Tuesday 15th, MAY 2007 WHA

PLENARY ASSEMBLY of the WHA (Morning) = > Delphine

Item 2
Reports of the Executive Board on its 118th, 119th and 120th sessions

The Executive Board summarised the decisions and discussions from the 118th (May 2006), 119th (November 2006) and the 120th sessions (January 2007).
This information can be found in Document A60/2.

Adress by Dr Margaret Chan, Director-General
Document to be distributed tomorrow A60/3.

Item 3

General Discussion:

China emphasized the importance of supporting health care improvement in Africa and encouraged the WHO to keep on working towards this. Indeed, the health situation in Africa is hindering their economic development. China also made three propositions:
1. Increase the role of the WHO and encourage states to fully support it. Health has repercussions in issues of security, economics, etc issue and WHO has to have a bigger role in this context.
2. Put in force a global disease control mechanism as well as an early warning system.
3. Help to improve health security in developing countries, because diseases don't respect physical borders. Health is a global issue.
Indonesia justified its decision to stop providing H5N1 samples to the WHO earlier this year by blaming the abusive use of samples by private actors. It advocated a fair and equal distribution of these samples. It wants a guarantee that the results of the research made possible by these samples will be redistributed fairly to developing countries. While providing these virus samples for free to the WHO, it wants to be sure that it will then have access to the vaccine produced for a reasonable price. It recommended the creation of a mechanism to allow it.
Algeria, talking on behalf of the health ministers of Arab countries, reminded the assembly that the situation in Palestine is problematic because infrastructure is lacking or has been destroyed by Israeli forces. It compared this situation to the one in Lebanon after the conflict of last summer. It also detailed the problematic health situations in Darfur, Somalia, Libya, as well as in Iraq and its neighbours, like Jordan, which welcome a significant number of refugees, and so put the balance of their health service in danger.
Zimbabwe complained about the international community’s lack of support for health matters in the country that could make the country even more vulnerable.
The Cook Islands, talking for the Pacific Islands, highlighted the link between poverty and health. It also expressed its concern about non-transmissible diseases, in particular obesity and mental illnesses.
Brazil asked for more cooperation on health issues that have a strong influence on the fight against poverty and hunger started by the President Lula. It also warned against the danger of the TRIPS and said that it should not limit health policies.
Item 4

Invited speakers:

The Prime Minister of Norway, Mr. Jens Stoltenberg, insisted that States should do more to achieve goals 4 and 5 of the Millennium Development Goals, to improve the health of children and mothers. He also called for better coordination and efficiency between the UN agencies.

The Executive Director of UNFPD, Mrs Nafis Sadik, expressed her wish to stop all unsafe abortion practices and affirmed that abortion should never be an official family planning policy. Women’s empowerment should also be encouraged in health issues as well as gender perspectives. Finally she asked for short-term solutions in addition to long-term ones and for more cohesion in the UN system.


PLENARY ASSEMBLY OF THE WHO (Afternoon)

Item 3
General discussion = > Christine


Israel focuses on health issues related to immigration and on the prevention of HIV/Aids. Despite its conflict with Palestine, it assures the correct medical treatment of Palestinian patients on Israeli territory.
South Africa, speaking on behalf of the Southern African Development Community, developed a strategic plan to eradicate Tuberculosis. The South African emphasizes the importance to reduce the costs of pharmaceutical products in developing countries.
Bhutan stresses the fact that South East Asian countries often face natural disasters which have an important impact on health security. Furthermore, it requests additional resources for prevention and eradication of Tuberculosis and Malaria.
Sweden welcomes the adoption of the Medium-term strategic plan. It draws the attention on three important issues: 1) the abuse of alcohol consumption. Sweden faces the problem of increased alcohol consumption and therefore the Swedish delegation supports the interventions to reduce alcohol-related harm. 2) It is in favour of an increased HIV/Aids prevention and family planning. 3) It highlights the importance of a strong global leadership by WHO to ensure health security. Moreover, it mentions the impact of climate change on health.
Iran stresses the importance of tobacco control and calls attention that many diseases could be prevented if there was a better cooperation between member states.
Brunei Darussalam demands more investment in the eradication of Avian Influenza. This includes the control of poultry, vaccination and prevention. The control of Tuberculosis is of special interest for it. It mentions as well that Brunei Darussalam has been made free of Polio and Malaria.
Pakistan mentions Polio eradication as its number one target and stresses the importance of both communicable and noncommunicable diseases. The Health Minister of Pakistan invites the member states to more efficiency and dedication in their actions.
Argentina highlights the importance of all individuals to have access to cheap medicine. To be poor should not mean to not be able to gain access to medical treatment.
Republic of Korea claims that spending on health matters should be more viewed as an investment.
Ghana mentions Africa’s high burden of diseases and demands that the cost of pharmaceutical products should be reduced.
Gambia’s incidences of malaria are decreasing and free medicine is provided for pregnant women and other vulnerable groups. It is confident to reach the Millennium Development Goals four and five.
Vietnam warns of pandemic influenza and reminds of the outbreak of avian influenza in 2003.
Malaysia stresses the impact of the Tsunami on health security. It has invested one million dollars for Polio eradication.


COMITTE A (Morning) = > Yussef

Item 10
Opening of the Committee
The chairman was the minister of health of Magadascar. He made a short statement to say how proud he was to chair this meeting.
The representative of the executive board expressed its concerns about developing country’s limitation concerning the access to cheap medicine. He claimed that the board fully supports a resolution which should strengthen relevant measures to enable a free access to medical treatment.

Item 12 Technical and Health matters
Item 12.1 Avian and Pandemic influenza
The secretariat emphasizes the importance to update the medicine against influenza more regularly. The secretariat finally added that discussions with medicine manufacturer are ongoing.

Then, a debate took place among the different delegations.

Indonesia took the floor on behalf of Algeria, Brunei Darussalam, Cuba, Korea, Iran, Iraq, Lao people’s democratic republic, Malaysia, Peru, Qatar, Saudi Arabia, Myanmar, Maldives, Solomon Islands, Sudan and Timor-leste and as a co-sponsor of the draft resolution concerning the responsible practices for sharing avian influenza viruses and resulting benefits.
He stresses the importance of the availability of the vaccines which is essential in order to fight against the avian influenza. He also talked about the current system which he described as unfair. Thus, the representative denounced abusive practices by private actors. Indeed, while providing these virus samples for free to the WHO, private enterprises commercialize these samples with developing countries.
The goal of this resolution is to provide a fair and equal distribution of these samples. It aims to ensure the access to the vaccine produced for a reasonable price and in a sufficient quantity.

The US representative stressed that his government made efforts to help developing countries affected by pandemics and fully support the resolution.

Finally, Thailand made a statement to join the Indonesian’s position concerning the cost of the medicine which can reach per dose. Thus, he made some proposals:

- quick measures in order to increase the developing countries’ capacity production
- create mechanisms in order to reduce costs of medicines
- enhance best practices to ensure a share more fair and equal
- to forbid the pharmaceutical industry to make such important profits


COMITTEE A (Afternoon) = > Marina

Item 12 (continued)
Item 12.1 (continued)

The different delegations kept on explaining their support to one of the two draft resolution concerning Avian and Pandemic influenza. The state of Australia first took the floor to declare that there was no quick or easy solution to such a problem and underlined the support of his country to the WHO system. The Distinguished Delegate of Australia also stressed the need for WHO to be granted enough means to increase the capacity of all the countries to respond to the pandemic influenza.
Cote d'Ivoire, on behalf of the African states members of the WHO reminded the assembly of the consequences of H5N1 between 2004 and 2007. In that period, 4 to 291 human case were detected and 178 persons died. He also recalled the different actions already settled in African countries in order to struggle against the diffusion of the virus. He talked about various meetings at a national, a regional and an international level. He underlined the efforts of WHO and the African states so as to ensure monitoring of the virus and training of people who are directly concerned. Finally, he addressed his thanks to the WHO and to all the partners that are still participating to actions of that kind. He also said that despite all these efforts, resources are still insufficient. He explained that the African countries he represented here were supporting the Jakarta agreement between the WHO and Indonesia. He invited the other delegations to support the resolution EB 120/57 and the constitution of a working group in charge of redacting a draft resolution that will meet the needs of all the state members. The president of the Committee took then the floor to explain that such a working group would aim at enabling the authors and sponsors of the two existing draft resolutions to elaborate a unique one together.
The Distinguished Delegate of Germany, on behalf of the EU member states, the EU candidates and the potential candidates, declared the European states were supporting resolution EB 120.

Then Kuwait considered that the particular situation of third world countries should be into account and that those countries should be helped in their access to sufficient quantity of vaccines. He asked for a financial support from developed countries in that regards.

The Delegation of France considered the sharing of information as a major priority in the context of avian and pandemic influenza. To the Distinguished Delegate of France, access to information would determine the efficiency of the response of the international community. He also referred to the International Sanitary rule adopted in 2005. According to France, the WHO should contribute to increase the visibility of such a rule. Finally the issue of the access to vaccines was raised saying that a stock of pre-pandemic vaccines should be constituted in order to help infested areas in South East Asia and in Africa.

Item 12.2 Smallpox eradication: destruction of variola virus stocks

While the working group started its work upon a common draft resolution, the president proposed to deal with the issue 12.2 and the debates started but the debate was adjourned.







PUBLIC MEETINGS

 SAVING LIVES, SAVING MONEY: achieving rational use of medicines in health services (Item 4.9) = > Aurélie
12:30 am to 2:00 pm

Chair: His Excellency Lyonpo Dr Jigme Singay
Co Chair: Dr Palitha Abeykoon
Dr Ravi Narayan
Dr Otto Cars

More than 50% of all medicines worldwide are prescribed, dispensed or sold inappropriately and 50% of patients fall to take them correctly.
The proportion of national health budgets spent of medicines ranges between 10% and 20% in developed countries and between 20% and 40% in developing countries.

Common types of irrational use of medicine are:
- the use of too many medicines per patient (or called polypharmacy),
- inappropriate use of antibiotics, often in adequate dosage, for non bacterial infections,
- over-use of injections when oral formulations would be more appropriated,
- failure to prescribe in accordance with clinical guidelines,
- inappropriate self-medication

Lack of access to medicines and inappropriate dose result in increasing morbidity and mortality, particularly for childhood infections or chronic diseases.
Inappropriate use and over-use of medicines is a waste of resources.
The over-use of antibiotics is leading to increased antibiotic resistance.
Irrational use of medicines can also stimulate inappropriate patient demand, lead to reduced access and attendance rates due to medicine stock-outs and loss of patient confidence in the health system.
The first step to correcting irrational use of medicines is to measure it.

Strategies to promote rational use of medicines:
1- Measuring the impact: Studies should be done in areas where rational use policies have
been developed and successfully implemented
2- Formation of alliances, between prescribers, consumers and politicians
3- Communication strategies, by using the media
4- Empowermemt of consumers
5- Providing practical messages: countries that have managed to implement policies with positives outcomes have to promote their successes
6- Advocacy and lobbying
7- Address at global level: policies on rational use should be clearly defined and supported by organizations at the global level (WHO, World Bank, …)
8- Address industry power: WHO and other international organizations should address “big pharma” issues such as the pharmaceutical industry in developed countries.

Irrational use of medicines has a global dimension, as the image of antibiotic resistance. No country today on its own can isolate itself from resistant bacteria. Antibiotic resistance is a growing international problem, affecting both current and futures generations.



 Oral Health in the 21st century = > Mehdi
5:30 to 7:00 pm

During this meeting, several experts, representing different regions and NGOS, including the FDI World Dental Federation (FDI) and the International Association for Dental research (IADR) were present. They expressed their concern on the current existing oral diseases, such as dental caries, periodontal disease, tooth loss, oral cancers, oral manifestations of HIV/AIDS, noma and the serious public health problem they constitute. The general aim being to consider the draft resolution contained in resolution EB120.R5, which frames the future policies and strategies for oral health to adopt.

The main causes of oral diseases evoked are bad alimentation essentially due to cultural habits (developed countries) and deprivation (developing countries). The most harmful being the massive consumption of sugar, acidic food, alcohol, and tobacco. Asia is particularly exposed, oral health problems affect increasingly young people and the level of mortality is very high (~ 80%) and essentially concerns deprived population. Oral cancer is the 3rd most common case of cancer in Eats Asia.

The different experts insisted the role of early diagnoses, systematic health promotion of good nutrition and diet via public awareness campaigns, early education. Big emphasis was made on the introduction of fluoride as a central element of oral health, via salt, water, milk or toothpaste. This product is central in the prevention of oral diseases, easy to develop and not costly. According to FDI, with efficient promotion, 95% of oral diseases can be prevented at low cost.