economic studies (CE) developed - Research institutes - Health Policy and Health Planning commissions - Health Ministry - Network of health economists - Donors working with communities, local and state- level government bodies - WHO Collaborating Centres and National Centres of Excellence network - Researchers; planners and programme managers at country level; researchers, health care workers, health facilities, NGOs, trainers of health care workers - Health Ministry - WHO - Capacity-building to carry out socio- economic research - Protocols and guidelines - Regional approach. - One research protocol for selected countries/specific country research proposals Report of the Twenty-ninth Session Page 44 ORK PLANS ON HEALTH Annex 5 LIST OF WORKING DOCUMENTS Sl. No. Document Names Document No. 1. Terms of Reference and Criteria of SEAACHR membership SEA/ACHR/29/1 2. Provisional Agenda SEA/ACHR/29/2 3. Programme of Work SEA/ACHR/29/3 4. List of participants SEA/ACHR/29/4 5. Global work on health research SEA/ACHR/29/5 (Agenda item 2.1.1) 6. Regional work on WHO health research programme SEA/ACHR/29/6 (Agenda item 2.1.2) 7. Situation analysis on emerging infectious diseases SEA/ACHR/29/7 (Agenda item 2.2.1) 8. Health research priorities on emerging infectious diseases (Group work) SEA/ACHR/29/8 (Agenda item 2.2.2) 9. Work Plan for health research priorities on emerging infectious diseases for South-East Asia (2004-2007) – Group work SEA/ACHR/29/9 (Agenda item 2.3) 10. Other documents