Director-General

Regional Committee for South-East Asia, fifty-eighth session

Colombo, Sri Lanka
6 September 2005

Mr Chairman, Honourable Ministers, Distinguished representatives, Colleagues,

It is good to be back here in Sri Lanka. Eight months ago (4-8 January) I was in Kalmunai and Galle in Sri Lanka, and Aceh in Sumatra; critical arenas of the Tsunami crisis. You have achieved so much in this short time. Those scenes of devastation and distress - broadcast worldwide - have changed. You have moved from disaster to reconstruction. There is still much more to do, but essential progress has been made.

The key legacy of the Tsunami for the public health of the Region is the importance of strengthening health systems to be capable of detecting and dealing with disease at a very early stage. This is a lesson that must be taken very seriously. we saw on television in the United States, there are other emergencies waiting to happen. You have to be prepared to cope with them. We will give you our full support to do this.

We are closer to a pandemic of flu than at any time since 1968. It is not a question of whether the pandemic will come, but when it will come. In this Region, avian flu virus is already firmly entrenched in poultry in parts of Indonesia and Thailand. It is also known to be present in many parts of Viet Nam, some areas of Cambodia, China, and possibly Laos. In late July this year the virus was carried beyond Asia, being also found in Russia and Kazakhstan

The known bird reservoirs have been decisively handled. Over 140 million birds have been culled. This was an essential contribution to control pandemic flu by poor farmers. This sacrifice is very much appreciated, especially because those who lost their livelihood had little or no financial compensation. This needs consideration in future. Further culls may well affect a multitude of small farmers who cannot afford to lose their flocks and may need an incentive to comply. The associated economic losses from the first cull are estimated at between 9.7 and 14.6 billion dollars. It is impossible to know or to guess how much higher the cost of inaction would have been. Based on this, the culling was justified.

Inaction is not an option now. We know that influenza is coming. We must prepare for it now.

So far, a total of 112 human cases have been confirmed in four countries: Cambodia, Indonesia, Thailand and Viet Nam, with 57 fatalities. Fortunately, so far the virus has not crossed easily from birds to people, nor has it spread easily among humans. But the geographical range of the virus increases opportunities for human cases to occur. These in turn increase opportunities for the virus to become more contagious.

WHO has recently prepared guidelines to help countries prepare effectively for a pandemic. They have been sent to all Member States and copies are here for you today. The guidelines detail the strategic actions to take, in three phases. What we have to achieve now, in the pre-endemic phase, is the reduction of opportunities for human infection and a strengthening of the early warning system. This tactical response goes together with taking the best medical precautions available.

Rapid deployment of assets and resources contain outbreaks at an early stage. That means availability of health care workers, antiviral medicines like Tamiflu, vaccines against influenza, and quarantine or other measures. Scaled up vaccine production requires rapid technology transfer. We know that the demand far outstrips supply. We have therefore to find a way to avoid this bottleneck and expand vaccine manufacturing sites. Currently fewer than 10 countries have domestic vaccine companies engaged in work on a pandemic vaccine. Trained health workers are needed, to deal with the pandemic and educate the public in epidemic response. This may involve the need to create quarantine sites and close schools and other public places. We must also keep firmly in mind that the threat of a pandemic has political and social dimensions. Poorer countries will not be able to protect themselves as effectively as the wealthy.

In the past, developing countries have usually received vaccines after the pandemic has passed. This should not be the case this time.

Massive international cooperation is needed now to contribute towards global antiviral stockpiles and pandemic vaccine development. Decisive action is needed now by donors and international partners to help the countries affected to limit the scale of the bird flu outbreak and to reduce the risk for humans. Clearly, if we had known a year ago that the Tsunami was going to strike, we would have been prepared. This is another kind of tsunami, which we know will come. Now we have the time and the will to be prepared for it.

Turning to polio. In just four months India developed a monovalent oral polio vaccine type 1 and is using it with great success. There have been no further type 1 cases in India for two months. There is a real chance that transmission of indigenous virus can be stopped by the end of this year.

And it must be stopped. Conclusively.

Polio eradication is a priceless gift for the whole world. We must protect the progress we have made so far. Indonesia is doing this with its massive response to an imported poliovirus, vaccinating 24 million children across the country in just two days. These activities have an immediate local focus, but global implications for polio eradication. Previously there was some debate over whether it was wiser to focus resources on polio eradication single-mindedly or to use these resources more broadly for EPI, or building the infrastructure. Now, at this stage, our only option is to finish the job. The many lessons we have learnt can be applied in the future. At this point we must complete the polio eradication campaign.

The populations of Bangladesh and Nepal have been able to prevent reinfection by poliovirus. Sharp vigilance and efficient early warning systems allow for quick response. In some parts of the Region the surveillance networks already include other vaccine-preventable diseases including measles and neonatal tetanus. The people working in them are a vital workforce not just for polio but for all disease outbreaks.

While we must be able to cope with crises, the long-term work towards health for all is a measured, planned process. Our common vision for the next decade recognizes that health is influenced by a wide range of non-medical factors like poverty and education . Social, environmental, economic, and political issues, such as intellectual property rights and trade agreements play a part in health outcomes. Their consequences are clear in the accumulating burden of chronic disease and the continuing death toll from infectious diseases like HIV/AIDS, tuberculosis and malaria. However, the question of how to apportion responsibility for reducing or stopping their causes is a complex one. Your discussion later on the draft general programme of work will make an important contribution to this.

There are important equity issues we have to face boldly in looking at the resources needed to deal with a flu pandemic. Those issues, of making life-saving measures available to all, equally, are already pressing. Two years ago I talked to this Regional Committee about getting 3 million people onto antiretroviral treatment by the end of 2005 as a first step towards universal access. Many people thought that "3 by 5" was too ambitious. Good. We should set aggressive targets. But it was a lot to achieve in the timeframe. Reaching 3 million people will take a little longer than originally anticipated. But the principle of universal access remains a key objective.

Much has been achieved in a short space of time. Close to 1 million people were on antiretroviral treatment at the end of June in low and middle-income countries. Based on this progress, universal access is now increasingly recognized worldwide as a moral and social imperative, and as a practical necessity. The commitment made by Member States to increase access to treatment has become a movement which now cannot be turned back. This has inevitably led to the G8 recently setting an even more ambitious target. This was to get "as close as possible to universal access to treatment for all those who need it by 2010". Access for everyone to the treatment they need is now recognized as not only absolutely necessary for people who live with HIV, but entirely feasible.

Overall, antiretroviral drug prices are falling as more products become available and the market expands. WHO has already prequalified 63 antiretroviral drugs, including 29 generic formulations. The recent confidentiality agreement between WHO and the US Food and Drug Administration will further support the prequalification programme, speeding up the availability of lower-priced generic antiretroviral medication.

By making treatment more widely available, more people are now motivated to come forward for testing. This is especially important to avert the spread of HIV infection among young people in the Region. The availability of testing and counseling must be further expanded for the more-than 7 million people living with HIV in this Region. Treatment and prevention go hand in hand, each supporting the other's ability to save lives.

Over the years of the polio eradication effort, we have together made progress towards almost universal vaccine coverage in polio-endemic countries. Universal access is also a key to tuberculosis control. India and Indonesia have made major progress in the area of tuberculosis control. But this Region still has the highest burden of tuberculosis globally and there is much more to be done to reach the targets for 2005 and for the Millennium Development Goals. Indeed, if this Region does not meet its goals, the world will not, since one third of all cases are found here.

"Make every mother and child count" was the theme of this year's World Health Day. Here too, financial barriers to access need to be reduced and an effective workforce built.

Let's look at the story of one person Renu Sharma from Delhi. At the time this photograph was taken she was five months' pregnant with her third child and still working hard to look after the family's livestock and fields. She had not yet had her first antenatal checkup, although she is lucky in having a clinic just one km away. Almost half of all pregnant women in India never attend an antenatal clinic and in 2000, 136 000 Indian women died in childbirth. Four months later in hospital, Renu successfully delivered little Monica, who weighed 3kg. She was lucky to get one of the nine beds; there were 25 other women waiting. Yet less than half of deliveries in India are assisted by a skilled birth attendant. Within her first week of life, Monica has been vaccinated against polio, TB and hepatitis, substantially improving her chances of survival. In India, 33 out of every 1000 babies die in their first 7 days of life from preventable disease and one in 12 die before they reach the age of five.

These are the figures that we have to change. All the Monicas of this world must have the best possible chance of health - equally. We need to keep those individuals firmly in our minds as we consider the large-scale plans of public health.

The adoption of the International Health Regulations 2005 by the Health Assembly this year was a historic step towards building improved health security and improving global coordination. No effort must be spared to build the necessary mechanisms for disease detection, alert, response and information-sharing, both within countries and between them. Despite the many challenges for controlling infectious diseases, we cannot afford to ignore NCDs. Cancer and cardiovascular diseases are now the leading cause of death worldwide. The global report on preventing chronic disease, coming out in October, will stress the importance of taking steps now, in all developing countries, to curb the rise of cancer, cardiovascular disease, chronic respiratory disease and diabetes, among others.

I thank all of you whose countries have signed the Framework Convention on Tobacco Control and especially those nine countries that have ratified it in this Region. I urge the two countries that have not yet ratified to do so in order to become Parties to the Convention. In February 2006, the first meeting of the Conference of the Parties to the FCTC will be held.) The Convention is an excellent example of how international cooperation can provide strong support for national efforts to tackle the root causes of many cancers and heart disease.

There is great potential for progress here. The main problems are known, recognized, and are being tackled. There are tools on hand to deal effectively with disease epidemics. The decisions you will be making this week can speed up these positive trends, and bring equitable, life-saving interventions to the many people who count on your support.

I wish us all success in the important discussions of this week..

Thank you.

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