It is a pleasure for me to open this 22^nd Session of the JCB, which will be a special one.

It is special in many ways.

First of all – of course – because you are the Board of a Special Programme.

But also because you are special. For over two decades you have been an active partner of WHO. This stable and dedicated commitment to TDR was crucial to make it one of the success stories of this Organization. In a rapidly changing world it is not common to find such a long-standing dedication to health. But in the field of research it is truly needed – and I extend to you our invitation to go on for another two decades and beyond.

We need determination to invest in health. We need even more determination to invest in long-term research aiming at solving health problems of poor populations, and to keep doing this for decades.

Twenty-four years ago, you found an ingenious model:

• You realised that WHO could not divert its meagre resources to fund long-term and risky goals, even if extremely important and noble;
• You realised that WHO had to be an active partner in the search for new tools;
• You concluded on the need for developing and nurturing new mechanisms and partnerships, thereby sharing with us not only the dreams and the hopes – but also the responsibilities and the costs.

The model you found is even more vigorous today than 24 years ago. I am, of course, referring to the co-sponsorship and to the Special Programme that you created and are responsible for.

TDR has emerged as a unique partnership, bringing together not only the three UN agencies and the traditional donors, but also industry, private and public research institutions and foundations. And even more important, in my view, is the fact that developing countries are full partners in both the governance of the Programme through the Scientific Steering Committees, the Scientific and Technical Advisory Committee (STAC), and the Joint Coordinating Board (JCB) as well as in the funding of the Programme. More than 97% of TDR's budget comes from voluntary contributions, most of which are undesignated. This is a true partnership.

Some have asked about the future of the Special Programmes in the new organizational structure of WHO – and since I have this unique opportunity to meet with so many of our partners I would like to make a few comments and put a few issues straight.

First, my view has been to lean on the old wisdom that "if it ain't broke, don't fix it". TDR is far from broke, although I am sure that David Heymann and Carlos Morel would have appreciated less financial concerns. TDR is a success story and its contribution is very much needed in the years to come. That goes for the other big co-sponsored programme as well, HRP – research in reproductive health.

My second comment relates to the very notion of partnerships. Ever since I took office as Director-General 11 months ago, I have pleaded the cause of extensive partnerships in public health. I have done so for several reasons, the most obvious being that we can achieve more by supporting each other according to our comparative advantages. WHO, the lead agency in health, cannot and should not do all by itself. Its outreach is enhanced by working closely with a whole range of partners from different walks of life.

In this perspective the special programmes are right on target. I would not have objected to more such partnerships. I believe we can do more to live up to our mandates and respond to the call from our Governing bodies by rallying our forces in this close and intimate way. There can be different models – Roll Back Malaria is one – and the structure of the emergent Global Coalition for Immunization is another. But the idea is the same – pooling our resources – supporting each other and maximising our efforts.

There is, however, a considerable challenge to manage such partnerships, not least to keep pace with a changing world in which also the partners have to adjust and change. We need extensive dialogue to see to it that all the partners share the same vision as we go along.

WHO, as you know, is going through change. We had to, given how the Organization had developed and how the demands on us had evolved. That also goes for the area of communicable diseases – a backbone of WHO's past, present and future role - where many of our partners and constituencies had asked for better coordination, less fragmentation and closer links between research and control. That is what we are about to achieve through the new structure in which Carlos Morel and his team are more fully integrated into the Communicable Disease cluster.

In doing so, I feel we have listened to the call from a broad consensus among our partners. I read with attention the report of the Third External Review Committee and I have met personally with the Committee members. They made suggestions on how to make a good Programme even better and as you will learn during this session of the Board, we are already implementing their recommendations.

• The Committee stated that TDR will be needed for at least ten more years. We not only preserved TDR in the reform process, we actively engaged it in the process of change of the Organization;
• It recommended to re-emphasize the role of research and modern science in fighting disease. We have created the Department for Research and Development in the Communicable Diseases cluster to house TDR, and we gave TDR and its Director the responsibility of planning and shaping the future work in this area. Through this approach TDR is expanding its impact and its clout.
• It recommended to make stronger links between research and control – and we designed the Communicable Diseases cluster with this purpose in mind.

What, then, is our vision for taking forward this successful programme?

Together with TDR's top scientific advisory board, STAC, we arrived at two main specific recommendations:

• Firstly: TDR has to move beyond its current research agenda – today almost exclusively biomedical. Ill health is not only a biomedical problem. Particularly in combating the diseases of the poor, the social, economic and behavioural sciences have a major role to play; therefore the suggestion of creating this additional component in TDR activities;
• Secondly: TDR should enlarge its disease portfolio. There are important new epidemics out there, there is a renewed need for better tools and for strengthening research capacity to develop them; therefore the proposal of including tuberculosis and dengue in TDR's mandate.

We will move TDR into its expanded role with caution. We must preserve its focus and strengths and we must do so in transparency and with the support of the partners. We must find the human and financial resources needed. And we must continuously evaluate and monitor the changes introduced.

We need some flexibility on both sides to make this process smooth and efficient. Issues arise that may relate to administration, planning or resource mobilization. But there is an obvious bottom line that should help us solve these issues: We – the partners of TDR – share the goal of taking an ambitious research agenda forward, to make a real difference, especially for the poor, and to do what it takes to get research results translated into efficient control and prevention strategies.

There is a challenging agenda ahead of us.

The French poet Anatole France once wrote, "to accomplish great things we must not only act but also dream. Not only plan, but believe". This seems to be a spirit embodied within TDR. WHO has, of necessity, a duty to respond to the immediate needs of its Member States. But TDR has invested substantially in both helping cope with medium and long-term needs. You have indeed both planned and believed. You have made the wise choice to take a stake in the future.

And your investment is paying off. Not only are the returns now being realised – they have truly attracted a high interest. Infrastructure and skills are being brought to bear against a range of diseases, and not just those within TDR's current mandate.

TDR has directly invested over half a billion dollars in carefully selected priorities and projects. The report of the External Review Committee is clear when it describes the contribution of TDR, along with other partners, in fostering the development of:

• new strategies and policies, such as multi-drug therapy against leprosy;
• new tools for disease prevention, such as impregnated bednets for malaria control;
• new drugs or drug regimens, such as ivermectin against onchocerciasis.

And let us not forget TDR's capacity building activities in over 90 countries, including the training of over 900 trainees at the graduate level, institutional strengthening and numerous short training programmes. This represents a major thrust to the development and self-reliance of disease endemic countries.

Through direct investment TDR catalysed, promoted and implemented changes that would not happen if WHO would only preach for them. That's why TDR's role is so crucial, its contribution so important and its existence so necessary.

Our challenge now, after 24 years, is to learn from the past, decide on the strategic directions for the future and strengthen TDR to make this mechanism even more useful and efficient.

Today, we must accept that in health matters, we are dealing with a complex of interdependent factors. Diseases should not be seen in isolation. Malaria exists alongside tuberculosis, diarrhoeal diseases and malnutrition. And environmental and socio-economic factors are main determinants for health. WHO must reflect this reality - this interdependency - and we are determined to do so. And again, we cannot act alone - as TDR cannot exist or operate on its own. We must create and strengthen partnerships to bring about effective, sustainable improvements in global health.

Research and knowledge will be the solid foundation upon which these partnerships are built. The Research Policy and Cooperation Department within the Evidence and Information for Policy cluster, under the leadership of its newly appointed director, Dr Tikki Pang, will help take WHO's research agenda new steps forward, as will the lessons learned from the extensive review of WHO's research policies.

WHO has to relate to two time frames. One is immediate. Member States have immense problems today, and cannot be asked to wait decades for their solution. They need and they want action now. "Roll Back Malaria" and the "Stop TB Initiative" both address this issue. There are no ideal tools to fight malaria or tuberculosis – but this is no excuse to delay action.

The other time frame is long term. We must keep alive the dream of developing new and better tools for the future. It is because we lack them, that developing new tools has to be a top priority. In short: We have to act now with what we have at our disposal; and we have the responsibility for fostering the development of new and improved tools against the problems of today and tomorrow.

That is why the solution you found 24 years ago is still needed. Immense progress has been achieved in the control of four of the TDR diseases: leprosy, filariasis, onchocerciasis and Chagas disease. That's the good news.

The bad news is that the dynamics of disease are much more complex than we expected. Old enemies developed new weapons and defences – and new enemies emerged. The progress in our fight against disease will never be a linear one and progress will not always be on our side.

We have had to learn this lesson the hard way. The recrudescence of malaria, the resurgence of tuberculosis, the emergence of HIV/AIDS leave no doubt: we may win some battles, but the war against communicable diseases will be perennial.

We need to strengthen the partnership for research to find better tools and methods to combat the infectious diseases that still affect the lives and development perspectives of societies in most developing countries. A partnership that brings together research institutions in north and south, public and private sectors, foundations and companies, developed and developing countries, as well as the UN agencies.

In the World Health Report 1999 we point to the need for renewed efforts to combat poverty through better and more targeted health interventions. It will require that WHO rethinks the way its carries out its mandate. It will require a refocusing of the areas of work which would make the largest difference for the poor.

The research component of this agenda is critical. We need to mobilise more resources for research into the diseases of the poor, and here TDR will be crucial. We need to strengthen further the links to our partners so that the knowledge we produce makes the largest possible impact. In short we ask TDR to do more, and to do it even better than today.

In return, TDR is making the case for more support from its founding agencies, the World Bank and UNDP, as well as from all of our partners. WHO for its part has decided to increase its contribution to TDR by 25% in the next biennium and I hope that you will do the same.

You will have all my support to promote the improvements needed. I urge you to grasp this opportunity and wish you success in this important meeting.