Director-General

Regional Committee for the Americas, fifty-seventh session

Washington D.C., USA
27 September 2005

Madam President, Honourable Ministers, Distinguished Representatives, Dr Roses, Regional Director, Colleagues,

Exactly one year ago, I expressed my condolences for those lost or struggling to survive the hurricanes in the countries of the Caribbean and in Florida. Again, I extend my sincere sympathies to those whose families, homes and livelihoods have been affected by the recent natural disasters.

Exactly two weeks ago, I was part of a summit of ASEAN Heads of State in the United Nations in New York. I said there very bluntly that there will be another human influenza pandemic. I warned that no Government, Head of State, or Minister of Health can afford to be caught off guard. There is a storm brewing that will test us all. We must anticipate it and prepare to the very best of our combined ability.

Good preparation means using reliable and timely information. It means the maximum possible use of proven medical resources, and strategic action. Perhaps most important of all, it means creating and working through partnership. Our joint skills can and must reinforce our efforts.

Humans will have had no chance to develop a natural immunity to a new flu virus. We therefore need excellent early warning systems. That means systems capable of detecting human-to-human transmission at the earliest stage possible.

Antiviral medication will help to limit spread of new human-to-human infection if we can quickly get it to the source. Quarantine measures will help to stop further transmission if we can rapidly isolate cases and contacts. The WHO guidelines recently sent to you all set out the phased steps that need to be taken to prepare.

The political, social and economic cost of such a pandemic will be huge. I cannot emphasize this enough. Failure to take this threat seriously and prepare appropriately will have catastrophic consequences.

Flu pandemics in the past have been lethal on a massive scale. There were between 20 and 50 million deaths in the 1918 flu pandemic. In the pandemics of the 1950s and 1960s, 5 million people died. Those were considered relatively mild pandemics. SARS showed us how vulnerable our closely interconnected world has become. Fewer than 1000 people died during the SARS outbreak. But the social and economic costs were enormous. Just imagine if we have another "mild" flu epidemic in which 5 million people die.

We don't know exactly when the next flu pandemic will strike, but all the signs are that it is coming. The only condition missing is the emergence of a changed H5N1 virus that is able to spread easily among humans.

The viruses that caused the human flu pandemics of 1957 and 1968 originated when avian flu viruses combined with human viruses. Many scientists believe that the virus responsible for the deadly 1918 pandemic was a purely avian virus that gradually adapted to humans. It is also likely that the next flu pandemic will emerge from one of the countries that has avian flu infection in its bird populations. Highly pathogenic H5N1 virus is now entrenched in many parts of Asia, and is moving further afield, to Kazakhstan and the Russian Federation.

The human cases of avian flu that have occurred so far are where the virus is widespread, where there is close personal contact with poultry, and where farming practices are not hygienic. This is the situation in several countries already.

These countries will need international political and financial support to take the drastic steps needed, such as to cull and compensate. Poor farmers will need incentives to sacrifice their means of livelihood.

President Bush recently launched The International Partnership on Avian and Pandemic Influenza at the United Nations General Assembly. This initiative needs full international cooperation if it is to fulfil its aims. I ask you all to sign up and to give it your active support. At the end of October I will be attending an international meeting in Canada which aims to advance global cooperation.

Good communication with the agriculture sector is vital to establish reliable surveillance and reporting.

This is a critical moment for you, the health leaders of the Western Hemisphere, to interact decisively with your counterparts in agriculture, finance, education and industry, to share information and plan strategically. Your ability to do this will be vital.

Every country must have a national pandemic control plan. Every country must also have a communications strategy. It should be able to inform the public about the pandemic, what is happening and what to do. It is not enough to have resources available. They must be appropriate and deliverable. Two weeks ago, at the Millennium Summit in New York, I said this: at our current rate of progress, the Millennium Development Goals health goals on child health, maternal mortality, HIV/AIDS, tuberculosis and malaria will not be met in the poorest countries.

We need focused, short-term goals to generate intense action. How is this to be achieved?

The call to provide antiretroviral treatment to 3 million people living with HIV/AIDS by 2005 provides an example of this sort of short-term goal. It made a start in changing the global mind set that access to drugs is only for those who can afford it. In July the G8 group of countries set the target of getting "as close as possible to universal access to treatment for all those who need it by 2010". This was followed by the United Nations General Assembly's commitment to ensure, inter alia, that "…enhanced access to affordable medicines …are provided universally by 2010". The International Financing Facility for Immunization was recently launched in London by Chancellor Gordon Brown. This is another initiative to provide funding to support achievement of the MDGs.

Member States in this Region have taken a lead in ensuring that "3 by 5" became a viable goal, notably though Canadian support, the President's Emergency Plan for AIDS Relief, and the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

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. Half of those infected here in the Region are aged between 15-24 years. Treatment and prevention go hand in hand, each supporting the other's ability to save lives. Brazil has made an important step forward, offering ARV therapy through the public sector to all its people in need of treatment.

We already have the curative and preventive technology to address much of the global burden of disease. But countries do not have the systems to deliver them. The development of fully functioning and equitable health systems is the only way to achieve lasting progress in health. Countries need to identify fair and sustainable financing for health systems and make them affordable to the poor - who need them most.

If the world is to meet the goals of reducing maternal and under-five mortality by 2015, only a focused, coordinated effort can bring women, children and newborn infants the care they need. The aim of the Maternal, Child and Newborn Health Partnership, launched in New York two weeks ago, is to make sure that happens.

The adoption of the International Health Regulations 2005 by the World Health Assembly this year was a historic step towards building better health security and improving global coordination. These frameworks set up the structures for collaboration and communication. These will be essential elements in a more prepared world.

Strategic planning exercises, like the development of the next 10 years' general programme of work, aim to redefine the agenda and articulate the new role for health. Many of the factors that are significantly influencing health outcomes are not under our control. Social, economic, environmental or political issues, such as poverty, education, intellectual property rights and trade agreements play a central part in those health outcomes. It will be increasingly important to reflect a multisectoral approach in all our efforts.

We set the highest professional standards for our work. Member States expect us to be efficient and fully accountable. We have an obligation to manage the resources entrusted to us with the greatest integrity and transparency. This is especially important when the level of resources being allocated to countries and regions is being so substantially increased. These are the fundamental bases on which we build our credibility as leaders in public health.

As you consider all these issues this week, I invite you to articulate the implications of this knowledge for WHO's role in world health. Our range of responsibilities is changing. As a secretariat we need to know what our Member States expect of us, and shape ourselves accordingly. As the whole organization, we need to agree on the perspectives for the future.

I value your thoughts on this very highly. I thank you for bringing your experience to this Regional Committee.

Thank you.

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