Address at the opening session of the Thirtieth TDR Joint Coordinating Board
Dr Margaret Chan
Director-General of the World Health Organization
Mr Chairman, honourable ministers, friends and colleagues,
I was together with many of you last year in Accra. Let me extend my gratitude to the Minister of Health of Ghana for the excellent arrangements and warm hospitality we all enjoyed.
Let me recognize a founding father, Dr Mahler, who is with us today. I also want to honour the presence of two of the Programme’s three previous directors, Dr Lucas and Dr Morel.
Indeed, this is a continuity of leadership that stretches back to the inception of TDR.
I want to acknowledge the strong representation of health officials from disease endemic countries. Your leadership has always been a part of the very fabric of TDR programmes and governance.
This leadership role will no doubt increase in the future.
I thank TDR’s partners, many of whom are present, for their technical and financial support over the years.
One of the strengths of this Programme is its ability to draw support from a diversity of partners and well-developed research networks.
Ladies and gentlemen,
This is indeed a very distinguished gathering.
We are about to launch a new vision and strategy for TDR. This is a far-sighted plan, covering the next ten years. I believe the ambitions it has set for TDR address some of the most pressing needs in public health today.
Since its inception, TDR has always been concerned with the neglected needs of neglected populations. It has always brought the power of rigorous scientific investigation to bear on the infectious diseases of the poor.
The many lasting achievements are set out in a new publication, which commemorates this anniversary event.
I find it particularly striking that five TDR diseases are now targeted for elimination, largely as a result of tools and strategies developed through TDR-coordinated activities.
Over the past 30 years, TDR has consistently demonstrated its flexibility. Based as it is on science, the Programme has adapted in line with evidence of the changing epidemiology of diseases.
With its new strategy, TDR is also adapting to the changing landscape of public health research. In just the last few years, this landscape has changed enormously.
In my address to the Health Assembly last month, I described the complexities of the public health landscape and the challenges they present for WHO and its many partners.
On the positive side, health has never before enjoyed such a high profile on the development agenda. As clearly stated in the new strategy, control of infectious diseases is a prerequisite for poverty alleviation and the achievement of the Millennium Development Goals.
Unprecedented commitment has been accompanied by a surge of new initiatives and innovative funding mechanisms, and a rapid growth of public-private partnerships.
These partnerships include new models for conducting R&D for product development. As we know, some of these models were nurtured in TDR.
While these are certainly welcome trends, they have also introduced some problems.
The field is crowded. There are more actors in health than in any other sector.
Roles and responsibilities are blurred, as are lines of accountability. Who is in charge – countries or donors?
We have seen a burst of interest, and a burst of activity. We have seen an increase in initiatives and an increase in funds. But what is the impact on health outcomes? Are we closing the gaps, especially among the poor?
As we all know: enthusiasm dissipates very quickly in the absence of results.
Here is the catch: if we want better health to work as a poverty-reduction strategy, we must reach the poor. This is the acid test, and this is where we are failing.
The poor are traditionally the hardest group to reach. They tend to live in remote rural areas or urban shantytowns that are beyond the reach of the formal health system.
Nor is health care from the private sector the right answer when the target group is the poor. The cost of health care should not be allowed to drive poor people even deeper into poverty.
Unless we make some radical changes in the way we deliver services to the poor, we will not achieve our international commitments.
We know the lessons from decades of experience: build national capacity, and promote local ownership and community engagement. We need to make local priorities, local conditions, and the local expertise of scientists our point of departure.
We know that demand-led initiatives have the greatest chance of sustainable success.
We know that the great promise of new products is not always realized in the real-life situation of endemic countries.
As I have said on a previous occasion, now is the time for us to focus on the hardest tasks. All the donated drugs in the world will have no impact in the absence of systems for their delivery.
The huge investment in product development is jeopardized when implementation fails. Interventions that work well in affluent countries may be inappropriate and largely ineffective in other settings.
This is especially true where resources are constrained and people suffer from multiple infectious diseases.
Improvements for just one of these diseases will not be enough to lift people out of poverty.
If I had to give you a short summary of the main concerns expressed during last month’s Health Assembly, I could do so with two words: interventions and implementation.
As so firmly acknowledged in the new strategy, health leaders in endemic countries know best what they need most. And they know what works in their countries.
They want existing interventions to be affordable and accessible. They know, too, that we will not see breakthrough progress for some diseases of the poor until we have better tools.
And these tools must perform well in real-life situations.
It is good to see that TDR will continue to engage in product development for the most neglected diseases, like the helminths, that are not being addressed by others.
Countries also want support for implementation. Many of the huge gaps in health outcomes arise from implementation failure.
We are not getting existing interventions to those who need them.
As just one example, most of the yearly 10.5 million childhood deaths could have been prevented through existing, effective, and affordable measures.
Let us take another obvious example: malaria. We have effective interventions and we have proven strategies, but we are not making progress.
We are not able to implement what we have in hand.
Ladies and gentlemen,
The new directions for TDR will increase our ability to attack, on multiple fronts, some very long-standing and seemingly intractable problems.
I mean here our ability to reduce the huge gaps in health outcomes.
Our ability to scale up show-case pilot projects to reach large populations. Our ability to improve access to existing interventions or reach the poor on an adequate scale.
I also mean our ability to address multiple health needs in a cost-effective, integrated way.
All of you will know that the points I am stressing pertain to elements in the new vision and strategy.
The new ambitions fixed for this Programme greatly expand the portfolio of strategies being pursued in our collective efforts to improve health and alleviate poverty.
They help round out the picture. We are closing in.
The new vision and strategy give TDR a more strategic role, and allow a more holistic approach. These are very welcome attributes in the complex landscape of public health.
We greatly need coordination, cohesion, and coherence. We need stewardship for an effective global effort. And we need to enable endemic countries to take a leadership role in this effort.
In line with the strategy, I believe we must build on what exists, but not by doing the same old things in the same old ways. I am personally very glad to see TDR move into new territory.
These are the hard tasks, but it is absolutely vital that they be addressed.
We must be smart in the way we respond to increased commitment and resources. I welcome the initial focus on community-based interventions and strategies.
Since inadequate delivery systems are a key bottleneck, it is smart to deliver packages of interventions, and to use established systems to do so. It is smart to build on what works well in difficult situations.
TDR is doing this with APOC, which is reaching 60 million people. Integrated delivery of multiple interventions is a value-added approach that brings multiple benefits for health.
But we need an evidence-based understanding of which combination of tasks can be effectively integrated, and of how community empowerment can be sustained.
If we want initiatives to be demand-led, we must pick the right entry point. TDR is doing this with malaria.
It is smart to integrate the clinical management of people co-infected with diseases long addressed by single initiatives.
TDR is gathering evidence for a treatment policy for TB and HIV co-infection, focusing on national control programmes at the primary care level.
These are just some of the “hot topics” set out in the new strategy.
I warmly welcome the major new emphasis being given to implementation research, especially for large-scale disease control.
TDR will be looking for innovative ways of getting new and existing interventions to populations who have poor geographical or economic access to services.
TDR will also be strengthening its traditional work on training and capacity building. Capacity is the key to self-sufficiency and sustainability.
One unfortunate consequence of the surge of international interest in health is this: scientists in disease endemic countries are being left behind in global research planning and priority setting. We must not allow this to happen.
Technology transfer is one solution. But actually engaging scientists in endemic countries in product development is likely to bring the most rewarding results for all concerned.
Finally, I welcome the new business line model for streamlining administrative procedures. This business plan is another solid backbone of support for TDR’s future.
Ladies and gentlemen,
The strategy calls on TDR to strengthen its strategic links with co-sponsoring agencies, and most especially with WHO. I warmly welcome this move.
TDR’s experience and expertise make a vital contribution as WHO develops its health research strategy and supports the Intergovernmental Working Group on Public Health, Innovation and Intellectual Property.
The tasks mapped out for TDR over the coming years are not easy, but they are absolutely vital to our goals and our prospects for long-term success.
These new functions, if performed well, will greatly increase our chances of making life better for the world’s huge population of neglected people with neglected health needs.
I wish you every success.