WPRlRC56/SRl4
SUMMARY RECORD OF THE FOURTH MEETING (Jacques Iekawe Conference Hall, SPC) Wednesday, 21 September 2005 at 08:30 CHAIRPERSON: Mr KHA W BOON WAN (Singapore) CONTENTS page 1.
Proposed Programme Budget 2006-2007 ................................................................ . Consideration of draft resolutions ............................................................................ . 2.1 2.2 Report of the Regional Director ..................................................................... Eleventh General Programme of Work, 2006-2015 and guiding principles for strategic resource allocations .......... ... ....... ........ ...... ..... ....... .....
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Asia Pacific Strategy for Emerging Diseases ............................................................ . Child Health ............................................................................................................. .
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PROPOSED PROGRAMME BUDGET 2006-2007: Item 9 of the Agenda (Documents WPRJRCS6/S and WPRJRCS6/S Corr.1) The REGIONAL DIRECTOR, introducing the item, recalled that at the fifty-fifth session of the
Regional Committee he had presented a proposed programme budget for 2006-2007 consisting of three parts: the global budget, the proposed regional strategic programme budget, and the indicative country planning figures for the Region. The Committee had been able to comment on the budget for the Organization as a whole, prior to its submission to the Executive Board and to the World Health Assembly, and before the preparation of detailed plans for countries and areas. The proposed
programme budget for 2006-2007 for the Western Pacific Region, an expansion of the proposed programme budget presented at the fifty-fifth session, was set out in document WPRJRCS6/S. In preparing the budget, the regional orientation had been taken from WHO in the Western Pacific Region: a framework for action, which had been adopted previously by the Regional Committee as a set of guiding principles for WHO's work in the Region in the early years of the 21st century (resolution WPRJRCSO.Rl). WHO's work as a whole was organized by 36 areas of work, which were independent of the structure of WHO and referred to functional groupings of work across all levels of the Organization. The regional programme budget for 2006-2007, which had been prepared in accordance with resultsbased management principles, was presented by the same areas of work. As in the past, it was also presented by country and area. Regional objectives and expected results had been developed for each area of work, bearing in mind the relevant global goal, objective and expected result, as well as country needs. Country goals and objectives were in line with the corresponding regional goals and objectives. Performance indicators would be used to monitor progress regularly and as the basis for the assessment of programme budget implementation, which would be conducted every six months. The proposed programme budget was the third to use the guiding principles, which had been designed to enhance transparency of the country allocation process and ensure that it was based on objective criteria. As a consequence of the appropriation resolution adopted by the Fifty-seventh World Health Assembly, the regional allocation of regular budget funds for 2006-2007 was US$ 76 SOS 000, a 6.2% increase over the allocation for 2004-200S. There had been a steady decline in the relative proportions of the total budget of WHO allocated to the Western Pacific Region over the previous four bienniums. However, there was a slight increase for 2006-2007. In the past, the Western Pacific Region had only received a small proportion of the total of "other sources" of funds available to the Organization, but there had been a significant increase in the proportion of all sources of funds received by the Region in the last two bienniums. There would be increases in both regular budget
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and extrabudgetary funds in 2006-2007 compared with 2004-2005, with extrabudgetary funds representing 67% of the total allocation for the Region. Of the regular budget funds for 2006-2007, 56% had been allocated to country activities, and the remaining 44% to regional and intercountry activities. The proportion of the regular budget allocated to country activities had been maintained when compared with the 2004-2005 biennium. The requirement for extrabudgetary funds was US$ 156 356 000, an increase of 28.7% compared with 2004-2005. In addition, the proportion of extrabudgetary funds to be allocated to countries and areas had increased markedly to 60% in 2006-2007, compared with 41% in 2004-2005. Likewise, the proportion of the planned overall budget going to countries and areas had increased from 47% to 59%. The increase reflected the needs of the Region and was in line with the Organization's shift of resources to countries and regions. Mr IW ABUCHI (Japan) said that with the emergence of greater burdens on global health, expectations regarding the roles and leadership of WHO were growing. The proposed programme budget for 2006-2007 represented a p;oper response and reflected the rapidly changing environment of global needs and priorities. Efforts to shift allocation of the Organization's increased resources to the regional and country levels should be continued. He asked how and by whom the biannual monitoring of budget performance would be undertaken. In the interests of transparency, the results should be made widely available, for example on the Regional Office web site and in reports to the Regional Committee. He also asked how the results would be reflected in the continuing
implementation of the programme budget. The proposed programme budget for the Region was divided into the 36 areas of work identified by WHO Headquarters, but it was not entirely clear how those areas related to the Regional Office organizational structure. For example, he had been unable to find the area "Violence, injuries and disabilities" on the Regional Office organizational chart. The differences made it difficult to assess the work undertaken in the Region. He requested further clarification regarding the allocation of regular budget and extrabudgetary resources, which did not seem to have been proposed in accordance with the principle of using the former for core functions and the latter for additional programmes. He also asked whether there was sufficient consultation between WHO and donors regarding the allocations. Mrs BLACKWOOD (United States of America) commended the commitment of the Regional Office to improving results-based budgeting and to implementing an integrated budgeting approach, making the best use of the total resources available whether from the regular budget or extrabudgetary contributions. Referring to Table 3 of the proposed programme budget document, she asked for further clarification of the shifts in allocations between regular budget and extrabudgetary sources in
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the various areas of work and requested that such information be provided in future programme budgets. There was room for continued refinement of the processes for developing expected results and indicators and applying the lessons learnt from the results achieved. Evaluation of programme implementation would benefit from greater specificity in the narrative descriptions of baselines and targets, and greater measurability of indicators and targets. Global priorities should be reflected as regional priorities. However, while the Regional Office had recognized the specific priority given by WHO to planning, resource coordination and oversight, it had not allocated any regular budget resources for the activity, and the overall budget for the activity had been halved. It was therefore difficult to see how the current level of output in that area could be maintained. The United States supported the proposed programme budget and applauded the efforts being made to enhance performance and accountability. Dr QI (China), welcoming the increase in allocations to priority areas, supported the proposed programme budget in principle. While participation by Member States in the formulation of the proposed programme budget in respect of regular budget funds was comprehensive, it was insufficient in regard to the use of extrabudgetary resources. The latter now accounted for around two thirds of the total budget and, in the interests of transparency, Member States should be much more involved in planning and implementing their use. There was also a need to strengthen the monitoring and
evaluation of programme implementation. While the narrative statements pertaining to each working area were clear, they were not consistent as regards the level of detail provided, which complicated the assessment of their relative importance. Further, some of the baselines for indicators were set at zero. He asked whether that meant that the indicators were new, and cautioned against the Information
introduction of too many new indicators, which was not conducive to continuity.
regarding activities in the area of traditional medicine, which were an important programme for many Member States of the Region, had not be given sufficient emphasis in the document. Following approval of an increase in the allocations to the Region, countries were planning additional activities. However, it was not clear whether those activities were consistent with the proposed programme budget. Table 2 of the proposed programme budget document indicated that the proportion of regular budget funds to be allocated to country activities for the 2006-2007 biennium was at the same level as for the previous biennium, at around 55%, although the Regional Director had indicated that the proportion from the overall budget would be nearer to 60%. China welcomed the shift towards countries and hoped that the increased funds would be used in country programme activities rather than in strengthening WHO country offices.
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Mr lATIKA (Vanuatu) commended the clear fonnat of the proposed programme budget document, which highlighted the leadership role of the Regional Office. Vanuatu expressed appreciation for ongoing support from WHO in respect of the development of its health system and the delivery of health services at all levels.
Mr DAVIES (Australia) supported the proposed programme budget for 2006--2007 for the Region, which reflected the Director-General's six priority areas. The strong consensus in support of an increase for the biennium, which had been joined by countries such as his own that had usually argued for zero growth, was an acknowledgement of WHO's increased level of activity and efficiency and also of the increased expectations of Member States. Australia welcomed the substantial
increases in allocations to the programmes for epidemic alert and response, and surveillance, prevention and management of chronic noncommunicable diseases. The increases were appropriate given the Region's vulnerability in respect of emerging diseases and the disturbing assessment provided by the regional evaluation of the noncommunicable disease prevention and control programme, discussed earlier by thtl Committee. He requested an explanation for the reduction in spending on tuberculosis, given the high prevalence of and mortality from the disease in the Region, and on immunization and vaccine development, which remained fundamental to child health and to the prevention of epidemics. The recent outbreak of poliomyelitis in Indonesia had highlighted the necessity of maintaining constant vigilance and high levels of immunization. He noted the high proportion of funding from voluntary sources, which might be uncertain and episodic in its arrival. The budget format provided a clear statement of expected results and measurable performance indicators. However, the indicators focused on positive achievements, such as the number of targeted countries that had taken a particular action. It might be useful to introduce indicators that measured the number of countries that had not taken action, particularly for an area such as epidemic alert and response, where the Region's preparedness would be determined by its weakest link. Such a move would also indicate the nature and extent of work still required to achieve particular objectives. An increased budget and the shift towards country activities entailed particular challenges in
respect of scaling-up of activities and recruitment of additional staff. Infonnal reports of less than adequate perfonnance and delays in staff recruitment at the country level were therefore a cause for concern. The proposed planning, resource, coordination and oversight programme should establish mechanisms to monitor performance, identifY problem areas and ensure that any weaknesses were dealt with promptly.
Mr HYUN (Republic of Korea) supported the proposed programme budget in general and welcomed the clarification of indicators, in particular in relation to health settings, tobacco and noncommunicable diseases. The Republic of Korea would honour its assessed contribution as
scheduled and would continue efforts to increase its voluntary contributions. It was gratifYing to note
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that his country's requests at the previous session of the Committee for increases in the allocations for communicable disease prevention and control and research on noncommunicable disease were reflected in the budget. Dr TANGI (Tonga) said that, at the Executive Board and at the World Health Assembly, he had already expressed his disappointment that the increase in the overall WHO proposed programme budget for 2006--2007 had not been fully reflected in the increase for the Western Pacific Region. He endorsed many of the comments made by previous speakers and requested further clarification on the allocation and use of extrabudgetary resources Dr SUYOI OSMAN (Brunei Darussalam) welcomed the 6.2% increase in the proposed programme budget allocation to the Western Pacific Region for 2006--2007, which reflected growing concerns in the Region, in particular regarding the emergence and re-emergence of infectious diseases. The focus on WHO goals in the 36 work areas was also to be commended. Brunei
Darussalam wished to thank the Regional Director for the continued technical and human resources support provided by WHO for several national programmes, including those on HIV/AIDS and the WHO Framework Convention on Tobacco Control. Proposals for support for 2006--2007 included programmes on: strengthening laboratory services in the areas of blood transfusion, tuberculosis and emerging infectious diseases; development and implementation of a surveillance system for noncommunicable disease risk factors; and strengthening of scientific laboratory services to ensure compliance with radiation legislation and regulation. Support would also be needed in respect of other areas of strategic importance. For example, in relation to HIVI AIDS and other sexually transmitted infections, efforts were needed to strengthen surveillance and laboratory capacity, overcome under-reporting from private health facilities and ensure compliance with notification requirements. Mr SELUKA (Tuvalu) supported the proposed programme budget for 2006--2007 and welcomed the efforts made by the Director-General to honour his pledge to shift resources to countries and regions. The increase in allocations to the Region should result in the achievement of significant results at the country level. The budget document provided a useful overview of the challenges, goals and strategic approaches in the Region, in addition to the details of regional allocations. He welcomed the additional allocation proposed for Tuvalu, which would be used to strengthen health system responses to epidemics. Mrs HIRO (France) supported the proposed programme budget for 2006--2007. The increased allocation to the Region was in line with the increase in the global WHO budget and with the Director-General's policy of decentralization. However, the increasing proportion of extrabudgetary resources continued to be a cause for concern, and complicated the budgeting process. France welcomed the significant increase in the allocation for the epidemic alert and response programme.
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with a strong emphasis at the country level, which should enable countries to meet the challenges of the revised International Health Regulations and increase response capacities. France also welcomed the increase in the allocation for noncommunicable disease prevention and control, given the significant numbers affected by noncommunicable diseases in the Region. The substantial increases in the budgets for certain countries no doubt reflected the lack of past investment. Weaknesses in national capacity to absorb increases remained in some countries, however, and rigorous management and evaluation of activities would be required. Mr PEP (Papua New Guinea) supported the proposed programme budget for 2006-2007 and welcomed the increased allocation to the Western Pacific Region. He hoped that governments would rise to the challenge of committing more funds to health activities. The REGIONAL DIRECTOR, thanking representatives for their comments and suggestions, said that he would respond to specific questions. Replying to the representative of Japan, he explained that the change of style from "focuses", as had been used in the Programme budget 2004-2005, to "areas of work" had been made to er,sure consistency of reporting across the Organization to the governing bodies. The areas of work referred to functions and not to organizational structure; the limited size of the Regional Office meant that it could not have one department for each of the 36 areas of work, and thus the activities would continue to be focused on four themes. With respect to the use of regular budget and other sources of funds, he said that the principle was to apply regular budget funds to core functions. Because the regular budget was limited and did not cover some of those functions, it was necessary to approach donors for extrabudgetary funding. The Regional Office tried to be as transparent as possible in giving potential donors a complete picture of which components were or were not covered by the regular budget and other sources. Generally, the funds provided by donor agencies enabled the Region to meet the expected results agreed upon by the World Health Assembly. The representative of the United States of America had questioned the zero allocation in 2006-2007 for the Planning, resource coordination and oversight area of work compared with US$ 1 million in the previous biennium (Table 3). In 2004-2005, it had not been decided whether that activity would be a country or Secretariat function, and the allocation had been made at the country or area level. For the 2006-2007 biennium the decision had been taken that it would be a Secretariat function, and consequently the funds had been transferred from the country or area line. He agreed with the observation of the representative of China that Member States' participation in the allocation of other sources of funding, in contrast to the regular budget, was minimal. Until recently information about the extent of available extrabudgetary resources had not been readily accessible, but transparency and sharing of that information were improving. Despite the understandable uncertainty inherent in other sources of funding, the better sharing of information
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across the Organization greatly facilitated planning; previously funds arrived unexpectedly, for which no provision had been made. He had already undertaken to provide at least 60% of extrabudgetary resources to countries or areas. Variation in the length of the section on issues and challenges was not related to the importance of the area of work, but simply reflected the complexity of the subject and the wish to provide a complete picture. Addressing the concern of the representati ve of Australia about the decline in funding for such an important programme as tuberculosis, he noted that the reduction had not been substantial. He recalled that resolution WPRlRC50.R5 on tuberculosis prevention and control had asked him to make Stop TB a special project and had urged Member States to allocate sufficient resources. Donors had responded generously and rapidly, and the mobilization oflarge resources had laid the foundations for good progress. The mid-term targets for 2005 had almost been reached and he expressed confidence that, despite the small reduction, they and the goals for 2010 would be achieved. A similar consideration applied to immunization and vaccine development, with the goal of poliomyelitis eradication having been reached. The consequent slight decline in funding accounted for the difficulty in responding to the possible threat to the Region posed by the recent outbreak of the disease in Indonesia and the choice of concentrating on the areas most vulnerable to potential importation of poliovirus. Increases elsewhere in the programme budget inevitably had negative consequences on such areas. In response to the representative of Tonga, he said that when the proposed programme budget 2006-2007 had been prepared, it had been impossible to quantify the allocation to each country. Other sources of funding depended on donors' preferences, which he could not have pre-empted. Subsequently there had been a better estimation of the amount of other funding available for each area of work. Discussions with Member States on the allocations could be held, thus increasing therr involvement in the decisions about use of those funds. The DIRECTOR, PROGRAMME MANAGEMENT, responding to the comments by the representative of Japan on performance assessment, said that a monitoring exercise was held every six months. At the country level, usually in consultation with the governments concerned, staff and the WHO representatives or country liaison officers examined the programme budget and submitted a report to the Programme Committee in the Regional Office. That Committee further reported to the Regional Director. The 12-month monitoring report was used as the basis for reporting to the Regional Committee, and was a mechanism for being as transparent as possible. On the basis of those exercises, adjustments could be made to the programme budget.
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The Regional Office would take note of the several useful comments and suggestions regarding baselines and indicators, such as the use of zero for some baselines whereas others reflected continuing activities, the need for more specific and measurable indicators, and the recommendation that it would be more useful to record the number of Member States that did not achieve goals. He pointed out that baselines and targets had been introduced for the first time in the proposed programme budget 2006-2007. Attempts would be made to standardize the approaches taken for various areas of work. Turning to the question from the representative of China about the increase in the proposed programme budget, he said that the overall programme budget had been approved by the World Health Assembly in May and that the allocations for countries would be increased pro rata by the Regional Director. WHO representatives and country liaison officers were discussing with governments the distribution of funds across the Organization's five priority areas. The process entailed submission of work plans to the Programme Committee and then to the Regional Director for approval. The outcome would be reflected in the next interim financial report. The CHAIRPERSON requested the Rapporteurs to prepare an appropriate draft resolution. 2. CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions. 2.1 Report of the Regional Director (Document WPRlRC56/Conf.Paper No.1) Dr QI (China) proposed that paragraph 2 should be amended by inserting the words "in collaboration with Member States and partners" after "accomplished", and that paragraph 3 should be amended by inserting "emerging infectious diseases, such as" before "avian influenza". Decision: The draft resolution, as amended, was adopted (see resolution WPRlRC56.RI). 2.2 Eleventh General Programme of Work, 2006-2015, and guiding principles for strategic resource allocations (Document WPRlRC56/Conf.Paper No.2) Decision: The draft resolution was adopted (see resolution WPRlRC56.R2). 3. ASIA PACIFIC STRATEGY FOR EMERGING DISEASES: Item II of the Agenda (Document WPRlRC5617) The REGIONAL DIRECTOR said that the Asia Pacific region was again, unfortunately, at the epicentre of an avian influenza outbreak after SARS had been contained in July 2003. Outbreaks of avian influenza A(H5NI) in poultry in Asia in 2004 had been unprecedented in their scale and
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economic consequences. Since December 2003, nine countries in Asia have been affected, with so far a total of 113 human cases, including 58 deaths, reported in Cambodia, Indonesia, Thailand and VietNam. Past experience and lessons learnt from SARS and avian influenza indicated that additional diseases would emerge somewhere in the world. In Asia and the Pacific, communicable diseases, especially emerging infectious diseases, continued to pose serious public health threats to many Member States. Countries and areas must be well prepared for early detection and rapid response in order to minimize the impact of future emerging diseases on health and economic development and to prevent them from spreading internationally. Countries in the Western Pacific and South-East Asia Regions shared significantly large border areas and were experiencing common communicable disease problems, and there was thus an urgent need to strengthen intercountry and biregional collaboration. Given the vulnerability of the Region to communicable disease threats and the increasing need for stronger intercountry collaboration in Asia and the Pacific, the Regional Committee, at its fiftyfifth session in September 2004, had requested that the Regional Office for the Western Pacific should develop, in collaboration with the Regional Office for South-East Asia, a biregional strategy for strengthening capacity for communicable disease surveillance and response. Most importantly, the International Health Regulations (2005), adopted by the World Health Assembly in May 2005. requested Member States to build, strengthen and maintain the core capacities for surveillance and response and to mobilize the resources necessary for implementation of the revised Regulations. He was pleased to report that a draft of the Asia Pacific Strategy for Emerging Diseases had been finalized by the two WHO regional offices in consultation with leading public health experts, including experts from the Member States in the Western Pacific Region. The purpose of the Strategy document was to provide a road map for countries in the two WHO regions to strengthen the capacities required for effective preparedness planning, prevention, and prompt detection of and rapid response to emerging infectious diseases that threatened national, regional and global health security. Implementation of the Strategy would be an important step towards the successful implementation of the International Health Regulations (2005). The proposed Strategy comprised five interrelated objectives and several expected results. Dr ENKHBAT (Mongolia), citing recent regional experiences of infectious diseases, supported
adoption of the Strategy and expressed his appreciation of the collaborative interregional work undertaken in its preparation. Given the adoption of the International Health Regulations (2005), the Strategy would strengthen the Region's immune system. Success would be measured by the extent to which Member States implemented it. Different degrees of preparedness and differences in infrastructure explained ad hoc responses to epidemics. He proposed the following measures to
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advance implementation: assessing the preparedness for emerging disease and categorizing countries on that basis; defining medium- and long-term goals for each category of country, on the basis of which each Member State should formulate an annual action plan; ensuring the commitment of governments to implement and report on such plans; and providing support in accordance with countries' needs. Such a set of measures would provide a clear framework for the mobilization of resources to build and strengthen national response capacities and could raise all Member States to the same level of preparedness and hence prepare the ground for effective joint regional action. Dr TRAN TRONG HAl (Viet Nam) commended the WHO Regional Offices for the Western
Pacific and South-East Asia on the development of the biregional strategic framework to strengthen national and regional capacity for early detection, rapid response and preparedness for emerging diseases in the Asia Pacific region. He considered the formulation of the Strategy to be timely and necessary, since the threat of a pandemic was looming. His country had had to cope with serious outbreaks of SARS and avian influenza in the previous two years. His Government supported the proposed Strategy but wanted to see more emphasis on the following areas: (I) early detection and proper isolation and handling of imported cases, aided by timely information-sharing through strengthened early warning systems; (2) promotion of close intersectoral collaboration, which-was indispensable for emerging zoonotic diseases, political commitment at the national level and active involvement at various levels in disease prevention and control; (3) adoption of strict regulations to secure laboratories conducting research on deadly viruses; (4) strengthening of intercountry collaboration on epidemiological research on new and exotic disease pathogens, disease prevention efforts such as vaccine development, and development of effective treatment regimens; (5) formation of a regional task force that would stand in readiness to respond and provide support to countries threatened by disease outbreaks and conduct periodic exercises among countries to simulate outbreak response, with coordination from WHO. He urged developed countries to contribute more resources since developing countries were already overburdened and the nature of emerging diseases required a concerted global effort. Dr CHEN (China) concurred with the key principles, objectives and actions contained in the
Strategy. He recalled that, as early as 1997, WHO had called for prevention and control measures for emerging diseases. In recent years, the Asia Pacific region had witnessed the emergence of Nipah virus encephalitis, SARS and avian influenza, all of which had threatened public health and economic security. He supported the Stratel,'Y and had the following recommendations: (I) Asia Pacific
countries should further enhance information exchanges, technical cooperation and setting up of bilateral and multilateral reporting mechanisms for communicable disease outbreaks;
(2) strengthening of the WHO technical network to improve surveillance capability, especially since emerging disease had non-specific symptoms, making diagnosis difficult; (3) improved technical
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exchanges and training of health personnel on surveillance and response, since sharing of experience and information was crucial to stem cross-border transmission; and (4) taking of preparatory steps
for the implementation and promotion of the revised International Health Regulations by Member States and the implementation of relevant regulations at national level.
Dr NAKASHIMA (Japan) said his country appreciated the efforts of the two WHO regional offices working jointly to develop the Strategy. Biregional cooperation was crucial since the two regions shared common borders and were similarly threatened by emerging diseases; avian influenza had affected areas in both regions. The need for an effective framework was fully recognized and the proposed Strategy was strongly supported by Japan. To cope with evolving disease patterns, new strategies and action plans were being developed and would continue to be developed at different levels, alongside the formation of new partnerships and coalitions. The newly formed International Partnership on Avian and Pandemic Influenza had met in New York during the previous week, and countries of the Region were expected to cooperate under the framework of that new partnership. To take that and similar developments into account, he proposed amendment of the section on page 17 of the Strategy which defined its scope, particularly the initial statement: "The Strategy seeks to complement existing global and regional communicable disease control programmes ... ". The amended statement would thus begin: "The Strategy seeks to complement existing and developing global and regional communicable disease programmes and frameworks, as appropriate ... " (proposed amendments underlined). Dr TUIKETEI (Fiji) said that the Strategy would provide direction for the development of new initiatives and the strengthening of existing programmes to respond to emerging diseases in a more comprehensive manner. Fiji welcomed the new dimensional shift. Proper coordination, management, monitoring and evaluation mechanisms would require sustained approaches and mobilization of resources; Member States would look to WHO's leadership in that area. The revised International Health Regulations prescribed key actions for Member States and \VHO. To support the
communicable disease control programme, she endorsed the recruitment of a permanent epidemiologist for communicable diseases at the office of the WHO Representative in the South Pacific in Fiji. In Fiji, a manual on national communicable disease surveillance and communicable disease outbreaks was in the final stages of development; five priority areas had been identified. A public health emergency and disease plan, with pandemic influenza preparedness and management components among its four priority areas, was also being developed. Issues that had been addressed in the proposed Strategy and the revised International Health Regulations would be addressed and integrated into those two documents. Planning for strengthening of the communicable disease
surveillance system and the capacity of laboratory services, based on WHO guidelines, was ongoing.
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Funds provided by Australia and Japan through WHO would support the improvement of laboratory facilities at the provincial level. The key role of the Pacific Public Health Surveillance Network was acknowledged, but its collaboration with WHO and other development partners should be given more prominence. Mr UNTALAN (United States of America) recognized the control of emerging diseases as a high priority for Member States in the Region; his Government was actively involved in the Western Pacific and South-East Asia Regions in activities aimed at reducing the risk of emerging diseases. He supported the Strategy and endorsed the amendments proposed by the representative of Japan; the Strategy would aid the timely and effective institution and implementation of the revised International Health Regulations in the Region. To comply with the requirements of the revised regulations, he urged Member States to improve surveillance, reporting, laboratory services, and coordination among themselves and partners. The rapid movement of people and goods in the era of trade globalization required greater cooperation and heightened vigilance to minimize the risk of disease transmission across borders. Early detection and rapid response to infectious disease outbreaks required openness and transparency among Member States. Close links between government agencies with
responsibility for health and agriculture would be crucial in responding to potential outbreaks of zoonotic diseases, particularly avian influenza. He affirmed his government's close collaboration with WHO in activities to protect the population from avian influenza and other infectious diseases and offered bilateral and multilateral support to Member States to improve national capacities for dealing with human and zoonotic strains of influenza. He urged all countries to develop pandemic preparedness plans; the threat of a
widespread outbreak of avian influenza was real. The President of the United States of America had announced the launching of the new International Partnership on Avian and Pandemic Influenza in his address to the United Nations General Assembly on 14 September. He said that members of the partnership recognized the crucial role of key international organizations in coordinating global efforts, and the value of close cooperation with WHO; one of the core principles of the partnership was mandated prompt sharing of epidemiological data and specimen samples with WHO. Countries from the regions that were at maximum risk from the threat of avian influenza could be expected to join the new voluntary partnership, adhere to its core principles, and commit politically to the worldwide efforts for outbreak readiness and response. He commended the steps taken by countries of the Region, at great economic cost, to protect the health of their populations, and ofthe world. Dr LAM (Hong Kong, China) said that, in Hong Kong (China), the level of political and
professional commitment and investment of resources to improve the national capacity to respond to public health emergencies was high, two years after the serious outbreak of SARS in that area. A new
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centre called the Centre for Health Protection, with responsibility for disease control and new health challenges in collaboration with local stakeholders and international partners, had been created within the Department of Health in 2004 .. Its three core commitments were real-time surveillance, rapid response and responsive risk communication. Its objectives and operational mechanisms, instituting transparency and openness, were generally compatible with the recommendations in the proposed Strategy. A review of existing health legislation for the control of communicable diseases to bring it in line with the revised International Health Regulations had been completed; steps were under way to meet the core capacity requirements. He supported the proposed Strategy and stressed the need for a mutually supportive approach. Dr TEP (Cambodia) said the recent outbreaks of SARS and avian influenza in Cambodia had increased public awareness of the devastating effects of epidemics and the need for effective mechanisms for prevention and control to prevent international transmission. Cambodia appreciated the substantial support from WHO and other partners for the strengthening of the surveillance system based on case data from public health facilities, reassessment of the burden from communicable diseases, and expansion and strengthening of the reporting system for infectious diseases. He lauded the adoption of the revised International Health Regulations by the Word Health Assembly in May 2005; the regulations would be another cornerstone for ensuring global security. He recognized that full implementation of the regulations required a specific time frame and called for renewed vigilance in the face of an imminent threat from avian influenza in the Western Pacific and South-East Asia Regions. He therefore commended the efforts of the two WHO regions in developing the proposed Strategy. Dr TONG (Macao, China) supported the Strategy. For the implementation of the strategy to be
effective and successful, he urged WHO to formulate strong and targeted advocacy activities and organize training for health workers of Member States in such areas as field epidemiology and management of health emergencies. Dr PARK (Republic of Korea) recalled that his Government had discussed the need for enhanced preparedness for emerging and re-emerging diseases such as SARS and avian influenza at the previous session of the Regional Committee and had actively supported the adoption of the resolution urging Member States t{) take appropriate action for disease outbreak response and requesting the Regional Director to develop a biregional strategy for strengthening capacity for communicable disease surveillance and response jointly with the WHO Regional Office for SouthEast Asia. He commended the effort that had gone into the development of the Strategy; he
considered it to be broad in scope and relevant in content. He endorsed the amendments suggested by the representative of Japan. He expected that the situational analysis in the Republic of Korea would be guided by the framework.
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He made the following recommendations related to the implementation of the strategy: (1) the establishment of a joint biregional task force on emerging diseases for rapid response, situational assessment and field investigations by experts from the two WHO regions whose Member States shared common borders; (2) the inclusion of health issues of interest to the two regions on the agendas of future Regional Committee sessions (currently, risk reduction, early detection and response, and preparedness for pandemic influenza should be given highest priority); and (3) WHO's assumption of a more significant role as a catalyst for facilitating exchanges of information and sharing of resources among countries from different regions that shared common borders and health risks. He proposed the inclusion of a report on the implementation of the Strategy on the agenda of the fifty-seventh session of the Regional Committee. He also welcomed the formation of the new International Partnership on Avian and Pandemic Influenza and assured his country's active involvement. Dr RAHMAT (Malaysia) commended the two WHO regional offices on their effective
collaboration and supported the key actions to attain the five objectives of the Strategy. Malaysia would be guided by the Strategy in its efforts to strengthen national capacity for dealing with emerging diseases and would mobilize the necessary resources for its implementation. Mr DAVIES (Australia) commended the jOint action of the Regional Offices for South-East Asia and for the Western Pacific in developing the Strategy. Australia endorsed the Strategy and welcomed the links with other fram~works,
such as the International Health Regulations. It remained
seriously concerned about emerging communicable diseases and the potential threat of a pandemic in the Asia Pacific region and globally, and continued to view WHO as an essential partner in responding to the public health implications of such diseases. The early detection, rapid response and preparedness capacities within countries were fundamental to the control of emerging diseases. For its part, Australia had developed an interim management plan for pandemic influenza, which provided a detailed guide for the country's response to such a threat. In some countries, relevant capacities were currently less than optimal, however, and medium- to long-term support would be needed to ensure that they could meet the minimum core capacity requirements of the revised International Health Regulations. Plans would need to take into account the individual needs of each country and, for the least developed countries, priorities would need to be set for the achievemenfof the various objectives. In that context, Australia shared the . concern expressed by the representative of Fiji and others regarding the long delay in strengthening capacity in the area of communicable diseases in the WHO office in Suva, and urged swift and decisive action to remedy the situation. Australia was committed to working in partnership with regional and global organizations to build the Region's capacity to prevent and control outbreaks of emerging infectious diseases; it had funded 17 separate initiatives targeting emerging diseases to an amount of AU$ 18.2 million; had
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contributed more than AU$ 6 million to a new emerging and resurging zoonotic diseases initiative; and had contributed funds to support other activities at the global, regional and country levels. WHO should cost the Strategy, identify funding priorities and move to support implementation in a timely manner. The CHAIRPERSON remarked that the plan mentioned by the representative of Australia was available on the Australian Government website and had provided inspiration to Singapore during the preparation of its own preparedness plan.
Mr MATHESON (New Zealand) welcomed the development of the Strategy, which reflected the importance of the control of emerging diseases and of regional and interregional collaboration in supporting rapid and effective responses. He requested further information on the consultation procedures implemented during the development of the Strategy aimed at ensuring maximum relevance at the national level. He asked whether there were any plans to support small countries in undertaking the mapping and assessment that fonned part of preliminary national planning, which appeared to be resource intensive. It was not clear whether those activities would cover assessment of national capacity to implement the revised International Health Regulations or whether that would be a separate, parallel process. Sufficient recognition should be given to the importance of strengthening regional response capacity, for example, the EpiNET teams established under the Pacific Public Health Surveillance Network. The network was an excellent example of multi country collaboration and was particularly important for small island states. Greater emphasis should be given to the role of clinical services in preparing for and responding to emerging diseases. All components of the health sector should be ready to respond. National preparedness efforts should also include other sectors, which should be involved at an early stage. The objectives and expected results were clearly key parts of the Strategy document but the status of the proposed areas for action was not entirely clear. He assumed that the proposals were indicative and that details would be determined at the country level in accordance with the national situation.
Dr ISMAIL (Brunei Darussalam) said that the recent outbreaks of SARS and avian influenza had drawn attention to the social, political and economic consequences of infectious diseases, as well as their impact on health. They had also highlighted cross-border issues, regional collaboration and the need for vigilance. The revision of the International Health Regulations had pointed to the need to strengthen national capacities to ensure early case detection and rapid responses to outbreaks. In response, Brunei Darussalam, with technical support from a variety of partners, had strengthened its surveillance system, revised relevant legislation and supported regional networks. A recent review of the Ministry of Health strategic plan had identified priority themes, such as national health
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emergencies preparedness and management, and the Ministry was currently finalizing a national influenza pandemic preparedness plan. Brunei Darussalam welcomed global, regional and bilateral cooperation in combating emerging infectious diseases and commended WHO on the development of the Strategy, which should go a long way towards strengthening efforts to meet the current challenges. Mr UNA (Solomon Islands) commended the collaboration between the two WHO regions in developing the Strategy. The inclusion of the five interrelated objectives broadened its scope. Solomon Islands endorsed the Strategy and looked to WHO for leadership in risk management activities.
Dr RADFORD (United Kingdom of Great Britain and Northern Ireland) endorsed the Strategy, which was comprehensive in scope and clearly identified the key elements that needed to be addressed. The Strategy recognized the different levels of capacity for preventing, detecting and managing emerging diseases across the Region and gave appropriate emphasis to capacity-building in terms of both technical and human resources. She endorsed the call made by the representative of Australia for urgent support for capacity-building tailored to individual country needs. The Strategy also acknowledged the importance of risk communication. Communication should not be limited to outbreak situations but should be undertaken proactively to raise awareness of potential risks and provide accurate information on sensible risk management. The Strategy was ambitious and farreaching, and it would therefore be essential to set realistic priorities that were consistent with existing national capacities and formulate appropriate action plans. Recent events had placed the Western Pacific Region in the spotlight in relation to emerging diseases and had also shown that it was not possible to predict where or when the next threat to human health would materialize. Disease had no respect for national boundaries and it was essential to take the Strategy forward in order to be prepared for every possible emergency. She commended the Regional Offices for South-East Asia and for the Western Pacific for their work in developing the Strategy and for their handling of the recent disease outbreaks, and looked to them for continued leadership in the area. Dr T ANGI (Tonga) joined previous speakers in endorsing the Strategy and thanking the two regions for their rapid response to the call for action by the Regional Committee at its previous session. He supported earlier comments on the need for activities to take account of the needs and capacities of individual countries and endorsed calls for urgent action to fill the vacant post for a communicable diseases specialist in the WHO Suva office. During the recent outbreaks of SARS and avian influenza, the countries concerned had had to rely on the Internet to obtain information and advice. He expressed appreciation for the response of donors to requests for support at that time. The strong commitment of the Director-General to preparedness activities gave hope that the world would be able to cope with the next pandemic, whenever it might arise.
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Mrs ABEL (Vanuatu) endorsed the Strategy, which provided a road map to guide countries, especially small nations such as her own. Vanuatu's experience during the recent SARS outbreak, which had included establishing a border control committee to monitor the movement of people in and out of the country, had highlighted the challenges facing the Ministry of Health and other sectors of government in such situations. Given the resource constraints, WHO support would be needed to coordinate strategy activities and ensure information exchange with countries and with the Pacific Public Health Surveillance Network. She urged WHO to collaborate with the Pacific Islands Forum Secretariat, which was developing a Pacific plan that would encourage Pacific island countries and areas to identify common interests and share their strengths. She supported calls for the vacant post in the WHO Suva office to be filled. Mrs ARTHUR (France) supported the three measures proposed and the multi sectoral nature of the work. Avian influenza went beyond WHO, and countries should work with WHO, the World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) in each country, especially the poorest and most vulnerable. France pointed out the importance of the WHO office in Lyon, France, in view of the entry into force of the International Health Regulations (2005) and the impending avian influenza crisis. Countries should help to develop the Global Outbreak and Response Network, providing rapid response with teams of experts for the affected zones. Dialogue with drug companies should help in development of a vaccine. There should be solidarity in distribution of vaccines, and cooperation on logistics and vaccine use. Dr CUTTER (Singapore) supported the Strategy and congratulated the Western Pacific and South-East Asia Regional Offices on the document. He recommended that the Strategy should be a regular item on the agendas of future Regional Committee sessions. Mr TEOKOT AI (Cook Islands) said that the Pacific Public Health Surveillance Network (PPHSN) would playa critical role in the Pacific. He thanked WHO and New Zealand for helping with the emergency preparedness plan. At the invitation of the CHA[RPERSON, a statement was made by the representative of the World Organization for Animal Health. The REGIONAL DIRECTOR pointed out that emerging diseases were not unique to the modern world. Chickenpox and measles, for example, had only been found in animals until 6000 years ago, when they were first transmitted to humans. In recent times, over the previous 20 years in particular, a new disease had been. emerging somewhere in the world every year, most of them zoonotic. The emergence of SARS in Asia in 2002 had not been fully explained. No sooner had it been contained, in July 2003, than avian influenza had become a threat. There was no single reason for
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these events, but several factors were in play: the frequent movement of people and goods, especially in Asia; the density of the poultry population in those areas where the outbreaks had occurred (in India there was a similar density of human population, but much less poultry); and the husbandry practices in Asia (In Western Europe, there were as many chickens, but fewer outbreaks, perhaps because of better control practices.) It was to be expected that most emerging diseases would be of animal origin. Tonga had mentioned the timing and gravity of the anticipated pandemic, over which there was great uncertainty. The only certainty was that, if an outbreak did occur, it would be much more widespread than SARS. As with tsunamis and earthquakes, preparedness was of the essence. Agreeing with the suggestion of the Republic of Korea that the Western Pacific and South-East Asia Regional Offices should continue to work together, he drew attention to the organizational chart on page 40 of document WPRlRC5617, which proposed a structure comprising national level working groups; a technical advisory group of external experts, as for polio eradication; and a secretariat provided by WHO. He noted that several Member States had called for the Strategy to be included on the agenda of future meetings, and he promised that that would be done. In view of limited resources, there was a need to prioritize the countries which would receive support, although he was confident that more support would be received from donors. Regarding the post of communicable diseases advisor in Fiji, he explained that the Regional Office had had great difficulty in finding a suitable candidate. There was a temporary recruit, and a staff member from the United States Centers for Disease Control and Prevention was expected to take up the position on completion of his current work, after February 2006. Australia had asked about the cost of implementing the Strategy, and a costing would be provided. The DIRECTOR, COMBATING COMMUNICABLE DISEASES, noted that the Strategy had taken account of the requirements of the International Health Regulations (2005) for countries to develop core competencies for their implementation and was thus a step on the way to compliance with the revised llIR. Some representatives had asked WHO to coordinate and collaborate with countries, organizations and partners. She saw the document more as a framework for donor coordination, with Member States using it for strategy to strengthen national capacities in fulfilment of the International Health Regulations, working with neighbouring countries to use resources. WHO would use it to secure funds.
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Countries should indeed be categorized, and WHO would do this, the better to target support. Activities would also have to be prioritized, and successful implementation would depend on a multisectoral approach, including the agricultural sector. Sharing of information would be vital to a prompt response. WHO had been working with country networks, and article 44 of the International Health Regulations (2005) called on Member States to collaborate with and support one another. The scope of the Strategy was new and its five objectives were very comprehensive. Intercountry consultations and donor forums were soon to take place, and WHO would report on implementation at the fifty-seventh session. The REGIONAL ADVISER, COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE, observed that a number of Member States had already drawn up their national emergency preparedness plans. WHO was continuing to provide technical support to those that were in the elaboration stage, and had developed practical tools such as a check list for preparation of the plans, desk-top exercises, and a model national plan. preparedness plan. Replying to the representatives of Viet Nam, the United Kingdom of Great Britain and Northern Ireland and others, he concurred that strengthening of laboratory capacity was crucial for early detection and reporting of such emerging diseases as avian influenza A(H5Nl). WHO had been providing technical support to affected countries for the laboratory diagnosis of A(H5Nl) and other emerging diseases through partners such as the United States Centers for Disease Control and Prevention, the National Institute for Infectious Diseases (Japan), the Centre for Health Protection (Hong Kong, China), and the International Network of Pasteur Institutes. In response to queries from Cook Islands, Fiji, New Zealand and Vanuatu, he explained that the
It had also revised the global influenza
Pacific Public Health Surveillance Network (PPHSN) was actively supporting countries and areas in the Pacific to strengthen surveillance and response capacity. WHO was working closely with the Secretariat of the Pacific Community to implement activities within the framework of the Network. The CHAIRPERSON requested the Rapporteurs to draft an appropriate resolution. 4. CHILD HEALTH: Item 12 of the Agenda (Document WPRJRC56/8) The REGIONAL DIRECTOR, introducing the item, recalled that at its fifty-fourth session the Regional Committee had discussed the tragic and unacceptable child mortality situation in the Region, where some 3000 children under five years of age were dying every day from common neonatal conditions, pneumonia and diarrhoea. The majority of those deaths could have been averted with readily available, cost-effective interventions. Unfortunately, those interventions were beyond the reach of many poor families, particularly in less developed countries and areas. Overshadowed by
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other more visible priorities, those children had been left behind, allowing a silent epidemic to fester year after year. Concerned about the situation and committed to reducing the under-five mortality rate by two thirds between 1990 and 2015, a target contained in the Millennium Development Goals, the Regional Committee had urged Member States to place child health higher on their political, economic and health agendas. It had similarly requested the Regional Office to give greater priority to child survival and to lead a new drive to reduce childhood mortality in those Member States with the greatest need. Accordingly, WHO, in collaboration with UNICEF, had elaborated a joint Regional Child Survival Strategy that addressed the key aspects and gaps in child survival. Technical experts from other partner agencies and several institutions from Member States in the Region were also involved in shaping the Strategy. The Strategy recommended that all children in the Region should be given access to an effective package of essential interventions for child survival, and that those services should be delivered in an integrated manner, building on existing approaches, including the Integrated Management of Childhood Illnesses .. Providing such services did not require new technology, but simply called for political will and the sharing of financial and human resources that matched the burden of disease among children. In order to ensure greater accountability, the Strategy urged the establishment of one formal, high-level coordinating mechanism, one national plan for child survival, and one outcome-oriented monitoring and evaluation mechanism with commonly agreed indicators in order to measure progress regularly. Advocacy efforts would have to be stepped up to make those life-saving interventions widely available, and sufficient financial and human resources needed to be mobilized to accelerate and sustain progress in child survival.
Dr BRIDLE (Deputy Regional Director, UNICEF East Asia and Pacific Region) informed the Committee that the 7th East Asia and the Pacific Ministerial Consultation on Children (Siem Reap, Cambodia, 2005) had called on UNICEF to address child survival in a more concerted manner, with particular focus on reducing disparities. The joint WHOIUNICEF Regional Child Survival Strategy represented a way that both organizations could contribute to achieving the goals contained in the Millennium Declaration, particularly those related to human rights and protection of vulnerable groups, and to make a practical commitment to the target of reducing under-five mortality by two thirds by 2015. Further, it reiterated their commitment to guaranteeing that all children had equal access to good quality health care in a region where, despite economic advances, large numbers of
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children and women had not benefited from improvements in health and nutrition. It had generated synergy between the two organizations through a common approach to the survival of marginalized children. The Strategy could be expanded to cover other problems of children and women, particularly maternal mortality and maternal and child undernutrition, that also needed to be tackled through the concerted efforts of governments and all partners involved. In addition to increased national
resources, donor funding would be crucial to ensuring the improvement of child survival. It would help maintain a consistent focus on marginalized children by providing financial support to those countries that continued appropriate interventions up to 2015 . . The meeting rose at 12:08.