WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC FIFTY-FOURTH SESSION Manila, Philippines 8-12 September 2003
REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY MEETINGS
Manila November 2003
WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC FIFTY-FOURTH SESSION Manila, Philippines 8-12 September 2003
REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY MEETINGS
Manila
November 2003
PREFACE
The fifty-fourth sessIOn of the Regional Committee for the Western Pacific was held Manila, the Philippines, from 8 to 12 September 2003.
III
Dr Manuel Dayrit (Philippines) and
Dr Mulitalo Siafausa Vui (Samoa) were elected Chairperson and Vice-Chairperson, respectively.
Mr Tony Kingdon (Australia) and Ms Myriam Abel (Vanuatu) were the Rapporteurs. The Report of the Regional Committee is in Part I of this document, on pages I-58, the summary records of the plenary meetings are in Part II, on pages 59-212.
ii
CONTENTS
page PART I - REPORT OF THE REGIONAL COMMITTEE ........................................ ..
r. II.
INTRODUCTION AND SUMMARy ................................................................ .. RESOLUTIONS ADOPTED AND DECISIONS MADE RESOLUTIONS WPRJRC54.R I WPRlRC54.R2 WPRJRC54.R3 Nomination of the Regional Director ................................ . Report of the Regional Director ......................................... .. Expanded programme on immunization: measles and hepati tis B .................................................... .. Proposed programme budget: 2004-2005 .......................... . Sexually transmitted infections, including HIV/AIDS ...... Tuberculosis prevention and control ................................ .. Severe acute respiratory syndrome (SARS) and other outbreak-prone diseases .................................... .. WHO Framework Convention on Tobacco Control .......... Child health ....................................................................... . Fifty-fifth session ofthe Regional Committee .................. . Resolution of appreciation ............................................... .
3 8
8
8
9 11
WPR/RC54.R4 WPR/RC54.R5 WPRJRC54.R6 WPRlRC54.R7
13 15
17
WPRJRC54.R8 WPR/RC54.R9 WPRlRC54.RI0 WPRlRC54.Rll
19 21 22
23
DECISIONS WPRlRC54( I) Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee ....................................................................... .. Special Programme for Research and Training in Tropical Diseases: Membership ofthe Joint Coordinating Board ......................................................... ..
24
WPRlRC54(2)
24
iii
page ANNEXES: 1. AGENDA LIST OF REPRESENTATIVES ................................... :....................................... . LIST OF NONGOVERNMENTAL ORGANIZATIONS WHOSE REPRESENTATIVES MADE STATEMENTS TO THE REGIONAL COMMITTEE ....................................................................................................... . 25
2.
29
3.
57
PART II - SUMMARY RECORDS OF THE PLENARY MEETINGS ...................... SUMMARY RECORD OF THE FIRST MEETING ......................................................... 1. Opening of the session .......................................................................................... . Address by, the retiring Chairperson ..................................................................... . Election of new officers: Chairperson, Vice-Chairperson and Rapporteurs ....... . Adoption of the agenda ......................................................................................... . Address by the Director-General ............................................................................ .
59 63
64 64 64 65 65 83
2. 3. 4.
5.
SUMMARY RECORD OF THE SECOND MEETING ................................................... 1. 2. Nomination ofthe Regional Director ................................................................... . Report of the Regional Director ............................................................................ .
84 84 99 100 100 101
SUMMARY RECORD OF THE THIRD MEETING ........................................................ 1. 2. Address by the incoming Chairperson .................................................................. . Report of the Regional Director (continued) ........................................................ . Programme budget 2002-2003: budget performance (interim report) ................ . Proposed programme budget: 2004-2005 ............................................................. .
3.
4.
lOS 119 120 131
SUMMARY RECORD OF THE FOURTH MEETING .................................................... 1. 2. Expanded programme on immunization: measles and hepatitis B ....................... . Sexually transmitted infections, including HIV / AIDS
SUMMARY RECORD OF THE FIFTH MEETING .........................................................
137 138
I.
Sexually transmitted infections, including HIV/ AIDS (continued) ...................... .
iv
page
SUMMARY RECORD OF THE FIFTH MEETING (continued) 2. Consideration of draft resolutions ........................................................................ .
145 145 145 146 146 151 152 153 154 154 155 160 160 160 163 173
2.1 2.2
2.3 3.
Report of the Regional Director................................................................. . Proposed programme budget: 2004-2005 ............................................... . Expanded programme on immunization: measles and hepatitis B .......... .
Tuberculosis .......................................................................................................... .
SUMMARY RECORD OF THE SIXTH MEETING ........................................................
I.
Ministerial round table: future directions for public health in the Region ........... .
SUMMARY RECORD OF THE SEVENTH MEETING ..................................................
I.
Ministerial round table: Future directions for public health in the Region .......... . 1.1
Summary by moderator ............................................................................ .
2. 3.
Tuberculosis (continued) ...................................................................................... . Consideration of draft resolutions ........................................................................ .
3.1 3.2 4.
Proposed programme budget: 2004-2005 ................................................ . Sexually transmitted infections, including HIV/AIDS ............................ .
Severe acute respiratory syndrome ....................................................................... .
SUMMARY RECORD OF THE EIGHTH MEETING
I. 2.
Severe acute respiratory syndrome (continued) Expression of sympathy in connection with the recent SARS outbreak Regional strategy for improving access to essential medicines in the Western Pacific, 2004-2009 ........................................................................... . Framework Convention on Tobacco Control ........................................................ .
174 180 180 185 197 198 207 207 207 207 208
3. 4.
SUMMARY RECORD OF THE NINTH MEETING ........................................................
I.
Child health ............................................................................................................ . Consideration of draft resolutions .......................................................................... .
2.
2.1 2.2
2.3 2.4
Sexually transmitted infections, including HIY/AIDS .............................. . Tuberculosis prevention and control ......................................................... . Severe acute respiratory syndrome (SARS) and other outbreak-prone diseases ............................................................................ . WHO Framework Convention on Tobacco Control .................................. .
v
page
SUMMARY RECORD OF THE NINTH MEETING (continued)
3. 4.
Coordination of the work of the World Health Assembly, the Executive Board and the Regional Committee .............................................. .. Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee ................................................................................ . Special Programme for Research and Training in Tropical Diseases: Membership of the Joint Coordinating Board ..................................... . Time and place of the fifty-fifth and fifty-sixth sessions of the Regional Committee .................................................................................. .. Consideration of draft resolutions .......................................................................... . 7.1 Child health ............................................................................................... .
208
209 210 211 211 211 212
5. 6.
7.
8.
Closure of the session ........................................................................................... .
VI
PART I REPORT OF THE REGIONAL COMMITTEE
I. INTRODUCTION AND SUMMARY
The fifty-fourth session of the Regional Committee for the Western Pacific was held at the Regional Office in Manila, the Philippines, from 8 to 12 September 2003. The session was attended by representatives of Australia; Brunei Darussalam; Cambodia; China; Cook Islands; Fiji; Hong Kong (China); Japan; Kiribati; the Lao People's Democratic Republic; Macao (China); Malaysia; the Republic of the Marshall Islands; the Federated States of Micronesia; Mongolia; New Zealand; Niue; the Republic of Palau; Papua New Guinea; the Philippines; the Republic of Korea; Samoa; Singapore; Solomon Islands; Tonga; Tuvalu; Vanuatu; and Viet Nam, and by representatives of France, the United Kingdom of Great Britain and Northern Ireland and the United States of America as Member States responsible for areas in the Region. Representatives of the Food and Agriculture Organization of the United Nations; Joint United Nations Programme on AIDS; Global Alliance for Vaccines and Immunization; Global Fund to Fight AIDS, Tuberculosis and Malaria; the Secretariat of the Pacific Community; Health Canada; the Nippon Foundation and Sasakawa Memorial Health Foundation; and 27 nongovernmental organizations also attended. At the first plenary meeting, the Committee elected the following officers: Chairperson: Vice-Chairperson: Rapporteurs in English: Mr Tony Kingdon (Australia) in French: Ms Myriam Abel (Vanuatu) Dr Manuel Dayrit (Philippines) Dr Mulitalo Siafausa Vui (Samoa)
The outgoing Chairperson addressed the session and thanked the Committee for its support over the previous l2 months. The Director-General then addressed the Committee. Representatives congratulated him on his recent election and noted with satisfaction Dr Lee's background in the Western Pacific Region. In the discussion that followed, several representatives expressed concern at the outbreaks of severe acute respiratory syndrome (SARS) in the Region and stressed the need for further preparedness measures in case of future outbreaks. Associated with this was a recognition that the Region's health systems needed significant strengthening, both to counter outbreaks of diseases such as SARS (through improved surveillance, for example) and more generally (through improved human resources policies and reform of health systems). Several representatives noted with regret that the Region's allocation from WHO's regular budget had fallen.in recent years. While the Director-General's refocusing of resources on regional
4
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
and country levels was welcomed, a number of speakers argued that appropriate budgetary allocations were needed if countries were to make real progress. The adoption of the WHO Framework Convention on Tobacco Control by the Fifty-sixth World Health Assembly was welcomed. Many representatives saw the adoption of the Convention as heralding a new era in tobacco control. In his response, the Director-General stressed the need for vigilance against SARS and other emerging and re-emerging diseases, explained how he planned to further unify the budget, and said that he would strive to maintain and improve good relations among WHO Headquarters, regional offices and country offices. On the specific issue of the emigration of health workers from small island countries, he agreed that this was serious issue and noted that he had had personal experience of the issues facing such countries during his previous close involvement with programmes in the Pacific. At the second meeting, the Committee went into private session to consider nominations for the post of Regional Director. The Committee nominated Dr Shigeru Omi (Japan) for a further five-year term. The appointment, beginning on I February 2004, is to be proposed to the Executive Board (resolution WPRlRC54.Rl). The Regional Director thanked the Committee for its continued support and then introduced his report for the period 1 July 2002 to 30 June 2003. Many comments on the report focused on the grave threat posed by outbreaks of communicable diseases such as SARS and the need to bolster health services to combat such threats, in particular the need to improve surveillance. Other matters referred to by representatives included the dual burden of communicable and noncommunicable diseases suffered by many Member States, the continuing relevance of primary health care, the promising progress made in recent years to combat tobacco, and the importance of a more holistic approach to health care. At the third meeting, the incoming Chairperson addressed the Committee. He was followed by the Regional Director, responding to some of the issues that had been raised at the previous meeting., With regard to future annual reports, he said that it was now time to look closely at the report and at what its intended audience should be. Naturally this should take place with fuJI consultation of
Member States and he explained that he would be contacting them in this regard (resolution WPRlRC54.R2). The next item for discussion was the inl.erim report on the programme budget: 2002-2003. In introducing the report, the Regional Director explained that the SARS outbreaks had led to a number
REPORT OF THE REGIONAL COMMITTEE
S
of difficulties in implementation, both because some activities, such as meetings, had had to be cancelled or delayed, and because some funds had had to be diverted to SARS-related activities. Nevertheless, he was confident that 100% implementation would be achieved. The Regional Committee then turned its attention to the biennium to come and examined the proposed programme budget: 2004-200S. Many speakers commented on the reductions in country budgets that had followed the adoption of resolution WHASl.31 by the World Health Assembly in 1998. There was a general consensus that health programmes had suffered significantly because of these reductions and many speakers hoped that the effects of resolution WHASl.31 would cease at the end of the current biennium. Another area of concern raised by several representatives was the distribution of extrabudgetary resources within the Organization; it was felt that the Western Pacific had received a small share of these resources in comparison with those received by other regions (resolution WPRlRCS4.R4). The fourth meeting began with an examination of the Expanded Programme on Immunization (EPI) and considered the proposal that measles elimination and hepatitis Bcontrol should be selected as the twin pillars to strengthen the EPI. Representatives were supportive of the proposal. It was agreed that the elimination of measles should be a regional goal and that a target date for eradication should be established as soon as possible (resolution WPRlRCS4.R3). The Regional Committee then addressed the issue of sexually transmitted infections, including HIV/AIDS (a discussion that was continued during the fifth meeting). Representatives commended the global target of delivering antiretroviral treatment to 3 million people by 200S and other moves to extend treatment to AIDS patients. However, concern was also expressed about the potential for an increase in drug-resistant HIV in the Region. With regard to prevention, WHO's recommended strategies to combat HIVI AIDS among population groups at high-risk, such as sex workers and injecting drug users, were also addressed by the Committee (resolution WPRlRCS4.RS). The
Assistant Director-General responsible for family and community health reminded the Committee that in her country, Botswana, the epidemic had begun with only small numbers of cases, yet now the country had the unfortunate distinction of having the high HIV prevalence in the world. Tuberculosis (TB) was covered at the fifth and seventh meetings. The Regional Director and the leader of an independent team that had reviewed the Stop TB special project introduced the subject. Although considerable progress had been made since the Committee's declaration of a "tuberculosis crisis" in 1999, it was acknowledged that much needed to be done if the targets were to be achieved by the end of 200S. Among the challenges highlighted by the representatives were the rise in TBIHIV co-infection, the strong association between tuberculosis and poverty, funding gaps,
6
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
weak laboratory services and problems of DOTS implementation in difficult areas, including those where there was armed conflict (resolution WPRlRC54.R6). At the sixth meeting there was a ministerial round table on the subject "Future directions for public health in the Region". The round table was preceded by a presentation by a Director in the office of Evidence and Information for Policy at WHO Headquarters. The moderator presented a summary of the discussions at the beginning of the seventh meeting. 'nle SARS outbreaks in the Region were intensively discussed during the seventh and eighth meetings. The agenda item began with a presentation by the Regional Adviser in Communicable Disease Surveillance and Response, in which he described the broad spectrum of the activities undertaken by the Organization during the outbreaks. During the discussions, it was agreed that, while health workers had displayed great dedication and courage during the outbreaks, SARS had exposed serious weaknesses in global and national health systems. The outbreaks had been contained, but much needed to be done to ensure that the Region was better prepared for the possible reemergence of SARS, or other outbreak-prone diseases. Part of this would involve improvements to disease surveillance in which both Member States and WHO would have a role. The Committee also highlighted the need for better laboratory containment of the SARS coronavirus, the reporting of all public health events of international importance, the investigation of such events by WHO, better infection control in health care settings, and the supply of influenza vaccine to high-risk groups, where feasible (resolution WPRlRC54.R7). At the conclusion of the discussion, the Regional
Committee observed a minute of silence in tribute to WHO staff member Dr Carlo Urbani and other health workers who had lost their lives during the SARS outbreak. The eighth meeting continued with an examination of the regional strategy for improving access to medicines in the Western Pacific, 2004-2009. While applauding the aims of the strategy and acknowledging the contribution to health made by the essential medicines concept, representatives raised a number of issues with regard to the strategy's implementation. These included the very different contexts in countries of the Region, the need to define the role of medicines not included in the list, the role of research-based pharmaceuticals, and the recent WTO agreement. It was agreed that a small working group would be convened to revise the draft regional strategy in the light of the comments made. The Committee then turned to the WHO Framework Convention on Tobacco Control. WHO's leadership role in the negotiations that led to the adoption of the Convention was praised and there was a consensus that the Convention represented a very significant opportunity for tobacco control efforts in the Region. It was noted that six Member States from the Region had already signed the
REPORT OF THE REGIONAL COMMITTEE
7
Convention and the Committee encouraged the remaining Member States to do so at the earliest opportunity. It was also noted that the provisions of the Convention should be reflected in national policies and legislation (resolution WPRJRCS4.R8). The ninth meeting began with the topic of child health. The Regional Director's observation that the goal of a two-thirds reduction in childhood mortality by 201S, from 1990 levels, was a key Millennium Development Goal was echoed by many subsequent speakers. Representatives noted that the knowledge to improve child survival was available - the task now was to translate that knowledge into large-scale action. The Integrated Management of Childhood Illness (IMCI) strategy, which brought all the relevant interventions together, was recognized by the Committee as an evidencebased strategy that had the potential to make a significant improvement to child health in the Region. Member States implementing IMCI were encouraged to prioritize, strengthen and scale-up the strategy (resolution WPRJRC54.R9). Also at the ninth meeting, the Committee examined a number of matters covered at the Fiftysixth World Health Assembly with relevance for the Region. These included the resolutions that had been adopted on prevention and control of influenza pandemics; the joint FAOIWHO evaluation of the Codex Alimentarius Commission; traditional medicine; and the revision of the International Health Regulations. The Committee then selected the Lao People's Democratic Republic to serve on the policy and coordination committee of the Special Programme of Research, Development and Research Training in Human Reproduction (decision WPRJRC54(1)) and Mongolia to serve on the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases (decision WPRJRCS4(2)). Regarding future sessions, the Committee agreed that the fifty-fifth session would be held from 13 to 17 September 2004 in Shanghai, China. The Committee expressed its grateful appreciation to the Government of China for its offer to act as host for the session (WPRJRCS4.RI0). At the closure of the session, the Regional Director and the Committee expressed their appreciation to the chairperson, vice-chairperson, rapporteurs, presenters, and representatives of intergovernmental and nongovernmental organizations for their oral and written statements (WPRJRC54.Rl1).
8
REGIONAL COMMITIEE: FIFTY-FOURTH SESSION
II. RESOLUTIONS ADOPTED AND DECISIONS MADE WPRlRC54.Rl NOMINATION OF THE REGIONAL DIRECTOR
The Regional Committee, Considering Article 52 of the Constitution; and In accordance with Rule 51 of its Rules of Procedure; I. NOMINATES Dr Shigeru Omi as Regional Director for the Western Pacific; and
2. REQUESTS the Director-General to propose to the Executive Board the appointment of Dr Shigeru Omi for a period of five years from 1 February 2004.
Second meeting, 8 September 2003 WPRlRC54/SRl2
WPRlRC54.R2
REPORT OF THE REGIONAL DIRECTOR
The Regional Committee, Recalling resolutions WPRlRC50.R3 on reform in the Western Pacific Region, WPRlRC53.R6 on ethical issues related to new developments in the health sector, and WPRlRC53.R7 on essential public health functions; Having considered the report of the Regional Director entitled The Work of WHO ill the Western Pacific Region: 1 July 2002 - 30 June 2003' and noted the major directions for the next five years contained in the Regional Director's address to the Regional Committee; Appreciating the improvements that have been made to the report over the past five years; Recognizing that Member States' views on the report should be sought in order to ensure the most appropriate coverage, form and content; i\ ware of the many health inequities that remain in the Western Pacific Region;
Concerned about emerging challenges to health, including new diseases such as severe acute respiratory syndrome (SARS), the continuing threat from other communicable diseases, and rising levels of noncommunicable diseases throughout the Region;
I
Document WPR/RC54/2.
REPORT OF THE REGIONAL COMMITTEE
9
Acknowledging that significant health advances have been made in the Western Pacific Region over the past 50 years and that the quality of health services now needs to be addressed, taking into account such issues as the physical and psychological needs of patients, patient safety, and social and environmental factors; 1.
THANKS the Regional Director for his report; REQUESTS Member States: (I) to work with WHO to address health inequities and to ensure that health gains are enjoyed by previously underserved populations; (2) to build up health systems that are capable of carrying out essential public health functions and of responding to new challenges; to ensure that health policies lead to improvements in the quality of health care and that (3) they take account of such issues as human dignity, patients' rights and needs, and the role of families, culture, and society;
2.
3.
REQUESTS the Regional Director: (1) to work with Member States to encourage the integration of principles of equity and fairness into health policies;
(2)
to continue to work with Member States to strengthen health systems;
to support Member States to improve the quality of health care and ensure that broader (3) psychological, social, ethical and cultural determinants of health are taken into account; (4) to seek the views of Member States on the form and content of his annual report.
Fifth meeting, 10 September 2003 WPRlRC54/SRJ5
WPRJRC54.R3
EXPANDED PROGRAMME ON IMMUNIZATION: MEASLES AND HEPATITIS B
The Regional Committee, Noting the historic achievement of the Region in becoming the second WHO region to be declared poliomyelitis-free; Recognizing the positive impact of poliomyelitis eradication in the Western Pacific Region on the Expanded Programme on Immunization (EPI) and the wider health sector; Mindful of the high burden of disease, disability, and deaths from vaccine-preventable diseases, especially measles and hepatitis B;
10
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Aware that this burden could be very significantly reduced by use of available vaccines that are safe, effective and inexpensive; Noting that in some countries there is a lack of laboratory capacity for confirmation of measles cases; Recalling resolution WHA56.20 on global reduction of measles mortality; Noting that 95% population immunity is essential to achieve measles elimination; Recognizing that some countries have made significant progress towards achieving this level of immunity; Noting with appreciation the significant contribution to hepatitis B control in the Region by the Global Alliance on Vaccines and Immunization and other partners; l. DECIDES that, in the Western Pacific Region, measles elimination and hepatitis B control should be the two new pillars to strengthen the EPI;
2. CONFIRMS that measles elimination should be a regional goal and that the establishment of a target date should be made at the earliest opportunity and should be based on an annllal review of progress; 3. FURTHER CONFIRMS that the objective of hepatitis B control programmes should be HBsAg prevalence ofless than 1% in five-year-olds born after hepatitis B immunization started; 4. ENDORSES the Western Pacific Regional Plan of Action for Measles Elimination and the Western Pacific Regional Plan to Improve Hepatitis B Control through Immunization; 5. URGES Member States: (I) to develop or strengthen national plans for measles elimination and hepatitis B control as part of overall plans for immunization services;
(2) to use measles elimination and hepatitis B control strategies to strengthen EPI and other public health programmes, such as prevention of congenital rubella syndrome; (3) to offer, in principle, all children two doses of measles vaccine, taking into account local situations, so that the 95% population immunity of each birth cohort can be achieved and maintained in every district; (4) to develop or strengthen measles surveillance systems and laboratory confirmation of cases; (5) to ensure that at least 80% (ideally 95%) of each birth cohort in every district receives three doses of hepatitis B vaccine by the age of 12 months, except in countries where a highrisk approach (i.e. immunization for babies of carrier mothers) has been shown to be effective; (6) to improve the quality of routinely reported immunization coverage data and to monitor both immunization (including timely scheduled birth dose of hepatitis B vaccine, i.e. within 24 hours of birth) and disease data at district level in order to improve programme management;
REPORT OF THE REGIONAL COMMITTEE
11
6.
REQUESTS the Regional Director: (I) to further strengthen technical cooperation with Member States, in particular the improvement of immunization coverage and surveillance, including strengthening laboratory capacity in the Region, in order to achieve measles elimination and to improve hepatitis B control; (2) to seek the additional resources required to support these activities;
(3) to report on progress regularly to the Regional Committee and to propose a target date for regional measles elimination in due course.
Fifth meeting, 10 September 2003 WPRlRC54/SRl5
WPRlRC54.R4
PROPOSED PROGRAMME BUDGET: 2004-2005
The Regional Committee, Having examined the proposed programme budget, 2004-2005 for the Western Pacific Region to be financed from the regular budget and other sources offunds;l Recalling resolution WPRlRC53.R2, and noting the negative impact on collaborative programmes of the reduced regular budget allocation to the Region resulting from the implementation of resolution WHA51.31, including difficulties in carrying out WHO's priority programme activities, reductions in country planning figures and difficulties in maintaining WHO's core presence; Noting that resolution WHA51.31 applied only to regular budget allocations to the six regions and that Headquarters was excluded; Extremely concerned at the small share of extrabudgetary resources received by the Western Pacific Region compared with other regions; Appreciating that the increased level of estimated extrabudgetary resources in the proposed programme budget takes into account projected global extrabudgetary resources, but also noting the difficulty in estimating such projected resources; Appreciating further the presentation of the proposed programme budget, and the inclusion of expected results and measurable indicators to address the goals, objectives and strategies of regional focuses, countries and areas; Welcoming the Director-General's commitment to allocate a greater share of resources to regional and country levels;
I
Documents WPRlRC54/4 and WPRIRC54/4 Corr.l.
12
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
1. THANKS the Regional Director for his comprehensive presentation of the programme budget and for taking into account the views and concerns expressed by the Regional Committee during its review of Part 2 of the proposed programme budget at its fifty-third session; 2. APPRECIATES his commitment to continuous improvement of the presentation of the proposed programme budget, taking into account the views expressed by the Regional Committee; 3. URGES Member States to work with WHO to make every effort to implement the programme budget; 4. REQUESTS Members of the Executive Board from the Region: (I)
to convey to the Executive Board, and through the Executive Board to the Health Assembly, the view of the Regional Committee that: (a) the reduction in the regional allocation for the Western Pacific resulting from resolution WHA51.31 should be implemented over only three bienniums, namely 2000-2001,2002-2003 and 2004-2005; (b) in the future the method of allocating WHO's regular budget and extrabudgetary resources to WHO Headquarters, the regions and countries should ensure a more equitable and transparent allocation of resources and take into account the DirectorGeneral's commitment to allocate a greater percentage of resources to regional and country levels;
(2) to work with members of the Executive Board from other regions similarly affected, taking into account the views of the Regional Committee; 5. REQUESTS the Regional Director to convey to the Director-General the view of the Regional Committee that: (I) the negative impact of the use of the model on the Western Pacific Region over the three bienniums during which it has been applied should be included in the evaluation that the Director-General presents to the Fifty-seventh World Health Assembly;
(2) in the future the method of allocating WHO's regular budget and extrabudgetary resources to WHO Headquarters, the regions and countries should ensure a more equitable and transparent allocation ofresources and take into account the Director-General's commitment to allocate a greater percentage of resources to regional and country levels; 6. REQUESTS the Regional Director to ensure that the Regional Committee's views and concerns, as noted in the summary record, are fully taken into account in the implementation of the programme budget for 2004-2005.
Seventh meeting, 11 September 2003 WPRlRC54/SRl7
REPORT OF THE REGIONAL COMMITTEE
13
WPRJRC54.RS
SEXUALLY TRANSMITTED INFECTIONS, INCLUDING mY/AIDS
The Regional Committee, Having considered the annual report on sexually transmitted infections (STI), including HIV/AIDS;1 Noting with deep concern the continued increase in HIV infections and AIDS cases in the Region, the high prevalence and increasing incidence of STI in selected areas and populations, and their potential negative impact on people and health systems; Recognizing the importance of reinforcing healthy lifestyle choices; Further recognizing the role that health promotion plays in educating vulnerable groups, particularly youth, about the dangers of high-risk behaviour; Appreciating the positive. results observed from condom promotion and health education programmes targeting commercial sex workers and their clients in Cambodia, the extension of these programmes and the establishment of similar pilot projects in other countries of the Region; Further appreciating the results of well-targeted prevention programmes among specific vulnerable population groups, such as injecting drug users in selected countries of the Region; Observing that high-level political commitment has been a key component of successful programmes; Noting that there have been recent global developments that have the potential to improve access to and use of antiretroviral treatments, and of therapy for opportunistic infections; Further noting the potential for an increase in drug-resistant HIV in the Region; Noting the high rales of tuberculosis (TB) in the Region, leading to TBIHIV co-infection; Appreciating the financial support received by several Member States in the Region from the Global Fund to Fight AIDS, Tuberculosis and Malaria; Acknowledging the importance of strengthening policies and legislation to support STI and HIV/AIDS prevention and control programmes; I. URGES Member States: (I) to strengthen epidemiological surveillance, including behavioural surveillance, of STI and HIV/ AIDS;
(2) to promote lifestyle choices, such as delay of sexual activity, or safe sex practices, that lead to reductions in transmission of STI and HIV/AIDS;
I
Document WPRlRC54/6.
14
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
(3) to strengthen health promotion targeted at vulnerable groups, particularly youth, in the context of an integrated approach; (4) to continue to reinforce primary prevention of HN transmission, including targeting those at greatest risk of HN infection with effective condom promotion programmes, appropriate management and control of ST!, and harm reduction programmes for injecting drug users; (5)
to continue to reinforce blood safety programmes;
(6) to further investigate the feasibility, costs and benefits of programmes to prevent lIlY transmission from infected mothers to their infants; (7) to make greater efforts to involve men in all aspects of HIV/AIDS prevention programmes; (8) to strengthen the implementation of policies and programmes to reduce stigmatization of patients with AIDS and to give effect to the Declaration of Commitment on lIIV / AIDS adopted by the twenty-sixth special session of the General Assembly, in particular the clauses stressing gender equality and empowerment of women (clause 14), recognizing the essential role of the full realization of human rights (clause 16), affirming the key role of partnerships (clause 32), and acknowledging the particular roles played by young people and people living with HIV/AIDS (clause 33);
(9) to develop or strengthen national policies for HIV/AIDS care that are comprehensive and multi sectoral, improve access to treatment for HIV/AIDS, including access to drugs for HN and AIDS, and that mitigate the effects ofliving with HIV/AIDS; (10) to prepare health systems to meet the increasing demand for care from growing numbers of AIDS patients; (1 J) to secure and strengthen political commitment and mobilization of additional resources for HlV/AIDS programmes within an integrated approach;
(12)
to strengthen multisectoral collaboration;
2.
REQUESTS the Regional Director: (I) to continue to improve the regional surveillance system for STI and HIV/AIDS and related blood-borne infections and surveillance of drug-resistant HIV; (2) to work with Member States to promote healthy lifestyle choices;
(3) to further strengthen technical collaboration with Member States, paymg particular attention to:
(a)
primary prevention through condom promotion;
(b) appropriate evidence-based strategies for harm reduction among injecting drug users; (c) appropriate strategies for the prevention of HN transmission from infected mothers to their infants;
REPORT OF THE REGIONAL COMMITTEE
15
(d) (e) (f)
blood safety policies; care for AIDS·patients, including access to drugs for HIV and AIDS treatment; appropriate policies to prevent drug-resistant HIV; TBIHIV co-infection;
(g)
(h) appropriate legislation, including that in support of the United Nations General Assembly Declaration of Commitment on HIV/AIDS and in relation to access to HIV/ AIDS drugs; (4) to strengthen WHO's coordination with UNAIDS, its other cosponsors and partners and to increase mobilization of resources; (5) to continue to provide support to Member States for the preparation of high-quality proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria and the implementation of approved projects; (6) to continue to report annually to the Regional Committee on the situation of STI and HIV/AIDS in the Region.
Ninth meeting, 12 September 2003 WPRlRC54/SRl9
WPRlRC54.R6
TUBERCULOSIS PREVENTION AND CONTROL
The Regional Committee, Noting that just over two years remain before the target date for the regional targets set by the Regional Committee of regionwide coverage by directly observed treatment, short-course (DOTS), an 85% cure rate and a 70% case detection rate; Recognizing that the most critical obstacle to reaching the 2005 targets in Member States with a high burden of tuberculosis (TB) is insufficient human resources, especially at central level; Concerned that the current case detection rate of 41 % of estimated new smear-positive cases is still far below the regional target of 70%; Recognizing that implementation of DOTS is associated with an increase in the case detection rate; Further recognizing the need to improve the quality of laboratory services, increase community awareness of TB, and strengthen public private cooperation, in order to improve case detection; Acknowledging that national programme reviews by ministries of health and involving all partners will facilitate the monitoring of progress towards the 2005 goals;
16
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Concerned about increasing rates ofTB/HIV co-infection and multidrug-resistant TB; Recognizing that, despite the progress achieved in addressing the issue of TB and poverty, access to TB services by economically and otherwise disadvantaged groups needs to be further improved; Welcoming continued financial and technical support from WHO and other partners in the Region to strengthen human capacity building and to introduce new regional guidelines on laboratory quality assurance; Further welcoming collaboration among Member States, WHO and partners in secunng financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria; Appreciating the evaluation of the special project carried out by the external evaluation team; I I.
URGES Member States: (I) to strengthen political commitment and to accelerate DOTS coverage in Member States with a high burden ofTB in order to reach regionwide coverage by DOTS by 2005; (2) to strengthen human capacity building for TB control in order to build strong central management units; (3) to foster collaboration with partners in order to make the most efficient use of disbursements from the Global Fund to Fight AIDS, Tuberculosis and Malaria, in order to reduce the funding gap still further; (4) to improve the quality of laboratory services, strengthen community awareness of TB and, if appropriate, to expand public-private cooperation in order to increase the case detection rate; (5) to focus on T8 and poverty issues in order to improve access by economically disadvantaged patients to free T8 diagnosis and treatment, in the context of poverty reduction; (6) to strengthen monitoring by organizing programme reviews that include all partners;
(7) to improve surveillance for TBIHIV co-infection and to strengthen monitoring of drugresistant TB; 2. REQUESTS the Regional Director: (I) to support Member States to strengthen human capacity building for TB control in order to build strong central management units; to support Member States to strengthen TB laboratory services, implement new regional (2) quality assurance guidelines for sputum microscopy examination, strengthen community awareness of TB and expand public-private cooperation in order to achieve a 70% case detection rate by 2005; (3) to continue collaboration with partners, in order to reduce the funding gap for TB control in the Region; I
Programmatic Evaluation of Tuberculosis Control through Technical Cooperation at the Country Level in the Western Pacific Region 20 February-l March and 6·15 April 2003, annex to document WPRlRC5417.
REPORT OF THE REGIONAL COMMITTEE
17
(4) to collaborate with Member States and partners to monitor the TB control programme, including conducting joint programme reviews; (5) to support Member States to respond more effectively to the impact of poverty and marginalization on TB control; (6) to support Member States to develop better estimations of TB incidence by using all available data and improving estimation methods and in so doing to enable a more accurate assessment of the case detection rate; (7) to support Member States to improve surveillance for and management of TBIHIV and multi drug-resistant TB; (8) to ensure that the recommendations of the external evaluation team are carried out.
Ninth meeting, 12 September 2003 WPRlRC54/SRJ9
WPRlRC54.R7
SEVERE ACUTE RESPIRATORY SYNDROME (SARS) AND OTHER OUTBREAK-PRONE DISEASES
The Regional Committee, Recalling resolution WHA56.29 on severe acute respiratory syndrome (SARS) and WHA56.28 on the revision of the International Health Regulations; Recognizing the dedication and courage of the health workers of the Western Pacific Region in responding to SARS outbreaks; Further recognizing the health workers who lost their lives combating the disease and WHO staff member Dr Carlo Urbani, who in late February 2003 first brought SARS to the attention of the international community and died ofSARS on 29 March 2003; Acknowledging that strong government commitment, excellent collaboration between Member States and the international community, and rapid mobilization of human and financial resources in affected countries enabled effective measures to contain the spread of SARS to be implemented; Concerned that outbreak-prone diseases such as SARS pose serious threats to public health, health care systems and economic stability in the Western Pacific Region; Recognizing the need to have access to information from all sources, including informal sources, and to exchange information about disease outbreaks in a timely and transparent manner in order to prevent the international spread of diseases; Noting that many Member States in the Region still do not have adequate capacity to detect and respond to outbreak-prone diseases such as SARS;
18
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Noting further that the outbreaks exposed serious weaknesses in public health systems at all levels as well as in infection control practices; Recognizing the importance of lahoratory safety to prevent laboratory-acquired SARS infections; Further recognizing that suspected SARS cases can cause disruption in health services and that cases of pneumonia related to influenza may be classified as suspected SARS cases; 1.
URGES Member States: (I) to strengthen, where appropriate, epidemiological and laboratory capacity for surveillance of and response to outbreak-prone diseases, including emerging diseases; (2) to establish a system capable of verifying all infonuation on public health events of potential international concern and of responding to requests from WHO; (3) to participate actively in regional surveillance, including collaboration between laboratories, and sharing of biological samples, so that timely and accurate infonnation can be shared with other Member States; to take all measures to ensure the laboratory containment of SARS coronavirus when (4) handling potentially infectious materials and to conduct research involving the SARS coronavirus only in qualified laboratories approved by the appropriate body and with an appropriate level of biosafety; (5) to report all public health events of international concern promptly to WHO, and to provide other relevant infornmtion requested by WHO; (6) to collaborate promptly and fully with WHO in the investigation and implementation of control measures, including border control measures, for disease outbreaks of international concern; (7) to provide influenza vaccine, where feasible, to high-risk groups, in particular older persons, people with chronic diseases and health workers, in order to reduce the number of pneumonia cases caused by influenza that may be classified as suspected SARS cases; (8) to establish or strengthen national programmes for infection control in health care settings, including the implementation of appropriate national training programmes;
2.
REQUESTS the Regional Director: (I) to support Member States to strengthen capacity for communicable disease surveillance and response;
(2) to further strengthen regional surveillance, taking into account reports from sources other than official notifications, so that infonuation on communicable diseases can be shared among Member States; (3) to collaborate with Member States to ensure that all public health events of international concern are investigated promptly and comprehensively and to send WHO missions to investigate such events whenever necessary;
REPORT OF THE REGIONAL COMMITTEE
19
(4) to coordinate and stimulate research into important public health areas related to SARS, including the possible role of a natural reservoir of SARS in the environment; (5) to ensure that the major events and lessons learned from SARS outbreaks are properly recorded and shared among Member States; (6) to incorporate lessons learned when working with the Director-General on future travel advisories and with the Member States on border control measures.
Ninth meeting, 12 September 2003 WPRlRC54/SRl9
WPRlRC54.R8
WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL
The Regional Committee, Recalling and reaffirming resolutions WHA56.1 and WPRlRC52.R6; Having considered the report on the WHO Framework Convention on Tobacco Control (the Convention); I Acknowledging that tobacco use is a major risk to health in the Western Pacific, and that it is maintained by nicotine addiction; Noting, with concern, the large and increasing burden of disease and preventable death caused by tobacco in the Region; Concerned about the continued increase in per capita consumption of tobacco, particularly among young people in the Region; Recognizing the hazardous effects of tobacco on the health of smokers and nonsmokers alike; Appreciating the complex and transnational nature of the tobacco epidemic, and the need for tobacco control to address health, economic, political and sociocultural issues; Acknowledging that agreement to the Convention required a long process to negotiate a compromise to resolve the differences and nuances in the interests of all Member States and interested parties; Acknowledging further that multi sectoral and multinational involvement is crucial to effective tobacco control; Recognizing the need to be alert to any efforts by the tobacco industry to undermine or subvert tobacco control efforts and the need to be informed of activities of the tobacco industry that have a negative impact on tobacco control efforts;
I
Document WPRlRC541l0.
20
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Further recognizing that the Convention provides a comprehensive set of interventions for controlling the tobacco epidemic, and that its success depends on coordinated and committed participation by Member States at global, regional and national levels; I. ENCOURAGES Member States: (1) to sign, ratify, accept, approve, formally confirm or accede to the Convention, at the earliest opportunity, if they have not already done so;
2.
URGES Member States: (I) to reflect the provisions of the Convention in national policies and legislation;
(2) to implement tax policies for tobacco products as a means of reducing tobacco consumption, without prejudice to the sovereign right of the Member States to determine their policies; (3) to ensure sustainable financing and support for tobacco control programmes, in line with the provisions of the Convention; (4) to be alert to and resist all attempts to undermine the Convention or to reduce the effectiveness of regional, national and local tobacco control programmes; (5) to develop mechanisms for multilateral cooperation within the Region so that Member States are able to address tobacco control issues that have transnational dimensions; 3. REQUESTS the Regional Director: (1) to support Member States Convention; In
the process of ratification and implementation of the
(2) to support Member States in their tobacco control efforts, particularly in the development of national intersectoral tobacco control strategies consistent with the Convention, and in the pursuit of partnerships with other Member States for regional action against the tobacco epidemic; (3) to report to Member States at regular intervals on progress in implementing the provisions of the Convention in the Westem Pacific Region.
Ninth meeting, 12 September 2003 WPRlRC54/SRl9
REPORT OF THE REGIONAL COMMITTEE
21
WPRJRC54.R9
CHILD HEALTH
The Regional Committee, Recalling resolution WHA56.21 1m the strategy for child and adolescent health and development; Recognizing that, despite overall progress in reducing child mortality in the Region, in the past decade progress has stalled or even been reversed in some countries; Further recognizing that differences in the child survival rates in countries and areas in the Region are widening; Concerned about the unacceptably high number of children that die from preventable and treatable conditions before they reach their fifth birthday; Reaffirming the commitment of Member States to the attainment of a two-thirds reduction in under-five mortality by the year 2015 compared with 1990, in line with the development goals of the United Nations Millennium Declaration and the United Nations General Assembly special session on children; Aware that Article 24 of the Convention on the Rights of the Child calls on Member States to implement measures to reduce infant and child mortality, ensure the provision of necessary medical assistance and health care to all children, and combat disease and malnutrition; Acknowledging that international cooperation will be needed if children's rights are to be fully realized, particularly in developing countries; Noting that interventions are available to reduce child and infant mortality and that the Integrated Management of Childhood Illness (IMCI) is an evidence-based strategy that delivers these interventions in an effective, efficient and equitable manner, by focusing on the m!l:ior threats to children's survival, growth and development; Further noting that similar delivery strategies could benefit the health of newborns; Acknowledging that lMCI has been endorsed by major development partners as a cost-effective strategy for improving children's health; Noting the need for strategic coordination among the various donqr partners involved in child health activities at the national level; Appreciating the progress made so far in implementing lMCI in the Region and the urgent need to scale-up interventions in order to achieve the desired child health outcomes; I. URGES Member States, in particular those with high child mortality: (I) to place child health higher on their political, economic and health agendas, to protect every child's inherent right to life, and to ensure the provision of health care and medical assistance to all children in need; (2) to target child survival interventions on geographical areas and segments of society with the highest burden of childhood mortality and morbidity;
22
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
(3) in countries implementing IMCI, to prioritize, strengthen and scale-up implementation of the strategy and, utilizing all available sources of finance, to provide adequate human and financial resources for the full implementation of IMCI; (4) to strengthen national health systems and service delivery, and, where appropriate, to include IMCI in ongoing and planned health sector reform efforts; (5) to designate, where appropriate, a national coordinating body responsible for planning, implementation, monitoring and evaluation of child health activities, including !MCI; 2. REQUESTS the Regional Director: (1) to continue to support Member States to achieve internationally agreed goals and targets for the reduction of under five mortality, especially in countries and areas with marginalized and poor populations with high infant and under-five mortality; (2) to develop indicators to assist Member States to monitor progress towards the achievement of the development goals of the United Nations Millennium Declaration; (3) to give priority to child survival and, in particular, to intensify implementation of IMCI in the Region; (4) to promote collaboration among child-health-related programmes and partners in health;
(5) to stimulate the development of health care delivery strategies that are consistent with lMCI to improve the health ofnewboms; (6) to lead a new drive to reduce childhood mortality in Member States in greatest need, to support these countries to m!'nilize the resources needed, and to report on progress to the Regional Committee.
Ninth meeting, 12 September 2003 WPRlRC54/SRl9
WPRlRC54.RIO
FIFTY-FIFTH SESSION OF THE REGIONAL COMMITTEE
The Regional Committee, 1. EXPRESSES its appreciation to the Government of China for confirming its offer to host the fifty-fifth session of the Regional Committee; 2. CONFIRMS that the fifty-fifth session will be held in Shanghai, China, provided a satisfactory agreement can be concluded between the Government and WHO by 31 March 2004;
REPORT OF THE REGIONAL COMMITTEE
23
3.
DECIDES that the dates of the fifty-fifth session shall be from 13 to 17 September 2004.
Ninth meeting, 12 September 2003 WPRlRC54/SRl9
WPRlRC54.RII
RESOLUTION OF APPRECIATION
The Regional Committee, EXPRESSES its appreciation and thanks to: (\) (2) (3) the Chairperson, Vice-Chairperson and the Rapporteurs elected by the Committee; the presenter at the ministerial round table; the Moderator of the ministerial round table;
(4) the representatives of the intergovernmental and nongovernmental organizations for their oral and written statements.
Ninth meeting, 12 September 2003 WPRlRC54/SRl9
24
REGIONAL COMMTITEE: FIFTY-FOURTH SESSION
DECISIONS
WPRlRC54(l)
SPECIAL PROGRAMME OF RESEARCH, DEVELOPMENT AND RESEARCH TRAINING IN HUMAN REPRODUCTION: MEMBERSHIP OF THE POLICY AND COORDINATION COMMITTEE
The Regional Committee, noting that the period of tenure of the representative of Papua New Guinea as a member of the Policy and Coordination Committee of the Special Programme of Research, Development and Research Training in Human Reproduction would expire on 31 December 2003, selected the Government of the Lao People's Democratic Republic to nominate a representative to serve on the Policy and Coordination Committee for a period of three years from 1 January 2004 to 31 December 2006.
(Ninth Meeting, 12 September 2003)
WPRlRC54(2)
SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASES: MEMBERSHIP OF THE JOINT COORDINATING BOARD
The Regional Committee, noting that the period of tenure of the Lao People's Democratic Republic on the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases expires on 31 December 2003, selected the Government of Mongolia to nominate a representative to serve on the Joint Coordinating Board for a period of three years from 1 January 2004 to 31 December 2006.
(Ninth Meeting, 12 September 2003)
REPORT OF THE REGIONAL COMMITTEE
25
ANNEXl AGENDA Opening of the session and adoption of the agenda 1.
Opening of the session Address by the retiring Chairperson Election of new officers: Chairperson, Vice-Chairperson and Rapporteurs Address by the incoming Chairperson Adoption of the agenda WPRlRC54/1 Rev.3
2. 3. 4.
5.
Keynote address 6. Address by the Director-General
Nomination of the Regional Director 7. Nomination of the Regional Director WPRlRC54/16
Review of the work of WHO 8. Report ofthe Regional Director WPRlRC54/2
9.
Programme budget 2002-2003: budget performance (interim report) WPRlRC54/3 WPRlRC54/3 COIT.l
Policies, programmes and directions for the future 10. Proposed programme budget: 2004-2005 WPRlRC54/4 WPRlRC54/4 COIT.l WPRlRC54/INF .DOC./I
26
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Annex 1
11.
Expanded programme on immunization: measles and hepatitis B WPRJRC54/5
12.
Sexually transmitted infections, including HIV/AIDS WPR/RC54/6
13.
Tuberculosis WPR/RC5417
14.
Severe acute respiratory syndrome WPRJRC54/8
15.
Regional strategy for improving access to essential medicines m the Western Pacific, 2004-2009 WPRJRC54/9
16.
Framework Convention on Tobacco Control WPRJRC5411 0
17.
Child health WPR/RC54111
18.
Coordination of the work of the World Health Assembly, the Executive Board and the Regional Committee WPRJRC54/12 WPRJRC54/1NF.DOC.l2
Ministerial round table
19.
Future directions for public health in the Region WPRJRC54/13
Nominations
20.
Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee WPRJRC54/14
REPORT OF THE REGIONAL COMMITTEE
27
Annex 1
21.
Special Programme for Research and Training in Tropical Diseases: Membership of the Joint Coordinating Board WPRlRC54115
Other matters
22. 23.
Time and place of the fifty-fifth and fifty-sixth sessions of the Regional Committee Closure ofthe session
28
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
REPORT OF THE REGIONAL COMMmEE
29
ANNEX 2 LIST OF REPRESENT AT1VES I. AUSTRALIA
REPRESENTATIVES OF MEMBER STATES Mr Philip Davies Deputy Secretary Australian Department of Health and Ageing GPO Box 9848, MDP 84, Canberra ACT 2601 Tel: 61-2-62898410 Fax: 61-2-6285 1994 E-mail: Philip.Davies@health.gov.au Mr Antony Kingdon Assistant Secretary, Policy and International Branch Australian Department of Health and Ageing GPO Box 9848, MDP 85, Canberra ACT 2601 Tel: 61-2-62898019 Fax: 61-2-62897087 E-mail: Tony.Kingdon@health.gov.au
(Chief Representative)
(Alternate)
Dr Moira McKinnon Medical Officer, Communicable Disease Branch Population Health Division Australian Department of Health and Ageing GPO Box 9848, MDP 14, Canberra ACT 2601 Tel: 61-2-62894022 Fax: 61-2-62898098 E-mail: moira.mckinnon@health.gov.au Ms Elaine Ward Director Asia Pacific Health & Development Section Policy and International Branch Australian Department of Health and Ageing GPO Box 9848, MDP 85, Canberra ACT 2601 Tel: 61-2-62897638 Fax: 61-2-62897087 E-mail: elaine.ward@health.gov.au
(Alternate)
(Alternate)
30
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Annex 2
AUSTRALIA (continued)
Ms Annette Checksfield Assistant Director Asia Pacific Health & Development Section Policy and International Branch Australian Department of Health and Ageing GPO Box 9848, MDP 85, Canberra ACT 2601 Tel: 61-2-62894606 Fax: 61-2-62897087 E-mail: annette.checksfield@health.gov.au Ms Susan McKeag UN and Commonwealth Section Australian Agency for International Development GPO Box 887, Canberra ACT 2601 Tel: 61-2-62064778 Fax: 61-2-62064998 E-mail: susan_mckeag@ausaid.gov.au Mr Miles Armitage Counsellor and Deputy Head of Mission Political Section, Australian Embassy Manila, Philippines Tel: 63-2-7578100 Ms Katie Smith Policy Officer, Political Section Australian Embassy, Manila, Philippines Tel.: 63-2-7578100
(Alternate)
(Alternate)
(Alternate)
(Alternate)
BRUNEI DARUSSALAM
Pehin Dato Abu Bakar bin Haji Apong Minister of Health, Ministry of Health Bandar Sen Begawan 1210 Brunei Darussalam Tel.: (673) 238037 Fax: (673) 2381980 Dr Haji Affendy bin DSP Haji Abidin Director General of Medical Services Ministry of Health, Bandar Seri Begawan BB3910 Brunei Darussalam Tel.: (673) 2382031 Fax: (673) 2380687
(Chief Representative)
(Alternate)
REPORT OF THE REGIONAL COMMITTEE
31
Annex 2 BRUNEI DARUSSALAM (continued) Hajah Nora'Alia binte PDPD DP Haji (Alternate) AbdRahim Acting Director, Laboratory Services Department of Laboratory Services Ministry of Health, Bandar Seri Begawan 1210 Brunei Darussalam Tel.: (673) 2242424 Extension 317 Fax: (673) 2220869 E-mail: nora408@yahoo.com Haji Idris bin Haji Md. Ali Acting Assistant Director Department of Policy and Planning Ministry of Health, Bandar Seri Begawan 1210 Brunei Darussalam Tel.: (673) 2383103 Fax: (673) 2383016 E-mail: rdhealth@brunet Dr Hajah Rahmah binte Haji Md. Said Head, Disease Control Division Department of Health Services Ministry of Health, Bandar Seri Begawan 1210 Brunei Darussalam Tel.: (673) 2381640 Extension 770217710 Fax: (673) 2382755 E-mail: rahmahms@hotmail.com CAMBODIA Professor Eng Huot Director General for Health Ministry of Health, Phnom Penh Tel: (016) 813 151 Fax: (855 23) 677 956 E-mail: dghhuot@online.com.kh Dr Lo Veasna Kiry Deputy-Director Department of Planning and Health Information Ministry of Health, Phnom Penh Tel: (855) 2388 0260; 012810 505 Fax:: (855) 2388 0407 E-mail: veasnakiry@online.com.kh CHINA Dr Wang Longde Vice Minister, Ministry of Health 1 Nanlu, Xizhimenwai Xicheng District, Beijing 100044 Tel: 8610-6879-2031 Fax: 8610-6879-2279 E-mail: wangld@moh.gov.cn (Alternate)
(Alternate)
(Chief Representative)
(Alternate)
(Chief Representative)
32
REGIONAL COMMITfEE: fIFTY-FOURTH SESSION
Annex 2
CHINA (continued)
Mr Yang Xiaodu Vice Mayor of Shanghai Shanghai Municipal People's Government Shanghai Tel: 0086-21-63212810 Fax: 0086-21-6329 1395 Dr Shao Mingli Deputy Director-General State Food and Drug Administration No. A-38, Beilishilujia Street Xicheng District, Beijing 100810 Tel: 8610-6831-5647 Fax: 8610-6831-5648, 6831-0909 Dr Ren Minghui Deputy Director-General Department of International Cooperation Ministry of Health, I Nanlu, Xizhimenwai Xicheng District, Beijing 100044 Tel: 8610-6879-2283 Fax: 8610-6879-2279 E-mail: renmh@moh.gov.cn Dr Lill Guohua Deputy Director-General Shanghai Municipal Health Bureau 223 Hankou Road, Shanghai 200002 Tel: 0086-21-63218786 Fax: 0086-21-63291395 E-mail: liuguohua@smbh.gov.cn Dr Mao Qun'an Deputy Director-General Department of General Administration Ministry of Health, 1 Nanlll, Xizhimenwai Xicheng District, Beijing 100044 Tel: 8610-6879-2026 Fax: 8610-6879-2082 E-mail: maoqa@moh.gov.cn Dr Yu Jingjin Deputy Director-General Department of Disease Control, Ministry of Health, 1 Nanlu, Xizhimenwai Xicheng District, Beijing 100044 Tel: 8610-6879-2331 Fax: 8610-6879-2514 E-mail: yujj@moh.gov.cn
(Alternate)
(Alternate)
(Alternate)
(Alternate)
(Alternate)
(Alternate)
REPORT OF THE REGIONAL COMMITTEE
33
Annex 2 CHINA (continued) Dr Qi Qingdong Director, Division of Multilateral Relations Department of International Cooperation Ministry of Health, 1 Nanlu, Xizhimenwai Xicheng District, Beijing 100044 Tel: 8610-6879-2275 Fax: 8610-6879-2279 E-mail: qiqd@moh.gov.cn Ms Cao Bin Assistant Consultant Division of Children's Health Department ofPHC and MCH Ministry of Health, I Nanlu, Xizhimenwai Xicheng District, Beijing 100044 Tel: 8610-6879-2275 Fax: 8610-6879-2279 E-mail: caobin2305@ib3.com Mr Chen Di Third Secretary, Embassy of the People's Republic of China in the Philippines 4896 Pasay Road, Dasmarinas Village, Makati, Metro Manila, Philippines Tel: (632) 8443148 Fax: (632) 843 9974 E-mail: chen_di@mta.gov.ch CHINA (HONG KONG) Dr Yeoh Eng-Kiong Secretary for Health, Welfare and Food Health, Welfare and Food Bureau 191F Murray Building, Garden Road, Central Government of the Hong Kong Special Administrative Region Tel: (852) 29738100 Fax: (852) 2526 3753 E-mail: ekyeoh@hwfb.gov.hk Dr Lam Ping Yan Director of Health, Department of Health 211F, Wu Chung House 2 I 3 Queen's Road East, Wanchai Government of the Hong Kong Special Administrative Region Tel: (852) 2961 8551 Fax: (852) 2573 7487 E-mail: P_Y_lam@dh.gov.hk (Alternate)
(Alternate)
(Alternate)
(Chief Representative)
(Alternate)
34
REGIONAL COMMITfEE: FIFTY-FOURTH SESSION
Annex 2
CHINA (HONG KONG) (continued)
Dr Tsang Ho Fai Thomas Consultant (Community Medicine) Communicable Diseases, Department of Health 181F Wu Chung House 213 Queen's Road East, Wanchai Government of the Hong Kong Special Administrative Region Tel: (852) 2961 8878 Fax: (852) 2575 4110 E-mail: Thomas_tsang@dh.gov.hk Dr Ng Ping Sum Sammy Senior Medical Officer, Department of Health 181F Wu Chung House 213 Queen's Road East, Wanchai Government of the Hong Kong Special Administrative Region Tel: (852) 2961 8782 Fax: (852) 2575 4110 E-mail: smo_cml@dh.gov.hk Mr Lau Kam Kuen David Administrative Assistant to Secretary for Health, Welfare and Food Health, Welfare and Food Bureau 191F Murray Building, Garden Road Central Government of the Hong Kong Special Administrative Region Tel: (852) 29738135 Fax: (852) 2523 5206 E-mail: david_kk_lau@hwfb.gov.hk Ms Lee Siu-Ling Brenda Press Secretary to Secretary for Health, Welfare and Food Health, Welfare and Food Bureau 19/F Murray Building, Garden Road Central Government of the Hong Kong Special Administrative Region Tel: (852) 2810 2626 Fax: (852) 25214653 E-mail: bsllee@hwfb.gov.hk
(Alternate)
(Alternate)
(Alternate)
(Alternate)
REPORT OF THE REGIONAL COMMITTEE
35
Annex 2
CHINA (MACAO)
Dr Chui Sai On Secretary for Social Affairs and Culture Government of the Macao Special Administrative Region of the People's Republic of China Tel: (853) 989 5148 Fax: (853) 728 354 E-mail: carlos.sasc@raem.gov.mo Dr Koi Kuok Ieng Director of Department of Health Government of the Macao Special Administrative Region of the People's Republic of China Tel: (853) 390 7105 Fax: (853) 713 105 E-mail: kikoi@ssm.gov.mo Dr Kun Sai Hoi Sub-Director of Department of Health Government of the Macao Special Administrative Region of the People's Republic of China Tel: (853) 569 0 II Fax: (853) 568 859 E-mail: shkun@ssm.gov.mo Dr Lam Chong Coordinator of Prevention and Control of Communicable Diseases Center for Disease Control and Prevention Department of Health Government of the Macao Special Administrative Region ofthe People's Republic of China Avenue Sidonio Pais, No. 49-51 China Plaza, 4th Floor Tel: (853) 533 525 Fax: (853) 533 524 E-mail: ndiv@ssm.gov.mo Dr Cheong Tak Hong Head of Pneumology Department Estrada do Visconde de S. Januario Government ofthe Macao Special Administrative Region of the People's Republic of China Tel: (853) 3902410 I 2411 Fax: (853 3902406 E-mail: cheongth@ssm.gov.mo
(Chief Representative)
(Alternate)
(Alternate)
(Alternate)
(Alternate)
36
REGIONAL COMMI1TEE: FIFTY-FOURTH SESSION
Annex 2
CHINA (MACAO) (continued)
Dr Tan Mui Chan Coordinator of Chronic Disease Prevention and Health Promotion Center for Disease Control and Prevention Department of Health Government of the Macao Special Administrative Region of the People's Republic of China Avenue Sidonio Pais, No. 49-51 China Plaza, 4'11 Floor Tel: (853) 533 525 Fax: (853) 533 524 E-mail: tmchan@ssm.gov.mo Ms Joyce Vong Technical Advisor to the Secretary for Social Affairs and Culture Government of the Macao Special Administrative Region of the People's Republic of China Tel: (853) 989 5137 Fax: (853) 728 354 E-mail: joycevong.sasc@raem.gov.mo Mr Carlos Lo Special Assistant to the Secretary for Social Affairs and Culture Government of the Macao Special Administrative Region of the People's Republic of China Tel: (853) 989 5142 Fax: (853) 726980 E-mail: carlos.sasc@raem.gov.mo
(Alternate)
(Alternate)
(Alternate)
COOK ISLANDS
Mr Vaevaetaearoi Vaevae Pare Minister of Health, P.O. Box 109 A varua, Rarotonga Tel: (682) 20261 Fax: (682) 20262 E-mail: ceol@health.gov.ck Mr Vaine Teokotai Secretary of Health, Ministry of Health P.O. Box 109, Avarua, Rarotonga Tel: (682) 29664 Fax: (682) 23109 E-mail: sohl@health.gov.ck
(Chief Representative)
(Alternate)
REPORT OF THE REGIONAL COMMITTEE
37
Annelll FIJI
Mr Solomoni Naivalu Minister for Health, Ministry of Health P.O. Box 2223, Government Building, Suva Tel: (679) 322 1501 Fax: (679) 330 6163 Dr Lepani Waqatakirewa Director, Public Health, Ministry of Health P.O. Box 2223, Government Building Suva Tel: (679) 330-6177 Fax: (679) 330-6163 E-mail: lwaqatakirewa@health.gov.fj
(Chief Representative)
(Alternate)
FRANCE
Monsieur Leopold Joredie Membre du governement, Ministre charge du secteur de l'enseignement et des questions de societe de la Nouvelle-Caledonie 8 route des Artifices BP M2 98849 Noumea cedex, Nouvelle-Caledonie Tel: (687) 246 577 Fax: (687) 246 583 Monsieur Jean-Alain Course Directeur adjoint Direction des affaires sanitaires et sociales Angle des rue GaJlieni et Republique BP N4 98851, Noumea cedex, Nouvelle-Caledonie Tel: (687) 243700 Fax: (687) 243702 E-mail: dass@gouv.nc Dr Catherine Bilger Medecin Inspecteur sante publique Ministere de la Sante, de la FamiIle et des Personnes handicapees 8, avenue de Segur - 75350 Paris 07 SP Tel: 33140567385 Fax: 331405672 43 E-mail: catherine.bilger@sante.gouv.fr
(Chief Representative)
(Alternate)
(Alternate)
38
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Annex 2 FRANCE (continued) Dr Jean-Paul Grangeon Medecin inspecteur Direction des affaires sanitaires et sociales de la Nouvelle-Caledonie, BP N4 98851 Noumea cedex, Nouvelle-Caledonie TeI: (687) 243 700 Fax: (687) 243 702 E-mail: jpgrangeon.dass@gouv.nc Dr Philippe Biberson Attache de Cooperation Sante et Deve\oppement Social Ambassade de France au Viet Nam 57 Tran Hung Dao, Ha Noi Tel: (84-4) 943 7719 Fax: (84-4) 943 9655 E-mail: philippe.biberson@diplomatie.fr JAPAN Mr Yoshiharu Otsuka Vice-Minister Ministry of Health, Labour and Welfare Japanese Government, 1-2-2, Kasumigaseki Chiyoda-ku, Tokyo 100-8916 Tel: 81-3-3595-2404 Fax: 81-3-3501 2532 E-mail: otsuka-yoshiharu@mhlw.go.jp Dr Hideo Shinozaki Director General National Institute of Public Health Japanese Government, 1-2-2, Kasumigaseki Chiyoda-ku, Tokyo 100-8916 Tel: 81-3-3595-2404 Fax: 81-3-3501-2532 E-mail: shinozaki-hideo@mhlw.go.jp Dr Shigeru Ueda Assistant Minister for Technical Affairs Minister's Secretariat Ministry of Health, Labour and Welfare Japanese Government, 1-2-2, Kasumigaseki Chiyoda-ku, Tokyo 100-8916 Tel: 81-3-3595-2404 Fax: 81-3-3501 2532 E-mail: ueda-shigeru@mhlw.go.jp (Alternate)
(Alternate)
(Chief Representative)
(Alternate)
(Alternate)
REPORT OF THE REGIONAL COMMITTEE
39
Annex 2
JAPAN (continued)
Mr Akio Egawa Minister (Deputy Chief of Mission) and Consul-General Embassy of Japan in the Philippines 2627 Roxas Boulevard Pasay City 1300, Philippines Tel: (632) 551-5710 Fax: (632) 551-5780 Mr Masaru Watanabe Minister (Head of Chancery) and Consul Embassy of Japan in the Philippines 2627 Roxas Boulevard Pasay City 1300, Philippines Tel: (632) 551-5710 Fax: (632) 551-5780 Mr Tetsuya Ishii Minister, Embassy of Japan in the Philippines 2627 Roxas Boulevard Pasay City 1300, Philippines Tel: (632) 551-5710 Fax: (632) 551-5780 Mr Kazutaka Nakazawa Director, International Affairs Planning Office hlternational Affairs Division, Minister's Secretariat Ministry of Health, Labour and Welfare Japanese Government, 1-2-2, Kasumigaseki Chiyoda-ku, Tokyo 100-8916 Tel: 81-3-3595-2404 Fax: 81-3-35012532 E-mail: nakazawa-kazutaka@mhlw.go.jp Dr Yusuke Fukuda Director, International Cooperation Office International Affairs Division Minister's Secretariat Ministry of Health, Labour and Welfare Japanese Government, 1-2-2, Kasumigaseki Chiyoda-ku, Tokyo 100-89\6 Tel: 81-3-3595-2404 Fax: 81-3-35012532 E-mail: fukuda-yusuke@mhlw.goJp
(Alternate)
(Alternate)
(Alternate)
(Alternate)
(Alternate)
40
REGIONAL COMMillEE: FIFTY-FOURTH SESSION
Annex 2
JAPAN (continued)
Dr Eriko Hagino Counselor, Council and Medical Attache Embassy of Japan in the Philippines 2627 Roxas Boulevard Pasay City 1300, Philippines Tel: (632) 551-5710 Fax: (632) 551-5780 Dr Takeshi Kasai Deputy Director, International Affairs Division Minister's Secretariat Ministry of Health, Labour and Welfare Japanese Government, 1-2-2, Kasumigaseki Chiyoda-ku, Tokyo 100-8916 Tel: 81-3-3595-2404 Fax: 81-3-35012532 E-mail: kasai-takeshi@mhlw.go.jp Mr Jun Yoshida Deputy Director, International Affairs Division Minister's Secretariat Ministry of Health, Labour and Welfare Japanese Government, 1-2-2, Kasumigaseki Chiyoda-ku, Tokyo 100-8916 Tel: 8 I -3-3595-2404 Fax: 81-3-35012532 E-mail: yoshida-jun@mhlw.gojp Dr Azusa Iwamoto Deputy Director, International Affairs Division Minister's Secretariat Ministry of Health, Labour and Welfare Japanese Government 1-2-2, Kasumigaseki, Chiyoda-ku Tokyo 100-8916 Tel: 81-3-3595-2404 Fax: 81-3-3501-2532 E-mail: iwamoto-azusa@mhlw.gojp Dr Koji Sasaki Second Secretary, Health Attache Embassy of Japan in the Philippines 2627 Roxas Boulevard Pasay City 1300, Philippines Tel: (632) 551-5710 Fax: (632) 551-5780
(Alternate)
(Alternate)
(Alternate)
(Alternate)
(Alternate)
REPORT OF THE REGIONAL COMMIITEE
41
Annex 2 JAPAN (continued) Dr Naoko Ishikawa Chief, Division of International Cooperation National Institute of Infectious Diseases Japanese Government 1-2-2, Kasumigaseki, Chiyoda-ku Tokyo 100-8916 Tel: 81-3-3595-2404 Fax: 81-3-350 I 2532 E-mail: ishikawa-naoko@mhlw.go.jp Ms Hiroko Ishii International Affairs Division Minister's Secretariat Ministry of Health, Labour and Welfare Japanese Government 1-2-2, Kasumigaseki, Chiyoda-ku Tokyo 100-8916 Tel: 81-3-3595-2404 Fax: 81-3-35012532 E-mail: ishii-hiroko@mhlw.go.jp KIRIBATI Dr Takeieta B. Kienene Permanent Secretary of Health Ministry of Health, Tarawa Tel: (686) 28151 Fax: (686) 28152 E-mail: mhfp@tskl.net.ki Dr Bounkouang Phi chit Vice Minister, Ministry of Health Vientiane Tel: (856) 21214003 Fax: (856) 21214003 Dr Nao Boutta Deputy Director of Cabinet Ministry of Health, Vientiane Tel: (856) 2121 7869 Fax: (856) 21214003 E-mail: nboutta@laotel.com MALAYSIA Dato' Seri Dr Suleiman Mohamed Deputy Minister of Health, Ministry of Health Block D, Levell, Jalan Cenderasari 50590 Kuala Lumpur Tel: (603) 269 22862 Fax: (603) 269 29442 (Alternate)
(Alternate)
(Chief Representative)
LAO PEOPLE'S DEMOCRATIC REPUBLIC
(Chief Representative)
(Alternate)
(Chief Representative)
42
REGIONAL COMMITTEE: FIFTY -FOURTH SESSION
Annex 2 MALAYSIA (continued) Tan Sri Dato' Dr Mohamad Taha bin Arif Director-General of Health, Ministry of Health Block D, Level 2, lalan Cenderasari 50590 Kuala Lumpur Tel: (603) 269 25196 Fax: (603) 269 11436 E-mail: kpk@moh.gov.my Dato' Dr Shafie bin Ooyub Deputy Director General of Health (Public Health), Ministry of Health lab. Kes. Awam, Level 2, Block A Kompleks Pej. Kes. Awam, lalan Cenderasari, 50590 Kuala Lumpur Tel: (603) 269 46489 Fax: (603) 269 46503 E-mail: sooyub@dph.gov.my Dr Daud bin Abdul Rahim Deputy Director Disease Control (Non-Communicable Diseases) Ministry of Health Block A, Level 3, Kompleks Pej. Kes. Awam lalan Cenderasari, 50590 Kuala Lumpur Tel: (603) 269 46484 Fax: (603) 269 46503 E-mail: daud@dph.gov.my Dr Safurah binte laafar Deputy Director Family Health Development (Primary Health Care) Ministry of Health Levell, Block B, Kompleks Pej.Kes. Awam lalan Cenderasari 50590 Kuala Lumpur Tel: (603) 269 46544 Fax: (603) 269 46570 E-mail: safurah@moh.gov.my REPUBLIC OF THE MARSHALL ISLANDS Mrs Irene Paul Assistant Secretary of Health Kwajalein Health Care Services Bureau Ministry of Health, P.O. 5219, Ebeye Marshall Islands 96970 Tel: (692) 329 8030 Fax: (692) 329 3385 E-mail: irene_ebeye@hotmail.com (Alternate)
(Alternate)
(Alternate)
(Alternate)
(Chief Representative)
REPORT OF THE REGIONAL COMMITTEE
43
Annex 2 FEDERATED STATES OF MICRONESIA Dr Jefferson B. Benjamin Secretary of Health, Education and Social Affairs P.O. Box PS 70, FSM National Government Palikir, Pohnpei FM 96941 Tel: (691) 320 2619 Fax: (691) 320 5263 E-mail: fsmhealth@mail.fm Professor Pagvajav Nymadawa Minister of Health, Ministry of Health Government of Mongolia, Ulaanbaatar Tel: (976) 9111-9959 Fax: (976) 11 320 916 E-mail: nymadawa@moh.mng.net Ms Byambajar Khongorzul Officer, International Cooperation and Public Relations Department Ministry of Health, Government of Mongolia, Ulaanbaatar Tel: (976) 11-327 874 Fax: (976) 11-320916 E-mail: khongorzul@moh.nmg.net NAURU* NEW ZEALAND Dr Annette King Minister of Health, Ministry of Health Beehive, Parliament Buildings, Wellington Tel: (04) 470 6554 Fax: (04) 495 8445 E-mail: annette.king@parliament.govt.nz Dr Don Matheson Deputy Director-General, Public Health Directorate Ministry of Health, 133 Molesworth Street, Wellington Tel: (644) 4954438 Fax: (644) 4954401 E-mail: donmatheson@moh.govt.nz (Chief Representative) (Chief Representative)
MONGOLIA
(Chief Representative)
(Alternate)
(Alternate)
• did not attend.
44
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Annex 2
NEW ZEALi\ND (continued)
Mr Harvey Steffens Manager, Sector Policy Directorate Ministry of Health P.O. Box 5013, Wellington Tel: (04) 496 2253 Fax: (04) 496 2340 E-mail: harvey.steffens@moh.govt.nz Ms Jannine McCabe Second Secretary, New Zealand Embassy Manila Tel: (632) 891 5358 Fax: (632) 891 5357 E-mail: jannine.mccabe@mfat.govt.nz
(i\lternate)
(Alternate)
NIUE NIOUE
Dr Pokotoa Sipeli Associate Minister of Health Ministry of Health, Alofi Tel: (683) 4200 Fax: (683)4206;4232 Dr Haresimelika Hare Paka Director of Health, Ministry of Health i\loft Tel: (683) 4100 Fax: (683) 4265 E-mail: malolotino@mail.com.nu
(Chief Representative)
(Alternate)
REPUBLIC OF PALi\U
Mrs Sandra S. Pierantozzi Vice President and Minister of Health Ministry of Health, Korar Tel: (680) 4885552 Fax: (680) 488 1211 E-mail: healthminister@palau-healthnet.com Dr Stevenson J. Kuartei Director, Bureau of Public Health Ministry of Health, Korar Tel: (680) 488 2552 Fax: (680) 488 1211 E-mail: skuartei@palaunet.com
(Chief Representative)
(Altemate)
REPORT OF THE REGIONAL COMMITTEE
45
Annex 2
PAPUA NEW GUINEA
Dr Nicholas Mann Secretary for Health, Ministry of Health Waigani, NCD Tel: (675) 301 3601 Fax: (675) 325 1466 E-mail: healthsec@health.gov.pg Mr William Kenjibi First Secretary to the Minister, Ministry of Health, Waigani, NCD Tel: (675) 301 3601 Fax: (675) 325 1466 E-mail: healthsec@health.gov.pg
(Chief Representative)
(Alternate)
PHILIPPINES
Dr Manuel M. Dayrit Secretary of Health, Department of Health Building 1, San Lazaro Compound Rizal Avenue, Sta Cruz, Manila Tel.: (632) 7119502 Fax: (632) 743 1829 E-mail: osec@central.doh.gov.ph mmdayrit@doh.gov.ph Dr Antonio S. Lopez Undersecretary of Health, Office of the Secretary Building 1, San Lazaro Compound Rizal Avenue, Sta Cruz, Manila Tel.: (632) 781 4853 Fax: (632) 711 6075 E-mail: useclopez@yahoo.com Dr Milagros L. Fernandez Undersecretary of Health for Visayas and Mindanao Office of the Secretary Building 1, San Lazaro Compound Riza1 Avenue, Sta Cruz, Manila Tel.: (632) 338 3377 Fax: (632) 781 8840 E-mail: mlfernandez@co.doh.gov.ph Dr Margarita M. Galon Undersecretary of Health for Luzon Office of the Secretary Building 3, San Lazaro Compound Rizal Avenue, Sta Cruz, Manila Tel.: (632) 743 7236; 781 8842 Fax: (632) 743 7236 E-mail: osec@centra1.doh.gov.ph
(Chief Representative)
(Alternate)
(Alternate)
(Alternate)
46
REGIONAL COMMITIEE: FIFTY -FOURTH SESSION
Annex 2
PHILIPPINES (continued)
Mrs Remedios V.S. Paulino Director IV Bureau ofInternational Health Cooperation Department of Health Building I, San Lazaro Compound Rizal Avenue, Sta Cruz, Manila Tel.: (632) 7438301 loc. 1301 Fax: (632)781 8843 E-mail: rspaulino@co.doh.gov.ph Dr Roderick Poblete Officer-in-Charge Philippine National AIDS Council Office of the Secretary Building 12, San Lazaro Compound Rizal Avenue, Sta Cruz Manila Tel.: (632) 7438301 Fax: (632) 743 0512 E-mail: pnacsecretariat@yahoo.com Dr Jaime Lagahid Officer -in-Charge Infectious Disease Office National Center for Disease Prevention and Control Office of the Secretary Building I, San Lazaro Compound Rizal Avenue, Sta Cruz Manila Tel.: (632) 711 9502 Fax: (632) 743 1829 E-mail: jaimelagahid@edsa.com.ph Dr Juanita Basilio Medical Officer VII Center for Family and Environmental Health Office of the Secretary Building I, San Lazaro Compound Rizal Avenue, Sta Cruz Manila Tel.: (632) 732 9956 Fax: (632)711 7846 E-mail: nitzbasilio@hotmail.com
(Alternate)
(Alternate)
(Alternate)
(Alternate)
REPORT OF THE REGIONAL COMMITTEE
47
Annex 2 PHILIPPINES (continued) Dr Timoteo Badoy, If. Medical Officer VII, National Drug Policy Staff Office of the Secretary Building 12, San Lazaro Compound Rizal A venue, Sta Cruz, Manila Tel.: (632) 7812516 Fax: (632) 743 1829 E-mail: ljbadoy@co.doh.gov.ph Dr Juan Lopez Officer-in-Charge National Epidemiology Center Office of the Secretary Building 4, San Lazaro Compound Rizal Avenue, Sta Cruz, Manila Tel.: (632)7119502 Fax: (632) 743 1829 E-mail: jlonec@yahoo.com Dr Florante Trinidad Medical Officer VII Bureau of International Health Cooperation Department of Health Building 3, San Lazaro Compound Rizal Avenue, Sta Cruz, Manila Tel.: (632) 743 8301 Fax: (632) 743 8843 E-mail: ante@doh.gov.ph REPUBLIC OF KOREA Mr Moon Kyung Tae Deputy Minister for Planning and Management Ministry of Health and Welfare Iungang-dong 1, Kwacheon-city, Kynggi-do Tel: (82 2) 503 7519 Fax: (822) 2110 6096 E-mail: ktmoon@mohw.go.kr Mr Lee Yong-su Counsellor, Embassy of the Republic of Korea to the Republic of the Philippines, Manila Mr Kim Heon-joo Director, International Cooperation Division Ministry of Health and Welfare Iungang-dong 1, Kwacheon-city, Kynggi-do Tel: (822) 503 7524 . Fax: (82 2) 504 6418 E-mail: heol1ioo@mohw.go.kr (Alternate)
(Alternate)
(Alternate)
(Chief Representative)
(Alternate)
(Alternate)
48
REGIONAL COMMITIEE: FIFTY-FOURTH SESSION
Annex 2
REPUBLIC OF KOREA (continued)
Ms Lee You-Young Assistant Director International Cooperation Division Ministry of Health and Welfare lungang-dong 1, Kwacheon-city, Kynggi-do Tel: (822) 503 7524 Fax: (822) 5046418 E-mail: dew77@mohw.go.kr Ms Go Unyeong Senior Research Scientist National Institute of Health 5, Nokbun-Dong Eunpyung-Gu, Seoul Tel: (822) 3801482 Fax: (822) 380-1541 E-mail: unyng@nih.go.kr
(Alternate)
(Alternate)
SAMOA
Dr Mulitalo Siafausa Vui Minister of HeaIth, Ministry of Health, Apia Tel: (685) 23621; 23786; 25352 Fax: (685) 25057 E-mail: siafausam@samoa.ws Dr Lolofietele Taule'ale'a Eti Enosa Chief Executive Officer Ministry of Health, Private Bag, Apia Tel: (685) 23330 Fax: (685) 26553 E-mail: dg@health.gov.ws Mrs Tuft Mulitalo S. Vui c/o Ministry of Health, Apia Tel: (685) 23621 Fax: (685) 25057 E-mail: minhelth@pacifika.net
(Chief Representative)
(Alternate)
(Alternate)
SINGAPORE
Dr Balaji Sadasivan Minister of State for Health Ministry of Health College of Medicine Building 16 College Road, Singapore 169854 Tel: (65) 6325 9220 Fax: (65) 6224 1677 E-mail: balaji_sadasivan@moh.gov.sg
(Chief Representative)
REPORT OF THE REGIONAL COMMITIEE
49
Annex 1 SINGAPORE (continued) Dr Jeffery Cutter Deputy Director, Noncommunicable Diseases Epidemiology and Disease Control Division Ministry of Health, College of Medicine Building 16 College Road, Singapore 169854 Tel: (65) 6325 9220 Fax: (65) 6224 1677 E-mail: jeffery_cutter@moh.gov.sg Mr Koh Kok Hong Counsellor Embassy of the Republic of Singapore in the Republic of the Philippines 35 th Floor, Tower I The Enterprise Center 6766 Ayala A venue, Paseo de Roxas, Makati City Tel: (632) 7512345 Fax: (632) 751-2346 E-mail: singemb@singemb.org.ph SOLOMON ISLANDS Mr Benjamin P. Una Minister of Health and Medical Services Ministry of Health, P.O. Box 349, Honiara Tel: (677) 22376 Fax: (677) 20085 Dr George Malefoasi Undersecretary for Health Care Ministry of Health, P.O. Box 349 Honiara Tel: (677) 24097 Fax: (677) 20085 E-mail: ushc@solomon.com.sb TOKELAU* TONGA Dr Viliami Ta'u Tangi Minister of Health Ministry of Health, Nuku'alofa Tel: (676) 23200 Fax: (676) 24291 E-mail: mohtonga@kalianeUo (Chief Representative) (Alternate)
(Alternate)
(Chief Representative)
(Alternate)
• did not attend.
50
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Annex 2
TONGA (continued)
Dr Litili 'Ofanoa Director of Health Ministry of Health, Nuku'alofa Tel: (676) 23200 Fax: (676) 24291 E-mail: mohtonga@kalianet.to Dr Alesana Kleis Seluka Minister of Health, Ministry of Health Vaiaku, Funafuti Tel: (688) 20402; 20493 Fax: (688) 20832 E-mail: minhes@tuvalu.tv Dr Tekaai Nelesone Director of Health, Health Division Ministry of Health, Vaiaku, Funafuti Tel: (688) 20765 Fax: (688) 20481 E-mail: enelesone@hotmail.com
(Alternate)
TUVALU
(Chief Representative)·
(Alternate)
UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
Dr Wendy Thome Senior Public Health Adviser Department of Health International Branch, Richmond House 79 Whitehall, London SWIA 2NS Tel: (44) 20 7210 5529 Fax: (44) 2072105804 E-mail: wendy.thome@doh.gsi.gov.uk
(Chief Representative)
Ms Nicole Cadwallader Second Secretary Global Issues and Economic Affairs British Embassy, LV Locsin Building 6752 Ayala Avenue 1226 Makati, Metro Manila Tel: (632) 8167116 Fax: (632) 813 7755 UNITED STATES OF AMERICA Mr Pedro T. Untalan Deputy Secretary for Public Health and Administration Department of Public Health Commonwealth of the Northern Mariana Islands P.O. Box 500409 Saipan, MP 96950 Tel: (670) 236 8701 Fax: (670) 236 8700 E-mail: healthl@vzpacifica.net
(Alternate)
(Chief Representative)
REPORT OF THE REGIONAL COMMnTEE
51
Annex 2 UNITED STATES OF AMERICA ( continued) Mrs Ann S. Blackwood Director for Health Programs Office of Technical and Specialized Agencies Bureau of International Organization Affairs Department of State Washington D.C. 20520 Tel.: (202) 647 1546 Fax: (202) 647 8902 E-mail: blackwoodas@state.gov Mr Amarnath Bhat, Ph.D. Director, Office of Asia and the Pacific Office of Global Health Affairs Department of Health and Human Services 5600 Fishers Lane, Room 18C17 Rockville, MD 20857 Tel: 301-443-1410 Fax: 301-443-1397 E-mail: abhat@osophs.dhhs.gov VANUATU Mr Donald Kalpokas Masikevanua Minister of Health, Ministry of Health Private Mail Bag 9042, Port Vila Tel: (678) 22545 Fax: (678)26113 E-mail: dkalpokas@vanuatu.gov.vu Mr Alfred Kalontas First Political Advisor, Ministry of Health Private Mail Bag 9042, Port Vila Tel: (678) 22545 Fax: (678) 26 113 E-mail: akalontas@vanuatu.gov.vu Ms Myriam Abel Director-General of Health, Ministry of Health Private Mail Bag 9042, Port Vila Tel: (678) 22512 Fax: (678) 25438 E-mail: mabel@vanuatu.gov.vu VIETNAM Madam Dr Tran Thi Trung Chien Minister of Health Ministry of Health of the Socialist Republic of Viet Nam, Ha Noi Tel: (844) 846 3826 Fax: (844) 846 2195 (Alternate)
(Alternate)
(Chief Representative)
(Alternate)
(Alternate)
(Chief Representative)
52
REGIONAL COMMffTEE: FIFTY-FOURTH SESSION
Annex 2
VIETNAM (continued)
Mr Duong Huy Lieu Director, Planning and Financial Department Ministry of Health ofthe Socialist Republic of Viet Nam, Ha Noi Tel: (844) 846 3826 Fax: (844) 846 2195 Mr Trinh Quan Huan Director, General Department of Preventive Medicines and HIV / AIDS Control Ministry of Health of the Socialist Republic of Viet Nam, Ha Noi Tel: (844) 846 3826 Fax: (844) 846 2195 Mrs Le Thi Thu Ha Deputy Director Department of International Cooperation Ministry of Health of the Socialist Republic of Viet Nam, Ha Noi Tel: (844) 846 3826 Fax: (844) 846 2195 E-mail: lethuha_moh@yahoo.col11 Mrs Dao Thi Khanh Hoa Deputy Head of the General Affairs Unit Ministry of Health's Cabinet of the Socialist Republic of Viet Nam, Ha Noi Tel: (844) 846 3826 Fax: (844) 8462195
(Alternate)
(Alternate)
(Alternate)
(Alternate)
II.
OBSERVERS
HEALTH CANADA
Dr Jean Lariviere Senior Medical Adviser, Health Canada International Affairs Directorate, Ottawa Tel: (613) 957-7315 Fax: (613) 952-7417 E-mail: jean_lariviere@hc-sc.gc.ca Professor Kenzo Kiikuni Chairman of the Board, Sasakawa Memorial Health 5th Floor Nippon Zaidan Building 1-2-2 Akasaka, Minato-Ku Tokyo 107-0052, Japan Tel. 81 3 62295377
NIPPON FOUNDATION AND SASAKAWA MEMORIAL HEALTH FOUNDATION
REPORT OF THE REGIONAL COMMITTEE
53
Annex 2
GLOBAL ALLIANCE FOR VACCINES AND IMMUNIZATION
Mr Bo Stenson Principal officer, GAVI Secretariat c/o UNICEF, Palais des Nations, 1211 Geneva 10, Switzerland Tel: +41229095412 Fax: +41229095931 E-mail: bstenson@unicef.org Dr Yoshiko Saito Fund Portfolio Director East Asia, Southeast Asia and Oceania The Global Fund to Fight AIDS, TB and Malaria Avenue Louis casai 53, Centre Casai 1216 Cointrin, Geneva, Switzerland Tel.: (4122) 791 1726 Fax: (4122) 791-1701 E-mail: yoshiko.saito@theglobalfund.org
THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA
III.
REPRESENTATIVES OF UNITED NATIONS OFFICES, SPECIALIZED AGENCIES AND RELATED ORGANIZATIONS
FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS
Mr Sang Mu Lee FAO Representative in the Philippines 106 Amorsolo Street, Legazpi Village Makati City, Philippines Ms Adriana Gomez-Saguez Deputy Team Leader of UNAIDS SEAPICT 3/F" B, United Nations Building Rajadamnem Nok Avenue, Bangkok, Thailand Tel: 662288 1272 Fax: 662 288 1090 E-mail: gomez-saguez@un.org
JOINT UNITED NATIONS PROGRAMME ON AIDS
IV.
REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS
SECRETARIAT OF THE PACIFIC COMMUNITY
Dr Mark Jacobs Public Health Programme Manager Secretariat of the Pacific Community BP D5 98848 Noumea Cedex, New Caledonia Tel.: (687) 262000
54
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Annex 2
VI.
REPRESENT ATIVES OF NONGOVERNMENT AL ORGANIZATIONS Mr Mike Davis
CHRISTOFFEL BLINDENMISSION
COMMONWEALTH MEDICAL ASSOCIATION
Dr Teoh Siang Chin Dr Annamalai Rajamohan Dr Muthu Ponnusamy Dr Sellamah Sellappan Dr Noel G. Chua
INTERNATIONAL AGENCY FOR THE PREVENTION OF BLINDNESS INTERNATIONAL CATHOLIC COMMITTEE OF NURSES AND MEDICO-SOCIAL ASSISTANTS INTERNATIONAL COLLEGE OF SURGEONS
Mrs Lucia Soltes Mrs Shirley Pen a
Professor Chun-Jean Lee Mr Max Downham Dr Hsiao-Chen Chiu Dr Wen-Cheng Wu Dr Tomas P. Maramba, JT.
INTERNATIONAL COUNCIL FOR STANDARDIZATION IN HAEMATOLOGY INTERNATIONAL COUNCIL OF NURSES
Dr Marilyn D. Yap Professor Thelma F. Corcega Mrs Concordia Martin-Pascual Ms Nona S. Ricafort Ms Rose Lay Ms Edita Diokno Mrs Rosie Yanes Dr Lyra Ruth Clemente-Chua
INTERNATIONAL COUNCIL OF WOMEN INTERNATIONAL FEDERATION OF BUSINESS AND PROFESSIONAL WOMEN
INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS INTERNATIONAL FEDERATION OF HEALTH RECORDS ORGANIZATIONS INTERNATIONAL FEDERATION OF MEDICAL STUDENTS' ASSOCIATION INTERNATIONAL FEDERATION OF OTORHTNOLARYNGOLOGICAL SOCIETIES
Mrs Lourdes Palapal
Mr Joel Hernandez Buenaventura Mr Toshiaki Baba Professor Jun-Ichi Suzuki
REPORT OF THE REGIONAL COMMITTEE
55
Annex 2 INTERNATIONAL FEDERATION OF PHARMACEUTICAL MANUFACTURERS ASSOCIATIONS INTERNATIONAL PEDIATRIC ASSOCIATION INTERNATIONAL PHARMACEUTICAL FEDERATION INTERNATIONAL SOCIETY OF CHEMOTHERAPY INTERNATIONAL UNION OF ARCHITECTS INTERNATIONAL UNION OF NUTRITIONAL SCIENCES WORLD ASSOCIATION OF GIRL GUIDES AND GIRL SCOUTS WORLD CONFEDERAnON FOR PHYSICAL THERAPY WORLD FEDERATION FOR MEDICAL EDUCATION WORLD FEDERATION OF CHIROPRACTIC WORLD FEDERATION FOR MENTAL HEALTH Mr Leo P. Wassmer, Jr.
Dr Perla Santos Ocampo
Mr Reynaldo Umali
Dr Jaime C. Montoya
Professor Prosperidad C. Luis
Mrs Azucena Limbo
Dr Catherine R. Banta Professor Maria Eliza S.D. Ruiz
Professor Cheng Boji
Dr Jameson Uy
Ms Regina de Jesus Ms Myrna Lachenal Dr Chueh Chang Mr Po-Tswen Yu Dr Eugene Yu-Chang Peng Dr Shu-Yu Lyu Professor Cao Hongxin Dr Zhou Jie Mme Situ Wen Professor Liao Chun Hua Professor Liow Tuck Soon Mr Leo P. Wassmer, Jr. Mr Eufe M. Tantia
WORLD FEDERATION OF ACUPUNCTURE - MOXIBUSTION SOCIETIES
WORLD SELF-MEDICATION INDUSTRY
56
REGIONAL COMMITTEE: FIfTY-FOURTH SESSION
REPORT OF THE REGIONAL COMMITTEE
57
ANNEX 3
LIST OF NONGOVERNMENTAL ORGANIZATIONS WHOSE REPRESENTATIVES MADE STATEMENTS TO THE REGIONAL COMMITTEE At the invitation of the Chairperson, statements were presented by the following nongovernmental oganizations: Global Alliance for Vaccines and Immunization Global Fund to Fight AIDS, Tuberculosis and Malaria International Federation of Medical Students' Associations International Federation of Otorhinolaryngological Societies Nippon Foundation Sasakawa Memorial Health Foundation World Association of Girl Guides and Girl Scouts
58
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
PART II SUMMARY RECORDS OF THE PLENARY MEETINGS
CONTENTS PART 11- SUMMARY RECORDS OF THE PLENARY MEETINGS Agenda item number 1.
Agenda item
page
Opening of the session Address by the retiring Chairperson .............................................................. . Election of new officers: Chairperson, Vice-Chairperson and Rapporteurs .. Address by the incoming Chairperson ........................... :............................... . Adoption of the agenda .................................................................................. . Address by the Director-General ................................................................... . Nomination of the Regional Director ............................................................ . Report of the Regional Director ..................................................................... . Programme budget 2002-2003: budget performance (interim report) ......... . Proposed programme bUdget: 2004-2005 .................................................... . Expanded programme on immunization: measles and hepatitis B ............... . Sexually transmitted infections, including HlV/AIDS
64
2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. [4.
64, 73 64 100,115 65 65, 77 84 84, 100, 145 101 105, [45, 160 [20, 146
.......... ~ ....................... 131,138,160,207 146,155,207 163,174,207 180
Tuberculosis .................... _ .............................................................................. . Severe acute respiratory syndrome ................................................................ . Expression of sympathy in connection with the recent SARS outbreak
15.
Regional strategy for improving access to essential medicines in the Western Pacific, 2004-2009 ................................................................ . Framework Convention on Tobacco Control ................................................. . Child health ................................................ :................................................... . Coordination of the work of the World Health Assembly, the Executive Board and the Regional Committee ........................................ . Future directions for public health in the Region .......................................... . Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee ......................................................................... .
180 187,208 198,211
16. 17. 18.
208 152,154, 169
19. 20.
209
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Agenda item
Agenda item
page
21. 22. 23.
Special Programme for Research and Training in Tropical Diseases: Membership of the Joint Coordinating Board ..... .... ....... ..... .... .... ............. ....... Time and place of the fifty- fifth and fifty-sixth sessions of the Regional Committee Closure of the session .....................................................................................
210 211 212
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WPR/RC54/SRII
PROVISIONAL SUMMARY RECORD OF THE FIRST MEETING WHO Conference Hall, Manila Monday, 8 September 2003 at 09:30 CHAIRPERSON: Dr Hideo SHINOZAKI(Japan) later: Dr Manuel DAYRIT (Philippines)
CONTENTS page
1. 2.
Opening of the session .................................................................................................... .. Address by the retiring Chairperson ................................................................................ . Election of new officers: Chairperson, Vice-Chairperson and Rapporteurs .................. .. Adoption of the agenda .................................................................................................... . Address by the Director-General ....................................................................................... . ANNEX 1 - Address by the retiring Chairperson ............................................................. ANNEX 2 - Address by the Director-General.................................................................
64 64 64 65 65 73 77
3. 4. 5.
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G4
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
l.
OPENING OF THE SESSION: Item I of the Provisional Agenda The retiring Chairperson, Dr Hideo SHINOZAKI (Japan) declared open the fifty-fourth session
of the Regional Committee for the Western Pacific. 2. ADDRESS BY THE RETIRING CHAIRPERSON: Item 2 of the Provisional Agenda The retiring Chairperson, Dr Hideo SHINOZAKI (Japan), made a statement to the Committee (Annex 1). 3. ELECTION OF NEW OFFICERS: CHAIRPERSON, VICE-CHAIRPERSON AND RAPPORTEURS: Item 3 of the Provisional Agenda Election of Chairperson Dr BENJAMIN (Federated States of Micronesia) nominated Dr Manuel DA YRIT (Philippines) as Chairperson; the nomination was seconded by Dr SULEIMAN (Malaysia). Decision: Dr Manuel DAYRIT (Philippines) was elected unanimously. Dr DA YRIT took the chair. 3.2 Election of Vice-Chairperson Mr MOON (Republic of Korea) nominated Dr Mulitalo Siafausa VUI (Samoa) as Vice-Chairperson; the nomination was seconded by Mrs PIERANTOZZI (Palau). Decision: Dr Mulitalo Siafausa VUI (Samoa) was elected unanimously. 3.3 Election of Rapporteurs Professor NYMADA WA (Mongolia) nominated Mr Tony KINGDON (Australia) as rapporteur for the English language; the nomination was seconded by Dr WANG (China). Professor ENG Huot (Cambodia) nominated Ms Myriam ABEL (Vanuatu) as rapporteur for the French language; the nomination was seconded by Dr TRAN THI TRUNG (Viet Nam). Decision: Mr Tony KINGDON (Australia) and Ms Myriam ABEL (Vanuatu) were elected unanimously.
3.1
SUMMARY RECORD OF THE FIRST MEETING
65
4.
ADOPTION OF THE AGENDA: Item 5 of the Provisional Agenda (Document WPR/RC5411 Rev.3) The CHAIRPERSON moved the adoption of the Agenda. Decision: In the absence of comments, the Agenda was adopted.
5.
ADDRESS BY THE DIRECTOR-GENERAL (Item 6 of the Agenda) The DIRECTOR-GENERAL addressed the Committee (Annex 2). Mr KALPOKAS (Vanuatu), referring to the Director-General's comments on severe acute
respiratory syndrome (SARS), observed that although the disease had been contained in the Region, Member States were concerned about a reCUITence, since there was no cure. Had research on a treatment progressed? Dr WANG (China) congratulated the Director-General on assuming his office (a sentiment echoed by subsequent speakers). With his experience and global influence, he would surely lead to WHO to great achievements, such as realizing the Millennium Development Goals and improving the health conditions of humankind The Region had a large population coupled with a heavy burden of disease, and its Member States were at different stages of development. Yet after the outbreak of SARS, all were facing the challenge of reforming and improving the management of their health systems, in addition to such tasks as combating other communicable diseases, controlling tobacco use, and assuring food and road safety. None the less, as from 2000, regular budget allocations to the Region had been decreasing while the Region's share of extrabudgetary resources was among the lowest of all the WHO regions, an inappropriate situation in view of the circumstances. Referring to the remarks on inequality among countries, he trusted that the Director-General would take concrete measures to redress imbalances. He welcomed the Director-General's resolve to strengthen country offices and looked forward to enhanced cooperation between the Organization and its Member States. He was, therefore,
interested in the measures the Director-General intended to take to intensify WHO's work at country level, his conception of coordination between Headquarters and regional offices, and his plans to improve work relations between those two levels. Commending the more extensive cooperation between WHO and other international bodies, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, he hoped that WHO would
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REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
intensify its leadership in global public health and make every effort to relieve the burden of disease and the socioeconomic problems stemming from it. The Government of China was ready to strengthen its cooperation with WHO and make its due contribution to improving the health of people both in China and throughout the world. Mr OTSUKA (Japan) commended the Director-General's focus on devolving more authority and resources to countries and regions, where they would have a more direct impact, achieving the Millennium Development Goals, and determining essential health indicators for poverty reduction and development. He also welcomed the appointment of several prominent public health officials from the Region to the senior management team at Headquarters. The Government of Japan would provide maximum support 111 SIX
key areas:
(I) implementation of the policy to increase allocations of human and financial resources to country
level, for which clear guidelines were required; (2) continued reform within WHO's secretariat in order to enhance efficiency, improve geographical representation among the staff, and strengthen cooperation with Member States in tackling emerging health problems; (3) strong leadership in the introduction and maintenance of antiretroviral therapy, despite the risk of drug resistance: (4) complete eradication of poliomyelitis throughout the world; (5) further progress of the WHO Framework Convention on Tobacco Control; and (6) reinforcement of links and partnerships with other leaders in public health. Those areas were also his Government's priorities. Japan would provide particular support for strengthening partnerships promoted by both the Director-General and the Regional Director, and remain proactive in its relationship with WHO. Dr KING (New Zealand) expressed confidence that, under the leadership of the new Director-General, who had had a long and fruitful association with the Western Pacific Region, WHO would remain the pre-eminent international health body. In his address the Director-General had clearly set out the challenges facing the Organization and some of its achievements. The adoption at the Fifty-sixth Health Assembly in 2003 of the WHO Framework Convention on Tobacco Control was one of those achievements. New Zealand would ratify the Framework Convention as soon as possible. However, the treaty should be seen only as a first step in the fight to control tobacco use. In that connection, she welcomed the smoke-free status of the Regional Office, as United Nations buildings should set an appropriate example. SARS had tested WHO, the Region and the public health services, health workers, border security and economies of its Member States. She expressed appreciation for the leadership and
SUMMARY RECORD OF THE FIRST MEETING
67
guidance shown by WHO and the action taken by Viet Nam during the emergency. The experience had clearly shown the importance of cooperation, coordination of efforts and early warnings. In that context, she commended the successful meeting on SARS held in Thailand earlier in the year. The needs of the Pacific countries in respect of resources to combat HNIAIDS should not be overlooked by WHO and the Global Fund to Fight AIDS, Malaria and Tuberculosis. The disease would be devastating if it gained a significant hold in the smaller Pacific island countries. She welcomed the timely emphasis being given to diet, physical activity and health, especially given the alarming increase in childhood obesity in many countries of the Region and the health problems that might arise in adulthood as a result. Dr SELUKA (Tuvalu) welcomed the Director-General's intention to continue the process of WHO refornl and to bring the Organization closer to the people living in its Member States. He urged WHO to devote greater resources to research and development, through partnerships with the private sector as appropriate, in respect of disease epidemics. Such emergencies were of deep concern to the Pacific island countries and affected the underprivileged in particular. As the SARS emergency had shown, it was vital to have the capacity for early detection and diagnosis, and for all countries, rich and poor, to cooperate. He commended the Member States of the Region on their actions to contain the disease during that emergency. Dr NAN ALU (Fiji) assured the Director-General of Fiji's commitment to work in partnership with WHO to achieve better health for all people in Fiji and throughout the Region. The WHO Framework Convention on Tobacco Control was a milestone for the Organization. Such global initiatives should be a regular feature of WHO's work. He therefore welcomed the new initiati'c for achieving treatment of 3 million people with antiretrovirals by the end of 2005 (the "three by five" target), which he hoped would supplement the Global Fund allocations recently approved for the Pacific island countries and lead to more susl:.:iilable treatment in the future. Dr TANG! (Tonga) commended the Director-General's emphasis on the development of a more realistic programme budget and greater transparency in the budgeting exercise. He looked forward to discussion of those matters in greater depth during consideration of the proposed programme budget under item 10 of the Agenda. He also welcomed the renewed emphasis being given to action at the country level, as that was vital to the strength of the Organization. Countries needed appropriate allocations to enable them to implement programmes. The negative impact of the migration of members of the health workforce had been the subject of numerous meetings in the
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REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
recent past, but the results had been meagre. He looked forward to the achievement of real progress in that area. Mr DAVIES (Australia) paid tribute to the contribution made by the Director-General in the control of tuberculosis and vaccine-preventable diseases in his previous roles in WHO, and welcomed his stated commitment to reform of the Organization and to strengthening actions at the regional and country levels. While the proposed targets were bold and ambitious, he was sure that they could be achieved if everyone worked together. The experience gained during the SARS epidemic had illustrated the outstanding results that could be achieved through cooperation. Dr BENJAMIN (Federated States of Micronesia) welcomed the appointment of an old friend of his country to the position of Director-General. He applauded the renewed focus on decentralization to the regional offices. He hoped that small countries, such as his own, would benefit from an increase in country budgets, and that transparent criteria for the allocation of resources would be observed. Dr GALON (Philippines) endorsed the directions and priorities set out by the Director-General for the future work of WHO. She expressed appreciation, in particular, for the emphasis given to the strengthening of the regional and country offices, and to transparency in management. Her country looked forward to working with the Organization with a view to making real improvements in the health of people in the Region. Dr MANN (Papua New Guinea) hoped that the election of someone from the Western Pacific Region to the post of Director-General would ensure that the concerns of the small Pacific island countries would be heard at Headquarters. The large popUlation and high disease burden in the Region demanded an increased allocation of resources. He echoed the call by the representative of New Zealand for due attention to be given to the needs of the Region in respect of allocations for the fight against HIV/AIDS, and expressed appreciation for the recent approval for funding from the Global Fund. Given that his country had among the highest rates of infant and maternal mortality, he was greatly encouraged by the proposed strategies for tackling complications of pregnancy and childbirth, and management of childhood illnesses. He endorsed the views of the representative of Tonga regarding the continuing loss of trained health professionals from certain countries and he too looked forward to progress in that area. Dr SIPELI (Niue) welcomed the new Director-General and paid tribute to the work of his predecessor, noting that, while policies might change, the overall objectives of WHO remained the same. The SARS epidemic had scared everyone into the realization that many countries were ill-prepared to cope with such emergencies. In particular, greater efforts were needed to strengthen
SUMMARY RECORD OF THE FIRST MEETING
69
areas of capacity-building, especially as regards surveillance skills. I-Ie expressed appreciation for the invaluable information and guidance provided by WHO during the crisis and urged the Regional Office to renew its support for the small island cOlmtries should SARS re-emerge. Dr ENOSA (Samoa) commented that the election of Dr Lee to the post of Director-General of WHO was yet another indication that the Region bred good leaders. With regard to SARS, he thanked the Organization for the delivery of personal protective equipment to his country and asked that WHO keep cOllntries up to date Oil the results of research on the pathology of the disease and help them to prepare for a possible re-emcrgence. It was to be hoped that the Global Fund to Fight AIDS, Tuberculosis and Malaria would
provide financing to all Pacific island countries. In view of the high cost of antiretroviral agents, much of the funding should go to the purchase of such treatment. He asked how least-developed countries could obtain the drugs at lower cost, as had been mentioned during the Fifty-sixth World Health Assembly. In respect of the Director-General's comments regarding food safety, he felt that WHO should
give a clear answer to the question of whether health took precedence over trade, particularly in the light of current demonstrations against globalization. Reiterating the remarks of previous speakers with regard to the migration of health workers, he emphasized that positive, effective steps needed to be taken to address the problem as soon as possible. Mrs PIERANTOZZI (Palau), also addressing the drain of human resources from poor to rich countries, asked for WHO support to stop the trend. Support would also be needed for human resource development in health management and health care appropriate to the health indicators of each country. The recent SARS epidemic had shown the importance of improving early surveillance systems in all countries. The Member States of the Region should also prepare themselves to deal with road traffic accidents and biolerrorism. Professor NYMADA WA (Mongolia), noting the Direclor-General's call for broader collaboration between health administrators and public and private organizations, w-ged WIlO to ensure that a proper balance was maintained in such cooperative ventures, maintaining a stroilg tcchnical role and health as the first priority.
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REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Dr KJENENE (Kiribati) recalled that most countries of the Region had been caught unprepared during the recent SARS outbreak; subsequently, they had received almost daily assistance and information from WHO and support from the Pacific Public Health Surveillance Network. A plan of action should be put in place to prepare for any further outbreak. The DlltECTOR-GENERAL noted that SARS had been the first new disease of the Cllnent millennium, and more new and emerging diseases could be expected ill the coming decades. As no treatment had yet been found for SARS, 18th century measures of isolation and contact tracking had been resorted to. With the advellt of winter in the northern hemisphere, cases of the common cold and influenza could be expected, the symptoms of which might readily be taken for SARS, unless rapid diagnostic tests were used. It would take many years before a vaccine could be developed. Strong leadership in the face of the outbreak had been shown by both Dr Brundtlaud and Dr Omi, and there was every reason to expect that excellent collaboration would continue between Headquarters and the Regional Office. In response to the comment by the representative of Palau concerning bioterrorism, he said that WHO was enhancing its global surveillance network to address outbreaks of diseases of both natural and artificial origin. That would be the role of WHO in global security. Responding to the remarks of the representative of China, he recalled that a decision had been taken to present a comprehensive, integrated budget to the Health Assembly, comprising both the regular budget and extrabudgetary resources. Greater transparency would be achieved regarding the source of the eXh·abudgetary funds by closer coordination with donor countries. His hope was that ultimately it would be possible to have just one budget, encompassing both regular and extrabudgetary funds. To that end, both sources of funding had been put under one cluster, General Management, in Headquarters. Good relationships between Headquarters and regional and country offices were of vital importance. Nevertheless, regional offices differed in their ability to deliver programmes and in their management skills. In that respect, the Westem Pacific Regional Office was a model for the rest of WHO. He told the representative of Japan that eradication of poliomyelitis should be completed by 2005. Signature of the WHO Framework Convention on Tobacco Control marked the end of only the first step ill the long process of implementation of the provisions of that treaty. He had the advantage of personal unders1anding of the particular problems of the small island countries, owing to his close involvement in programmes in Pacific island countries such as the
SUMMARY RECORD OF THE FIRST MEETING
71
Federated States of Micronesia and Tonga. Addressing the issue of the emigration of health care personnel from the Region, he noted that the Fiji School of Medicine had been successful in training and retaining medical personnel. There were shortages of doctors and nurses in both developed and developing countries, and the problem must, therefore, be solved by multilateral discussions. WHO was addressing its own difficulty in recruiting staff from under-represented countries by seeking out likely candidates and training them before recruitment, either by WHO or hy other international agencIes.
In response to the request by the representative of Mongolia for WHO to ensure the primacy of the health aspect in its partnerships, he said that WIIO had an unquestioned leadership role in carrying out its normative functions, but that balance was indeed required in ensuring its role in other partnerships.
The meeting rose at 12:05.
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SUMMARY RECORD OF THE FIRST MEETING
73
ANNEX 1 ADDRESS BY THE RETIRING CHAIRPERSON
This morning, as I entered the gates of what looked like an oasis amid the bustle of crowded and lively metropolitan Manila, I was happy and excited to be back in the place where I had my first experience of international work. This visit is something of a homecoming for me. Manila is a special place and I am delighted to be here with you for the fifty-fourth session of the Regional Committee. As I welcomed you to Kyoto last year as Chairperson of the fifty-third session, please allow me to welcome you again this time to my second home, Manila. Distinguished Representatives, time goes quickly. Since our last meeting in Kyoto, events have unfolded which have challenged our resolve to ensure that health is enjoyed by all. Global events like the war in Iraq and the tension in the Middle East sent ripple effects that were felt in many of our countries. The SARS outbreak hit the Western Pacific particularly hard as over 95% of cases were in our Region. The outbreaks clearly illustrated the vulnerability of our health systems, yet they also brought out the best in our health workers, colleagues and partners. Clinical and public health staff showed selfless dedication to the service of the people, unwavering commitment to the cause of health, and a true spirit of solidarity in the battle to contain SARS. There were other events of global significance during the period. The unanimous adoption of the WHO Framework Convention on Tobacco Control by the Fifty-sixth World Health Assembly in May this year was yet another testament to how countries can collaborate to counter a global threat. Many countries in our Region were actively involved in finalizing the text of this treaty. What we need to do now is to ensure the treaty is signed by countries that have not already done so and then ratified so that it comes into force. We have made steady progress in addressing communicable diseases such as tuberculosis, HIV/ AIDS and malaria. Many of our countries have been able to access much needed resources from such sources as the Global Fund to Fight AIDS, Tuberculosis and Malaria. I would like to
acknowledge the crucial role that WHO played in helping countries to prepare proposals for the Global Fund.
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REGIONAL COMMITIEE: FIFTY-FOURTH SESSION
Annex 1
In the area of lifestyle-related diseases, the past year saw a flurry of activities and some important commitments. The results of our ministerial round table discussions held in Kyoto last year helped to form the basis for the Region's contribution to the development of a Global Strategy on Diet, Physical Activity and Health. The Kyoto Declaration on Health Promotion, which was
adopted immediately after our last session, included high-level commitments to promote healthy lifestyles by involving partners from outside the health sector. In March this year, Pacific Health Ministers adopted the Tonga Commitment to Promote Healthy Lifestyles and Supportive Environments. Countries and WHO have also been looking closely at how to make the health sector more responsive to the needs of the population. The discussions we had on essential public health functions last year helped us to clarify the responsibilities of Ministries of Health, and hence of Governments, and to define what they should actually be doing. Last year we also started to address the ethics of public health and I am sure that this is an area we shall continue to investigate. Dear colleagues, during the past year, we learned only that the best way to address the many threats to health is to work together in a unified way. Dr Omi, the Regional Director, and his WHO colleagues have provided strong and committed leadership during these challenging times. Let me turn now to the present. We are deeply honoured to have with us this morning, Dr J.W. Lee, the new Director-General o[WHO. As many of you know, Dr Lee also spent many years in this Region. Like me, Dr Lee must surely feel nostalgic to return to the Regional Office. So welcome home Dr Lee. I am sure that we will all look forward to your address to the Committee later this mornlllg. Distinguished Representatives, we shall soon elect a new Chairperson who will steer our deliberations over the next five days. I shall tum over this important task confident that you and the Secretariat will extend the same excellent cooperation that you have so kindly extended to me. I thank my fellow office bearers, the Vice-Chairperson, Dr Eliuel Pretrick, the rapporteurs, Dr Tee All Sian and Dr Nao Boutta, for their support. Allow me to thank you all most sincerely for having entrusted me with the great honour of being your Chairperson and for your warm friendship and unconditional support. 1 must say [ greatly enjoyed the job that was entrusted to me and will take many happy memories with me as I move on to another phase of my career as Director General of the
SUMMARY RECORD OF THE FIRST MEETING
75
Annex 1 National Instit.ute of Public Health. I shall never forget the openness and spirit of camaraderie that have characterized our meetings. Thank you all for the very rewarding expeIiencc and thank you for your friendship.
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REGIONAL COMMITIEE: FIFTY-FOURTH SESSION
SUMMARY RECORD OF THE FIRST MEETING
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ANNEX 2
ADDRESS BY DR l.W. LEE, DIRECTOR-GENERAL OF THE WORLD HEALTH ORGANIZATION AT THE OPENING SESSION OF THE FIFTY-FOURTH SESSION OF THE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC I am honoured to be back here in Manila and to join your discussions on our work in the Western Pacific Region. The countries in the Western Pacific have been in the news and on the front pages for much of this year as a result of SARS. SARS tested us to the full. This was the area hardest hit by the world's newest disease. We had to work to understand what was causing it at the same time as we struggled to treat those most directly affected. We won this battle. Of course, none of us can predict what will happen later this year. Will SARS come back or not? We have to prepare on the assumption that it will come back. Our challenge now is to enhance surveillance networks that will detect and deal with SARS if it does return. The United Nations system is now going through a testing time. We were profoundly shocked by the bombing of the UN premises in Baghdad and by the deaths and injuries of so many of our colleagues. Despite these terrible losses, we continue our missions with great determination. Mr Chairman, I feel a great responsibility being in charge of WHO, a key part of the UN system, and am grateful for all of your support and expressions of good wishes for success. Most pressingly now, success means achieving specific goals in disease control. That is part of a longer-term effort to rethink and rebuild health systems in countries and for the world as a whole. This need is seen more devastatingly in the continued spread of HIV /AIDS, tuberculosis and malaria. "Unequal development in different countries in the promotion of health and control of disease ... is a common danger", our Constitution says. In some countries, conditions associated with poverty are bringing life expectancy down to 40 years, while in others, wealth and health technology are enabling it to rise towards 80. Inequality on this scale is not just a danger, but an injustice to human well-being. On this 25th Anniversary of the Alma Ata Declaration on Primary Health Care, it is good to remind ourselves that health is for all. Everyone equally needs health, and, when society fails massively through negligence to meet that need, it is in very serious trouble.
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REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Annex 2 The greatest challenge facing us now across the globe is the catastrophe of HIV/AIDS. A growing number of affected people urgently need treatment. It has to come through an integrated global lIlY/AIDS strategy linking prevention, care and treatment. I am working with local, national and international partners to design the necessary programmes to treat 3 million people with antiretrovirals by the end of 2005. "Three by five" will not solve the problem of AIDS but it will mark the beginning of a solution and proof that it is possible. A comprehensive strategy for making this happen will be announced on I December, World AIDS Day, less than three months from now, and our work with countries will be initiated immediately. We are working with many partners including UNAIDS and the Global Fund, to mobilize the resources to put these plans into action. It will require the commitment of civil society, United Nations agencies and the private sector. Above all, it will require the commitment of each one of us here today. The growing epidemic of tuberculosis must be another of our key focuses. SARS has brought an extraordinary level of attention to respiratory infections. But the fact is that TB is a great threat. We must do more to ensure that those suffering from TB receive the effective DOTS treatment. The countries in the Western Pacific are free of polio - a great achievement for public health. We must now press home this hard-won advantage to complete global eradication during this year and next, delivering slIbstantial dividends for the health services of every country. The need for health care starts at birth. Protection during pregnancy, childbearing and
motherhood forms the core of the health system. Around the world, half a million women die every year from giving birth. Skilled attendants are needed in pregnancy and childbirth, with access to emergency obstetric care when complications arise. Despite the struggle of parents for their children's survival, 10 million children in low- and middle-income countries die every year before reaching the age of five. Seven million of those deaths are from five preventable and treatable conditions: pneumonia, dialThoea, malaria, measles and
malnutrition. We can reduce this toll substantially by working with countries to build up strategies such as Making Pregnancy Safer and Integrated Management of Childhood Illnesses. Reducing child mortality worldwide by two-thirds by 2015 is probably achievable. But it will not happen without major rethinking and commitment.
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Annex 2
Surveillance systems in WHO and our Member States showed their effectiveness in the eradication of smallpox, and earlier this year, in stopping the SARS epidemic. They are a key to success now, both for the eradication of polio and for the control of new and re-emerging infections. We also need to finalize the important work on the Revision of the International Health Regulations. Meanwhile, noncommunicable diseases and il1juries account for a growing share - now about 60% - of the burden of disease worldwide. In May, the World Health Assembly adopted the WHO Framework Convention on Tobacco Control. This was a global achievement in the fight against tobacco-related diseases. Our Member States took a united stand. The Convention has now been signed by fifty countries and ratified by one. It will give the world the means to protect people from tobacco harm by banning advertising, preventing smuggling, raising tobacco taxes and enforcing more visible warning notices on packages. We must do everything we can to speed the process to the ratification by forty countries that will bring the Convention into force. The unbalanced nutrition now affecting all societies, rich and poor, poses a major challenge for health. Our objective is integrated approaches that work against malnutrition .- from deficiencies and excesses. WHO's Global Strategy on Diet, Physical Activity and Health wiII be presented to the World Health Assembly next May. This year's Health Assembly reviewed the work of the Codex Alimentarius and concluded that the health sector should playa more prominent role in setting safety standards for food. The Health Assembly also stressed that developing countries should be given more support to participate fully in the process of international food standard-setting. In many cases, this is a matter not just of food safety but of food security - of ensuring intake of the minimum calories essential for survival and health. Every year, more than a million people die in traffic accidents around the world, making it a leading cause of death in all regions. What is needed is to raise awareness and strengthen our
response. World Health Day 2004 will be dedicated to road safety and to the clear public health interventions that can be taken to reduce the number of people injured and killed in traffic accidents. Everything we are doing is about reinforcing national health systems. Our work everywhere is important, but the real centre of it has to be countries. We have to give our country offices more people, more realistic budgets anrl more authority. At the same time, we also have to ensure sound management and financial practices, as well as, transparent budgeting.
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Annex 2
At Headquarters, all the Assistant Directors-General are looking at the global issues under their responsibility, to see which of their activities could be better carried out in regional and country offices. Overall, I want to see these changes come through in the 2006-2007 budget. Strengthening country offices is a major objective for me because, having worked for 20 years in WHO, I can see very clearly that strengthening our work in countries is by far the most effective way to help achieve the goals of our Member States. Health systems depend most of all on skilled and dedicated personnel, and here we face a major challenges: the brain drain. It is, above all, good health workers that will enable us to reach "three by five", and achieve the Millennium Development Goals, and everyone is short of human resources. We wiII be working closely with countries on innovative methods to train, deploy and supervise health workers with particular emphasis on the community and primary health care level. That is where we can make the swiftest progress in getting results. In many countries, the systems for providing reliable health information are also inadequate. This is one area in which the trend is on our side: the means for building effective information systems are becoming more powerful and more affordable all the time. I believe this problem can be effectively addressed with the health metrics network being formed by WHO's information partnership with Member States, foundations, the World Bank and UNICEF. Mr Chairman, over the years, WHO has built up strong and effective working relations with Member States, foundations, nongovernmental organizations, the private sector and fellow multilateral organizations. Our work depends on partnerships, some long-standing and some more recent. By combining our strengths we can do so much more. There is a commitment to partnership by global leaders on a scale we have not seen before. At the United Nations Millennium Summit in September 2000, the global community committed itself to eight goals. Three of them were directly about health: to reduce child mortality, improve maternal health, and control major infectious diseases. The five others are about poverty, education, gender equality, the environment and global palinership. All these, as we have seen, have a direct bearing on health.
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Annex 2
I look forward to listening to your debate. Better health for all is our common goal. Let's work together to achieve this. Thank you.
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WPRlRC54/SRl2 SUMMARY RECORD OF THE SECOND MEETING WHO Conference Hall, Manila Monday, 8 September 2003 at 14:00 CHAIRPERSON: Dr Manuel DAYRlT (Philippines)
CONTENTS page 1. 2.
Nomination of the Regional Director ....................................................... ....................... . Report of the Regional Director .................................................................. ..................... .
84 84
83
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I.
NOMINATION OF THE REGIONAL DIRECTOR: Item 7 of the Agenda (Document WPRlRC54/16) The meeting was held in private session from 13:50 to 14:20 and resumed its work in public
session at 14:30. At the request of the CHAIRPERSON, Mr KINGDON (Australia), Rapporteur for the English language, read out the resolution that had just been adopted by the Regional Committee in private session:
The Regional Committee, Considering Article 52 of the Constitution; and In accordance with Rule 51 of its Rules of Procedure; I. NOMINATES Dr Shigeru Omi as Regional Director [or the Western Pacific; and
2. REQUESTS the Director-General to propose to the Executive Board the appointment of Dr Shigeru Omi for a period of five years [rom 1 February 2004.
Decision: The resolution was adopted. Representatives of the following Member States took it in tum to congratulate Dr Omi on his nomination: China, Japan, Republic of Korea, Australia, Solomon Islands, Mongolia, Viet Nam, Philippines, New Zealand, Niue, Singapore, Fiji, Cook Islands, France, Malaysia, Hong Kong (China), Vanuatu, United States of America, United Kingdom of Great Britain and Northern Ireland, Marshall Islands, Samoa, Tuvalu, Tonga, Kiribati, Brunei Darussalam, Palau, and Federated States of Micronesia. The REGIONAL DIRECTOR thanked the Regional Committee for the collegial way in which countries had worked with him and with the secretariat over the previous five years. He also thanked his colleagues in the World Health Organization. He appreciated the trust shown in him by Member States, and expressed his readiness to assume the responsibility that that entailed. 2. REPORT OF THE REGIONAL DIRECTOR: Item 8 of the Agenda (Document WPRlRC5412) The REGIONAL DIRECTOR began by saying that, since the fifty-third session of the Regional Committee in Kyoto last September, WHO and its Member States had entered a new era [or public health. The outbreak of severe acute respiratory syndrome, or SARS, that had originated in the
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Region and then had raced around the world had stretched health systems in some Member States almost to breaking point. In the most affected cities, hospitals had no longer been perceived as places of healing, but as centres of contagion. This had been a terrifying prospect for patients, hospital workers and public health authorities. Daily life had become disrupted - children in some countries had gone to school in masks, when they had gone to school at all. Rapid mass travel, one of the great social trends of the last century, suddenly became perilous. The Western Pacific had been the
epicentre of the epidemic, with over 95% of cases occurring in the Region. As soon as WHO staff had begun to receive telephone calls at the Regional Office in early February about apparent outbreaks of atypical pneumonia, they knew that they had to move quickly. In his 14 years at WHO he had never seen the Organization respond with such speed and intensity. In the critical early days of the outbreaks, it had been clear that swift and decisive action was needed, despite the fact that the Organization did not have a total picture at that time. WHO had mobilized the very top epidemiologists and hospital infection control experts to support affected Member States. All in all, WHO had recruited 115 consultants during the crisis. Guidelines on infection control and surveillance had been drafted immediately. Expert missions had been conducted to affected areas. Information had been disseminated to countries suffering large-scale outbreaks. Equipment and
personal protection supplies had been dispatched rapidly with support from partner agencies. In Member States, the effort had also been immense. At the peak of the crisis, clinical and
public health staff in China (including Hong Kong), Singapore, Viet Nam, the Philippines, Mongolia and other centres had worked literally day and night. Many had done so at great personal risk. The dedication of front-line health workers, combined with strong political commitment at the national level, had averted a global health crisis. He congratulated the Member States for the excellent job that they had done. However, it was too early to close the book on SARS. The outbreaks had exposed many weaknesses in the Region's health systems. To avoid a similar crisis the next time, surveillance and preparedness against emerging and re-emerging diseases should be greatly improved. He said these were the issues that the Committee should address; it would discuss SARS in more detail later that week. He then covered some of the issues dealt with in Chapters 1-5 of the report. He recalled that four years earlier, in Macao, the Committee had declared a "tuberculosis crisis" in the Western Pacific, and had mandated him to make Stop TB a special project of WHO in the Region. In response, the resources devoted by numerous partners and WHO had helped to reduce the funding gap for TB control from $260 million to $67 million. The percentage of the Region where TB patients
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had access to DOTS had increased significantly. It was particularly encouraging that regional cure rates had already exceeded the 85% target, indicating that, once the strategy was administered, patients had an extremely good chance of being cured forever. He said there was still a long way to go before the Region would achieve the targets of a 70% case detection rate and regionwide DOTS coverage. The HlY/AIDS epidemic in the Region continued to be a major public health concern, although the report indicated some positive developments. WHO now had a much clearer idea of the pattern of the epidemic, because of recent improvements in surveillance systems and data analysis. Over the past four years WHO had continued to target high-risk groups such as sex workers, with considerable success. In Cambodia, for example, the" I00% condom use" strategy had been in place in parts of the country since 1998. In five provinces implementing the strategy, consistent condom use by all types of sex workers had increased from 51 % in 1998 to about 90%, and this had been accompanied by a halving of the HIV prevalence rate among direct sex workers, from 48% to 23%. That was a
remarkable achievement for a country with limited resources. Injecting drug use remained a major route for transmission of the virus in some countries. WHO had therefore stepped up its support for harm reduction strategies. By 2005, WHO estimated that there would be 120 000 people living with AIDS in the Region. WHO's new Director-General was determined to achieve the ambitious global target of providing antiretrovirals to 3 million people living with AIDS by 2005, the so-called "three by five goal". He proposed that WHO Western Pacific Region and its Member States should give their full support to Dr Lee's call. The Regional Director then turned to lymphatic filariasis, a disease that particularly affected Pacific island countries. Mass drug administration and vector control measures had led to dramatic reductions in microfilarial prevalence, in some cases by over 90% after two or three rounds of mass drug administration. Recent successes had been due in large part to one of WHO's partners, Pac ELF, the Pacific Programme for the Elimination of Filariasis, and to the firm commitment shown by ministers in the Pacific. With a final push, WHO would be able to eliminate this terrible and disfiguring disease from the Region. He noted that the report also provided evidence of enormous progress against other communicable diseases such as leprosy (Chapter 3) and malaria (Chapter 2).
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Chapters 6-10 of the report dealt with building healthy communities and populations. In that area in particular, WHO had made great efforts to deal with problems upstream instead of waiting until it was too late. With regard to tobacco, he said that fortunately, over the previous five years the Governments of the Region had woken up to the need for immediate action against tobacco. Countries from the Region had played a leading role in the lengthy negotiations for the WHO Framework Convention on Tobacco Control adopted in May 2003 by the World Health Assembly. To date, six countries from the Western Pacific - Marshall Islands, Mongolia, New Zealand, Palau, the Republic of Korea and Viet Nam had already signed the treaty; Samoa, Tonga, the Solomon Islands and Malaysia were about to sign. He congratulated them and urged the countries that had yet to sign the Convention to do so as soon as possible. Chapter 9, noncommunicable diseases (NCD) and mental health, recorded an almost universal increase in noncommunicable diseases in the Region. NCD accounted for six out of ten deaths in the Western Pacific. The NCD burden would continue to grow in the foreseeable future, but WHO could reduce that growth. He mentioned a few important examples of progress that had been made over the last five years. First, the Western Pacific Region had made important contributions to the establishment of a global standard for NCD surveillance. Fiji, Marshall Islands, the Federated States of Micronesia and Samoa had already embraced this standard and nine more would do so in the next biennium. Second, innovative national models that combine health promotion and clinical control had been developed in Mongolia and Viet Nam. Regional clinical management targets for diabetes had been established in two Asian and six Pacific countries. External partners had already committed themselves to significant new funding for those developments. Overall, the Region had started to move from an era dominated by rhetoric to one characterized by action. A good example of this had been the meeting of Pacific ministers of health in Tonga earlier in the year, chaired by Honourable Minister Dr Tangi, where ministers not only had committed themselves to addressing rising levels of NCD, but had also adopted indicators to monitor progress. Over the past three years, the profile of mental health in the Region had been raised considerably. A regional strategy for mental health had been endorsed by the Regional Committee in Brunei Darussalam in September 2001. The strategy had subsequently been presented at many
regional forums, and was being used by several countries as the basis for national strategies. Yet, mental illness remained a major problem almost everywhere. For example, suicide claimed over 1000
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lives every day in the Region. Not only that, in almost every country in the Region many people feIt a sense of disconnectedness, from society in general and from health services in particular. The
predominantly biomedical approach which had characterized public health for the previous century had served humankind weIl, but WHO and its Member States should now turn to the critical areas that they had neglected. They had to move beyond merely treating diseases, and to adopt a more holistic approach to health care, where the whole person was treated and cared for. This meant dealing with people in the context of their human dignity, their rights, their families, their culture, and their society. He pointed out that, in spite of these gains, many chaIlenges lay ahead in WHO's work to build healthy communities and populations. WHO was engaged in changing human behaviour patterns, some of which were very deeply rooted and resistant to change. Individual efforts were only part of the story. Governments also had to provide supportive environments to enable individuals to make healthy choices easy and exciting, everywhere. He then recalled that in 1999 he had admitted to the Committee that health sector development was an area where WHO had been weak. The Committee knew that progress in this area would be incremental, but chapters 11-14 of the report indicated some promising developments. With regard to health financing, he said that in some countries, for every three doIlars that had been spent on health care, two doIlars came from the pockets of the sick person or his or her family. Hospital bills and even the cost of prescribed medicines alone could drive a family into a downward spiral of debt. This could not be all owed to continue. WHO was encouraging countries to adopt or extend social health insurance. Rural community health insurance schemes were already being piloted in the Lao People's Democratic Republic, the Philippines and Viet Nam, with WHO support. Insurance legislation had been amended in Mongolia and evaluations of best practice had been carried out in China. Such financial safety nets were critical if WHO and its Member States were to stop ill-health from driving families into poverty. Over the previous few years WHO had also worked closely with several countries, including China, Mongolia and Viet Nam, to institutionalize national health accounts. Samoa was the first country in the Pacific to put in place national health accounts. If WHO was able to extend the use of national health accounts in the Region, the information they provided would enable health managers to make more rational decisions on the aJlocation ofresources. WHO had provided considerable support for regional and national quality management capacity in blood transfusion systems. With support from Singapore, WHO had trained senior staff of blood centres and blood banks in quality management practices. Almost all employees of blood
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transfusion services at provincial and prefecture levels in China had been trained using WHO distance learning materials. Many of these trainees had already applied their training and had established quality management systems in their national blood transfusion services. Despite the progress that had been achieved, WHO recognized that much more needed to be done. SARS had highlighted the fact that many health systems were fragile, even in developed He said that, over the next five years, WHO and its Members had to strengthen the
countries.
Region's health systems still further, so that they were able to withstand shocks and to become more efficient, responsive, and caring. With regard to chapters 15-17, during the SARS crisis WHO's public information staff had worked at full throttle to make sure that WHO was accessible to the many different media that needed information about the outbreaks. At the height of the crisis, WHO's media office had been fielding calls every few seconds ali day, and well into the night, from the BBC, CNN and countless other regional and global news media. Page views on WHO's website had shot up from 80 000 to quarter of a million a month. In supporting the media in this way the Regional Director believed that WHO had helped to calm unjustified fears, reveal the facts about the crisis, and generally enable the people of the Region to take a balanced and informed view of the epidemic. This had been paralleled by the efforts of Member States, some of whom had held press conferences and issued press releases on a daily basis and set up excellent websites and telephone hotlines. Over the last five years, Member States and WHO had achieved much together. Many
excellent partnerships had been formed. He thanked the health workers that the Member States represented, for their hard work and dedication. He said that, as mentioned by Dr Lee that morning, it was important that WHO should place its greatest emphasis on work at the country level. WHO's whole reason for being was to support its Member States. Over the last few years WHO had been working hard to improve the quality of its collaboration with countries in the Region and he pledged to its Member States that this would continue. WHO would be with its Member States, not only in times of crisis like SARS, but also in carrying out long-term capacity building. There was still much to be done, but with the levels of determination and drive that Member States had already shown, the Regional Director was confident that together they would succeed. Dr NAN ALU (Fiji) commended the Regional Director's report, which was readable, informative and comprehensive. He suggested that future reports should provide information on the implementation of programmes financed by country allocations in alternate years, following the
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conclusion of a biennium. Such information would serve as an evaluation of performance and as a tool to facilitate planning for future activities and for future programme budget allocations, in particular at the country level. He wished to comment on regional focuses that were not covered by subsequent items on the agenda. In respect of Healthy Settings and Environment, he thanked WHO for the support given for provision of consultants to facilitate the review and finalization of Fiji's Food Safety Bill, which had been passed in August 2003. The Public Health Act was undergoing a similar process of scrutiny and should be finalized early in 2004. It was designed to plug gaps in the regulations concerning communicable disease control that had been revealed during the recent SARS outbreak. Fiji thanked the Government of Australia for the funding provided over the last five years for its national health reform process. Emphasis had been given to a decentralized management structure that would facilitate decision-making related to patient care and institutional and health service management. The mortality from the cyclone that had affected Fiji, especially the second largest island Vanua Levu, early in 2003, had been the highest of any natural disaster in the past three decades, and had emphasized the need for emergency-preparedness, especially during the season for such events. He expressed appreciation for the donation of funds from WHO that had financed the purchase of insecticides and rodenticides for use following the cyclone. Mr OTSUKA (Japan) commended the Regional Director and his staff on the report, in particular those units responsible for writing and editing the text. The report fulfilled the need to keep Member States well informed about the work of the Regional Office in a concise and readable format. The report covered the SARS outbreak, which had eventually been contained thanks to the commitment of WHO in assisting Member States, and was dedicated to Dr Urbani who had lost his life during that effort. He expressed his condolences to all those who had died from the disease and suggested that, to honour their memory, WHO should publish a special record of the outbreak. Japan had given priority to control of communicable diseases, including tuberculosis, since the 1997 G8 Summit in Denver, United States of America. He therefore welcomed the progress achieved since the declaration of a tuberculosis emergency in 1999 and the indication that the Western Pacific was the most advanced region in its implementation of Stop TB. In view of the increasing number of reports on medical accidents, he welcomed the ongoing
discussions on provision of patient-centred services and looked forward to the outcome of those
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discussions. He assured the Regional Director of Japan's commitment to working with WHO to tackle the many complex public health issues in the Region. Mrs PIERANTOZZI (Palau) endorsed a holistic approach to patient care and safety and therefore welcomed the emphasis being given by the Pacific island nations to the development of social structures and the translation of spirituality into more tangible initiatives. Well-being should include social and spiritual as well as physical and mental health. WHO should support social marketing of health promotion as a means of achieving health for all. Mr MOON (Republic of Korea) commended the report and its coverage of the SARS outbreak, which had emphasized the importance of reliable surveillance. The unselfish commitment of the health workers involved had alerted the world to the measures needed to combat such threats, regardless of economic and social losses. His Govemment stood ready to participate in efforts by WHO to improve global surveillance systems. The Ministry of Health and Welfare in his country was collaborating with the Ministry of Finance to implement the Tobacco Free Initiative. Prices of tobacco would be increased by almost 60% and a target had been set to reduce the proportion of adult smokers in the population from 55% (030% or less by 2007. Funds generated by tobacco price increases would be used to strengthen the public health system, promote smokers' health, and reinforce the fight against cancer. It was hoped that the various initiatives would bear fruit and that the Republic of Korea could share its experiences with others. He thanked the Member States of the Region for supporting the appointment of a national from his country as the new Director-General of WHO, and expressed confidence that they would continue to cooperate closely with WHO in working to enhance the level of health of people in the Region. Dr WANG (China) commended the improved format of the report, which had taken into account the requests made by Member States at the previous session of the Regional Committee. The executive summary was particularly useful. However, with further changes, the report could be made even more useful to Member States and WHO's other partners. The work of WHO in the previous year had attracted worldwide attention, in particular the advice and guidance given to countries affected by the SARS outbreak. He expressed appreciation to WHO and Member States for their solidarity, trust and support during that emergency. He was certain that, with such a spirit of cooperation, WHO and its Member States would prevail over similar future challenges. He urged WHO to continue efforts to control emerging and re-emerging communicable diseases, especially in those countries experiencing a dual burden of communicable and
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noncommunicable diseases, as well as social and economic transformations that were producing changes in the disease spectrum. In China, for example, recent floods, other environmental effects and changes in public health measures had led to a resurgence of schistosomiasis, which required renewed attention. Countries should exchange information on health system reform in order to promote coordinated social development. He thanked WHO for the support given to China and looked forward to future cooperation with the Organization. Mr UNA (Solomon Islands) expressed appreciation to all those governments in the Region that had provided military assistance in restoring law and order to his country following the recent period of civil unrest. He agreed with previous speakers that more progress was needed in regard to the migration of skilled health professionals. The code of practice initiative discussed at a previous meeting would be a useful instrument and he looked forward to hearing of progress with regard to its implementation. As indicated by Figures 2.1 and 2.2 in the Regional Director's report, malaria remained a serious public health problem in Solomon Islands. He was, therefore, pleased to learn that a new malaria specialist would take up a post in his country soon and expressed the hope that, with the return oflaw and order, and with the promise of funding from the Global Fund, the community would once again be able to focus on efforts to fight the disease. He welcomed the emphasis on healthy settings and the environment and the key elements of primary health care in the report. He also looked forward to continued support from WHO for surveillance of vaccine-preventable diseases and increased coverage of the Expanded Programme on Immunization. He thanked all the organizations and governments that had provided support for the reconstruction of the health services in his country. Mr JOREDIE (France) thanked the Regional Director for his full and clear report, and for providing a French translation in time for it to be studied. The report showed what the Regional Office and the countries had accomplished in the Western Pacific Region, where so much remained to be done towards health for all. The SARS epidemic had demonstrated both that a new disease could become a serious pandemic, and that vigilance and immediate, full mobilization of national public health services and international organizations could stop it. The disease had taken its toll, and it was likely that such situations would recur.
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The Expanded Programme on Immunization had shown the way to eradicate certain diseases, and that work should continue. New Caledonia was proud of its programme in that area, since it had very high levels of coverage, and none of the principal diseases covered by the programme had been in evidence for several years; there had been no case of measles for seven years, and no epidemic for 15 years, thanks mainly to a catch-up campaign. However, there were a few cases of hepatitis among adults. For tuberculosis and leprosy, New Caledonia supported the programmes established by WHO, and had instigated direCtly observed treatment, short-course (DOTS) the previous year, in order to accelerate the steady reduction in numbers of cases. New Caledonia looked to WHO for increased support in preventing transmission of HIV and other sexually transmitted diseases. He praised the support of WHO and the Pacific Community in monitoring of communicable diseases, which he saw as an excellent way of joining forces and institutions, both to control public health problems and to improve reaction time and efficacy of response. The coordination of international organizations also helped to rationalize demand for data from countries. The report showed that noncommunicable diseases represented one of the major threats of the 21 st century and he thanked WHO for the remarkable achievement of the WHO Framework Convention on Tobacco Control. New Caledonia was preparing draft regulations in that area. Dr SULEIMAN (Malaysia) commended the various achievements of the past year, including the successful containment of the SARS outbreak thanks to the strong global leadership shown by WHO and the cooperation of the Member States of the Region. He welcomed the integrated approach to health protection and promotion using the healthy settings approach, the implementation of national plans of action on child and adolescent health, and reproductive and maternal health, and the focus on noncommunicable diseases, including the adoption of the WHO Framework Convention on Tobacco Control. Although Malaysia had made good progress in improving the health of its people, problems remained, such as the high levels of malaria and tuberculosis mainly among iJlegal immigrant workers. He assured WHO of his country's continued cooperation with the Regional Office. Mr DAVIES (Australia) joined previous speakers in commending the report, which highlighted the wide range of WHO's work in the Region and demonstrated the balance achieved between activities to promote disease prevention, undertake health system reform and improve accessibility of health services. Tackling the dual burden of emerging noncommunicable diseases and the continuing prevalence of communicable diseases was a particular challenge. Australia had been saddened by the loss of life resulting from SARS, but had welcomed the prompt action taken by WHO to contain the
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outbreak and the opportunity to make a contribution to that effort. He endorsed the regional framework for health promotion and expressed a readiness to give increased emphasis to health promotion, which was cost-effective and also improved quality and length of life. Australia was committed to ensuring that prevention became a fundamental component of a more effective and sustainable health care system. The support provided by the Regional Office in the area of health policy and legislation would provide a valuable framework for the provision of high-quality health and clinical services that were affordable and accessible. He looked forward to future reports during the Regional Director's second term of office. Dr Bounkouang PHICHIT (Lao People's Democratic Republic) congratulated the Regional Director on the quality of his report. The many analytical data clearly showed the health situations in the various countries of the Region. Although the mortality rates for mothers, infants and children under five in his country were very high, a recent survey had shown some improvement in the overall health of the people. Nevertheless, there were still huge gulfs between poor and rich countries in the Region, and further efforts should be made to improve the quality of life of affected populations by reducing poverty. He thanked WHO, other international organizations and a number of countries for their continuing technical and financial support in helping to reduce the disparities and the prevalence of avoidable infectious diseases. Mr UNTALAN (United States of America) commended WHO and the Regional Office for its work in containing the SARS outbreak. A coordinated response, including strengthened surveillance and contingency plans, should, however, be maintained to ensure that the disease did not re-emerge or become endemic. The Region could be proud of its poliomyelitis-free status; nevertheless, surveillance for acute flaccid paralysis must be continued and integrated with surveillance for other communicable diseases, and laboratory testing. Further development of human resources should include training in field epidemiology and laboratory methods. His country considered that high rates of immunization coverage should be maintained and that a target date should be established for elimination of measles in the Region. The United States of America was in favour of preventive intervention with regard to high-risk behaviour for sexually transmitted infections, including HIV. The report lacked an integrated approach to changing behaviour, such as encouraging delay of sexual initiation and abstinence among young people and promoting fidelity and a reduced number of partners. His country was concerned that the existing approach would inadvertently support or condone prostitution in the Region. The report also lacked sufficient emphasis on preventing drug use and HIV infection. Certain components of the Region's harm reduction programme might inadvertently promote and condone drug use. The
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Regional Office should emphasize evidence-based programmes and interventions for injecting drug use. His country supported WHO's integrated, evidence-based global strategy for the health of children and adolescents and looked forward to discussions on family health in 2004, which would be the tenth anniversary of the International Year of the Family. The United States of America was committed to strengthening global public health capacity by training, collaborative research and technical support. Dr TRAN THI TRUNG (Viet Nam) noted that the report mentioned a decrease in external funding for malaria control for Cambodia, the Lao People's Democratic Republic and Viet Nam. That would imperil the progress made in malaria control over the past decade, and more support from WHO was needed. Much progress had been made in the control of tuberculosis in the Region since the inception of the Stop TB programme. A recent evaluation of the programme in her country showed that all districts were covered by the DOTS strategy, 81 % of all new cases were detected and 89% were cured. The new challenges to the programme were to find funding after 2005, to counteract the increasing trend of co-infection with HIV in some provinces and to encourage the involvement of the private sector in implementation of DOTS. The support of WHO in resource mobilization and continued technical support would be required. An estimated 55 000 new cases of AIDS were being diagnosed in the Region, but only a small
proportion of those patients had access to care and antiretroviral treatment. A national strategy for HIV/AIDS control was being developed in Viet Nam, and support was expected from the Global Fund to Fight AIDS, Tuberculosis and Malaria for strengthening the care, counselling and support of people living with HIV/AIDS, and for related community-based activities. The Ministry of Health had proposed a doubling of funds to buy antiretroviral agents and was considering local production. The recent outbreak of SARS had highlighted the need to strengthen disease surveillance and response in the countries of the Region, and Viet Nam was looking to WHO and other partners to provide the necessary support. Her Government had decided to sign the WHO Framework Convention on Tobacco Control, and several activities had been initiated, including a smoke-free policy for the Twenty-second South East Asian Games and the ASEAN Para Games 2003, which were to be hosted by Viet Nam at the end of the year. Dr MANN (Papua New Guinea) commended the Regional Director for his clear, comprehensive report. His Government had been encouraged by the success of Cambodia in its fight
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against HIV/AIDS, described in the report. He thanked his country's development partners in the Region and various international and national agencies. The fight against the SARS epidemic had, however, revealed a previously unrecognized problem: the issue of insurance for health workers. That issue and poverty reduction with sustainable development were areas on which countries should be given guidance by WHO. Mr KALPOKAS (Vanuatu) said that the report illustrated the dedication of the Regional Office to its Member States and showed that governments could cooperate effectively, as in the containment of the SARS epidemic. Cooperative campaigns had also been waged successfully against a variety of re-emerging and new scourges, such as yaws, malaria, lymphatic filariasis, tuberculosis and poliomyelitis. Nevertheless, he agreed with the Regional Director that there was no room for complacency, especially in view of the rising prevalence of sexually transmitted infections and of noncommunicable diseases. Emphasis should be placed on the promotion of public and family health. Dr BENJAMIN (Federated States of Micronesia), recalling that his country was one of two in the Region in which leprosy was still a public health problem, said that his Government would continue to make a concerted effort to eliminate it. That would require WHO support, in addition to valuable assistance from private donors. Dr GALON (Philippines) expressed her country's appreciation for the guidance of the WHO Representative in controlling the SARS epidemic and his active involvement in other national public health activities. She also commended the Regional Office for its assistance in the formulation of her country's proposal to the Global Fund. The support from that Fund would accelerate achievement of the Millennium Development Goals by the Philippines. As her country appeared to be prone to both natural and man-made disasters, the support of WHO in the development of systems and capacitybuilding in health emergency and disaster management was appreciated. She also acknowledged the help given by the Regional Office in improving access to essential drugs. She looked forward to support for implementing health insurance, health sector reform, intensified surveillance, healthy lifestyles, tobacco control and waste management, including waste from health facilities. Dr THORNE (United Kingdom of Great Britain and Northern Ireland) commended the report and in particular the proposed programmes for quality of care and patient safety. She also asked for further information on the strategies foreseen for strengthening communicable disease surveillance and response systems and the capacity to detect and provide early warning of outbreaks. She welcomed the draft guidelines on antimicrobial resistance.
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Dr PARE (Cook Islands) said that the Regional Director's report was an improvement over previous ones. It clearly outlined both the achievements and the challenges that lay ahead. He was convinced that the Region, in collaboration with its various partners, would continue the advances made. Dr KIENENE (Kiribati) noted with appreciation that the report included the data submitted by Member States and had a useful executive summary. The description of the SARS epidemic was not complete, however, and he asked for the information to be updated. The statistical annexes were useful because they highlighted figures that were important at the global level for achieving the Millennium Development Goals. It was essential to look at issues from both a regional and a global perspective. At the invitation of the CHAIRPERSON, statements were made by representatives of the Nippon Foundation and Sasakawa Memorial Health Foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the International Federation ofOtorhinolaryngological Societies.
The meeting rose at 17:00.
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WPRJRC54/SRl3 SUMMARY RECORD OF THE THIRD MEETING (Who Conference Hall, Manila) Tuesday, 9 September 2003 at 09: 15 CHAIRPERSON: Dr Manuel DAYRlT (Philippines) CONTENTS page 1. 2. 3. 4. Address by the incoming Chairperson ............................................................................. . Report of the Regional Director (continued) ................................................................... . Programme budget 2002-2003: budget performance (interim report) ............................. . Proposed programme budget: 2004-2005 ........................................................................ . ANNEX - Address by the incoming Chairperson ................... ............. ............................ 100 100 101 105 115
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1.
ADDRESS BY THE INCOMING CHAIRPERSON: Item 4 of the Agenda The CHAIRPERSON addressed the Committee (Annex).
2.
REPORT OF THE REGIONAL DIRECTOR: Item 8 of the Agenda (Document WPRlRC5412) (continued) The REGIONAL DIRECTOR, responding to comments and quenes made on his report,
grouped his replies by theme. In response to the suggestion by the representative of Fiji that in future he should include information on the implementation of programmes financed by country allocations in his report, he proposed that such information be incorporated instead into the reports on budget performance. The representative of China had asked that the report be made accessible to a wider public. In his view, one of the main purposes of his report was to provide detailed explanations to Member States of how the Regional Office had responded to their health needs and problems. That information would not necessarily be of interest to other readers. A balance would need to be struck between accountability to countries and accessibility to a broader public. He would consult with Member States on ways of making the report more accessible. Several representatives had emphasized the importance of strengthening surveillance for severe acute respiratory syndrome (SARS). Discussions had been held over the past few months with various agencies, and the Asian Development Bank had agreed to provide substantial support. At least four additional experts would be stationed at the Regional Office and would travel to countries in the Region to advise them on strengthening surveillance and laboratory systems for SARS and other infectious diseases. The representative of Japan had suggested that a special publication be prepared on the SARS outbreak; the representative of Kiribati had also asked for a complete record. A booklet was already being prepared, based on reports from countries on how they had handled the crisis, which he hoped would be distributed by the next session of the Regional Committee. The representative of the United States of America had warned that the approach advocated by the Regional Office for combating HIV/AIDS might promote promiscuity. He agreed with the representative that it was essential to promote healthy behaviour, including sexual abstinence and fidelity, but it was also critically important to deal with the reality of high-risk behaviour through evidence-based strategies. He noted that the two countries in which leprosy was still a public health problem had stepped up their efforts to reach the regional target of elimination, with the support of the Sasakawa Memorial Health Foundation.
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He was pleased to note that several countries in the Region had signed the WHO Framework Convention on Tobacco Control, and the representatives of the Republic of Korea and Viet Nam had expressed their strong commitment to that treaty. As the Director-General had said, however, signature was only a first step towards implementation of the provisions. In response to the comments of the representatives of several countries concerning health sector reform, he said that much progress had been made in that respect over the past five years. The representatives of Japan and the United Kingdom had stressed the importance of patient safety, and the representative of Palau had endorsed a holistic approach to patient care. More attention would be paid to improvements to patient care and safety in the future. In some countries, medical services in the Region had reached a level that would allow more attention to be paid to their quality, and not only to the quantity. There being no further comments, the CHAIRPERSON requested the rapporteurs to draft an appropriate resolution. 3. PROGRAMME BUDGET 2002-2003: BUDGET PERFORMANCE (INTERIM REPORT): Item 9 of the Agenda (Documents WPRJRC54/3 and WPRlRC54/3 COIT.l) The REGIONAL DIRECTOR, introducing the interim report on the budget performance for the biennium 2002-2003, contained in document WPRJRC54/3, said that it gave details of the financial implementation of the regular budget and extrabudgetary sources from 1 January 2002 to 31 May 2003. It also provided information on programme outcomes, covering the period from 1 January 2002 to December 2002. That information was based on a mid-biennium assessment exercise that had been conducted by all focuses and country offices. He said that detailed information on WHO activities during the biennium could be found in the Regional Director's reports for 2001-2002 and 2002-2003. The interim report was intended to keep Member States informed of developments since the budget proposals had been presented to them in 2001. It was part of the process of transparency that was a feature of financial reporting in the Region. He explained the details of financial implementation, which were outlined in Annexes 1 and 2 of the document. Annex 1 showed the changes in the overall amount of the original budget between its presentation to the Regional Committee in September 2000 and 31 May 2003. Annex 2 showed the status of financial implementation by theme and focus. Column 2 of that annex showed the changes due to efficiency savings and other programme changes. The appropriation resolution adopted by the Health Assembly in May 2001 for the financial period 2002-2003 had encouraged Dr Brundtland to continue her efforts to effect efficiency savings,
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in accordance with resolution WHA52.20, to be applied towards the required adjustments for cost increases and currency fluctuations. An additional US$ 1.3 million, largely from staff-related costs, had been distributed to a number of programme activities. After those changes had been made, the operating budget was as shown in column 3. The total regular budget obligation incurred by 31 May 2003 was US$ 55 845 698, representing 77 .68% of the effective working budget. Preparation and control activities to combat the outbreak of SARS in the Region had been given high priority, and that had delayed implementation of some activities of lower priority, including several meetings. Now that SARS had been successfully controlled, he expected that regular budget funds would be fully obligated by the end of the biennium. The extrabudgetary funds used for regional and country activities appeared by focus in Annex 2, column 6. The total obligation, as at 31 May 2003, was US$ 43 183 627. Columns 7 and 8 showed total implementation of all funds and implementation by focus as percentages of all funds used. All country offices and focuses had undertaken a mid-biennium assessment of programme budget implementation. Annex 3 showed the outcome of that exercise and described progress towards the achievement of expected results, as had been requested by the representatives of several Member States at the fiftieth session of the Regional Committee. The final report on the budget performance would be presented to the Regional Committee at its fifty-fifth session in 2004. Dr UEDA (Japan) welcomed the format of the interim report, which correlated with information contained in the Report of the Regional Director and the programme budget for 2002-2003. Noting with satisfaction the financial implementation rate and the volume of
extrabudgetary resources expended, he urged WHO to make every effort to deliver its programmes as planned. Mrs PIERANTOZZI (Palau) expressed her concern that the regular budget allocation to the Region was decreasing, despite rising costs and unexpected challenges. The Region's sound
performance and greater efficiency seemed to lead only to reductions that benefited other regions. Mrs BLACKWOOD (United States of America) commended the report's clear presentation of information, particularly Annex 3. The Region had made good progress, which reflected the
usefu lness of results-based budgeting and the definition of clear and measurable indicators.
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Dr SELUKA (Tuvalu) welcomed the report, which provided health managers with the information they needed to make rational decisions for future planning. He thanked WHO for its support, which had made it possible to finance postgraduate training for health professionals. Dr WANG (China) observed that successful performance, as reflected in the implementation rate, was the result of close cooperation between WHO's Member States and secretaliat, which should be maintained in order to ensure full implementation of programme activities. Noting the reference to the mid-biennium assessment, he asked how that exercise had been conducted. Had it indicated any problems in programme implementation? If so, what measures had been taken to solve them? Future assessments should cover, not only programme activities, but also problems encountered and challenges for the future. Dr LOPEZ (Philippines) commended the clear and transparent presentation of budget allocations and the use of funding. He thanked WHO for its support for his country's poliomyelitis immunization campaign and its health sector reform, which had been financed from extrabudgetary resources. Dr Nao BOUTI A (Lao People's Democratic Republic) expressed his appreciation that regular budget allocations to least developed countries had not been reduced. Although such financing was intended for strategic interventions, a major problem in his country was lack of funds to cover "local costs". It had used WHO allocations to cover shortfalls in the health sector budget, but amounts that could be used in that way were limited to 15% of the total. He requested that that limit should be reviewed. Dr KING (New Zealand), referring to identification of priorities for expenditure, pointed out that the Regional Director's report had shown that the mortality rate was high for noncommunicable diseases, and that a few risk factors accounted for a considerable part of the global burden of disease. Why, therefore, had the largest budgetary reductions been made in such areas as community health, noncommunicable diseases and mental health? If such areas were identified as priorities, they should be followed through in term of programmes. Dr MANN (Papua New Guinea) asked if it was possible to indicate what percentage of extrabudgetary resources had been earmarked for each country. The REGIONAL DIRECTOR said that he would respond to Palau's intervention under agenda item 10, Proposed programme budget: 2004-2005. Referring to queries raised by the representative of
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China concerning the mid biennium assessment, he explained that that exercise was to be conducted at the end of the first year of each biennium for all focuses and all countries, in order to ascertain problems encountered and gauge progress towards expected results. The assessment had indicated that, overall, all countries and focuses had made reasonable progress. However, the speed of the exercise and its quality and depth of understanding could be improved; staff were being trained for that purpose. rectified. Responding to the question raised by New Zealand, he explained that resource allocations had to be reprogrammed in the course of implementation. Whether a programme was a priority or not, some adjustment was inevitable. Reductions in one area meant increases in another, where the need was greater. The SARS outbreak was a case in point: reprogramming had made it possible to allocate resources to several countries, including from extrabudgetary resources, and resources for Communicable disease surveillance and response had increased. Healthy settings and environment had received additional resources for activities in food safety, health and environment, and health promotion. Although the final allocation to Healthy settings and environment was lower than He agreed that any problems identified should be recorded so that they could be
originally planned, a minor reduction in no way meant that those activities were no longer a priority. Certainly health promotion and healthy settings were among the most important issues that had to be tackled in the coming years, and he hoped allocations could be increased in the next biennium. In reply to Papua New Guinea, he recognized that the allocation of extrabudgetary resources among the three levels of the Organization lacked transparency. Some funds were earmarked by donors for specific purposes; others had no strings attached and were given to the Organization as a whole. However, it was often difficult to know how much had been received, or how it would be allocated to regions and countries. It had been proposed that principles governing the allocation of extra budgetary resources should be drawn up, but that suggestion had not yet been taken up. The Director-General had indicated that the use of extrabudgetary resources would be based upon country needs, and that Member States would know the level of their allocations at the beginning of the budget cycle. He pointed out, however, that, unlike the regular budget, there were inherent difficulties in projecting the amount of extra budgetary funding for the biennium. The DIRECTOR, PROGRAMME MANAGEMENT, responding to the query from the representative of the Lao People's Democratic Republic, explained that the 15% limit on "local costs" was an Organization-wide policy. WHO tried to use its limited resources at country level for such strategic activities as training or policy development; they were not intended to supplement national budgets or to cover recurrent costs. It was unlikely that that policy would change.
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4.
PROPOSED PROGRAMME BUDGET: 2004-2005: Item 10 of the Agenda (Documents WPRJRC54/4, WPR/RC54/4 Corr.! and WPR/RC54/INF.DOC.ll) The REGIONAL DIRECTOR presented document WPRJRC54/4 - Proposed programme
budget: 2004-2005. At the fifty-third session of the Regional Committee, he had presented a proposed programme budget for 2004-2005 that had consisted of three parts: the global budget, the regional overview and the indicative country planning figures for the Region. Members States 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 the detailed plans. In preparing the budget, the General Programme of Work for 2002-2005 and WHO in the
Westem Pacific Region: Aframeworkfor action had provided the global and regional orientations. The proposed programme budget was contained under the four themes that guided WHO's work in the Region (Combating communicable diseases, Building healthy communities and populations, Health sector development, and Reaching out and programme management), as well as Administration and finance. These themes were broken down into focuses. The budget was also presented under countries and areas of the Region. Document WPR/RC54/4 was an expansion of the regional overview that had formed part 2 of the document the Regional Director had presented to the Regional Committee at its fifty-third session. It had been prepared according to the principles of results-based management. Regional objectives
and expected results had been developed for each focus, bearing in mind the relevant goal, objective and expected results from the related global areas of work and the needs of the Region's Member States. Country goals and objectives were in line with the corresponding goals and objectives of regional focuses. Performance indicators would be used to monitor progress regularly and would be used as the basis of assessments of programme budget implementation, conducted at six-monthly intervals. In order to improve alignment with the global areas of work, for the 2004-2005 biennium, the
focus on Health systems reform had been split into Health systems development and financing, and Health technology and pharmaceuticals. Another new focus, Programme planning, monitoring and evaluation, had been added, reflecting the importance attached to that part of WHO's work. Activities to strengthen WHO's
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presence in countries were included in that focus. This reflected WHO's determination to strengthen its country presence. The proposed programme budget for 2004-2005 was the second in the Western Pacific Region to use the principles outlined in resolution WPRJRC50.RI, adopted by the Regional Committee at its fiftieth session. That resolution had been designed to make the process of determining country allocations more transparent and to ensure that it was based on objective criteria. As a consequence of the appropriation resolution adopted by the Fifty sixth World Health Assembly, the regional allocation for 2004-2005 was US$ 71 540000. The distribution of resources among the six regions continued to be governed by a resolution on the review of the constitution and regional arrangements, adopted by the World Health Assembly in 1998, resolution WHA51.31. At its fifty-third session, the Regional Committee had expressed
concern at the continuing negative effect of that resolution on country planning figures and regional resources. Over three bienniums, the Western Pacific Region would have lost almost US$ 9 million. The Region's allocation for 2004-2005 was 2.4% less than for the current biennium, largely as a result of a reduction of US$ 1 957 000 due to the implementation of resolution WHASl.31. Further information on the impact of resolution WHA51.3l could be found in the information document entitled Regular budget allocations to regions. That document consisted of two parts: part 1 was a note for regional committees on regular budget allocations to regions, prepared by the WHO Headquarters secretariat; and part 2 was the perspective of the Western Pacific Regional Office secretariat and included information on the impact on the Region of the use of the model to determine regional allocations. Of the total regular budget for 2004-2005, 56% had been allocated to country activities. The remaining 44% had been allocated to regional and intercountry activities. In response to the continued emergence of threats to public health, including severe acute
respiratory syndrome (SARS), and following concern expressed at the Fifty-sixth World Health Assembly, an additional US$ 500 000 had been allocated to the Western Pacific Region for implementation of the Revised International Health Regulations. Dr NAIV ALU (Fiji) thanked the Regional Director for the clear and informative presentation of the proposed programme budget 2004-2005. Resolution WHA51.31 had been the subject of
discussions for the past five years. The reduction of US$ 8.7 million over three bienniums was
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significant, with implications varying from country to country and affecting even the internal workings of WHO. Fiji reaffirmed its support for resolution WPRlRC53.R2 which had been adopted by the Western Pacific Region in September 2002. It had called for the implementation of resolution
WHA51.31 over three bienniums only, ending at the conclusion of biennium 2004-2005. Resolution WHA51.31 had necessitated the Fiji Government providing additional funding for its important health programmes, specifically HNIAlDS, dengue fever, filariasis, leptospirosis and reproductive health. Another adverse impact had been the reduction of intercountry posts in the regional office, involving EPI, Environmental health, Health promotion and Health informatics. The WHO South Pacific Office had lost three intercountry posts and responsibilities had had to be shared among the staff. In line with enhanced measles and hepatitis B control efforts, Fiji would like appropriate
officers to be identified and recruited to manage those programmes, including an EPr programme officer to coordinate activities in all the Pacific island countries. He believed that with vision and planning, WHO and Member States, in partnership, would be able to sustain the present !evel of achievement in health in the Region despite a reduced budget allocation. That had been demonstrated in the past biennium and he was convinced that it could be done again.
Dr SULEIMAN (Malaysia), while welcoming the proposed programme budget 2004-2005, said that the reduction in the regular budget would require more modest activities and optimal use of funds. Malaysia considered the four themes of Combating communicable diseases, Building healthy communities and populations, Health sector development, and Reaching out and programme management as significant areas of concern. Also important were evidence-based proposals that would ensure sustainable and equitable financing of the health system which could protect health and reduce mortality, morbidity and disability. Globalization and its effect on the national health system had also been important to Malaysia and greater attention would be paid to health sector development. The presentation of the proposed programme budget, with clear goals, objectives, indicators and strategies, could be used as a useful guide, not only for assessment and follow-up action, but also for comparison against budget performance. Dr WANG (China) said the proposed programme budget truly reflected the challenges and problems facing the Region. It had also taken the global targets into consideration and thus it would be easy to measure the expected results during the biennium.
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In the process of fonnulating the budget, WHO had been able to strengthen programme
management training in order to improve the quality of country budgeting, and he hoped that such training would continue in future. At the fifty-third session of the Regional Committee, China had voiced its concern over the proportion of global extrabudgetary resources allocated to the Region. For 2004-200S, he hoped that WHO would take advantage of extrabudgetary funds to build up programme management and public health. The country budget had been prepared at the end of 2002. However, the SARS epidemic had occurred during the first half of the present year, and he wondered whether there would be adjustments as a result. The reduction in the regular budget for three consecutive bienniums had not only had a negative impact on regular activities at national level, it had also seriously affected personnel arrangements and capabilities at regional level. He recommended that the provisions of resolution WHASl.31 should cease and a thorough evaluation of the current appropriation model be conducted so that WHO's resources could be rationally distributed and utilized in accordance with actual needs. Dr TANGI (Tonga) expressed concern about the country allocations and suggested that the representatives look more critically at resolution WHAS1.31. That resolution clearly indicated that the reduction for any region would not exceed 3% per year, which had been done, and that the reduction should be spread over a period of only three bienniums, 2000-2001, 2002-2003, 2004-200S. He had heard that some regions were trying to spread the reduction over a longer period, instead of ending it in 200S. He reminded representatives that, in Kyoto in 2002, they had agreed, in resolution WPRlRCS3.R2, that the reduction should end in 200S, and he wished to re-emphasize that point. He wondered whether that had been discussed by the Executive Board. If not, he requested the members of the Executive Board from the Region to put that point across very clearly at the next meeting. He gathered that 40% of the overall budget came from regular budget or regular donations of Member States, and 60% from extrabudgetary resources. In 2000-2001, the Western Pacific Region had received only 3.3% of this figure and in 2002-2003, only 4%. He felt that there had been a lack of transparency and that the regions had no say in detennining how funds were to be distributed. He sincerely hoped that transparency in allocations would become a reality, as mentioned by the Director-General. Mr COURSE (France) noted with concern the increase in the proportion of funding from extrabudgetary sources, in WHO as in other international organizations. Although it helped to
increase technical cooperation, if extrabudgetary funding predominated, this could result in the
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funding of politically attractive programmes rather than essential health priorities.
He therefore
encouraged the Regional Director to develop a unified budget, as contemplated by the DirectorGeneral. He welcomed the extra resources for revision of the International Health Regulations, but regretted the reduction in regular budget allocations to combat communicable diseases, including AIDS. The link between global health safety, surveillance and information technology should be stated more clearly. He welcomed the increase in regional resources for tobacco control. Mr DUONG HUY (Viet Nam) asked that the figure for the population of Viet Nam on page 225 of document WPRlRC54/4 be corrected to 82 million. Noting that the budget allocated to the Western Pacific Region and to his country had been reduced, partly because of resolution WHA51.31, he pointed out that the net result for Viet Nam, as stated on page 234 of the proposed programme budget, was a reduction of almost 7% in the regular budget compared with 2002-2003. In view of the country's situation in terms of infant and child malnutrition, communicable diseases, AIDS, the trend in noncommunicable diseases, and the sustainability of tuberculosis and malaria control, WHO's resource mobilization and technical support would be needed. Professor ENG Huot (Cambodia) noted the reduction in the budget, much of which affected healthy settings and financing of health systems. He wished to know which activities would be sustained at country level in those programme areas. Given that country budgets constituted only a fifth of the total budget, he asked the secretariat to set out country budgets by source at the start of the budgetary period. In a multi sectoral context, that would help health ministries in countries such as Cambodia to prepare medium-term spending plans and to identify shortages in the health sector. Mr DAVlES (Australia) strongly supported WHO's results-based budgeting, and asked for reporting of higher-level outcomes as well as outputs, which would provide a useful indication of progress in addressing regional issues. WHO had to be able to demonstrate results in that manner, in order to gain and retain donor support. He recognized the financial pressures on the Regional Office, and called for continuation of tight controls over administrative and personnel costs. Since 1998, extrabudgetary funding had fallen, along with regular budget provisions. The Western Pacific Region received the lowest of any region's extrabudgetary funding. which was not appropriate, given the size of the Region and the health problems it faced. Australia provided US$ 6.5 million annually in extrabudgetary funds, in support of work that directly benefited the Region. That support was intended to focus attention on the needs of countries. He strongly encouraged WHO to formulate clear criteria for allocation of extrabudgetary resources in the Region.
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Dr KING (New Zealand) supported implementation of resolution WHA51.3l for three bienniums only. The formula had to be reviewed regularly to ensure it corresponded with reality. The review that produced the formula had been a move away from budgeting by precedent to budgeting in the light of equity and greatest need; the formula itself now had to be reassessed in the light of those same principles. She remarked that there was scant incentive to advance health if funding was cut when this was achieved. The system had to include incentives. She agreed with the representative of Tonga that the Western Pacific Region had to express its views on resolution WHA51.31 strongly at the next meeting of the Executive Board. Turning to extrabudgetary funding, she asked how it was allocated, whether the same allocation criteria applied across all the regions, whether the funding was earmarked, and whether moral judgments on countries or programmes were made in the process of allocation. If such judgments were indeed made, then perhaps it would be wise to wait and see where extrabudgetary funding went before allocating regular funds. She pointed out that the budget did not reflect total expenditure on health in a region, and that WHO should know how much was spent, and on what, before it decided where to allocate its resources. Mrs BLACKWOOD (United States of America) noted that the regular budget for 2004-2005 once again showed a decrease in line with resolution WHA51.31. That had been a decision by consensus in 1998, a hard one for the four regions that suffered cuts over three bienniums. WHO was to make a full evaluation of that process and report to the Executive Board and the World Health Assembly in 2004. That evaluation would cover the global impact of the resolution. The exclusion of Headquarters from that resolution was something that would need to be examined when the WHO Executive Board considered the issue. She approved the level of detail on allocations in the document under consideration, and the distribution of resources, but regretted that expected results and indicators were not always readily measurable. Baseline data should be available whenever possible to show whether results were
minimal improvements or substantial advances. She enjoined the Regional Office to continue to refine its approach. She welcomed the projected increase in extrabudgetary funding, but asked how sure the Regional Director was of receiving the US$ 140 million in question. The amount did reflect proposed requirements, but she wondered if the figure was realistic. The comparison of figures for 2003-2003 with those for 2004-2005, on page 9 of the document, showed a total of US$ 73 262 000 for 2002-2003, but that had never been the working amount: the
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final report showed it had been changed prior to implementation to US$ 71 578000, which meant that the budgetary reduction had not been as great as it appeared. She asked for that point to be taken into account in future presentations. Mr KIM (Republic of Korea) noted that the 2004-2005 country allocation for the Republic of Korea was 89% less than in the previous fiscal period; while he understood the rationale, he shared the concern of other countries about the implications for the Region. His country was paying Close
contributions as scheduled and was working hard to increase funding for the future.
connections existed between healthy settings, noncommunicable diseases and the Tobacco Free Initiative; there was a danger of overlapping or omission in the intersections between those programmes. Similarities in indicators in those programmes showed that coordination was important, and the secretariat should use an integrated approach to improve presentation of the budget plan for the next fiscal period. Indicators tended to be lacking in objectiVity; better indicators were needed to measure programme results as accurately as possible. Mr NAKAZAWA (Japan) referring to resolution WHA51.31 and the resultant 2.67% cut in the budget proposed for 2004-2005, asked for the effects of that resolution to be ended with that biennium. Japan's support for WHO was in two main areas: control of communicable diseases, and a geographical focus on the Western Pacific Region. Japan, therefore, had made a significant voluntary contribution to the Western Pacific Region, but the Region had not received sufficient extrabudgetary funding from Headquarters. He welcomed the Director-General's decision to devolve resources to country level, and proposed that a new mechanism for budget allocation be used from 2006 onwards, one which included Headquarters as well as the regions in the formula. The Western Pacific Region should receive more extrabudgetary funding. Dr LOPEZ (Philippines) regarded the 56% aIJocation to country activities in the proposed budget as evidence of the commitment by WHO as a whole and the Western Pacific Region in particular to strengthening its country presence, a trend which would increase in 2005-2006 as Headquarters devolved functions to the regions and countries. The additional information on each country and area in the Region, the expected results, indicators and estimates for extrabudgetary funding, and results-based programming, all accorded with the spirit of transparency evoked by the Director-General. He welcomed the new focus on Programme planning, monitoring and evaluation, along with the increase in funding from Headquarters for implementation of the revised hlternational Health Regulations, in response to emerging threats such as SARS. In preparation of the proposed programme budget, the General programme of work 2002-2005 and the Framework for action had been used; in view of ongoing United Nations reform and the focus on the Millennium Development Goals, some fine-tuning would be needed at country level.
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Mr MASlKEVANUA (Vanuatu) followed other speakers in encouraging WHO to continue to make its budget more transparent, and thanked the Organization for its approval of his country's successful implementation of its projects. The REGIONAL DIRECTOR thanked representatives for their comments and replied to the specific questions that had been raised. As the representative of Fiji had indicated, several posts across different programme areas in the Region had been cut, including an immunization post in the WHO country office in Fiji. Those cuts were a direct result of the impact of resolution WHA51.3I. He was currently trying to mobilize extrabudgetary funding to ensure continued implementation of the programmes concerned. Replying to questions raised by the representatives of China, Tonga and the United States of America, he explained that the Regional Office had estimated that the Region would be allocated around 7% of the extrabudgetary funds likely to be received by WHO during 2004-2005. While the overall level of the regular budget was known in advance of the biennium, since it was based on assessed contributions by Member States, extrabudgetary funding could only be predicted - a difficult process. The likely sum was arrived at through discussions with Headquarters, Member States and donors, taking various factors into consideration: indications by donor countries (whose budget cycles were often different to those of WHO) and organizations; evaluation of the current programme situation, including cuts made because of the impact of resolution WHA51.31; and estimation of future programme requirements, given the need to restore cuts to important programmes, and anticipated additional needs, such as strengthening of communicable disease surveillance. The representative of China had asked whether it was possible to adjust country programmes to meet unanticipated changes, for example by diverting allocations for noncommunicable disease programmes to cover unexpected requirements in communicable disease programmes, such as those arising from the recent SARS outbreak. Clearly, countries should have some flexibility in that regard. In reply to the representative of the United States of America, he confirmed that the regular
budget total approved by the Health Assembly for the Region for 2002-2003 had been US$ 73 million, while the working allocation available at the start of that biennium had shown a reduction to around US$ 71.5 million. The difference was due to sums withheld by the DirectorGeneral to cover the shortfall in collection of assessed contributions and additional security costs (2% and 0.3% of the total, respectively). He anticipated that similar adjustments would be made in respect of the regular budget for the 2004-2005 biennium so that once again the working allocation would be slightly less than the total shown in the proposed programme budget document.
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He agreed with the representative of New Zealand that it was important to see the whole picture as regards total expenditure on health in a region. Allocation of extrabudgetary funds was a complex process. Some funds were earmarked entirely for a particular country and activity while others were only partially earmarked. In the latter case, a donation made for a particular activity in one Region may be retained at Headquarters. Although it would in due course be spent on an activity in the specified Region, it would not necessarily be channelled through the Regional Office. Objective criteria for the allocation of extrabudgetary funds, and better monitoring and evaluation of their use was required to ensure greater transparency. The DIRECTOR, PROGRAMME MANAGEMENT, responding to comments from the representatives of the United States of America, Republic of Korea and Australia, explained that, under the results-based budgeting process adopted by WHO, the expected results and indicators in the regional proposed programme budget referred to what could be achieved by the WHO secretariat, in other words to WHO's manageable interest, while the objectives were the collective goals of WHO and the Member States. For example, an objective for tuberculosis was the strengthening of tuberculosis control programmes so that 70% of smear-positive cases could be detected. However, it was difficult to identify expected results and indicators that could be considered, strictly speaking, as WHO's manageable interest alone, one factor being that, once staff costs had been deducted, many regional and country programmes had very limited budgets (often much less than US$ 100 000). Nevertheless, work was continuing to refine the expression of expected results and indicators. Those for 2004-2005 showed improvements compared to those for 2002-2003, and it was hoped that, with guidance and training, staff would make further progress in that area in the future. The REGIONAL DIRECTOR, responding to a request for clarification from the representative of the United States of America regarding possible differences between the approved level of the regular budget for 2004-2005 and the working allocation provided at the start of that biennium, said that it was for the Director-General to decide on the strategy to be adopted nearer to the time of implementation. However, it was his understanding that sums of the order of those applying in 2002-2003 were likely to be withheld, for the same reasons. The CHAIRPERSON said that a consensus appeared to be emerging that the Regional Committee considered that resolution WHA51.31 should be re-examined at Executive Board level. He requested the Rapporteurs to prepare an appropriate draft resolution for consideration later in the session.
The meeting rose at 12:00.
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ANNEX ADDRESS BY THE INCOMING CHAIRPERSON I would like to welcome you all to the historic city of Manila, a melting pot of the Eastern and Western cultures, traditions and races. During your brief stay, I hope that you will discover the interesting facets and diversity of Filipino culture that make it unique, as well as the convergence points that we share with the entire global community. Distinguished representatives, I wish to thank you sincerely for giving me the honour and the privilege to be the Chairperson of the fifty-fourth session of the Regional Committee for the Western Pacific. It is an honour for me to chair this very important gathering especially at this time when all of us are being called upon to collectively take a fresh look at and face the emerging challenges of the new millennium. It is also significant that this is a time when the World Health Organization is turning over a new leaf in its leadership, at both global and regional levels. Dr J.W. Lee, who is no stranger to this Region, recently assumed the post of Director-General, and yesterday, the Committee nominated Dr Shigeru Omi for a second term as Regional Director for the Western Pacific Region. The Director-General, Dr Lee, shared with us his vision for WHO when he addressed the Fiftysixth World Health Assembly in May this year and our own body yesterday morning. He talked about the core values of security and justice, and thus the need for "leadership in the ongoing struggle for security from infections, and justice for those worst affected by diseases of poverty". This is very much in tune with what the Regional Director, Dr Omi, said yesterday about harnessing the Region's resources to address the health needs of the disadvantaged or those who for some reason may have been neglected. Dr Omi also spoke about advocating a holistic approach to health care and the need to develop or enhance the health infrastructure and I am sure that these issues will be on Dr Lee's agenda too. The "changing of the guards" has presented us with the many opportunities to take advantage of the vision and the leadership of Dr Lee and Dr Omi. We look up to this leadership as we chart new goals and directions in the face of changing realities. Dear Colleagues, recent events have underscored that in this era of globalization, our community of nations needs effective global health leadership. As mentioned yesterday by both the Director-General and the Regional Director, the threat of severe acute respiratory syndrome or SARS was a defining moment in global public health, especially for the Western Pacific Region. It
highlighted how a single new disease could bring out the best in our capacity to respond to a global
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Annex public health threat and to overcome the obstacles that came our way. At the outset, allow me to thank WHO, especially the Western Pacific Regional Office, for its leadership and unwavering support to Member States in the Region throughout the SARS outbreak and up to the present, as we continue our work to fully understand this new health challenge. Our collective experiences with SARS highlighted four important lessons. First, they
underscored the importance of achieving speed in surveillance and in identifying a public health threat at the global level. Second, it was critical that our health systems were consistent in their response, despite the inherent limitations we faced. Third, effective communication, within the global health infrastructure as well as with the general public, galvanized cooperation, not only from the public but from other sectors as well. And last but not the least, our credibility as the vanguards of public health allowed us to exert our influence over a situation and over sectors with remote and even distant mandates, which made an important difference in controlling the spread of the disease. This could not have happened without effective global health leadership. SARS taught us what public health may need to be in the years to come. We have seen and continue to be witnesses to how an inspiring and effective health leadership at the global and regional levels has steered us towards our goals of universal coverage for immunization, control of tuberculosis, reductions in the burden of disease from HIV/AIDS, ratification of the Framework Convention on Tobacco Control, and in protecting the gains we have made in primary health care. I look forward to our deliberations during the next few days, as these will clarify and guide us in translating these global objectives at country level. In today's globalizing world, the borders of the nation states have been blurred by the speed by which people, ideas and even biological agents can travel. Bold and strategic interventions are needed to ensure that the community of nations will work together to address these problems. Speed, consistency, communication and credibility - these must be at our command. Honourable Representatives, in the next few days, our discussions will also lead us to consider our response to challenges that are not new, but which demand our continuing attention and action. The growing burden of noncommunicable and other lifestyle-related diseases, the vulnerability of marginalized groups in a rapidly changing world, and unacceptable levels of infant, child and
maternal mortality in many countries still have to be addressed. I do believe that now is the time to take a serious look at how we have been addressing these problems, and to renew our commitment to ensuring a healthy population in the Region in the years ahead.
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Annex
In line with this, we must consider the infrastructure for health care that will enable us to respond to these challenges. The need to invest more in health, to use resources more effectively, to develop systems where equity is ensured and to build the capacity and the hwnan resources for the health sector are priorities. I therefore look forward to our round table discussion on Wednesday on the "Future directions for public health in the Region" when we will look at the evolving role of public health in our rapidly changing environment. Distinguished Representatives, there is a lot that is expected of us. However, I am confident that together, we will succeed. I look to WHO, even as it provides the global leadership in health, to also playa prophetic role by informing people about future trends and what may need to be done. And we, as members of this community of nations, must take on the challenges with resolve. At the same time we must be vigilant and seize opportunities to advance our work whenever and wherever we are called upon to do so. As we proceed with our work in the next few days, the need for effective global leadership must be at the back of our minds. But we must not define this leadership as something that elpanates and ends at the top, but as an enabling process that must be developed at all levels of our organizations in public health. I am talking about a leadership that we will take back to our respective countries where we make our mark and make a positive difference in the health of our people in these times of change. I would like to thank you for your trust and confidence when you elected me to be your chairperson. To my predecessor, Dr Hideo Shin ozaki from Japan, your excellent performance last year is worth emulating and inspires me to do my best to live up to all of your expectations. Once again, I welcome you to the Philippines and wish you all an enjoyable and fruitful stay.
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WPRJRC54/SRl4 SUMMARY RECORD OF THE FOURTH MEETING (WHO Conference Hall, Manila) Tuesday, 9 September 2003 at 14:15 CHAIRPERSON: Dr Manuel DAYRIT (Philippines)
CONTENTS page 1.
Expanded programme on immunization: measles and hepatitis B .................................. . Sexually transmitted infections, including HIY/AIDS .................................................... .
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EXPANDED PROGRAMME ON IMMUNIZATION: MEASLES AND HEPATITIS B: Item II of the Agenda (Document WPRlRC54/5) The REGIONAL DIRECTOR said that on 29 October 2000, in Kyoto, Japan, the Western
Pacific Region had been declared poliomyelitis-free. That historic achievement showed what the Region could do when the Member States and WHO all worked together. Today, two new initiatives for the Expanded Programme on Immunization (EPI) were being proposed, to build on its achievements to date. Those two new initiatives could stTengthen health services as well as the EPl. Immunization services needed to reach every child, and to keep reaching every new birth cohort indefinitely. Thus immunization could provide the foundation for other basic health services. Measles was likely to be the next target for global eradication once global eradication of poliomyelitis had been achieved. Earlier in 2003, the World Health Assembly had adopted a
resolution to reduce measles mortality, which was attached to document WPRlRC54/5 as Annex I. He believed that WHO and its Member States could eliminate measles from the Region. Three other regions had already established elimination goals. In fact for brief periods, the Region of the
Americas had even achieved elimination. However, without global elimination, the re-introduction of the disease was inevitable, and if immunization coverage was not maintained, virus transmission would become re established. That was why global coordination of efforts was so important. WHO and its Member States would not need to wait for global efforts to eliminate measles in the Region. If they could reduce the current disease burden, the benefits to the Region would be immediate. Immunization had already reduced the number of measles cases in the Region by 90% and the number of deaths by 95%. However, it was possible to prevent all of them and for the Region to once again show leadership in disease eliminatioll. To succeed in eliminating measles would reqUire three key strategies: immunization,
surveillance and laboratory support. A group of experts had helped WHO to devise a Regional Plan of Action for elimination, which was attached to document WPRlRC54/5 as Annex 2. The experts had recommended that regional elimination should be the goal for measles control, but, since measles control was at very different stages in different countries, it was proposed that the target date for elimination be set at a future date - based on an annual review of progress. The second proposed new pillar to strengthen the EPI was hepatitis B control. There was a very large burden of disease from hepatitis B in the Region. Although only a quarter of the world's population lived in the Region, it was estimated that more than half of all the hepatitis B-related deaths occurred in the Western Pacific. Every two minutes someone died from hepatitis in the
Region, usually from liver cancer in \ater life as a result of chronic infection acquired in early
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childhood. Those deaths could be prevented by hepatitis B immunization, although it would take decades before the full benefits of such immunization were realized. Hepatitis B vaccine was the only anticancer vaccine currently available. The Western Pacific was so far the only WHO region where hepatitis B vaccine was included in every national immunization programme. However, more work was needed to make sure that every newborn infant in the Region was protected from hepatitis B infection by the highly effective vaccine. So far, the hepatitis B control initiative had largely concentrated on strengthening routine immunization services, and making sure that every child received timely immunization. It was
particularly important that the quality of routinely reported immunization coverage data be maintained in order to monitor the programme. Hepatitis B was unlike other EPI diseases, as the impact of immunization on the disease was not easily measured, so coverage was the main way of monitoring the programme. He hoped that Member States would agree with WHO's proposal that measles and hepatitis B be selected as the two new pillars to strengthen the EPI, and looked forward to heruing about their experiences in measles and hepatitis B control, and their support for the new initiatives, including their readiness to establish a target date for regional measles elimination. Dr WAQATAKIREWA (Fiji) endorsed the proposal to include elimination of measles and
control of hepatitis B in the EPI. The objective of the hepatitis B control programme - a hepatitis B surface antigen (HBsAg) prevalence of less than 1% in five-year oIds - was challenging, but achievable. In view of a recent outbreak of rubella, Fiji had changed its immunization schedule so that
measles and rubella vaccine could be administered to all infants at 12 months. Rubella vaccination could also be included in the EPI, reflecting new patterns of disease occurrence and control efforts. Dr SULEIMAN (Malaysia) said that his country was fully committed to elimination of measles and control of hepatitis B. The measles elimination programme had been given high priority; a national plan had been established and targets set. Children would have a second opportunity for measles vaccination and surveillance systems would be improved through laboratory confirmation of suspected cases. Routine vaccination services were being strengthened in order to control hepatitis B, adhering to the strategies outlined in the regional plan. Mr UNTALAN (United States of America) applauded the inclusion of measles elimination and hepatitis B control in the EPI. Achieving and maintaining high immunization levels in all
communities was in the interest of national security and social equity, and his country strongly
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supported the efforts of the Regional Office to raise vaccination levels. He urged other Member States to endorse the initiative, and to assure the political commitment and financing needed for a successful immunization programme. Immunization programmes had notably reduced measles morbidity and mortality, bringing the Region close to elimination, and he looked forward to the setting of a target date. Lessons learnt from experience in different parts of the Region would guide future control efforts, including the need for adequate surveillance mechanisms. Dr YU (China) reported that, in 2002, the incidence rate for measles in China had been 4.76 per 100 000, with some 64 000 reported cases. China was currently conducting a project to strengthen routine immunization services, including measles control, in poor areas of the country, which should provide valuable experience. It had established a national measles surveillance plan in 1999, which had been amended in 2000 to set out specific regulations, including strengthening of the surveillance system through laboratory confirmation. China fully endorsed the strategies and activities set out in the regional plan of action for measles elimination. However, even though the plan indicated that target dates would be determined on the basis of annual reviews of measles control in each country, other factors needed to be considered. China's large popUlation, its huge surface area, imbalances between regions at different stages of development, efforts needed to maintain polio-free status, and lack of funding, all made it difficult to set a target date for elimination. China also agreed with the proposal to include hepatitis B immunization in the EPI. The Ministry of Health and Ministry of Finance of China had issued joint instructions in 2001 to include hepatitis B immunization in the routine immunization programme. Together with domestic financing, the programme was receiving strong support from the Global Alliance for Vaccines and Immunization (GAVI), particularly for providing supplies to the poorer provinces. China had recently redefined its targets for hepatitis B vaccination and control, including a HBsAg rate of less than 2% in children under three years old at provincial level. As the targets had been detennined after careful study of the actual situation in China, the proposed regional objective represented a considerable challenge. Dr RAHMAH (Brunei Darussalam) welcomed the consensus that measles elimination was technically feasible and agreed with establishment of the target date through a process of annual review. She also fully supported the regional plan for hepatitis B control and the requirements
defined to achieve the regional objective.
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Both measles and hepatitis B vaccination had been included in her country's national immunization programme for many years, resulting in coverage of over 95% and a significant reduction in the number of clinical cases. None the less, areas in need of further strengthening had been identified, with a view to achieving elimination. Dr SELUKA (Tuvalu) endorsed the regional action plans for measles elimination and hepatitis B control. The last outbreak of measles in Tuvalu had occurred in 1998 and had caused five deaths. The establishment of the Pacific Public Health Surveillance Network would make it possible to respond effectively to future disease outbreaks through the sharing of information. In that regard, an outbreak manual had been designed to enable staff in peripheral health clinics in Tuvalu to identifY and respond to suspected outbreaks. His country had one of the highest hepatitis B prevalence rates in the Region, despite high vaccination coverage. Research was required, with the support of WHO, to uncover the underlying contributing factors. Professor NYMADAW A (Mongolia) fully endorsed the regional action plans for measles elimination and hepatitis B control. However, a developing country could not eliminate measles alone, even with high vaccination coverage. Mongolia had long experience with measles
immunization. Following the introduction of measles immunization in 1973, the number of cases had dropped to zero, but this had not been sustained and outbreaks had returned to pre-vaccine-era levels. Since 1987, Mongolia's policy had been to provide a first dose after nine months and a second six months later. However, his country would be unable to meet the regional elimination target without strengthening its laboratory services. In order to achieve the target, a collaborative effort was needed, especially through a network of laboratories. Moreover, Mongolia's experience showed that the results of many years' efforts could quickly be destroyed if the vaccination schedule was not maintained every year. GAVI had calculated that US$ 30 was sufficient to protect a child for life. However, on average, immunization programmes accounted for only 3.2% of total health expenditures and less than 0.2% of GDP. GAVI was, therefore, requiring all countries eligible for funding to draw up a five-year financial sustainability plan. Mr JOREDlE (France) supported WHO's proposal to eliminate measles in the Region and to reduce the incidence of hepatitis B through high immunization coverage. The same method been used to eradicate poliomyelitis. The French territories in the Pacific had always been very anxious to have immunization coverage higher than 90% and they were near to achieving their goal for measles immunization.
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In New Caledonia, vaccination against hepatitis B at birth had been compulsory since 1989. The measles virus had been absent from the territory for the past 10 years, thanks to the very active immunization policies carried out by public health authorities. Four years ago, a mass immunization campaign had been carried out, enabling the country to avoid epidemics such as that in 1986, following which more than 16 cases of sclerotic sub-acute encephalitis had been recorded. Dr LOPEZ (Philippines) endorsed the selection of measles elimination and hepatitis B control as the two new pillars to strengthen EPI. In 1998, the Philippines had embarked on a 10-year measles elimination plan, with an initial catch-up campaign targeting children between 9 months and 19 years of age, providing a second opportunity for measles immunization. A follow-up campaign would be undertaken in February 2004, targeting children between 9 months and 8 years. The Japanese
Government would donate all vaccine requirements, syringes and needles and safety disposal boxes. The door-to-door strategy, which had been employed in the poliomyelitis eradication campaign in 2001, would be used and would focus on high-risk areas such as urban slums and hard-to-reach places. In 1991, the Philippines had introduced hepatitis B into its EPI. The eventual aim would be to add receipt of three doses of hepatitis B vaccine by 12 months to the definition of a "truly immunized child". A law on hepatitis B immunization had also been enacted. Although an allocation for hepatitis B immunization had been made in the national EPI, the allocation for the more expensive hepatitis B vaccines had been reduced to cover the requirements for other vaccines. A proposal had been submitted to GAVI for funding for hepatitis B control efforts. The Philippines welcomed the two initiatives as a means to strengthen and improve the EPI from the technical as well as the programme management perspective, and as a means of raising financial support. To improve advocacy, there was a need to resolve such technical issues as the birth dose for hepatitis B; the use and availabili ty of monovalent measles vaccines and hepatitis B vaccine versus multivalent vaccines; use of plasma-derived hepatitis B or the more expensive recombinant type; use of autodisable syringes and needles; and disease surveillance and laboratory confirmation. Ms GO (Republic of Korea) said that her country fully supported the selection of measles elimination and hepatitis B control as the two new pillars to strengthen the EPI in the Region. Every infant needed to be protected from hepatitis B infection to prevent an important disease burden in later life. In the Republic of Korea, a catch-up measles-rubella vaccination campaign had been conducted in 2001 to cope with a severe outbreak of measles. The target date for elimination of measles was 2005 and efforts would continue to eliminate measles in the Republic of Korea. For hepatitis B, the
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Government had, since 2002, paid the cost of vaccination and testing of newborn infants whose mothers had acquired hepatitis B in order to prevent Illother-to-child transmission. Dr FUKUDA (Japan) welcomed the proposal that measles elimination and hepatitis B control should be the two new pillars to strengthen the EPI in the Region and said his country fully supported measles elimination as a long-term regional target. However, measles epidemiology and control varied from country to country and WHO should take those differences into consideration when making recommendations for each country. Every year 100 000 to 200 000 measles cases occurred in Japan, with ten or more deaths reported. Most cases occurred in non-vaccinated persons, especially in the one-year-old group, only half of which had been vaccinated. The report of a technical expert committee for measles control, published in May 2003, had recommended the prioritization of increased immunization coverage in the one-year-old group. Routine immunization provided an opportunity for single dose vaccination to all children throughout the year. The primary strategy was to increase awareness through an advocacy campaign to improve immunization coverage. The National hlstitute of Infectious Diseases of Japan had been designated as the regional reference laboratory for measles. It was committed to providing technical support for the improvement of measles diagnosis in each country of the region. ill Japan, the HBsAg of expectant mothers was first examined and, upon the birth of the baby,
its HBsAg and hepatitis B antibodies were also examined. Immunization depended on the results of these tests. He was confident that the system provided sufficient protection to prevent mother-to-child transmission and for hepatitis B control. He concluded by noting that Japan was fully committed to supporting WHO activities to further enhance EPI, including strengthening the surveillance system and laboratory support. Dr KOI (Macao, China) said that, in Macao, immunization activities had formerly included only one dose of measles vaccine. Immunization coverage had been low and there had been a largescale measles epidemic in 1988, with 672 cases reported. After the introduction of second and third doses and increased coverage, the incidence of measles had gradually decreased. Since 1994, only sporadic cases had occurred every year. A measles elimination programme had now been established, according to the recommendation of the Technical Advisory Group. The programme had recommended two doses for 12- and 18-month-old infants since January 2003. Clinical doctors were required to arrange laboratory confirmation for every measles case. Although Macao (China) covered a small geographical area, there was frequent communication with other peoples and countries. To eliminate measles, therefore, efforts had been made to achieve high coverage with two doses of vaccination. Elimination of measles in other regions was equally important. He agreed with the
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selection of measles elimination and hepatitis B control as the two new pillars to strengthen the EPI and with measles elimination as a regional goal. The seropositive rate for HbsAg was about II % in the adult population, and liver carcinoma was the second major cause of cancer deaths. Chronic hepatitis B infection was an important public health problem. Since 1990, the Macao Government had provided free hepatitis B immunization for newborn infants and for those born after 1985. The immunization rate for newborn infants was over 99%, and exceeded 92% for children aged 12 months with 3 doses. Following the recommendations of the Technical Advisory Group, Macao would carry out a sampling survey of the seropositive rate for HbsAg in children to evaluate the efficacy of the immunization programme. It was hoped that the rate would be less than 1%. Mr DAVIES (Australia) stated that Australia recognized and was concerned by the burden of disease attributable to measles and hepatitis B in the Region. His country supported the selection of measles and hepatitis B as the two new pillars to strengthen the EPI. Measles elimination and control of hepatitis B were appropriate goals for the Region to pursue and built on the success of the poliomyelitis eradication campaign. He agreed that the target date for regional measles elimination should be based initially on an annual review of progress, although Australia would like to see a clear, ambitious but achievable target date set at an early stage. He recognized the importance of the EPI in controlling and eliminating preventable diseases in the Region and believed that such interventions made financial sense. Recent research carried out in Australia suggested that every AUS$ 1 spent on measles immunization could yield savings of more than AUS$ 150 in future health care costs. AusAID had identified the prevention and control of communicable diseases as a priority area. In 2003-2004, Australia would provide AUS$ 225 million for health assistance to developing countries. A substantial proportion of that assistance was for basic health services, including Through AusAID, Australia had provided support for immunization and vaccine Funds had also been
immunization.
efforts to Cambodia, Papua New Guinea and 14 Pacific island countries.
provided to the International Vaccine Institute for a project covering Viet Nam and China. Australia urged WHO to give appropriate consideration to the constraints that countries faced in scaling up to plan, managing and delivering immunization services. He asked WHO to provide support for countries' efforts to overcome those constraints. Dr SIPELI (Niue) said that his country had been carrying oul routine measles immunization using the triple vaccine, measles-mumps-rubella (MMR), giving the first dose at 15 months and the
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second at four years. Coverage was 100%. Hepatitis B immunization had been offered to all infants since 1986 at four weeks and six months, based on the recommendation of the vaccine manufacturers. Babies were now delivered in hospitals and were routinely immunized 12 hours after birth. Niue endorsed the regional action plans for the elimination of measles and hepatitis B control. Dr MANN (Papua New Guinea) said the two regional action plans for measles elimination and hepatitis B control would provide countries with the guidelines necessary to develop national implementation plans. Immunization coverage in Papua New Guinea was very low, and had hovered around 45% and 50% for the last five years, resulting in several measles epidemics among children and young adults. His country had been continuing efforts to ensure that infants received one dose of measles vaccme soon after birth. In addition, children may receive another two doses and he requested
support to determine whether that policy was appropriate.
A supplementary immunization
programme would be launched next month. He extended thanks to Australia and Japan for their strong support for Papua New Guinea's EPI activities. Dr ENOSA (Samoa) joined previous speakers in commending the selection of two new pillars to strengthen the EPI in the Region. However, for the Pacific island countries the main constraint in the implementation of such initiatives was always cost. Samoa had started a measles immunization programme some five years earlier but had recently, like Tonga and Fiji, experienced the emergence of rubella. The implications of that development, especially as regards pregnant women, were under consideration, and WHO would be requested to provide support for a survey to determine the extent of the problem. It was likely that the more expensive triple MMR vaccine would be needed. He expressed appreciation for the generous financial support for the EPI in the Pacific island countries provided by the Governments of Australia and Japan. Dr MALEFOASI (Solomon Islands) also welcomed the timely new initiatives, which accorded with his country's recovery plans. Solomon Islands would support relevant WHO strategies. Implementation would constitute a considerable challenge, however, since immunization coverage was at a low level following the recent civil unrest. It would require a strategic, holistic approach, but he was confident that it could be achieved given the ongoing improvement in primary health care services and the low incidence of measles and hepatitis B. The Ministry of Health, with support from nongovernmental organizations, was preparing action plans to re-establish all aspects of the EPI, which was a key component of the economic recovery plan for the coming decade, to be submitted shortly to potential donors.
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Mrs PAUL (Marshall Islands) voiced her country's commitment to the improvement of its immunization programme and to the elimination of measles - a recent outbreak of measles had affected the young in particular and had claimed three lives. However, it was difficult to see how plans to increase immunization coverage and upgrade laboratory facilities could be realized given the proposed cut of around 38% in the WHO country allocation for that area. She, therefore, asked the Regional Office to reconsider that allocation. Dr CUTTER (Singapore) expressed support for the selection of measles elimination and
hepatitis control as the two new pillars to strengthen the EPI, and urged that a target date for measles elimination be set as soon as possible. He outlined the progress made in Singapore's immunization programme. A second dose of MMR vaccine for children of 11-12 years had been included since 1998, following an outbreak of measles the previous year, and had resulted in a dramatic fall in the number of recorded cases. Hepatitis B had been included since 1997, with a three-dose coverage of around 90%, and had substantially reduced the seroprevalence of HBsAg and the incidence of acute hepatitis B. Incidence in children under 15 years of age had been reduced to zero. Mrs PIERANTOZZI (Palau) also supported the proposals. Palau had succeeded in maintaining immunization coverage above 90% thanks to its small population and to a policy of administering vaccines at birth, with good follow-up. However, migration across the Region posed a challenge in respect of both immunization and surveillance. WHO support was requested to ensure better regional coordination of the EPr, especially in migrating populations. WHO support for the deVelopment of regional laboratory diagnostic facilities and safe blood services was also needed. WHO had paid considerable attention to maternal and child health. She proposed the
development of initiatives to improve men's health and to involve men as partners in family health actions, for example, by encouraging them to support the immunization of their children. Dr LAM (Hong Kong, China) reported that Hong Kong provided the MMR vaccine, free of charge, to all children as part of its EPI, with a two-dose schedule. The first dose was given at 12 months and a second opportunity was provided at six years. Children who had missed the first dose could receive free vaccination at health centres before the second dose was due. Hepatitis B
immunization had been introduced in 1985, with a first dose administered within 24 hours of birth for most babies. Coverage with three doses was more than 88%, and children aged one to four years showed zero seroprevalence for HBsAg. Hong Kong was fully committed to continuing its efforts to eliminate measles and to control hepatitis B, under the guidance of the Regional Office.
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Dr KIENENE (Kiribati) supported the proposal to select two new pillars to strengthen the EPI. The reduction of HBsAg seroprevalence to I % was an ambitious target given the high rates currently observed in some Pacific island countries such as his own, where it was 25%-30%. However, he was sure that, with support from WHO, that objective could be achieved. Mr TEOKOTAl (Cook Islands) supported the proposals to strengthen the EPI and to adopt the objective of measles elimination. The effectiveness of the programme was illustrated by the lack of incidence of the diseases concerned in his own country. Immunization coverage was 96% for
children under 12 years for measles, with a second dose given at school entrance, and 99.7% for hepatitis B. The ongoing objective was to maintain that high coverage. He agreed with the
representative of Fiji that immunization against rubella should also be included in the EPI, as it would be only a matter of time before the disease emerged elsewhere in the Pacific island countries. It was important to give due attention to surveillance and to the capacity of diagnostic laboratory facilities in Pacific island countries. Dr DUONG HUY (Viet Nam) supported the selection of the proposed new pillars to strengthen the EPI and commended the two regional plans. Viet Nam had developed a strategy for the elimination of measles by 20 I o. Coverage for children under one year of age had been maintained at more than 90% for many years, and the number of measles epidemics had declined in northem provinces following the first national immunization campaign. A second dose would be offered as a routine component of the EPI from 2006. Thanks to the provision of vaccines by GAVI, Viet Nam had introduced hepatitis B immunization in 44 provinces since 2002, but coverage remained a problem in remote and mountainous areas. WHO and the Program for Altemative Technology in Health (PATH) had supported the preparation of a plan for incorporation of immunization against hepatitis B in the EPI. Viet Nam was constructing facilities for local production of vaccines against measles, with support from the Govemment of Japan, and hepatitis B. He expressed appreciation for the support provided by WHO and others and looked forward to further cooperation in the future. At the invitation of the CHAIRPERSON, the representative of the Global Alliance for Vaccines and Immunization made a statement to the Committee. The REGIONAL DIRECTOR thanked representatives for their support for the proposal to use immunization against hepatitis B and measles as twin pillars to strengthen the EPI. He recalled that up to 800 people died each day in the Region from conditions related to infection with hepatitis B virus. The death toll was similar to that of tuberculosis, but less attention had been paid to hepatitis B. The representative of China had suggested that, even though he supported the proposed initiative, the target of reducing the prevalence of hepatitis B virus infection to 1% was somewhat ambitious. That
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goal could, however, be achieved in coming years as the cost of the vaccine decreased. He agreed with the representative of Japan that the situation differed from country to country, and that comprehensive screening of mothers for hepatitis B surface antigen and immunization could be effective in reducing mother-to-child transmission. Measles outbreaks had occurred in the Region in the recent past, as vaccine coverage as high as 80% or 90% still meant that 20% or 10% were not immunized, in addition to those who did not become immune after vaccination. Those percentages accumulated over time, until a threshold for periodic resurgence of the disease was crossed. Both theory and experience showed that an immunization rate of 95%, with two doses, would be required to interrupt transmission of indigenous wild virus. The representative of Mongolia had clearly expressed the need for regional collaboration, laboratory systems and sustained financial support to eliminate the highly infectious measles virus. Despite the differences in country situations described by the representative of Japan, it was therefore essential that there be an overall regional strategy, although he fully agreed that this should not be imposed inflexibly. Although the representative of Australia had proposed that a target date for elimination of measles be set as soon as possible, there were a number of reasons why this was problematic at present. Poliomyelitis had not yet been entirely eliminated, and the introduction of immunization against measles might overstretch the available international immunization capability and financial support. Furthermore, immunization programmes in Member States were currently at very different stages. Once poliomyelitis had been eradicated, a target date could be set for elimination of measles. The REGIONAL ADVISER IN COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE said that, in order to counteract the lack of adequate laboratory capacity for confirmation of measles cases in the Region, the LabNet system had been set up within the Pacific Public Health Surveillance Network. The first meeting of LabNet was being held in Suva, Fiji, concurrently with the present session of the Committee. That meeting was discussing various issues related to the strengthening oflaboratory capacity in Pacific island countries and he believed that it would represent a milestone in efforts to improve such capacity. The REGIONAL ADVISER IN EXPANDED PROGRAMME ON IMMUNIZATION said that the measles elimination programme would provide a good opportunity to reduce or eliminate congenital rubella syndrome. As mentioned by the Regional Director, at least 95% coverage would be needed for a measles elimination programme, and rubella vaccine could safely be given with tlle measles vaccine. As rubella was less infectious than measles, it would be easier to eliminate. The drawbacks to combined immunization were the additional cost and the different age ranges covered. As long-term funding for immunization against measles had not yet been secured, it would be
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premature to add rubella vaccine in most countries. When that was possible, however, as in Tonga, combination immunization was preferable. The situations in individual countries should be reviewed, so that programmes could be drawn up for the addition of rubella immunization when appropriate. 2. SEXUALLY TRANSMITTED INFECTIONS, INCLUDING HIV I AIDS: Item 12 of the Agenda (Document WPRlRC54/6) The REGIONAL DIRECTOR, introducing the report, said that WHO continued to have a very active HIVI AIDS programme in the Western Pacific Region. The promotion of condom use had led to significant reductions in the prevalence of HIV infection among sex workers, particularly in Cambodia. The" 100% condom use" strategy was being extended to a number of countries with low HIV prevalence, such as the Lao People's Democratic Republic and Mongolia. The rates of condom use were increasing significantly among individuals at high risk of infection in many countries. Injecting drug use remained a major path of transmission in China, Malaysia and Viet Nam. In collaboration with WHO Headquarters and the South-East Asia Region, the Regional Office had developed a strategic framework for a hann reduction-based approach to HIV prevention among injecting drug users in Asia, which was described in Annex 2 of document WPRlRC54/6. Partnerships among governments, United Nations agencies, bilateral and multilateral partners and nongovernmental organizations to fight HIV/AIDS in the Region continued to be good. One example was the success of proposals from the Region to the Global Fund to Fight AIDS, Tuberculosis and Malaria. In January 2003, the Global Fund had approved three more proposals addressing HIV/AIDS, from Cambodia, from Mongolia and from 11 Pacific island countries. Those had brought the total support from the Global Fund for HIV/AIDS projects in the Region to US$ 53.5 million. Excellent, close collaboration among countries, UNAIDS and WHO had contributed greatly to the high success rate of proposals to the Global Fund from the Region. Despite those positive developments, he said that WHO and its Member States should not be lulled into a false sense of security. Although the regional prevalence rate was relatively low, the large populations of several countries in the Region meant that the regional rate masked large numbers of infections and significant human costs. There was also a danger that increasing levels of HIV infection among highly vulnerable populations could lead to spread of the epidemic to the wider community. In some countries, up to half of all new cases of HlV infection were among wives of infected men. In Cambodia, about onethird of new cases were in children infected by their mothers. Efforts to reach those most at risk for
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infection with large-scale interventions of proven effectiveness should continue and indeed be increased. WHO and its Member States should work together to reduce the burden on individuals with AIDS, their families and communities and health services. Broader access to antiretroviral therapy and its rational use were needed where HIV testing and counselling were available, as part of comprehensive HIV/AIDS care. Annex 3 to the document gave details of WHO's work to expand antiretroviral therapy in the Region. The Region was facing the risk of a general HIV /AIDS epidemic, and WHO and its Members States should do everything possible to prevent it. The REGIONAL DIRECTOR urged Member States to address carefully the four proposed actions listed in document WPRlRC54/6: political commitment, prevention, surveillance and HIV/AIDS care. Looking back over the many excellent achievements in the Region since the emergence of HIV/AIDS, he was confident that WHO could continue to prevent a general HIV/AIDS epidemic in the Western Pacific Region. Dr KIENENE (Kiribati) said that HIV/AIDS appeared to be here to stay. However, he noted two positive developments mentioned in the report: the launching of the International Treatment Access Coalition and the approval of some proposals to the Global Fund from the Region. His country was one of the beneficiaries of the latest round of approved proposals and was now working hard to complete the formalities so that funds could be released. He recalled that at the Asia Pacific ministerial meeting on HIV/AIDS held in October 2001 in Melbourne, Australia, the Director of UNAIDS had pointed out that the peoples of Asia and the Pacific had been given "the gift of time", but that this was rapidly running out. Dr RAHMAH (Brunei Darussalam) applauded the support of the Regional Office to Member States in their fight against the escalating HIV/AIDS epidemic. Although few cases had been reported in her country, it was vulnerable to factors associated with the spread of the disease. One area in which difficulty had been encountered was in accurately estimating and projecting the number of cases, which was of paramount importance for assessing the burden of disease and the associated needs. Although she welcomed the development of models such as the Epidemic Projection Package, the specifications for data limited its application by countries with low prevalence or lacking the required data. She therefore urged that alternative tools be developed to overcome that limitation. Dr DAUD (Malaysia) said that the effects of the HIV/AIDS epidemic extended to the social, economic and cultural sphere. Therefore, not only political commitment but also greater involvement of nonhealth and community-based players was needed. The strategies that had been used to elicit
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greater commitment from communities in his country included advocacy on issues related to HIV/AIDS through an interministerial committee; building capacity in the nonhealth sector; collaborative interventions for the prevention and control of AIDS through a multisectoral coordinating committee; financial and technical support to appropriate nongovernmental
organizations; coordinated institutional and community-based programmes for prevention, treatment, care and support of women, children and adolescents affected by HIV I AIDS; and provision of diagnostics and affordable antiretroviral drugs through direct negotiations with pharmaceutical companies. The Association of Southeast Asian Nations was guiding national responses to the HIV/AIDS epidemic; promoting a positive environment for confronting stigma, discrimination, denial and silence; ensuring the availability of affordable drugs; helping countries to reduce vulnerability to the disease; and preventing HIV infection among migrant workers. The Ministries of Health and Education in his country had established a programme to mobilize young people in communities, based on the concept 'action by youth, through youth and for youth' and aimed at remaining healthy within the framework of sociocultural norms and values. The programme had trained 49 000 peer motivators and 820 clubs to sustain the momentum. In 2002, a code of practice for the prevention of HIV/AIDS in the workplace had been formulated by the Ministries of HeaIth and Human Resources and the Malaysian AIDS Council. Dr KOI (Macao, China) reported that screening of foreigners applying for work permits indicated that most HIV cases reported in Macao belonged to that group. megal foreign workers were also cause for concern. Although reported cases of sexually transmitted disease detected by
anonymous, non-linked screening were few, they were slowly increasing. The health services were concentrating on educating foreigners working in the entertainment industry, and on harm reduction in other groups, such as young people. Further evaluation of education activities was needed.
Treatment of HIVIAIDS was available to residents of Macao free of charge, as it was for any sexually transmitted infection. Since cases were still few, that did not affect resource allocation within the health service. Dr BILGER (France) praised progress made, particularly in Cambodia, thanks to a proactive prevention strategy aimed at high-risk groups, including sex workers and injecting drug-users. However, more had to be done for those groups in terms of accelerating risk reduction, including such measures as provision of drug substitutes. France endorsed the WHO policy on integrated
management of HIV and urged the Organization to establish a forum to address equitable access to treatment, and to set up a programme with the following elements: encouraging countries that had not already done so to put antiretrovirals on their list of essential medicines; promoting a policy for procurement of antiretrovirals at the lowest cost, since cost was a key factor in equitable access;
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advocating the adoption of a policy for quality generic drugs; and developing local capacity for production of antiretrovirals. To that end, WHO should gather the information needed to evaluate the situation in the Region. WHO should also continue to coordinate with the Global Fund and to provide it with technical support for implementation of programmes to improve access to antiretrovirals, as the representative of the Fund had requested. Mr UNT ALAN (United States of America) held that few topics were more important to the health of the world and of the Region than HIV/AIDS. His government had been the largest
contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, with a total pledge of over US$ 1.6 billion until 2008, and US$ 623 million deposited in the trustee account to date. His
country's support for the Global Fund and for other multilateral HIV/AIDS initiatives was combined with over US$ I billion spent annually on bilateral research, prevention, and care and treatment activities. He commended the evidence-based approach taken by the Western Pacific Regional Office to prevention of HIV and other sexually transmitted infections, blood safety, epidemiological data and coordination with other partners. The Regional Office approach to AIDS care was particularly
comprehensive, encompassing palliative care, treatment of opportunistic infections, home- and community-based care, and antiretroviral treatment. Cambodia and other Member States were
managing to reduce the prevalence of HIV/AIDS, to keep it stable, or to remain HIV-free. Every country could learn from the experience of others. His country supported interventions targeted at individuals whose behaviour placed them and those around them at risk of lIIV or other sexually transmitted infections; prevention a.nd reduction of transmission should be supported. Nevertheless, he could not fully endorse plans of action that did not include critical behavioural components such as delay of sexual initiation, abstinence, promotion of fidelity and partner reduction. Greater emphasis should be given to mother-to-child transmission. While commercial sex workers were an important target population, male clients also had to be educated. lIIV education should neither encourage prostitution nor condone the trafficking of young people and women. Dr TSANG (Hong Kong, China) welcomed the attention devoted to injecting drug users in the strategic framework. There was a cumulative total of 2000 reported cases of lIIV/AIDS in
Hong Kong, most of which had contracted the disease through sexual contact. Thus far, only some 2.6% of reported infection had been associated with drug injection. That had been an incidental result of the methadone maintenance programme, which had been introduced in the 1970s. A media
campaign had been launched in 2002, based on harm-reduction principles advocated by the Regional
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Office; the methadone maintenance programme was one of its essential elements. Universal HIV testing for methadone users had been piloted in 2003 as had an outreach programme, which made 400 contacts with drug users per month. The work on HIV treatment and care, promotion of safer sex, and strcngthening of HIV surveillance were in line with the regional framework document. Mr DAVIES (Australia) acknowledged the need for timely surveillance as a basis for national strategic plans and care for people who were infected. Australia mirrored the goals and guiding principles of the WHO global strategy for health sector response to HIV/AIDS. The country was implementing a six-year, AUS$ 200 million global HlV/AIDS initiative, to assist countries in the Asia-Pacific region to respond to the epidemic. Major programmes were under way in Papua New Guinea, Viet Nam, Indonesia and southern China. Earlier in the year, Australia had approved funding for a four-year AUS$ 12.5 million regional HlV/AIDS project in the Pacific. He agreed that strong political commitment was needed to reduce HIV transmission and other sexually transmitted infections. Australia had provided AUS$ 1 million in seed funding to the Asia-Pacific Leadership Forum, a strategy designed to increase political leadership and action against the HlV/AIDS epidemic, through support for a network of key politicians, leaders and decision-makers. Dr UEDA (Japan) appreciated the support from the Global Fund for several countries in the Region, which had been obtained with the assistance of WHO, UNAIDS and the respective governments. Japan felt it was important to work with other countries in the Region while dealing with domestic problems in Japan. Examples of such work included capacity-building on HNIAIDS surveillance in Cambodia, strengthening of diagnosis and research in the Philippines, and support to various workshops on HIV/AIDS. Although HlV prevalence was comparatively low in the Region, new cases were set to increase. Member States had to be reminded of that fact. Large-scale
interventions targeted at high-risk groups were to be encouraged, especially since prevalence in the Region was still low. However, it was often hard for governments to approach those most at risk. Support had to be given to nongovernmental and non-profit organizations for that purpose. Experience should be shared and replicated in Member States, and WHO had a role to play in this. He praised the efforts to improve access to antiretrovirals, but noted that many developing countries did not have the infrastructure to monitor administration of the drugs. A framework was needed to extend the provision of antiretrovirals and achieve the global target of treating 3 million people by 2005. Compliance with drug regimens for HIV/AIDS should be taken into consideration, and guidelines should be developed with partner agencies. Intensive education, counselling, support, treatment and follow-up with families were essential in ensuring compliance with treatment and prevention of drug resistance. It was hard for most hospitals in developing countries to provide such services, since they could not charge for them. The day-care centre approach advocated by the
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Regional Office, involving peer support linked with clinical services and the community, should be a key mechanism for encouraging treatment compliance. Such centres, especially at district level, should be used to increase antiretroviral treatment in the Region. Top priority should be given to the provision of antiretrovirals to prevent perinatal transmission of HIV; he advocated a pilot project to study that topic in depth. Harm reduction strategies, such as supply of needles and syringes, could enhance illegal activities, so related measures required careful consideration. WHO should encourage use of condoms for prevention of sexually transmitted diseases. He regretted that the 7th Asian HIV/AIDS Congress, which had been scheduled for November 2003 in Kobe, Japan. had been postponed for two years on account of SARS. He asked representatives to make it known in their countries that the congress would indeed take place in 2005.
WPRlRC54/SRl5 SUMMARY RECORD OF THE FIFTH MEETING (WHO Conference Hall, Manila) Wednesday, 10 September 2003 at 09:00 CHAIRPERSON: Dr Mulitalo Siafausa VOl (Samoa) later: Dr Manuel DAYRIT (Philippines)
CONTENTS page
1. 2.
Sexually transmitted infections, including HIV/AIDS (continued) ................................. . Consideration of draft resolutions .................................................................................... . 2.1 2.2 2.3 Report of the Regional Director ........................ :........................... .......... ............... Proposed programme budget: 2004-2005 ............................................................. Expanded programme on immunization: measles and hepatitis B........................
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3.
Tuberculosis ..................................................................................................................... .
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1.
SEXUALLY TRANSMITTED INFECTIONS, INCLUDING HIY/AIDS: Item 12 of the Agenda (Document WPRlRC54/6) (continued) Dr YU (China) expressed appreciation for the report, particularly the analysis of the current
situation in the Region and the collaboration between WHO and Member States, the issues, and the proposed future actions. He recognized the support provided by WHO in HIV/AIDS prevention and control, in particular, capacity building, harm reduction, prevention of mother-to-child transmission, and guidance on the preparation of funding proposals for the Global Fund to Fight AIDS, Tuberculosis and Malaria. As an example of this support, he cited a successful project to promote 100% condom use in four pilot areas in China. With the global spread of HIV/AIDS in recent years, the Asia-Pacific was becoming the most important region, after Africa, for HIV/AIDS control and prevention. WHO support to Member
States should be further enhanced, through the establishment of special programmes and budgets for capacity building for health workers, scaling up of the 100% condom use project, and improvement of care and treatment for people living with HIV/AIDS. WHO should also provide support to Member States in facilitating negotiations relating to patents for antiretroviral drugs and capacity building for surveillance, health education and advocacy. China was implementing a comprehensive IIIVI AIDS prevention and control pilot project, for which he hoped there would be WHO support. Dr GO (Republic of Korea) noted that the document highlighted recent international developments in HIY/AIDS prevention and control, as well as the danger of a wider epidemic spreading from concentrated epidemics in high-risk populations. That was a threat, even though most countries in the Region still had low HIV prevalence. Various sources of funding, including the Global Fund, should be used to strengthen prevention, treatment and surveillance systems. She
supported regional initiatives to improve access to antiretroviral therapy and promote harm reduction among injecting drug users. HIV prevalence in the Republic of Korea was below 0.01 % and few cases of HIV infection due to needle sharing had been reported. Since male homosexuals were at highest risk for infection, focused prevention programmes should target that group. Confidential HIV testing was currently available for Korean and foreign nationals. Private organizations, including those representing people living with HIV/AIDS, supported education, counselling and care programmes. Peer counselling programmes were encouraging the sharing of experience among people living with HIV/AIDS. Dr KING (New Zealand) said that her country supported regional initiatives on sexually transmitted infections, including HIV/AIDS prevention and control, and that there were four key aspects to their successful implementation: (I) an open and honest assessment of the problem, putting
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aside taboos relating to sexuality; (2) stronger emphasis on prevention programmes which, for most countries, were more affordable than treatment; (3) protection of human rights, especially the rights of women to freedom from violence and to control their own sexuality; and (4) involvement of civil society and communities, especially vulnerable groups. There was a need to develop new initiatives with a strong emphasis on prevention, without neglecting treatment and care, and to involve civil society. Dr TANGI (Tonga) emphasized the importance of promoting good moral values to control the spread of sexually transmitted infections including HIV/AIDS, as discussed by the representative of the United States of America at a previous meeting. He cited a recent survey of 700 single men and 530 young women from the 19-24 years age group in Tonga, which had been conducted by a foreign expert. That survey had found that 95.6% of respondents had had no sexual experience. Among youth groups, his Government was advocating making the right choice and youth advocates had been recruited to spread the message. He was looking forward to a future where people would be able to enjoy sexual relations and would be protected by their strong moral values rather than through the continual use of condoms. Professor NYMADAWA (Mongolia) said that only four cases of HIV/AIDS had been reported in Mongolia in the last 10 years. Nevertheless, there was a significant threat of an increase in view of the high prevalence of sexually transmitted infections, a growing sex trade and the spread of the HIV/AIDS epidemic in neighbouring countries. Population mobility, widespread poverty, the low level of education of people at risk, low rates of condom use, and other social and behavioural factors also increased the risk. The mode of transmission in the reported cases so far had been sexual contact, but other modes of transmission could be responsible for still undetected cases. More cases of sexually transmitted infections were reported than of any other communicable disease and comprised 40.8% of reported cases of infectious disease in 2002. The Government had responded to the threat of HIV/AIDS by launching the national HIV/AIDS programme in 1987 and had continually increased Mongolia's capacity to fight the epidemic. The establishment of the national HIV/AIDS resource centre and the HIV/AIDS laboratory had allowed routine HIV testing. Other activities had included training of health workers, and continuing health promotion activities among the general population and vulnerable groups. The national AIDS committee, established in 1992, had been incorporated into the National Committee of Public Health chaired by the Prime Minister, and HIV/AIDS control had been incorporated into the national communicable disease programme. The national strategy had targeted improvements in the HIV/AIDS legal environment, strengthening of management and policy making at all levels,
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improving diagnostic and treatment capacity of sexually transmitted infections and HIV/AIDS services, introducing sentinel surveillance, promotion of condom use, and supply of quality condoms. He thanked WHO for the technical support in the preparation of a grant proposal to the Global Fund and the Global Fund for approving the proposal in 2003. The main objectives and strategies of the proposal had been based on recommendations from an evaluation of the situation by the UNAIDS regional team. Dr LOPEZ (Philippines) recognized WHO's facilitation of exchange of information through partnerships with Member States and civil society, including people living with HIV/AIDS. He cited four areas that would need continued support in the Philippines and throughout the Region: (1) progress towards the "three by five" goal through better access to treatment and cheaper ARV drugs; (2) expansion of behavioural and sentinel surveillance for sexually transmitted infections, including mY/AIDS; (3) focused harm reduction programmes, involving vulnerable groups, and
prevention programmes based on changes not only to individual behaviour but also to social norms, promotion of human rights and removing the fear, stigma and discrimination surrounding the issue of HIV/AIDS, and (4) technical support for the treatment and control of sexually transmitted infections. Dr PARE (Cook Islands) said that his country's strategic plan for 2003-2007 involved both the public and communities. A review of the plan earlier in the year had resulted in the re-establishment of the national committee on sexually transmitted infections and HIV /AIDS, which also served as the country coordinating mechanism for the Global Fund. In Cook Islands, with its tourism-based economy, complacency was the greatest danger. One case had now been recorded, and the sense of invulnerability had been somewhat dispelled by the establishment in his country of the Pacific Islands AIDS Foundation, a regional NGO whose main objective was to work with people living with AIDS. The successful application of I I Pacific island countries to the Global Fund would allow some programmes to be implemented; however, further assistance would be needed in formulating policies for the procurement of drugs and guidelines for clinical care and management of patients. He thanked all those involved for assistance in the review of the country's sexually transmitted infections, including HIV/AIDS programme and in preparation of the proposal to the Global Fund. Dr SELUKA (Tuvalu) reported that, in the past few months, his country had seen a sudden increase in the number of cases of AIDS, especially among adolescents, despite good participation by that age group in prevention programmes. At anyone time, 5% of the population was out of the country, either for educational purposes or working on ships, and health awareness programmes had been instituted to help them protect themselves. Surveillance systems had been strengthened, and
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health was promoted through the media. The successful proposal by the Pacific island countries to the Global Fund, with WHO's assistance, would allow those countries to begin implementation of their programmes by the end of the month. Mr TRINH QUAN (Viet Nam) said that nearly 70 000 HIV infections had been reported in his country. Some positive results had been obtained in harm-reduction programmes carried out among injecting drug users and commercial sex workers and in implementation of the' 100% condom use' strategy, which was to be expanded from six provinces and cities to 21 in the framework of a project financed by the United Kingdom's Department for International Development. Viet Nam had considered prevention to be the key measure for the control of HIV IAIDS in its programme for 2001-2005; however, the growing number of people living with HIV/AIDS had made patient care and treatment an urgent issue. During the past year, with WHO support, a communitybased model of care and support had been piloted in a number of cities. WHO was also helping in preparation of a national strategy for HIV/AIDS prevention and control for the period 2004-2010, with a vision up to 2020. His country supported WHO's 'three by five' initiative for antiretroviral treatment. In the past, only 0.68% of Viet Nam's patients had been able to receive treatment. However, the draft strategy for 2004-2010 projected that 70% of patients would have access to antiretroviral drugs by 2010. WHO was helping Viet Nam to prepare a proposal for accessing those drugs and to implement the project supported by the Global Fund. Mr UNA (Solomon Islands) said that the prevalence of sexually transmitted infections in his country had been stable but underreported. The first comprehensive national strategic plan to control sexually transmitted infections and prevent HIV I AIDS had been launched in the previous week, after endorsement by the Government. A system of testing would be instituted to uncover previously unreported HlV cases. His country would continue to support endeavours to control sexually transmitted infections, including HlV/AIDS, in the Region. Dr NAlV ALU (Fiji) said that he was the current chairman of the regional country coordinating mechanism for the project approved by the Global Fund, which was designed to address innovative areas of HlVI AIDS control that were not catered for by current funding sources. In Fiji, the new area was treatment with antiretroviral drugs. The recent WHO announcement of negotiations for drug supplies was welcome, as that would probably be the long-term solution to the problem once the contribution from the Global Fund had been exhausted. An initial sum of US$ 1.22 million for the first six months' implementation of programmes had been received by the Principal Recipient, the
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Secretariat of the Pacific Community, in August 2003. That money would be channelled to the 11 Pacific island countries. Accounting for the first six months would, however, take place on 31 December, giving the countries only three and a half months in which to implement the activities outlined for the first half of the annual work programme. Moreover, the sum of US$ 1.22 million did not include the funding that had been requested for procurement. He asked the WHO procurement office to assist the Pacific island countries to procure the equipment and supplies listed in the proposal to the Global Fund. That assistance would help them to implement the programme for the first six months. A follow-up meeting of the Pacific island country coordinating mechanism was to be held in Nadi, Fiji, in October, and he invited key officers from the Regional Office to attend. He had received full political commitment from the Prime Minister in the battle against HIV/AIDS and had made ministerial statements in Parliament regarding the Government's strategic plan. The Cabinet had asked him to focus attention on churches and vanua, the traditional communities, as 80% of the 119 cases of confirmed lIIV/AIDS had been among the Fijian community. The Government's political commitment to lilY/AIDS control had also resulted in a specific budgetary allocation of F$ 300 000 (US$ 160 000) for lIIV/AIDS for the biennium 2002-2003, which was expected to be increased in the forthcoming three-year strategic plan for 2004-2006. As Minister of Health, he was also Chairman of the National Advisory Committee on AIDS, which included representatives of nongovernmental organizations, civil society and government ministries. Fiji was developing an appropriate legal framework for the implementation of its HlY/AIDS policy, which would take account oflegal implications associated with confidentiality, privacy, human rights, mandatory testing and related issues. Dr MANN (Papua New Guinea) said that sexually transmitted infections, in particular HIY/AIDS, were a serious problem in his country. Heterosexual transmission accounted for 98% of cases and mother-to-child transmission for the remainder. The incidence of HIY/AIDS was higher among females than among males in the 15-29 age group and higher among males than among females in the 35-45 age group. A possible explanation of that pattern was that older men were economically capable of procuring sex from young females, although it had also been suggested that young women preferred older men. In Papua New Guinea, where polygamy was a cultural norm and common practice, the HIV/AIDS issue was complex. The epidemic had now become generalized, and the prevalence rate among pregnant women was 1.12%-3.35%. As of 31 July 2003, there were over 7000 reported cases of HIV/AIDS and possibly another 60 000 that had gone unreported. The annual rate of increase in the country was currently over 100%. Given that grave scenario, the country required extraordinary help.
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Implementation of the first five-year plan had been completed and had been reviewed in November 2002 by UNAIDS and the Agency for International Development of the United States. Two important findings were: (I) that, although the general population was aware ofrnessages about the mode of transmission of HIV, their sexual behaviour had not changed, and (2) that more care and counselling should be provided, backed up by targeted interventions. A multi sectoral plan for the coming five years was being drawn up with the assistance of donors. Two pieces of landmark legislation had been passed in June 2003. The mY/AIDS Management and Prevention Act addressed protection of people with HIV/AIDS, health workers and blood and tissue donors, and included provisions to penalize people who purposely transmitted HIV in the community. The second instrument was the Public Health Amendment Act 2003. He thanked Australia, the United States of America, the European Commission, UNAIDS, UNICEF and WHO for their support in his country's fight against HIV/AIDS and hoped that Papua New Guinea's second application to the Global Fund would be approved. Despite the statement in the report of the Regional Director that the incidence of HIV/ AIDS in the Region was low, in Papua New Guinea it was high, and he looked to WHO for strong support. Mr KALPOKAS (Vanuatu) warned against complacency in the fight against HIV/AIDS. He recalled that the first case of AIDS in his country had been announced during the fifty-third session of the Regional Committee in 2002. He thanked the Global Fund for its help and WHO for assistance in procuring antiretroviral drugs. Mrs PIERANTOZZI (Palau) said that her Government supported the efforts of the Regional Office against HIV/AIDS but continued to advocate strategies that would involve men in assisting mothers and children to address the issues of HIV/AIDS and other sexually transmitted infections. Men and women should work in partnership for health, particularly in the area of sexually transmitted infections. At the invitation of the CHAIRPERSON, statements were made by representatives of the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Association of Girl Guides and Girl Scouts; and the International Federation of Medical Students' Associations. The REGIONAL DIRECTOR thanked the distinguished representatives for their excellent comments and suggestions, all of which would be taken into account when pursuing further the implementation of HIV prevention strategies. He would take up the more general points made and would leave the technical issues to be dealt with by the Regional Adviser on Sexually Transmitted Infections, including HIV / AIDS.
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The 100% condom use programme, which had been instrumental in reducing HIV prevalence In
high-risk groups in some countries of the Region, may have given the impression that the
Organization was promoting promiscuity. That was not the case, nor did WHO's support for the programme show a neglect of moral values such as fidelity and abstinence. WHO did promote such values, especially among young people. However, the existence of high-risk groups and their
importance as sources of infection must be faced and dealt with, otherwise the situation would deteriorate. That was the reason for promoting harm-reduction strategies targeted at high-risk groups, such as the 100% condom use programme. In a similar way, there was no real dichotomy between prevention and cure.
Prevention
remained the major strategy to deal with the disease. At the same time, however, efforts must be intensified to provide antiretroviral drugs while strengthening and developing health systems. The REGIONAL ADVISER IN SEXUALLY TRANSMITTED INFECTIONS, INCLUDING HIV/AIDS said that a country survey on the status of each antiretroviral drug - in terms of price, production of generics and other factors - would soon be carried out. That survey would show the Region's capacity for coordination among countries in production, monitoring of quality, and the export and import of generics, within the legal framework for intellectual property established by the World Trade Organization and under the Doha Declaration, particularly after the crucial year 0[2005. He assured the representatives of Brunei Darussalam and other Member States that surveillance, not only of HIV seroprevalence, but also of hazardous behaviour and sexually transmitted infections in general, were very important to WHO. Data from such surveillance were needed to monitor both the epidemic and the impact of actions taken against it. In view of the difficulty in producing good estimates for countries with low prevalence, WHO was working with UNAIDS and Family Health International on new modelling systems. A project involving a group oflow-prevalence countries had been started in Bangkok, Thailand, in June. Syringe and needle exchange programmes were among the activities recommended by WHO and had produced good results in several countries in the Region. With the support of AusAID, WHO was developing those programmes in China and Viet Nam. The WHO ASSISTANT DIRECTOR-GENERAL FOR FAMILY AND COMMUNITY HEALTH, WHO HEADQUARTERS, explained that she had been a commissioner on HIV/AIDS for the Secretary-General of the United Nations and that she was also a citizen of Botswana, the country with the highest HIV infection rate in the world. Like many countries in the Western Pacific Region today, Botswana once had only a handful of people infected, and the authorities had believed that
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HlV I AIDS was restricted to high-risk groups and would not spread. They had imagined that one or two interventions would be enough, that prevention through promotion of moral values and abstinence as a standard for young people would suffice. But now 39% of pregnant women were infected. The epidemic was a moral, social, economic, security and political imperative for the whole global community. Half measures would not work. The impact ofHIV/AIDS on society and on the economy would not be temporary, but would reverse the gains that had been made over years. She warned that countries' investment in human capital might be brought to nothing. Full-scale, multisectoral, fully-integrated, aggressive interventions were needed now. One intervention would not suffice. Even if 96% of a country's population was HIV-negative, the 4% who were seropositive were still sexually active and the problem would grow. Countries must promote condom use; there was no alternative. Multisectoral interventions must ensure that every part of society played its role. Curricula from primary school onwards had to feature HIV I AIDS. No opportunity should be missed; everyone must know· their status. Routine testing had to be provided now by health systems. Vertical programmes on HIV IAIDS were not useful; they had to be integrated now with the rest of the health system, because health professionals had to know immediately how to handle the epidemic. It would be wrong to concentrate on prevention alone: care and treatment had to be provided now, since that would reduce infection rates. This would be costly, but it would be much cheaper now for a few cases than later on for many. If action were not taken now, then in ten or twenty years the price to pay would be very high indeed. 2. CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions: 2.1 Report of the Regional Director (Document WPRlRC54/Conf.Paper No.1) Decision: The draft resolution was adopted (see WPRlRC54.R2). 2.2 Proposed programme budget: 2004-2005 (Document WPRlRC54/Conf.Paper No.2) Suggested amendments were presented by the representatives of the United States of America; Hong Kong, China; Tonga; and Palau. At the suggestion of the Chairperson it was agreed that those representatives would meet informally with the Rapporteurs to redraft the conference paper for re-submission to the Committee for its further consideration.
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2.3
Expanded programme on immunization: measles and hepatitis B Document (WPRlRC54/Conf. Paper No.3) Mrs BLACKWOOD (United States of America), referring to second operative paragraph,
proposed that the phrase "at the earliest opportunity and" should be inserted after the words "target date should be". Dr WAQATAKIRENA (Fiji) proposed that a new, fourth preambular paragraph should be inserted that read "Noting that, like measles, rubella infections do occur as outbreaks in some countries in the Region;" The RAPPORTEUR FOR THE ENGLISH LANGUAGE considered that the proposed amendment had already been reflected in the operative paragraph 5(2), which referred specifically to congenital rubella syndrome. The representatives from SAMOA and MONGOLIA expressed their preference for the original versIOn. Dr WAQAT AKlRENA (Fiji) agreed to withdraw his suggested amendment. Professor NYMADAWA (Mongolia) proposed that a phrase should be inserted at the end of operative paragraph 6(2) that would reflect the considerable support for hepatitis B control received by the Region from the Global Alliance for Vaccines and Immunization (GAV!). The CHAIRPERSON suggested that the new text could be inserted as a final preambular paragraph rather than in an operative paragraph. It was agreed that a new ninth preambular paragraph would be added to read: ''Noting with appreciation the significant contribution to hepatitis B control in the Region from the Global Alliance for Vaccines and Immunization and other partners;" Decision: The draft resolution, as amended, was adopted (see WPRlRC54.R3). 3. TUBERCULOSIS: Item 13 of the Agenda (Document WPRlRC5417) The REGIONAL DIRECTOR said that, in 1999, the Committee had declared a "tuberculosis crisis" in the Western Pacific Region and had asked him to make "Stop TB in the Western Pacific Region" a special project of the Regional Office. Significant progress had been made since then towards achieving the project's goals. These had been: first, regionwide DOTS expansion; second, an 85% cure rate; and, third, a 70% case detection rate by 2005. The 85% cure rate was already being achieved in areas implementing DOTS.
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He was very encouraged by the success of the foundation building that had taken place since 1999. Political commitment by countries had increased very significantly, symbolized by the
development of five-year national acceleration plans. There had also been significant support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, which had led to a dramatic reduction in the funding gap, from 40% to about 10%. WHO and its Member States were now entering a very critical period. Time was short - there were only two years to go until the end of 2005, and WHO and its Member States would have to be totally focused if they were to achieve those targets. They were still attainable, but WHO and its Member States had to be very honest about the significant barriers that remained. Of the seven countries with a high burden of TB, three had not yet reached the 2005 target of 100% DOTS expansion. In all of those countries, strengthening human capacity building at the central level would be critical if regionwide DOTS coverage was to be achieved. In addition, the current case detection rate of 41 % of estimated new smear-positive cases was still far below the regional target of 70%. It was necessary to expand DOTS in both public and private sectors, improve sputum microscopy, and increase community awareness of TB if a regional case detection rate of 70% was to be achieved. Countries were also facing a number of emerging issues related to TB control. In the last few years, the special project had placed great emphasis on addressing TB/HN coinfection, multidrugresistant TB; the need to involve the private sector, and the relationship between TB and poverty. In future, particular attention would be paid to addressing rising levels of TBIHN coinfection in some countries and in further developing policy on TB and poverty. It was essential to improve access to DOTS services by poor communities. In 2002, the Regional Office had been asked to select a programme to undergo an external
thematic evaluation. He had selected the Stop TB special project because he had felt it would be helpful to have a critical review of WHO's role and recommendations for future directions. An independent team had conducted the review and the executive summary of its report was annexed to document WPRlRC5417. He commended the very professional work and many useful
recommendations of the members of the evaluation team. Dr TEE Ah Sian, leader of the independent review team responsible for the thematic evaluation of the Stop TB Special Project, speaking at the invitation of the CHAIRPERSON, highlighted the main features, findings and recommendations of the review, with the aid of overhead projections. The review team of four had carried out its work in two phases, at the regional and country levels, during the period from February to April 2003. The objectives had been to strengthen WHO's capacity to
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provide teclmical assistance and to conduct programme evaluations, in addition to evaluating the Stop TB project itself. The team had examined the Regional Committee resolutions on tuberculosis control adopted in the period 1999-2002, and summarized their requests for intensified action under WHO's five core functions. Focusing on countries with a high burden of tuberculosis, the team had also reviewed documents, guidelines and mission reports; undertaken interviews, using a special questionnaire, with 60 key officers in the Regional Office, Ministries of Health, WHO country offices, nongovernmental organizations and other partner bodies; visited China and the Philippines; and held a teleconference with officials in Cambodia (the visit to that country had had to be cancelled owing to the SARS outbreak). The main project activities undertaken to date were then mapped. WHO had acted rapidly following the declaration of a "tuberculosis crisis" and the call for the establishment of Stop TB as a special project in the Western Pacific Region at the fiftieth session of the Regional Committee in 1999. After three months it had formed a TB Technical Advisory Group (TAG) and a Regional InterAgency Coordination Committee (ICC) and was formulating a regional strategic plan. Since then it had organized numerous activities, including meetings and training courses, and support for the development of national plans and ICCs. The commendable speed of the response had been crucial to the success of the project. Under the core function of policy, advocacy and funding, the evaluation had shown that WHO had played a leading and strategic role in advocacy, and that the Regional Office had demonstrated the ability to develop workable plans, form coordinating committees, facilitate high-level meetings and provide support for applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The funding gap in seven high-burden countries had been reduced from 40% to 10% during 2003. The team had recommended that WHO should continue its activities in those areas, encourage extension of advocacy campaigns to lower levels of government, and collaborate with countries and the Global Fund to ensure support for the implementation of approved projects. In the area of teclmical support, WHO had shown excellent leadership, increasing technical country visits, augmenting staffing at country and regional levels, developing a regional framework on HIVItuberculosis co-infection, supporting country surveillance and planning activities, and sharing best practices in the Region. WHO should extend its teclmical guidance further, deVelop a framework on tuberculosis and poverty and guidelines on diagnosis and treatment of tuberculosis in children, and facilitate research into social and cultural barriers in relation to tuberculosis control.
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WHO had been successful in attracting and coordinating partners, and in providing well presented and good quality information on tuberculosis and the progress of the project, including a useful Stop TB website. The Organization should strengthen partnerships and continue to disseminate technical and advocacy information and reports. In the area of norms and standards, the targets set for the project had been assessed as
incentives to motivate partners and countries. Of the three targets set for attainment by 2005, the 85% cure rate had been achieved in the Region, and good progress had been made towards 100% DOTS coverage. However, the target of 70% case detection remained a challenge and there was an urgent need to obtain more accurate tuberculosis mortality data. WHO should continue to set clear targets and to support countries in implementing and analysing prevalence studies. The review team had concluded that WHO was well on the way to achieving its initial targets for the Stop TB Special Project. It had established successful approaches, with strong teams at regional and country levels and valuable partnerships for funding and technical cooperation. However, further efforts would be needed in order to sustain and expand activities and to address the issues of concern identified during the evaluation.
The meeting rose at 12:00.
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WPRlRC54/SRJ6 SUMMARY RECORD OF THE SIXTH MEETING (WHO Conference Hall, Manila) Wednesday, 10 September 2003 at 14:00 MODERATOR: Mrs Sandra PIERANTOZZI (Palau)
CONTENTS
1.
Ministerial round table: Future directions for public health in the Region ...................... .
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MINISTERIAL ROUND TABLE: FUTURE DIRECTIONS FOR PUBLIC HEALTH IN THE REGION: Item 19 of the Agenda (Document WPR/RC54/13) The REGIONAL DIRECTOR explained that the ministerial round table would be preceded by
a presentation. Dr Robert Beaglehole, a Director in the Office of the Assistant Director-General, Evidence and Information for Policy, WHO Headquarters, gave a presentation titled "Future of public health in the Western Pacific Region". The presentation was followed by the ministerial round table on future directions for public health in the Region. Mrs Sandra Pierantozzi (Palau) served as moderator of the round table.
The meeting rose at 17:00.
WPRlRC54/SRl7 SUMMARY RECORD OF THE SEVENTH MEETING (WHO Conference Hall, Manila) Thursday, 11 September 2003 at 09:00 CHAIRPERSON: Dr Manuel DAYRIT (Philippines)
CONTENTS
1.
Ministerial round table: Future directions for public health in the Region ...................... . 1.1 Summary by moderator ..........................................................................................
154 154 155 160 160 160 163
2. 3.
Tuberculosis (continued) ................................................................................................. . Consideration of draft resolutions .................................................................................... . 3.1 3.2 Proposed programme budget: 2004-2005 .............................................................. Sexually transmitted infections, including HNIAIDS ...........................................
4.
Severe acute respiratory syndrome .................................................................................. . ANNEX - Ministerial round table: Future directions for public health in the Region - Summary of discussion ..... ..... .......... ...... .......... ...... .......
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MINISTERIAL ROUND TABLE: FUTURE DIRECTIONS FOR PUBLIC HEALTH IN THE REGION: Item 19 of the Agenda (Document WPRJRC54/13) Summary by moderator Mrs S. PIERANTOZZI (Palau), moderator of the ministerial round table, summarized the
1.1
previous afternoon's discussions (Annex). The REGIONAL DIRECTOR said that he had found the views expressed at the previous day's ministerial round table useful and stimulating; they would be seriously considered. Several ministers had discussed the lack of public interest In important public health issues. In this regard, he related his discussion with the Dean of the Harvard School of Public Health, who had observed an identity crisis concerning public health among students and professors in his school. Similar sentiments had been expressed at a recent conference of the Japan Public Health Association in Tokyo. He listed three factors influencing the low profile of public health. First, politicians, who had the power to decide on resource allocation, were interested in immediate results and visible projects, such as the construction of hospitals, rather than long-term benefits from investments in public health. Second, the general public, and patients especially, valued the skills of surgeons and clinicians, but often failed to recognize the value of effective public health initiatives, such as immunization. Third, the mass media focused on events concerned with dichotomy, disaster and drama, but had little interest in such issues as health promotion or health legislation. At a press conference the previous day, for example, he had shared his views and priorities for public health in the Region, but most of the questions that had been asked were related to the one suspected new SARS case in Singapore. Some preconceived ideas had to be countered. Politicians concerned about re-election needed to be convinced that public health efforts could produce visible results in a short time, even before their term was over. As mentioned at the previous session, with strong government commitment and the concerted efforts of the public and private sectors, a decline in, for example, diabetes prevalence, could be achieved in one or two years. Apart from the evidence-based approach, innovative
approaches that could appeal to political interests should be adopted. 'Glamorizing' public health in order to influence the general public even through unconventional means, such as the production of films featuring SARS heroes, should also be considered. Public health initiatives should involve, not only politicians and decision-makers, but also communities, various professionals and, especially, the intended beneficiaries. The representative from Hong Kong (China) had mentioned the need for instigators of change in the community. He agreed, and pointed out that public health workers themselves could instigate
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changes that would not only prevent disease but also promote health. Public health leaders could do a lot to revitalize the community and shape the future. It was important to broaden the scope of the medical profession and to change the mind-set of some medical professionals with tunnel vision. 2. TUBERCULOSIS: Item 13 of the Agenda (Document WPRlRC5417) (continued) Dr ISHIKAWA (Japan) said that the Stop TB special project faced two challenges: achieving
its goals within a limited timeframe and tackling emerging problems, such as multidrug-resistant tuberculosis and HlV/tuberculosis co-infection. She welcomed the proposal to finalize DOTS
acceleration plans in countries with a high burden of tuberculosis in order to meet the target of ensuring that all notified cases in the Region were treated by directly observed treatment, short-course (DOTS) by 2005. One reason for the special project's success was the practical advice it provided, tailored to individual countries. That approach should be applied to efforts to increase case detection. Her country had been contributing to tuberculosis control for many years by developing human capacity through the international training course at its Research Institute of Tuberculosis. More than 1700 alumni throughout the world were prominently engaged in tuberculosis control in their home countries. The Regional Office should continue to' emphasize monitoring and evaluation in order to improve the quality of DOTS services, Japan offered to provide specialists to participate in
programme evaluations. Further, joint evaluations could be conducted with such bodies as the Global Fund to Fight AIDS, Malaria and Tuberculosis in order to make optimal use of countries' capacity. The programme evaluation had noted that tuberculosis and poverty had been only partially addressed in the Region's strategies, Could the Regional Director provide an explanation for this? Mr UNTALAN (United States of America) strongly endorsed the actions proposed to advance the special project in the Region. Although good progress had been made, DOTS needed to be applied more widely, which implied political will and additional resources, including staff and supplies, He recognized that geographical isolation made implementation difficult in some countries, The mV/AIDS epidemic was further adding to the burden. His country supported the regional framework for tuberculosis and HlV' which would be adopted in countries with high rates of coinfection. All available mechanisms had to be used to bridge funding gaps, including the Global Fund to Fight AIDS, Tuberculosis and Malaria. His country was willing to provide technical support for the preparation of funding proposals.
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Dr LOPEZ (Philippines), referring to one of the conclusions of the programme evaluation, namely, that it was misleading to say that DOTS coverage in the Philippines was 100%, pointed out that 100% DOTS coverage related only to the public sector. The five-year DOTS expansion plan for 1997-2001 focused on improving the quality of DOTS implementation in the public sector and reaching difficult areas, including those where there was armed conflict. Nearly one third of patients received care in the private sector. Training was starting in that sector and models were being built for a "public-private mix" of DOTS implementation. However, delayed drug procurement and distribution was a concern, and his country had submitted a proposal to the Global Drug Facility for setting up an emergency buffer stock. A procurement system was being established for tuberculosis drugs; all recommended action was being taken. Since HIV prevalence was low in his country, tuberculosislHIV co-infection was not a significant problem. He supported the recommendations contained in the programme evaluation. Professor NYMADAW A (Mongolia) fully endorsed the conclusions and recommendations of the programme evaluation. Although Mongolia had one of the highest prevalence rates in the Region, it had almost reached the regional targets for tuberculosis control. Yet prevalence was not declining, even though the cure rate was high. More than half of new cases were in the productive age group, which had an additional economic impact. A particular problem was drug resistance of Over 50% among penitentiary inmates. TB
prevalence among that group was already 30 times higher than among the general public. Access to second-line tuberculosis drugs was, therefore, urgently needed. He requested WHO and Member States to work towards inclusion of such drugs in the current round of negotiations on WTO's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).
Dr BENJAMIN (Federated States of Micronesia) agreed that the causes of tuberculosis in small island states included shortage of skilled staff, medication and resourceS. The number of cases in his country continued to rise, with pulmonary tuberculosis comprising 80% of diagnosed cases. Few people completed a course of treatment, and even fewer, preventive therapy. Suspected cases were often not confirmed by laboratory tests. Paediatric tuberculosis needed special control and prevention measures. He requested WHO to try to find a solution to a statistical problem that particularly affected countries with small populations. In such countries, a few cases could make the prevalence or incidence rate appear high.
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Ms GO (Republic of Korea) said that her country worked closely with other countries to implement national tuberculosis control programmes, and had provided an international tuberculosis training course every year since 1995. In the Republic of Korea, cure rates were high in the public sector, but private .sector activities needed to be improved. strategy to that effect. She fully supported the proposal to establish a strong central management unit in countries to ensure the efficient management of financial support and effecti ve monitoring of tuberculosis control. Dr SULEIMAN (Malaysia) reported that his country had 100% DOTS coverage and was already implementing a five-year action plan. Malaysia had introduced a new information system that covered all aspects of case management, including referral systems and monitoring of multidrugresistant tuberculosis. It had also produced guidelines for tuberculosis management and control,
Her Government was drawing up a
which had been distributed to all involved in tuberculosis control, including the private sector and nongovernmental organizations. Malaysia intended to create new supervisory teams to monitor tuberculosis control. He asked WHO to identify a centre of excellence in the Region where middle-level managerial staff could be sent for training. Dr Nao BOUTIA (Lao People's Democratic Republic) expressed appreciation for the technical support received from WHO in preparing a successful application to the Global Fund to Fight AIDS, Malaria and Tuberculosis. The application had been for a two-year grant to finance extension of the DOTS strategy to the whole country. The main challenge was the lack of human resources, and continued support from WHO would therefore be appreciated. Mr V AEV AE PARE (Cook Islands) expressed strong support for the regional proposals on tuberculosis control. Although tuberculosis prevalence in Cook Islands was low. there was no room for complacency. There was a need to improve the quality of laboratory services, strengthen community awareness and pay due attention to other public health activities, particularly tuberculosis surveillance. The ongoing training oflaboratory and public health staff was greatly appreciated. Dr SELUKA (Tuvalu) endorsed the regional proposals, agreeing that there was a need to strengthen national management capacity and partnerships with nongovernmental organizations in order to obtain maximum benefit from disbursements from the Global Fund. Tuberculosis prevalence and incidence in Tuvalu were among the highest in the Region, and greater efforts were needed to improve surveillance and strengthen community participation in control activities. On the recommendation of a WHO consultant, greater attention was being given to case detection through
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sputum smear examination, and to monitoring of tuberculosis cases and contacts; it had been advised that all contacts under the age of six years should receive treatment. Dr WANG (China) endorsed the regional analysis of the tuberculosis situation in his country and supported the proposals for future action. China attached great importance to control of the disease and had formulated a 10-year national programme for nationwide implementation of the DOTS strategy. Allocation of resources had been increased and the country was cooperating with WHO, partner governments and other organizations with a view to accelerating the process. Although progress had been achieved, resource constraints were hampering control efforts; the detection rate and public awareness about the disease remained low. The large migrant population posed a particular challenge. There was a need for increased investment in control efforts at all levels of government, particularly in the west of the country. He expressed appreciation for the technical support received from WHO, which he hoped would continue. Mr KALPOKAS (Vanuatu) thanked WHO for the support given to the Member States of the Region in implementing the DOTS strategy and, in particular, for the services of a short-term consultant to train Vanuatu health workers in all aspects of the strategy, and for the opportunity to send health workers for training in Viet Nam. Activities in Vanuatu had also included the launching of a manual on DOTS. He expressed appreciation for the materials provided by New Zealand for use in raising public awareness of tuberculosis. Dr KUN (Macao, China) said that tuberculosis remained one of the most common notifiable diseases in Macao with an average annual incidence of 90 per 100 000 population. Tuberculosis control had been allocated increased resources, and DOTS was available to the whole population free of charge. Other activities included the establishment of a new tuberculosis centre, upgrading of laboratory equipment, screening of high-risk populations, efforts to increase treatment compliance, and research into the reasons for failure to comply. The tuberculosis cure rate was currently 90%. However, incidence had not declined noticeably and he hoped that WHO would strengthen efforts in countries and areas with an intermediate burden of the disease, such as his own. Dr LAM (Hong Kong, China) said that Hong Kong remained an area with an intermediate burden of tuberculosis. Strategies for prevention and control of the disease had been formulated by the Tuberculosis and Chest Service of the Department of Health. Consultation and DOTS were provided free of charge in the 18 clinics operated by the service, which were accessible to the whole popUlation; DOTS was also provided in the private sector. Hong Kong had made good progress towards attaining the Stop TB regional goals. However, the rate of decline in notification of the disease had slowed in the past 10 years, probably due to the ageing of the population and to
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endogenous reactivation rather than progressive primary infection or exogenous re-infection. Steps were being taken to review and evaluate the tuberculosis control programme, improve the surveillance and information systems, boost health education and promote DOTS more vigorously. Hong Kong would continue to support the WHO Global Project on Anti-tuberculosis Drug Resistance Surveillance and the strategic plan to control tuberculosis in the Region. Dr KUARTEI (Palau) greatly appreciated the support provided by WHO for the LabNet services of the Pacific Public Health Surveillance Network. However, as multidrug-resistant tuberculosis increased, a regional reference laboratory for tuberculosis was needed, especially for the small Pacific island countries. Mrs PAUL (Marshall Islands) reported that the Marshall Islands, like other small island countries, was facing an increase in tuberculosis cases and had therefore taken steps to increase community awareness about the disease and to strengthen implementation of the DOTS strategy through use of community volunteers. She urged WHO to provide support for staff training and upgrading of limited laboratory capacity, as limitations in those areas were hampering tuberculosis control efforts. Dr MANN (Papua New Guinea) informed the Committee that the high prevalence of tuberculosis in his country was accompanied by a rising rate of co-infection with HIV - in the largest hospital more than 34% of tuberculosis patients were HIV -positive. There were plans to extend the DOTS programme, which currently covered only 30% of the population, but lack of skilled human resources at the central level and low availability of antituberculosis drugs were major constraints. Although the situation was improving gradually, Papua New Guinea would continue to require substantial support in those areas. The representative of the International Federation of Medical Student Associations, speaking at the invitation of the CHAIRPERSON, made a statement to the Committee. The REGIONAL DIRECTOR, responding to comments made by the representative of Japan concerning the link between tuberculosis and poverty, reminded the Committee that 1000 people in the Region were dying every day, many of them at an economically productive age. Moreover, tuberculosis prevalence was higher among economically disadvantaged groups and the illness, which prevented them from working, could push them into poverty. DOTS, which enabled patients to return to work, was therefore a strategy that could help to reduce poverty. WHO was taking steps to develop specific interventions to reach such vulnerable groups and to undertake more active surveillance. In
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addition, in Cambodia the World Food Programme had agreed to supply free food to tuberculosis patients who had been hospitalized and thereby lost income. The REGIONAL ADVISER IN TUBERCULOSIS, replying to comments concerning limited human resources, indicated that three well developed training courses in tuberculosis management were available in the Region: at the Research Institute of Tuberculosis in Tokyo, Japan (where many health professionals had been trained since the 1960s); at the Korean Institute for Tuberculosis in Seoul, Republic of Korea (a similar course that had been running since the mid-I 990s); and through a course organized jointly by the International Union against Tuberculosis and the national control programme in Ha Noi, Viet Nam, which would be given twice a year from 2004. The WHO Collaborating Centre on Tuberculosis Bacteriology in Brisbane, Australia, offered on-the-job training courses in laboratory skills. In addition, WHO, together with the Secretariat of the Pacific Community, planned to organize similar training courses for the Pacific island countries, for which financing from the Global Fund had been secured. The CHAIRPERSON requested the rapporteurs to draft an appropriate resolution. 3. CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions. 3.1 Proposed programme budget: 2004-2005 (Document WPRlRC54/Conf.Paper No.2 Rev. 1) Decision: The draft resolution was adopted (see resolution WPRlRC54.R4). 3.2 Sexually transmitted infections, including HIV/AIDS (Document WPRlRC54/Conf. Paper No.4) Dr KING (New Zealand) suggested two amendments. To operative paragraph 1,
subparagraph 7, the following should be added: "and to give effect to the Declaration of Commitment on HIV / AIDS adopted by the twenty-sixth special session of the General Assembly, in particular the clauses stressing gender equality and empowerment of women (clause 14), recognizing the essential role of the full realization of human rights (clause 16), affirming the key role of partnerships (clause 32), and acknowledging the particular roles played by young people and people living with lIIV/AIDS (clause 33);". Her second suggestion was to replace operative paragraph 1, subparagraph 8 with "to develop or strengthen national policies for HIV/AIDS care that are comprehensive and multisectoral, that improve access to treatment for lIIV / AIDS, including access to drugs for HIV / AIDS, and that mitigate the effects of living with mV/AIDS". She explained that that had been proposed in order to
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take up the concerns raised by the Assistant Director-General for Family and Community Health the previous day. Dr FUKUDA (Japan) suggested three amendments. A new preambular paragraph should be inserted after the eighth preambular, to read "Noting the potential for an increase in drug-resistant HIV in the Region;" The words "and drug-resistance surveillance for HIV" should be added to operative paragraph 2, subparagraph 1. A new subparagraph 3(1) should be inserted in operative paragraph 2, to read "appropriate policies to prevent creation of drug-resistant HIV". The DIRECTOR, PROGRAMME MANAGEMENT suggested the removal of the words "creation of' from Dr Fukuda's last amendment. Dr BILGER (France) suggested that the original operative paragraph 2, subparagraph 3(1), now subparagraph 3(g), be amended to read "appropriate legislation, including laws related to HIV/AIDS drugs". Mrs BLACKWOOD (United States of America) suggested five amendments to the text. In the fourth preambular paragraph, the w~rds "the dangers of' should be inserted before "high-risk behaviour". A new preambular paragraph, which could follow the paragraph inserted by the representative of Japan, should read: "Noting the high rates of tuberculosis in the Region, leading to TBIHIV co-infection." In operative paragraph I, subparagraph 2 after "to promote lifestyle choices" the words "such as delay of sexual activity by youth" should be added. In operative paragraph 2, subparagraph 3(b) the words "evidence-based" should be inserted before "strategies for harm reduction". In operative paragraph 2, a new subparagraph 3(e), to read "TBIHIV co-infection", should be added. She asked for clarification of the amendment proposed by the representative of France. Dr BILGER (France) requested a written text, in French, of the amendments proposed by the
United States of America. Explaining her own proposed amendment, she said that the text of operative paragraph 2, subparagraph 3(g), as it stood, had been too vague; it ought to specify what the legislation was about. France favoured national legislation to ensure that drugs would be available in the countries. The REGIONAL DIRECTOR recalled that a complex discussion was under way concerning the availability of drugs under the TRIPS agreement, which included a number of special arrangements of which Member States might wish to avail themselves. In order to do so and at the
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same time to respect intellectual property rights, Member States would have to amend or create national laws. Mrs BLACKWOOD (United States of America), echoing the intervention of the representative of New Zealand, said that the Declaration of Commitment made at the United Nations General Assembly special session on HIV/AIDS called upon governments to enact legislation addressing many aspects of HIV/AIDS. Model legislation was available. She proposed that operational paragraph 2, subparagraph 3 (g) read: "appropriate legislation, including that in support of the United Nations General Assembly Declaration of Commitment on HIV/AIDS and in relation to HIV/AIDS drugs." She accepted the suggestion of the RAPPORTEUR for the English language to add the words "access to" before "IIIV/AIDS drugs". Dr BILGER (France) said that she wished to see a French translation of the text before she could accept the amendment. Mrs PIERANTOZZI (Palau) proposed that a new subparagraph be inserted after operational paragraph 1, subparagraph 6, reading: "(7) to make greater efforts to involve men in all aspects of IIIV/AIDS prevention programmes;", to reflect her country's view that men should also be involved in family health, sharing the burden with women. In response to a comment by Dr KIENENE (Kiribati), the CHAIRPERSON asked the
Secretariat to align the punctuation of the phrase "STI and HIV/AIDS" throughout the document. Dr MATHESON (New Zealand) said that the proposed amendment to add the example ", such as delay of sexual activity by youth," to operative paragraph 1, subparagraph 2 was an oversimplification of a complex societal problem. For instance, older men often misused their position of power to oblige young women to have sexual relations with them, so that the choice was not confined to youth. Mrs BLACKWOOD (United States of America) countered that encouraging delay of sexual activity had been shown in many countries to be an effective intervention for reducing new infections with HIV. At the suggestion of the Chairperson, it was agreed that the representatives concerned would meet with the rapporteurs to redraft the conference paper for re-submission to the Committee for its further consideration.
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4.
SEVERE ACUTE RESPIRATORY SYNDROME: Item 14 of the Agenda (Document WPRlRC54/8) The REGIONAL ADVISER IN COMMUNICABLE DISEASE AND RESPONSE recalled
that the Western Pacific Region had been the epicentre of the severe acute respiratory syndrome (SARS) outbreak. It was now believed that the SARS outbreak had started in Guangdong Province, China, in November 2002, and had then spread to other countries via Hong Kong. The human chain of transmission had been interrupted and the outbreak contained globally by early July 2003. More than 30 countries and areas had reported cases of SARS to WHO, and all the severely affected areas had been in the Region, except Toronto, Canada. A total of 8422 probable cases had been reported to WHO, of which 8087 (96%) were in the Western Pacific Region. The Regional Office had taken immediate action after receiving information about an outbreak of respiratory illness in Guangdong Province from informal sources in early February 2003. On 20 February, the Regional Director had proposed that a WHO team visit Guangdong, and on 23 February the first WHO team had arrived in Beijing to discuss the outbreak in Guangdong. By 5 March, Dr Carlo Urbani in the WHO country office in Viet Nam had recognized a cluster of cases of febrile illness among hospital workers and reported the outbreak to the Regional Office. On 11 March, the Hong Kong Government had reported another hospital outbreak. WHO had issued a global alert on 12 March. A regional SARS team had been established to conduct response activities in affected countries and preparedness activities mainly in unaffected countries. Both sets of activities included surveillance, infection control, quarantine, laboratory testing, logistics and relations with the media. Several teleconferences had been organized each day with WHO Headquarters, field teams and technical experts to discuss operational and technical issues, and the Regional team had had to work day and night owing to the time difference between Manila and Geneva. Communication had been maintained with WHO country offices and the governments of Member States in order to exchange the most up-to-date information. In addition, the Regional Office had provided Member States with technical support and emergency supplies. Part of the technical support had consisted of practical guidelines and training tools for infection control developed by the Regional Office. WHO had sent technical experts to support response activities in affected countries as early as February, and by the end of August, 164 consultants had been sent to countries such as China (including Hong Kong and Taiwan), Viet Nam, the Philippines and Singapore. The consultants sent to unaffected countries to work with their national counterparts to strengthen preparedness for SARS had included infection control experts, epidemiologists and virologists.
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Confirmation of diagnosis by laboratory testing was vital in SARS surveillance, and the Regional Office had established a regional laboratory network to ensure that the necessary testing could be done for countries that did not have adequate laboratory capacity. Shipping of clinical specimens between national and regional reference laboratories had thus been organized, and safety guidelines had been distributed to relevant laboratories in the Region. WHO had distributed emergency equipment to most countries of the Region, which included personal protective equipment, with the support of the Japan International Cooperation Agency. The need for timely dissemination of accurate information had been recognized, and the Regional Office had created a SARS website to provide the latest information, including guidelines and the answers to frequently asked questions. Press conferences had been organized and press releases issued in Beijing, Ha Noi and Manila. The print, television and radio media had all played vital roles in disseminating information to the general public. SARS had been contained owing to unprecedented efforts in the affected countries. In China, there had initially been reluctance to share information; however, when the Government at the highest level decided to take strong action, the response had been immediate and comprehensive. The Government of Hong Kong had implemented effective surveillance and had played a leading role in identifying the causative agent and developing the best treatment protocols. Singapore had taken highly effective control measures, such as isolation and quarantine, with extensive contact tracking. Viet Nam had been the first country to interrupt local transmission by instituting strong infection control measures in affected hospitals. The Philippines had undertaken comprehensive contact tracking. Mongolia had promptly instituted strict measures for infection control in hospitals and had had no cases among health care workers. Countries in the Region with no local transmission had undertaken a number of proactive measures, including screening of incoming passengers, training in infection control and stockpiling of personal protective equipment. Member States and WHO had organized a number of meetings to discuss response and preparedness to the SARS outbreak, including several meetings of the Association of Southeast Asian Nations and a WHO Global Conference on SARS in Kuala Lumpur, Malaysia. WHO and the Secretariat of the Pacific Community had organized a meeting of the Pacific Public Health Surveillance Network in the past week to discuss preparedness for SARS in the Pacific region. After a four-month-Iong battle, the human chain of transmission had been interrupted, and SARS had been contained globally. The key elements of that success had been: (1) high levels of leadership and commitment in each country; (2) the dedication and hard work of public health and health care staff; (3) strong international collaboration, with rapid, effective support from partners
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including the governments of Australia, Japan and New Zealand and the Centers for Disease Control and Prevention in the United States; and (4) the willingness of governments to give health top priority. Nevertheless, a number of issues remained. In the area of governance, each country had issued a travel advisory based on its own assessment, and there had been no standard criteria for travel advisories, passenger screening or health declaration cards. Follow-up of cases across borders had often been hampered by incomplete data collection. The SARS outbreak had highlighted the lack of adequate surveillance systems, particularly effective early warning systems, in many countries. Initially, there had been barriers and delays in the sharing of surveiilance data by some countries, which had been overcome subsequently. A lack of epidemiological capacity to analyse data at national and subnational levels had been identified in some countries. Problems had been encountered in information sharing and communication between hospital and public health authorities. In some cases, foreign experts had violated professional ethics with regard to the ownership of data and specimens. The SARS outbreak had challenged public health and health care systems. Many of the basic measures for containment had been found to be effective, but resource-intensive. The infection control practices in health care settings had not been optimal in many countries; the messages given to the public had sometimes been inconsistent, resulting in confusion; and the personal protective equipment was expensive and had been found difficult to wear properly all the time. Risks had not always been communicated skillfully. WHO should take a number of steps on the basis of the lessons it had learnt in dealing with the SARS outbreak. The International Health Regulations should be revised to allow WHO to act more proactively in outbreaks of international significance. The Organization should work with its partners to strengthen its capacity to respond to outbreaks, and at least four additional experts would be recruited by the Asian Development Bank to work as a regional response team. Regional epidemiological networks should be identified and strengthened to enhance outbreak preparedness and response. WHO needed to promote the development of reliable laboratory tests to detect SARS in the early stage of infection. WHO should also plan and manage resources for dealing with outbreaks that might persist over long periods, as its resources had been fully stretched at the height of the outbreak. Much knowledge had been gained about the disease and the causative virus over the past six months, but many research questions remained. WHO should coordinate further research on the origin of the virus, the best treatment protocols, development of vaccines and antiviral agents and the environmental factors involved in transmission. National governments should further strengthen their capacity for surveillance and outbreak response and should plan and manage the appropriate resources. Their public health infrastructure should be strengthened, and each country should establish a programme to control infections.
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Sustained high-level commitment should be solicited, to enable strong interventions against outbreaks of existing and emerging infectious diseases. SARS might come back in the coming months, and a new case had been confirmed in Singapore. Nevertheless, the Region was better prepared than it had been six months previously. If SARS re-emerged, early containment would be possible. It was important to maintain vigilance, so that any possible cases were detected and reported promptly, and all the necessary measures were implemented. Dr SADASIVAN (Singapore), noting the interest in the recent case of a person who had tested positive for the SARS virus in Singapore, gave the Meeting the latest information available. The patient was a 27-year-old man who had not recently travelled outside the country. On 23 August 2003, the patient, who was a post-doctoral research student working on West Nile fever, had visited a laboratory in Singapore where live SARS cultures were being studied. He had developed a fever on 27 August and had been admitted to hospital and isolated on 3 September. His fever had since subsided, and none of his contacts showed any symptoms. The patient had not developed atypical pneumonia and did not, therefore, meet the criteria for a clinical diagnosis of SARS; however, polymerase chain reaction (PCR) and serological tests had shown the presence of the SARS coronavirus. Those tests were being repeated, in Singapore and on samples of the original specimens at the Centers for Disease Control and Prevention in the United States of America. Although the patient had not developed clinical SARS, the positive results suggested that he might have been exposed to the SARS coronavirus. The Government of Singapore was taking the case seriously and had temporarily closed the two research laboratories in which the patient had worked. All laboratory safety procedures were being reviewed, and WHO had been asked to send experts to investigate and review the biological safety procedures at the two laboratories. WHO had agreed to send two experts, one from Australia and one from Japan, to assist in the investigation and review. The Government considered the case to be an isolated incident of exposure to the SARS virus and that the risk to public health was very low. There was no person-to-person transmission of SARS. The finding of the SARS virus in specimens from the patient should not be considered to constitute an outbreak ofSARS.
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The research effort in Singapore had resulted in identification of the genome of the virus. Kits for SARS diagnosis had been developed, and had been used in several countries during the outbreak. His country would be vigilant and would ensure that the highest standards of biological safety were maintained at laboratories where research on the SARS virus was being conducted.
The meeting rose at 12:25.
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ANNEX MINISTERIAL ROUND TABLE: FUTURE DIRECTIONS FOR PUBLIC HEALTH IN THE REGION SUMMARY OF DISCUSSION Participants at the ministerial round table agreed that the public health challenges in the Region are many and varied, both old and new. To date, public health has not fulfilled its potential, for many reasons. This was recognized as an important and opportune time to build and strengthen the public health infrastructure and to push for increased resources. Various events have more explicitly
demonstrated the deficiencies in current systems; there is growing recognition of the double burden from both noncommunicable and communicable diseases and changing disease patterns that health systems must respond to. However, it was also noted that, while some problems demand urgent and immediate attention, such as SARS, efforts should be made to ensure other services of importance are not compromised. Urgent emerging health issues or diseases should also be considered within the broader context of national health priorities. It was emphasized that public health interventions are, in general, cost-effective and can have a positive effect in a relatively short time. A recurring theme centred around the need to strengthen the two-way links with communities, at all levels from national planning and policy development through to service delivery. Health
workers and communities can have quite different views and understanding on health issues that should be considered a priority. Provision of appropriately oriented information was an important function of public health, to empower and motivate communities to make appropriate healthy choices and to inform and support government policies and programmes. It was noted, however, that more sophisticated advocacy and communication strategies need to be developed. It was also important to recognize that communities have structures, such as family units,
which may be a fruitful basis for public health work, and also to particular at-risk groups within communities that are often overlooked, such as men. In addition, needs and perspectives from the point of view of communities and consumers must be considered. People needed to be considered holistically, including their social context and spiritual health. Individuals and communities had
reasonable expectations that, firstly, public health systems and services are operating effectively so that they are not unnecessarily exposed to diseases or health risks and, secondly, they need to be assured that basic services are affordable and available when needed.
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Additionally, many participants recognized the need to strengthen coordination and integration, not only for services that are provided within the sector, but also in the way in which the goverrunent health sector works with other parts of government and with others outside government. Leadership and political commitment to public health were recognized as critically important, both within the health sector and across sectors. Some countries have established high-level mechanisms to ensure improved cooperation and communication among key government departments or agencies. Providing examples of impacts on health, and in particular feedback to other sectors and agencies, can also help strengthen partnerships and commitments of others. Not surprisingly, resources were identified as a critical part of strengthening the infrastructure. However, it was pointed out that working within limited resources can force a re-examination of what is being done, and may result in changing priorities or refocusing publicly-funded activities. In some cases, sector-wide management or approaches are being developed to provide mechanisms for clearer coordination of resources and commitments, from government, donors and other parties, towards goals based on priorities identified by the country. In well-regulated markets, public-private
partnerships can also add benefits. It was recognized that there has been much talk over the years about shifting more resources to prevention activities, but this had rarely materialized. There is a need for a strong base of evidence to enable prioritization of cost-effective interventions, which will also serve to protect resources available in public health and improve the likelihood of getting more. In a number of cases, Member States have recognized the need for a 'vision' for public health
and for formal strategic plans, as wen as longer term human resource planning, financial planning, and the setting of goals and targets. These plans were often given formal status through legislation or other mechanisms. Structural changes in the public sector may be needed to successfully implement these plans. Public health has an overall integrating function across the health sector. It was also identified that decentralization should only be undertaken with appropriate consideration for each service, balancing national and local considerations. Care must be taken to maintain coordination between decentralized services, and sufficient trained personnel must be in place to ensure the system functions effectively. A particular area of comment concerned the health workforce. Many difficulties were
identified, particularly the need to strengthen skills in a range of areas, such as health promotion, surveillance, advocacy, planning and management. Reductions in some groups of primary health care
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Annex
workers have been particularly evident, in situations where resources have been redirected to hospitals and clinics, rather than to ensuring that public health nurses, for example, remain available to serve local communities. A point was made that we need to find ways to 'glamorize' public health workers, which could heIp to attract younger people into careers in public health, as well as additional resources. It was also emphasized that the increasing complexity of public health and the context in which it operates has resulted in an even broader range of skills being needed in public health - for example, international law, environmental design, health impact assessment and international trade. Information systems were recognized as a key underlying factor in the ability of public health to provide improved evidence-based information and support the effectiveness and efficiency of both day-to-day operations as well as decision-making. Not only do these systems need to be strengthened, but it is also important to examine the quality and relevance of data, for resources may be wasted in collecting and analysing worthless data. Good information on public health activities, costs and on the impacts of public health activities was identified as essential for convincing ministries of finance and others that investment in public health is worthwhile and fruitful. Good information is also important for supporting the appropriate use of 'business' practices to improve the management of services and increase transparency for communities. It was also frequently highlighted that many health problems do not just affect one country.
There is therefore an increasing need for countries to work collaboratively with each other in good faith to collectively diminish some health risks and problems. An example of developments in the northern Pacific illustrated how cooperation .between countries may be able to help share professionals and support professional development, and to examine best practices. The potential role of WHO was discussed by a number of participants. A common aspect identified was the importance of WHO strengthening its position as a leading player in intersectoral action at the regional and global levels, and in providing key guidelines and frameworks. A key example of this is the WHO Framework Convention on Tobacco Control. WHO can also provide a vehicle for cooperation between countries, particularly on an issue such as SARS. WHO also provides an important role in facilitating access to relevant expertise and in providing up to date information. Sharing information that can be used to help people understand preventive programmes, particularly for non-communicable diseases, would be helpful. In addition,
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there may be a role in countering the global impacts and resources of large business entities which tend to overwhelm health messages and which individual countries are in a difficult position to counter. Although WHO was recognized as having a regional and global role, it was also identified that it was very important for WHO to understand and listen to individual country needs. In addition, information and mechanisms to assist countries to identify and prioritize health needs would be of value. In conclusion, this was a stimulating discussion which has the potential to improve the future prospects of public health in the Region.
WPRlRC54/SRl8 SUMMARY RECORD OF THE EIGHTH MEETING (WHO Conference Hall, Manila) Thursday, 11 September 2003 at 14:00 CHAIRPERSON: Dr Manuel DAYRIT (Philippines)
CONTENTS page I. 2. Severe acute respiratory syndrome (continued) ............................................................... . Expression of sympathy in connection with the recent SARS outbreak Regional strategy for improving access to essential medicines in the Western Pacific, 2004-2009 .................................................................................. . Framework Convention on Tobacco Control .................................................................... . 174 180
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SEVERE ACUTE RESPIRATORY SYNDROME: Item 14 of the Agenda (Document WPRlRC54/S) (continued) Dr WAQATAKIREWA (Fiji) praised the efforts made by Member States to control the
outbreak of severe acute respiratory syndrome (SARS), thanks to which the disease had not entered Fiji. Although three cases had been suspected, they had not been confirmed. None the less, in view of the staging of the South Pacific Games in Suva in July, his Government had introduced the requirement that all travellers from identified SARS-infected countries had to produce a certificate of good health. That episode had provided a good test of the integrity of Fiji's public health system; it had helped to uncover loopholes in current quarantine and public health legislation; had demonstrated the need to strengthen infection control procedures; and had raised awareness of the need to maintain disease surveillance in ports of entry even during periods oflow risk. The SARS outbreak had led to concentration at the highest political level and cooperation between many organizations. That had proved to be effective in containing the outbreak, and could be applied in other cases, such as the HfVI AIDS pandemic. Mr TRINH QUAN (Viet Nam) endorsed the actions proposed in the report under review and expressed his country's commitment to setting up robust systems to detect and respond to SARS should it reoccur. Viet Nam had been one of the first countries affected by the outbreak, and its response had been widely acknowledged as exemplary. In preparation for a potential resurgence, it was convening a symposium in Ha Noi in October to review containment experience, draw lessons for the future and share national preparedness plans. He invited ASEAN Members and other countries in the Region to participate. Dr FUKUDA (Japan) paid tribute to Dr Carlo Urbani and the many health workers who had
lost their lives in combating SARS. Member States had succeeded in controlling the outbreak through their intense efforts and with WHO's unfailing support. Japan had provided emergency funding for the purchase of equipment. An international laboratory network, which included the National Institute of Infectious
Diseases of Japan, had been set up during the outbreak, and had identified the pathogen. Nevertheless, the origin of the corona virus had not yet been identified, and no treatment yet existed. Countries, therefore, had to be prepared for a reoccurrence of the disease. Japan was giving priority to
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development of a rapid diagnostic test and the means to distinguish SARS from other respiratory infections. It had also learnt from the outbreak that its infection control legislation was not optimal; it was therefore revising its law on the prevention of infectious diseases. Dr ABIDIN (Brunei Darussalam) thanked WHO for the exceptional support given to his country during the SARS outbreak, but expressed his concern that, at the beginning of the influenza season, there were still no specific diagnostic kits and the symptoms of influenza and SARS were similar. Priority should be given to development of a testing kit and a more specific case definition. Guidance was also needed on regional and international travel. In that regard, the revision of the International Health Regulations, which would address some of the issues raised by the emergence of SARS, was very timely. Professor NYMADAWA (Mongolia) said that nine cases of SARS, all imported, had been reported in Mongolia, together with a large number of contacts, from which an infectivity index had been calculated of six cases per thousand contacts. Thanks to external support and national efforts, none of the patients had died, nor had health workers been infected. Mongolia's national control efforts had been guided mainly by WHO's website. However, the outbreak had highlighted the importance of timely provision of information to neighbouring countries. All Member States had a duty to others to provide timely information. The outbreak had also emphasized the vital need to strengthen laboratory services for future control of SARS or other emerging diseases. Without such services, cases could not be confirmed nor appropriate action taken. Development of diagnostic test kits would be a first step, and the
establishment of a regional network of reference laboratories was needed to prevent the resurgence. Dr MOHAMAD TAHA (Malaysia) said that five probable cases of SARS, all imported, had been reported in Malaysia. His country had issued improved SARS surveillance guidelines which incorporated all WHO's post-outbreak recommendations. The meeting of ministers of health of the Region in Kuala Lumpur at the height of the outbreak, and the subsequent conference of heads of government in Bangkok, Thailand, had highlighted the strong commitment at the highest political level to combat a common threat. That response to SARS had demonstrated the importance of cooperation through laboratory networking, standardization of prevention and control activities along common borders, and prompt notification of cases. However, uniform and common enforcement of international regulations was needed to prevent the spread of infectious diseases
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Another requirement was a classification system for control purposes. For example, did WHO classify the current case in Singapore as "probable" or "suspect"? What criteria were used to classify the case? Dr YU (China) endorsed the actions proposed in the report. China had recently undertaken a number of steps to enhance prevention and control and reduce the risk of a resurgence of SARS. Among other measures, it had: drawn up national guidelines which defined the technical and
management aspects of SARS prevention and control, together with guidelines on SARS surveillance and reporting; convened a number of expert consultations on detection, diagnosis and control in the case of a recurrence of SARS; revised principles and working procedures for detection of SARS and its differentiation from influenza; revised the reporting categories of infectious diseases that were prescribed by law; issued guidelines on response to public health emergencies in order to improve preparedness at different levels; and provided nationwide training on SARS, including the drafting of teaching materials on disease prevention, control and surveillance. China intended to focus on disease prevention and control, optimization of rapid response mechanisms, and improvement of information, monitoring and reporting systems, giving priority to rural health work. WHO should pay special attention to the development of rapid diagnostic tests, effective therapy, and legal aspects of infection control, as little progress had been made in those areas. Dr LOPEZ (Philippines) expressed his appreciation for the strong support received from WHO both during and after the outbreak. There were many lessons to be learnt from the experience, not only the need to strengthen epidemiological capabilities and maintain surveillance systems, but also to reaffirm infection control measures and personal hygiene practices. It had highlighted the importance of collaboration and networking at all levels and, above all, of political commitment at the highest level. Dr LAM (Hong Kong, China) affirmed that SARS was the biggest public health challenge that Hong Kong (China) had faced in recent years, and had cost the lives of some of its most dedicated health-care workers. prevent a resurgence. He fully endorsed WHO's updated surveillance framework for SARS. Hong Kong had greatly improved its surveillance of respiratory infections and was launching an influenza vaccination programme in order to reduce confusion between influenza and SARS during the coming influenza As one of the most affected places, it was taking all possible measures to
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season. It was massively expanding and upgrading hospital isolation facilities, providing training on infection conh·ol, and enforcing strict health measures at all entry points Hong Kong was utterly committed to collaborating with WHO and the international health community in combating SARS. It had joined a regional disease surveillance network that included parts of mainland China and Macao, China, and was allocating further human and financial resources to preparedness plans for a potential emerging infection. Dr GRANGEON (France) said that health checks had had to be rapidly set up at entry points into New Caledonia and French Polynesia, together with procedures for handling suspected cases. That had implied, at the height of the alert, checking tens of thousands of passengers arriving at Noumea international airport, which had required making available considerable human and financial resources. Fortunately, the three suspected cases had not been confirmed; otherwise it would have been necessary to quarantine the patients. In view of the regulatory problems that such action would have entailed, of the need to take account of ethical considerations and the legitimate expectation of patients to be treated in their home countries, of the lack of procedures to coordinate the interventions of insurance companies and airlines involved in a health evacuation, he requested WHO to give priority to establishing a common regulatory framework for adoption by Member States. Further, in the case of a crisis, WHO should, for strategic reasons, assume direction of the communication strategy on behalf of all involved, in order to provide sound and transparent information to both health professionals and the general public. Mr UNT ALAN (United States of America) asked whether WHO intended to amend its procedures for drafting and issuing travel advisories. hl particular, there should be adequate
consultation with the Member State involved before such advisories were issued. Another concern was the transport of biological specimens by commercial airlines, a common practice in the Region. Agreements should exist with all airlines to ensure that all appropriate
safeguards against infection were applied when transporting such specimens. Moreover, the bans on the sale for human consumption of animal species that were suspected reservoirs of the SARS virus and known reservoirs of coronaviruses should be maintained. He urged Member States to maintain and strengthen surveillance and to draw up preparedness plans in case of a resurgence of SARS. Further, Member States should share, not only tissue samples of SARS patients and possible animal reservoirs with the international network oflaboratories set up by WHO, but also the findings of SARS research conducted during and after the outbreak.
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Dr SELUKA (Tuvalu) said SARS had revealed the weaknesses in global and national health systems and had brought home the lesson that a regional surveillance network needed to be established to ensure rapid information exchange during disease outbreaks. Tuvalu appreciated the efforts of the WHO office in Suva and the Pacific Public Health Surveillance Network in keeping them informed of the daily development of the outbreak. He supported adoption of a resolution that would urge Member States to strengthen their national capacities for surveillance and outbreak response and establish effective infection control programmes. Dr McKINNON (Australia) acknowledged that the outbreak had stretched the resources of the Regional Office and countries in the Region. Australia had been pleased to have been able to contribute AUS$ 1.7 million to WHO for prevention and control of SARS outbreaks in the Western Pacific Region. Australia joined other Member States in emphasizing the importance of a regional surveillance and laboratory network. SARS had been declared a quarantinable disease in Australia under the Commonwealth Quarantine Act, making it a notifiable condition under the public health legislation at the State and Territory level. Through colleagues In
Hong Kong, samples of the SARS virus had been obtained by the
National High Security Quarantine Laboratory, which enabled it to develop and validate diagnostic tests for SARS. Although the Asia-Pacific region had contained SARS, the risk of another outbreak remained and Australia's health authorities, in close consultation with WHO and regional partners, remained vigilant and ready to increase protective health measures again if necessary. Australia broadly supported the actions proposed by WHO and acknowledged the challenges that the Region faced in preparing for serious infectious disease outbreaks. He would be interested to receive further information on the proposed regional stockpile of emergency supplies. The SARS epidemic had highlighted the importance of revising the International Health Regulations to make them relevant to the early detection and rapid response to epidemics. Australia was participating as a 'collaborating country' in that revisioll. Dr KUN (Macao, China) related that Macao had had only one imported case of SARS and no hospital or community outbreak, in spite of its proximity to Guangdong Province. That was largely
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due to the government's swift action to prevent and control SARS, which had included the setting up of a multi sectoral task force to oversee preventive and control activities. The Regional Director during his visit to Macao in August had emphasized the importance of early preparedness, strong political commitment, and good infection control facilities and practices, as welI as strict isolation and tracing procedures and a sensitive surveillance system. WHO's support had been sincerely appreciated. Macao strongly supported the strengthening of surveillance, response and coordination capabilities. Ms GO (Republic of Korea) thanked WHO for its efforts to control SARS. Thanks to Government action, there had been only three probable cases in her country, and no secondary transmission. The Republic of Korea was developing programmes to increase preparedness for any potential resurgence of SARS, including monitoring and control, capacity building of epidemiologists and various education activities. The REGIONAL DIRECTOR expressed his deep appreciation of the wholehearted and unprecedented support that WHO had received from Member States in the colIaborative efforts to contain SARS. In response to the query from Malaysia regarding the most recent SARS case in Singapore, he said that, in consultation with Singapore and colleagues in the Region, and based on the present, very good, level of surveillance in that country, no evidence could be found of human-to-human transmission. Although the case, who worked in a laboratory, had manifested only fever and not pneumonia, or other respiratory symptoms or abnormalities, he had tested positive by polymerase chain reaction (PCR) and serological testing. He believed that he had been infected through exposure to the virus in the laboratory. The Singapore authorities had already undertaken precautionary
measures and there was no cause for alarm. On the concerns that had been raised by the representatives of the United States of America and France regarding the need for a more consistent travel advisory policy, he infomled the meeting that, when WHO had had to issue a travel advisory against Hong Kong and Guangdong, it had been a very difficult decision to make because of the tremendous negative impact WHO knew it would have on their economies. The ongoing revision of the International Health Regulations would make the
process more objective and transparent in future. The REGIONAL ADVISER IN COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE informed the meeting that WHO had issued a new case definition of SARS on
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14 August. Referring to the new case in Singapore, he said the case did not meet clinical definitions of SARS but did meet the laboratory case definition. Emergency supplies had already been sent to countries using funds from the Japanese Government and he urged countries to maintain stockpiles of supplies to deal with future disease outbreaks. There were also stockpiles in the Regional Office. Recommendations on border controls were being reviewed and recommendations would be made in terms of emerging diseases. The CHAIRPERSON requested the rapporteurs to draft an appropriate resolution. 2. EXPRESSION OF SYMPATHY IN CONNECTION WITH THE RECENT OUTBREAK. OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS) At the proposal of the Chairperson, the Regional Committee observed a minute of silence in tribute to WHO staff member Dr Carlo Urbani and other health workers who had lost their lives during the SARS outbreak. 3. REGIONAL STRATEGY FOR IMPROVING ACCESS TO ESSENTIAL MEDICINES IN THE WESTERN PACIFIC, 2004-2009: Item 15 of the Agenda (Document WPRlRC54/9) The REGIONAL DIRECTOR said access to good quality essential medicines could make a vital contribution to improving health and reducing mortality and morbidity. However, essential medicines would save lives and improve health only if they were available, affordable and properly used. During the past 25 years, WHO had worked with Member Sates to implement the concept of essential medicines. Many countries in the Western Pacific Region now had national essential
medicine lists, which to some extent served as a basis for procurement in the public sector. However, despite national essential medicines lists, treatment guidelines and medicine formularies, many people in the Region did not yet have regular access to the medicines they needed. This had a major impact on health, since most common illnesses in developing countries could be treated or alleviated with simple essential medicines. In contrast, unnecessary and nonessential medicines were often widely available, draining limited resources. Trade globalization and the implementation of the Agreement on Trade Related Aspects of the Intellectual Property Rights (TRIPS) had made the issue of access to essential medicines, and especially to patented medicines such as antiretroviral agents, more acute than ever. This had been
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recognized by the Fifty-sixth World Health Assembly in May 2003 and by the Regional Committee at its last meeting in Kyoto. In response, the Regional Office had worked closely with international experts and Member States to draft the regional strategy for improving access to essential medicines in the Western Pacific Region, 2004-2009, attached to document WPRlRC54/9 as Annex 2. The overall objective of the regional strategy was to provide operational and practical guidance to Member States and WHO on improving access to essential medicines. A dramatic improvement in access to essential medicines, particularly among the poorer populations in the Region, would be seen if the strategies and actions recommended in the regional strategy were carried out by both Member States and WHO. He hoped that the Regional Committee would welcome the regional strategy and discuss how to implement the recommended strategies and actions. The Committee's ultimate goal should be to make medicines available and affordable to every person in the Region in need of them. That goal was still a long way off, but he was looking forward to hearing from Member States on how the regional strategy could be used to bring it a little closer. Mr YOSHIDA (Japan) supported the aims of the strategy in general, but said that the overall text needed further review. He addressed two issues arising from the strategy. The first was dissemination of best practice. It was often difficult to apply best practice that had been identified in one country in another because of differences in systems. Criteria or standards based on biological findings, such as treatment
guidelines and drug safety guidelines, were more likely to be standardized, as were materials for public education and advocacy. These could be standardized across the Region. However, the effects of policy interventions, where financial incentives played a key role, would be directly influenced by the system in a particular country. Drug pricing policy, for example, might depend on the role of pharmacists or the reimbursement system for physicians. It was, therefore, necessary to be careful about implementing best practices across the Region. Each country should be able to come up with the option best suited to its local context The second issue related to consistency ll1
the regional strategy regarding "issues and
challenges", "strategies" and "actions". He believed that strategies and actions should correspond with issues and challenges. Regarding the language used in the text in the area of "quality" he requested clarification on the scope of this term, and asked whether it covered counterfeit or substandard medicines.
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He asked that a small working group be set up to further review the draft text with the participation of interested countries. Dr SHAO (China) said that the accessibility of medicines had significantly improved since the adoption of the essential medicines list by many countries in the Region. However, with an
increasing occurrence of HIV/AIDS, drug-resistant malaria and tuberculosis in the Region, coupled with the SARS outbreak earlier in the year, access to essential medicine had become even more challenging and important. Ensuring that essential medicines were accessible to China's 1.2 billion population was not an easy task, so the Govemment was carrying out a national essential medicines policy. China, as a developing country, had faced the problems and challenges mentioned in the regional strategy. China's list of essential medicines had not always been used as the basis of medicine procurement, reimbursement and prescription. Irrational or unnecessary use of medicine including counterfeit
medicines, still existed. Joint efforts by every sector would be needed to develop and implement the policies. The draft regional strategy could serve as a guide in the next five years to strengthen and promote China's national medicine policies. Dr HARE PAKA (Niue) pledged his country's support for the proposed regional strategy.
Procurement and transportation of essential medicines to and within small island countries, such as his own, represented a considerable challenge. Cost was also a major constraint. Support in those areas was vital to ensure equitable access to affordable medicines. He suggested that WHO should evaluate the outcome of earlier training workshops in the area of essential medicines prior to the next workshop, to be held in Fiji in November 2003. Dr MANN (Papua New Guinea) commended the draft regional strategy, which he supported. Papua New Guinea had approved its national drug policy and the Medicines and Cosmetics Act in 1998. The country currently imported all medicines, including sterile water. He endorsed the WHO List of Essential Medicines in principle, but suggested that, for each country, selection of medicines should be based on the morbidity pattems and types of intervention being employed, and that use should be in accordance with standard treatment manuals, as was the case in Papua New Guinea. Such procedures would facilitate the procurement and quality control of essential medicines, and their rational use. In addition to the development of treatment guidelines, activities to evaluate the impact of interventions on prescribing patterns, drug resistance and commercial interests should also be considered. WHO would need to provide technical support for capacity-building in those areas.
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Although the price of medicines had decreased significantly, many were still too expensive for developing countries, and further measures were needed to improve affordability. Governments should ensure commitment to the sustainable financing of essential medicines, especially for use in primary health care activities and priority programmes for the poorest people in the community. The recent economic decline in Papua New Guinea had reduced its capacity to supply rural health facilities with essential medicines, although the Australian Government had provided support for procurement and distribution. A survey was being conducted on expenditure on drugs and other medical supplies, disaggregating urban and rural data, with a view to improving efficiency and costeffectiveness. WHO should disseminate best practices in the Region and make further efforts to establish a multi-country mechanism for bulk procurement at competitive prices. WHO should facilitate appropriate training in the management of supply systems and encourage further research on rational selection and use of drugs, quality control, financing mechanisms and supply system management. The establishment of a regional collaborating centre on quality control, linked to bulk purchasing mechanisms, would greatly assist Member States. He expressed appreciation for the generous support provided by WHO, UNICEF, Australia, China and Japan in the area of essential medicines. Dr GRANGEON (France) commended the Regional Office on the approach taken in developing the proposed regional strategy, in particular as regards financing mechanisms. While he endorsed the strategy in principle, further work was needed to define the methods and tools to be used and to set out a timetable for implementation. He welcomed the current list of essential medicines as well as the publication of the reasons for inclusion on or exclusion from the list and the establishment of an electronic database providing information on rational use. Clearly, exclusion of a medicine from the list should not prohibit the use of that medicine. The inclusion of antiretroviral drugs for the treatment of
nIV
infections and not only for the prevention of mother-to-child transmission of the
infection was a welcome development. Price was a determining factor and a policy in favour of generic drugs, as suggested in the proposed strategy, should be adopted. New Caledonia had formed a working group on rational use of drugs in accordance with the government health expenditure programme, which included a component of compulsory continuing training for health professionals. Most of the population had access to drugs thanks to a provincial medical aid system.
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In French overseas departments and territories, there was a free-market as well as a hospital-
based drug supply and management system. In New Caledonia the free-market system was competitive and provided flexibility in supply options. Quality control was carried out by the health authorities in metropolitan France, as there were no local facilities. He welcomed the recent WTO agreement concerning compulsory licensing for countries with no local drug mannfacturing facilities, with particular reference to drugs used for the treatment of HIV infection, which had been achieved thanks to pressure from WHO and certain States, including France. It was vital for all countries to have operational access to essential medicines. The effective provision of essential medicines demanded adequate financing, and he welcomed the additional sums being made available by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Mr BHAT (United States of America), recognizing the need for improved access to essential medicines in the Region and across the world, welcomed the recent agreement reached at WTO concerning paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health, which would facilitate access to generic and patented drugs. While he supported promotion of availability of generic drugs - indeed the United States had a robust generics industry - such agents were not always the best or least costly option. For example, the research-based pharmaceutical industry had recently agreed prices lower than those of comparable generic drugs for sales of certain patented drugs in some African and Asian countries, and governments and industry had undertaken a variety of collaborative activities in Africa that might serve as a model for the Western Pacific Region. It was a matter of regret that the draft regional strategy made no reference to the research-based pharmaceutical industry, since providers of both patented and generic drugs would be necessary for its implementation. All countries and citizens should pay due attention to the need for rational use of essential medicines, and transparent and ethical national policies to ensure adequate financing, quality control, effective procurement and supply, and distribution management systems would be essential elements of the regional strategy. Ministries of health should collaborate with other government sectors and interested parties to develop and implement strategies to ensure strict adherence to appropriate laws and regulatiuns and to target and penalize manufacturers and distributors of ineffective and counterfeit drugs. Comprehensive monitoring and evaluation programmes, with the authority to act on findings, would be needed.
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He said that there were factual inaccuracies in the draft strategy conceming the roles of WHO and WTO in relation to the TRIPS Agreement and that there was a bias towards generic drugs. In his opinion, the text required revision, in particular to reflect the recent WTO agreement and the comments made by Regional Committee representatives. He therefore supported the proposal made by the representative of Japan. Dr LO Veasna Kiry (Cambodia) commended the draft regional strategy and requested further
information on the actions proposed for supporting Member States in ensuring quality control and tackling the problem of counterfeit drugs. Ms WARD (Australia) commended the timely discussion of a regional strategy on essential medicines. The relation between international trade and equitable access to drugs had recently dominated discussions, although there were many other important factors to be taken into account, including national policies, drug supply systems and availability of appropriate human resources. Nevertheless, the recent historic WTO agreement would enable poorer countries that lacked pharmaceutical manufacturing capacity to make use of compulsory licensing agreements. The draft regional strategy under consideration proposed various actions that would be relevant to different countries in different circumstances, some of which had not yet been costed. She therefore supported the proposal made by the representative of Japan that a working group should be established to revise and refine the strategy. Australia stood ready to participate in the group, in which all relevant interests should be represented. Dr BENJAMIN (Federated States of Micronesia) expressed support for the completion of the
draft regional strategy, which would provide useful guidance to Member States, especially those with limited resources, in improving access to essential medicines in the face of increasing commercial pressures. His country was currently finalizing a five-year national drug policy that took the regional strategy into account. He thanked WHO for the provision of technical support for that activity. Dr LOPEZ (Philippines) said that equitable access to affordable essential medicines, which was vital to improve health, required strong partnership between the public and private sectors and between developed and developing countries. He supported the draft regional strategy and commended the extensive consultation process followed by WHO during its preparation. Dr SULEIMAN (Malaysia) supported the draft regional strategy, elements of which had been
incorporated into Malaysia'S national medicines policy, which was currently being finalized. A national essential drugs list had been drawn up in 2000 and, to promote rational use, the Ministry of Health was collaborating with relevant professional bodies to produce consensus statements to serve
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as treatment guidelines. Negotiations with patent holders had been conducted, using the avenues available under the TRIPS Agreement, and patent laws had been amended. He endorsed the use of compulsory licensing by countries lacking phannaceutical manufacturing capacity. The REGIONAL DIRECTOR, thanking representatives for their comments, said that, although the complex factors affecting access to essential medicines had been discussed many times at the Executive Board and Health Assembly, the subject had not been considered by the Regional Committee in recent years, and there had been no regional strategy or action plans in that area. Yet Member Stales had frequently requested him to ensure that WHO played a more proactive role in improving the accessibility and afford ability of essential medicines. Moreover, the declaration adopted at the 200 I United Nations General Assembly special session on HIV I AIDS had called for the development of regional alliances to combat that disease. He had therefore requested his staff to develop a draft strategy for improving access to essential medicines as a starting point for discussions in the Region. A consultation to which a wide range of experts from inside and outside the Region had been invited had been planned for March 2003. Owing to the SARS outbreak, however, the consultation had been postponed until July 2003 and there had been little time since then to draft the strategy, which he agreed needed refining. The representative of Japan had made some useful proposals, in particular as regards definition of terms, the need for consistency between challenges and proposed activitics, and the potential problems associated with user fees. He suggested that a working group should be convened in the coming months to revise the draft strategy in the light of the comments made, and requested Member States to indicate their interest in participating in that exercise. The REGIONAL ADVISER IN PHARMACEUTICALS responded to commments from several countries on best practices. Whether the subject was promotion of certain practices, or supply or delivery of essential medicines, WHO sought to explain in detail why certain practices did work and others did not. This took into account the relevant environmental factors. In this way countries could decide whether a given practice was applicable in their context. WHO would update the
regional strategy in the light of the recent agreement by the Council of the World Trade Organization on the use of compulsory licensing for countries without manufacturing capacity, and would seek to assist countries in making best use of the Agreement on Trade-Related Aspects of Intellectual Property (TRIPS). The matter of counterfeit drugs had been raised by Cambodia and the United States of America; this was a growing problem that WHO had been fighting for many years by developing guidelines, training, strengthening of inspections, as well as registration and regulation of drugs.
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However, the approach had to be adjusted, with more emphasis on law enforcement. In response to the question from the United States of America, he said that monitoring and evaluation of pharmaceutical sectors was proceeding in Malaysia, the Philippines and other Member States, where the availability, quality and affordability of essential medicines were being assessed. The information gathered could then be used as baseline data, to measure progress. A meeting on the situation in Pacific island countries and other small countries would be held in Fiji in November. The CHAIRPERSON suggested that, as proposed by the representative of Japan and supported by several other representatives and the Regional Director, a working group be formed, and that a revision of the draft strategy should be submitted to the Regional Committee for consideration at a subsequent session. 4. FRAMEWORK CONVENTION ON TOBACCO CONTROL: Item 16 of the Agenda (Document WPRlRC54110) The REGIONAL DIRECTOR said that the epidemic of tobacco use was one of the greatest threats to global health today. In response, for the first time in its 55-year history, the World Health Organization had led negotiations that eventually produced an international treaty to regulate tobacco and protect the public from the hazards of smoking. In May 2003, 192 governments from around the world had adopted the WHO Framework Convention on Tobacco Control (the Convention) at the Fifty-sixth World Health Assembly. The resolution adopting the Convention, which had the text annexed to it, was attached to document WPRlRC54/10. The first challenge for this Region was to add to the six countries that had already signed the Convention. While congratulating the representatives of Marshall Islands, Mongolia, New Zealand, Palau, the Republic of Korea and Viet Nam for the fact that their countries had already signed the Convention, he urged representatives of the remaining countries to use their persuasive powers to the utmost to convince the rest of their government colleagues of the many health benefits that would accrue from signing the Convention. He understood that five other countries - Malaysia, Samoa, the Solomon Islands, Tonga and Singapore - would be signing within the month. The next stage was for all the signatories to ratify the Convention and to ensure that its provisions were reflected, or even exceeded, in domestic legislation. The Convention had set the minimum basic standards for tobacco control, and countries were encouraged to exceed the provisions of the treaty. But this could not happen until a critical mass of countries ratified it and made their domestic laws conform to it. Hence, the challenge ahead was to ratify the Convention and to muster the political will to implement it.
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Dr RAHIM (Malaysia) congratulated WHO on the Convention. Unlike the rapid response to SARS, the tobacco epidemic had raged for decades before an international response had emerged. Malaysia had taken part in the work over the past three years, and was pleased with the outcome. The Convention would allow the global community to move towards a tobacco-free future. A World Bank report had shown that increases in taxation led to sharp reductions in consumption in certain groups, especially children, without affecting government revenue. Malaysia welcomed the proposal to boost tobacco taxes under article 6 of the Convention, and was studying a system for using tax revenue from tobacco and alcohol to run tobacco control and other health-promotion activities. The Government of Malaysia held that human health should prevail over the profits of a few corporations. Malaysia would be signing the Convention that month, and it hoped to ratify the instrument as soon as possible. Dr TANGI (Tonga) had travelled to Geneva to sign the Convention, but delays in preparing the document for signature had meant that he was unable to do so. However, his Prime Minister would soon be travelling to New York, and would therefore sign on behalf of Tonga. He asked what arrangements had been made for countries that had trouble travelling to Geneva or New York. Dr FUKUDA (Japan) said that his country had agreed on the Convention because it recognized its importance, and that it would enable each party to take steps to control tobacco in accordance with national law. Japan was in the process of signing and ratifying. It would subscribe to action plans as long as they accorded with the Convention, which had taken a long time to accommodate the differences of opinion between Member States. Care must be taken not to misinterpret clauses, especially those on taxation, labelling and liability. Referring to document WPRlRC54/1O, Japan supported proposed action (I), but parliamentary approval was not swift in countries such as Japan, so WHO should not carelessly urge ratification of the Convention. Proposed action (2) seemed to suggest negotiation of protocols before the
Convention came into effect, contrary to the understanding that this would not happen before the rules of procedure of the Conference of the Parties had been written. He therefore requested that the expression "while awaiting the entry into force of the Convention on Tobacco Control" be removed. He supported action 3. Action 5 seemed to encourage each country to establish a health foundation with revenues from tobacco taxes. Such a specific matter should be left to individual countries. Japan therefore requested amendments to that recommendation. Dr AFFENDY (Brunei Darussalam) said that strengthening tobacco control was a priority in his country. The Sultan had recently reiterated the need to further strengthen tobacco control and agreed to ratify the Convention.
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He hoped WHO would continue to provide advice and support for such areas as legislation, strengthening of national tobacco control policy, provision of clinical cessation services, and other activities. He suggested that the Convention should remain on the Regional Committee's annual agenda for several years, examining various aspects of the Convention, so Member States could benefit from each other's experiences. Dr JOO (Republic of Korea) reported that his country had signed the Convention in July, and was preparing to raise cigarette prices by 60%; implement a comprehensive ban on advertising,
promotion and sponsorship; put wamings on at least 30% of the surface of packaging; prevent the use of misleading descriptions of tobacco products; ban sales methods that afford direct access to children and adolescents; and forbid the sale of cigarette-shaped toys or sweets. The relevant laws, including the National Health Promotion Act and the Tobacco Industry Act would be amended, coming into effect upon ratification of the Convention. Dr KIENENE (Kiribati) said that his country had not signed the Convention because of changes of govemment. The former govemment had been very supportive of the Convention; had it remained in power until the World Health Assembly, and had the papers been ready for signing then, the Convention might have been signed already. Nevertheless, he hoped his country would be ready to sign in New y'ork soon. Dr REN (China) expressed his country's appreciation of WHO's long-term efforts to control tobacco globally, and its strong support for that action. China was the world's largest tobacco
producer and consumer, but the govemment had taken steps to reduce the resultant harm. Lawson protecting the rights of children and adolescents, tobacco sales and prevention of juvenile delinquency, all contained clauses on tobacco control. Many provinces and cities had passed laws to ban smoking in public places. The country was now working with WHO on implementation of several tobacco control programmes. The legal procedures for ratification of the Convention were under way and China was preparing to implement its provisions. In China, health education was used to protect children and young people from smoking. Since 2000, an activity called "refuse the first cigarette in your life" had been under way in primary and secondary schools. So far over 3 million students had taken part. The Government had introduced strict control of tobacco production and intensified its efforts to reform the tobacco industry. Over 50 tobacco factories had been closed, and about 100000 workers had been re-assigned to other employment. The tobacco industry had been encouraged to engage in
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other areas of production. No new tobacco factories were allowed to open, nor were tobacco joint ventures permitted. The impact of tobacco production on the economy had been studied at a workshop. Events had been organized such as tobacco-free sports, television programmes, films and fashion shows. Mrs BLACKWOOD (United States of America) said her country had been glad to join the adoption of the Convention by consensus and that its goal had been the achievement of a strong, effective instrument. It was now reviewing the text in order to make an informed decision on signature. Her country was committed to international tobacco prevention activities, such as the Global Youth Tobacco Survey, which covered 150 countries, to prevent future death and disease. The United States was gratified to see its own tobacco control activities emulated and built upon in many other countries, and it intended to continue its leadership role in research and technical assistance. The Convention and the global dialogue on tobacco control had already borne fruit in many countries. Referring to document WPRlRC541l 0, she requested a change in the wording of action I, replacing 'ensuring' with 'seeking', to leave each Member State to take its sovereign decision on the matter. While she commended countries that had signed the Convention, the speaker held that flexibility was needed for countries that had not yet decided to sign. She agreed with the other actions set out on page 5 of the document, with the exception of action 2 which, as the representative of Japan had observed, ran counter to the understanding that discussion of protocols was to be considered by the Conference of the Parties (article 33), and not before then. Dr CUTTER (Singapore) said that for many years his country had been implementing policies consistent with those covered in the major provisions of the Convention, such as a ban on all tobacco advertising. It had been increasing taxes for over 20 years. Tobacco companies had been driven to introduce ever smaller packets of cigarettes, to keep prices attractive, so there would soon be a ban on small packets of cigarettes. Cigarette packets would have to bear graphic messages against smoking. The prevalence of smoking in Singapore had fallen from over 20% in the 1980s to 13.8% in 2001. The ministry of health was preparing for imminent signature of the Convention. Dr LOPEZ (Philippines) said that the Philippines had been active at the global level and within
ASEAN during preparation of the Convention. The Tobacco Regulation Act of 2003 mirrored the
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salient provisions of the Convention, especially as regards banning of advertisements within a given time frame. The government was working on implementation of the Tobacco Act, with assistance from WHO. The Department of Health had excluded the tobacco industry from participation in its tobacco control initiatives. With regard to signature of the Convention, the Government was currently investigating whether the Secretary of Health could be granted full powers to sign. The Philippines intended to sign the Convention as soon as possible. At the suggestion of the Philippines, the ASEAN Senior Officials Meeting on Health Development had investigated the convening of a joint meeting of senior economic and health officials. That meeting would address how to tobacco could be removed from trade liberalization in the 10 ASEAN countries. The Government of Malaysia would implement that initiative before the year ended, and the Philippines would provide all the help it could. He asked representatives from ASEAN countries to commence discussion with trade officials in their countries in order to advance tobacco control in the Region. Dr GRANGE ON (France) spoke of the long-established commitment of the French Government to tobacco control, and welcomed the adoption of the Convention. He noted that French Polynesia had started legislating against tobacco several years previously, and New Caledonia somewhat later, when it realized that 110 deaths every year, or 11.6% of all deaths reported, could be attributed to smoking. Policies were being put in place in New Caledonia to address the threat to public health posed by tobacco; although they were at the start of the process, these specific measures should help reduce the problem in the long run. Dr ENOSA (Samoa) said that his Government would sign the Convention before the end of the month and then ratify it. A WHO consultant had assisted in drafting legislation for tobacco control, which was being prepared for passage by the end of the year. He noted the concerns expressed by the representatives of Japan and the United States of America. Some of those issues had been accommodated in his country's legislation. Taxes on tobacco products had been increased and would probably be increased further. Dr MANN (Papua New Guinea) thanked WHO for its leadership in supporting adoption of the Framework Convention and for helping his country to participate fully in the work of the Intergovernmental Negotiating Body. The Ministry of Health had prepared the necessary submissions, so that the Government could endorse the Convention and give its approval for its representative at
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the United Nations to sign it. Recommendations had been made that the Council prepare the necessary instruments, so that Parliament could ratify the Convention, perhaps before the end of the year. He asked the Regional Committee to call for countries to stand together in implementation of the Convention, as the tobacco industry was aggressive and cunning. Member States should therefore adopt measures that were stronger than the text of the Convention. Dr MALEFOASI (Solomon Islands) said that Solomon Islands supported the call to ratify the Convention. The Ministry of Health was concerned about the increasing rate of smoking among schoolchildren and especially among girls. Although the Minister of Health had been empowered to sign the Convention, that had not been done owing to financial constraints. Draft legislation on tobacco control had been passed by the Cabinet in 200 I, but had not yet been presented to Parliament. The delay had allowed time for revision, to ensure that the key issues in the Convention were covered. Mrs PIERANTOZZI (Palau) said that her Government had been one of the first to sign the Framework Convention. The former Director of Public Health, Dr Caleb Otto, had been a tireless supporter of the Convention and had received the Director-General's award for his negotiations within the Pacific region. The Convention was now being ratified, and Congress had raised taxes on cigarettes recently. With regard to the actions proposed in paragraph 5 in Section 3 of Document WPRlRC5411 0, she agreed with other speakers that decisions should be taken by individual countries. Ms WARD (Australia) said that her country remained committed to reducing the health, social and economic harm wrought by tobacco use. The most recent national campaign had been the most intensive yet. The Convention was being considered within the country's treaty-making process. It was clear that concerted international action was required to reduce the harmful consequences of tobacco use globally, particularly to address those aspects of tobacco control that transcended national boundaries. Her Government supported inclusion of the priorities and policies of the Convention in the Regional Action Plan for Tobacco Control for 2005-2009. Australia strongly supp0l1ed WHO's Tobacco Free Initiative and, through its international aid agency, AusAID, supported regional programmes, including projects to reduce lifestyle-related risk factors. Tobacco use increased the burden of noncommunicable diseases in developing countries, and tobacco control was beginning to be integrated into regional and bilateral health projects. AusAID provided support to WHO's surveillance programme for noncommunicable diseases in the Pacific. Previous initiatives in the Region had included health promotion and a workshop at which regional representatives had shared views on including tobacco control in public health agendas.
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Member States should give tobacco control high priority. The Convention could give them leverage for promoting tobacco control. It should provide an impetus for the introduction of simple, cost-effective measures that could serve as a foundation for future activities. Dr SELUKA (Tuvalu) said his Government continued to support the Framework Convention. It hoped to sign it before the end of the year and to ratify it before June 2004. Subsequently, the country's tobacco policy would be defined, and the necessary laws to control tobacco consumption would be enacted. Dr W AQATAKIREWA (Fiji) recalled that his country had been part of the Global Youth Survey on Tobacco Use in 1999, which had shown that 13% of young people in Fiji were regular or established smokers. That alarming figure would be used as a benchmark in efforts to limit tobacco use. Deaths due to tobacco use constituted a significant part of mortality from noncommunicable diseases: currently, 300 deaths per year were estimated to be due to cigarette smoking. The Ministry of Health, therefore, fully supported the aims of the Convention. At the end of 2002, a WHO expert had given the Prime Minister and most members of his Cabinet, attended by the media, a briefing on tobacco use and its effects and had described the key objectives of the Convention. Immediately after adoption of the Convention in May 2003, the Cabinet had agreed to sign and subsequently ratify it. The signing would take place during a scheduled visit of the Prime Minister or the Minister for Foreign Affairs to Europe or the United States, to save costs - in any case well before the deadline of June 2004. Fiji was serious about limiting tobacco use. The Tobacco Act 1999 incorporated most of the objectives of the Convention. Furthermore, the tax on tobacco products had been increased still further in 200 I, and about 50% of the monies received from the tax was channelled to the Ministry of Health for use by the National Health Promotion Council for their programme activities. The Government had begun to review its tobacco legislation to bring it into line with the Convention. In response to his country's recognized weakness in enforcing its tobacco legislation, a new tobacco control enforcement unit was to be established within the Ministry of Health in 2004. The Government had made a budgetary commitment for that unit, the role of which was expected to complement that of the Health Promotion Unit and the National Health Promotion Council. Research and information were needed to ascertain the disease burden due to tobacco use in Fiji, in order to update information on the situation. The research, sanctioned by the National Health Research Council and with funding from the Ministry of Health, was expected to be completed in early 2004. Later in 2004, the Ministry would issue a paper on the economic outcomes of tobacco use and production, in view of the presence in the country of a cigarette company and tobacco farming.
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Mr KALPOKAS (Vanuatu) thanked WHO for its help in informing the country's population of the dangers of tobacco smoking. Like the representative of Tonga, his Government had been ready to sign the Convention in Geneva in May but had been thwarted. It was hoped that either the Prime Minister or the Minister for Foreign Affairs would sign it in New York City. Dr MATHESON (New Zealand) said that his Government had signed the Convention in Geneva in June 2003. His country was committed to the prevention and control of tobacco use and to completing the necessary actions that would allow it to ratify the treaty. He noted the difficulty that some of the small Pacific island countries were experiencing in signing and ratifYing the Convention and looked forward to working with WHO and donor agencies to assist them in that regard. The REGIONAL DIRECTOR, replying to comments, said that the representative of Tonga had raised an important issue. The ministers of virtually all the countries of the Region had been present in Geneva in May, but the Convention had not been ready for signing. He would discuss this with legal counsel. He noted the suggestions by the representatives of Japan and the United States of America regarding the first action proposed in Section 3 of Document WPRJRC54/1O. He agreed that the word "ensuring" could be replaced by "seeking". Countries with powerful tobacco industries would obviously find speedy ratification more difficult than others; however, in order that the spirit of the provision not be lost, perhaps the word "speedy" could be replaced by "as soon as feasible", or words to that effect. The representatives of Japan and the United States of America had also objected to the wording of paragraph 2, which was not consistent with discussions held at the Health Assembly. He agreed with them. In response, to the comment of the representatives of Japan and Palau that the decision to establish health foundations, as stated in the fifth proposed action, should be left to individual governments, he recalled that some had already done so. The phrase should be qualified by words such as "if possible" so as not to lose the value of the proposal. He assured the representative of Brunei Darussalam that the Secretariat would continue to keep Member States and the Regional Committee regularly informed of progress regarding the signature, ratification and implementation process. The REGIONAL ADVISER IN TOBACCO FREE INITIATNE said that Member States that could not travel to New York City to sign the Framework Convention before the deadline or did not have permanent missions to the United Nations could authorize the representative of another Member State to sign the Convention on their behalf. He presented a model document, in which the Head of
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State or the Minister for Foreign Affairs gave full powers for signature. In order for the authorization to be valid, it was essential that it read as follows:
"FULL POWERS "I, [name and title of the Head of State, Head of GovemlT'ent or Minister for Foreign Affairs of the authorizing State], "HEREBY AUTHORIZE [name and title of the representative of the other State] of [name of other State] to sign subject to ratification the Framework Convention on Tobacco Control, 2003 on behalf of the Government of [name of authorizing State]. "Done at [place] on [date]. "[Signature]"
WHO would facilitate discussions between States that wished to enter into such an arrangement. The CHAIRPERSON asked the rapporteurs to prepare an appropriate draft resolution for consideration by the Regional Committee. A minute of silence was observed to commemorate the victims of the terrorist attack in New York City on 11 September 2001.
The meeting rose at 17:35.
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WPRJRC54/SRl9 SUMMARY RECORD OF THE NINTH MEETING (WHO Conference Hall, Manila) Friday, 12 September 2003 at 09:00 CHAIRPERSON: Dr Manuel DAYRlT (Philippines)
CONTENTS
1.
Child health ....................................................................................................................... . Consideration of draft resolutions ...................................................................................... . 2.1 2.2 2.3 2.4 Sexually transmitted infections, including HIVI AIDS ............................................. Tuberculosis prevention and control.......................... .............................................. Severe acute respiratory syndrome (SARS) and other outbreak-prone diseases ..... WHO Framework Convention on Tobacco ControL..............................................
198 207 207 207 207 208
2.
3. 4.
Coordination of the work of the World Health Assembly, the Executive Board and the Regional Committee ......................................................... .. Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee ........................................................................................... . Special Programme for Research and Training in Tropical Diseases: Membership of the Joint Coordinating Board ................................................................. .. Time and place of the fifty-fifth and fifty-sixth sessions of the Regional Committee .............................................................................................. . Consideration of draft resolutions ...................................................................................... . 7.1 Child health ........ .......... ............................ ....................... ................. ................... .........
208
209
5.
210
6.
211 211 211 212
7.
8.
Closure of the session ...................................................................................................... .
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1.
CHILD HEALTH: Item 17 of the Agenda (Document WPRlRC54/l1) The REGIONAL DIRECTOR said that child survival was one of the most important measures
of global development. The goal of a two-thirds reduction in childhood mortality by 2015, from 1990 levels, was therefore one of the key Millennium Development Goals. Every year more than I million children in the Western Pacific Region died before their fifth bil1hday, which meant that about 3000 children were dying unnecessarily every single day. There was overwhelming evidence that simple and tested interventions could easily prevent at least 60% of those deaths, but such services were not accessible by many of the children and carers in greatest need. Integrated Management of Childhood Illness (!MCI) was a technically sound, comprehensive and evidence-based strategy that focused on the major threats to children's health in a systematic and integrated way. It provided standard guidelines, adapted to local conditions, on interventions to prevent and manage the common conditions that kill children, combining them with nutritional interventions and immunization. !MCI improved the skills of health professionals, strengthened health systems and empowered families through interventions within the community. It had been ranked by the World Bank as among the most cost-effective health interventions in low- and middle-income countries and as the "best buy" in child health. !MCI had already been successfully introduced in the Region. Its implementation had been monitored and evaluated thoroughly from the outset, and reviews had consistently shown that it empowered health workers to provide improved quality of care to sick children. It also equipped mothers and other child carers with new knowledge on how to care for children, in sickness and in health. The reviews had also pointed out that strong policy and health system support, including significant increases in human and financial resources, and firm coordination of actions would be needed if large-scale improvements in child health were to be made and long-term gains in childhood mortality reduction were to be achieved. It was time to examine critically the way in which obligations to improve children's chances of
survival were being implemented. Piecemeal offerings and pilot projects were not enough. Children were particularly vulnerable to the effects of inequity, poverty, hunger and social and economic injustice. Their well-being should be at the forefront of efforts to reduce inequities in health. WHO and its Member States were committed to achieving the Millennium Development Goals. They knew what the challenges were, and they had the tools to address them. Interventions that had already been successfully implemented in many countries must be intensified and scaled-up and the unmet needs of children placed high on the political and development agenda. With dedication,
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strong support and coordinated action, he was confident that WHO and its Member States could take a big step towards improving children's survival, growth and development in the Western Pacific. He therefore urged Member States to embrace lMCI as an opportunity for child mortality reduction and as an effective and cost-efficient way of achieving the Millennium Development Goal for reducing childhood mortality. Dr IWAMOTO (Japan) agreed that it was time to put into practice action to reduce child mortality if the Millennium Development Goal was to be achieved. The lMCI strategy would be central to that effort. There were a number of reasons why the reduction in child mortality had stagnated or even been reversed since the mid-l 990s: lMCI was a complex strategy, which was difficult for donors and decision-makers to understand; there was a lack of scientific evidence that its introduction had contributed to a reduction in child mortality; and there had been resource constraints, in particular for training. As an initial step to remedy the situation, the Regional Office should develop essential indicators to monitor the impact of the strategy. She endorsed the incorporation of child health interventions into national health policies as a priority for health system reinforcement. Children's health should be given the highest priority. WHO, in collaboration with other organizations, should therefore make every effort to ensure intensification of the effectiveness of lMCI. She would be interested to hear the Regional Director's views on the attainability of the Millennium Development Goal. Dr TANGI (Tonga), emphasizing the importance of child health programmes, pointed out that during the present session of the Regional Committee some 15 000 children in the Region had died. Yet it was the death of a single soldier in Iraq or of a few people as the result of a terrorist bomb that made the headlines. He urged the mass media to pay greater attention to the fate of the world's children. WHO should make a greater commitment to child health in the Region and at the global level. More resources should be invested in that area and more time should be devoted to discussion of the various issues involved. Dr SAFURA (Malaysia) reported that child health status in Malaysia had improved over the past decade, with substantial reductions in infant and child mortality, achievement of the Universal Child Immunization target and mid-decade goal, and an increase in breast-feeding. In addition, all government hospitals were now accredited as baby-friendly hospitals. Economic growth and lifestyle changes had led to further improvements, which in tum had affected the definition of health priorities. With strong political commitment from the Government at national, state and community levels, the Ministry of Health had focused on noncommunicable causes
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of mortality, including screening of newborn infants, early child care and development, safe environments, water and sanitation, mental health, safety and injury prevention, and nutrition. lMCI was an important component of strategies to attain the Millennium Development Goal and had been adapted and implemented in selected districts. Additional courses would be conducted to train health care providers so that lMCI could be further expanded. Training in IMCI was also being integrated in curricula for nurses and medical assistants. She was confident that Malaysia would achieve the Millennium Development Goal. Ms CAO (China) endorsed the Regional Office analysis of the regional and global child health situation and supported the proposed actions. The Chinese Government attached great importance to ensuring the well-being of its popUlation together with improvements to the economy, the environment and use of resources, as the basis of sustainable development. During the 1990s, it had pursued the commitments made at the 1990 World Summit for Children and formulated an action plan focusing on child health. For the new century, a ten-year child health plan had been launched. The rights of children were enshrined in the constitution and protected by legislation. Although conditions for children were gradually improving, China was a developing country with a vast population and many children. Preventable diseases represented 60% of total deaths in children. However progress was restricted by the slow pace of socioeconomic development in certain areas and by the many disparities across the country, in particular between urban and rural areas and between richer and poorer groups in the community. Health services were often underused, owing to lack of awareness as well as economic reasons. The achievement of the Millennium Development Goal represented a considerable challenge, especially in the west of the country. Surveys had shown that congenital abnormalities, low birth weight and premature births were increasing, so efforts would be needed to reduce the neonatal mortality rate. The number of people living with HIV/AIDS was increasing so mother-to-child transmission of HIV was another factor. IMCI had been introduced in 1998 and incorporated into the guidelines on childhood development in 2001. Implementation was now expanding, with increased financial allocations at central and local levels. It was hoped that WHO would continue to provide technical and financial support, in particular to developing countries, to ensure that child health was given the priority it deserved and that IMCI was extended across the Region. Dr LO Veasna Kiry (Cambodia) commended the inclusion of the item on the Committee's agenda. Cambodia had ratified the United Nations Convention on the Rights of the Child and those rights were enshrined in the constitution. It was also committed to the attainment of the Millennium
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Development Goals and recognized its responsibilities for child survival. Cambodia had the highest rates of infant and child mortality in the Region despite considerable progress in controlling vaccinepreventable diseases. Acute respiratory infections, diarrhoeal disease, perinatal conditions and malnutrition were the main killers. The national health sector strategic plan for 2003-2007 gave the highest priority to mortality reduction and the fight against childhood malnutrition. External support would be needed, however, if the ambitious targets set out in the plan were to be achieved. He therefore hoped that the focus being shown by the Regional Office would be echoed by other international organizations. The knowledge to improve child survival was available - the difficult task was to translate that knowledge into large-scale action. IMCI, which brought all the relevant interventions together, had the potential to provide the solution. To date implementation of IMCI had been limited to small-scale projects supported by external donors and greater efforts were needed to strengthen child health programme infrastructures. Experience in the elimination of poliomyelitis and leprosy reduction in Cambodia had shown that key elements of success included: setting of clear targets, political commitment from the government and donors; clear attribution of responsibilities; and adequate funding. In the area of child survival, the first two of those elements were already in place and, given the interest shown by the Regional Office and the Regional Committee, it should be possible to mobilize additional support from donors. However, improvements in IMCI management, monitoring and evaluation were needed to strengthen implementation and enhance accountability. In addition, greater attention should be given to health outcomes directly linked to child mortality. WHO's efforts should be targeted on countries and regions within countries with high mortality rates. Dr UNTALAN (United States of America) expressed strong support for the WHO global strategy on child and adolescent health adopted at the Fifty-sixth World Health Assembly. It provided an integrated, science-based framework centred on the family and adopted a lifecycle approach to health and development. It was incumbent upon Member States to translate the strategy into public policy. Child and adolescent health should be a top priority on political and health agendas, and there should be national commitment to adequate levels of financial, human and technical resources. IMCI, with its focus on proven and cost-effective interventions, was a means of strengthening and sustaining activities. In that context, he commended regional efforts to reduce measles morbidity and mortality and looked forward to the establishment of a target date for elimination of the disease in the near future.
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Ms NORA'ALlA (Brunei Darussalam) expressed strong support for WHO's strategic directions for improving the health and development of children and adolescents. Her country was fully committed to disease prevention and health promotion targeted at children at the primary, secondary and tertiary health care levels. At the primary level, immunization coverage was more than 95% and services were decentralized to improve accessibility. Proactive early screening was undertaken at the secondary level, and a new hospital for women and children was planned. Tertiary level services included early rehabilitation programmes for children with special needs and referral abroad, with full government support, for children requiring further specialized care. Brunei Darussalam was a signatory of the United Nations Convention on the Rights of the Child and had enacted The Children Order Act in 2000 to protect the health and general well-being of every child. Dr SIPELI (Niue) recalled that representatives had emphasized the need for political commitment in respect of most of the subjects discussed by the Committee at the present session. Countries would decide, however, on their own priorities - for example, as to whether they favoured child health or material gains for the general public. Politicians were the key players in determining those priorities and should be proactive in ensuring that the simple, effective and technically sound interventions that were available were provided in order to protect children against disease and premature death. He therefore supported WHO's renewed global commitment on child health. Mr JOREDIE (France) endorsed WHO's approach to child health. His country's priority was the integrated management of childhood illness, particularly by assuring the autonomy of families within a community approach. School health programmes were also a useful means of providing health education to individual children. Health services in the French overseas territories had focused on developing human resources for maternal and child care within the different public health structures. The number of maternal and child health centres around Noumea had increased, and the number and ratio of midwives was very high. Further, the range of their skills had officially been extended to include prevention activities, particularly vaccination. A thorough study was under way to identify the reasons for premature births and low birth weight, which still amounted to 7% of total births in New Caledonia. Mr NAIVALU (Fiji) said that Fiji had officially launched the Integrated Management of Childhood Illness in August of the current year during the observance of World Breast-feeding Week in a joint ceremony with the Ministry of Health, UNICEF and WHO.
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In January 2004, Fiji would launch an iron fortification and enrichment of wheat flour
programme in collaboration with UNICEF, the Government of Fiji and a local business entity. That initiative would be a milestone in public health, since iron deficiency anaemia had been a chronic public health problem in his country. It was hoped that the iron fortification programme would reduce the problem by 30%. In view of the importance of the annual session of the Regional Committee he said that it would
be helpful if other relevant UN agencies could be present to share their views. Dr KUARTEI (Palau) pointed out that the term "Integrated Management of Childhood Illness" appeared to promote the idea of dealing with child health indicators from an illness standpoint. He agreed with the representative of Japan that IMCI indicators must be drawn up and said that these should include not only treatment and prevention of illness, but also health protection and promotion. Such integration would lead to a broader intersectoral approach, encompassing economic strategies, the legal system and cultural participation. management of child health. Mr VAEVAE PARE (Cook Islands) said that since the 1960s the Cook Islands Ministry of Health had placed child health high on its agenda and therefore supported the proposed actions contained in the IMCr strategy. He also supported Japan's request for WHO to develop tools that could be used to monitor the progress of IMCI progress in the Region. In his country the school curriculum was being developed with the Ministry of Education, other
These were part and parcel of the approach to the
relevant government ministries had been co-opted to address areas of concern. Support would be sought for the establishment of a databank as part of efforts to ensure 100% coverage of all children in Cook Islands. Dr GALON (Philippines) agreed with the Regional Director that now was the time to focus on the unfinished agenda of child survival, growth and development. Although there had been a
significant reduction in child mortality, children still died of the same illnesses that had affiicted them 20 years ago. Efforts had to be intensified to attain the Millennium Development Goal of reduction of childhood mortality by two-thirds by 2015. Dr CHAN (Macao, China) supported the new strategy for child health. Following WHO guidelines, Macao had started a healthy school project with the cooperation of the Education Department. He was confident that more schools would join the initiative.
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Dr ENOSA (Samoa) explained that Samoa had recently taken a step forward by requesting New Zealand to fund a three-year programme called Family and Child Welfare, which would end in July 2004. He hoped that New Zealand would continue to fund future projects. Samoa's Education Department had been involved in incorporating the health awareness programme into school curricula. He joined other countries in calling for further involvement from donor partners such as UNICEF, AusAID and JICA, in providing assistance to Pacific island countries. Dr MATHESON (New Zealand) said that his country endorsed the goal of reducing under-five mortality rate by two-thirds hy 2015. His country focused especially on support for primary health care and on reducing the underlying causes of health inequalities that had an impact on children. The Maori health strategy emphasized the central role of families in the provision of a safe and supportive environment for children. An annual review ensured that the strategy was effecting improvements in child well-being.
In response to the comment by the previous speaker, he assured him that New Zealand was fully committed to maintaining collaboration with its Pacific neighbours. Mrs PAUL (Marshall Islands) commented that child health was particularly important for her country, where over half of the popUlation was under 20 years of age. A recent study conducted in the Marshall Islands on children's social, educational and health problems had identified child neglect as one ofthe root causes. It was an overlooked problem, but an important one. Dr KIENENE (Kiribati), agreeing with the representative of Fiji, asked why other organizations involved with children's welfare, such as UNICEF, UNFPA and ILO, were not represented in the discussions. He was also pleased that the Regional Director's report included many important issues, such as water and sanitation, which, while not under the Ministry of Health's mandate, were nevertheless areas where it could work in partnership with other ministries. He observed that in his country, they were concentrating on traditional birth practices, since some many births attended by traditional birth attendants were not registered. This was a vicious cycle, since, if the babies had not been registered, they would not receive immunization. These children were then vulnerable to vaccine-preventable diseases, which meant that the infant mortality rate increased. IMeI had not started in Kiribati but his country was addressing child health in the broadest way possible, taking these issues into account.
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Dr MANN (Papua New Guinea) pointed out that the high rate of infant and child mortality in his country was attributable to malaria and vaccine-preventable diseases, which was a matter of considerable concern. With the cooperation of WHO and UNICEF, !MCI programmes had been launched in pilot areas and were beginning to show results in terms of child welfare. His country was therefore fully supportive of that initiative. The REGIONAL DIRECTOR, referring to the query from Japan as to whether the child mortality target of the Millennium Development Goal was achievable, replied that earlier success had demonstrated that with determination, sufficient resources, effective strategies and appropriate programmes, targets could be met. !MCI was a cost-effective intervention that was already
contributing to reductions in child mortality, although on a small scale. In reply to Fiji's suggestion that other agencies involved in the child health should be invited to
the session, he confirmed that invitations had been issued, but recipients had been unable to attend. China had raised the point of the disparity between rural and urban areas in terms of child health, and he agreed that that was a matter on which the Region as a whole would have to focus in the future in order to meet the needs of marginalized groups. He agreed with speakers that special efforts were needed to mobilize additional resources. When secured, extra funds would be channelled to child health and to activities at country level. He also drew attention to a recent article published by WHO in The Lancet which analysed all the issues related to child health. The MEDICAL OFFICER IN CHILD AND ADOLESCENT HEALTH AND
DEVELOPMENT, responding to the issue of the scientific evidence for !MCI and the proposed development of indicators, which had been raised by the representative of Japan, said that IMCI was based on interventions for which sound evidence had been established, such as oral rehydration therapy to save children from dying of dehydration and antibiotics to avert deaths from pneumonia. Exclusive breast-feeding for the first six months of life would provide good protection against childhood illnesses and malnutrition. She agreed with several representatives that there was a need to better demonstrate the progress towards mortality reduction. The request for better indicators was in line with the findings of a recent meeting and this would, as the Regional Director had said, be looked into as a matter of priority.
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The WHO ASSISTANT DIRECTOR-GENERAL FOR FAMILY AND COMMUNITY HEALTH, WHO HEADQUARTERS, noted the concern that had been expressed about the rates of child mortality in the Region. She assured the meeting that the challenge was not peculiar to the Region: 30000 children died throughout the world every day and 10.9 million children under the age of five died every year. That figure could be compared with the 2.8 million people who died from AIDS each year. The depletion of global potential due to the deaths of children was thus more than three times greater than that due to the HIV /AIDS epidemic, yet the cost of interventions to reduce the carnage by 60% was only 10% of the cost of controlling HIV/AIDS. Ironically, a child saved now could promote economic growth and contribute to development for about 40 years, whereas the adults who were being saved from the HIV/AIDS epidemic would contribute for only 10 or at most 20 more years. By combining the forces of all global partners, all national stakeholders and the community to address prevention, case management, nutrition and immunization, 1800 young lives in the Region could be saved daily. That could be achieved only with commitment. The children of the world wanted a place fit for them to live in, with adults who were fit to be their parents. In order to justify their confidence, indicators were needed. Partnerships should be created, national plans of action developed, resources mobilized and allocated, not only by WHO but also by countries and donors. She supported the vision of the Director-General and the Regional Director of an environment that was safe and healthy for children. The DIRECTOR, DEPARTMENT OF CHILD AND ADOLESCENT HEALTH AND DEVELOPMENT, WHO HEADQUARTERS, welcomed the support of the Region for the overall strategy for child and adolescent health and development that had been adopted at the Health Assembly and for the IMCI strategy. He agreed with the Regional Director that it would be possible to achieve the Millennium Development Goal of reducing child mortality. Published articles and evaluations had shown that interventions were available that would reduce mortality rates by 60%70%. No new vaccines or techniques were needed; the existing interventions (such as oral rehydration, antibiotics and bed nets) would suffice. Ten to fifteen years previously, Member States had urged WHO to integrate the various interventions. The strategy for integrated management of childhood illness did just that, promoting integration for greater efficiency. It was a comprehensive approach based on existing, proven, cost-effective interventions. The stumbling block was the lack of human, health system and financial resources. The tools were available to tum knowledge into action, but global funding for child health had decreased over the past 10 to 15 years. With regard to indicators to monitor progress, he explained that WHO was conducting a multinational evaluation of IMCI, while at the same time evaluating its cost-effectiveness. The study would be completed in 2005. Analytical reviews were also being conducted, and indicators were being identified both for progress in implementing IMCI and for reductions in child mortality.
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The CHAIRPERSON asked the rapporteurs to draft an appropriate resolution. 2. CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following resolutions. 2.1 Sexually transmitted infections, including HIV I AIDS (Document WPRlRC54/Conf.Paper No.4 Rev. I) The RAPPORTEUR FOR THE ENGLISH LANGUAGE drew the attention of the Committee to the changes to operative paragraphs 1(2) and 2(3)(h). These had been agreed after discussion by the representatives of France, New Zealand, and the United States of America. Decision: The draft resolution, as amended, was adopted (see WPRlRC54.R5). 2.2 Tuberculosis prevention and control (Document WPRlRC54/Conf.Paper No.5) Professor NYMADAWA (Mongolia) proposed that in operative paragraph 2(7) the words "and management of' be introduced after "surveillance for", in order to cover treatment protocols with second-line drugs. Decision: The draft resolution, as amended, was adopted (see WPRlRC54.R6). 2.3 Severe acute respiratory syndrome (SARS) and other outbreak-prone diseases (Document WPRlRC54/Conf. Paper No.6) Mr BHAT (United States of America) proposed that operative paragraph 1(3) be amended by addition of the words "and sharing of biological samples" after "collaboration between laboratories". In operative paragraph 1(6), he asked that the words ", including border control measures," be added
after "control measures". Operative paragraph 2(4) should be amended by addition of the words "and stimulate" after "to coordinate". He proposed the addition of a new subparagraph 2(6), which would read: "to incorporate lessons learned when working with the Director-General on future travel advisories and with the Member States on border control measures." Dr KIENENE (Kiribati) proposed that operative paragraph 2(5) be amended by addition of the words "and shared among Member States" after "properly recorded". Dr FUKUDA (Japan) asked that the last part of operative paragraph 1(4) be changed to read " ... the SARS corona virus only in qualified laboratories approved by the appropriate body and with an appropriate level of biosafety;", in order to allow authorities to decide which laboratories they accredited.
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Decision: The draft resolution, as amended, was adopted (see WPR/RC54.R7). 2.4 WHO Framework Convention on Tobacco Control (Document WPR/RC54/Conf.Paper No.7) Dr FUKUDA (Japan) recalled that negotiation of a compromise text that addressed the interests of all interested parties had been a long, arduous process. His Government supported the Convention and was doing its best to ratify it. In order to avoid entering into the same discussions again, he suggested that the language upon which compromise had been reached should be retained. In that spirit, he proposed that a new preambular paragraph be added after the seventh existing one, reading: "Acknowledging that agreement to the Convention required a long process to negotiate a compromise to resolve the differences and nuances in the interests of all Member States and interested parties;". The second proposed amendment was to replace the tenth preambular paragraph, beginning "Noting with profound concern", by the following text, which had been used in the Framework Convention: "Recognizing the need to be alert to any efforts by the tobacco industry to undermine or subvert tobacco control efforts and the need to be informed of activities of the tobacco industry that have a negative impact on tobacco control efforts;". At the end of the last preambular paragraph, he proposed that the word ", regional" be inserted between "global" and "and national". He suggested that operative paragraph 2(2) be amended to read: "to implement tax policies for tobacco products as a means of reducing tobacco consumption without prejudice to the sovereign rights of the Member States to determine their policies;". Finally, he asked that in operative paragraph 2(4), the words "by the tobacco industry and its allies" be deleted. Decision: The draft resolution, as amended, was adopted (see WPR/RC54.RS). 3. COORDINATION OF THE WORK OF THE WORLD HEALTH ASSEMBLY, THE EXECUTIVE BOARD AND THE REGIONAL COMMITTEE: Item 18 of the Agenda (Documents WPRlRC54/12 and WPRlRC54/INF.DOC.l2) The DIRECTOR, PROGRAMME MANAGEMENT explained that document WPR/RC54/12 referred to resolutions adopted by the Fifty-sixth World Health Assembly that were of particular significance for the Western Pacific Region. The resolutions themselves were attached to the document. Resolutions adopted by the Fifty-sixth World Health Assembly that related directly to other items on the agenda had been annexed to the documents covering those items.
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He drew the attention of the Committee to the operative paragraphs, which related to activities that Member States could undertake in the Region to implement the resolutions. Resolution WHA56.19 dealt with prevention and control of influenza pandemics. It was
particularly relevant to the Western Pacific Region, since so many new strains of influenza originated there, particularly in southern China. WHO and the Ministry of Health of China were already
working closely together on a five-year project to improve influenza surveillance. He drew the Committee's attention in particular to operative paragraphs 1(1) and 1(2) of resolution WHA56.19 on national influenza vaccine policies and to operative paragraph 1(3) on the need for national plans for preparedness for influenza pandemics. Resolution WHA56.23 dealt with the joint FAOIWHO evaluation of the Codex Alimentarius Commission. He drew the Committee's attention to operative paragraph 3, which invited the regional committees to review regional policies on standard setting and nutrition information. Resolution WHA56.31 dealt with traditional medicine. The resolution took note of the global strategy for traditional medicine, which was in line with the regional strategy endorsed by the Regional Committee in 2001. With regard to the Health Assembly's specific requests to Member States and to the Director-General, those were also broadly in line with activities already being carried out in the Region in the fields of traditional medicine, pharmaceuticals, human resources, and health systems development. The multicountry outbreak of SARS earlier in the year had lent a sense of urgency to the revision of the International Health Regulations, which was was covered in resolution WHA56.28. He said the Committee might particularly like to note that the Health Assembly had decided to establish an intergovernmental working group open to all Member States to review the draft regulations. Information about that intergovernmental working group could be found in paragraphs 2 and 5 (6). 4. SPECIAL PROGRAMME OF RESEARCH, DEVELOPMENT AND RESEARCH TRAINING IN HUMAN REPRODUCTION: MEMBERSHIP OF THE POLICY AND COORDINATION COMMITTEE: Item 20 of the Agenda (Document WPRlRC54fI4) The DIRECTOR, PROGRAMME MANAGEMENT explained that the Policy and Coordination Committee, which was the governing body of the WHO Special Programme of Research, Development and Research Training in Human Reproduction, was composed of four categories of members and had a total of 32 members. Category 2 comprised 14 Member Stales elected by the WHO regional committees for three-year terms; three Member States were to be
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selected by the Western Pacific Region. At present, the three from the Western Pacific Region were Papua New Guinea, Viet Nam and Fiji. The term of Papua New Guinea would expire on 31 December 2003. The Regional Committee was now requested to elect one Member State, whose three-year term would start on 1 January 2004, to succeed Papua New Guinea. In electing members, due consideration was to be given to a Member State's financial or technical support to the Special Programme and its interest in the field of human reproduction, as reflected in its national policies and programmes. The Regional Committee might choose to select the Lao People's Democratic Republic. The next meeting of the committee was scheduled to take place from 30 June until 1 July 2004. It was so decided (see decision WPRlRC54(l)). Dr MANN (Papua New Guinea) thanked the Regional Committee for having chosen his country to serve on that important committee and expressed his country's readiness to serve in a similar way in the future. 5. SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASES: MEMBERSHIP OF THE JOINT COORDINATING BOARD: Item 21 of the Agenda (Document WPRJRC54/15) The DIRECTOR, PROGRAMME MANAGEMENT said that paragraph 2.2.2 of the Memorandum of Understanding on the Administrative and Technical Structures of the Special Programme for Research and Training in Tropical Diseases provided for the selection by the WHO regional committees of two Member States from among those directly affected by the diseases dealt with by the Special Programme, or from among those providing technical or scientific support to the Special Programme. The two Member States of the Western Pacific Region who were currently members of the Joint Coordinating Board in this category were the Lao People's Democratic Republic and Cambodia. Since the three-year period of tenure of the representative designated by the Lao People's Democratic Repuhlic would end on 31 December 2003, the Committee would wish to appoint a Member State to send a representative to represent the Western Pacific Region from I January 2004. The Regional Committee might wish to consider Mongolia as a replacement for the Lao People's Democratic Republic. It was so decided (see deCision WPRlRC54(2)).
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6.
TIME AND PLACE OF THE FIFTY-FIFTH AND FIFTY-SIXTH SESSIONS OF THE REGIONAL COMMITTEE: Item 22 of the Agenda The Chairperson invited Dr Omi to say a few words about the place and proposed dates of the
fifty-fifth session. The REGIONAL DIRECTOR recalled that at its fifty-third session, the Regional Committee had accepted the kind invitation of the Government of China to host the fifty-fifth session of the Regional Committee in 2004. The Chairperson called on the representative of China to take the floor. Dr WANG (China) reconfirmed to the Committee that China would host the fifty-fifth session of the Western Pacific Regional Committee of WHO, in Shanghai, China. China would maintain close cooperation with the Regional Office in preparation of the meeting, to ensure complete success. The CHAIRPERSON thanked the representative of China. The REGIONAL DIRECTOR proposed the dates of the session, which had to take account of the dates of all the regional committees, both to enable the Director-General to attend part of each session, and to allow time for discussion of those committees to be reflected in documentation for the Executive Board meeting in January 2004. He therefore proposed the dates of 13 to 17 September 2004. The CHAIRPERSON asked the rapporteurs to draft an appropriate resolution, reflecting appreciation to the Government of China. 7. CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following resolution. 7.1 Child health (Document WPRlRC54/Conf.Paper No.8) Dr WAQATAKIREWA (Fiji) queried the wording of preambular paragraph 6, since he believed the expression should be not "the United Nations Millennium Development Goals" but "development goals of the United Nations Millennium Declaration". Mrs BLACKWOOD (United States of America) agreed with the representative of Fiji. Dr KUARTEI (Palau): suggested that the word "economic" be inserted in operative paragraph 1(1) after "political,".
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Dr MATHESON (New Zealand) proposed deletion of the expression "pockets of' from operative paragraph I, since in some Member States child mortality was of a much higher order than that wording suggested. He further proposed that, in operative paragraph 1(1), "health care" should precede "medical assistance", since the former was a broader term. The CHAIRPERSON said that, for the point raised by the representatives of Fiji and the United States of America, the secretariat would ensure the proper terminology was inserted. Decision: The draft resolution was adopted (see WPR/RC54.R9). 8. CLOSURE OF THE SESSION: Item 23 of the Agenda Dr TANGI (Tonga) thanked the CHAIRPERSON and other office bearers, all participants, the
Regional Director and the secretariat. Dr THORNE (United Kingdom) seconded the vote of thanks to all concerned. The REGIONAL DIRECTOR thanked Member States for the trust and confidence they had shown in re-electing him. He pledged to do his best throughout his second term. He thanked the secretariat also for its hard work behind the scenes. He thanked the Chairperson and presented him with the gavel as a token of his appreciation. The CHAIRPERSON said there were three reasons why the meeting had been memorable. Firstly, because it was the first meeting after the SARS outbreak, which had helped Member States to work more closely together with WHO. The second anniversary of the terrorist attack on New York had also taken place during the session, just as the attack itself had taken place during the fifty-second session. Finally, the meeting had re-elected Dr Omi as regional director. He thanked all participants and the secretariat for their work. He said the draft report of the session would be sent out to all representatives with a covering letter indicating the dates by which comments on the draft should reach the Regional Office. After that date, the report would be considered to have been accepted. The CHAIRPERSON declared the fifty-fourth session of the Regional Committee closed.
The meeting rose at 12: 15.