WHO Director-General addresses first meeting of BRICS health ministers

Dr Margaret Chan
Director-General of the World Health Organization

Remarks delivered at the first meeting of BRICS health ministers
Beijing, China

11 July 2011

Thank you, honourable ministers, for these reports on your contribution to better health, domestically, internationally and collectively through your collaboration on common problems with shared objectives.

In my view, the promotion of innovation and access to affordable, high-quality medical products is an ideal topic to launch this platform of ongoing dialogue.

I want to acknowledge your contributions to global health in this area with just a few personal comments.

I have personally visited the Oswaldo Cruz Foundation in Brazil and the country’s Immunobiological Technology Institute. I have personally seen Brazil’s world-class scientific contribution to innovation in public health, especially in the production of high-quality public health vaccines.

But Brazil is best known internationally for its ground-breaking policy on the provision of free antiretroviral therapy to people living with HIV/AIDS. This is an example of equitable access to essential care at its best.

As we all know, this was a difficult achievement, but a great one on the moral front: people should not be denied access to life-saving medicines for unfair reasons, including an inability to pay.

People have a right to health, as enshrined in the Constitutions of WHO and of Brazil. Brazil won for its citizens, but also for the entire community of people affected by HIV.

Collectively, BRICS countries have sizeable pharmaceutical, vaccine, and health technology industries. They are also home to major producers of active pharmaceutical ingredients. And many have a high volume of exports in these sectors, especially for generic medicines, in addition to producing medical products for domestic use.

India, with its concentration of talented scientists, is a true hot spot for pharmaceutical innovation and a leader in the production and exportation of low-cost medical products.

But let me single out the Serum Institute of India, which has been a major player in one of the best success stories in recent years: the launch last December of a new conjugate vaccine that has the power to prevent epidemics in Africa’s meningitis belt.

The project was coordinated by WHO and PATH, with core funding from the Bill and Melinda Gates Foundation.

It was launched in response to requests from African health leaders, who also stipulated the price they could afford: 50 cents a dose. As one health minister stated, a vaccine that is too expensive for a developing country is worse than no vaccine at all.

All the major vaccine manufactures were approached, but all declined because of the very low target price. The Serum Institute of India said yes.

A consortium of scientists developed a new method for making a conjugate vaccine and transferred this technology, at virtually no cost, to India.

BRICS countries want to see access to affordable medical products work as a lever for overall development. So let me give you just two facts about what preventing epidemics means for the 25 African countries in the meningitis belt.

A single case of meningitis can cost a household the equivalent of three to four months of income. Mounting an immunization campaign to control an epidemic can absorb as much as 5% of a nation’s entire health budget.

WHO and its partners are currently assessing the impact of the initial mass immunization campaigns, including their safety and efficacy. Early results suggest that even the most optimistic expectations have been surpassed.

India, all signs indicate that you have given Africa a very safe and effective new vaccine.

During the May World Health Assembly, I heard repeated calls from developing countries for assistance in strengthening R&D capacity and transferring the necessary technology and skills to build their own domestic manufacturing capacity.

Doing so is viewed as a route to more cost-effective medicines and greater self-reliance.

In this regard, I want to thank the Russian Federation for its recent transfer of technology to Thailand, under a WHO umbrella programme, to boost global influenza vaccine production capacity in the developing world. The plant will be operational as early as next year.

Especially relevant to today’s meeting is the April Moscow Declaration on healthy lifestyles and noncommunicable diseases. The Declaration is the outcome of the first global ministerial conference on this topic, organized by the Russian Federation.

Among its many statements and commitments, the Declaration calls for a move from disease-centred to people-centred approaches, and for population-wide preventive measures involving multiple sectors.

It calls for integrated solutions that work to strengthen health systems. And it stresses the need to facilitate the access of low- and middle-income countries to affordable, safe, effective and high-quality medicines.

Ladies and gentlemen,

I personally believe that BRICS countries will be the true proving ground that demonstrates the real impact of chronic diseases, not just on health, but also in terms of huge economic losses.

I further believe the economic costs of these diseases can become so great that they cancel out the so-called benefits of modernization and economic growth.

Initially associated with affluent societies, chronic diseases have certainly not been neglected by R&D and the pharmaceutical industry.

In wealthy nations, the health impact of chronic diseases has been masked by the identification of high-risk groups and early detection of disease. It has been masked by treatments ranging from drugs that lower cholesterol, manage hypertension, and deliver insulin, to bypass surgery, heart transplants, and sophisticated treatments for cancer.

Here is just one figure to illustrate the utter lack of similar capacity throughout the developing world. Some 30 developing countries, including 15 in Africa, do not possess even a single radiation therapy machine.

The tell-tale sign of bad trouble on the horizon is the skyrocketing prevalence of obesity, now seen in nearly every corner of the world. Obesity as a signal of unhealthy lifestyles cannot be masked, just as the high costs of care cannot be masked.

For example, January 2011 statistics from the USA indicate that detected cases of diabetes cost the country $174 billion a year, of which $116 billion goes for direct medical costs.

That is a huge pile of money for a largely preventable disease. Prevention is by far the better option, yet most risk factors for these diseases lie beyond the direct control of the health sector.

Many BRICS countries are wide-awake to the problem and are steaming ahead with solutions that will serve as models for the entire developing world.

In attempting to influence policies made in other sectors, it is good to have support from the recommendations of the Commission on Social Determinants of Health. But more is needed. I thank the government of Brazil for organizing a major conference in October to address these issues.

Ladies and gentlemen,

Much of sub-Saharan Africa’s clinical and epidemiological research capacity, regulatory expertise, and pharmaceutical production capacity is concentrated in South Africa.

This country has the largest economy on the continent, but also the largest population of HIV-infected individuals in the world.

South Africa has gone to battle with the pharmaceutical industry on the issue of access to antiretroviral therapies. In 2001, the South African government was taken to court by 29 multinational pharmaceutical companies.

The fact that South Africa won the legal battle was a huge moral victory in the broader fight to make life-saving drugs more affordable.

I particularly welcome the African network for drugs and diagnostics innovation, or ANDI, which is working to create a sustainable platform for R&D innovation in Africa. In doing so, it is taking forward the WHO Global Strategy and Plan of Action for Public Health, Innovation and Intellectual Property.

I should add that, in negotiating this and other recent global strategies, BRICS countries strongly demonstrated their negotiating power on the international stage and the firm principles that underlie this power.

Like India, China has lifted many millions of its vast population out of poverty. Most recently, the government has embarked on a massive reform of its health care system, giving priority to access to essential and affordable care in its large rural populations.

As in several BRICS countries, China has enormous scientific and institutional capacity to find innovative technical solutions to meet health care needs, at home and abroad.

In a major collaborative effort, Chinese authorities and WHO have worked together to upgrade the manufacturing practices for medical products in China to meet the highest international standards, set out in WHO’s Good Manufacturing Practices.

This effort resulted in WHO prequalification of Chinese regulatory authorities for vaccine production, giving Chinese manufacturers the “green light” needed for local manufacturers to go global in their exportation of quality-assured medical products.

The process of winning this endorsement involved changing China’s overall vaccine approval framework, from market authorization and licensing, to post-marketing surveillance, to regulatory inspections of manufacturing sites and distribution channels.

In a value-added way, these measures will upgrade the quality of the roughly 70% of Chinese medical products produced for domestic use.

This is an ideal example of a win-win solution facilitated by WHO.

Ladies and gentlemen,

Let me conclude with an expression of appreciation and support.

This is appreciation for the clear contributions of BRICS countries to the improvement of global public health.

And this is a strong commitment of continuing support from many programmes at WHO, including those that facilitate your work in producing high-quality, low-cost generic medicines.

In my view, BRICS represents a block of countries with a fresh and invigorating approach to global health, a new block of rising power with increasing diplomatic as well as economic clout.

I respect your great potential to move global public health in the right direction.

And by “in the right direction”, I mean towards reducing the current vast gaps in health outcomes and introducing greater fairness in the way the benefits of medical and scientific progress are distributed.

It has been a great privilege to speak to you about just a few of your many innovations and new ways of doing things for the betterment of world health.

Thank you.