Director-General

Regional Committee for the Eastern Mediterranean, fifty-second session

Cairo, Egypt
24 September 2005

Your Royal Highnesses, Madam Chairperson, Honourable Ministers, Distinguished Representatives, Dr Gezairy, Regional Director Colleagues,

In these last few weeks, as I have talked to the Regional Committees for Africa, South-East Asia, Europe, and the Western Pacific, and to world leaders at the General Assembly in New York, I have stressed the absolute necessity to be alert and prepared against the destabilizing and destructive effects of uncontrolled epidemics.

Every government, everywhere, should be certain that it has done all it can to protect itself and its peoples.

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, so that our combined skills reinforce our efforts.

The recent outbreaks of polio show how failures in immunization programmes in one country can allow poliovirus transmission to re-establish elsewhere. We are all vulnerable to the actions of others. Our global polio eradication effort is only as successful as its least effective programme.

Your reaction to re-infection with poliovirus in the Region was immediate and effective. In most places you were able to respond within four weeks. This rapid reply is essential for containment. You have done it in rich and poor countries, from Sudan and Saudi Arabia to Yemen and Somalia.

At the same time you are making steady progress in Afghanistan, Egypt, and Pakistan. Groundbreaking work is being done here in the use of monovalent oral polio vaccine. You have found ways to solve the challenges of poor data. And you have spoken as one voice to encourage others to re-start mass immunization and so strengthen the overall chain of eradication.

These are all vital strengths. They are needed in the current struggle against the infectious diseases which already have a firm hold here, as well as against the group of chronic diseases which are rapidly increasing their toll.

They are also strengths that you must use to prepare for the next human influenza pandemic.

We cannot predict when this will happen, but history tells us clearly to expect it. The only condition missing is the emergence of a virus that is able to spread easily among humans.

That crucial and deadly development is likely to occur in one of the countries that has avian flu infection in its bird populations. Highly pathogenic H5N1 virus is now entrenched in several parts of Asia, and is moving further afield, to Kazakhstan and the Russian Federation.

Good communication with the agriculture sector is vital to establish reliable surveillance and reporting. The Food and Agriculture Organization is already working with the Office of International Epizooties (OIE) and in collaboration with WHO to achieve the necessary coordination and agreed procedures.

This is a critical moment for you, the health leaders in your countries, to interact decisively with your counterparts in agriculture, finance, education and industry, to share information and plan strategically.

Humans will have had no chance to develop a natural immunity to this kind of new virus. We need early warning systems. We must have systems capable of detecting clusters of cases, closely related in time and place, so as to identify human-to-human transmission at the earliest stage possible.

Antiviral medication will help to limit spread 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 before they infect a wider population. The guidelines recently sent to you all set out the phased steps that need to be taken to prepare.

What is the expected political, social and economic cost of such a pandemic? It will be huge.

No government, head of state or minister of health can afford to be caught off guard.

I cannot emphasize this enough. Failure to take this threat seriously 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 mild pandemics. SARS, the first new disease of the twenty-first century, 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.

Every country must have a national pandemic control plan. Every country must also have a communications strategy and be ready and able to inform the public about what is happening and what to do. Above all, the public must know what is a pandemic and what is not. The recently announced International Partnership on Avian and Pandemic Influenza recognized the importance of international cooperation. Massive international collaboration is needed now on the advance preparation of global antiviral stockpiles and pandemic vaccine development. Action is needed on issues like compensation to farmers whose flocks have been culled. 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.

You have been successful and innovative in protecting your peoples against polio. But the problems you are experiencing in controlling HIV are indicative of gaps in your preparedness for other pandemics.

Several countries here are in post-conflict or emergency situations and face problems in providing even the most basic health care. Many countries need to improve their survey data. Difficulties exist in raising awareness of the problem, especially where prevention programmes have to target vulnerable groups.

All of these areas would be critical weaknesses in the event of a flu pandemic. Data gathering, communications, and distribution of medical aid will be central features of a successful response.

I hope that the proposed WHO Strategy for strengthening the health sector response to HIV/AIDS and sexually transmitted infections will really perform its wider role. It must look well beyond infectious disease, to health system strengthening. We must rapidly evolve the levels of communication and coordination that we will need, and ensure equity of access to life-saving vaccines or medicines.

Universal access is a central goal in our efforts to combat disease. The "3 by 5" initiative has 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 set 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". This was followed by the General Assembly's commitment to ensure, inter alia, that…enhanced access to affordable medicines …are provided universally by 2010". Access for everyone to the treatment they need is now recognized as entirely feasible for people who live with HIV, if everyone plays their part.

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. Social, environmental, economic, and political issues, such as poverty, education, intellectual property rights and trade agreements play a complex 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 difficult one. It is, nonetheless, essential to build an agreed role for public health that reflects this understanding. Your discussion later on the draft general programme of work will make an important contribution to this.

The current speeding growth in chronic diseases worldwide illustrates the importance of implementing the strategies that we know will reduce the disease burden and death rate. New projections estimate that deaths due to chronic diseases will increase by 25% in this Region over the next 10 years. In that decade diabetes-related deaths are projected to increase by more than 50%.

Next month, we will launch a new report: Preventing chronic diseases: a vital investment, which presents the latest scientific information and makes the case for urgent action.

Here is the story of one woman who has been living with diabetes since she was 45. But she didn't know it.

Zahida Bibi is from Pakistan. The first time she consulted a doctor about her symptoms, she was wrongly told that her condition was entirely normal. For eight years, Zahida lived with her worsening condition. Finally, once she had moved to Islamabad, she had a second blood test which confirmed her diabetes. With insulin, she started to feel better. But an ulcer developed on one foot. She didn't seek treatment and her leg had to be amputated. The local hospital should have recognized her raised blood sugar. Zahida herself should have sought help for her leg. Like other chronic diseases, type 2 diabetes can be prevented. So can many of the complications which can lead to amputation.

This story tells us that even where there are health services, they may not work properly. This is especially so in countries undergoing emergencies. People may not use health clinics through inability to pay the charges, or through lack of knowledge. The poor can be faced with a terrible choice: to pay for treatment and face catastrophic debt, or to neglect their health and face disability or death.

More than three quarters of diabetes-related deaths occur in low and middle income countries. Zahida's story is being repeated over and over again among the people who can least afford to lose their mobility or their health. These are the people for whom the principles of health for all were invented. We need to do everything in our power to reduce financial barriers to health and to continue to improve access and coverage.

As leaders in health you can make sure that the knowledge of how to prevent chronic disease is used. The Global Strategy on Diet, Physical Activity and Health has the express purpose of improving health through minimizing exposure to the risk factors that cause chronic disease.

Please remember Zahida, and the millions like her, as you consider the large-scale plans of public health this week and prepare to implement them.

The Framework Convention on Tobacco Control is a positive example of how we can gather international consensus on damaging health behaviours, and work collectively on solutions. I thank all of you here who have already ratified. In February 2006, the first meeting of the Conference of the Parties to the FCTC will be held. I urge all of you who have not yet signed, or ratified, to do so.

The adoption of the International Health Regulations 2005 by the World Health Assembly this year was also a historic step towards improving global coordination. These frameworks set up the structures and the expectations for better collaboration and communication.

It is you, here in this room, who have the power to bring paper agreements to life. You can each make an important difference to health through your leadership.

The challenges are clearly there before us. I wish you well in your discussion of them this week.

Thank you.

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