Final report of the fourteenth session of the Regional Committee for the Western Pacific

,. , - • WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC FOURTEENTH SESSION Port Mbresby, 5 to 10 September 1963 REPORT OF THE REGIONAL COMMITTEE MINUTES OF THE PLENARY SESSIONS MANILA October 1963 ->; NOTE The fourteenth session of the Regional Committee for the Western Pacific was held in the legislative Council Ch~,mbers, Port Moresby, from 5 to 10 September 1963, under the chairmanship of Dr R.F.R. Scragg (Australia), with Dr J.C. Thieme (Western samoa), as Vice-Chairman. Dr L. Uyguanco (Philippines) and Dr A. Ferron (France) were the Rapporteurs. The Regional Committee met on 5, 6, 9 and 10 September. Technical discussions ilere held on 7, 9 and 10 September. The report of the Committee will be found in Part I of this document on pages 1-54, the minutes of the plenary sessions in Part II on pages 59-163. The SUb-Committee on Programme and :l"0.get met on 6 and 9 September. The report of the Sub-Committee will be found on pages 29-44. -11- ... PART I REPORT OF THE REGIONAL COMMITrEE .. CONTENTS IlirRODUC'rION •.••••••••.•••••••.••.•••••••...•••••••••••••• 1 I ANNUAL REPORT OF Trffi REGIONAL DIRECTOR ••..•••.•••••.•••.•• 2 II PROPOSED PROGRAMME AND BUDGE'f ESTIMATES III FOR 1965 ................. c • ~ .................... __ • • • • • • • • • • • 6 ~R ~TTERS DISCUSS::D .•..•..••...•.......•......••...•.. 1. Fluoridation of water supplies ..•••.••••••.•••.•••••• 2. Kuru in the Territory of Papu~ and 3. 4. 5· 6. l'Jew Guinea ...............•.......••....•.•••.•..•...• Facilities for education and training of health personnel in the Western Pacific Region ...................................... . Studies on cholera El Tor •••.••.•••.•.••••••••••••••• Resolutions of regional interest adopted by the thirty-first and thirty-second sessions of the Executive Board and the Sixteenth World Health Assembly ...••.•.•••••••••••.•• Popul.ation problems ................................. . 7 1 7 9 9 11 11 OTImR BUS mESS ••••••.••••••••.••••.•••.•••.••••••••••••••• 12 1. Progress reports from governments on heal. th acti vi. ties .................................... 12 2 . 'I'echnical Discussions ............................... . 13 t ,. v 1 2 3 4 5 CONTENTS RESOLUTIONS ADOPTED BY THE COMMITTEE ...•...•.............. WP/RCI4.Rl WP/RCI4.R2 WP/RCI4.R3 WP/RC14.R4 WP/RCI4.R5 WP/RCI4.R6 WP/RCI4.R7 WP/RC14.R8 WP/RC14.R9 Annual Report of the Regional Director ..... Kuru ............................................................ . Proposed programme and budget estimates for 1965 ................................................... . Education and training ...................•. Cholera ................................................................. .. Genetic profiles .................................................. .. Technical Discussions •....•...•....••...... Resolution of appreciation .•...•..•..•...•. Adoption of the report ....•..•.•...•.....•• .Agenda .............................................................................................. .. :List of representative s ................................................................. .. Report of the Sub-Committee on Programme and Budget .....•. Technical. Discussions ................................................................... .. List of documents ............................................................................ .. -v- 15 15 16 17 18 19 20 20 21 22 23 25 29 45 53 , (WP/RCl4/l3 Rev.l) REPORT OF THE REGIONAL COMMITTEE INTRODUCTION The fourteeuth session of the Regional Committee for the Western Pacific was ina\1gurated at the L:!gislative Council Chambers by the Right Honourable, Sir Robert ~nzies, Prime Minister of the COIllIllOn- wealth of Australia. Also present were His Honour the Administrator, Sir Donald Cleland, the Honourable Minister of State for Territories, Mr Paul Hasluck, and the Honourable Minister of state for Health, Senator Harrie Wade. The session lasted from 5 to 10 September 1963. The meeting was attended by representatives of nine Member States in the Region and of France, Portugal, the United Kingdom of Great Britain and Northern Ireland and the United states of .America. Representatives of the South Pacific Commission and of five non-governmen- tal organizations in official relations with WHO were also present. The Committee elected the following officers: Chairman Dr R. F. R. Scragg (Australia) Vice-Chairman Rapporteurs in English in French Dr J. C. Thieme (Western Samoa) Dr L. Uyguanco (Philippines) Dr A. Ferron (France) FormaJ. statements were made by the representatives of the South Pacific Commission and of four non-governmental organizations in official relations with WHO. The agenda is given in Annex 1 and the list of representatives in Annex 2. REGIONAL COMMITTEE: FOURTEENTH SESSION At its first plenary session the Committee established a Sub- Committee on Programme and Budget, composed of representatives of the follOwing countries: AustraJ.ia (Chairman), China (Taiwan), Japan, Malaya, New Zea.la.nd, the United Kingdom and Viet-Name The Sub- Committee held two meetings, following which it submitted a report to the main Committee. Further deta.1ls are given in Part II and Annex 3 of this report. In -.ccordance with the principle of rotation, the fifteenth session of the Committee will be held in Manila and the sixteenth se.ssion in Seoul, Korea. In the course of five plenary sessions ~ tbe Comm:l.ttee adopted Dine resolJlt:Lons. which.are set out in Part V. PART I. ANNUAL REPORT OF THE REGIONAL DIRECTOR The RegionaJ.. Director, in introducing his Annual Report, sUDlll8ot'1zed the major .Q,evelopments during the period under review. The generaJ.. expansion of public heaJ.th services had continued with pa.rt1cula.:r attention being paid to 10caJ.. and rural health services. In the field of nursing, one of the remarkable feature s of the past year had been the replacement of the emergency training of nurses by regu.l..a.r well-established courses. Interest in health education had grown and an increasing number of countries and territories were following WHO- recommended standards for health education, leadership and organization. As a result of the intensive information programme launched during the year, there had been rapid strides in the development of nutrition programmes, and plans were now well in hand for a number of new projects. A greater degree o£ self...;reljan.ce and vigour was a.l.read,y ma.n.1feat in .. .. f REPORT OF THE REGIONAL COMMITTEE 3 many medi.cal and nursing schools and public health training institutions. The fellowship programme had continued to expand and no less than 50 per cent of the fellowships awarded during the period under review had been undertaken exclusively within the Region. Although there was as yet no country in the Region in which the malaria campaign had reached the stage of certification of eradication, further progress had. been made. Encouraging results regarding the interruption of transmission had been obtained from the two malaria eradication pilot projects. With the completion of the mass treatment survey of the population in Tonga, all the known yaws-endemic areas in the southern part of the Region, except Portuguese Timor, had now been covered by mass treatment. No report of any recrudescence of the disease had been received from the other former yaws-endemic areas in the Pacific. The attention of the Committee was then drawn to some of the areas of weakness in the regional programme. In a number of cases a difficult question to decide was whether a country was in a position to absorb all the assistance it had requested. This question related specifically to the developing countries where the needs were all embracing and it was, therefore, in these areas that planning became of fundamental importance. It was not possible to combat all problems at the same time, one must be selective in accordance with the situation in each country. The basic health needs and the problems had to be studied and investigated, priorities for action determined, and precise proposals formulated, aimed at the orderly development of a long-term health plan. To be fully effective this plan should form an integral. part of any social and economic programme. It was, therefore, essential to impress upon other government departments that economic and social development depended on good health. 4 REGIONAL COMMITTEE: FOURTEENTH SESSION New programmes should only be undertaken when continuing one s were well established. It was essential not to disperse available resources but to use them in the most efficient manner, to support the projects in operation to the utmost limits, to sustain interest so that the combined efforts of the Organization and governments would grow constantly in scale and in intensity. Although maternal and child health programmes had expanded, there had been little diminution, if any, in the mortality and morbidity rates of the pre-school child. There was a great need to establish services for this a~-group which had, until now, been possibly the most neglected section of the community. Malnutrition and even under- nutrition continued to be widespread in the Region but programmes to remedy the situation were few. New approaches in nutrition education were, therefore, required. A further problem was the faUure in most countries to realize what malnutrition meant in terms of economics. There could be no question of allOwing the slightest weakening in the efforts to control the communicable diseases. Cholera was still occurring in some countries, the tuberculosis problem was so tremendous that control programmes would be required for many years to come, health ailm1 n1 strations must be aware of the significant persistent increase in the incidence of the venereal infections. The malaria eradication programme must not be allowed to di mi ni sh in strength because of the short~ of funds. When one considered the direct bearing community water supplies and other sanitary facilities had on the prevention of disease, it was unfortunate that the initiative for improvements in the env:i.ronment stemmed from non-public health agencies. Health ailm1nistrations must exercise vigorous leadership and watchful guardianship in this 1m,portant field. <. REPORT OF THE REGIONAL COMMITTEE 5 The Regional Director then referred to what was possibly the most important field in the regional programme, that of education and training. If full use were to be made of regional training centres, standards for medical education must be established and maintained. It was also imperativf~ to create a stable and. progressive faculty. Improve- ments were required not only in the selection of candidates for fellow- ships but also for participation in inter-country group educational acti vi tie s . The attention of the Committee was drawn to the particular interest of WHO in radiation health and medicine and the i:aq:>ortance of the estab- lishment of radiation health programmes within the framework of the regular public health activities was stressed. The Committee reviewed the annual report chapter by chapter. In the course of the discussion, attention was drawn to the difficulties encountered in the recruitment of experts of a high calibre. It was suggested that this problem might be overcome if a review were made of basic salaries, allowances, post adjustments, etc., which might require to be increased, in order to permit the recruitment of the most highly qualified persons. The 1:aq:>ortance of providing advisory services on the proper planning of medical care facilities and on hospital administration was stressed. It was also suggested that the appoint- ment of a regional adviser in this field would be beneficial to the governments of developing countrie s • In discussing the part of the report relating to maternal and child health, the suggestion was made that this field provided an opportunity for bringing together a number of related professional skills. Specific reference was made to the 1:aq:>ortance of the nutritional aspects of 6 REGIONAL COtOO:TTEE: FotJRTEmTH SESSION maternal and child health and it was felt that future attention should be focused on this aspect. Further points raised covered the importance of health administra- tions giving leadership in the field of enviromrental health, the investigation of genetics in isolated areas where the people were emerging from a primitive to a more modern way of living (see resolution WP/RCl4.R6) and studies connected with population problems (see Part III, section 6). A number of representatives made statements on the progress of WHO-assisted activities in their own countries. The Committee adopted resolution WP/RC14.R1. PART II. PROPOSED PROGRAMME AND BUDcmr FOR 1965 The Sub-Committee on Programme and Budget (established in accordance with resolution WP/RC1.R1 adopted by the Committee at its seventh session) held two meetings, during which it made a detailed examination and analysis of the Regional Director's proposed programme and budget estimates. The Regional Committee examined the proposals for 1965 in the light of the findings and observations of the Sub-Committee. The proposed regional. programme and budget for 1965 was approved by the Committee for transmission to the Director-General (see resolution WP/RC14.R3). The report of the Sub-Committee is contained in Annex 3. REPORT OF THE REGIONAL COMMITTEE 7 PART III. OrHER MATTERS DISCUSSED 1. Fluoridation of water supplies (Document wr/RC14/4 Rev.l) The Committee discussed a paper presented as a sequel to the Technical Discussions held in Wellington in 1961. This provided a digest of all available information on the safety, simplicity and economy of fluoridation of drinking water as the most efficacious single measure against dental decay. In the course of the discussion, information was presented by the representatives of Australia, New Zealand and the Philippines on the action taken in their countries in connection with the fluoridation of community water supplies. The representative of the International Dental Federation presented a statement on the value of fluoridation, which he considered was the greatest single advance made in the field of preventive dentistry. 2. Kuru in the Terri tor of Papua and New Guinea (Document WP/RCl4/S The Committee reviewed a report presented by the Director of Public Health of the Territory of Papua and New Guinea on kuru, which occurs in a defined area in the Okapa Sub-District of the Eastern Highlands of the Territory. It also considered a paper by Dr D.C. Gajdusek of the National Institute of Neurological Diseases and Blindness, National Institutes of Health, Bethesda, Maryland, United States of America, which gives a clear assessment of the past and present position. On the invitation of the Chairman, and with the consent of the Committee, Dr F.D. Schofield, Assistant Director of Medical Research, Papua and New Guinea, addressed the Committee. He stated that kuru occurred only in the Fore area of the Highlands and the epidemiology was peculiar because among children, boys and girls were equally 8 REGIONAL COMMITrEE: FOURTEENTH SESSION affected, whereas among adults, women suffered much more frequently than men. There was progressive degeneration of the centra.l nervous system, leading to ataxia, involuntary movements, muscular inco-ordination, paralysis and death usually in less than a year. The social effects were extremely seriOUS, personal tragedies being frequent and adult men greatly outnumbering adult women because so many of the latter died of kuru. ~here ",ras no effective treatment and the disease was always, or almost a.lways, fata.l. As regards aetiology, a genetic factor had been demonstrated by Professor Bennett of Adelaide University, but the disease closely resembled scrapie of sheep which is a virus disease. It a.lso somewhat resembled amyotrophic sclerosis fro~ which a virus had been reportedly isolated in Guam. Anthropologists believed that the disease had existed for less than 100 years, the primary focus had been identified and the disease was still spreading and its incidence increasing. Genetics. alone could not explain these facts and some environmental factor, at present unkno'WIl, must a.lso be involved. Dr Schofield described the intense scientific interest which this unique disease had caused" since it was first descri'ued by Dr Zigas six years ago,and the international. research taking place in many countries to investigate all aspects of it. It was hoped tha.t this 'WOrk would throw light on other degenerative diseases of h~~ beings at present incurable, such as amyotrophic latera.l sclerosis, disseminated sclerosis, etc. He also described the measures being taken by the Administration and the missions to alleviate the situation pending the results of further research (see resolution WP/RCl4.R2). , :v REPORT OF THE REGIONAL COMMITTEE 9 The COmmittee, at its thirteenth session, reviewed a report presented by the Regional Director on the facilities available for the education and training of health personnel within the Region, and adopted a resolution urging governments to submit full information on training programmes suitable for foreign students, so that it might be distributed to Member governments in the Region. A second report wB,S, therefore, presented to the Committee summarizing the information received to date. It was noted that some replies were still awaited and that as soon as these had been received, full information on training programmes suitable for foreign students would be distributed to Member governments in the Region. During the discussion, the view was expressed that more thought and attention must be given to the development of mechanisms whereby graduates could continue their education effectively in the places where they worked. The Committee adopted a resolution recommending that efforts should be made by governments to encourage the organization of refresher courses and in-service training programmes and to provide facilities for continuation stUdies for health workers (see resolution WP/RC14.R4). 4. Studies on cholera El Tor (Document WP/RC14/7) The Regional Director, in accordance with a request made by the Committee at its thirteenth session, submitted a paper incorporating the replies received from governments in connection with the cholera studies being carried out in the Region. Additional information was also provided by China (Taiwan) on "The epidemic of El Tor vibrio paracholera in Taiwan II and by Japan on the activities of its Research Committee on El Tor cholera 10 REGIONAL COMMITTEE: FOURTEENTH SESSION which, during the past ten months, had concentrated its efforts on the differentiation between the E1 Tor cholera vibrio and classical cholera vibrio based on the following approach: (1) the antigenic structure, (2) the haemo1ysin test, (3) the phage sensitivity test and (4) cultural. methods. Studies had also been carried out on the differentiation of the El Tor cholera vibrios into the Celebes and the other types. The Committee was also informed that the Commonwealth Serum Laboratories, Australia, had under preparation a vaccine against cholera El Tor which had been inoculated into animals and had shown very minor toxic or side-effects. Double blind trials of the vaccine had been arranged with the Department of Public Health as to its acceptability for immunizing human beings in the villages, and particularly in the Sepik District of the Territory. In view of WHO's recommendations during the Manila Conference that Asiatic cholera vaccines should always be given, it was proposed to give the new vaccine to one group and the new vaccine plus Asiatic cholera vaccine to the control group. If this trial were undertaken in the Terri tory, official guidance from. WHO would be required. During the discussion, attention was drawn to the importance of further studies on the problem of carriers. It was also proposed that any problem. relating to the adequate vaccination of the personnel of fishing boats and similar ships moving casually from country to cOUntry should be referred to the Regional Director. The opinion was expressed that the importance of considering the bio-social factors involved in a planned attack on cholera should be emphasized. It was, further, suggested that the Directors of the WHO Regional Offices for the Western Pacific, South-East Asia and Eastern tediterranean should consult together and explore ways and means of , y ... REPORT OF THE REGIONAL COMMITTEE 11 securing closer integration of anti-cholera work with the ultimate aim of eradicating the disease from the entire area (see resolution wp/RCJ.4. R5) • 5· Resolutions of regional interest adopted bl the thirty-first and thirty-second sessions of the Executive Board and the Sixteenth worid Health Assemb!y': (Document WPjRCl4j8) The attention of the Committee was drawn to seventeen resolutions of regional interest adopted by the Executive Board and the World Health Assem~)l.y. These covered the Expanded Programme of Technical Assistance (resolution EB3l.R47); Decentralization of United Nations Activities (resolution EB3l.R49); Malaria Eradication Special Account (resolutions EB31. R26, WHAl6.l7 and EB32. R23); Development of the Malaria Eradication Programme (resolutions EB3l.R3l and WHAl6.23); Developments in Activities assisted jointly with tJNICEF (resolutions EB31.R32 and WHAl6.24); Voluntary Fund for Health Promotion: Medical Research (resolution WHAl6. 26); Voluntary Fund for Health Promotion: Community Water SUpply (resolution WHA16.27); Continued Assistance to Newly Independent States (resolutions EB31.R39 and WHAl6.3l); Smallpox Eradication (resolution WHA16.37); United Nations Development Decade (resolutions EB3l.R50 and WHAl6.4o); and Co-operation with other Organizations: Programme Matters (resolution EB32.R1l). 6. Population problems The possibility of WHO assisting in programmes connected with population problems was raised. The attention of the Committee was drawn to the fact that WHO's interest in this field was confined to the research aspects. The Government of the United States of America had made a voluntary contribution to WHO to support a unit which VlOuld 12 REGIONAL COMMITl'EE: FOURTEENTH SESSION carry out research 'WOrk connected with human population studies. The Committee noted that until such time as the World Health Assembly decided to formulate a programme in this field, no action could be taken by the Secretariat. It was finally agreed that it 'WOuld be preferable to defer detailed consideration of this subject until governments had an opportunity of studying the matter further and deciding whether it should appear on the agenda of the next session of the Committee. PART IV. OTHER BUSINESS 1. Progress reports from governments on health activities The Chairman acknowledged the following reports which had been transmitted to the Regional Director: (1) AUSTRALIA - Report of the Director-General of Health for the year ended 30 June 1962; Report of the National Health and M:dical Research Council, 1963; A brief summary of the more important matters in the Director-General's Report for 1962/63; June issue of the Health Journal published by the Department of Health; ( 2) BRITISH SOLOMON ISLANDS PROTECTORATE - Report on the progress of health activities during 1962; (3) BRUNEI - Report on the progress of health activities for the year 1962; (4) CHINA (TAIWAN) - Report on the progress of health activities during the fiscal year 1963 (1 July 1962 - 30 June 1963); (5) FEDERATION OF NALAYA - Report on the progress of health activities during 1961-1962; 2. 2.1 REPORT OF THE REGIONAL COMMITTEE - (6) JAPAN - Report on the progress of health activities for the fiscal year 1962 (April 1962 - March 1963); A brief report on public health administration in Japan for the period January 1962 - July 1963; (7) KOREA - Report on the progress of health activities in 1962; (8) NEW ZEALAND - Report on the progress of health activities during 1962; (9) NORrH BORNEO .. Report on the progress of health activ:l.t1es during 1962; (10) PHILIPPINES - Report on the progress of health activities for the fiscal year 1962-1963; (ll) SARAWAK ... Medical and. Health Department Annual Report, 1962; (12) SINGAPORE - Report on the progress of heal~ activities during the year 1962; (13) TERRITORY OF PAPUA AND NEW GUINEA .. Annual Report of the Department of Public Health for 1962_1963; Report on the progress of health aativities during 1962; (14) VIET-NAN - Report on the progress of health activities during 1962-1963; (15) WESTERN SAMOA .. Report an the progress of health activities, 1962.1963. Technical Discussions Designation of Chairman At its eleventh session, the Regional Commit.t.ee adopted a resolution (WP/RCll.Rll) recommending that the Cba.irma.n of the 13 14 REGIONAL COMMITTEE: FOURTEENTH SESSION Technical Discussions should be appointed well in advance of the meeting. FollOwing consultations between the Regior:13.l. Director and the Chairman of the Regional Committee, Dr Le-Cuu-TruQng, Director- General of Health and Hospitals in Viet-Nam, was selected for this office. 2.2 Organization The theme of the Technical Discussions was "The role of the local health services in leprosy control" and four working papers were prepared covering the follOwing subjects: (1.) The problem of leprosy in Viet-Nam from the public health pOint of view, by Dr Le-CUu-Truongj (2) A review of the present-day concepts of leprosy control with special reference to the role of the local health services, by Dr L.M. Bechellij (3) Case-finding, follow-up and management of leprosy cases with ~articular reference to the integration of these activities into those of the established health services, by Dr R.A. ~lssell; (4) The centrol of leprosy in li'iji within the pub1.ic health programme, by Drs D. VI. Beckett and A.J •. Hibell. The first session consisted of an introductory statement by the Chairman, a panel presentation nf the subject and an open discussion. In the second session, the participants were divided into groups which met separately and conducted a free discussion in accordance with guide- 1.ines and references provided. The third session was again a p1.enary one at which the reports prepared by the discussion groups were presented, the views and o:riJllons expressed were consolidated, and conc1.usions drawn. .. of REPORT OF THE REGIONAL COMMI'ITEE 15 Full details are contained in the report of the Technical Discussions which appears in Annex 4. 2.3 EvaJ..uation Of the completed questionnaires received, all 22 assessed the choice of the topic as timely; 10 participants rated the Technical Discussions as very good and 8 as reasonably good; 9 said they had gained many new ideas or concepts, and 12 as gaining some. 2.4 Selection of topic for the Technical Discussions in 1964 The Committee selected I~he use of statistics in public health administration" as the subject foor the discussions in 1964 (see resolution WP/RC14.R7). PART V. RESOLUTIONS ADOPrED BY THE COMMITTEE WP/RC14.Rl ANNUAL REPORT OF THE RIDIONAL DIRECTOR The Regional Committee, Having reviewed the Thirteenth Annual Report of the Regional Director covering the period from 1 July 1962 to 30 June 1963,1 1. NOTES with satisfaction the progress made in the period under .. review; 2., EMPHASIZES that the field of maternal and child health provides an opportunity for bringing together a number of related. professional skills; and Bearing in mind the fact that research has clearly indicated the importance of nutrition in the early years of life, 1 Unpublished document WP/RC14/2 16 REGIONAL COMMITTEE: FOURTEENTH SESSION 3. RECOMMENDS that attention should be concentrated on the nutritional aspects of maternal and child health; 4. REQUESTS the Regional Director: (1) to draw the attention of the Director-General to the importance of reviewing the Organization's recruitment procedures, with particular attention to salaries, allowances and post adjustment, in order that governments may be provided with the most highly qualified experts; (2) to study the possibility of appointing a regional adviser on medical care and hospital administration in order that governments may be provided with advisory services enabling them to plan, improve and expand their facilities in these fields; 5. CONGRATULATES the Regional Director on his comprehensive report. WPR Handb.Res., 4th ed., 2.2.13 Fourth meeting, 9 September 1963 WP/RC14.R2 KURU The Regional COmmittee, Having considered with interest the report presented on ''Kuru'', a disease only found in the Territory of Papua and New Guinea? 1 Unpublished document WP/RC14/5 ,. .,. REPORT OF THE REGIONAL COMMITTEE 17 EXPRESSES its appreciation to the Department of Public Health in Papua and New Guinea for having made this information available to the Cornmi ttee . WPR Handb.Res., 4th ed., 1.3.3(2) Fourth meeting, 9 September 1963 WP/RC14.R3 PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 1965 I The Regional COmmittee, Having examined the programme and budget estimates proposed for the Western Pacific Region in 19651 and the report of the Sub-Committee on Programme and Budget, 2 1. ENDORSES the proposed programme under the regular budget and those proposed to be financed from the Malaria Eradication Special Account and the Special Account for the Community Water Supply Programme; 2. NOTES the programme proposed to be financed under the Expanded Programme of Technical Assistance; and 3. AGREES that the following inter-country group educational activities are important and should be undertaken in 1965: Filariasis seminar Seminar on helminthic diseases Seminar on haemorrhagic fevers Seminar on health planning in urban development Nursing conference on guides for staffing of nursing services and methods of study Seminar on leprosy; ~published document WP/RC14/3 2Unpublished document WP/RC14/11 Rev.1 18 REGIONAL COMMITTEE: FOURTEENTH SESSION 4. NOTES that the costing of the above activities is based on their being held in Manila, and 5. DECIDES that if a government wishes to serve as host to any inter-country group educational activity, the additional expenses involved should be met by the government concerned; II Having studied the supplementary list of projects, which were requested by governments, including those brought forward during the meeting, which could not be accommodated within the regional allocation for 1965, 1. BELIEVES that these projects should be considered part of the regional progra.zmne; 2. REQUESTS the Regional Director to implement as many of the projects in the supplementary list as possible, as and when funds are available; III REQUESTS the Regional Director to transmit the proposals to the Director-General. WPR Handb.Re:s., 4th ed., 3.1.13 Fourth meeting, 9 September 1963 WP/RC14.R4 EDUCATION AND TRAINING The Regional Committee 1. RECOGNIZES the value of keeping health and medical workers abreast with progress in medical science; 2. EMPHASIZES the need for health and medical personnel to continue their education; 3. RECOMMENDS that efforts should be made by governments to encourage refresher courses, in-service training programmes and ensure facilities for continuation stUdies for health workers .. WPR Handb.Res., 4th ed., 1.7.4 Fourth meeting, 9 September 1963 REPORT OF THE REGIONAL COMMITTEE 19 WP/RC14.R5 CHOI~ ., The Regional Connnittee, -'". '-"i;. Having reviewed the report presented by the Regional Director on the studies of cholera El Torland the additional information furnished. by representatives, 1. NOTES: (1) that the existing endemic foci serve as a threat to other countries; (2) the problems connected with cholera carriers; 2. CONSIDERS that further attention should be given to the bio-social factors involved in a planned attack on cholera, and 3. RECOMMENDS that: (1) the problem of adequate vaccination of the personnel of fishing boats and similar ships moving casually from country to country should be referred to the Regional Director for appropriate action; ( 2) the Organization should encourage and co-ordinate further studies on the problem of carriers; (3) the Directors of the WHO Regional Offices for the Western Pacific, South-East Asia and Eastern Mediterranean should consult together and explore ways and means of securing closer integration of anti-cholera 'WOrk, with the ultimate aim of eradicating the disease from the entire area. WPR Handb.Res., 4th ed., 1.3.3(1) Fourth meeting, 9 September 1963 1 Unpublished document WP/RC14/7 20 REGIONAL COMMITTEE: FOURTEENTH SESSION WP/RC14.R6 GENETIC PROFILES The Regional Committee 1. NOTES the advances m.a.d.e in recent years in understanding the genetic factors of a wid.e range of diseases; 2. EMPHASIZES the importance of studies aimed at determining the genetic profiles of isolated groups living in developing countries in the Western Pacific Region, and the urgency of such studies while suitable groups still remain; 3. RECOMMENDS that WHO should take the initiative in exploring the possibilities of such research and should bring this to the attention of qualified research workers in different countries and of the governments of countries where suitable communities reside. WPRHandb.Res., 4thed., 1.5.3 Fifth meeting, 10 September 1963 WP/RC14.R7 TECHNICAL DISCUSSIONS The Regional Committee I NOTES the report on the Technical Discussionsil 2. EXPRESSES its appreciation to Dr Le-CUu-Truong for having so ably served as Chairman, and to the other experts who served as members of the Panel; II Having considered the topics proposed. for the Technical Discussions in 1964,2 DECIDES that the subject shall be '~ use of statistics in public }:ealth administration". WPR Handb.Res., 4th ed., 5.5.2(11) Fifth meeting, 10 September 1963 1 unpublished document WP/RC14/l2 2 Unpublished document WP/RCl4/9 REPORT OF THE REGIONAL COMMITTEE 21 I >- WP/RC14.R8 RESOLUTION OF APPRECIATION • The Regional Committee EXPRESSES its appreciation and thanks to: (1) The Government and people of Australia and of the Territory of Papua and New Guinea for: (a) having invited the Regional Committee to hold its fourteenth session in Port MOresby, (b) the excellent arrangements and facilities provided, (c) the generous hospitality received, and. (d) the interesting tours which have enabled representatives to see some of the achievements of the Terri tory; (2) the Right Honourable the Prime Minister, Sir Robert Menzies, for having formally opened the fourteenth session of the Regional Committee; (3) the Honourable Minister of State for Health, Senator Harrie Wade, His Honour the Administrator, Sir Donald Cleland, and the Honourable Minister of State for Territories, Mr Paul Hasluck, for having honoured the Committee with their presence at the opening ceremony; (4) the Director of Public Health, Dr R.F.R. Scragg, and his staff for the excellent arrangements made for the meeting; (5) the Chairman and other officers of the Committee; (6) the Chairman of the Technical Discussions, Dr Ie-Cuu- Truong, for his excellent planning and chairmanship, and 22 REGIONAL COMMITTEE: FOURTEENTH SESSION the other experts who served as technical. advisers and resource personnel; (7) the representatives of the South Pacific Commission and the non-governmental organizations who made statements; (8) the Regional. Director and the Secretariat for their work in connection with the meeting. Fifth meeting, 10 September 1963 wp/RCJ.4. R9 ADOPTION OF THE REPORT The Regional Committee, Having considered the draft report on the fourteenth session of the COmmittee, ADOPTS the report. Fifth meeting, 10 September 1963 I ~ I REPORT OF THE REGIONAL COMMrTTEE ANNEX 1 AGENDA 1 Opening of the session 2 Address by retiring Chairman 3 Address by the Director-General 4 Election of new officers: Chairman, Vice-Chairman and Rapporteurs 5 Address by incoming Chairman 6 Adoption of the agenda 7 Technical Discussions 7.1 statement by the Chairman 7.2 Acceptance of the Programme for Technical Discussions 8 Proposed programme and budget estimates for the financial year 1 January - 31 December 1965 9 8.1 Establishment of the Sub-Committee on Programme and Budget 8.2 Consideration of the report presented by the Sub-Committee on Programme and Budget Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities 10 Report of the Regional Director 11 Fluoridation of water supplies 12 Kuru in the Territory of Papua and New Guinea 13 Facilities for education and training of health personnel in the Western Pacific Region 14 studies on cholera El Tor 15 Besolutions of regional interest adopted by the thirty-first and thirty-second sessions of the Executive Board and the Sixteenth World Health Assembly 16 Selection of topic for the Technical Discussions during the fifteenth session of the Regional Committee 24 REGIONAL COMMI'l"rEE: FOURTEENTH SESSION 17 Consideration of the report presented by the Technical Discussion Group 18 Time, place and duration of the fifteenth and sixteenth sessions of the Regional Committee 19 other business 20 Adoption of the draft report of the Committee 21 Adjournment " , .:-- I'~ AUSTRALIA AUSTRALIE CHINA CHINE REPORT OF THE REGIONAL COMMITTEE LIST OF REPRESE~TATlVES LISTES DES REPRESENTANTS 25 ANNEX 2 I. REPRESENTATIVES OF MEMBER STATES REPRESENTANTS DES ETATS MEMBRES Dr R.F.R. Scragg Director of Public Health Department of Public Health Territory of Papua and New Guinea Dr C. Haszler Regional Medical Officer Department of Public Health Territory of Papua and New GUinea (Chief Representative) (Chef de delegation) (Alternate/Suppleant) Dr Kila Wari (Alternate/Suppleant) Department of Public Health Territory of Papua and New Guinea Dr Himson Mulas (Alternate/Suppleant) Department of Public Health Territory of Papua and New Guinea Major-General W.D. Refshauge (Alternate/Suppleant) Director-General of Health Commonwealth of Australia Dr H.E. Downes (AlternatejSuppleant) Assistant Director-General of Health Commonwealth of Australia Dr C.J. Ross-Smith ~. General Secretary Australian Medical Association (Alternate/Suppleant) Dr C.K. Chang (Chief Representative) Director (Chef de delegation) Department of Health Administration Ministry of Interior Taiwan, Republic of China Dr T.e. Hsu ~ COmmissioner of Health Department of Health Taiwan Provincial Government Taiwan, Republic of China (Alternate/Suppleant) 26 FRANCE JAPAN JAPON KOREA COREE MALAYA MALAISIE NEW ZEALAND NOUVELLE-ZELANDE REGIONAL COMMITTEE: FOURTEENTH SESSION Dr A. !<'erron ~ Medecin-Chef du Sanatorium hansenien de Noumea Nouvelle-Caledonie Dr E. Wakamatsu Director Public Health Bureau Ministry of Health and Welfare Tokyo, Japan Dr J. Ohmura Chief National Sanatorium Section Medical Affairs Bureau Ministry of Health and Welfare Tokyo, Japan Mr Y. Matsuda Third Secretary Embassy of Japa,n Manila Dr K. Hamano Chairman Board of Directors Japanese Leprosy Foundation (Tofu-Kyokai) Japan Dr Suk Woo Yun Director Bureau ~f Public Health Seoul, Korea Dato Dr Mohamed Din bin Ahmad Director of Medical Services Federation of Malaya (Chief Representative) (Chef de delegation) (Alternate/Suppleant) (Alternate/Suppleant) (Adviser/Conseiller) (Chief Representative) (Chef de delegation) Dr Haji Abbas bin RaJi Alias (Alternate/Suppl.eant) Deputy Director of Medical Services Federation of Mal.aya Dr D. P. Kennedy Director Division of Public Health Department of Health New Zealand ':C 'y- PHILIPPINES PORTUGAL UNITED KINGDOM ROYAUME-UNI UNITED STATES OF AMERICA ErATS-UNIS D'AMEBIQUE REPORT OF THE REGIONAL COMMITTEE Dr L. Uyguanco Director Bureau of Disease Control Department of Health Manila Dr F.T. Diy Director Regional Health Office No. 6 Department of Health Cebu City Dr E.L. Villegas Medical Adviser Department of Health Manila Dr Antonio Rosario Pinto Chief of the Health Services Timor Dr C.H. Gurd Director of Medical Services Fiji (Chief Representative) (Chef de delegation) (Alternate/Suppleant) (Alternate/Suppleant) (Chief Representative) (Chef de delegation) Dr R. Dickie (Alternate/Suppleant) Deputy Director of Medical Services Sarawak Dr C .H. James Acting Deputy Director of Medical Services North Borneo Dr J. Watt Director Office of International Health United States Public Health Service Department of Health, Education and Welfare Washington Dr R.K.C. Lee Director (Alternate/Suppleant) (Chief Representative) (Chef de delegation) (Alternate/Suppleant) Public Health and Medical Activities University of Hawaii Honolulu Dr Saipele Matagi Department of Medical Services American Samoa (Adviser/Conseiller) 28 REGIONAL COMMITTEE: FOURTEENTH SESSION VIET-NAM Dr Le-Cuu-Truong Directeur,general de la Sante et des HOpitaux Saigon, Viet-Nam WESTERN SAMOA Dr J.C. Thieme SAMOA OCCIDENTAL Director of Health Health Department Western Samoa II. REPRESENTATIVES OF OTHER INTER- GOVERNMENTAL ORGANIZATIONS AND .OF NON-GOVERNMENTAL ORGANIZATIONS REPRESENTANTS D' AUTRES ORGANISATIONS INTER-GOUVERNEMENTALES ET NON. GOUVEB.NEMENT.A.S INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS ASSOCIATION INTERNATIONAL DE PROPHYLAXIE DE LA CECITE INTERNATIONAL COONeIL OF NURSES COUNCIL INTERNATIONAL DES INFIRMIERES INTERNATIONAL DENTAL FEDERATION FEDERATION DENTAIRE INTEflliATIONALE LEAGUE OF RED CROSS SOCIErIES LIGUE DES SOCIETES DE LA CROIX-ROUGE SOUTH PACIFIC COMMISSION COMMISSION DU PACIFIQUE SUD WORLD MEDICAL ASSOCIATION ASSOCIATION MEDICALE MONDIALE Dr J.J. Loschdorfer Medical Specialist (OphthalmOlogist) General Hospital Port Moresby Miss V. Bi~old Administrative Sister Department· of Public Health Konedobu Papua Mr T.E. Hubble c/o Director of Health Port Moresby Mr H. Buchanan Red Cross Society Melbourne Dr R.A. Chappel Medical Officer South Pacific Commission New Caledonia Dr C.J. Ross-Smith General Secretary Australian Medical Association , ,. -...-- f t REPORT OF THE REGIONAL COMMI'ITEE ANNEX 3 REPORT OF THE SUB-COMMITI'EE ON PROGRAMME AND BUDGET 1. INTRODUCTION At its seventh session, the Regional Committee, in resolution wp/RC7. R7, decided "that the establishment of a sub-committee on programme and budget l consisting of six members plus the Chairman of the Regional Committee; should become a routine activity of the Regional Committee II; and recommended. that ''the membership of this sub-committee be rotated among the Representatives of various Members, subject to the provision that any Representative d.esiring to be a member of the sub- committee should be entitled to participate". The members of the Sub-Committee and their alternates and advisers were as follows: Australia Dr R.FoR. Scragg (Chairman) China Dr C.K. Chang Japan Dr J. Ohmura Mr Y. Matsuda (alternate) Malaya Dato Dr MOhamed Din bin Ahmad Dr Raji Abbas bin Haji Alias (alternate) New Zealand Dr D. Po Kennedy United Kingdom Viet-Nam Dr Le-Cuu-Truong The meetings were also attended by Dr C. Haszler (Australia), Dr H.E. Downes (Australia), Dr Kila Wari (Australia), Dr Suk Woo Yun (Korea), Dr E.L. Villegas (Philippines), Dr R.K.C. Lee (United States of America) and Dr Saipele Matagi (United States of America). REGIONAL COMMITrEE: FOURTEENTH SESSION In the course of its meetings on 6 and 9 September, the Sub-Committee, in accordance with the guide-lines given on po~ 41, made a detailed examination and analysis of the proposed programme and budget estimates. 2. GENERAL BEVIEW OF THE PROPOSED PROG~ AND BUDGET ESTDfATES FOR THE FINANCIAL YEAR 1 JANUARY - 31 DECEMBER 1965 (Document WP/RC14/3) In introducing the proposed programme and budget in the Sub-COmmittee, the Regional Director stated that the effective working budget proposed for the Region under the regular programme in 1965, excluding mal.aria activities, amounted to $2 477 000, an increase of $414 147 or 20 per cent over the level for 1964. Of the proposed increase, $387 599 were allocated to field activities and only $26 580 to the Regional Office. This was in line with the policy that the major proportion of any increase should be directly applied to field activities. The increases in the Regional Office, 6-1/2 per cent, the Regional Advisers, 1 per cent, and the WHO Representatives, 2-1/3 per cent, were attributable to statutory increases and uneven distribution of home leave between the two years. The Regional Director pointed out that the proposed programme for 1965 was based on government requests, taking into account continuing cOmmitments, previously established criteria for regional programme priOrities, and the allocation provided by the Director-General. From the summary of field activities, it would be seen that the 1965 field activities proposals totalled $2 038 904, representing an increase of $387 559, 23 per cent, over the corresponding estimate for 1964. One hundred and twenty-one projects were proposed under 19 different major subject head1ngs compared to 92 in 1964; 107 were country and 14 inter- country projects; 130 fellowships were included in the proposals and 33, 25 per cent, of these were for study within the Region. • • • :<: .. REPORT OF THE REGIONAL COMMITTEE The Regional Director referred to document V~/RC14/P&B/2 (see page 43) which showed the differences between the proposed estimates for 1965 and the corresponding estimates for 1964 by amounts and percentages. It would. be noted that in 1965 continuing projects accounted for approximately 74 per cent of the estimates. Emphasis continued to be placed on projects relating to the basic needs and 31 problems of the Region, including public health administration, education and training, strengthening of nursing and maternal and child health services, environmental health activities, and campaigns against communicable diseases. The largest individual percentase of funds continued to be budgeted for public health administration, with 26.78 per cent of the total, followed by education and training, 12.93 per cent, and nursing, 10.35 per cent. In line with the recommendations of previous meetings of the Regional Committee supporting projects benefiting more than one country, various region-wide activities were proposed. These included the continuation of the regional tuberculosis advisory and inter-country treponematoses teams, seminars on filariasis and haemorrhagic fevers and a conference on the public health aspects of' protection against ionizing radiation. In addition, provision was made for an intra- regional survey of dental diseases. The remaining inter-country projects covered consultant services and fellowships. Despite the Significant increase in the proposed programme for 1965, it was still impossible to accommodate all the requests submitted by Member governments. It had, therefore, been necessary to relegate certain requests amounting to $728 100 to the supplementary list for possible implementation if funds became available. REGIONAL COMMITTEE: FOURTEENTH SESSION The Regional Director explained that the 1965 Technical Assistance programme printed in the document was, of course, tentative as government requests for the 1965/66 biennium had not yet been submitted to the Technical Assistance Board. This included continuing commitments of long- term projects, which had already been approved beyond 1964 by the Technical Assistance Board, and recommendations of the Regional Office covering project extensions or modifications, and new activities for the 1965/66 biennium. He stressed the importance of health administrations ensuring that the final submission to the Technical Assistance Board should contain full provision for both continuing projects and new requirements. In the current biennium there had been instances where the amounts requested and approved were not sufficient for the proposed programme. A great deal of difficulty had been encountered in attempting to cover deficits by savings. The Regional Office supplied governments with cost estimates for their Technical Assistance projects based on WHO's costing averages. Failure to use these co stings would result in incorrect amounts being approved by the Technical Assistance Board and would jeopardize the successful operation of the programme. The overall importance and relationship of health programmes to the economic and social growth of developing countries was of the highest importance and , • this should be made clear to national co~ordinating bodies when the Technical Assistance programme was being planned. The Regional Director informed the Committee that commencing in 1964, a separate allocation had. been provided. within the regular budget to cover all malaria activities, except those carried under the Technical Assistance budget. The proposals for malaria activities remained at '\ apprOximately the same level as in 1964. A slight increase in the prOvision for Regional Advisers was mainly attributable to statutory • . " ~' REPORT OF THE REGIONAL COMMITTEE 33 increreen"Gs and hOlr:e leave costs. There were no char:..ges in the staffing pattern. At present five countries in the Region had full malaria eradication projects in operation, namely, China, North Borneo, Philippines, Ryukyu Islands and Sarawal~. Assj,stance to China would be discontinued in 1965 as it was expected that malaria would be eradicated by the end of 1964. It was prorosed to commence a pre-eradication programme in Laos during 1965. Pro:posals under the Special Account for Community Water Supply were tentative and subject to the contributions received. In addition to projects providing expert or consultant services to seven countries of the Region, a regional seminar on water utility problems in urban develop- ment had been included in the proposals. In concluding, the Regional Director considered that the proposed budgetary increase for 1965 was reasonable, particularly if one viewed the many requests which had had to be allocated to the supplementary list because of limitations in funds. 3· DErAILED EXAMINATION AND ANALYSIS OF THE PROPOSED PROGRAMME AND BUDGET ESTIMATES In the course of the Sub-Committee's study, the following matters were discussed: 3.1 Country ;?rojects 3.1.1 Cambodia 9 - Rural health training programme (pages 25-26) It was noted that the duration of assistance to this project was estimated to be ten yeexs and information was requested on the number of personnel to be trained. The Regional Director stated that he could not provide a definite figure of the n~~ber involved but that students from the School of Nursing and the Royal School of ~dicine used this training centre for F.EGIONAL COMMIT~EE: FOURI'EENTH SESSION rural health experience. The training of sanitary agents was also being undertaken. The project had been faced with a number of difficulties, one of which was the recruitment of suitable counterparts for WHO personnel. The situation was, however, improving and a senior counter- part had recently been appointed. As he had pointed out in his Annua.l Report, unless governments provided counterparts, WHO staff would have to remain in the country longer than originally planned. It would, therefore, be necessary for assistance to this project to continue for the next four years. 3.1.2 China 3)+ - Trachoma control (pages 33-34) Information was requested on this project which it was noted was an extensive one which had been going on for a number of years. It was felt that the moment had possibly come to evaluate progress and determine whether the desired results were being achieved. The Sub-Committee was informed that the programme had been originally designed to provide treatment for schoolchildren and also, in certain areas, blanket treatment of family contacts. As the results had not been satisfactory, epidemiological studies had been carried out in 1960-1961 by a "mo team, composed of a trachomatologist and an epidemio- logist/ statistician, and the national team. Therapeutic trials had been carried. out at the same time to cLl1Ipare the effectiveness of continuous and intermittent treatment with antibiotic ointment. It had been found that trachoma was not confined to the school-age groups and that the highest prevalence was conSistently found in the 15-20 age group I irrespective of overall prevalence rate,and the decline beyond this peak was very gradual. The therapeutic trials had showed that inter- mi ttent treatment by achromycin ointment yielded results which were superior or at least as good as those of continuous treatment. ~ , .. REPORT OF THE REGIONAL COMMITTEE The project had been redefined to provide for the treatment of all age groups in the belief that the approach used would. reduce the average prevalence. In undertaking the revised prograw~, the enormity of the task had impressed the Government and the terun, and therefore very careful and detailed. plans had been made. There had been trials of all proposed methods to test their practicability in the field before starting the mass campaign. The survey teams which were dOing case-finding and treatment had covered to date over 90 per cent of the population,and in most cases up to 99 per cent, indicating the effectiveness with which the progr~ was being carried out. It was realized that such a programme, to be effective, depended upon a systematic approach and, if possible, on a 100 per cent coverage. It was a tremendous challenge but it was expected that the results would be satisfactory. Provision had been made for an annual evaluation of the programme by a consultant and in the last year there would be a consultant team which would do a complete evaluation. 3·1.3 Korea 19 - Tuberculosis control (pages 55-56) Attention was dravm to the fact that, although this project had started in 1963 or earlier and was expected to finish in 1967, there was no evidence of any diminution in WHO assistance. It was felt that this point covered a number of programmes and it appeared that in many cases there was no tapering off of WHO assistance until the completion of the project. It should be possible for competent counterparts to replace the WHO staff gradually SO that assistance was given on a d1minjshing scale. The Regional Director pointed out that in many cases the budget provision was to meet the cost of fellowships to be awarded to train REGIONAL COMMITTEE: FOURTEENTH SESSION local. people. In 1965, for e~le, there was provision for fellowships in the amount of $9800, which represented intensified training of national. staff. The tuberculosis project in Korea had only just started and one could not expect the government staff to take over within such a short period of time as four years. The aim was not merely to delOOnstrate tuberculosis control but to work out a national plan. During the past months, the progress achieved had been quite impressive. 3.1.4 Malaya 40 - As~1.stance to the University of Malaya (pages 77-78) The Sub-Com:n:i. ttee was informed that the medical education programme in Malaya was being e>:;panded and developed. The representative of MaJ.a.ya. asked, therefore, if the fellowships appearing in the proposed programme and budget could perhaps be advance-awarded. The early assignment of the consultants would also be desirable. He further requested that the two- year fellowship for study of vital statistics in the United Kingdom should be changed to a two-year fellowship for study of epidemiology and statistics in tbe United states of America, and that the reference to London University, followed by practiCal. training in Africa and India, in connection with the nutrition fellowship, should be deleted .. 3.1. 5 New Zealand 200 - Public bealth administration (pages 79-80) The Regional Director was requested to amend the text to read "To enable an office inspector in the Department of Health to study public health administration and finance". 3.1.6 Papua and New Guinea (pages 85-88) The Sub-Committee ims informed that a majority of the fellowships awarded in past years ~o Papua and New Guinea had. been taken by Europeans, as there had been no medically tre.ined local. personnel. This would not be so in 1965, as all but one fellowship in the surgery of leprosy were for nationaJ.. personnel and this trend would be followed in future years. REPORT OF THE REGIONAL COMMITTEE - 37 3.2 Inter-country Programmes (pages 127-142) 3.2.1 Site of inter-country seminars and meetings The Sub-Committee noted that, in general, seminars and inter-country meetings were held. in Na.nila. A suggestion was macle that some of these might be held elsewhere, as it was considered that M=mber countries would derive more benefit from this arrangement. The Regional Director stated that he appreciated this proposal which would, hO"Wever, present economic difficulties. Since the programme and budget was prepared two years ahead, it was not know then whether any M=mber governments wished to act as host and the Regional Office was, therefore, used as the central point and basis for the calculation of t expenses. It would also be a pity not to use the regional office facilities for conference purposes since quite a large amount had been spent for this purpose. If, however, a government wished to invite WHO to hold a seminar or meeting in its country, this could be arranged, but the additional costs would have to be borne by the government concerned. It was suggested that Member governments should be provided with a record of the places where seminars, conferences or meetings had. been held over the last five years, as this would be a valuable guide in deciding which country might be suitable for a particular meeting - for example, Japan for radiation and Malaya for haemorrhagic fever. Following further discussion, it was decided that the draft resolution presented to the Committee should contain a reference to the fact that if a seminar were held outside of regional headquarters, the additional expenses should be met by the host country. 3.2.2 Participation in educational meetings (pages 141-142) FollOwing a query by a member of the Sub-Committee as to the prOvision under Participation in Educational Meetings, the Regional REGIONAL COMMITrEE: FOURTEENTH SESSION Director stated that, normaJ.ly, WHO did not finance participation in congresses and similar meetings. There were, however, times when a fellow was already, for example, in Europe and wished to attend a meeting there; payment for his attendance could be made from this particular allocation. On other occasions, it might be of interest to governments to send participants to meetings sponsored by WHO Headquarters or other regions. This, too, would be covered under this allocation. 3.3 Malaria Eradication Programme (pages 147-162) A question was asked as to whether the integration of the malaria budget into the regular budget had resulted in governments prOviding further support for the malaria programme in the form of increased appropriations. The representative of the Philippines stated that as a result of the assistance given by WHO, the interest of his Government had been greatly stimulated in malaria eradication activities. If' the amount: of money appropriated five or ten years ago was compared with that appropriated at the present time, it could be said that the expenditure for malaria had increased tenfold. The Regional Director believed that all governments embarking on such programmes had done everything possible to increase their own appropriations in order to reach the objective of eradication. ~Cial Account for the Community Water Supp1r Programme pages 164-169) The SUb-Committee noted that the community water supply programme was entirely financed by voluntary contributions and that planning had, therefore, to be done on a yearly basis. The proposed programme was therefore a very tentative one and its inq>lementation would depend on whether WHO received suff'icient voluntary contributions in 1965 to support it. , ... REPORT OF THE REGIONAL COMMI'1'1'EE _. 3.5 Supplementary List (pages 186-201) In reply to a question, the Regional Director stated that the number of projects included in this year's supplementary list was slightly smaller than in the previous year. In 1964, the total had been approximately $933 000, whereas in 1965 it was $728 100. At the request of the representatives concerned, the following items were added to the supplementary list: Philippines A twelve-month i'ellowship in health education for study in the United states of America A three-month consultant in hospital administration in support of the programme at the Institute of Hygiene Japan A six-month fellowship in the organization, planning and administration of medical rehabilitation services. It was hoped this fellowship could perhaps be advance- awarded in 1964. 4. OTHER POINTS RAISED It was noted that there was an increase of 20 per cent in the proposed budget. It was pOinted out, howver, that in the past years there had. been a great many requests from the African :Region whose budget bad. been rather larger than that of the Western Pe.cific Region. It would appear, therefore, appropriate that the Western Pacific Region should not be neglected and in 1965, therefore, the Region had received an increased allocation. The hope was expressed that similar increases would not be brought forward by all the regions of WHO when the proposed programme and budget was considered by the World Health Assembly. The SUb-Committee noted that the proposal covering the es.tabl1shDent of a special progr~ and bud8et committee had. been based on the bellef that a sma.l.Ulr committee would be able to d.1scuss the budget more 40 REGIONAL COMMITTEE: FOURl'EENTH SESSION < thoroughly. The representative of the Philippines suggested -that consideration might perhaps be given to the possibility ot having the programme and budget discussed in plenary session by all representatives, rather than sub-dividing the Committee and rotating membership among the various countries. It was pointed out by other representatives that although the Sub-Committee was composed of certain countries, any country not a member of the Sub-Committee was always free to participate in the discussions. It was finally agreed that the representative of the Philippines should present this proposal to the Committee when the programme and budget was discussed, should he so desire. 5. CONCLUSlONS The Sub-Committee agreed that the programme was balanced and followed the general programme of work approved by the Regional Committee and the World Health Assembly, and that the priorities established were acceptable. , ' .... 1. REPORT OF THE REGIONAL COMMITTEE SUGGESTED GUIDE-LINES FOR THE SUB-COMMITTEE ON PROGRAMME AND BUDGET General review of the proposed programme and budget estimates for the financial year 1 January - 31 December 1965 (Document WP/RCl4j3) The general review should include, inter alia: (1) New activities in 1965, including new projects and new cozqponents of current projects. (2) Cozqparison of the cost of new activities in relation to the total cost of field activities. 2. Detailed examination and analysis of the proposed programme and budget estimates (1) Review of summaries (2) Review of the Regional Office (3) Review of Regional Advisers and WHO Representatives (4) Review of field activities including inter-country projects 3. Formulation of q,uestions of 1zqPortance 41/42 The Sub-Committee should list any q,uestions which it considers the Regional Committee should discuss in plenary session. 4. General conclusions In drawing its conclusions, the SUb-Committee should answer the follOwing q,uestions: (l) Is the programme balanced? (2) Does the programme follow the general programme of work approved by the Regional Committee and the World Health Assembly? (3) Are the priorities given to the regional activities acceptable? Should some types of activities be excluded from the proposed programme and new types of projects included? , - ',.. REPORT OF THE REGIONAL COMMITrEE ANALYSIS OF PROPOSE[) PROGRAMME AND BUDGET ESTIMATES REGULAR FUNDS - 1964-1965 SUMMARY 1964 uS$ Regional Committee Meeting costs (Appropriation Section 3) .. 6 000 Regional office costs (Appropriation Sections 5 and 7) ..... 411 508 Fie~d activities (Appropriation Sections 4 and 7) .......... 1 663 772 Malaria activities (Appropriation Sections 4 and 7) ........ 867 314 TOTAL (GROSS) ..................................... 2 948 654 ======== ANALYSIS OF FIELD ACTIVITIES - REGULAR - 1964 (EXCLUDING MALARIA) Continuing Projects New Projects US$ % US$ '" 'l'tlberc\lJ.osis .................. 104 464 6.28 48 900 2.94 Venereal diseases and treponematoses •••••••••••••• 44 025 2.65 2 500 0.15 Bacterial diseases •••••••••••• 8 818 0·53 - -Parasitic diseases ••••••••.••• 8 878 0·53 .. .. Virus diseases ................ 30112 1.85 4.200 0 .. 25 IA!prosy ..••....••.•..•.......• 8 871 0·53 2500 0.15 Public health Mmini stration •. 404047 24·29 108 508 6·52 Vital and health statistics ••• 58 013 3.49 4 000 0.24 Dental health .•••..••••••••••• 29 360 1.77 - - Nursing ......••...•..•.•...... 154 637 9·29 15 100 0 .. 91 Social and occupational health 14 300 0.86 10600 0.64 Health education •••••••••••••• 45 837 2.75 34 082 2.05 Maternal and child health ••••• 92 407 5·56 2200 0.13 l4ental. health ................. 45 023 2·70 14 600 0.88 Nutrition ..................... 41 082 2.47 33 800 2.03 Environmental health •••••••••• 101 556 6.10 12 800 0·77 Education and training •••••••• 132 186 7·95 37 300 2.24 other activities •••••••••••••• 8 400 0'20 - - 1965 uS$ 6 000 438 (96 2 130 776 861 060 3 435 932 ========= Total US$ '" 153 364 9. 22 46 525 2.80 8 818 0·53 8 818 0·53 34 912 2.10 11 377 0.68 512 555 30.81 62 013 3.13 29 360 1.17 169 731 10.20 24 900 1.50 79 919 4.80 94 6CJ7 5·69 59 623 3·58 74 882 4.50 114 356 6.81 169 486 10.19 8400 '20 TOTAL (GROSS) ........ 1 332 682 80.10 331 ~o 19.90 1 663 712 100.00 ========= ===== ====== ===== ========= ====== 44 REGIONAL COMMI'ITEE: FOURTEENTH SESSION ANALYSIS OF FIELD ACTIVITIES - REGULAR - 1965 (EXCLUDING MALARIA) Continuing Projects New Projects Total Us.$ "/0 US$ ~ US$ 'Yo Tubercul.osis ...... It It •••••• It ••• 114 733 5·39 71 428 3.35 186 161 8.74 Venereal diseases and treponematoses ••.••••••.••.• 52 230 2.45 27 064 1. 27 79 294 3·72 Bacterial diseases ••.••••••••• 8 795 0.41 - - 8 795 0.41 Parasitic diseases •••••••.•••• 8 795 0.41 45·396 2~13 54 '-91 2.54 Virus diseases ................ 11 994 0·57 10900 0.51 22 894 1.08 Leprosy ....................... 8 794 0.41 22 078 1.04 30 872 1.45 Public health administration .• 503 Cf99 23.61 67 578 3.17 570 677 26.78 Vital and health statistics ••• 28 080 1.32 11 600 0·54 39 680 1.86 Dental health ......•...•..•... 14 200 0.67 - - 14 200 0.67 Nursing ....................... 185 590 8.71 34.942 1 .. 64 220 532 10.35 Social and occu;pational health. 15 800 0.74 6 200 0.29 22 000 1.03 Health education .••••..•.••••• 74 252 3.48 17 600 0.83 91 852 4.31 Maternal and child health ••••• 89 039 4.18 3 650 0.17 92 689 4.35 Mental health ••.•••.••••..•••• 101 365 4.76 2 500 0.12 103 865 4.88 Nutrition .... It •••••••• It It It ••••• 38 333 1.80 34 348 1.61 72 681 3.41 Radiation and isotopes ••.••••. - - 47 375 2.22 47 375 2.22 Environmental health •••••••••• 125879 5··91 37 078 1.74 162 957 7.65 Education and training ...•.••. 183 755 8.62 91 806 4.31 275 561 12.93 other activities ..•.•••••••••. 11 100 0.80 11 400 0.82 ~4 200 1.62 TOTAL (GROSS) It It •• It ••• 1 581 833 74.24 548 943 25·76 2 130 776 100.00 ======== ===== ======= ===== ========= ====== ~ ANALYSIS OF ~JLARIA ACTIVITIES - REGULAR - 1964-1965 Continuing Projects New Projects Total (Gross) US$ % US$ % US$ 'Yo 1964 867 374 100.00 - - 867 374 100.00 1965 794 152 92.23 66 908 7·77 861 060 100.00 , '. REPORT OF THE REGIONAL COMMrTTEE 45 ANNEX 4 TECHNICAL DISCUSSIONS 1. SUBJECT The subject of the Technical Discussions as decided by the Committee at its thirteenth session was liThe role of the local health services in leprosy control". 2. ORGANIZATION OF DISCUSSIONS The first session consisted of an introductory statement by the Chairman, a panel presentation of the subject and an open discussion. In the second session the participants were divided into three groups which met separately and conducted a free discussion in accordance with guide-lines provided. The third session was a plenary one in which the reports prepared by the sub-groups were presented and commented on. 3. FIRST SESSION In his introductory statement which opened the first session, the Chairman referred to the enormity of the world problem of leprosy and the need to eradicate the disease. He stated that those in charge of public health should design leprosy control programmes in accordance with modern concepts,but they should be adapted to local conditions, and. the approach in these programmes should not only be along scientific and technical lines, but should be humane. He referred to the present- day changed concepts of the infectiousness of the disease and to the effectiveness of drug treatment. The present-day attitude to leprosy was completely different from that of the past. There were new concepts regarding the control 46 REGIONAL COMMITTEE: FOURTEENTH SESSION of the disease and it was necessary to apply these. In the panel discussion, it was brought out that it was generally accepted that leprosy was a chronic disease of relatively low infectiousness and was curable in a high percentage of cases with ava.1l.able drugs, that the essentials of leprosy control 'Were the early diagnosis of all cases and their regular continued treatment. Early diagnosis was important and was possible by clinical examinations, bacteriological examinations and biopsy. There was no general agree- ment on the value of the leprOmin test and there was the need for research in the diagnosis of leprosy. It was believed that cases diagnosed should be divided broadly into non-infectious and infectious cases, and that it was desirable to treat the infectious cases in isolation to remove the foci of infection from the community. However, leprosy endemic areas usually had limited resources in money, trained personnel and health services, and many could not therefore treat all infectious cases in isolation. Accordingly, there was an increasing adoption of domiciliary treatment. There was general agreement that DDS was the drug of choice for routine treatment and the importance of early treatment in achieving a better response and the prevention of defOrmity was stressed. There was some d.1 vergence of opinion on the value of sulphone drugs in reducing infectiousness in a patient and in 'Weakening the transmission of infection. Trained personnel and an informed community 'Were essential for carrying out case-finding and treatment effectively. In most endemic areas there was the need for training in leprosy for all categories of health personnel and also for medical, nursing and other REPORT OF THE REGIONAL COMo1ITTEE 47 students in training. Health education of the patient, his family and the general public was also essential. For the protection of the population, effective early diagnosis and treatment were important, but there was no general agreement on the effectiveness of chemoprophylaxis or of BCG vaccination. In some countries, infectious cases were segregated in institutions or colonies and after being rendered bacteriologically negative for • 5. varying periods, were referred to the local health services for continuation of treatment and surveillance. However, in others, including those with large leprosy problems, there was a liberalization of laws dealing with the segregation of cases of leprosy and the adoption .. of case-finding by static and mobile clinics and treatment on·an out- patient basis. It was indicated that the mobile clinics provided in- service training for perso~~el of the local health services who took over the care of the patients diagnosed after the mobile clinics moved to another area. Among the problems created by the segregation of cases in institutions ~~re the disruption of the family unit, and the difficulty of re-integrating the patients into their communities afterwards because of their inability to readjust themselves to normal life. Further, it was brought out that compulsory segregation tended to drive leprosy into hiding and also isolated know~edge of the disease, so that only the specialized person::el were familiar with it, and other health personnel, who should contribute to the control programme, did not have the necessRry experience to do so. The important problem of dealing with the negative cases accumulated in long-established leprosaria was brought up, and particular mention was made of the cost of maintaining these patients. One representative informed 48 REGIONAL COMMITTEE: FOURTEENTH SESSION the group of the large resettlement programme which had been started in his country, where leprosaria were being converted into hospitals for the treatment of reactions, inter-current infections, the correction of defOrmities, and the care of the crippled. Reference was made to the part played by the local health services and it was generally agreed that the treatment of cases on an outpatient basis, follow-up, health education, the examination of contacts and case-finding could be undertaken in the general outpatient clinic. However, training and supervision by the leprosy service was necessary and mention was made of the effective use of the personnel of the tuberculosis service in carrying out the needed surveillance of patients, after they bad received appropriate training in leprosy. The need for humane and sensible legislation to prevent the disease from going under~ ground was agreed on and one representative stressed the importance of the protection of the identity of the patient. Leprosy was a complex problem and the approach, techniques and methods should be adapted to the local conditions of prevalence, resources, priorities in the health programme, social and cultural development of the population, geographical feature s, etc. The gaps in the knowledge of leprosy were apparent and the need for the exchange of information and the pooling of experiences was recognized. It was suggested that consideration should be given to the holding of conferences or seminars on leprosy at intervals in the Western Pacific Region where there were many similarities in the problems and populations of endemic areas. -.J. • r .... REPORT OF THE REGIONAL COMMITTEE 49 4. SECOND SESSION The participants were divided into three groups which met independently, selected their own chairmen and rapporteurs and prepared reports on the group discussions of the subject "The role of the local health services in leprosy control". The discussions were directed to a limited number of major points included in the guide-lines prepared and there was a striking similarity in the differences of opinions expressed and. conclusions reached by the individual groups. 5. THIRD SESSION In the third session the Chairman explained the purpose of the meeting, reviewed the major pOints raised in the discussions, stressing again the need for applying present-day concepts of leprosy control, including the public health approach, the adaptation of the programme to local conditions, the need for amendment of legislation in accordance with present-day concepts. He was glad that the need for research.had been stressed and expressed the opinion that the problem of leprosy control could not be solved without the use of the general health services. The reports of the three discussion groups were then presented and discussed, after the chairman of each group had made comments on his group report. Based on the reports and the discussions at this seSSion, the following conclusions were reached: 1. That the local health services had a very important part in the leprosy control programme with particular respect "~. to dOmiciliary treatment, health education and training and case-finding. 50 REGIONAL COMMrTTEE: FOURTEENTH SESSION 2. That there was the need. for training in leprosy for health personnel of all categories and of students in training. 3· That the health education of the patient, his family and the general public was essential for reducing the stigma associated. with the disease and for the effective execution of the leprosy control programme • . 4~ That there was the need for sensible humane legislation on leprosy in line with present-day concepts of the disease. 5·i That although it was desirable to treat infectious cases of leprosy in isolation, the compulsory segregation of cases had many disadvantages, including the high cost, the disruption of the family, the difficulty of re-integrating the patient into the community on discharge l and the driving of cases into hiding. 6. That no statistical data were available on the comparative results of hospital and domiciliary treatment for infectious cases. Accordingly it was desirable that an effort be made to collect and collate any relevant information on this matter, and to make it available to health arlminj strations in the Region. If satisfactory data could not be obtained, consideration should be given to setting up a project aimed at the relative evaluation of these two types of treatment as had been done for tuberculosis. REPORT OF THE REGIONAL COMMITTEE 51/52 .. 7, That the examination of contacts of known cases of leprosy, of patients attending routine outpatient clinics and of population groups collected for any form of health activity was important in leprosy case-finding and that the local health services could play an important part in this. 8, That other leprosy patients and lay administrative personnel conversant with the disease could make a valuable contribution by referring patients to clinics. 9 I That proper maintenance of a register for leprosy patients was important in leprosy control and that the local health services had a part to play in this activity . . ~ 10 I That there were many gaps in the present knowledge of leprosy, for example in the real mechanism of the transmission of the disease, and these were responsible for the divergence of opinions expressed and the many problems faced in the approach to leprosy control. It was important to underline the fundamental necessity for research which is essential for any progress in leprosy control . .. '-..... . .:.- ~ i '--A" REPORT OF THE REGIONAL COMMITTEE 53 WP/RC14/1 WP/RC14/1-a WP/RC14/2 WP/RC14/3 WP/RC14/4 Rev.l WP/RC14/5 WP/RC14/6, Add.l and 2 WP/RC14/7 WP/RC14/8 WP/RC14/9 WP/RC14/10 WP/RC14/11 Rev.l WP/RC14/12 WP/RC14/13 Rev.l (unnumbered) ANNEX 5 LIST OF DOCUMENTS Agenda Annotated agenda Thirteenth Annual Report of the Regional Director to the Regional Committee for the Western Pacific Proposed programme and budget estimates for the financial year 1 January - 31 December 1965 Fluoridation of water supplies Kuru in the Territory of Papua and New Guinea Facilities for education and training of health personnel in the Western Pacific Region Studies on cholera El Tor Resolutions of regional interest adopted by the thirty-first and thirty-second sessions of the Executive Board and the Sixteenth World Health Assembly Selection of Technical Discussion topics for the fifteenth (1964) session of the Regional Committee List of representatives Report of the Sub-Committee on Programme and Budget Report of the Technical Discussions Report of the fourteenth session of the Regional Committee for the Western Pacific Kuru - Reprint of a paper by Dr. D.C. Gajdusek, National Institute of Neurological Diseases and Blindness, National Institutes of Health, Bethesda, Maryland, United States of America r REGICllAL COMMITTEE: FOURTEENTH SESSION WP/RC14/Min/l Rev.l Minutes of the First Meeting - 5 September 1963 WPjRC14/Min/2 Rev.l Minutes of the Second Meeting - 5 September 1963 WPjRC14/Min/3 Rev.l Minutes of the Third Meeting - 6 September 1963 ~. 41 WPjRC14/Min/4 Rev.l Minutes of the Fourth Meeting - 10 September 1963 WPjRC14/Min/5 Rev.l Minutes of the Fifth Meeting - 10 September 1963 "' .. WP /RC14/p&:B/l Suggested guidelines for the Sub-Committee on Programme and Budget WPjRC14/P&B/2 Analysis of proposed programme and budget estimates - regular fUnds, 1964-1965 WPjRC14~Dl Procedures and techniques for the Technical. Discussions WPjRC14/TD2 Suggested programme for the Technical Discussions WP jRClA-/TD3 Guidelines for the Technical Discussions WP/RC14/TD4 The problem of l€prosy in Viet~ fram the public health point of view ~ .. WP /RCl4 jTIY5 A review of the present-day concepts of leprosy control with special reference to the role of the local health services wpjRc14/m Case-finding, follow-up and management of ...-leprosy cases with partiCular reference to the integration of these activities into those of the established health services WPjRC14/TD7 The control of leprosy in Fiji within the public health programme WP/RC14/TDB Rev.l Discussion group memberships WP/RC14/TT19 Discussion group reports WP/RC14jTD1O Individual evaluation questionnaire tor the Technical Discussions PART II ";0, MINUTES OF THE PLENARY SESSION " ... • '0"- v Agenda Item No. 1 2 3 CONTENTS Opening of the se ssion .••.••••••••••••••••••••••••• Address by retiring Chairman •••••••.••••••••••••••• Address by the Director-General ••••.••••••••••••••• 4 Election of new officers: Chairman, 5 6 7 7.1 Vice-Chairman and Rapporteurs •••••••.•••••••••••••• 67 Address by incoming Chairman •••.••..••••••••••••••• 69, 120 Adcption of the agenda ...••.••••••••••••••••••••••• Technical Discussions •••••••••.••••••••••• , •••••••• statement by the Chairman .••••••.••••••••••••••• 7.2 Acceptance of the Programme 8 for Technical Discussions ••••••••••••••••••••••• 70 Proposed programme and budget estimates for the financial year 1 January" 31 December 1965 .•....•.••.•••••••.•••• 70, 152 8.1 Establishment of the Sub-Committee 8.2 9 10 II 12 13 14 15 on Programme and Budget ..•••.••••••••••••••••••• 70 Consideration of the report pre sented by the Sub-Committee on Programme and. Budget ••• e· •••••••••••••••••••••••••••••••••••••• Acknowl.edgrnent by the Chairman of brief reports received from governments on the ~rogress of their health activities •••••••••••••••• Report of the Regional Director ••.••••••••••••••••• $~uoridation of water supplies .•••••••••••••••••••• Kuru in the Territory of Papua and New Guinea ••••••••••••••••••••••••••••••••••••••••• Facilities for education and training of health personnel in the Western Pacific Region .•........•.•...•••.••••••••••••••••• Studies on cholera El Tor •.•••••••••••••••••••••••• Resolutions of regional interest adopted by the thirty-first and thirty-secand sessions of the Executive Board and the Sixteenth World Health Assembly ••.••••••••••••••••• -57- 152 71 90, 137, 146 112 122, l46 124, 151 126, .147, 155 132 CONTENTS Asenda Item No. ~ 16 Selection of topic for the Technical Discussions during the fifteenth session of the Regional Committee .......................... 133 17 Consideration of the report presented by the Technical Discussion Group .................. 160 18 Time, place and duration of the fifteenth and sixteenth sessions of the Regional Committee .......................................... 144 19 Other business Announcements: TrBllsport ................................•.•. Working hours ................................ Genetic profiles ................................ 71 7l- 140, 144, 160 Resolution of appreciation •••••••••••••••••••••• 161 Statement by the Representative of the United Nations Children I s Fund .............. Statements by representatives of the inter-governmental organizations and of non-governmental organizations in official relations with WHO: Representative of the International Association for the Prevention of 106 Blindn.e ss ........................••.•••••••.. lll. Representative of the International Dental Federation ............................. 114 Representative of the League of Red Cross Societies .•••••••••.••••••••••••••• loB Representative of the South Pacific Commission ..••.•••••.•••••••••••••••• 109 Representative of the World Medical Association •••••••••••••••••••••••••• 107 20 Adoption of the draft report of the Cozmni ttee ........................•..........•.••••. 160 21 AdJ ournme nt .......•........................... ..... 161 -58- .,.. .. '", . ;:: (WP/RC14/Min/l Rev.l) MINUTES OF THE FIRST MEETING Legislative Council Chambers Thursday, 5 September 1963 at 8.15 a.m. CHAIRMAN: Dr R. F. R. Scragg CONTENTS 1. Formal open1.ng •••••••••••••••••••••••••••••••••••••••••••••• 62 2. Address by retiring Chairman .•.••••.•••••••••••••••••••••••• 65 3. Election of new officers .•.•..•••••••••••..•••••...•••••••••• 67 4. Address by incoming Chairman ..•••••••.•..•..•••••••••••••••• 69 5. Adoption of the agenda ................................•..•.. 69 6. StateDEnt by the Chairman of the Technical Discussions...... 6Q 7· Acceptance of the Programme for Technical Discussions ....... 70 8. Establishment of the Sub-Committee on Programme 8ll.d B1ld.get ••••••••••••••.•••••••••••••••••••••••••••••••••••• 70 9. Acknowledgement by the Chairman of brief reports received from governments on the progress of their lleal th activities ........................................... 71 10. .Ann.OllncelDents. • • . • . . . . . • . . . . . . . . . . • . . . • . . . . . . . . . . . • . . • . • • . • • 71 ANNEXES 1 Address of welcome by the Honourable Minister of state for Health, Senator Harrie Wade •.•••••••••••••••••• 73 2 Address by the Right Honourable Prime MLnister of the Comm:>nwealth of Australia, Sir Robert Mmzies •••••••• 77 -59- 60 REGIONAL COMMITTEE: FOURTEENTH SESSION First Meeting Thursday, 5 September 1963 at 8.15 a.m. PRESENT I. Representatives of Member States ,.... AUSTRALIA Dr R.F.R. Scragg Dr C. Haszler Dr Kila Wari Dr Himson Mulas Major-General W.D. Refshauge Dr H.E. DO'WIles Dr C.J. Ross-5mith CHINA Dr C.K. Chang Dr T.C. Hsu FRANCE Dr A. Ferron JAPAN Dr E. Wakamatsu Dr J. Ohmura Mr Y. Matsuda Dr K. Hamano KOREA Dr Suk Woo Yun MALAYA Dato Dr Mohamed Din bin .Ahmad Dr Raji Abba.s bin Raj1 Alias NEW ZEALAND Dr D. P . Kennedy PHILIPPINES Dr L. Uyguanco Dr F.T. Diy Dr E.L. Villegas "'- UNITED KINGDOM Dr C.H. Gurd Dr R. Dickie Dr C.H. James UNITED STATES OF AMERICA Dr J. Watt Dr R.K.C. ~e Dr Saipele Matagi VIET-NAM Dr Le-CUu-Truong WESTERN SAMOA Dr J. C. Thiema .. ' F MINUTES OF THE FIRST MEm'ING 61 ... -, II. ReEresentatives of other inter-sovernmental organizations and of non-~overnmental or~an1zations '" INTERNATIONAL ASSOCIATION FOR Dr J.J. Loschdorfer THE PREVENTION OF BLINDNESS INTE&~ATIONAL COUNCn., OF NURSES Miss V. Bignold ... - INTERNATIONAL DENTAL FEDERATION Dr T.E. Hubble LEAGUE OF RED CROSS SOCIETIES Mr H. Buchanan SOUTH PACIFIC COMMISSION Dr R.A. Chappel i- WORLD MEDICAL ASSOCIATION Dr C.J. Ross-Smith III. WHO Secretariat SECRETARY Dr I. C. Fang Regional Director " 62 REGIONAL COMr.fiTrEE: FOURTEENTH SESSION 1. FORMAL OPENING: Item 1 of the Provisional Agenda The fourteenth session of the Regional Committee for the western Pacific was formally inaugurated at the legislative Council Chambers by the Right Honourable, Sir Robert Menzies, Prime Minister of the Commonwealth of Australia. The Honourable Minister of state for Territories, Mr Paul Hasluck, and His Honour the Administrator, Sir Donald Cleland, were also present. The Prime Minister was introduced by the Honourable Minister of State for Health, Senator Harrie Wade. 1.1 Address of welcome by the Honourable Minister of state for Health, Senator Harrie Wade The address of welcome by the Honourable Minister of state for Health is contained in Annex 1. 1.2 Address by the Right Honourable the Prime Minister of the Commonwealth of Australia, Sir Robert Menzies The address by the Right Hcnourable the Prime Minister of the Commonwealth of Australia is contained in Annex 2. 1.3 Message from the Director-General: Item 3 of the Provisional Agenda The REGIONAL DIRECTOR conveyed to the meeting the greetings of the Director-General who regretted exceedingly that he was unable to be present. The Regional Director then stated that WHO adhered to the concept that the protection and improvement of health were essential elements MINUTES OF ~lHE FIRST MEETING in any attempt to raise national standards of living. These principles had, in fact, been strongly asserted at the launching of the United Nations Development Decade, when it had been declared that the widening of man's horizon through education and training and the lifting of his vitality through better health were not only essential pre-conditions for develormE'nt, they were also arcong its major objectives. In the annual report presented to the committee a year ago, he had emphasized that governments in the Region were now becoming increasingly aware of the intricate relationship between the development of a sound national economy and that of adeql!ate health services. Recent events had shown the truth of this statement and it was against this back- ground that one should view the significance of the meeting being held in Port Moresby. All present were active participants in the great drama of change that dominated the contemporary scene in the Region. They could, therefore, appreciate and perhaps profit more from the achievements tb~y would see d~ing their stay in the Territory of Papua and New Gu,mea. Sinr.e his arrival he had seen evidence of tr~ tremendous task being undertaken by the Goverl1I"'..ent of Auctralia on behalf of the people of the Territor~r. After t~e forthCOming tour to the remote parts of the country he i-iaS sure that everyone "!QuId echo the words of praise of the United Nr.tions lI..iss:' ... on w!1.ich had m.ae.e a visit in April 1962. This group had stated that the n1..'1gni tude of the undertaking which Australia faced in New Guinea presented a challenge and opportunity with few parallels in the history of under-developed areas. Australia had tackled this task with courage, enterprise and drive and had soon produced remarkable results. The Mission had also spoken of the 64 REGIONAL COMMITTEE: FOURTEENTH SESSION admirable progress in the field of public health and of the high standards of hospital construction and administration. In the span of a decade and a half, roads had been built and airline services estab- lished. School-buildings had been constructed and education had made big strides. Plans had already been made for a University of Papua and New Guinea. The recent economic survey made by the World Bank. indicated the concern of the Australian Government for the economic development of the Territory and he was happy that WHO had particip3.ted in this survey. All these developments served to confirm the seriousness and dedication with which the Australian Government undertook its obligations and international comnitments. On this score the Regional Director could speak from personal experience. The Regional Office in Manila had received, excellent co-operation from the Australian Government. Leading scientists and public health officials from Australia were members of WHO's br~in trust for medical research and WHO's expert oommittees. The Australian people themselves were contributing much to international understanding through their acceptance of WHO fellows from other parts of the world. He hoped that this would result in even greater participation on their part in international health work and looked forward with eagerness to the day when more Australian public health experts would join WHO. In the past the Australian Government had requested little assistance from WHO for the Territory, as it had preferred that the limited resources available should be directed to those Member governments which needed them most. This generous attitude was much appreciated. However, if more assistance were required in the future, WHO would be most happy to do all it could to meet any such requests. j -. MrNUTES OF THE FIRST MEETnm In closing, the Regional Director conveyed the thanks of the Director-General, Dr M.G. Candau, as well as his own, for the most generous hospitality extended by the Government. 65 With the completion of the formal opening, the Committee adjourned for a short intermission. 2. ADDRESS BY Rm'IRING CHAIRMAN: Item 2 of the Provisional Agenda In the absence of the retiring Chairman, Dr Duque (Philippines) and the retiring Vice-Chairman, Dr MacKenzie (United Kingdom), the speech of the retiring Chairman was read by the REGIONAL DIRECTOR. Dr DUQUE stated that presiding over the thirteenth session of the Regional Committee had been a privilege and a pleasant experience. Last year, after having been elected chairman, he had planned to join the Committee in Port Moresby. First, because he wanted to meet health workers who were performing herculean tasks in combatting disease and infirmity under the most trying conditions. Second, because he wanted to visit Australia and learn from and profit by the experiences of its health workers. He had, however, been asked to serve his country in another capacity and he regretted exceedingly that he was thus unable to be present at the fourteenth session of the Committee. As retiring Chairman, he wished to extend his most sincere and warm wishes for a. successful meeting. In the last Regional Committee Meeting, he had emphasized the need to eradicate the communicable diseases, which he had referred to as the challenge of the 1960s. That need was perhaps 66 REGIONAL COMMUTEE: FOURTEENTH SESSION even more pressing today following the resurgence of such diseases as cholera and smallpox in a number of countries in the area. Many other communicable diseases were still the cause of the high morbidity and mortality rates in the Region and millions of dollars would certainly be spent by governments to bring about the early control, if not eradication, of these diseases. The individual efforts of Member countries within the Region to promote and protect the health of their peoples represented an effective contribution to the attainment of international bealth. WHO had also contributed its share in improving the health of the people and had, in fact, taken the initiative in undertaking global activities to bring about the control and/or eradication of some communicable diseases. He was pleased to know that the Committee would discuss the role of the local health services in the control of leprosy, the disease that had not only caused social dislocations and family problems from biblical times, but had. retarded economic life as well. The recent trends in leprosy control were indeed encouraging. The eventual acceptance of leprosy patients in society had been brought a step nearer realization through the new attitude being adopted in many countries concerning the abolition of segregation. While these developments seemed promising, he wished to caution health authorities and health workers against the temptation to over- simplify the problems of leprosy and especially the means of its control. There was still much to be learnt about the disease. The mode of trans- mission, its incubation period, the future of sulphones as the drug of choice, etc., were some of the areas that required further investigation. The situation called for even more intensive research activities, all aimed at bringing about an early understanding of the various epidemio.- logical unknowns. - MJNUTES OF THE FIRST MEETING He suggested that WHO might consider making funds available for leprosy research purposes. There was an army of leprosy workers all over the world who, because of lack of financial support and lack of facilities, were unable to proceed with their very important and far-reaching stUdies. These people should be encouraged by the Organization through grants-in- aid. Their findings would result in a better understanding of the disease, and health authorities would be able to plot a course of action that would ultimately resolve their leprosy problems. He hoped that the Committee's discussions on the role of the local health services in the control of leprosy would bring forth new knowledge and new areas of agreement on the methods of control and how they might be achieved in any given area. It was also his hope that the experiences in the Region would be pooled and used to advantage in areas where present control activities for leprosy left much to be desired. In concluding, Dr Duque thanked the representatives of the COmmittee, as well as the staff of the Regional Office and its Director, Dr Fang, for the support and assistance given him, and congratulated the incoming Chairman vn his appointment. 3. ELECTION OF NEW OFFICERS: Item 4 of the Provisional Agenda 3.1 Election of Chairman Dr DIN (Malaya) nominated Dr Scragg (Australia) as Chairman; this was seconded by Dr CHANG (China). Decision: Dr Scragg was elected with acclamation. The CHAIRMAN expressed appreciation of the honour paid Australia and Papua and New Guinea by the holding of the meeting in Port Moresby and also 68 REGIONAL COMMITl'EE: FOURTEENTH SESSION the honour paid him and the Territory by his election as Chairman. 3.2 Election of Vice-Chairman Dr KENNEDY (New Zealand) nominated Dr Thieme (Western Samoa) j this was seconded by Dr WAKAMATSU (Japan). Decision: Dr Thieme was elected unanimously 3.3 Election of Rapporteurs Dr WATr (United states of America) nominated Dr Ferron (France) as Rapporteur for the French language; this was seconded by Dr GURD (United Kingdom) • Dr FERRON (France) noted that at previous meetings representatives of France, Portugal and Laos had served as French rapporteurs but no representative of Viet-Nam had ever been elected to this position. As Viet-Nam was a French-speaking country, its representative might perhaps be elected as Rapporteur for the French language. Dr TRUONG (Viet-Nam) thanked Dr Ferron for proposing his name as French rapporteur, but stated that he was very busy with matters connected with the Technical Discussions. He wished, therefore, to support the proposal to appoint Dr Ferron as French rapporteur. Dr YON (Korea) nominated Dr Uyguanco (Philippines) as Rapporteur for the English language; this was seconded by Dr DOWNES (Australia). :Qecis1on: Dr Ferron and Dr Uygua.nco were lma.ni mously elected Rapporteurs. MINUTES OF THE FIRST MEETING 69 4. ADDRESS BY mCOMING CHAIRMAN: Item 5 of the Provisional Agenda The CHAIRMAN requested that his address should be postponed untU Friday morning. He then informed the Committee that information had been received that neither Cambodia nor Laos were able to send representatives. The Portuguese representative would arrive tomorrow. (See minutes of the third meeting, section 1.) 5. ADOPTION OF THE AGENDA: Item 6 of the Provisional Agenda The CHAIRMAN moved the adoption of the agenda. This was seconded by Dr GURD ( United Kingdom). Decision: The agenda was adopted. 6. STATEMENT BY THE CHAIRMAN OF THE TECHNICAL DISCUSSICIlS: Item 7.1 of the Agenda The CHfURMAN announced that, in accordance with the resolution adopted by the Regional Committee at its eleventh session, the Hegional Director, in consultation with the Chairman of the Regional Committee, had selected Dr Le-~Truong, Director-General of Health and Hospitals in Viet-Nam, as Chairman of the Technical Discussions. Dr TRUONG (Viet-Nam)" Chairman of the Technical Discussions, expressed his appreciation of the honour paid both to him and his country • by this appointment . He then pre sented the proposed arrangemnts for this year IS Technical Discussions. As aJ.ready known, the them was "The role of the local health services in leprosy control ", which had been selected by 10 REGIONAL COMMITrEE: FOURTEElNTH SESSION the Regional Committee at its thirteenth session. Documents WP/RC14/TD1, 2 and 3, which had been distributed, gave the general scheme of the discussions, as well as the guidelines. Three sessions had been set aside for the discussions, Saturday morning, MJnday morning and after- noon. In addition, on Sunday, there would be a tour, designed for those interested in rural leprosy problems, consisting of visits to two Hansenide colonies, a field leprosy control unit and village clinic facilities. (For consideration of the report on the Technical Discussions, see minutes of the fifth meeting, section 2.) 7. ACCEPTANCE OF THE PROGRAMME FOR TECHNICAL DISCUSSIONS: Item 7.2 of the Agenda (Document WP/RC14/TD2) Dr TRUONG (Viet-Nam), Chairman of the Technical Discussions, moved the adoption of the programme for the Technical Discussions. This was seconded by Dr WATr (United States of America). Decision: The programme for the Technical Discussions was accepted. 8. ESTABLISHMENT OF THE SUB-COMMITTEE ON PROGRAMME AND BUDGET: Item 8.1 of the Agenda In accordance with the principle of rotation, it was agreed that the membership should be composed of the representatives of China (Taiwan), Japan, Malaya, New Zealand, the United Kingdom and. Viet-Nam. It was also agreed that the Sub-Committee would meet at 2.30 p.m. on Friday, 6 September, and that, if necessary, discussions would continue on Saturday afternoon. (For consideration of the report of the SUb-Committee on Programme and Budget, see minutes of the fourth meeting, section 4.) , y. MINUTES OF THE FIRST MEm.rJJi1G 71/12 9· ACKNOWLEDGEMENT BY THE CHAIRM'AN OF BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIEE: Item 9 of the Agenda The CHAIRMAN stated that progress reports on health activities had. been received from Australia, British Solomon Islands Protectorate, Br1.mei, China (Taiwan), Federation of MUaya, Japan, Korea, New Zealand, North Borneo, Philippines, Singapore, Territory of Papua and New Guinea, Viet-Nam and Western Samoa. In addition, the Commonwealth of Australia had. submitted the Report of the Director-General of Health for 1 July 1961 to 30 June 1962; Japan had. submitted A Brief Report on Public Health Administration in Japan, 1963; the Territory of Papua and New Guinea had submitted the Annual Report of the Department of Public Health for 1962-1963; Sarawak had. submitted the Annual Report of the ledica.l and Health Department for 1962. 10. ANNOUNCEMENTS The CHAIRMAN sugge sted that the Comm1 ttee should follow its usual practice and meet from 9. 00 a. m. to 12.00 noon , with a break. at about 10.30 a.m., and from 2.30 to 5.00 p.m., with a break at about 3.30 p.m. It was so agreed. It was further announced that official cars would carry represents.- tives between their hotels and. the cOnf'erence chambers. Unless otherwise notified, cars would depart from the Boroko Hotel at 8.30 a.m. and 2.00 p.m. and from the Papua Hotel at 8.45 a.m. and 2.15 p.m. on meeting days. The meeting adjourned at 11.20 a.m. MmUTES OF THE FIRST MmETING ANNEX 1 ADDRESS OF WELCOME BY THE HONOURABLE MINISTER OF STATE FOR HEALTH, SENATOR HARRIE WADE 73 The Prime Minister, Honourable Hasluck, His Honour the Administrator, very distinguished guests, ladies and gentlemen. It is my very great privilege and honour this morning to extend to delegates from thirteen countries a very -warm welcome to this neck of the woods. You have come from the four corners of the Pacific, from as far north as Japan, from as far south as New Zealand. In the east you have come from Fiji and Hawaii and from the west as far as Malaya, and each of you has come with a purpose, come with a desire to make a contribution for a better way of life for mankind, each of you has come to give and expect no reward; and with that quality of purpose of course your deliberations must succeed. You have come a long way since WHO was launched in 1948, or should I say WHO as we know it today, and during that period of time you have been able to catch something of the spirit and the vision of the men who launched this grand organization, men who had a very real I appreciation of the human rights of the individual expressed so adequately in the second principle of the Constitution. May I quote it to you, this is how they express themselves. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. I think that adequately indicates to the man in the street, to those who would be cynical as to what you may be accomplishing, that here is a charter that demands that the individual shall have the best that human endeavour can prOvide, and although you are co~arati vely young in years you have a magnificent record of achievement, not only in the control of disease, but what I believe 14 REGIONAL COMMI'I'l'EE: FOURTEENTH SESSION is by far the more important, in its prevention. There I believe the challenge today is even greater than before. Yet in spite of your success, every time you meet around the council table, you face new problems as well as the old, you meet new challenges as well as the old, but because you come to face these problems, to accept these challenges, your conferences must succeed and, therefore, I say to you, deliberate and conclude with confidence because all men throughout the world applaud your efforts. This time, Sir, too I think one should pay a tribute to those 2000 odd people who represent the World Health Organization, the men who transplant your thinking into action, the doctors, the ailmi n1 strators, and those who labour in the field, they too have a record that surely is a monument to them. So 1 Sir, I would like you to know that my country, Australia, is proud to be associated with WHO, and to prove my sincerity if such proof is necessary, we bring to you today our number one citizen, the Right Honourable Robert Gordon Manzie s, Prime MLnister of Australia, to open your Conference. Of course, you all know him as a world stateman, a man who has made magnificent contributions to affairs of the world. He has striven unceasingly to make the world a better place in which to live for the common man and we Australians recognize him as a man in his own right, as one who has great human <a.ualities, a man who has devoted a lifetime and very exceptional talents to improving the lot of his fellow men. And so, Sir, to you and :to Dame Pattie Manzies, we extend to you a most cordial welcome and I know, that when you rise to speak, the people assembled here will show their appreciation of what you have done to make this conference a success. So, Sir, finally may I say this to the delegates. We are delighted. to have you here, we believe MINUTES OF THE FIRST MEETING that your coming to this part of the world is an indication that you recognize that this part is going to take its place in the sun, and so I say to you, I do hope, and I am. sure, that your deliberations will be successful and I hope you may have a very happy stay while you are here. Thank you. MINUTES OF THE FIRST MEETING 77 ANNEX 2 ADDRESS BY THE RIGHT HONOURABLE THE PRIME MINISTER OF THE COMMONWEALTH OF AUSTRALIA, SIR ROBERT MENZIES, K.T., C.H., Q.C. Sir, distinguished representatives of your various countries, Ladies and Gentlemen. 1>:tY colleague Senator Wade has rather gloried me this morning. He attributes my presence entirely to virtue on my part. I would like to tell you that the last time I was here, though not in this building, they did their best to kill me. They cooked me, they cooked me, they cooked me, they ran me around and I agreed to come this time on the strict condition that the weather would be better and so it is. So it is not only a matter of pure virtue but of adulterated personal comfort. Sir, the Constitution of the World Health Organization not only contains those splendid words that were quoted by my colleague but they also contain the definition of health and I read this with great interest. They described health as a state of complete mental" physical and social well-being and not merely the absence of disease or infirmity. I think most of us must be rather unhealthy. The state of complete mental, physical and social well-being, well, give those words an extensive interpretation and they would discover almost all of the material problems of mankind, wouldn I t they, and therefore they would tend to defeat themselves. But what I like about the work of the WHO is that it has not lost itself in generalization, it has rather concentrated its mind upon the proposition that health in the nations and among the people does not represent merely the absence of disease, but includes these great activities to which my colleague has referred. In brief, the World Health Organization has not been just academic in 78 REGIONAL COMMITl'EE: FOURTEENTH SESSION its approach to problems. On every occasion it has sought to give a practical application to the work of medical scientists and discoverers, and to give that practical application in particular places for particular purposes. I was informed before I came here that 100 health projects had been assisted by the World Health Organization in the western Pacific, a hundred different and specific projects. Now, Sir, having said that to indicate that I do understand the essentially prac~ical purposes that you have, I perhaps ought to remind those of us who are not medical men that it is a pretty modern idea that public health problems are capable of solution. I don 't think that people troubled much about public health problems as we understand them, a couple of centuries ago. In Great Britain the eighteenth century has become known as the century of good taste, and indeed it was in many ways, but it must have produced many bad tastes in its fashion, because public health as we understand it was entirely unknown and indeed the practice of medicine in any of its forms was extraordinarily primitive. Indeed, ~ne has only to go back to the mid.dl.e of the nineteenth century .. a period which was well remembered by people like my own parents so that we are not so far removed from the middle of the nineteenth century - up to that time when the Red Cross was created, when the great figure and genius of Florence Nightingale became known, nursing as we understand it, treatment nf the wounded as we understand it, was almost entirely unknown. For the most part, in the dreadful occurrences of war the wounded were left to die, casualties which turned out tn be fatal were enormous compared to what they would be under similar circumstances today. And it was a good long time after that before it was realized by the hard economic elements in the community that disease is MINUTES OF THE FIRST MEETING economically wasteful, that no country can afford to have any disease in its country which skill and effort can avert, that econf'lmically this wastage of the economic contribution made by the individual is 79 not to be tolerated. That is a very modern idea, and so we have entered what we are pleased to believe to be the modern and enlightened era, of which the World Health Organization is a manifestation with 115 Members and a record of im!nense vigour and practical quality. But Sir, the health work of the modern world and the health work of the WHO cannot be done in a vacuum, they cannot be done extra-territorially. What we all need to do, what you have shown that you understand you must do, is to get down to cases, not to be too abstract, not to regard any problem as being capable of being solved in an office or a laboratory somewhere else in the world, and, therefore, as I understand the WHO, its main function is to stimulate activity in specific areas and to a great extent in relation to specific diseases of great endemic or epidemic proportions. Your topic for this conference is an illustration of this fact, and when you have a conference you are not merely engaging in a series of abstract remarks, you are concentrating your attention on the particular problem and pooling experience and skill, as it turns out here from thirteen or fourteen different countries. Now, Sir, you happen to be in Aus'i;.ralian Territory and I happen to be by the grace of the electors of Australia, though only narrowly, the Pr1lIe Minister. Now in these territories, Papua and New Guinea, we in Australia have accepted great responsibilities, responsibilities much too great to be passed off our shoulders lightheartedly or in a spirit of pure theory; we have immense responsibilities in these territories and we propose of course to discharge them. We look forward to the 80 REGIONAL COMMITTEE: FOURTEENTH SESSION time when these territories, the people of these territories, will be couv;>letely , politically and economically independent, where they will be a living, vital country, controlling their own destiny. This is the great objective of intelligent people in the twentieth century, but in the meantime we the Government of Australia have tremendous responsibilities and we will carry them forward to the conclusion, not slowly, not in a wild hurry, always with the understanding that the paramount considera- tion is the 'Welfare of the people of the Territory and not a mere desire to satisfy somebody else. Now this is a Health Organization Conference and, therefore, I should tell you that in the pursuit of this duty to which I have referred, the Administration, while very far from satisfied - nnne of us can afford to be satisfied, if you were satisfied about the state of health in the world, you would not be here, this is something about which you will never get satisfaction and therefore the Administration is not satisfied - but I venture to say that it can be very properly proud of what has been done, remembering always that these t'erritories embrace hundreds of different types of people, literally hundreds of different langua~s, stages of civilization or of uncivilization which perhaps are not to be found very easily in any other part of the world, ranging from what you see a.round you in Port Moresby to what we might see if we had the time, and tc.ok the trouble, and had the endurance to go into some of the more remote parts of Papua and New Guinea. This is a tremendously difficult place and yet, I repeat, the Administration may be very proud of what has been done. So far as we have been able to discover, there was simply no evidence of any established medical system in this great tract of country until European settlement first occurred. MINUTES OF THE FIRST MEErING The indigenous inhabitants, as was not uncommon perhaps at that stage in the world's history, believed that disease was the product of some 81 mysterious fault, perhaps a sorcerer, perhaps some form of witchcraft _ they were rather obscure, almost instinctive and superstitious ideas about how illness came about and how it ought to be dealt with. In other words, there was a state of affairs here only a decade, three- four decades ago, five decades ago, which strongly resembled the state of affairs which existed in a great number of our countries hundreds and hundreds of years ago, so that the task was a difficult one and had to be concentrated into a fairly short period of time. Well, by 1923, that is only forty years ago, there were in these territories, fourteen hospitals and thirteen medical officers, no great matter was it? Fourteen hospitals, thirteen medical officers represented an enormous improvement on what had been, but it was still no great matter, and then the progress that followed that was interrupted by war, because this country saw war and saw· it in a destructive form. I have been reminded that the war destroyed every hospital, except those at Port Moresby and at Samarai. Here is a splendid example, if that is the right word to choose, of the destruction that war can bring about; only two hospitals left standing, but of course the war also - by the strange irony of fate or the not always understood wisdom of Providence - the war brought great advances in medicine with the antimalarials and the insecticides and the antibiotics and the vaccines. I suppose that two of the remarkable effects of the war were that in medical science the discovery of how to fight disease was accelerated beyond words, while at the same time in the world of the physicist we saw results following upon the splitting of the atom, which has up to now rather 82 REGIONAL COMMITl'EE: FOURTEENTH SESSION increased the apprehensions of mankind, but may in due course, properly understood, add enormously to its resources. So there was a plus, there was a minus. Well, .Sir, when all the war was over, the Administration resumed and has pressed on with increasing activity ever since. Great territory-wide campaigns by 1957 'Were being waged against yaws, against tuberculosis, against malaria, leprosy, there was an increasing nedical examination of schoolchildren .. and after all, it isn't so long since there 'Were hardly any schoolchildren because there were hardJ..y any schools, this has been a tremendous development that I won't take time to speak of this morning .. but there has been over this period an increasing medical examination of schOOlchildren and a dental. health service. In 1962/63, the last financial year, there was an extensive procurement of vaccines against what - very interesting to recall the diseases that 'Were being attacked - against tetanus, against Whooping- cough, which in some of our countries is regarded sometimes as a sort of juvenile eccentricity, regarded with indifference by husbands and causing immense trouble for wives, but still whooping-cough in a country not so 'Well developed can be a dread disease and it was attacked. Diphtheria, poliomyelitis, smallpox, cholera, tuberculosis, all these things be ing attacked by the procurement and use of vaccine s, with tremendous personal. work being done by regular health patrols and, of course, by the improvement of nutrition. I said then by regular health patrols. You look at the relief map out in the foyer outside, somewhat exaggerated no doubt for the purposes of demonstration, you will realize that this is, in many respects, a tremendously mountainous country, with here and there a road, with here and there a track, but for the most part presenting the most tremendous difficulties of access - "..P .. (",- T lIDJUTES OF THE FIRST MEETING and, therefore, perhaps enabling more and more small communities in small valleys or in remote corners to be suffering from some disease, to be almost extinguishing themselves without access from the people who might be able to help them. If anybody ought to go down in history here with immense fame, it is the people who have gone out on patrols, who have put up with all these hardships, who have reached these inaccessible places, in order to bring medical help and apply medical resources to the needs of the country. That goes indeed in Papua and New Guinea for almost all the activities of administration. We are living in an age in which bringing the ordinary instruments of peace and progress and benefits to the people requires immense personal courage on the part of hundreds and hundreds of young men out on the trail. Now, Sir, I hesita.te to speak about money, because I find that sums of money that I think are quite big are regarded by opponents as trivial and so I hesitate to speak about money, but I think I should say that health services as you all know, are costly, indeed it is because you realize this that you have these regular meetings in order to produce more and more efficacy in the treatment of disease because the more efficient then the more justified is the expenditl~e of money. Now since 1953, that is ten years ago, the health services in these countries have cost us thirty-three million pounds. I had forgotten to add up the figures, all I remembered in a hazy way was that my colleague and friend, Mr Hasluck, who is the Minister for Territories in my Government, has a very beguiling way of getting more money for the Territories than the rest of us at first thought proper and lOOking back on it, there it is, thirty-three million pounds. In the last financial year which closed only the other day, five million pounds on health services, 84 REGIONAL COMMITTEE: FOURTEENTH SESSION that amounts to fifty shillings per head of the population and to all that you must add in these territories the immense work, the devoted, the skilled work of mission medical workers so that you will see just at a glance that what has been done here has really been done generously, enthusiastically, and of course when I say that, I am the first one to realize that what looks like a big figure this year, will look like a fairly smaJ.l and comfortable one before we are another five years older. If you add together the work of the Administration here and the work of the missions - and this is the last fact I want to put before you - if you add those two together, and you have in mind that after this last war there were tvro hospitals left standing, a mere handful of medical :people immediately available, and then listen when I tell you that in June of this year there were 100 government hospitals, 100, and a very large number, which I don I t have by me, of m1ssion hospitals, there were 528 maternity and child wel.fare centres, there were 1693 aid-posts or nedical centres, 1693, there were 148 doctors and there were 4400 other Dedical personnel, all this on June 30th of 1963; and you will see that you have come here representing all your talent, devotion, experience, to a country which affords a splendid example of an administration with the co-operation of the people going forward along the lines that you have been so much concerned with, bringing to the people a new chance of prolonged life, higher medical standards, better living, a better future, taking them out of the primitive and superstitious darkness before the medical era and giving them the benefit of the best that the worl.d can provide. This in other words, is a great experimental area in the world and I am delighted that you should, have come here in order to bring your minds together on a. disease I, , ~ MJJruTES OF THE FIRST MEErJNG 85/86 -well knOw. in these territories, so that the sum of knowledge may be added to, so that the enthusiasm of those on the spot here will be refreshed, so that our determination to go forward may be made stronger. It is in that spirit and having in mind all these things, that I -welcome you on behalf of the Government of AustraJ.ia and I have pleasure in declaring your Conference open. e " .l- 1. ): J 2. 3. f ). • . '( (WP/RC14/Min/2 Rev.l) MINUTES OF THE SECOND ME.Efi1ING Legislative Council Chambers Thursday, 5 September 1963 at 2.30 p.m. CHAIRMAN: Dr R.F.R. Scragg CONTENTS Report of the Regional Director •••• 'I ••••••••••••••••••••••• statements by the representative of the United Nations Children's Fund and representatives of inter- governmental and non-governmental organizations in official relations with WHO •••••••••••.•••••••••••••••••••• Fluoridation of water supplies . ............................ -87- ~ 90 106 112 88 REGIONAL CC>MM:r.r.rEE: FOURTEENTH SESSION Second M3eting Thursday, 5 September 1963 at 2.30 p.m. PRESENT I. Representatives of M3mber States AUSTRALIA CHINA FRANCE JAPAN KOREA MALAYA NEW ZEALAND PHILIPPINES UNITED KINGDOM UNITED STATES OF AMERICA VIm'-NAM WESTERN SAMOA Dr R.F.R. Scragg Dr Kila Wari Dr Himson Milas Dr H.E. Downes Dr C.J. Ross-Smith Dr C.K. Chang Dr T. C. Hsu Dr A. Ferron Dr E. Wakamatsu Dr J. Ohmura Mr Y. Matsuda Dr K. Hamano Dr Suk. Woo YUn Dato Dr J.t:>hamed Din bin Ahmad. Dr Haji Abbas bin Haji Alias Dr D. P. Kennedy Dr L. Uyguanco Dr F.T. Diy Dr E.L. Villegas Dr C.H. Gurd Dr R. Dickie Dr C.H. James Dr J. Watt Dr R.K.C. lee Dr le-Cuu-Truong Dr J. C. Thieme t-~ MINUTES OF THE SECOND MEETING 89 ~ II. Representatives of other inter-governmental organizations and .. INTERNATIONAL ASSOCIATION FOR Dr J.J. u;>schdorfer THE PREVENTION OF BLnIDNESS INTERNATIONAL COUNCIL OF NURSES Miss V. B1gtlf)ld mTERNATIONAL DENTAL FEDERATION Mr T.E. Hubble ,. _L_ LEAGUE OF RED CROSS SOCIETIES Mr H. Buchanan SOUTH PACIFIC COMMISSION Dr R.A. Chappel WORLD MEDICAL ASSOCIATION Dr C.J. Ross-Smith In. WHO Secretariat SECRETARY Dr I. C. Fang Regional Director , 90 REGIONAL COMMITrFE: FOURTEm'TH SESSION 1. REPORl' OF THE REGIONAL DIRECTOR: Item 10 of the Agenda (Document WP/RCl4/2) The REGIONAL DIRECTOR, in introducing the Annual Report, summarized the major developments during the period under review. The ~neral expansion of public health services had continued with particular attention being paid to local and rural health services. In the field of nursing, one of the remarkable features of the past year had been the replacement of the emer~ncy training of nurses by regular well-established courses. Interest in health education had grown and. an increasing number of countries and territories were follOwing WHO- recommended standards for health education leadership and organization. As a result of the intensive information programme launched during the year, there had been rapid strides in the development of nutrition programmes, and plans were now well in hand for a number of new projects. A greater degree of self-reliance and vigour was already manifest in many medical and nursing schools and public health training institutions. The fellowship programme had continued to expand and no less than 50 per cent of the fellowships awarded during the period under review had been undertaken exclusively within the Region. Although there was as yet no country in the Region in which the malaria campaign had reached the sta~ of certification of eradication, further progress had been made. Encouraging results regarding the interruption of transmission had been obtained from the two malaria eradication pilot projects . With the completion of the mass treatment survey of the population in Tonga, all the known yaws-endemic areas in the southern part of the Region, except Portuguese Timor, had now been covered by mass treatment. No report of any recrudescence of the disease had been received from the other former yaws-endemic areas in the Pacific. MINUTES OF THE SECOND MEETING 91 The Regional Director then stated that despite these developments, he would fail in his duty if he did not mention some of the areas of weakness in the regional programme. He referred to the months of preparation and planning required before the start of a field project, and stated that it was unfortunate that in some cases the objectives were not achieved as rapidly as one might have expected. The reasons for this were many, loss of candidates to other countries or regions because of delay in their clearance by the governments concerned, insufficient understanding of the role of the international staff, ineffective planning at the national level prior to their arrival, lack of qualified full-time counterparts and inadequate supervision at various levels. In some cases a difficult question to decide was whether a country was in a position to absorb all the assistance it had requested. This question related specifically to the developing countries where the needs were all embracing and it was, therefore, in these areas that planning became of fUndamental importance. It was not possible to combat all problems at the same time, one must be selective in accordance with the situation in each country. The basic health needs and the problems had to be studied and investigated, priorities for action determined, and precise proposals formulated, aimed at the orderly development of a long-term health plan. To be fully effective this plan should form an integral part of any social and economic pro~. It was, therefore, essential to impress upon other government departments that economic and social development depended on good health. New pro- grammes should only be undertaken when continuing ones were well estab- lished. It was essential not to disperse available resources but to use them in the most efficient manner, to support the projects in operation 92 REGIONAL COMMITTEE: FOURl'EENTH smSION to the utmost limits, to sustain interest so that the combined efforts of the Organization and governments would grow constantly in scale and in intensity. Referring to the fact that the expansion and progress of practically all health programmes were dependent on the availability of nursing services, the Regional Director stated that it was a matter of regret that the role of the nurse in national health services did not always receive the recognition and support it deserved. Al.though maternal and child health programmes had. expanded, there had been litttle diminution, if any, in the mo:rtaJ.ity and morbidity rates of the pre- school child. There was a great need to establish services for this age-group which had, until now, been possibly the most ~cted section of the community. Malnutrition and even under-nutrition, continued to be widespread in the Region but programmes to remedy the situation were few. New approaches in nutrition education were, therefore, required. A further problem was the failure in most countries to realize what malnutrition meant, in terms of economics. There could be no question of aJ.J.owing the slightest weakening 1n the efforts to control the communicable diseases. Cholera was still occurring in some countries, the tuberculosis problem was so tremendous that control programmes would be required for many years to come, health administrations must be aware of the significant persistent increase in the incidence of the venereal infections. The malaria eradication programme must not be aJ.J.owed to diminish in strength because of the shortage of funds. When one considered the direct bearing community water supplies and other sanitary facilities had on the prevention of disease, it was unfortunate that the initiative for improvements in the environment stemmed trom.llOn-public health agenc:Jes. MJ:Nu.rES OF THE SECOND MlmTING Nevertheless, he would emphasize the important role of the health administrations in exercising vigorous leadership and watchful guardianship in this important field. 93 The Regional Director then referred to what was possibly the most important field in the regional programme - that of education and training. If full use were to be made of regional training centres, standard.s for medical education must be established and maintained. It was also imperative to create a stable and progressive faculty. Improvements were required not only in the selection of candidates for fellowships but also for participation in inter-country group educational activities. There must be some assurance that the persons selected were not only working in the field of interest but would work in the same field on their return. The WHO-assisted education and training programme must be constantly appraised to ensure that it was meeting the ever-changing needs of all countries. This could only be done if the follow-up reports required. of fellows six months and two years after completion of the fellowship were submitted to the Regional Office. Here, the co-operation of governments was of the utmost importance, otherwise effective evaluation was not feasible. He hoped it might be possible during the discussions to find a solution to some of the problems he had raised so that progress in the future might be even greater than it had been during the past year. The Regional Director then drew the attention of the Committee to the particular interest of WHO in radiation health and medicine and stressed the importance of the establishment of radiation health pro- grammes within the framework of the regular public health activities. The Organization would do everything possible to assist governments in this work. 94 REGIONAL COMl([Tl'EE: FOURTEENTH SOOSION In conclusion, he paid tribute to those governments which had so willingly accepted WHO fellows. The education and training of health personnel would form an essential part of the regional programme for many years to come and the assistance provided by goverIllmnts in this field was of vi tal ~ortance. lIe also thanked all ~mber governments for the courtesies and assistance received from them during the past year. On the suggestion of the CFJCrP~, the Report was discussed section by section. Part I, Section 2.1.3 Pro,1ect staff (pages 4-5) Dr VILLEGAS (Philippines) extended his delegation's congratulations to the Regional Director for his excellent report. The Regional Director had referred to the difficulties encountered by WHO in recruiting experts, particularly the delays met in securing their clearance. The recruit- mant of first~class consultants was becoming more and more difficult as gover:lments were reluctant to allow their staff to leave the service. Another problem ·,re.s tha.t the rellIU.-:1.eration offered was often unattractive. He suggested that this situat:J.on ?hOl.:..ld be reviewed so that the best people could be recruited and that governments could benefit from their advice. This review s~ould include salaries, a.l..l.owances, post adjust .. mant, etc., a subject which he wot:.ld again raise during discussions on the programme and budget. Section 4 Co-ordination of work with other organizations (~ 6) Dr YUN (Korea) stated that a national co-ordination committee composed of representatives of not only the Ministries of Health and ) MINUTES OF THEl SECOND MEErING 95 Social Affairs, Defense and Education, but also those of international, voluntary and private agencies had recently been established in Korea. National co-ordinating committees had also been set up for tuberculosis and leprosy. Part II, Section 1.1 Public health administration and health laboratory services (pages 15-18) Dr DIN (Malaya) congratulated the Regional Director on his very comprehensive, well-balanced and informative report. The countries in the Western Pacific Region should be proud of the achievements in the past year, which represented a step forward in the betterment of the health of the people in the Region. Difficulties had been encountered by his Government in connection with the organization of the public health service and assistance had. been sought from WHO. The recommendations of the WHO consultant were now being implemented. Public health administration at the national level had been strengthened by the creation of a number of departments and his Government was trying to recruit various categories of personnel. He had recently visited Manila, where he had recruited a number of doctors for service in Malaya, and he wished to thank the Government of the Philippines for the help it had given. A public health advisory council had been set up to advise the Ministry of Health on various aspects of public health. This again, was one of the recommendations of the WHO consultant. Part II Section 1.2 Or anization of medical care - hos ital services pages 18-19 Dr KENNEDY (New Zealand) congratulated the Regional Director on the usual high standard of his annual report. He then referred to the REGIONAL COMMI'I'l'EE: FOURTEENTH SESSION question of medical care which included the proper use of narcotic drugs under the Jurisdiction of the medical pra.cti tioner. '!'be world-wide production, distribution and use of narcotic drugs were controlled by a large number of international instruments. About two years ago, as a result of some ten years of preparatory work by the Narcotic Commission of ECOOOC, a Single Convention on Narcotic Drugs had been signed in !few York. Around nine of the countries represented at the meeting had signed the Convention. The total number of ratifications at the moment was, however, only twenty and forty were needed before the Convention could become operative. Only two countries in the Region had ratified the Convention and he was happy to say that New Zealand was one of them. He realized that the health administrations were not always concerned with such matters, particularly when they referred to inter~ national legislation. Representatives might, however, wish to look into the matter on their return to their own countries. Dr. VILLEGAS (Philippines) eIlU?hasized the importance of providing advisory services to developing countries on the proper planning of medical care facilities. He. 'Proposed that an advisory post on medical care should be established in the Regional Office, the holder also being responsible for hospital administration. Part II, Section 1.4 Health education (pages 21-23) Dr CHANG (China) congratulated the Regional Director and his staff for producing such a comprehensive report. The reactivation of the post of regional adviser in health education and the strengthening of health education services in a number of countries in the Region had been noted with great interest. The ProvinciaJ. Health Department of Taiwan Province MINUTES OF THE SECOND MEErING 97 had recently appointed a qualified specialist to head its health education section. In addition, a training programme for health educa- tion specialists was being planned in co-operation with the Institute of Public Health. The REGIONAL DIRECTOR drew the attention of the Committee to page 22, where mention was made of the health education specialist training course leading to a !ester ("If Public Health degree at the Institute of Hygiene, University of the Philippines. He suggested that governments might keep this course in mind when sending health education specialists abroad for training. Part II, Section 1. 5 !eternal and child health (pages 24-26) Dr W.AKAMATSU (Japan) referred to the statenent of the Regional Director that there had been little diminution, if any, in the mortality and morbidity rates of the pre-school child. In 1961 his Government had established a new programme to examine the physical and mental condition of pre-school children, about 60 per cent of whom had undergone a health examination. Should this scheme be successful, it was planned to start a health promotion programme for the younger child. Dr WATT (United states of America) offered the congratulations of his delegation and himself for the comprehensive report which gave a full and significant account of the progress made. He then referred to the statement of the Regional Director regarding the need to concentrate available resources where they would have the greatest impact, and suggested that the field of maternal and child health provided such an area. There were a number of organizations, and a number of people representing organizations, whose primary interest was the protection 98 REGIONAL COMMITl'EE: FOURl'EENTH SESSION and development of the health of the mother and child. UNICEF was one of such organizations and there were several devoted. to the relief of hunger. The Freedom from Hunger campaigns, for example, were for the most part directed to the mother and child. In addition, research in recent years had shown quite clearly the importance of nutrition in the early years of life as a means to strengthen both physical and mental health. The lack of adequate protein in the early years had been sbown to have an effect on the development of the nervous system. Some forms of mental retardation were related to lack of nutrition in the early years. The area of maternal and child health provided, therefore, an opportunity for bringing together a whole host of related professional skills. It was gratifying to bear that the picture as far as nutrition was concerned was not as bad as one might conclude from early reports. The fact that there had been an improvement meant that there was an opportunity for concentration in this area that deserved a great deal of attention from the Committee. Dr TRUONG (Viet-Nam.) thanked the Regional Director for his excellent account of WHO activities. The work of the Regional Office during the past year corresponded truly to the scope and intents of WHO. He agreed with his colleague from the United states of ~rica that maternal and child health activities must be centred on child nutrition. In developing countries particularly, efforts should be made to provide assistance to under-nourished children. In Viet-Nam, many children 'Who might) or might not, be ill, but were certainly under-nourished, were sent by orphanages and private organizations to hospitals for treatment. However, on their return to their own enviromnent, they were given the san:e diet again. A programme of • MINUTES OF THE SECOND MEErING 99 assistance was, therefore, being planned whereby nutrition centres would be established where care would. be given to malnourished children. The children would stay in the centre from three to four months and, on their return to the orphanages, would be followed-up by social workers who would give advice and ensure that proper care was given to them. Dr YUN (Korea) stated that the maternal and child health programme in Korea was quite well developed and the population had, therefore, increased very rapidly. He believed that a study of population problems should form part of the public health programme. Such a programme had been started in Korea and he would like to hear about programmes being undertaken by other countries in the Region and also the attitude of the Organization to this problem. The REGI~U\L DIRECTOR stated that the question of population was such an important one that the United Nations had established a Population Commission. However, WHO's interest in this field was purely connected with the research activities. Until such time as the World Health Assembly decided. to formulate a more extensive programme the Secretariat could take no action. radiation medicine and human genetics The REGIONAL DIRECTOR requested that a correction should be made in the third paragraph, second last line of this section, which should now read ''purchase of instruments for use of radiOisotopes ". Dr WATr (United states of America) stated that in the Western Pacific and some regions in South America there were a few remaining groups whose 100 REGIONAL COMMI'I'I'EE: FOURTEENTH SESSION genetic background was relatively homogeneous and where inbreeding had occurred over the years simply because there had been no means of comrmm:l cation with other peoples. This static situation was changing rapidly. It would not be long before the primitive groups would be so admixed with other currents of human development that little would be possible in the way of significant historical studies. He believed it was very :I.nij;>ortant, therefore, that the health officials in the areas where such peoples lived should be aware of what sophisticated students of genetics could do in the way of building u;p a genetic profile and thus make it possible to obtain a basic genetic history. He hoped that it would be possible for the RegionaJ. Director, for example, to get from some of the men who were able to carry out such studies, some outline as to what might be done. In the United States, there were several such research centres and this was also probably true in many other countries where there were highly developed medical research institutions. These men, with relatively little effort, could provide a check list of the types of profile studies which could be doJ1e. Arrangements could then be made with the governments developing health facilities in these primitive areas, to get the blood and other appropriate specimens for analyses which would provide information on what happened during the period when the people emerged from a primitive to a much more modern way of living. He considered that this was something on 'Which action should be taken soon, as within the next ten years no such action 'WOuld be possible. • MINUTES OF THE SECOND MEEl'ING 101 Section 3. Environmental Health (pages 30 .. 32) Dr KENNEDY (New Zealand) compared the amounts spent on medical care and environmental health in his country. New Zealand t s capital expen- diture on sewerage and water supply was at present 50 per cent more than on hospitals. An amount of' ~30 million had been spent on sewerage and water schemes during the last five years. Another indication of the importance his Government placed on environmental health was the fact that an assistant director of public health engineering had recently been appointed to the Health Department. He was a qualified public health engineer and was senior in rank to the chief public health engineer in the Ministry of Works. He supported the Regional Director IS remarks on the importance of health administrators giving leadership in this field. Section 4. Education and Training (pages 32-38) Dr KENNEDY (New Zealand) stated that he had been instructed to raise the question of a.dJn:I.nistrative arrangements with regard to WHO fellows as certain difficulties had been encountered. Recently, there had been five cases of no authority being received to pay stipend; on other occasions no accommodation had been arranged due to lack of information as to their arrival dates; furthermore, fellowship pro- grammes had not always been well arranged. He hoped that arrangements could be made to prevent the repetition of such mistakes. Dr WAKAMATSU (Japan) said that a special school for the training of occupational therapists and physiotherapists had recently been established in Japan. He expressed his country I s appreciatton of the l.02 REGIONAL COMMI'ITEE: FOURTEENTH SESSION help extended by the Worl.d Haal.th Organization which had sent a consul.- tant to assist the teaching staff of the school.. At present there were 1000 and more physiotherapists and occupational therapists without l.icense, but legislation for such woul.d be passed very shortly. Dr YUN (Korea) referred to the fellowships awarded during the period under review and stated that amng them were a number g:1 ven to non-medical. persons, includ.:l.ng the governor of a provincial. government. These non-medical. recipients, particul.arly those connected with the l.ocal. health dem::>nstration project, which was being assisted by WHO and other international organizations, had activel.y participated in the work upon their return from the study tour. A very solid programme had been devel.oped with strong l.ea.d.ership. He wished al.so to thank those !ember countries which had received the Korea.n fellows. The REGIONAL DIRECTOR apol.ogized to the representative of New Zeal.a.nd for the inconvenience caused. The Regional. Office was not only hand1.ing its own fellows but al.so those coming from Africa, the Americas, the Eastern lediterra.nean, Europe and south-East Asia. There were times when the cbannel.s of communication might have been faul. ty but every effort was being made to improve the administrative aspects of the fellowship programme. Referring to Dr Yun' s remarks, the Regional. Director stated that this was the first time the Regional. Office had provided fellowships to non-medical persons. This had been done because one province in Korea had been sel.ected as a dem::>nstration area and it was hoped that, in due course, the services so developed would be extended to the other provinces. The fellowships awarded to the provincial. governor and his staff had • MINUTES OF THE SECOND MEETING 103 afforded them the chance to see what was meant by regionalized health services. On their return to Korea they had supported enthuSiastically their new health programme. The CHAIRMAN stated that in New Guinea the chairman of a local government council had also been sent to another council with a health centre in another part of the Terri tory to observe and to be fully aware of the benefits that could be derived from health centres proposed for his area. Section 6.2 Tuberculosis (pages 45-48) The CHAIRMAN referred to the seven pOints recommended by the Regional Director in planning a national tuberculosis control programme. He considered this rather unusual in the sense that it set a definite pattern rather than reporting on the progress of national tuberculosis control programmes. The REGIONAL DIRECTOR explained that the purpose of including the seven points was to obtain a uniform approach, as it had been noted that the concept of a tuberculosis control proGramme varied widely from country to country. Dr GURD (United Kingdom) referred to item 5 on page 47 and asked for an explanation of the statement: "Expensive methods of case-finding ••• should be avoided in countries where no X-ray machines are manufactured." It seemed that there were very few countries in the Region where X-ray machines could be manufactured whereas mass chest radio_photography was of extreme value. 104 REGIONAL COMMITTEE: FOURTEENTH SESSION The REGIONAL DIRECTOR stated that the text should, in fact, read: ''Expensive mat hods of case-finding, such as mass chest radio-photography, should be avoided in countries where X-ray machines are not easily available." Section 6.3.2 Yaws (pa~s 49-50) Dr GURD (United Kingdom) asked about the inter-relationship of yaws and syphilis. In the past WHO had assisted in the yaws control pro- gramme in Fiji and yaws was now extremely rare; on the other hand, an increase in the incidence of syphilis had recently been observed. He wondered whether any study was being undertaken on the inter-relationship of yaws and syphilis, or whether any work had been done on the control of yaws as predisposing to an increased incidence of syphilis. On the invitation of the CHAIRMAN, Dr HUGGINS, Regional Adviser on Communicable Diseases, informed the Committee that in all yaws eradica- tion campaigns WHO emphasized that the eradication of yaws might result in an increase in the incidence of syphilis and that health administra .. tions should be prepared to deal with this, should it occur. It had been recognized in certain areas in the South Pacific, for example, that where yaws was prevalent there was little incidence of syphilis. It appeared that the occurrence of yaws had prevented syphilis. No specific studies on the increase of syphilis follow.i.ng the yaws campaigns had, however, so far been carried out. He was particularly interested to hear of the increase of syphilis in Fiji follOwing the yaws campaign. The near eradication of yaws was possibly one of the factors responsible for this. However, there were, of course, since the yaws campaign was carried MmUTES OF THE SECOND MEETING 105 out ten years ago, other possible factors, such as the changing habits of people and the change in economic and social conditions, which might have favoured the spread of syphilis. Dr THIEME (Western Samoa) said that, with the assistance of WHO and UNICEF, his Government had been successful in bringing yaws under control and reducing it to a minor health problem. There were, however, in fact, a few cases of yaws still found in remote areas of the country which prevented the area being declared as a yaWS-free zone. Efforts were being made to deal with this situation by giving treatment to known cases. The Regional Director had offered to send a WHO treponematoses advisory team to Western Samoa to assist the Government to deal with this problem. There had been no increase in the incidence of syphilis up to the present. The CHAIRMAN shared the view that the report was a very comprehen- si ve and valuable one. However, one point which was relevant, partic- ularly in relation to places like New Guinea, was that countries which received little aid received little mention. This did not mean that much was not being done in these countries. The report covered only what WHO was dOing and how countries were utilizing the assistance given. There being no further discussion he proposed the adoption of the Report and asked the Rapporteurs to consult the Secretariat about the preparation of an appropriate resolution. It was so agreed. (For consideration of draft resolution, see minutes of the third meeting, section 7.) 106 REGIONAL COMMITTEE: FOURTEENTH SESSION 2. STATEMENTS BY THE REPRESENTATIVE OF THE UNITED NATIONS CHILDREN'S FUND AND P.EPRESENTATIVES OF INTER-GOVERNMENTAL AND NON-GOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO At the invitation of the CHAIRMAN, the following representatives presented statements. 2.1 Representative of the United Nations Children's Fund In the absence of Mr Brian Jones, Acting Director of the UNICElf' Asia Region, the R~GIONAL DIRECTOR read his statement. Mr JONES transmitted to the Committee the greetings and good wishes of the Executive Director of UNICEF for a successful meeting. It was very muc.h re gretted that the pre sent shortage of UNICElf' staff in the Asia Region had precluded the attendance of a representative. At the present time there were about forty health projects in the western Pacific Region actively assisted by UNICElf'. Mbst of these were long-range projects in the fields of maternal and child health, rural health services, and disease control. A good deal of emphasis had been, and continued to be, given to programmes for training staff. Allocations for health projects in the Western Pacific Region approved by the UNICEF Executive Board at its two most recent meetings (December 1962 and June 1963) totalled apprOximately US$2 564 000. It was hoped that additional allocations would be made by the Board at its next session, which would be held in Bangkok in January 1964. In concluding, Mr Jones expressed the appreciation of all UNICEF staff in the Region for the excellent co-operation received from Dr I.C. Fang and his advisers at all times. ~. 1 • MINUTES OF THE SECOND MEJl![IING 101 2.2 Representative of the World Medical Association Dr ROSS-SMITH stated that he had been asked by the Secretary-General of the World Medical Association to extend the greetings of the Association to the Regional Committee. As General Secretary of the Australian Medical. Association it was his personal pleasure to represent the World Medical Association at the meeting. He then referred to some of the Association's activities. Founded in 1948, it was an international body, corqprised of some 57 national medical associations and it thus represented the great majority of the practising medical profession in the world. One of its first achieve- ments in 1948 had been to draw up an International Code of Medical Ethics which had since been adopted by most medical associations throughout the world. At this present juncture, a further very important ethical matter was under consideration, that of medical ethics in relation to clinical research. Another field in which the Association had been very active was that of medical education. Two international conferences on medical education had already been organized, in London in 1953 and in Chicago in 1959. The third conference, which would deal with medical education in the developing countries, would be convened in 1966 in India, and undoubtedly, WHO would again be invited to participate, together with all the medical associations of countries in the western Pacific Region. A recent move of the World Medical Association, which should be of particular interest to the Regional COmmittee, entailed provision in the Constitution for regular meetings. No definite decision had been taken yet on the matter of marking specific regions, but it was expected that these were likely to follow the lines of the regions as adopted by the 108 RIDIONAL COMMITTEE: FotTRTEENTH SESSION World Health Organization. He believed that this decision had been greatly influenced. by the great success which the Organization had had since it instituted this practice. The first regional meeting of the World Medical Association in the Western Pacific was likely to be held in Perth, Western Australia, in August 1965 in conjunction with the Second Australian Medical Congress. 2.3 Representative of the League of Red Cross Societies Mr' BUCHANAN stated that there ws very close liaison between the Organization and the League of Red Cross Societies. The League valued very highly the opportunity to work with WHO. In 1959, during the adulterated oil poisoning in MOrocco, the United Nations had called upon the Red Cross to assist. In the Congo the resident medical services had been withdrawn to a great extent <"nd the Red Cross had. again been asked to help. These examples showed that the Organization and the Red Cross worked towrds the same objectives, although at different levels, WHO's stimulation being in the realm of goverru:Jent activity, whereas the Red Cross a.iJood at penetrating into publ:!.c feeling and recrui.ting volunteers to assist in its work. Mr B',lchanan then referred to the blood transfu- sion service in the Territory. Statistics indicated that in the year ending 30 June 1963 the contributions of indigenous b~ood were nearly four to one compared with the non-indigenous types. This clearly indicated the value of volunteer service in the improvement of health and in the development of better health standard.s. There must be, in the first place, an instinct to make a contribution for the welfare of the country. In this particular case, the collaboration of governments r -- MINUTES OF THE SECOND MEEl'ING 199 and voluntary organizations, e. g. the Red Cross, had been well demonstrated. The Government had very generously subsidized the blood transfusion service in the Territory, as the cost would have been quite beyond the resources of a voluntary organization. Mr Buchanan hoped that the co-operation existing between the Red Cross and the World Health Organization would continue and even expand and that, in the development of this collaboration, means would be sought of making use of the junior Red Cross sections. 2.4 Representative of the South Pacific Commission Dr CHAPPEL conveyed the good wishes of the Secretary-General of the South Pacific Commission, Mr W.D. Forsyth, and thanked WHO for its invitation to the Commission to send an observer and, secondly, but more importantly, for its co-operation manifested in so many ways in helping the Commission in the fulfilment of its aims in the health field. The Health Section of the Commission worked closely with the other two work programme sections in such common fields as nutrition, home economics, housing, veterinary public health and so on. It aimed to increase its share of the Commission's work, and co-operation with WHO would greatly assist this, as it had in the past, for the general good of the Pacific Islanders. ~les of this co-operation had been the regional maternal and child health survey, a joint SPC/WHO project, and the attendance of WHO staff at the Commission's Health Conference and Research Council Meeting in Tahiti. Furthermore, joint SPC/WHO seminars were to be held in Fiji in December and in New Caledonia next July. The Commission was helping llO REGIONAL COMMITI'EE: FOURTEENTH S&SSION with the health education aspects of the WHO-assisted malaria eradica .. tion pilot project in the British Solomon Islands Protectorate. The progress of WHO's work on school nutrition (with FAO) in French Polynesia, on tuberculosis control in Western Samoa, and on environmental sanitation and. yaws in Tonga, would be watched with sympathetic, and wherever possible, helpful interest. The Health Section of the Commission was at present actively engaged in research on fish poisoning and was undertaking experiments on solar distillation from sea water in French Polynesia; this was being done in collaboration with the Universities of Wisconsin and California, United states of .ADerica. Last year, research had been carried out on eosinophilic meningitis in man caused by the rat lung worm. The University of Hawaii and the Institut Franqais d' 0<:6an1e had collaborated in this. Dr Rosen from the National Institutes of Health had recently paid a visit and had collected 2000 blood samples from New Caledonia and. New Hebrides for viral stUdies. However, the Commission's main work in the health field was basic health education, sanitary engineering and the distribution of inf'orma.- tion. It was attempting to keep about 1500 indigenous general practi- tioners abreast of the times in general medicine with emphasis on therapy and public health. M:Jnthly leaflets, Health Information Service and. Technical Information Circulars, were issued with up-tO-date abstracts from the 140 journals received by the Commission. Although the Commission's activities were limited because of a restricted budget and. staff, it was perhaps better able to advise the various territories on their health needs and priorities by virtue of its long and very intimate association with the area and its problems. .. , I " - .. mNUTES OF THE SECOND MEETING For the sane reasons it was able to factii ta.te the work of other organizations. He hoped, therefore, that the Commission I s role of initiating and facilitating projects for bigger organizations would continue to be respected and that the present agreeable working conditions would be maintained. 2.5 Representative of the International Association for the Prevention of Blindne ss III Dr LOSCHDORFER stated that in the past twenty years, reports from various workers had clearly established the prevalence, and in certa1n areas the endemic proportion of trachoma in Fiji, Niue, Papua and New Guinea" Western New Guinea, Amarican and Western SanrJa. These reports dealt with the clinical aspects of the disease. It appeared that trachoma in these areas presented a somewhat different pattern to that in other parts of the world, such as the Middle East and Africa, mainly because sequels were milder. However, the disease accounted for a certain number of cases of blindness and a large proportion of considerably diminished sight, so that it was indeed a public health problem in these countries of the Western Pacific. TO appraise the effectiveness of any large-scale campaigns against trachoma, a uniform classification of the various stages of the disease was necessary. A conference of ophthalmologists from this part of the Western Pacific could provide a working base for a co-ordinated scheme to combat the disease. A uniform approach to the classification of the disease, criteria of health regulations and the most effective treatment on a large scale could then be decided. 112 REGIONAL COMMITl'EE: FOURTEENTH S~SION On beh.a.l.f' of his Organization he wished to recommend that the Begional Director should be requested to collect data from local health authorities on the 'WOrk already done on trachoma and to lIDderta.ke the organization of a conference. 3. FLUORIDATION OF WATER SUPPLIES: Item 11 of the Agenda (DocUlJlent WP/RCl4/4 Rev.l) In introducing the docUlJlent, the REGIONAL DIRECTOR said that the paper had been presented in view of the interest aroused in fluoridation during the technical discussions on dental health held during the twelfth session of the Regional Committee in Wellington. It was intended to provide a digest of all available information on the safety, simplicity and economy of flUoridation of drinking water as the most efficacious single measure against dental decay. As a number of cOlIDtries in the Region had already introduced flUOridation, it might be of interest to the Committee to hear brief reports of their experiences. Dr DOWNES (Australia) stated that the National. Heal.th and Medical Besearch COlIDcil of Australia had passed a resolution in November 1961, noting that in a number of countries fluoridation of public water supplies had been shown to result in a significant reduction of dental. caries in the population supplied with it, and that the procedure was safe. The COlIDcll had recommended that public authorities should give early consideration to the necessity of fluoridating water supplies. The AustraJ.ian Dental Association had strongly supported this recommenda- tion but, of course, hopes and fulfilment were two different things. Australia was a Federation; within the states there were local authorities and in the local authorities the health sections SOllEtimes did not run MINUTES OF THE SECOND MEEI'ING ll3 these activities. Engineers, water trusts and engineering water departments managed them, so that in the realization of these high hopes by the medical and dental advisers, Australia could be called a slowly developing cOlllltry. Several years ago, in Tasmania, a small state south of Australia, a fluoridation programme had commenced in a place called Beaconsfield. A few years later, a town in New South WaJ.es, namely Yass, bad its water supply fluoridated, the anti-fluoridation people waking up a little late. In the larger state of New South WaJ.es, the towns of Yass, Goulburn, Orange, Tumut and Condobolin had already fluoridated their water supplies. Two towns, Tamworth and Nambucca Heads, had accepted it but bad not yet implemented the techniques. It had been established in Bacchus Marsh, a town not very far from Melbourne, and in another town, SaJ.e in Gippsland, it was anticipated that it would soon commence. In the state of Victoria any water trust had the legal authority to carry out the procedure. In Western Australia, no fluoridation had taken place but a Fluoridation Act had been passed and a long list of towns were prepared to accept it, 70 per cent of the replies indicating that they were in favour of it. In Queensland, two towns, Townsville on the coast and Biloela, had been able to fluoridate. In Tasmania, West Tamar as well as Beaconsfield, already had it and. two of the largest towns, Hobart and Launceston in the North and Rosebery intended to fluoridate. These measures were not without significance, of course, to the anti- fluoridationists. Dr Downes informed the Committee that if any representative wished to see the article printed five days ago on this subject in the Journal of Australia, the Australian delegation had. a copy. ll4 REGIONAL COMMI'PrEE: FOURTEENTH SESSION Dr VILLEGAS (PhiJippines) said that the Philippine Government had recentl.y passed a law authorizing the National Waterworks Sewerage Authority, the agency concerned with water supply for the City of Manila and its environs, to fluoridate water. This was especially significant in view of the fact that the passage of this law had not been accompanied by the usual emotions connected with any proposal to fluoridate water supplies. Mr HUBBLE (International Dental Federation) expressed his Federation's appreciation of this opportunity to maintain close contact with the World Health Organization. It was quite clear that fluoridation was no longer an experimental or an academic project but a practical tool defined and proven worthy in the field of public health. In his opinion, it was the greatest single advance made in the field of preventive dentistry. Thinking should now centre on the problem of utilizing this important preventive measure and this could conveniently be divided into two fields: the application of fluoridation in advanced societies and its application in under-developed communities. As regards the first, one of the major problems was the education of government authorities, and the people as a whole, on the value of fluoridation and on the fact that no detrimental medical problems accrued from fluoridation in the correct quantities. The second problem that must be faced was the reduction, or attempted reduction, of the cost of the installation of sma.11er fluoridation plants. In under-developed countries, the problems, while being the same as those in more educated societies, included :Ln addition, the lack of reticulated. water supplies and of statistical background. .... ' MINUTES OF THE SECOND MEEl'ING 115 Firstly, there must be standardization of baseline surveys and WHO had commenced this work in the South Pacific area. These should accurately determine the dental requirements of the countries concerned, area by area, and the fluorine content of national water and diet. The surveys, to be practicable, should be as simple as possible, while providing what was desired. Secondly, having assessed the problem in terms of dental needs, evaluation should be made to determine at what points fluoridation -,.. could be efficiently applied. The major problem was that the majority of the population in developing countries did not enjoy a reticulated water supply. The Regional Committee might consider this point. It was worthy to note that urbanization, which was followed by reticulation of water supplies, also carried with it a change in the dietary patterns of the indigenous people, which favoured a rise in the dental caries rate. Finally, there was a possible alternative to the fluoridation of water, i.e., the administration of fluoride com- pounds by tablets. The practical problems in terms of safe and regular dosage associated with this type of administration were extremely great and it was not known if there had been any serious consideration of this alternative to fluoridation. Dr KENNEDY (New Zealand) stated that by the end of this year his country was committed to providing 200 000 people with a fluoridated water supply. When one looked at the municipalities that had decided to fluoridate, it was quite evident that the engineers of those municipal- ities were men with an exceptional interest in health matters and their continuing contact with the members of the municipalities had the desired effect. It was for this reason that he felt that paragraph 6 of the u6 REGICNAL C(H(l1'l'EE: FOURTEENTH SESSlat working paper on the teclmical and. engineering aspects was vital. Deference had been made by his predecessor to the importance of water supplies. The medical and. dental professions were in unanimity on this matter and. untU the engineering profession in general, and the municipal engineers in particular, were netted in the same programme, he felt that the progress that otherwise could be made would not be accomplished. The }Eeting adjourned at 5.10 p.m. (WP/RC14/Min/3 Rev.l) MINUTES OF THE THIRD MEETmG Legislative Council Chambers Friday, 6 September 1963 at 9.00 a.m. CHAIRMAN: Dr R. F. R. Scragg later Dr J.C. Thieme (Vice-Chairman) CONTENTS 1. Address by incoming Chairman •••••••••••••••••••••••••••••• 120 2. Kuru in the Territory of Papua and New Guinea ............. 12.2 3. Facilities for education and training of health personnel in the Western Pacific Region •••.••••••.••••.••• 124 4. Studies on cholera E1 Tor ••••.•••.•••••••••••••••••••••••• 126 5. Resolutions of regional interest adopted by the thirty-first and thirty-second sessions of the Executive Board and the .Sixteenth World Health Assembly ...........•..•........•................•....•.... 1.32 6. Selection of topic for the Technical Discussions during the fifteenth session of the Regional CoDlJllj. ttee •••••••• If •••••• If •••••••••••••••••••••••• If • • • • • • • • 133 7. Consideration of draft resolution on the Annual Report of the Regional Director ••••••••••••••••••••••••••• 137 -117- llB REGIONAL COMMITTEE: FOURTEENTH SESSION Third !eeting Friday, 6 September 1963 at 9.00 a. m. PRESENT I. Representatives of !ember States AUSTRALIA Dr R.F.R. Scragg Dr C. Raszler Dr H1mson Mllas Dr H.E. Downes ..... Dr C.J. Ross-Smith Dr C.K. Chang Dr T.C. Hsu FRANCE Dr A. Ferron JAPAN Dr E. Wak.a.ma.tsu Dr J. Ohmura Mr Y. Matsuda Dr K. Ha.ma.no KOREA Dr Suk Woo Y\m MALAYA Dato Dr M1~d Din bin Ahmad Dr Haji Abbas bin RaJi Alias NEW ZEALAND Dr D.P. Kennedy PHILIPPINES Dr L. Uyguanco Dr F.T. Diy Dr E.L. Villegas PORTUGAL Dr Antonio Rosario Pinto UNrrED KINGDOM Dr C.H. Gurd Dr R. Dickie Dr C.H. James UNITED STATES OF AMERICA Dr J. Watt Dr R.K.C. lee Dr Saipele Matagi VIEn'-NAM Dr Le-Cuu-Truong WESTERN SAMOA Dr J. C. Thieme • MINUTES OF THE THIRD MEETmG 119 II. Representatives of other inter-governmental organizations and of non-governmental organizations INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL DmTAL FEDERATION LEAGUE OF RED CROSS SOClm'IES SOUTH PACIFIC COMMISSION WORLD MEDICAL ASSOCIATION III. WHO Secretariat SECRETARY Dr J. J. Loschdorfer Miss V. Bignold Mt' T.E. Hubble MI' H. Buchanan Dr R.A. Chappel Dr C.J. Ross-Smith Dr I.C. Fang Regional Director 120 REGICliAL COMMITTEE: FOURTEENTH SESSION 1. ADDRESS BY INCOMING CHAIRMAN: Item 5 of the Agenda (continued from the first meeting l section 4) The CHAIRMAN welcomed Dr Pinto (Portugal) who had only arrived that m::>rning. He then expressed his thanks to the Committee for electing him as Chairmanl this was a great honour to the Australian Government and to the Territory of Papua. and New Guinea. He particularly regretted that it was not possible for the Director-General to be present as he felt it would have been of advantage to the Region to have him see some of the southern Pacific area and some of its peculiar problems. The Chairman then drew attention to the fact that during the year El Tor cholera had entered the island of New Guinea for the first time, but fortunately the disease had been controlled. He felt this pointed to a greater problem which should engage the attention of the World Health Organization and of the Committee. There were certain disease~ free areas in the world and, as this was a Regional Committee meeting, there should be concern for the keeping of new diseases out of regions and out of countries within that region. If there was consistent progress and disease-eradication measures were successful in anyone country, then the adjoining countries, regions and areas, should be requested to devote their attention to the eradication of these diseases within their own areas. The Chairman then referred to the recent resolutions of the Executive Board and the Sixteenth World Health Assembly, particularly those relating to malaria eradication which pointed to the need for MINUTES OF THE THIRD MEETING l2l further development of medical services and the importance of these services in the maintenance of malaria control and malaria eradication and whatever might be developed in this field. This was particularly relevant to papua and New Guinea which had very few roads and the majority of the villages and areas where malaria occurred could only . be reached on foot or by canoe. The need for an infrastructure, a rural health unit or health activity to maintain a health state in the local area was not, however, restricted to malaria. This applied equally to tuberculosis, yaws or leprosy programmes. In all areas a unit was required to fit the particular needs of a particular country to maintain and consolidate the health activity undertaken by special units in special programmes. Reference was then made to the comments of the Representative of the League of Red Cross Societies on the need for community participation and the assistance of voluntary agencies in all health programmes. In developed countries there was a large number of voluntary agencies designed to reduce the burden on the government of the cost of health services and to bring the community as fully as possible into the role of disease prevention and care of the infirm. In Papua and New Guinea, in particular, the community within the village had taken care of the social problems arising within that village. Organization, however, disturbed this community participation as also did every benevolent health administration by taking such persons from the village into institutions. Health education and health propaganda worked through the press and health education councils designed to bring the community into such programme s. But wi thin the community 122 REGIONAL COMMITT.EE: FOURrEENTH SESSION there were many who could help and take their part in the developm:!nt of health services, thus helping to reduce their cost and. making the programmes that were established more effective. This was a way to provide the basis for the development and effective use of the infra- structure. Turning to the programme for the meeting, the Chairman corur.ented on its wide scope, which covered the developed as well as the developing countries, and emphasized WHO's breadth of activity in its aim to bring good health to the peoples of the Western Pacific. In conclusion, he referred to the exhibits and documents presented to representatives which gave an indication of both the problems and progress of the Territory. He expressed the sincere wish that repre sentati ve s would take the opportunity of participa.ting in the government tours in order to gain a greater knowledge of the Territory. He hoped that many would find it possible to return some day to see the further progress in the health field which would have been made. 2. KURU m THE TERRITORY OF PAPUA AND NEW GUINEA: Item 12 of the Agenda. (Document WP/RC14/5) With the consent of the Committee, the CHAIRMAN invited Dr F.D. Schofield, Assistant Director of M3dical Research of Papua. and New Guinea, to spea..~ on Kuru which is a. new disease found only in the Territory. MINUTES OF THE THIRD MEEI'ING 123 Dr SCHOFIELD explained that Kuru occurred only in the Fore area of the Highlands and the epidemiology was peculiar,because among children, boys and girls were equally affected whereas among adults women suffered much more frequently than men. There was progressive degeneration of the central nervous system, leading to ataxia, involuntary movements, muscular inco-ordination, paralysis and death usually in less than a year. The social effects were extremely serious, personal tragedies being frequent and adult men greatly outnumbering adult women because so many of the latter died of Kuru. The people themselves attributed the disease to sorcery and until recently suspected sorcerers were brutally murdered, thus adding to social tension. There was no effective treatment and the disease was always, or almost always, fatal. As regards aetiology, a genetic factor had been demonstrated by Professor Bennett of Adelaide University but the disease closely resembled scrapie of sheep which is a virus disease. It also somewhat resembled amyotrophic lateral sclerosis from which a virus had been reportedly isolated in Guam. Anthropologists believed that the disease had. existed for le ss than 100 years, the primary focus had been identified and the disease was still spreading and its incidence increasing. Genetics alone could not explain these facts and some environmental factor, at present unkno'WIl, must also be involved. He then described the intense scientific interest which this unique disease had caused since it was first described by Dr Zigas six years ago and the international research taking place in many countries to investigate all aspects of it. It was hoped that this work would throw light on other degenerative diseases of 124 REGIONAL COMMITTEE: FOURTEENTH SESSION human beings at present incurable, such as amyotrophic lateral sclerosis, disseminated sclerosis, etc. He also described the measures being taken by the Administration and the missions to alleviate the situation pending the results of further research. Dr KENNEDY (New Zealand) tb.a.n.tced Dr Schofield for his interesting presentation which he had listened to with fascination. (For adoption of resolution, see minutes of the fourth meeting, section 3.2.) 3. FACILITIES FOR EDUCATION AND TRAINING OF HEALTH PERSONNEL IN THE WESTERN PACIFIC REGION: Item 13 of the Agenda (Document WP/RC14/6, Add.l and 2) The REGIONAL DIRECTOR referred to the resolution adopted at the thirteenth sessio~ urging governments to submit full information on training programmes suitable for foreign students, so that it could be distributed to Member governments in the Region. Following the meeting, a circular letter had been sent to governments and the report before the Committee s~ized the information received to date. Dr KENUED"J: (New Zeeland) reported that a course leading tl'l a diploma in dental. public health (D.D.P.H.) would be introduced in the University of Otago beginning next year. Dr WATT (United states of A..'1lerica) stated that the training of personnel was a key to the development of health throughout the world. MINUTES OF THE THIRD. MEErING 125 There was no question as to the need for additional trained manpower to carry out the results of the research effort being made all over the world in medicine. The very speed with which research was turning up new and more effective methods of treatment was a point to which he wished to speak. All persons concerned with the training of people recognized that far more thought and attention than ever in the past must be given to the development of mechanisms, whereby graduates could continue their education effectively in the places where they worked. It was no longer sufficient for a physician to receive refresher courses at intervals of five to ten years. This had been enough in the days when possibly one new drug appeared a year. He considered that it was of tremendous importance for the physician, once graduated, to be able to continue to educate himself while at the same time carrying out his duties. This was a point to which educators of today had given relatively little thought and attention. He did not mean to downgrade their efforts, but he did not consider the mechanisms of the universities or the teaching institutions had expanded at a rate commensurate with the pace of research. He felt, therefore, that it was of some importance for the Committee to give thought and attention to this situation. He believed that an organization such as WHO could assist in this aspect of education and training. The REGIONAL DIRECTOR stated that Dr Watt had raised a very important pOint. During his visit to the South Pacific some years ago he had noticed that the medical services were often completely isolated and out of conto.ct with the modern VIOrld. For this reason various seminars had been organized, such as the tuberculosis refresher course 126 REGIONAL C9MMI:r1EEi FOURTEFmH SESSION in Fiji and the refresher course on integrated rural health in Apia. A nursing education seminar would take place in Fiji in December and another tuberculosis refresher course would be organized in NOl.Ulea in 1964. It had been originally planned to have one seminar every other year, but because of the ~ortance attached to this type of activity, seminars and/or refresher courses were now being held each year with the assistance of the South Pacific COmmission. (For adoption of resolution, see minutes of the fourth meeting, section 3.4.) 4. STUDIES ON CHOLERA EL TOR: Item 14 of the Agenda (Docl.Ulent WP/RC14/7) The REGIONAL DIRECTOR stated that in accordance with the request of the Regional Committee, governments had been asked to provide information on the cholera studies in operation in the Region and on any future developments in this field. The doc'UIlent presented to the Committee contained a summary of the replies received to date. Since the report had been written, Sarawak had indicated that no research studies were being undertaken. Japan had provided information on the activities of the "Research Committee on El Tor Cholera", which had been established in July 1962. During the past ten months, efforts had been concentrated on the differentiation between the El Tor cholera vibrio and classical cholera vibrio by a study of: (1) the antigenic structure, (2) the haemolysin test, (3) the phage sensitivity test and (4) cultural methods. Studies had. also been carried out on the differentiation of the El Tor cholera vibrios into the Celebes and the other type s • ' ... MINUTES OF T:H:E THIRD MEETING 127 The attention of the Committee was also drawn to a paper received from the Government of China on "The epidemic of El Tor vibrio paracholera in Taiwan". On the invitation of the CHAIRMAN, Dr SCHOFIELD, Assistant Director of M3dical Research, Papua and New Guinea, stated that Dr Lang of the Commonwealth Serum Laboratories had under preparation a vaccine against cholera El Tor which had been introduced to animals and had shown very minor toxic or side-effects. Double blind trials of the vaccine had been arranged with the Department of Public Health as to its accept- ability for immunizing human beings in the villages, particularly in the Sepik District of the Territory, within the next few weeks. This would provide information whether or not the cholera El Tor vaccine could be used as a routine method of immunizing indigenous populations in this part of the world. The possibility of using the vaccine on a controlled field trial, should there be an epidemiC of cholera El Tor, had also been discussed with the public health authorities. Since this activity was considered to be a rather big proposition, with limited resources, he thought that it might be wise to inform WHO of what was being planned. There was, of course, the ethical situation as regards the controls of such a trial and at present, in v'j.ew of HHO' s recommendations during the Manila Conference that Asiatic cholera vaccines should always be given, Dr Lang proposed to use these as a control with a cholera El Tor plus Asiatic cholera vaccine as an experimental unknown. He considered that the Asiatic cholera vaccine had not been clearly demonstrated in cholera El Tor. Some authorities, including those present at the Manila Conference, had recommended that where adequate therapeutic 128 REGIONAL CCMocr'J.1lIEE: FOURTEENTH SESSION services were available, an immunized control group would be justified. If this trial were undertaken in the Territory" official guidance from WHO would be required. Dr Dm (MaJ..aya) stated that no studies on cholera El Tor had been undertaken in his country. The last time choJ.era occurred in MaJ.aya had been seventeen years ago. In early May this year, however, there had been several cases of gastro-enteritis in the State of Ma.lacca. El Tor cholera had been identified during the middle of the second week of May and investigations had shown that the water supply in the cities had not been properly and adequately treated with ,chlorine. It had, therefore, been thought that the water supply had caused this recent outbreak. Control measures had been immedUtely enforced and after treatment of the water supply no new cases had been reported up to the end of May. The preventive measures had included the following: (1) more effective chlorination of the water supply which had had a dramatic effect; (2) mass vaccination which had covered 90 per cent of the population; (3) restricted movement of the population from one state to the other; (4) ban on exports of perishable foodstuffs. It was felt, howver, that the treatment of the water supply had probably been responsible for the control of the outbreak. No new cases had been reported during June, although a fe-w isolated cases had been found in It&1.acca during the early part of July. The country had been declared cholera-free at the end of July. Dr CHANG (China) reported that cholera El Tor had occurred in Taiwan during the middle part of JUly last year and had lasted for fifty-seven days, with a total of 384 cases. It had been observed MINUTES OF THE THIRD MEErING 129 t that the duration of the convale scent carrier state lasted from four to .. seventeen days. Cases of cholera had been found among the crew members and a passenger aboard a ship that had sailed from Hong Kong. It had been noted that everyone in the ship had a valid immunization certificate against cholera. It was therefore feared that the present International Sanitary Regulations were not adequate to prevent the introduction of the disease, and it was strongly felt that further studies on the problem of carriers should be continued under the leadership of WHO. This new knowledge might result in amendments being made to the present Inter- national Sanitary Regulations. Dr HASZLER (Australia) drew attention to the fact that the crews of some ships that called casually at Papua and New Guinea ports did not have international certificates of vaccination. Originally, these ships had not intended to call Got foreign ports but weather conditions, breakdowns or illness had forced them to do so. This situation posed a potential danger and he suggested that the Regional Committee should ask ~mber governments to ensure that the crews of such ships should be provided with valid international certificates of vaccination. Dr VILLEGAS (Philippines) said. that in his country there had been serious outbreaks of cholera El Tor in the late summer of 1961 and sporadic cases had continued to appear in many places. There had been a slight resurgence of the disease d.uring the middle of 1963, but fortunately its spread had. been kept under control and the number of deaths reduced. Studies of cholera El Tor were being undertaken, particularly on its epidemiological characteristics,. Initial findings stressed the role of carriers in the spread of the d.isease. The use 130 of mixed vaccine for immunization was also being studied and laboratory findings had revealed that a mixture of cholera El Tor vibrio and the Ogawa strain was useful for immunization purposes. He hoped that full reports on these studies would soon be available. Dr WATI' (united states of America) recalled that the Regional Director's report summarized some of the projects which had been cOIqpleted in the past year, one of which was the pilot study of bUharziasis in the Philippines. The sl.ll!mlB.ry pointed out that bilharziasis constituted an extremely cOIqplex bio-social problem, and the actual control of the disease required collaboration between health authoritiea and those who dealt with social and economic develop- ment. This situation was analogous to that of cholera. The importance of considering the bio-social factors involved in a planned attack on cholera should be eIqphasized. Each of the countries threatened by this disease had. its own protective devices and, to some degree, there was collaboration in the prevention of spread from one to another. The history of cholera showed that cholera did not, and could not, maintain itself effectively in any population except under some very unique conditions. It had been :repeatedly introduced into the western world and population groups in the east without maintaining itself for a long period of time. It was a disease found in a:c-eas where there were maIlY people living in extraordinarily primitive sanitary conditions. Even a minimum amount of sanitation introduced into a large population group could prevent the disease from becoming endemic. The existing endemic foci served as a threat to the rest of the countries whose population l1ved under conditions- susceptible to its reception. Ways to solve '- MINUTES OF THE THIRD MEETING 131 some of the bio-social problems leading to the actual eradication of this disease from the world should be found. It was clear that the repeated introduction, with eventual disappearance in a relatively short time, meant that this organism did not effectively surviv~ and in places where it was "at home " it was not in a state of stable relationship with the human population. Therefore, assistance directed towards the bio- social factors would go a long way towards eliminating the disease as a threat to the human race in a short period of time. In areas where cholera was "at home", collaboration with other regions was de sirable. He believed that the Directors of the WHO Regional Offices for the Western Pacific and south-East Asia should work out some means whereby the actual eradication of cholera could be achieved. The REGIONAL DIRECTOR believed that the point raised by Dr Watt was very relevant and important. The Organization considered that immunization alone was not sufficient to control cholera. In his Annual Report he had stressed the very vital role played by environ- mental sanitation in the control of this disease. Unfortunately in many countries environmental sanitation was not the direct responsibility of the ministry or department of health but that of the public works or public utilities department. Close co-operation between these government bodies was very essential. The ministry or department of health must take leadership in this aspect of public health, for unless this was done, the programme would be ineffective and inadequate. (For consideration of draft resolution, see minutes of the fourth meeting, section 3.3.) 132 REGIONAL COMMITTEE: FOURTEENTH SESSION 5. RESOLUTIONS OF REGIONAL INTEREST ADOPTED BY THE THIRTY-FIRST AND THIRTY ... SECOND SESSIONS OF THE EXECUTIVE BOARD AND THE SIXTEENTH WORLD HEALTH ASSEMBLY: Item 15 of the Agenda (Document WP/RC14/8) The REGIONAL DIRECTOR stated that the document before the Committee contained resolutions of regional interest adopted by the thirty~first and thirty-second sessions of the Executive Board and the Sixteenth World Health Assembly. A note had been added in connection with some of these resolutions as it was felt that the attention of the Committee should be specifically drawn to certain parts. Mt- BUCHANAN (League of Red Cross SOcieties) noted that some of the resolutions mentioned called for special contributions and asked what results had so far been gained in these efforts. The REGIONAL DIRECTOR stated that the appeals to governments for voluntary contributions to the special accounts for some of the activities mentioned had not been very successful. There being no other comments, the CHAIRMAN proposed that the Committee take note of the resolutions given in document WP/RC14/8. It was so agreed. At this pOint, Dr THIEME (Western Samoa), Vice-Chairman, took over the Chair. Before proceeding to the next item on the agenda, he expressed his sincere thanks for the honour accorded him and his country by his election as Vice-Chairman. f 6. MINUrES OF THE THIRD MEETING SELECTION OF TOPIC FOR THE TECHNICAL DISCUSSIONS DURING THE FIFTEENTH SESSION OF THE REGIONAL COMMITTEE: Item 16 of the Agenda (Document WP/RC14/9) The REGIONAL DIRECTOR stated that document WP/RC14/9 contained 133 suggestions of the Secretariat for the Technical Discussions in 1964. It was for the Committee to decide which topic should be selected. Dr HASZLER (Australia) suggested four other topics for the consideration of the COmmittee, namely: 1. Urbanization in rural areas and its effects on health 2. Planning the infrastructure of the health department in the organization of rural health services 3. The changing disease patterns of modern life 4. Community participation in health programmes especially in the financing of health programmes. Dr KILA WARI (Australia) referred to the subject of community participation in health programmes and stated that in the Territory of Papua and New Guinea, health programmes with community participation had been introduced and financed by the Government of Australia. In some districts of New Guinea where there was little public health activity, problems -were dealt with by community participation. He believed that the participation of communities would be of great help in any health programme introduced in the Territory. Dr KENNEDY (New Zealand) asked for a definition of the word "infrastructure" • Dr HASZLER stated that the health department's infrastructure did the specialized work required by the different health campaigns REDIONAL COMlgTTEE: FOURTEENTH SESSION such as antimaJ.aria, anti-tuberculosis. To allow work to be done by one organization instead of parallel teams working along in the same area, it was necessary to reorganize the general health department's structure. The REGIONAL DIRECTOR believed that infrastructure actually referred to the peripheral health structure of the local health services. Dr WATT (United states of America) asked what staff worked in the infrastructure. Dr HASZLER replied that it. was c0Ili>0sed of the workers in the field hospitals, the aid-posts, the health centres, who did the actual work in the field and had been trained at headquarters. Dr VILLEGAS (Philippines) stated that according to his understanding the word meant the other services such as public works, waterworks, electricity, etc., that "Were supposed to support any health activity but were not services 'Within the health activity. He felt that the Australian delegation should define the word more precisely as otherwise the Comm1 ttee members might be thinking of it in different terms. Dr HASZLER called attention to resolution EB31.R3l, paragraph 2, 'Where the term. had been used 'With reference to malaria eradication. It could also, hO"Wever, be applied to other subjects. The Australian delegation wished to recommend that ''planning the infrastructure of health departments in the organization of rural health services" should be considered as the subject of the Technical Discussions. , tGNU'l'ES OF TI-m THIRD NEETING --------------------- 135 Dr DICKIE (United Kingdom) believed that in choosing a subject for the Technical Discussions, more concrete topics should be considered. He appreciated the suggestion made by the Australian delegation but from the discussions it was apparent that the meeting was at a loss as regards the meaning of the term infrastructure. Of the three subjects presented in document 'WP/RC14/9, t.opic No.3, "The role of statistics in public health administration" would seem to be the most interesting one. The value of having basic statistics of diseases was well known. In Sarawak, and in many countries in the Region, there was a great lack of proper statistics and a discussion on the best methods of collecting valid statistics would appear to l1e the most appropriate topic for the Technical Discussions in 1964. Dr YUN (Korea) supported the proposal of the representative of the United Kingdom. Dr WATT stated. that for many years in the Public Health Reports, which cont~ined the official reports of the United states Public Health Service on the occurrence of communicable diseases, there was a small quotation along the following lines: that any health officer in order to be able to do his job must know where, when, and under what circumstances, disease was occurring. In many cases, with the develop- ment of associated personnel, i.e. statisticians, etc., the importance of statistics to the medical officer himself was commonly overlooked. The statisticians had developed. their own world and were doing a fine job but the health officers frequently lost intimate contact with statistics as a working tool, as a means of planning and evaluating their work. He would, therefore, like to vote for topic No. 3 with REGIONAL COOITTTEE: FOURTEENTH SESSION a slight roodification, that the word "use" should be sUbstituted for "role ", thus amending the topic as follows: "The use of statistics in public health a.d.m:I.nistration". This would make the subject roore concrete rather than simply delineating the role, which did not convey the seriousness of the task of improving the work which the people were charged to do. This 'WOuld be a very valuable approach, especially in an area such as the Pacific, where the population groups were widely scattered, the distances between people were great, and the means of communicating what was going on between the different areas was not well developed. It 'WOuld be very useful for the Committee to look into the actual use of living statistics, not just for documentary and historical purposes, but as a prospective tool for evaluating and carrying out one's 'WOrk. The REGIONAL DIRECTOR explained that the three topics suggested by the Secretariat had been chosen after a review of the subjects of the previous Technical Discussions. The question of health education always came to the front no matter what kind of programme was being implemented. The Regional Office now had an adviser on health education and during the last year there had been developments in this particular field. It had, therefore, been thought that the subject "Health education leadership, organization and administration" might be a good one. The second topic, "Basis and methods for the evaluation of health progr~s ", had been chosen because it was felt that the Regional Office had reached a stage where a regular assessment should be made of the 'WOrk that had been done. MINUTES OF THE THIRD MEETING 137 Regarding the third topic, the statistical unit, section or department in many countries in the Region had not been very well developed. It was difficult to get statistics, particularly reliable ones, and it was realized that they were very ~ortant in public health administration. Although there had been seminars and training courses and there were some projects in this field in the Region, it had. never as yet been the subject of the Technical Discussions. The VICE-CHAIRMAN fltated that four subjects had been submitted and suggested that the Committee might wish to take a vote on them. The REGIONAL DIRECTOR stated that the three subjects presented in the document were only suggestions of the Secretariat and the document did not represent a recommendation. If the Committee wished to vote on the matter, he believed that there were two proposals on the floor, the first made by the Australian delegation and the second by the United Kingdom delegation, seconded by the United states of America delegation, which had proposed a slight modification. 7. Decision: The proposal of the United Kingdom delegation as amended by the United states of An¥3rica delegation was chosen by a majority. The topic of the 1964 Technical Discussions would therefore be "The use of statistics in public health administration " •. CONSIDERATION OF DRAFT RESOLUTION ON THE ANNUAL REPORT OF THE REGIONAL DIRECTOR (Draft resolution WP/RC14/wp/l) (continued from the second meeting, section 1) Dr FERRON (France), Rapporteur, read. draft resolution WP/RC14/wp/l to the Committee. 138 REGIONAL COOUTTEE: FOURTEENTH SESSION Dr YON (Korea) stated that the draft resolution covered quite well the discussions of the previous session. However, he wished to suggest the inclusion of an additional point. There was no need to explain the importance of statistics, particularly on birth and death rates. In Korea, statistics were available but these were sometimes not reliable due to the lack of organization, particularly at the local level. Sometimes statistics in official reports differed from those reported in other official d.ocuments. The amendment which he wished to propose to the Committee was the addition of another paragraph, perhaps between paragraphs 7 and 8, requesting the Regional Director to collect reliable statistics of births and deaths during the last ten years from Member countries in the Region and to make this information available to them. Dr DICKIE (United Kingdom) stated that his delegation felt that too much emphasis had been placed on the first subject dealing with genetic factors. The importance of this subject was appreciated but three paragraphs had been given to it in the resolution and it was a subject which perhaps was not widely significant in the Region. Dr WAKAMA,TSU (Japan) referred. to the question of population problems which had been raised during the discussion of the Regional Director's Annual ~port. He felt that more emphasis should be placed on this. A first step would perhaps be the collection of vital statistics. Dr WATT (United States of America) agreed with the representative of the United Kingdom that the item on genetics was possibly out of focus with respect to the Regional Director's report. The item which was of some importance,had been brought to the attention of the Secretariat • MDruTES OF THE THIRD MEETING 139 but it might be preferable to cover it in a separate resolution. The amendment proposed by the representative of Korea also seemed to him an item somewhat different from the report itself. The actual collection of statistics over a period of ten years was an item of technical magnitude and he was not prepared to decide on it at this particular moment untU he could see its possible utility. He would like to know what this would mean to the work of the Secretariat, how much work it would entail for M=mber governments, the investment in time and money that would go into it. It seemed more appropriate to deal with it under another item and after more discussion and thought had been given to it. He hoped that the representative of Korea might see fit to withdraw his proposed amendment and to present it under another agenda item. He was quite prepared to do the same on the subject of genetics. Dr YON stated that before proposing his amendment to the Committee he had considered 'Whether he should present it as a separate item or as a part of the draft resolution before the meeting. He had decided on the latter for two reasons. The discussion on the subject had taken place during the discussion on the Regional Director's Annual Report and the other reason was to save time. He had not thought that it would be necessary to discuss the proposal which he had made. However, if the M=mbers of the Committee wished to discuss it later as a separate topic, he would be happy to wi thdraw it at the moment. Dr VILLEGAS (Philippines) associated himself with the comments made by the representatives of the United Kingdom and the United states of America with reference to the parts of the resolution on genetics. He suggested that the three paragraphs concerned should be deleted and that the Committee should proceed to discuss the amended text. 140 BEG1JNAL COMMITTEE: FOURXEENTH SESSION Dr DICKIE suggested that the resolution should be referred back to the rapporteurs for redrafting. Decision: The draft resolution was referred to the rapporteurs for redrafting. (For consideration of the revised resolution, see minutes of the fourth meeting, section 3.1.) The REGIONAL DIRECTOR stated that an item "other Business" was provided in the agenda, and the subjects of genetics and statistics could be raised at that point. It was so agreed. (See minutes of the fourth meeting, section 2.) The meeting was adjourned at 11.45 a.m. • 1. (WP/RCI4/Min/4 Rev.l) MINUTES OF THE FOURTH MEETlNG Legislative Council Chambers MOnday, 9 September 1963 at 5.10 p.m. CHAIRMAN: Dr R.F.R. Scragg CONTENTS Time, place and duration of the fifteenth and sixteenth sessions of the Regional Committee 144 2. Other business ............................................ 144 3. Consideration of draft resolutions .•••••••.•..••••••••.••. 146 3.1 Annual Report of the Regional Director (continued) ......................................... 146 3.2 lOlru. . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 3.3 Cholera. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 3.4 Education and training •...•••..••••..•••••..•••••••. 151 4. Consideration of the report presented by the Sub-Committee on Programme and Budget ••••••••••.•••••••••• 152 5. Draft resolution on cholera (resumed) •.••.••••..•••••••••• 155 -141- l42 REGIONAL COMMITTEE: FOURTEENTH SESSION Fourth Meeting MOnday, 9 September 1963 at 5.10 p.m. PRESENT I. Representatives of Member States AUSTRALIA CHJNA FRANCE JAPAN KOREA MALAYA NEW ZEALAND PHILIPPINES PORTUGAL UNITED KINGDOM UNITED STATES OF AMERICA VIET-NAM WESTERN SAMOA Dr R.F.R. Scragg Dr C. Haszler Dr Kila Wari Dr Himson Mllas Dr H.E. Downes Dr C.K. Chang Dr T.C. Hsu Dr A. Ferron Dr E. Wa.kamatsu Dr J. Ohmura Mr Y. Matsuda Dr K. Hamano Dr Suk Woo Yun Dato Dr Mohamed Din bin Ahmad Dr Raji Abbas bin Haji Alias Dr D. P. Kennedy Dr L. Uyguanco Dr F.T. Diy Dr E. L. Villegas Dr A.R. Pinto Dr C.H. Gurd Dr R. Dickie Dr C.H. James Dr J. Watt Dr R.K.C. lee Dr Saipele Matagi Dr Le-Cuu-Truong Dr J.C. Thieme • ,.- MINUTES OF THE FOURrH MEETING II. Representatives of other inter-governmental organizations and of non-governmental organizations INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS INTERNATIONAL COUNCIL OF NURSES DlTERNATIONAL DENTAL FEDERATION LEAGUE OF RED CROSS SOCIEn'IES III. WHO Secretariat SECREn'ARY Dr J.J. Loschdorfer Miss V. Bignold Mr:' T.E. Hubble Mr H. Buchanan Dr I.C. Fang Regional Director 143 144 REGIONAL COMMI'l'TEE: FOURTEENTH SESSION 1. TIME, PLACE AND DURATION OF THE FIF'l'EENTH AND SIXTEENTH SESSIONS OF THE REGIONAL COMMITTEE: Item 18 of the Agenda The REGIONAL DIRECTOR stated that, unless the Committee decided otherwise, the fifteenth session would be held in Manila, in accordance with the past procedure that every second year the meeting would be held at regional headquarters. The COmmittee, at its twelfth session, had accepted the invitation of the Government of the Republic of Korea to hold its sixteenth session in Seoul, Korea. It was so agreed. 2. OTHER BUSINESS: Item 19 of the Agenda. (continued from the third meeting, section 7) The CHAIRMAN said that two questions had been previously raised: population problems and genetic profiles in developing areas. Dr YUN (Korea) stated that the question of population problems, particularly those related to maternal and child health, had been taken up earlier. At that t~ he had proposed that this point should be covered in the resolution on the Annual Report of the Regional Director, but in subsequent discussions it had been agreed that it should be taken up separately. After some private discussions, he thought that the matter would be better considered at the next meeting of the Regional Committee so that a more detailed study could be made, thereby making the discussions more fruitful. Dr GURD (United Kingdom) agreed that the discussion on population p'roblems ,should be deferred until some subsequent occasion as it was a delicate problem and the difficulties faced by WHO in this connection , y- • MINUTES OF THE FOURTH MEETING were understandable. Nevertheless, he supported the proposal that WHO should enter this field, when it could see its way to do so, because the question of population growth exceeding economic growth was one of the major problems encountered by many countries in the area, including Fiji. Dr WATT (United States of America) associated himself with the views expressed by the previous speaker. This was a very important subject, one which should be discussed in detail with adequate time for effective study before the meeting. His Government was very interested in this matter and at the last World Health Assembly it had made a voluntary contribution to WHO to start research work on human population stUdies. He agreed that the proposal represented an important agenda item for future consideration. The CHAIRMAN suggested that, if it was the feeling of the Committee that this subject should be placed on the agenda for the next meeting, a resolution to this effect might be prepared. Dr WATT stated that a formal resolution was not needed at the present time. Details could be worked out by the Regional Director, if necessary with M:mber governments, between now and the next meeting. Dr YUN agreed with the representative of the United States of America and added that between now and the next meeting his Government would study the question further and consult the Regional Director and other M:mber countries, if required. 146 REGIONAL COMMITTEE: FOURTEENTH SESSION Regarding the question of genetics, Dr WATr said that he did not think there was any need for further discussion apart from the considera- tion of a resolution. (For adoption of resolution, see minutes of the fifth meeting, section 1.) 3. CONSIDERATION OF DRAFT RESOLUTIONS 3.1 Re onal Director (Draft resolution continued from the third meeting, section 7) The draft resolution was read by Dr UYGUANCO (Philippines), Rapporteur • Dr VILLEGAS (Philippines) asked that the fourth line of sub .. . paragraph 4(2) be amended to read "advisory services enabling them to plan, improve and expand". Decision: There being no other comments, the draft resolution, as amended, was adopted (see resolution WP/RC14.Rl).· 3.2 Kuru (Draft resolution WP/RC14/wp/3) (continued from the third meeting, section 2) The draft resolution was read by Dr UYGUANCO (Philippines), Rapporteur • Dr TRUONG (Viet-Nam) asked 'Whether the spelling of the wrd ''kuru'' in French should be either "kourou" or 't.kuru". The CHAIRMAN explained that the word ''kuru'' was the phonetic spelling in pidgin English and in the local language. It had been requested that this disease should be listed in the International Causes of Death and this was the spelling used. .'4. .. , ;.r. • 3·3 MINUTES OF TID] FOURTH MEETING Decision: The draft resolution was adopted (see resolution WP!RC14.R2) • Cholera (Draft resolution WP/RC14/wp/4) (continued from the third. meeting, section 4) 147 Dr UYGUANCO (Philippines), Rapporteur, read the draft resolution. Dr KENNEDY (New Zealand) stated that, although he was in entire sympathy with the principles enunciated, he felt that paragraph 3(1) had perhaps gone inadvertently a little far. It was realized, of course, that the resolution was directed at the south-west Pacific, but this was rather a large area and there was a lot of shipping exclusively between cholera-free areas. As worded, the paragraph meant all the ships in the area. There was, for example, a great deal of shipping between Australia and New Zealand, for which cholera certificates were not required, and it was for this reason that he felt the resolution could possibly be improved by some wording along the follOwing lines: II. • •• all personnel in ships not sailing exclusively between cholera-free areas". He appreciated the intention of the resolution that it was to catch ships that were not initially sailing to cholera-areas but diverted to a cholera area. Dr WATT (United St9.tes of .America) called the Committee's attention to an oversight. In the discussions held earlier, mention had been made of the importance of collaboration between the Directors of the WHO Regional Offices for the Western Pacific and South-East Asia Regions. He wished to suggest that the Eastern Mediterranean Region should be included, since Pakistan was an important part of that region and was an area which should be involved. 148 REGIONAL COMMITTEE: FOURTEENTH SESSION The CHAIRMAN referred to paragraph 3(1) which stated that all personnel in ships should be provided with valid international certificates of vaccination. He assumed that this implied that they should be vaccinated. He suggested that the statement should be replaced to read: "all personnel in ships should receive adequate vaccination against cholera." Dr WATT did not think that certificates would be issued if the personnel had not been properly vaccinated. The CHAIRMAN mentioned that there had been cases of transmission of smallpox by persons not vaccinated but possessing certificates. Dr KENNEDY hoped that the reference to valid international certificates of vaccination was not directed at the provisions of the International Sanitary Regulations. Dr GURD (United Kingdom) commented that the point raised by the representative of New Zealand was important and he believed that the text should be carefully worded. The CHAIRMAN suggested that the paragraph should be rephrased as follows: "all personnel in ships originating or passing through cholera areas should receive adequate vaccination against cholera." Dr WATT understood that the problem was that people came into ports from areas where there was cholera, with no knowledge, or evidence of knowledge, of the international quarantine regulations, and the purpose of bringing it up had been to draw attention to the importance of the regulations and the necessity of vessels on coastal r MINUTES OF THE FOURTH MEEl'ING 149 trade complying with them. He recalled that the Australian delegation had raised this question and it might wish to make some comments. Dr DOWNES (Austral.ia) stated that his delegation I s purpose was to point out the necessity of complying with the International. Sanitary Regulations. Australian legislation required all persons arriving in Australia by air from any proclaimed place to have a valid cholera vaccination, and this involved not only the two traditional sources of cholera, namely India and Pakistan, but all places in South~ East Asia and the Western Pacific that had had cholera in the last two years. The REGIONAL DIRECTOR stated that it was a matter of routine that the persons ~n all ships on an international route should be vaccinated and given vaccination certificates. The question that had been raised was that some of the ships which were fisJUng in the open sea and had no intention of calling anywhere, had sometimes been forced into a port because of poor weather. As they had no certificates, they were detained. Paragraph 3(1) did not appear to apply to the situation that had been raised. Dr GURD endorsed the appro~h taken by the representative of the united States of America. The international regulations were valid and provided protection in most places. In the case of fishing boats that entered ports due to storm, these would be given quarantine and treated as special cases. If they entered territorial water illegally, then diplomatic channels would cover those cases. 150 REGIOOAL COMMITl'EE: FOURTEENTH SmSION Dr HASZLER (Australia) said that when the matter had been brought up he had been thinking of small ships outside of the international route going closely between countries and accidentally entering ports either due to sickness or a breakdown. There had been no intention of entering foreign ports and the ships 'Were not on on international route. The CHAIRMAN stated that one point that had not been mentioned in connection with this problem was that many countries had outlying islands. These ships could easily reach these islands without their p;esence being known and bring disease which might spread throughout the country. Since the presence of the ships was not known, it would not be possible to make representations through diplomatic channels. Dr WATI' said that he understood the problem, but he was at a loss to know how to deal with it without getting the Committee involved in a complicated matter. The only controls were the country of origin of such ships and. the international quarantine regulations that existed. Wherever a ship had been guilty of violation, this fact should be reported to the country of origin and the appropriate remedial action should be taken by that country. Dr TRUONG (Viet-Nam) wondered whether the draft resolution could specify that all personnel in ships going to sea, whatever their destination, should be provided with valid mternational certificates of vaccination. The REGIONAL DIRECTOR suggested that the matter might be referred to the Committee on International Quarantine. AJ3 stated by the representative of the United Kingdom, this was a rather complicated matter and a legal mind was required to formulate an appropriate text. , ",' ( -1- MINUTES OF THE FOURTH MEETING 151 The CHAIRMAN presented to the Committee the suggestion that the question of adequate vaccination of personnel on fishing and other ships occasionally moving from country to country should be referred to the Committee on International Quarantine. Dr WATT felt that this was a problem for which the Regional Committee itself could devise an appropriate oolution. He believed that bringing this problem to the attention of the Regional Director was sufficient, as he would know what to do and it was up to him to determine the action to be taken thereafter. Dr GURD suggested that the resolution should be redrafted accordingly. Decision: There being no objection, the draft resolution was referred to the Secretariat for redrafting. (For adoption of resolution, see section 5 belOW.) 3.4 Education and training (Draft resolution WP/RC14/wp/5) (continued fram the third meeting, section 3) Dr FERRON (France), Rapporteur, read draft resolution WP/RC14/wp/5 to the Committee. Dr KENNEDY (New Zealand) proposed that the last paragraph should be reworded as follows: "RECOMMENDS that efforts should be made by governments to encourage refresher courses, in-service training programmes and ensure facilities for continuation studies for health workers. " Decision: The draft resolution, as amended, was adopted unanimously (see resolution WP/RCl4.R4). 152 REGIONAL COMMITTEE: FOURTEENTH SESSION 4. CONSIDERATION OF THE REFORI' PRESENTED BY THE SUB-COMMITTEE ON PROGRAMME AND BUDGET: Item 8.2 of the Agenda. (Document WP/RC14/ll Rev.l) (continued from the first meeting, section 8) The CHAIRMAN presented the draft report and invited comments. Section 1. Introduction (pages 1-2) The CHAIRMAN noted that the names of three representatives of Australia who had attended the meeting had not been recorded. Section 3.1. 6 Papua and New Guinea (page 8) The CHAIRMAN asked that the last sentence should be corrected to read "in or after 1965 all fellowships except that in surgery in 1965, with particular emphasis on leprosy, were for national. personnel. " Draft resolution WP/RC14/wp/4 The CHAIRMAN presented draft resolution WP/Rc14/wp/4 on the proposed. programme and budget estimates for 1965. Dr FERRON (France) stated that during the Technical Discussions on leprosy, several countries had expressed the opinion that it would be valuable to have frequent meetings on this subject. He enquired whether it would be possible to include a leprosy seminar in the list of inter-country group educational activities in 1965. The REGIONAL DIRECTOR stated that the allocation received from the Director-General had been fully utilized, and much as. he would like to implement the proposed project, this could only be done if the members of the Committee were willing to delete one of the six seminars listed in the draft resolution. • ..,.' ~ ... MINUI'ES OF THE FOURTH MEETING 153 Dr WATT (United states of America) thought that a conference on leprosy as a continuing activity might be more important than a conference on radiation. In many countries in the Region, radiation was a problem of relatively small consequence compared to leprosy. The leprosy seminar might, therefore, be inserted instead of the conference on radiation. Dr KENNEDY (New Zealand) stated that although the subject of protection against ionizing radiation was of considerable interest to his country, which had no leprosy, he would be happy to support the proposal that a seminar, which had a far greater significance in the Region, should replace the conference on radiation. Dr TRUONG (Viet-Nam) supported the proposal of the representative of the United states of America. He suggested further that if funds were available, the conference on radiation should be held the follOwing year. Dr YUN (Korea) also supported the above proposal. It was so agreed. Dr WATT referred to paragraph I.l which endorsed the proposed programme and asked for clarification as to what commitment was involved in the word "endorses". There was mention in the report of the Sub- Committee that there were questions as to how the proposed budget fitted into the total overall budget of the Organization. He felt that the budget should be reviewed in relation to those of the other regions. His Government was agreed that the programme was a sound one and cOlJl)limented the Regional Director on the development of a well-balanced 154 ROOICUAL CaooTTEE: FOURTEENTH SESSION progrEllllll2. It was not prepared, however, to endorse unequivocably the 8.111)unt of money requested, as this had to be reviewed in relation to the projects submitted by other regions and by the Director-General. himself. It might be found that the total. had to be adjusted and that certain activities might not appear so high on the priority list when reviewed against the other proposals. He wished, therefore, to request the Regional Director to interpret the word "endorses" with a view to determining how strong the commitments were. The REGIONAL DIRECTOR referred to Annex 1 on page 13 of the report which listed the questions to be answered by the Sub-Committee in drawing its conclusions. Endorsement did not, in any way, mean that governments were committed to make the contributions which the budget called for. The representative of the United states of America, besides being a member of the Regional COmmittee, was also a member of the Executive Board and. was, therefore, worried about the Western Pacific Region receiving a 20 per cent increase. As he had previously stated, this was an unusual situation. When the African Region had. started, it had had a much sma.l.ler budget than the Western Pacific Region. As time went on, as a result of the increasing number of independent countries in that region, its budget had been greatly increased. On a number of occasions he had drawn the Director-General' s attention to the fact that the Western Pacific Region had been neglected and. in 1965 an increase had been received. Dr WATT asked if it would be possible to amend the statement to ''RECOMMENDS that the proposed programnM:l under the regular budget and those proposed to be financed from the MUs.ria Eradication Special Account and the Special Account (or the Community Water Supply , - . / --- f ":';,: . -.. MINUTES OF THE FOURTH MEEn'ING 155 Programme be forwarded to the Director-General". In other words I the Committee should merely recommend that the Regional Director should transmit the budget to the Director-General. The CHAIRMAN, having referred to the resolution passed on the same subject at the thirteenth session of the Regional Committee, said that this was apparently the standard phraseology used. 5· Decision: There being no other comments, the draft resolution was approved (see resolution WP/RC14.R3). DRAFT RESOLUTION ON CHOLERA (Draft resolution WP/RC14/wp/3 Rev.l) (resumed from section 3.3 above) The CHAIRMAN read the amended paragraphs 3(1) I (2) and (3) and asked for comments. Dr WATT (United states of .America) stated that he was a little concerned about the suggestion that the Regional Committee should refer the problem to the Committee on International Quarantine, with which the Regional Committee had no direct relationship. He would be more comfortable if this were left in the capable hands of the Regional Director for appropriate action. This amendment was approved. Dr TRUONG (Viet-Nam) suggested that all crews of deep-sea fishing vessels, irrespective of their destination, should be in possession of a valid international certificate of vaccination. The CHAIRMAN stated that this point had been covered by the New Zealand representative. He wondered whether there was any further REGIONAL COz.t4I'PrEE: FOURl'EENTH SESSION need to revise the paragraph again or whether it was now adequate. Dr TRUONG said he had suggested the above a.men~nt because he felt that, generally speaking, all personnel in ships undertaking international voyages should have a valid international certificate of vaccination. It was felt that fishing vessels, which did not actually intend to sail to another country, should also come under this rule. The REGIONAL DIRECTOR said that what the Committee was actually concerned about were casual visits of fishing boats which, because of engine trouble or natural calamities, were forced to call at ports and were detained. Dr TRUONG stated that, in view of the circumstances, he would agree with the resolution. Decision: The draft resolution was adopted (see resolution WP!RCl4.R5) . The meeting adjourned at 6.25 p.m. , (WP/RC14/M1n/5 Bev.l) MINUTES OF THE FIFTH MEm'ING Legislative Council Chambers Tuesday, 10 September 1963 at 9.00 a.m. and 4.25 p.m. CHAIRMAN: Dr R.F. R. Scragg ( 7 CONTENTS 1. Consideration of the draft resolution on genetic profiles ................................•.•.•...... 160 2. Consideration of the report presented by the Technical Discussion Group ••••••••••••••••••••••••••••• 160 3. Adoption of the draft report of' the COmmittee •••••••••••••• 160 4. ~i;. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 161 , "'1. -157- 158 REGIONAL OOMMITTEE: FOURTEENTH SESSION Fifth ~eting Tuesday, 10 September 1963 at 9.00 a.m. and 4.25 p.m. PRESENT I. Representatives of Member States AUSTRALIA CHINA FRANCE JAPAN KOREA MALAYA NEW ZEALAND PHILIPPINES PORTUGAL UNITED KINGDOM UNITED STATES OF AHSRICA VIET-NAM Dr R.F.R. Scragg Dr C. Hasz1er Dr Himson Mulas Dr H. E. Do'WIles Dr C.J. Ross-Smith Dr C.K. Chang Dr T.C. Hsu Dr A. Ferron Dr E. Wa.k.a.ma.tsu Dr J. Ohmura Mr Y. Matsuda Dr Suk Woo Yun Dato Dr ~ha.med Din bin Ahmad Dr Haji Abbas bin Haji Alias Dr D.P. Kennedy Dr L. Uyguanco Dr F.T. Diy Dr E.L. Villegas Dr Antonio Rosaric Pinto Dr C.H. Gurd Dr R. Dickie Dr C.H. James Dr J. Watt Dr R.K.C. ~e Dr Saipe1e Matagi Dr Le-CUu-Truong r; • l , .. -, .. MINUTES OF THE FIFTH MEETING 159 II. Representatives of other inter-governmental organizations and of non-governmental organizations INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS INTERNATIONAL COUNCIL OF NURSES INTERNATI: ONAL DENTAL FEDERATION LEAGUE OF RED CROSS SOCIETIES WORLD MEDICAL ASSOCIATION III. WHO Secretariat SECRETARY IX J.J. It.lsclldorfer Miss V. Bignold Mr T.E. Hubble Mr H. Buchanan Dr C.J. Ross-Smith Dr I.C. Fang Regional Director 160 REGIONAL COMMI'l"l'EE: FOURTEENTH SmsION 1. CONSIDERATIW OF THE DRAFT RESOLUTION ON GENllH'IC PROFILFB (Draft resolution WP/RC14/wp/6) (continued from the fourth meeting, section 2) The Committee met at 9.00 a..m. to consider the draft resolution on genetic profiles. Decision: There being no comments, the draft resolution was adopted (see resolution WP/RCl4.R6) The meeting was then adjourned until 4.25 p.m. when the following items were discussed. 2. CONSIDERATION OF THE REPORT PRESENTED BY THE TECHNICAL DISCUSSION GROUP: Item 17 of the Agenda. (Document WP/RCl4/12 and draft resolution WP/RC14/wp/7) (continued from the first meeting, section 6) As the Committee had no comments to make on the report of the Technical Discussion Greup, the CHAIRMAN read the draft resolution. Decision: The resolution was adopted (see resolution WP/RCl4. R7) ,. ADOPTION OF THE DRAFT REPORT OF THE COMMITTEE: Item 20 of the Agenda. (Document WP/RCl4/l' Rev.l) The CHAI~ presented the draft report of the Regional Committee and w:ew attention to the blue slip affixed to the cover page of the document. Note bad been taken of the amendments made to the report of the Sub-Committee on Programme and Budget and these would be incorporated in the final text to be sent to representatives and governments shortly I ':I MINUTES OF THE FIFTH MEETING after the meeting. He also asked the members of the Committee to review the provisional minutes of the meetings and those desiring to make amendments should inform the Secretariat as soon as possible. Dr CHANG (China) moved the adoption of the report; this was seconded by Dr YUN (Korea). Decision: The report was adopted (see resolution WP/RC14.R9) 4. ADJOURNMENT: Item 21 of the Agenda Dr WATT (United States of America) introduced a draft resolution of appreciation, copies of which had been provided to the Committee. He also expressed his personal. appreciation of the hospitality and kindness which had been shown to the members of the Committee during their stay in Port MJresby. This had been the highlight of his own experience in international health work. Elaborating on the last paragraph of the resolution, he commented on the effective assistance the Committee had. received from the members of the Secretariat. Their efficiency had been demonstrated in the way they had. been able to produce and distribute the reports of three sepa.ra.te groups this afternoon for the Committee I s consideration. It was always dangerous to single out any particular group for special. connnents since they wre all working together as a team in order to bring about these results. But since he had spoken a number of times and therefore had had a certain amount of responsibility for correcting the minutes, he was particularly grateful for the work of the precis-writers since they left him very little work to do in correcting the inadequate English -' ... 162 REGIONAL COMMITTEE: FOURTEENTH SESSION ... !I of statements he had made. Even at the risk of possibly slighting others" he expressed his thanks to them for the effective way they had. saved him work. He said that he was speaking on behalf of all the members of his delegation in his thanks. Dr UYGUANCO (Philippines) seconded the adoption of the resolution and expressed his delegation I s appreciation of the kindness and hospitality received from the people and Administration of the Territory. The visits to the various institutions and points of interest had been a very rewarding experience. They were impressed by the achievements of the Health Department and the work being under- taken by the Adm1 n1 stration and Government of Australia. in :furthering the health and welfare of the people of this territory. These were worthy of emulation. Dr KENNEDY (New Zealand) associated himself 'With the remarks Clf the mover and seconder of the resolution. It had been a most enjoyable Regional Committee meeting, full of interest" st:i.mul.ation, wrapped around with wonderful hospitality. The CHAIRMAN added his own thanks to the members of the Secretariat for their assistance and mentioned the organizationaJ. activity under- taken by the members of both his own department and those of the Administration, enabling this meeting and all that went with it to be so successful. • Dr WATT congratulated the Committee on its wisdom in the choice of a Chairman. He did not think that the representatives could have done a better job if they had spent much more time lOOking. MINUTES OF THE FIFTH MEETING The Committee was fortunate to have had a Chairman who had ably managed by various forms of persuasion to complete the session on time. There being no other business, the CHAIRMAN then declared the meeting closed and stated that he looked forward to meeting the group again at the next session of the Committee in Manila next year. The meeting adjourned at 4.35 p.m. PARr II - MINUl'ES OF THE MAIN COMMITTEE (See Part II of document WP/RC14/13 Rev.I) • PART III - PROGRA;ll~ AND BUDGET SUB-CO~}UTTEE DOCUlv~NTS (See Appendix of Annex 3, document WP/RC14/13 Rev.l) -l l PARI' IV - GOVERNJiJENl' REPORTS