Historical agreements at the Sixty-fourth World Health Assembly

Dr Margaret Chan
Director-General of the World Health Organization

Closing remarks at the Sixty-fourth World Health Assembly
Geneva, Switzerland

24 May 2011

Mister Vice-President, Excellencies, honourable ministers, distinguished delegates, ladies and gentlemen,

I can be selective in the points I make as you have just heard excellent and comprehensive reports from the Chairs of both committees. But I need to speak a bit longer than usual as an expression of respect to you for the historic achievements of this Assembly.

When I spoke at the start of this Assembly, I asked all of us to remember the people. Never forget the people we are here to serve. We have heard a lot of statistics over these past eight days, but numbers never show the faces or tell the stories.

A high point for me came with the presentations from our two invited speakers. Her Excellency, Sheikh Hasina, Prime Minister of Bangladesh, is a leader who has made health her top priority.

She believes, in particular, that good health for women is the bedrock of a healthy nation. She spoke about the compassion of the human spirit and the human face of all we do at WHO.

She showed how strong leadership and the right policies can bring major improvements in the health of a least-developed country, including impressive reductions in child mortality and a stunning 66% drop in maternal mortality.

She reminded us that poverty, hunger, and malnutrition have faces but little voice. It is our job to speak up for them and continue to give priority to the health needs of the vulnerable and marginalized. And I might add, we can do this best through a primary health care approach.

Mr Bill Gates reminded us that we in public health have one of the hardest jobs in the world, but also one of the most rewarding jobs. He also reminded us that work done by these Health Assemblies is having a tremendous impact on the health of this world.

Having seen his teenage dream of putting a computer in every home well under way, he is now committed to devoting his time, talent, and wealth to getting vaccines in every child.

Through the Decade of Vaccines, launched with a $10 billion pledge, he is using his wealth to spur innovation and to work with industry to get the prices of existing vaccines down.

His devotion to polio eradication is unwavering, and public health in many other areas has benefitted greatly from the generosity of the Bill and Melinda Gates Foundation. He reminded us of the absolutely critical importance of leadership and accountability in getting things done.

Ladies and gentlemen,

These are words we heard over and over again as you discussed what is probably the key item on this year’s agenda: the administrative, managerial, and financial reforms being undertaken at WHO.

The most important message for me was your clear consensus on the need for reform and your clear desire to see these reforms reinforce WHO’s position as the foremost authority on international health.

I heard respect for WHO accomplishments, and appreciation that some absolutely vital jobs cannot be done by any other organization.

Several developing countries asked for reassurance that the reform process will not in any way diminish the direct technical support they receive from WHO. As they said, so many projects and initiatives come and go, but WHO is always there, solid, reliable, effective, and trusted.

Many were disappointed by the lack of detail in the Secretariat’s report, while others understood this as a first broad sketch. This was the intention.

As I stated many times, the reform process must be a collaborative effort, driven by Member States. Had I come to you with fully detailed, pre-cooked plans, I would have defaulted on my promise.

I had a sense that you were comfortable with some general principles.

You want a step-by-step approach, but you want all reforms to come together as a coherent package.

You want a number of managerial and administrative reforms, such as a streamlined, more realistic budget that works as an accountability tool. You want reforms that make it easier to measure the impact of investments. You want greater transparency and alignment of work at all levels of the Organization. And you want this to happen now.

Many welcomed the proposed independent evaluation of WHO, and several suggested that work on the strengthening of health systems would be a good focus for evaluating WHO capacities and gaps.

I welcome this suggestion, as the impact of our work in countries, and on the lives of people, is the most important measure of our entire worth.

This is the immediate objective of the independent evaluation, which will be light, fast, focused on all levels of the Organization, and designed to inform the reform agenda. Its longer-term objective is to establish a culture of ongoing objective evaluation of WHO’s performance.

I was grateful, too, that many reminded Member States of their own obligations and duties in contributing to successful reform.

If you give us an average of 25 resolutions at each Health Assembly, yet give us insufficient funds, how can you hold WHO accountable for implementing your decisions and recommendations?

Most especially, I appreciate your understanding that the good performance of WHO depends absolutely on the quality of its staff and predicable and flexible financing. I thank you for approving the proposed programme budget, accepting it as a transitional budget at the start of a time of unprecedented reforms at WHO.

As one delegate noted, the fragmentation of health development has weakened the benefits of multilateral agencies like WHO. We now need to get those benefits back and strengthen them.

I personally appreciate the strong commitment of Member States to collaborate with the Secretariat as we articulate WHO’s unique roles and together find ways to strengthen them.

The reform process needs to be done quickly but also carefully. As another delegate wisely noted, we must avoid a quest for short-term savings that does long-term damage to WHO.

Several delegates expressed their reservations about the proposed World Health Forum. Nearly everyone recognizes the huge contribution of civil society organizations.

But some delegates are reluctant to introduce a new mechanism, with clear financial implications, that could dilute the intergovernmental nature of WHO, which is clearly one of our strengths.

I appreciate this concern. Your clear intention is to protect against any initiatives that could compromise this Organization’s reputation for objectivity and independence, and this includes strong mechanisms to protect against conflicts of interest.

Starting now, I will work closely with the Executive Board to flesh out, in more detail, a coherent package of reforms. This will be a fully consultative process, fully engaging Member States.

A report on our collaborative work will be presented to the January 2012 Executive Board for careful consideration and debate. As always, I will honour your wishes.

Ladies and gentlemen,

The item on implementation of the International Health Regulations and the related report of the Review Committee on WHO performance during the influenza pandemic also provoked an especially lively and enlightening debate.

You have confirmed that the International Health Regulations are the key international instrument for improving global health security. But nearly every intervention referred to the urgent need to strengthen core capacities so that every single country can comply with the provisions in this legal instrument.

This is the only way we will reach the intended goal of collective defence against universally shared threats. As I said in my opening address, this is now a top priority for me.

I will do my utmost to meet this request in smart and efficient ways. But as you know, WHO is constrained in so many areas by the tough new reality of nearly global financial austerity.

You gave the report of the Review Committee the warm welcome and extremely high praise it deserves. This is a report that will stand the test of time as a classic example of critical, objective, evidence-based evaluation.

It illustrates the complexities of decision-making in an atmosphere of considerable scientific uncertainty and the demands of responding to a public health emergency of long duration. I extend my heartfelt gratitude to the Chair and members of this Committee for a job well done.

Ladies and gentlemen,

Committee A experienced true euphoria when the item on pandemic influenza preparedness was discussed, based on the framework agreed in April.

I can summarize the significance of this agreed framework by quoting the words used by delegates during their interventions: a milestone, an historical agreement, a landmark, a momentous and remarkable achievement, and a proof of the democratic decision-making dynamics we see at WHO. Many delegates commended the strong collaboration of the pharmaceutical industry and the very useful perspectives provided by civil society organizations.

I will add my own comment. This agreed framework is a triumph for health diplomacy, under the superb leadership of chairs and co-chairs, as well as a triumph for public health. It is a tribute to the principles of equity, fairness, and solidarity that underpin everything we try to do at WHO.

The resolution on this matter was adopted, as amended, by consensus. As you know, this was the culmination of four years of very hard work which at times faced issues that appeared hopelessly deadlocked.

This was a high point for all of us, and especially, for the health security of the world. It vastly improves the world’s capacity to prepare for the next influenza pandemic through better surveillance and risk assessment, and to distribute the benefits of vaccines, antiviral medicines, and diagnostic tests more equitably.

With consensus now reached, delegates asked me to maintain close oversight of the framework’s implementation, working hand-in-hand with the Advisory Group, and to give particular attention to building the requisite capacities, skills, and know-how, including through technology transfer.

I am most pleased to do so.

Ladies and gentlemen,

You clearly remembered the people when you adopted five resolutions on health system strengthening.

All people, but most especially the poor, need the benefits of universal health coverage, with mechanisms of social protection that guard against catastrophic health expenditures that drive millions of people below the poverty line each and every year.

They need health systems designed and managed to meet nationally defined priorities and strategies, and they need access to services with adequate numbers of appropriately trained staff, including nurses and midwives.

And as the world has so sharply reminded us during just the past decade, they need resilient heath systems that can withstand emergencies, whether caused by ferocious weather events and extreme natural disasters, or by war and civil strife.

The rise of chronic noncommunicable diseases, which you also discussed, adds tremendous urgency to the agenda for building stronger health systems. It is good that you adopted a resolution on noncommunicable diseases as we strengthen our positions ahead of the major event in September.

Of course we need population-wide preventive measures for NCDs, developed with other sectors, but we also need to help individual people. We need to detect early, treat, manage complications, and often provide prolonged or even life-long care. It is my strong view that primary health care is truly the only efficient and effective way to do so.

I have no doubt that the new global health sector strategy on HIV/AIDS, which calls for greater integration with existing services, will also contribute to health system strengthening.

As I have said so many times, powerful interventions and the money to buy them will not achieve the overriding MDG objective of poverty reduction in the absence of strong delivery systems that reach the poor.

This is not easy, of course, since the poor are nearly always the hardest to reach. I deeply appreciate the attention this Assembly has given to these issues.

During my opening address, I mentioned my strong conviction that increased attention to health systems, and this includes the contribution of nurses and midwives, is one explanation for the significant drops in maternal mortality we are finally beginning to see.

Let me briefly mention the many other reports and resolutions you approved that give us a fighting chance to reach the health-related MDGs. I am referring to the items on malaria, cholera, on infant and young child nutrition, child injury prevention, the safe management of drinking-water and, of course, the global immunization vision and strategy.

You adopted two resolutions on the MDGs. One was amended to include special mention of the work of the Commission on Information and Accountability for Women’s and Children’s Health. I find this entirely appropriate.

The Commission’s report is a milestone in the quest for more effective aid. Its 10 recommendations build national capacity, rather than overburden it, and give us a framework for accountable global health governance in areas that extend well beyond women’s and children’s health.

I was greatly encouraged by the words of one Commissioner, who described this work as setting a new benchmark for the United Nations System in terms of its speed, clarity of language, and ambition.

Ladies and gentlemen,

The item on the Global immunization and vision strategy deserves special mention as an exciting contribution to the achievement of the MDG set for reducing child mortality. Well over 50 delegates and representatives of civil society organizations took the floor.

As we enter this Decade of Vaccines, we heard high praise for support from WHO and UNICEF, but especially for the GAVI Alliance. With GAVI support, vaccines that prevent pneumonia and diarrhoea, the two biggest childhood killers, are now being rolled out in a number of countries.

We heard first-hand accounts of what the new meningitis vaccine means for Africa and its people. Many countries have also added yellow fever and hepatitis B vaccines to routine immunization programmes.

I hardly need to remind you of what these efforts contribute to the attainment of MDG 4. But as I have said, and you agree, achievement of this goal also depends on some very basic and cost-effective measures best delivered through primary health care.

You gave us an extremely clear message. The achievement of ambitious, yet fully agreed goals, such as expanded immunization coverage, the introduction of new vaccines, polio eradication, and measles elimination is directly tied to funds.

We heard compelling pleas to fully replenish GAVI funds so that this spectacular recent progress, supported by strong country ownership, does not lose its momentum.

As I have heard on many occasions, a vaccine that is too expensive for the developing world is worse than no vaccine at all.

Many asked the international community to seek ways to reduce the costs of vaccines, especially the newer ones. Let me assure you. WHO, UNICEF, several other partners and, of course, the Bill and Melinda Gates Foundation are working on this right now.

You will see the results you so greatly need to maintain the current momentum. And I know you want this to happen. You strongly endorsed WHO plans for the development of a global vaccine action plan.

You referred to the need for technology transfer and skills training to enable local manufacturing of vaccines, especially in Africa. Some of you described WHO’s key role in achieving exactly this objective for the local manufacturing of pandemic influenza vaccines.

This is a decade with a vision, and vision always feeds that perennial optimism of public health that keeps us going despite the many obstacles and setbacks thrown our way by policies and events beyond our control.

This decade will help realize the full power of immunization to prevent morbidity and mortality, and the young lives saved from death or life-long disability will be numbered in the millions.

Several delegates mentioned the need for communication strategies that address public fears about the safety of vaccines, especially as these fears are responsible for several recent outbreaks that really should not have happened.

WHO was not proactive on social media during the influenza pandemic, and I believe that this allowed some unfounded criticisms to flourish and contributed to the decision of some groups, including members of the medical profession, to refuse vaccination as unsafe and unnecessary.

But we did use Twitter extensively during this Assembly, and our tweets about events over the past several days, on topics ranging from the reform agenda for WHO to pandemic influenza preparedness, reached more than three million people.

I like this example, as it required no special funds, just the discovery and reallocation of existing talent within this Organization to everyone’s satisfaction and motivation. For me, this is good human resource management.

Ladies and gentlemen,

In conclusion, I believe this has been an especially productive and profoundly effective Assembly.

I agree with Bill Gates. Public health is one of the hardest and one of the most rewarding jobs in the world.

I also agree that these World Health Assemblies are having a tremendous impact on the health of this world.

Above all, you have kept your eyes, minds, and that compassionate spirit that drives the best work of public health focused on the people we serve, the people who need us most.

Thank you.

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