WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE .
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE
WP/RC10/7 Add.l 31 August 1959 ORIGINAL: ENGLISH
Tenth Session Taipei 16-22 September 1959 Agenda Item 14 MALARIA ERADICATION
Since the production of document WP/RC10/7 several problems have arisen in connexion with the malaria eradication programme Ylhich are now brought to the attention of the Regional Committee. 1 RESIsrANCE TO INSEcrICIDE
An investigation carried out in Mindanao in the southern Philippines has revealed that the main vector Anopheles m1nimus flavirostris has become resistant to dieldrin, one of the most widely used residual insecticides. This disturbing discovery has underlined the fact that time is not on our side; unless malaria eradication projects are pushed forward with maximum effort there is the risk that everything that has been spent will be wasted.
2 ASSESSMENT MOre rigorous assessment in several countries has revealed that nru.aria tranomission is actually recurring in several areas from Ylhich it was thought to ha.ve been cleared. The importance of this finding cannot be over-emphasized; it is only after an energetic and rapid collection and analysis of data that it is possible to take speedy action to counter unexpected factors which tend to obstruct the campaigns. To achieve effective assessment requires not only knowledge of the correct technique but also efficient organization to enable this to be perfectly carried out.
:5
FUNDS
The disappointing response to the Director-GeneralIs appeal for Malaria Eradication Special Account funds underlines the fact that it is on national contributions that malaria campaigns must mainly depend. /The Special •••
WP/RCIO/7 Add.l page 2 The Special Account is designed to supplement and not to supplant the resources for malaria eradication projects available through the regular Dudget and under the Expanded Programme of Technical Assistance. It is felt, however, that a number of governments arc :-lOG 8.vrare of this policy. The matter is the more serious since under the existing TAB procedures the apportionment of Technical Assistance resources is left to the discretion of the governments concerned and it may have been felt that the existence of the Special Account made it J.ess incumbent upon the governments to provide under Technical Assistance for the continued financing of malaria projects. In 1958 the contributions to malaria eradication were divided as follows:
$ million Horld Health Organizationl •••••••••••••••••••• Pan American Health Organization2 ,
4.3 1.9 8.5 16.3 77.5
United Nations Children's Fund 3 ••••••••••••••• International Cooperation Administration + ••••• National Budget 5 Total •••••• J
$ 108.5
The above table shows that the bulk of the financing of malaria eradication is done from national budgets; unless the contributions to the Special Account are increased very greatly, the assistance to be expected from this source will be limited almost entirely to technical advice.
regular, TA and MESA (excluding reg~~ar budget expenditures at Headquarters and regional offices for personnel) from lillO 1958 Financial Report 2pAHO Special Malaria and PARO Regular Budget and Special Grants Fund, from AMRO 1958 Financial Report
lwao
3From UNICEF Draft Report to UNICEF Executive Board 4united States of America FY58 allocation 5From questionnaires received by'lillO. Estimated for countries not reporting on the basis of regional average per capita cost.
WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMrTTEE Tenth Session Taipei 16-22 September 1959 Agenda Item 14 MALARIA ERADICATION 1 INTRODUcrION
WP/RC10/7 27 July 1959 ORIGINAL: ENGLISH
1.1 During the ninth session of the Regional Committee a report l was presented giVing a brief statement of action taken by the Regional Office with particular reference to the intra- and Inter-regional co-ordination of malaria campaigns. Details were included of the status of .the Malaria Eradication Special Account (MESA). Malaria Eradication was also the subject of the Technical Discussions. Annex 1 contains the texts of resolutions WP/RC9.Rll end wp/RC9.Rl.2 adopted by the Committee. 1.2 The Executive Board at its twenty-third session also expressed concern at the prospects of obtaining sufficient funds to finance malaria eradication and emphasized the importance of adequate information on malaria eradication, particularly the free exchange of information between neighbouring countries. Annex 2 contains the texts of resolutions EB23.R62, EB23.R63 and EB23.R64. 1. 3 The Twelfth World Health Assembly emphasized the importance of
administrative efficiency in malaria eradication and expressed concern at the insufficient support received by MESA. Annex 3 contains the texts of resolutions WHAl2.l5 and WHAl2.49 adopted by the World Health Assembly.
2
ArnON TAKEN BY THE REGIONAL OFFICE Intra- and inter-regional co-ordination of malaria canwaignS
2.1
Inter-country co-operation and co-ordination of malaria campaigns are already well established in two areas and are being extended to other parts of the Region which have common problems. The Ant1malaria Co-ordination Board held its third meeting at Rangoon in December 1958. This .meeting was attended by all the members of the Board (Burma, Cambodia, Laos, Federation of Malaya, Thailand and Viet Nam) as well as representatives of the United States International Cooperation Administration (lCA). A WHO malariologist has been apPOinted as secretary Ito the Board ••• 1
Unpublished document WP/RC9/7
'WP/RC10/7 page 2 to the Board: his duty stat:'on is Saigon but he has made extensive visits to the border areas of the Member ccuntries in order to collect up-to-date information about the malaria situation; this information serves as a~asis for co-operative action. Regular r8ports have been prepared Which have been circulated to the Board members. The fourth meeting of the Board will be held in Kuala Lumpur in December 1959.
1958 and June 1959, respectively, and were again attended by representatives from all parts of Borneo. Steady progress has been made towards the co-ordination of malaria campaigns throughout the island.
The Seventh and Eighth Borneo
V~aria
Conferences were held in December
Arrangements are being made to hold a meeting in the Territory of Papua and New Guinea towards the end of 1959 in order to discuss the problems of malaria eradication in areas where the Anopheles E~:nctulatus group is the proven vector and to co-ordinate antimalarial activities. It is hoped that this meeting will be attended by representatives of the Governments of Netherlands New Guinea, the Territory of Papua and New GUinea, the British Solomon Islands protectorate and the New Hebrides. The Regional Office will assist the Governments to organize this meeting on the same lines as the successful Borneo conferences. In March 1959 the Third Asian Malaria Conference was held in New Delhi. It was attended by participants from thirteen countries in the Region and by participants from seven countries in the South-East Asia Region. At this meeting particular emphasis was given to the solution of the administrative problems facing malaria eradication. Twelve ministers of health were present during the first three days of the conference. 2.2 Administrative ass:i.stance Increased emphasis has been placed on the need for giving administrative advice on the organization of malaria eradication programmes. An administrative officer who has received special trsining on the administrative aspects of malaria eradication has recently joined the staff of the Regional Office and is available for giving advice to countries that re~uest such assistance. Increased emphasis has also been placed on the need for complete plans of operations for malaria eradication cf,mpaigns in order that the administrative needs, particularly with regard to financial S1ll?port and to the provision of trained personnel, may be accurately worked out before the campaign starts, thus avoiding disorganization e.nd unexpected expenditure in the later stages. Assistance has been given by the Regional Office on the preparation of plans of operations in Cambodia, Chino, (Ta.i.wan), the Federation of Ma.laya, the Philippines and Viet Nam. 2.3 Traini~
EmphaSis has continued to be laid on the need for increased training of ma.lar1.a eradication personnel within the Region. In 1959 a short-term consultant visited the Philippines end Viet Nr,,'U and gave advice on the organization of internatione~ malaria eradication training courses. The first international tl'aining course assisted by WHO was held at the Institute of Mala..:iology, Tala, Rizal J Philippines from April to June 1959 • It was attended by seven students from four countries within the Region. This course has been organized as a co.-operative effort by the /Government of the
...
WP/RC10/7 page 3 Government of the Philippines, ICA and WHO. WHO provided an international malariologist and sanitarian who assisted the national staff in organizing the course and providing instruction for the stUdents. A programme of training to be carried out in the future has been distributed. It is hoped to provide at least one similar course in the French language in Viet Nam for the benefit of students from Cambodia, Laos and Viet Nam. Fellowships continue to be awarded to malaria eradication personnel. Two students, one from Korea and one from Japan, have attended the international malaria training course in Jamaica. 2.4 Information and health education Information on the progress and technical details of malaria eradication has been disseminated even more widely throughout the Region by increasing the distribution of publications and technical material dealing with general and local malaria problems. The Regional Adviser on Health Education has taken an active part in the preparation of the syllabus for the international training course in malaria eradication held at Tala, Philippines.
3 MAlARIA PROGRAMMES IN THE WESI'ERN PACIFIC The status of malaria programmes receiving assistance from WHO in the western Pacific has been described in the Regional Director's report. In Cambodia the WHO advisory staff has been considerably strengthened and a plan of operations is being developed to transform the campaign from control to malaria eradication. It is intended to carry out a trial of malaria prophylaxis with medicated salt in one of the mountainous areas in Cambodia where it has been difficult to interrupt transmission by traditional methods. In China (Taiwan) the project has continued to make satisfactory progress towards malaria eradication and the small foci of residual transmission have been reduced to a few scatterred areas with a population of less than 4000. Assistance from MESA started in 1958 and is scheduled to continue until 1963. A WHO short-term consultant and a member of the headquarters staff of the Division of Malaria Eradication have visited Taiwan to gain information about the progress of the surveillance operations. Fellows from Hong Kong and Singapore attended the international training course on malaria eradication at Tala, Rizal, Philippines. A WHO consultant visited Japan in 1958 to study the malaria situation in the country and made suggestions as to how the small residuum of malaria could be rapidly eliminated. In Korea a pre-eradication malaria survey started in June 1959 assisted by WHO technical staff. In Laos an antimalaria campaign is being undertaken by the Government with assistance from ICA. /The Federation •••
wp/RC~O/7
page 4
The Federation of Malaya is
p~anning
a pilot project with the eventual
aim of a country-wide malaria eradication.
In North Borneo considerable progress has been made towards the interruption of transmission. Progress has also been made towards total coverage. This project is assisted by UNICEF. The Territories of Papua and New Guinea and Netherlands New Guinea are undertaking active malaria programmes and progress is being made in solving the problem of interrupting malaria transmission in these difficult areas. The programme in Netherlands New Guinea is being assisted by UNICEF and a project to test the effe.t of malaria prophylaxis with medicated salt is being undertaken also with assistance from tfl'TICb'F. In the Philippines, assistance from MESA made possible the institution of a widespread system of surveillance. This system effectively revealed the localities in which malaria transmission was continuing. The plan of operations for malaria eradication in the Philippines is undergoing a stringent review in order to overcome the difficult problem of interrupting continuing transmission in many parts of the country. This project is also assisted by ICA. The project was Visited during 1959 by a member of the WHO headquarters staff wo had made a special stu~ of surveillance procedures. A malaria eradication programme is being undertaken in some of the malarious Ryukyu Islands. In Sarawak satisfactory progress has been made. The institution of an efficient surveillance mechanism has revealed some pockets of continuing transmissionj total coverage has been achieved and it is hoped to transform the programme to one of eradication during the present year. The Government of Portuguese Timor has instituted an investigation into the malaria problems of that country. In Viet Nam, WHO staff are assisting the programme lihich receives considerable support from lCA. Large-scale antimalaria operations are in progress and it is hoped to work out a plan for eradication before the end of 1959.
4 MALARIA ERADICATION SPECIAL ACCOUNl' A considerable increase has taken place in the antjma1aria activities in the Region during the past year, largely financed from MESA. In the last six months of 1958 the assistance received by the Region from this account amounted to US$522 290. In addition to the assistance to eradication in Cambodia, China (Ta1ven), Japan, Korea and the Philippines, malaria advisory services in the Regional Office have been strengthened by the appointment of a regional entomologist and a regional sanitary engineer. These two new appointees, together with the Regional Malaria AdViser, have undertaken extensive travel within the Region in order to provide advice to governments and WHO project staff in the countries in which malaria eradication projects are being undertaken and to assist in the preparation of plans of operation. The Regional Office staff has also been strengthen d from this fund to bear the increased administrative burden arising from the expansion of the malaria eradication programmes. /ANNEX 1 •••
WE /1ClO/7
page 5
ANNEX l
(WP/RC9.Rll, l October
1958)
The Regional COmmittee, Having considered the report of the Technical Discussion Group and the conclusions contained therein, l. EMPHASIZES the importance of continuing the organization of malaria training courses in view of the great need for adequately trained staff in the greatly expanded malaria eradication projects in the Region, and stresses the need for some courses to be conducted in the French language; 2. RECOGNIZES that at all stages of the malaria eradication programme health education plays an essential part in gaining the co-operation ot' the 'Whole population and particularly members of the health service and leaders of local opinion , without 'Which the campaign cannot succeed;
3. CONSIDERS that spraying operations with residual insecticides are the mainstay ot' malaria eradication programmes and that in certain circumstances the use of antimalarial drugs can add greatly to their effectiveness and also hasten the stoppage of transmission;
4.
RECOMMENDS: (l) that in countries 'Where malaria is a serious public health problem, the malaria eradication service should initially be a primary division of the national public health service, and should only be integrated into the general public health service gradually during the surveillance period. It was recognized that in certain cases 'Where the local health services are particularly well developed, the malaria service can be integrated ir..itially into the public health service at the periphery; (2) that in planning and organizing malaria eradication programmes, governments should ensure that adequate support for the programme did not stop short of the achievement ot' eradication;
5. DECIDES that the subject of the Technical Discussions for the Tenth Regional Committee Meeting be "The Control of Tuberculosis II; Further, WISHES to place on record its appreciation of the assistance given to malaria eradication in the Region from the Malaria Eradication Special Account; and
6.
7. ENDORSES the recommendation of the Eleventh Horld Health Assembly rei terating the importance of malaria eradication and expressing the hope that adequate resources will be made available to the Organization to implement the programme as planned for the period 1959-1962. /(W/Fa).Rl.2 ...
WP/rlLiO/ ( Annex 1 p~e6
(wp/RC9.Rl2, 1 October 1958)
The Regional COmmittee, 1. NOTES the report on malaria eradication submitted by the Regional Director; and
2. DRAWS attention to the dangers of the development of undue optimism and the underestimation of the administrative aspects of malaria eradication programmes.
WP/RCIO/7 paG8 :1"
JJ\IHT:i.X 2
(EB23.R62, 30 January 1959) DEVELOPMENT OF MALARIA ERADICATION PROGRAMME
The Executive Board, Having considered the report of the Director-General on the present status of the world-wide malaria eradication effort; Appreciating the fact that the report constitutes the first comprehensive review of the situation in relation to malaria eradication throughout the world; Noting that very satisfactory progress has been made in many countries of the world but that there are still other countries Where malaria eradication programmes have not yet been initiated; Noting further that achievement of the goal of malaria eradication is dependent inter ~ on the availability of financial resources; Noting that in many geographical areas of the world mechanisms for inter-country co-ordination of malaria eradication programmes already exist; Realizing that such inter-country co-ordination becomes increasingly important as national programmes approach .the goal of malaria eradication; and Believing that information in the report would be of value to the World Health Assembly, 1. REQUESTS the Director-General to bring this report up to date for presentation to the Twelfth World Health Assembly;
2. REQUESTS all governments concerned to assist the Director-General by providing him with such information as he may request;
3. URGES all governments concerned to facilitate the free exchange of relevant information between neighbouring malarious or recently malarious countries and to collaborate with such neighbouring countries concerning measures to be taken in their frontier zones; and
4. URGES that all governments concerned should intensify their efforts towards the final goal of malaria eradication and that governments of countries Where malaria exists and Which have not yet undertaken programmes of malaria eradication should plan for such programmes as early as practicable.
/EB23. R6 3 •••
AllUex 2 paGe
8 (EB 23.R63, 30 January 1959) MALARIA ERADI CATION SPECIAL ACCOUIiJT l The Executive Board,
Having considered the report of the Director-General on the Malaria Eradication Special Account; Being concerned that adequate resources must be made available in the Special Account to ensure the successful functioning of the malaria eradication programme assisted by WHO; and Cognizant of the responsibility of the Board under the terms of paragraph 2 of resolution WHAll.16, 1. ENDORSES fully the action taken by the Director-General as described in his report; 2. EXPRESSES its appreciation for the substantial efforts made by the Director-General to obtain funds for the Malaria Eradication Special Account;
3. REQUESTS the Director-General to continue his efforts to obtain, from all possible sources, sufficient funds to finance the malaria eradication programme;
4. EXPRESSES appreciation to the governments which have already contributed to the Malaria Eradication Special Account, and urges that such governments increase the level of their contributions; 5. URGES Member governments which have not yet contributed to the Malaria Eradication Special Account to make every effort to do so; 6. INVITES foundations, industry, labour organizations, institutions and individuals to join with the World Health Organization in its efforts to eradicate malaria, and to that end to contribute to the Malaria Eradication Special Account; and
7. REQUESTS the Director-General to present a report on the status of the Malaria Eradication Special Account at the time of the Twelfth World Health Assembly.
(EB23.R64, 30 January 1959) MALARIA ERADICMION SPECIAL ACCOUNT: l PARrICIPMION OF GOVERNMENTS IN COSTS The Executive Board, Having considered the report of the Director-General on the Malaria Eradication Special Account; and /Considering that ••• 1
Off.
Rec. Wld Hlth Org. 91, Annex 28, part 2
WP/RC10/1 Annex 2 i')agc
971 0
Considering that, in future efforts of the Director-General to obtain voluntary contributions to the Special Account, additional and more complete information on the amount of funds devoted by governments to malaria eradication programmes in their own countries would be of value, INVITES Members of the Organization to make such information available upon request of the Director-General.
/ANNEX
:5 •••
WP/RClO/7 pace I I
J\1TNEX
3
(HHAl2.l5, 22 May 1959) MALARIA ERADI CATION SPECIAL ACCOUNT The Twelfth World Health Assembly, Having considered the report of the Director-General on the Malaria Eradication Special Account,l Having noted that funds are not yet available to finance WHO malaria eradication operations in 1960 and the following years; Realizing that, following the Eighth World Health Assembly's request (resolution WHA8.30) to governments to intensify plans of nation-wide malaria control, many of the malaria-stricken countries have already embarked upon eradication programmes.and invested and committed considerable sums for that purpose; Considering that lack of sufficient funds in the Malaria Eradication Special Account stands in the way of achieving the ultimc.te goal of malaria eradication, and Recognizing the responsibility of the World Health Assembly for the justified expectations of the malarious countries as to the World Health Organization's continued assistance based on the Eighth World Health Assembly's decision (resolution WHA8.30) that the World Health Organization should "take the initiative, provide technical advice, and encourage research and co-ordination of resources in the implementation of a programme having as its .ultimate objective the world-wide eradication of malaria", 1. NarES with regret the lack of adequate response to requests for contributions to the Malaria Eradication Special Account; 2. EXPRESSES its concern over the present position of the Malaria Eradication Special Account; ,. ENDORSES fully the action taken by the Executive Board and the DirectorGeneral as described in the Director-General's Report;
4. EXPRESSES its appreciation for the substantial efforts made by the Director-General to obtain funds for the Malaria Eradication Special Account; 5. REQUESTS the Executive Board and the Director-General to continue their efforts to obtain, from all possible sources, sufficient funds to finance the malaria eradication programme; 6. THANKS the Member governments and Associate Members which have already contributed to the Malaria Eradication Special Account, and invites them to increase the level of their contributions; URGES Member governments and Associate Members which have not yet contributed to the Malaria Eradication Special Account to make every effort to do so;
7.
/8.
INVITES •••
l\nncx :;
page 12
8.
INVITES foundations, industry, labour organizations, institutions and individuals to join with the World Health Organization in its efforts to eradicate malaria, and to that end to contribute to the Malaria Eradication Special Accountj
9. REQUEm'S the Executive Board to examine the position of the Malaria Eradication Special Account at its twenty-fifth session and, should contributions not be sufficiently forthcoming, to study and recommend measures to be taken by the Thirteenth World Health Assembly to ensure the continued financing of WHO's assistance to the malaria eradication programmej and 10. REQUESI'S the Director-General to submit a report to the Thirteenth World Health Assembly on developments in regard to the Malaria Eradication Special Account.
(WHAl2.49, 28 May 1959) MALARIA ERADICATION PROGRAMME The Twelfth World Health Assembly, Having considered the Report of the Director-General on the Present Status of the World-Wide Malaria Eradication Effor.t l and the recommendations of the Executive Board in resolution EB23.R62; Noting with satisfaction that an increasing number of countries of the world are undertaking programmes of malaria eradicationj Realizing that malaria eradication means the ending of the transmission of malaria and the elimination of the reservoir of infective cases in a campaign limited in time and carried to such a degree of perfection that, when it comes to an end, there is no resumption of transmissionj AppreCiating that, in order to carry such a programme through to ultimate success, it is essential that there should be not only sound technical planning and direction of operations but also a high degree of efficiency in administration and organization supported by adequate legislative action; and Realizing further that in addition to the existing problems, new technical problems can be anticipated which will require a continuation and expansion of co-ordinated research and technical development both in the laboratory and in the fieldj 1. URGES all governments concerned to ensure that their central and peripheral services for malaria eradication are provided with adequate administrative machinery to meet the stringent demands of such time-limited programmej
2. REQUEm'S the Director-General to make available, on request, to governments the requisite specialized administrative as well as technical advisory services; and ,. REQUESTS the Director-General to intenSity research in the problems of malaria eradication.
1
Document Al2/P&J3/10