Bio Vision - The World Life Sciences Forum
Fellow panellists, ladies and gentlemen,
I congratulate Bernard Kouchner on his exciting presentation. I would also like to thank the organizers of BioVision for providing us with this opportunity to shed new light on today's health needs and possibilities. With Dr Kouchner's vision and Sir Tom's practicality, who knows what we might achieve?
But first you have to listen to my remarks. I hope they will provide a kind of bridge between the two. My aim is just to give you some idea of how the prospects for health for all look now, from the point of view of the World Health Organization.
In the twentieth century, science gave us the power to prevent or cure most of the infections that kill children and young adults. It was an extraordinary achievement. Our concern now in the twenty-first century is to make sure we can keep and increase this wonderful new capacity. That can only be done by realizing its potential to promote well-being in all parts of the world, for all people, not just some of them.
As the founders of WHO put it in 1946: "Unequal development in different countries in the promotion of health and control of disease… is a common danger." The truth of that statement is even easier to see now, with the increased interdependence of countries and today's volume and speed of travel.
The theme of World Health Day last week was maternal, newborn and child health. The occasion was a kind of celebration of possibility, but it was also a painful reminder of difficulties and failures. More than 10 million children die every year before reaching the age of five, and more than half a million women die from pregnancy and giving birth. Two thirds of those deaths are preventable by simple and well-known health measures.
Unfortunately, that is only a part of the challenge. We are also well aware that 5 million adults die every year from inhaling the smoke of a harmful and unnecessary product; that nearly 3 million people die of AIDS every year because they have no access to the treatment which could restore them to health; that tuberculosis and malaria together continue to kill nearly 3 million people a year although the technical means of prevention and treatment are well known; and that there are still some places in the world where children are exposed to lifelong paralysis or death from polio, although the technology for eradicating this disease has been in our hands since 1954.
When world leaders put aside their differences in 1978 to endorse the Declaration of Alma-Ata, they were beginning to come to terms with reality. "Health for all", as the declaration came to be called, was not just an aspiration but a fact of life. It was now technically possible to meet everybody's need for effective health services, thanks to a large extent to modern science and industry. Those with access to such services could reasonably expect to live a full and disability-free lifespan.
This revolutionary possibility had become so self-evident by the 1970s that the health community of that time set a deadline for achieving it. They chose 'the year 2000'.
Now, five years beyond that imaginary turning-point, we still have the kind of mortality statistics I have mentioned.
One reaction is to say that this is consistent with the second law of thermodynamics, and that things have to go wrong in our world. Another is to try and ignore the obstacles, and believe that health will go on getting better and better for more and more people for ever. These passive reactions — fatalistic and optimistic alike — are equally blind, and can have equally disastrous consequences.
In 2003, fortunately, the reaction to the threat of SARS was entirely different. People were wide awake and working around the clock to control the outbreak. Not only health workers but scientists, government and nongovernmental organizations, and business people combined their efforts with an extraordinary display of strength and talent.
SARS, unknown till 2003, travelled to 30 countries in the space of four months, infecting over 8000 people, and killing over 800 of them. The outbreak ended quickly, almost certainly because of the decisive action taken worldwide by so many people who recognized the need for it.
Partly as a result of that experience, the health authorities in most countries are well aware of the current danger of a global pandemic of avian influenza, and are making every effort to be prepared for it.
Apparently if you put a frog in hot water it will jump out, but if you gradually heat the water it will not know what to do. It cannot summon the necessary energy to prevent itself from being boiled alive. Human beings may have a similar natural capacity to respond to a sudden danger and find it much harder to decide what to do about those that approach more slowly. Our well-being depends both on being prepared for new threats and on recognizing the existing ones that are growing and are equally in need of decisive action.
Among the more gradual kind are the infectious diseases I have mentioned, as well as steadily increasing mortality from cardiovascular diseases and cancers. In addition, there is the development of antimicrobial resistance, which increases over a number of years. Unless concerted action is taken, there is a risk of returning to the pre-antibiotic era, in which common infections could not be stopped. There are relatively few new drugs in the pipeline to replace those which lose their effectiveness. I am sure Tom McKillop will have more to say about this particular threat.
In short, constant vigilance and ever-renewed vitality in research are needed if we are to keep the advantages our own generation and that of our parents won for health in the twentieth century.
I will mention briefly six current activities of WHO that are aimed at catalysing and supporting the kind of security and improved prospects for health that are needed everywhere in the world today.
- The Commission on Intellectual Property Rights, Innovation and Public Health is working with all stakeholders to define common needs and propose the way forward. It will be reporting to the World Health Assembly in May 2006.
- The WHO and UNAIDS initiative to make antiretroviral treatment available to three million people by the end of this year is gaining momentum. It is based on the premise that universal access to treatment and prevention services is an absolute moral and practical necessity.
- The Commission on Social Determinants of Health, which we launched with President Lagos in Chile last month, is generating new research and action on how to strengthen health systems. It will complete its work in 2008. That will be 30 years after the Alma-Ata Declaration, and 60 years after WHO came into existence. Our hope is that it will produce a third such moment of clarity and a call to action.
- The Global Outbreak Alert and Response Network makes an essential contribution to the worldwide surveillance system we have been building since 2001. One of its key centres is right here in Lyon. It provides technical support to countries to improve their laboratories and early warning systems so that they can rapidly analyse emerging microbial threats and define the measures for controlling them.
- The Framework Convention on Tobacco Control entered into force on 27 February and now has 61 States Parties. It provides us with an inspiring example of how persistent negotiation can result in wise choices in spite of many obstacles and counter-pressures. There were people at every stage of the discussions who predicted that they would fail. We were extremely happy to prove them wrong.
- Finally, the revision of the International Health Regulations is currently under negotiation by our 192 Member States. They should be adopted by the World Health Assembly next month. The Strategic Health Operations Centre, opened last year in Geneva, provides the information and communication technology needed for putting the Regulations into practice and coordinating the response to emergencies.
WHO is involved in many other global and local initiatives. I mentioned these six just to give you an idea of some of the things that are going on, and to provide some possible parameters for your thinking on how to achieve health for all.
All of our major activities combine the efforts of many organizations and individuals. In that way they reflect the spirit of the BioVision conference. No one sector or organization can solve today’s health problems. But by combining our resources and talents we can find the solutions that will meet the health needs of today and tomorrow. We know from experience that this is so. It will continue to be so insofar as we recognize the needs and obligations, and act on them.