Fifty-fifth Session of the WHO Regional Committee
13 to 17 September 2004, Shanghai, China
Mr Chairman, Honourable Ministers, Distinguished Representatives, Colleagues,
A little over a year ago, in May 2003, some newspapers were saying that Shanghai might "shut down" because of the danger and the fear of SARS. It is a pleasure to see that they were wrong. But it can also be useful to remember the suspense we were living in at that time. It makes clear the need for preparedness, both to avoid pandemics and other disasters and to mitigate the harm they do.
The likelihood of a SARS pandemic has receded, thanks in large part to decisive action taken by many people, especially in this region. Other hazards, though, particularly that of avian influenza, are still very much with us.
I would like to suggest this need for security as one of the reference points for your discussions here this week. It is very closely linked to the need for equity, and for unity. All three - security, equity and unity - are fundamental principles of WHO, as our constitution states. Awareness of them is particularly needed now, both in public health and in international cooperation.
Equity has to be strongly reasserted, as the health effects of extreme disparities between communities become more and more evident.
Unity is indispensable for effective action, and it requires us to work more closely than ever before with our partners. Your current cooperation on regional and bi-regional disease control reflects this need and points the way forward.
To uphold these principles we have to be practical. The first thing to do is ensure that we have the resources to do our work.
During this meeting you will be discussing the proposed Programme Budget for 2006-2007. I would like to stress some important aspects of this budget.
First, it builds on our experience with results-based budgeting and the lessons learnt from the performance assessment of the 2002-2003 Programme Budget. Second, it reflects the priorities expressed by Member States in recent World Health Assembly resolutions and has been drafted in consultation between the headquarters, regional and country offices. Third, it reinforces and accelerates the decentralization process I initiated last year. You will note that it proposes an overall increase of 12.8%, all of which will be allocated to countries and regions.
The increase is accompanied by measures to ensure maximum efficiency in the use of resources. These measures delegate responsibility while calling for the highest standards of transparency and accountability.
Previous projections of budget growth have been matched by the generosity of our donors, enabling us to achieve the results to which we were committed. But essential activities cannot depend on generosity alone. That is why I am proposing an increase of 9% in assessed contributions from Member States.
The increase represents a break with the practice adopted some years ago of zero nominal growth in the regular budgets of UN agencies, which has been gradually turning WHO into an organization that depends mainly on voluntary contributions. At present, the Regular Budget, consisting of assessed contributions, represents only 30% of WHO's overall expenditure. If the current trend were to continue, it would be only 17% by 2015. To formulate and carry out a well-balanced global policy, a significant regular budget is needed.
The budget question becomes urgent in the context of our General Programme of Work for 2006 to 2015, which sets our longer-term objectives and thereby defines WHO's role in the world. Both of these items - the Programme Budget and the General Programme of Work - will be on the agenda of the Executive Board at its next meeting in January.
Your input through this session of the Regional Committee will make an important contribution to the Executive Board's recommendations, which then go to the Health Assembly.
To return to the question of security, epidemics continue to be a threat both to this region and to the world. The International Health Regulations are designed to minimize that danger. The revision now in progress has benefited from a high level of input from Member States through the regional consultations. The next step will be to agree on a revised text in the open-ended Intergovernmental Working Group which meets from 1 to 12 November at the UN Palais des Nations in Geneva.
The working draft will be made available later this month. If progress continues at the current rate, the revised Regulations can be adopted at the World Health Assembly in May 2005. The fullest participation possible of Member States in the Working Group discussions will be our best guarantee of success.
The longer-term challenge will be to ensure that the revised regulations are followed. This will require strong commitment within regions and countries, with the necessary investment in early warning and response systems.
These systems will be supported by WHO's Operations Centre, recently opened at headquarters. Using the most up-to-date technology, it enables us to respond rapidly to the earliest signs of outbreaks and other health emergencies by circulating the latest information and coordinating the necessary action.
Recently we have seen timely and well-managed responses in the Western Pacific and the South-East Asia to outbreaks of avian influenza. However, we are still in the early stages of building an adequate global outbreak alert and response system. This will require a sustained effort of investment. It involves not only the national, regional, bi-regional and global information hubs but also our many collaborating centres in the relevant areas of expertise.
A major concern at present is that avian influenza is now endemic in poultry in some parts of Asia, and it may not be possible to eliminate it. As long as the H5N1 virus remains in poultry there can be more human cases, with a high fatality rate. This virus, if it adapts to efficient human-to-human transmission, could cause a global pandemic of influenza in humans.
Our attention and energy must be focused now on every possibility that might exist of preventing or containing such a pandemic. The main tasks at present are: case detection and control in animals, surveillance for human cases, vaccine development, and research on how this virus evolves.
The health services also have to be prepared to manage disasters that do occur and are occurring now. Lack of access to AIDS treatment and prevention methods continues to be a glaring example both of insecurity and of inequity.
With 1.5 million people infected with HIV in this region, accelerated coverage with preventive action and treatment is urgently needed. Financing through the Global Fund for 13 of your proposals will contribute significantly to the excellent work you are doing to achieve this.
At the Bangkok conference on HIV/AIDS in July there was plenty of debate over methods of prevention and treatment, but absolute agreement about the need for both. We know that prevention bolsters treatment and vice versa, and that they must be integrated in a comprehensive way.
Globally, with all sources combined, almost 20 billion dollars have been pledged for integrated AIDS prevention and care over the next five years. At the same time, drug prices continue to fall, with the lowest-price triple-drug regimen coming down towards $140 per person per year. HIV treatment is now financially within reach for more countries, and more people, than ever before.
Enormous logistical and technical difficulties remain, but there are signs that they too are yielding to persistent efforts of our many partners working towards the '3 by 5' target within countries and internationally.
Guidelines for high-quality treatment using standardized regimens and simplified clinical monitoring are now available. We have developed training and monitoring systems to ensure the quality of treatment, and to increase the involvement of nurses and community workers in providing care and support. We expect to have at least 20 '3 by 5' country officers in place by the end of this year, greatly increasing our effectiveness on the ground. For this region two have been selected, and the selection of a third is under way.
One of our most pressing needs is to improve human resource capacity to support HIV treatment and strengthen activities across the health sector. This means retaining, training and deploying health care workers, and creating new types of treatment supporters, including people living with HIV/AIDS themselves. Social mobilization, with the very active involvement of community health workers, will be a key to achieving our goals in the Western Pacific Region.
The global target of 3 million patients on antiretroviral treatment by 2005 has provoked much discussion. To many it seemed like an over-ambitious idea one year ago; now it is a strong commitment made by many countries, many organizations, and many individuals. To speculate about whether we will meet the deadline is to miss the point. The point in the AIDS treatment emergency is the same as in other emergencies: to do as much as is humanly possible to save lives and reduce danger in the shortest possible time.
The initiative has helped to focus the world's attention on dealing with this emergency, and has galvanized action within our own organization. We must not relent in our efforts to reach the target for treatment and to accelerate HIV/AIDS prevention well beyond December 2005.
I am committed to continuing to mobilize all the human and material resources at our disposal to support you in this. It is not just a WHO target, it is your target - set by many organizations and many people acting at every level, from local to international. Effective action on HIV/AIDS in this region and globally is an absolute necessity.
On tuberculosis, we have seen some good progress in the Region on DOTS coverage and cure rates. The recent conference organized by the State Council has strengthened this effort in China, which has the largest number of TB cases in the region.
A high priority now must be to expand early case detection in marginalized populations, and improve referral systems. Drug resistance and co-infection with HIV also call for increased surveillance. The TB and AIDS programmes need to collaborate closely to ensure screening and cross-referral for treatment.
Major efforts are under way to improve the malaria situation. These are aimed at increasing people's access to insecticide-treated bednets, and widespread use of effective treatment regimens based on artesunate combination therapy. This combination of prevention and treatment measures can control malaria. The challenge is to put the human resources and systems in place to ensure that it is adopted.
As we see with disease control, making adequate health services available where they are needed is an enormous challenge in itself. But it is only one part of what it takes to promote health for all. Health also depends to a very significant extent on socially determined factors such as the environment, education and employment.
Knowledge about how these factors affect health enables us to target our activities for maximum effect. To gather the evidence needed for effective policies, the Commission on the Social Determinants of Health will begin its work in December. Regional and country-level input will be indispensable for this effort, and I encourage you all to contribute to the Commission's work.
The WHO Framework Convention on Tobacco Control, also aimed at tackling social and economic determinants of health, is proceeding well towards coming into force. In this region nine countries have ratified it. I urge all the rest of you to follow their excellent example, so that the Convention can fulfill its great potential for saving lives.
In May the WHO strategy on diet and physical activity was strongly endorsed by the Health Assembly. Since then, this region has been at the forefront in formulating a realistic implementation plan. Knowledge-sharing will be a major asset for preventing and controlling noncommunicable diseases. These are now the major cause of death and illness in every region of the world except Africa.
In parts of this region epidemics of overweight and obesity are emerging, leading to type 2 diabetes. In China, 20 million people are suffering from diabetes. The Ministry of Health is now working closely with WHO to develop a policy framework for responding to this growing challenge of chronic disease control. This work will be of great value for China and for many other countries.
It is research that has led to public recognition of some of the causes of chronic disease and how they can be tackled. The Ministerial Summit on Health Research, to be held in Mexico in November, aims to accelerate the same process for other causal factors of disease, especially the factors that block the way to the Millennium Development Goals. I encourage you to attend this meeting. In addition, the Sixth Global Conference on Health Promotion will be held in Bangkok in August 2005. Its title will be Policy and Partnership for Action.
Unity is the key to achieving the security and equity the world so desperately needs now.
In the coming months, our focus on maternal and child health will provide special opportunities to achieve it.
A large number of key organizations have combined forces to tackle the problems in this area. Their first step, earlier this year, was to draft a road map for attaining the Millennium Development Goals for maternal and child health. The World Health Report and World Health Day for 2005 will build on this momentum.
We are working with our colleagues in UNICEF, UNFPA and the many other organizations involved through the new Partnership for Safe Motherhood and Newborn Health, which is housed in WHO's Geneva office.
The focus on maternal and child health is reinforced by our country-specific cooperation strategies, whose principal aim is to strengthen health systems. With your regional agenda for strengthening the country offices, the work of decentralization through the single WHO country plan and budget is well under way in the Western Pacific Region. Some countries in this region are already reporting benefits from this work, and it will make a significant contribution to achieving national development goals.
The Regional Committee itself has been a powerful means of building unity between our Member States over the years. Health problems have no respect for national boundaries, and the means of solving them must transcend those boundaries as well. Solidarity is the key to disease control.
Your decisions here this week can help to build up that strength. For the sake of all the people who stand to gain from it, in the Western Pacific and beyond, I wish you every success.