Wednesday 16th, MAY 2007 WHA

PLENARY ASSEMBLY (Morning) = > Youcef
Item 3

General Discussion:

Bolivia begun by claiming that the poverty rate reach 27 % of the population whereas her country is not poor (Bolivia is a great silver exporter).
Moreover, the country is facing huge difficulties concerning cares access because of the privatization.
Afghanistan insisted on the importance of health policy in his country which is affected by war. The commitments in favour of the eradication of polio were beneficial. Then, he expressed his concerns about the situation of the refugees and entreated Iran to take care of them.
Iceland emphasized that HIV threats the growth of developing countries.
Bangladesh said that health should be the central point of all men activities. He added that while is country is not very affected by HIV, Bangladesh must remain vigilant. Furthermore, if the authorities had led efficient policies to fight against influenza, nevertheless, malaria still remain a threat.
Sri Lanka have the highest rate of breast feeding of south Asia region. The representative also claimed that Sri Lanka succeed in curbing the HIV epidemic.
Kazakhstan ensured the willingness of his government to integrate WHO recommendations in health policies. He ended by congratulating the initiative of Argentina that propose to organise a meeting concerning the basic cares.
Monaco welcomed the creation of an emergency crisis department within WHO. He reminded the interest of his country in health issues, notably through the commitment of the princess Stephanie towards ONU-SIDA.
Congo reminded that influenza, malaria and polio are still present. The representative also considered travels or migrations as health insecurity factors. He welcomed the work done by WHO in favour of women.
Norway said that investments in the field of health are essentials for development. The representative emphasized the issues of nutrition at school and would like to reduce inequality in the area of health.
Denmark ended the morning by expressing that non communicable diseases should be a priority because 60 % of deaths in the world are resulting from such diseases.

PLENARY ASSEMBLY (Afternoon) = > Christine

Item 3
General discussion

Nepal stresses the importance to ensure health security and of pandemics, as well as natural disasters.
Cameroon calls the attention that there must be a global response to the emerging problems of globalization. New actors have appeared as well. Thus, WHO has the duty, as the leader in health issues, to guide those new actors. Cameroon has focused on the control of HIV/Aids, malaria and polio.
Sao Tomé and Principe wants to ameliorate the sanitary conditions and calls special attention on noncommunicable diseases.
Djibouti concentrates on the eradication of HIV/Aids, malaria and Tuberculosis. It criticizes pharmaceutical concerns which set financial gain as their primary target and are not ready to sell drugs to cheaper prices what could safe a lot of lives.
Timor-Leste reminds of its poor health and low levels of education. This new independent country with limited resources lacks of well-trained health staff. It faces a high maternal and child mortality, as well as many incidences of infectious diseases like Tuberculosis, Malaria, Dengue and leprosy. With WHO support it tries to improve health care by decentralization and integrated control of communicable diseases. Furthermore, it is planning to distribute Vitamin A to children under five years of age. To continue its effort, Timor-Leste calls WHO for additional resources and support to achieve the MDGs.
Uzbekistan is reforming the financing of health care branches. Its priority lies in the protection of mothers and children. It has projects for the eradication of malaria incidences.
Tuvalu, as a small island, highlights its vulnerability to natural disasters. Its most common problem is the limited budget for health. Medical supplies and drugs are allocated by New Zealand, Australia and Taiwan. Tuvalu is concerned about the spread of Avian Influenza and considers HIV/Aids as a big challenge.
Iraq’s main objective is to enable every individual to get access to medical treatment.
Nigeria reminds of its first incidence of H5N1 in April 2006. The number of polio incidences has dropped due to measures taken by the Health Ministry and the reform of its health care system has been a success.
Malta highlights its efforts in humanitarian aid in totally 120 countries.



COMMITTEE A (Morning) = > Paul

Chairman : Dr Robinson R. Jean Louis (Madagascar)

Provisional agenda item 12.2
Smallpox eradication: destruction of variola virus stocks

Resolution WHA49.10 (1996) recommended that the remaining stocks of live variola virus maintained by WHO since 1984 should be destroyed on 30 June 1999, after a final decision to be taken by the Health Assembly in May 1999. The Fifty-second World Health Assembly decided by resolution WHA52.10 to authorize temporary retention of the remaining variola virus stocks, subject to annual review, but up to no later than 2002, for the purpose of carrying out a programme of essential public-health research. By resolution WHA55.15 it authorized further temporary retention of these stocks for the purpose of continuing further international research.

The great stake for the destruction of variola virus stocks lies in the fight against the bioterrorist threat. But some States underline the necessity to retain temporarily stocks for the purpose of research (Australia, Thailand, Barbados)

The draft resolution contained in resolution EB120.R8 is adopted, with some substantially amendments.

Provisional agenda item 12.3
Control of leishmaniasis

Leishmaniasis is endemic in 88 countries in the world and 350 million people are considered at risk. An estimated 14 million people are infected, and each year about two million new cases occur.
The disease contributes significantly to the propagation of poverty, because treatment is expensive and hence either unaffordable or it imposes a substantial economic burden, including loss of wages.
Leishmaniasis with HIV coinfection is an emerging condition that demands urgent attention.
Even when coinfected patients receive proper treatment, they relapse repeatedly and the outcome frequently is fatal. Leishmaniasis is caused by a protozoal parasite of the genus Leishmania which multiplies in certain vertebrates that act as reservoirs of the disease. The parasite is transmitted to humans through the bite of sandflies that have previously fed on an infected reservoir. Expression of the two basic forms of the disease, namely cutaneous and visceral leishmaniasis, depends on the species of Leishmania responsible and the immune response to infection. The cutaneous form tends to heal spontaneously leaving scars which, depending on the species of Leishmania responsible, may evolve into diffuse cutaneous leishmaniasis, recidivans leishmaniasis, or mucocutaneous leishmaniasis, with disastrous aesthetic consequences for the patient. Visceral leishmaniasis, the most severe form, is fatal in almost all cases if left untreated. It may cause epidemic outbreaks with high mortality.

Many countries are satisfied by the fact that this disease, relatively unknown, is registered in the provisional agenda of the WHA.
The great stake is the distribution of the disease, e.g. with the flows of refugees (Morocco).
Thailand: underlined the need of monitoring.
India : beginning of a collaboration with Nepal and Bangladesh to eradicate this disease in South East Asia (90% in Bangladesh, Brazil ,India, Nepal and Sudan).
Kuwait : need to expend the collaboration with threatened countries.

The Secretary underlined the decline of the 90 % price of the medicine, by the action of the WHO

Resolution EB118.R3 will be examined later, once the amendments taken in account.


Provisional agenda item 12.4
Poliomyelitis: mechanism for management of potential risks to eradication

In 2006, the remaining 6% of all new cases of poliomyelitis occurred in countries into which
poliovirus has been reintroduced. In order to reduce the risk of further international spread of wild poliovirus in 2006, countries judged to be at high risk of importing viruses (because of previous importations or having borders with areas where polioviruses are circulating) conducted additional campaigns against poliomyelitis. In order to protect individual travellers, WHO updated its guidance on international travel and health so as to recommend that all travellers to countries where poliovirus is known to be circulating should be fully vaccinated against poliomyelitis in accordance with the national immunization policy in their country of origin.

Great Issues discussed:

- Interrupting transmission of endemic wild poliovirus in Afghanistan, India, Nigeria and
Pakistan
- Limiting the risk of international spread of wild poliovirus
- Initiating a process to minimize and manage the risks of re-emergence of poliomyelitis in the post-eradication era

Greece: need to organize some media campaigns, public opinion sensitization
Ecuador: Migration of virus is a big problem
Swaziland: Money troubles do not allow to arrive at good results

To be continued this afternoon


COMMITTEE A (Afternoon) = > Marina

Item 11
Draft medium-term strategic plan, including proposed programme budget 2008-2009

Introductory speech of a representative of the Executive Board

The Representative of the Executive Board introduced two draft financial documents by stressing the new approach adopted by the World Health Organization concerning the guidelines of its budget. He expressed the E.B. satisfaction concerning the result based approach of the budgets but he also expressed his concerns about the use of an historical perspective for the budget attribution rather than the efficiency that might guide such an exercise.
The report on the 2008-2009 budgets was voted at the 100th session of the E.B. and it focuses mainly on strategic purposes following a result-based approach.
The floor was then given to the state members so that the Secretariat of the World Health Organization would welcome their comments, remarks and concerns. The discussions concerned both items 11.1, 11.2 and 11.3 (only referred to by the Distinguished Delegate of Switzerland). Before expressing their remarks, the member states all agreed that the different documents provided by the Secretariat of the WHO reflect a serious work and commitment to the effort of rationalisation (from 16 to 13 Strategic Objectives in the Draft Medium-term Strategic Plan or DMTSP) of WHO's functioning.

Item 11.1
Draft Medium-term strategic plan 2008-2009

Item 11.2
Proposed Programme budget 2008-2009

Item 11.3
Real estate: draft capital master plan

By regarding the whole discussions, some issues have been frequently invoked by the member states. Those issues can be shared between those concerning the nature of the funding (the different kinds of resources, part A) and the structure of the budget itself (as reflect of choices in terms of Strategic Objectives and their allocations, part B).

A. The balance between regular budget and voluntary contributions
The common worry of a majority of member states seems to be the preservation of WHO's integrity. The WHO should be granted a budget that guarantees its independence and that would allow it to keep on acting independently from the identity of donors. Many states among which were Canada, the Netherlands, France, Norway, Belgium, the Russian Federation, Surinam and the Islamic Republic of Iran deplored the increasing part of voluntary contributions in the global budget. They expressed their concern as they did not want the WHO to become progressively a U.N. fund. According to the Netherlands, all member states should take this into account and even if the proposals increase the budget of 15%, such a situation should not be mainly due to unforeseeable voluntary contributions. The D.D. of Belgium also asked for the establishment of priority in term of resources' allocation in case of financial problems and he deplored the absence of reference to the Declaration de Paris on the efficacy of the public aid for development. Other remarks were done by countries such as France or Greece asking for more precision in terms of budget attribution for each programme. The Russian Federation also asked for precision concerning evaluation tools or processes that would be use in order to compare the progress of the different countries and their contributions to the Strategic Objectives' achievement. The D.D. of Japan also insisted on a better mainstreaming of WHO's activities.

B. The specific demands concerning allocations of resources
The D.D. of the United States of America, supported by Malta, El Salvador, asked to the Secretariat to modify the formulation of Strategic Objective 4 concerning sexual and reproduction health services. They asked for an amendment in the DMTSP with the introduction of a statement in the official report of Committee A that would insist on the fact that providing services for abortion cannot be interpreted as an obligation regarding to the legislation of each country.
Then, on behalf of the African region, the D.D. of Liberia deplored the decrease in the budget dedicated to the second Strategic Objective of the DMTSP, namely the struggle against HIV/Aids, tuberculosis and malaria. The D.D. of Sao Tome and Principe supported such a viewpoint insisting on the fact that the Caribbean region was the second area touched by these diseases. The D.D. of Liberia also deplored the decrease of WHO budget (2008-2009) dedicated to the African region (from 28.7% to 28.2%).
Finally, the D.D. of Switzerland made a comment on the third document (Item 11.3) recalling the duty of the state members of international organizations in terms of financing real estate. She stressed that instead of investing money once the different infrastructures are damaged, the state members must contribute annually for keeping those infrastructures in good conditions. She also said that a part of the budget should be annually save for those purposes.

COMMITTEE B (Afternoon) = > Youcef

Election of vice-presidents of the committee:
 Mr Francis (Trinidad et Tobago)
 Dr Yussouf (Maldives)
 Dr Al-Faquiri (Saudi Arabia)

Item 14
Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan

The Distinguished Delegate of the Arab Republic of Egypt, as co-sponsor of a draft resolution (A60/B/Conf.Paper No 1) supported by 19 state members. The D.D. of Egypt has denounced the violation of human rights committed by Israel in the occupied territories. He officially asked for the suspension of the building of the wall in the Gaza area and stressed the fact that such an action does not respect international law. The WHO should pay a particular attention to the providing of a technical assistance to the Palestinian people as occupied people. According to him and the states on behalf of which he spoke, the WHO must strengthen its action in order to improve the current situation in Palestine. The D.D. of Egypt particularly emphasized that the aim of the resolution he presented there was totally guided by sanitary concerns and not by specific political aims.
The D.D. of the Syrian Arab Republic stressed that the occupation of Israel on the Syrian Golan has consequences on the living conditions of populations in that area. According to his country, the Gaza strip has become a giant jail. He brought his support to the D.D. of Egypt statement concerning human right violations and international law. The occupied villages are suffering from lack of infrastructures, transports and human resources for health. Doctors and more generally health staff are denied the right to get a labor authorization in occupied territories. He ended his declaration by expressing his deep concern as for the conditions in which the Arab prisoners are maintained in jail in Israeli's jails.

The D.D. of Israel considered the draft resolution proposed by the previous state members as partial and inexact. He declared that Israel is frequently attacked by Hamas' rockets. The adoption of the proposed resolution would not improve the current situation in the region, it is through cooperation and mutual help that the situation will improve and not with unfunded and inexact resolutions.

The D.D. of the United States of America expressed his regrets as this resolution seemed to be more a political one rather than a sanitary resolution. The D.D. of U.S.A. said that his country is deeply concerned by the health of the Palestinian people. Indeed the country has spent $US 12m in 2006-2007 in public aids dedicated to health projects.
However, the Palestinian government must stop its action through violent means and recognize the Israeli's state.

The floor was finally given to the Palestinian authority: Its Representative declared that his people were faced to a severe situation. He added that the number of check points (547) has increased once again in 2006 that block the access of patients and ambulances to hospitals.


TECHNICAL MEETING

Technical briefing at the 60th World Health Assembly = > Alice
1:00 to 2:30

The purpose of the meeting was to draw the Members States attention over the importance of the International Health Regulations (IHR) in the context of International Public Health Security and encourage multisectoral action within States to implement IHR before the entry into force in June.

Director-General WHO, Dr Margaret Chan, introduced the meeting by reminding that the pandemic influenza threat was to be the most difficult to deal with. The most important point made, according to her, was the necessity to share virus samples in order to track the mutations worldwide and to find the new resistance patterns. As the pandemic influenza is a virus that is very hard to deal with, Dr. Chan insisted on the fact that IHR needs a wide collective response. She also emphasized the need to support non pharmaceutical interventions effort as everyone can participate in that.
The Canadian Minister of Health, Mr. T. Clement, showed the significance of IHR as it permits to have policies defined before the crisis occur, and therefore the response is not a reaction but a real adaptation of the policy through the emergency. He insisted on collaboration and capacity building.
The Minister of Health from Côte d’Ivoire, Mr. A.K. Rémi, illustrated the problem of chemical pollution by giving the example of the crisis in Abidjan, August to November 2006. He reminded us of the help the WHO is able to give in such circumstances through the sending of experts, materials, and so on.
The Deputy Chief Executive, Food Safety Authority in Ireland, Mr. Alan Reilly, emphasized on the diseases transmitted through the food. He focused on the necessity of a genuine collaboration and teamwork between international and national agencies.

The overview of the IHR implementation stressed the following facts: IHR is evolving from focusing on boarder controls only to at the source containment. There are four principles issues to keep in mind which are International travel and transports, National surveillance and response, Global alert and response system, Threat specific control programmes. Their efficacy will be relying on legal procedures and monitoring in the implementation of the IHR.
_ The National Focal Point guidelines can be found on the WHO website.
_ Only 52 states have nominated an expert accordingly to art 47 (it remains voluntary).
Between 2007 and 2009 the national plans need to be defined.
Between 2009 to 2012 or 2014 depending on the success, is the time given to implement the national plans.
Partnership remains essential, with other organizations like the FAO, regional organizations like ASEAN, collaborating centres of the WHO, development agencies, academics and professionals associations, industry associations such as Iata, and NGOs.
The most notable difficulties are technical (like defining ground crossings), the timelines, the intersectoral nature of IHR, and the need of resources.

Simulation exercises, open to Member States, will take place by mid-June to test the collective ability of response.