WHO Priorities for the next 5 years

London School of Hygiene and Tropical Medicine

London, UK
7 October 2003

Professor Haines, Colleagues, Ladies and Gentlemen,

It is a pleasure to be here today, and to talk to you about some of the concerns we share about the health of our world.

At the UN General Assembly two weeks ago, WHO declared a global public health emergency. This emergency is due to the failure to deliver AIDS medicines to those who need them. In sub-Saharan Africa alone, over 4 million people need antiretroviral treatment, while only 50 000 are getting it. In some places four out of every 10 people are infected with HIV. One person’s illness, inability to work, look after their family and eventual death - is a tragedy. Add to this the three million people who die of AIDS every year, and we have a social catastrophe of huge proportions. The effects are multiplying across the hardest hit countries. WHO will take the lead to stop this from happening. Our first target is three million people on antiretrovirals by 2005 – the “3 by 5”. Our goal is universal access to treatment.

Leadership in global health is critical when one country’s health problem poses a risk to the rest of the world. The SARS epidemic was stopped through an early WHO global alert, followed by hard work from countries, health workers, and scientists. WHO had to take tough decisions and issue travel advisories. The economic impact of these actions was severe. But they were justified to stop the epidemic. Because the SARS threat transcended the interests of any one part of the world, it was WHO’s duty to lead. WHO was constituted in 1946 to meet international needs of this kind, following the second world war. It replaced several earlier attempts begun in the nineteenth century. As part of the United Nations system, WHO promotes security by coordinating disease control. It promotes justice by sharing health knowledge and resources. The two goals are complementary. You cannot have a healthy form of security without justice, and vice versa. This is easy to agree with in principle but often hard to uphold in practice, especially in situations of conflict and emergency of the kind we are seeing now. But those very dangers alone make the case for strong multilateral institutions. This year we are celebrating the twenty-fifth anniversary of the Declaration of Health for All, made at the International Conference on Primary Health Care in Alma-Ata, Kazakhstan. It called for "urgent action by all governments, all health and development workers and the world community to protect and promote the health of all the people of the world". It said the gross inequality of health status in the world at that time was unacceptable and of common concern to all countries.

The Health-for-All Declaration launched a global effort to redress the balance. It achieved a great deal. But progress has slowed and, in many cases, even been reversed by the upsurge of AIDS and the resurgence of tuberculosis and malaria. Today, we again see a dangerous and unacceptable imbalance. The majority of the world's population are still exposed to severe and fatal diseases that are mostly preventable and controllable. It is time for another global effort.

To achieve the “3 by 5”, we are working with UNAIDS and other partners to form country level emergency response teams, to draw up simple treatment guidelines, to build a global AIDS Drugs and Diagnostic Facility, to train health workers rapidly and to make feasible budgets for these activities. The detailed strategy and calendar of action will be ready by World AIDS Day - December the first — just under two months from now.

The Stop-TB partnership, in which the London School has been very active, provides a useful model for tackling other diseases as well, by synergizing the efforts of different types of organizations. An estimated one-third of the 42 million people living with HIV/AIDS are co-infected with TB. We need to coordinate our efforts to control both. The models which have worked so well for tuberculosis, such as surveillance systems to track disease outcomes and drug resistance, and the Global Drug Facility to increase access to drugs, can be developed for HIV/AIDS.

For malaria, we must better coordinate the interventions for prevention and control, and scale them up more rapidly. Over a million people a year die of malaria. Excellent research and training on vector control, treatment options and epidemic prediction are going on here at the London School. We need to find more ways to take advantage of this work and turn it into effective action. The Gates Malaria Partnership, to which WHO and the London School both belong, and whose secretariat is based here, will provide good opportunities for doing this.

There are also two areas in which we have made a great deal of progress but need now to press home the advantage. One of these is polio eradication. There are just seven countries left in which polio is still endemic. When we started this initiative in 1988 there were 125. Through mass immunization campaigns in these seven countries, we are making a final push to break transmission completely, and stamp out the disease in all countries. The other area in which we must consolidate our gains is the Framework Convention on Tobacco Control. It was adopted by the World Health Assembly this May and has been signed by 73 countries and ratified by two so far. Forty must ratify it for it to come into force. We are working hard to help countries with whatever information and advice they need to make this happen in the coming months.

The burden of noncommunicable diseases as a whole now outweighs that of communicable diseases in developing countries. In addition to the Framework Convention to stem tobacco-related diseases, preventive measures for cardiovascular diseases and road traffic accidents are a major concern. Much of this can be done by applying existing knowledge within the framework of a strong national primary health care system.

The goals set by the United Nations Millennium Summit in the year 2000 include control of the major infectious diseases, and reducing child and maternal mortality. They also set targets for poverty reduction, education, gender equality and the environment. All of these are directly health-related, and reflect the commitment of the global community to our work. They provide unprecedented opportunities for effective action through partnerships.

We are working more closely than ever before with other specialized agencies, non-health sectors of government, nongovernmental and professional organizations, and other national and international bodies. Much of what we have to do would be impossible without combining our strengths in this way. The same is true for those who work with us, whether to develop new vaccines, fight particular diseases, collect and analyse information, or just put their money to the best use possible.

Research and teaching institutions such as the London School are obviously of vital importance for our work, and we have been natural partners since the earliest days. We will look at some of our common research priorities during the round table discussion later today.

I would also like to mention a new training programme we are currently developing in WHO, called the Health Leadership Service. This is one of several initiatives designed to help overcome the critical shortage of health personnel in many developing countries. The HLS is a two-year programme of formal training and supervised work for young professionals, which will create cadres of dynamic health professionals with sound technical and managerial skills. These will be the global health leaders of the future.

WHO is a global organization, but it exists to serve countries. It is there we must get results. To do this, countries need strong national health systems. All of our disease control activities need to be designed and carried out in ways that contribute to building up those health systems. Good information technology can make a very important contribution, as can good facilities, sound financing mechanisms and adequate medical supplies.

Eventually, though, it requires well-trained staff who can inspire and help others to do the best work possible. This is where you, as students, teachers and researchers at the London School of Hygiene, can make a vitally important contribution to our current initiatives. You represent dozens of countries. Your minds are sharp. I know you will keep them tuned to the very best work possible in global public health. Thank you, in advance, for all the support I am sure you will be giving us. The London School was one of the first WHO collaborating centres, and the partnership between these two great institutions has produced many significant developments in global health over the years. I look forward to further developing and strengthening this partnership in the future, as together we strive for justice and security in global health.

Thank you.