Regional Committee for the Western Pacific, fifty-sixth session

Noumea, New Caledonia
19 September 2005

Madame Chairperson, Honourable Ministers, Distinguished Representatives, Colleagues, Dr Omi, Regional Director,

I have come here from the General Assembly in New York. At that meeting I said that there will be a human influenza pandemic. The only condition missing is a virus that is capable of rapid transmission among humans.

That virus will probably emerge in one of the countries that have avian flu infection in their bird populations. H5N1 virus is now entrenched in several parts of Asia, and is moving further afield.

The political, social and economic costs of a pandemic will be huge. No government or head of state can afford to be caught off guard.

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. Please remember that less than 1000 people died during the SARS outbreak. But the social and economic costs were enormous.

Humans have had no opportunity to develop a natural immunity. Our defences rely on what we can plan and do now.

You have already contributed enormously to the construction of these defences. Huge sacrifices have been made by small farmers in culling their poultry flocks. These people were under-compensated, sometimes they were not compensated at all. Yet theirs is the single biggest contribution made so far to the prevention of a human flu pandemic. The successes in controlling outbreaks among poultry in Hong Kong, Japan, and the Republic of Korea have provided critical lessons.

The outbreaks will be difficult to detect and control in rural backyard flocks. This is where the greatest risk of human infection lies. Yet the poultry industry is an important source of income and it will not be easy to ensure compliance or provide appropriate compensation. Good communication with the sector is vital.

The International Partnership on Avian and Pandemic Influenza launched in New York on the 15th of September recognized the importance of international cooperation. Partnership among countries and among the private sector and international community is essential. We all have different resources and talents. We must be open in sharing information and expertise.

We have recently been glad to welcome the valuable contribution of Chinese scientists to the WHO Expert Panel on Streptococcus suis.

Every country must have a national pandemic control plan. Every country must also inform its people.

Countries in this Region have shown strong leadership and the ability to respond quickly, in a coordinated way. The high level of vigilance you successfully maintain against the re-introduction of polio, will also help to protect us against the advent of a human flu pandemic

International agreements and accords are a necessary part of public health. However, they can seem far removed from ordinary daily reality.

Let us look at an individual's story. Bounlid is 27-years old. She lives in the Lao People's Democratic Republic. She is one of the women whose experience was described at the launch of the World Health Report this year

In this photo she is five months pregnant with her fifth child, and still working hard. She will deliver at home, with no skilled attendant. She did have a village birth attendant at her other deliveries, but says that the health clinic is too expensive. Only one out of five births in Laos is attended by a skilled birth attendant.

Bounlid hopes that everything will be fine, as there would only be a tractor to take her if needed. In her country, maternal deaths are estimated to be among the highest in the world. One in 25 women dies in pregnancy or childbirth.

With the help of her husband Nga, Bounlid gives birth to a baby girl. This is "Lang" who weighs about 1.8 kilos. Nga has cut the umbilical cord with a bamboo sliver and rinsed the floor with a bucket of water. In Lang's first week, mobile vaccinators visited to immunize her. In Laos, one in 11 children dies before the age of five. Bounlid's second daughter died at six weeks.

So far, this is mostly a positive story for Bounlid and her family. But Bounlid is exhausted and earns barely enough to survive. She won't visit the health clinic, nor has she been visited by a health worker. She would like to stop having children, but she doesn't know how. It is too expensive for her to pay for health care.

In many developing countries, the poor can be faced with a terrible choice when a member of their family falls ill or delivers a baby. Treatment can result in catastrophic debt, while lack of treatment can be fatal. As a result, even if the health services are there, many people do not use them.

These are the people for whom the principles of health for all were invented. We need to do everything we can to reduce financial barriers to health care. Keep that in mind as you consider the large-scale plans of public health.

The "3 by 5" initiative has made a start in changing the mind set that access to drugs is only for those who can afford it. The G8 recently 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". Access for everyone to the treatment they need is now recognized as absolutely necessary for people who live with HIV, and entirely feasible.

Antiretroviral drug prices are falling as more products become available and the market expands. 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, we also encourage testing. This is especially important to avert the continued spread of HIV infection among injecting drug users, especially in China and Viet Nam, and among sex workers, especially in Cambodia. Treatment and prevention go hand in hand, each supporting the other's ability to save lives.

It is an uncomfortable truth that many of the factors that are influencing health outcomes are not under our control. These concerns underlie our strategic planning for the next 10 years. The draft general programme of work proposes a wider frame of reference through constructive and purposeful relationships with those outside the health sector.

The Framework Convention on Tobacco Control is a positive example of how we can gather international consensus and work collectively on solutions. Fiji was the third country in the world, and the first developing country to ratify. 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 become Parties to do so, and thank those who have.

I look forward to the valuable contribution you will make from your experience. I sincerely thank all of you here for the valuable support you have shown for the work of WHO.

Thank you.