61st World Health Assembly
Notes from Day 2: Tuesday, 20 May 2008
Primary health care: In the first technical briefing of the Health Assembly, Dr Halfdan Mahler, former Director General of WHO (1973-1988), won a standing ovation for his talk on primary health care (PHC). PHC is essential health care based on scientifically and socially sound methods and technologies that is made available to everyone. It was inspirational to an earlier generation but lost its primary place in public health when it was replaced by vertical programmes, like smallpox eradication, with their single goal, funding and response structure.
Dr Mahler, 85, cautioned a room packed with hundreds of delegates that to make real progress we should stop seeing the world through medically-tinted glasses. Citing the "transcended beauty of the Constitution of the WHO", he said that PHC aims to address inequity and social injustices that still plague the countries.
Practitioners from around the world shared their experiences and challenges of implementing PHC. Dr Mirai Chatterjee from India gave a concrete example of empowering people through primary health care by putting health in the people's hands in her country. Another example of primary health care at work was given by Dr Francesco Campos of Brazil. He stressed the political nature of health in his country. Dr Komatra Chuengsatiansup of Thailand emphasized the need to fully involve civil society in the PHC process, and urged a compassionate approach that leaves no stakeholder without a voice.
This year's guest speakers, Her Royal Highness Princess Muna Al Hussein of Jordan and Bishop Desmond Tutu of Cape Town, both drew the attention of the delegates to current health challenges and approaches to address them.
Desmond Tutu, Archbishop Emeritus, Cape Town and Nobel Prize Laureate, paid tribute to the human spirit and the capacity of all people to do good and urged that spiritual health was essential to human well-being. He said that it is evident from generations of witness that there is no situation that cannot be transformed. "There is no set of circumstances that cannot be turned about by human beings and their natural capacity for love. It is essential that the world see such ideas are put into action through the promises of the WHO, on behalf of all people, communities and nations." Speaking on the right to health, Archbishop Tutu called upon "WHO to guard and guide the nations protecting their citizens and guaranteeing the right to health for all people. It is a sacred and solemn covenant – a promise, if you would – that you are called upon to undertake." He thanked the Health Assembly for what he called its "tenacious commitment and what this means in the lives of the more than 6 billion residents of this planet."
Her Royal Highness Princess Muna Al Hussein, a WHO Patron for Nursing and Midwifery in the Eastern Mediterranean Region since March 2003, spoke of the unrest in her own region where conflicts and other crises continue to disrupt and strain health systems and have an enormously negative impact on people's well-being. "There are clear examples where worsening health trends and lack of basic services, combined with poverty and unemployment, form the roots for civil unrest". The Princess urged ministers to focus on human resources in their own countries "No investment is better than investing in health and education," she said. "The responsibility heavily rests upon governments which must dramatically and conscientiously increase their efforts to provide better health and education services, and to empower women in efforts to save lives of children and prevent maternal deaths during, or as a result of, childbirth".
Intellectual property: During the first Committee meeting this morning, the delegates discussed public health innovation and intellectual property. Resolutions passed at the Health Assemblies in 2006 and 2007 directed WHO to draw up a global strategy and plan of action aimed at essential health research and development for diseases that disproportionately affect developing countries. An intergovernmental working group asked to take this work forward earlier this month resolved nearly 200 paragraphs in a draft strategy. A drafting group was formed this morning to work on about 20 unresolved paragraphs. The group will report back on its progress to the Health Assembly later this week. In a separate event this afternoon, Director-General Dr Margaret Chan again urged Member States to find agreement on the remaining differences so that the strategy can be implemented.
Polio eradication: Member States today urged the Director-General for continuing the intensified polio eradication efforts, drawing on the experience in polio-free areas. Recognizing the progress made against type 1 polio in Asia, Member States encouraged India, Afghanistan and Pakistan to fully implement targeted, large-scale vaccination to interrupt the final polio transmission chains. Particular attention was given to Nigeria, where a current outbreak in northern states threatens polio spreading from that country.
Delegates also stressed the need for all countries to maintain surveillance for the disease, to ensure high levels of routine immunization and to allocate necessary funds. Discussing the post-eradication era, they underlined the need for ongoing research to better understand the long-term risks associated with polioviruses and to develop strategies to deal with these risks.
Member States based their feedback on a report from the WHO Secretariat and a draft resolution put forward by the WHO Executive Board at its January 2008 meeting. As the day closed, discussions continued on the draft resolution. Once passed, this resolution will mandate WHO to enhance its assistance to Member States in stopping all polio transmission and in preparing for the management of long-term risks of polioviruses.
Smallpox: The destruction of existing stocks of live smallpox virus was discussed today in Committee A. Member States reiterated their support for the eventual destruction of the stocks. WHO in its update affirmed that all approved research is following the agreed timeline of completion by 2010, with a review to be presented at the 64th World Health Assembly in 2011. The delegates were told that promising candidates for developing safer drugs and vaccines are emerging, increasing the likelihood that the targets will be achieved in time. As suggested by Member States, the size of the Advisory Committee on Variola Virus Research has been increased and its composition altered to include more public health experts and developing countries.
International Health Regulations: Extensive debate occurred around this draft resolution as Member States considered both how effectively the International Health Regulations (IHR) (2005)) had been implemented so far, their obligations under the IHR (2005), and what more WHO should do to support Member States. The momentum to fulfil IHR requirements was high and positive comments made towards the support provided by WHO. However, some countries were concerned with the amount of time and resources that had to be dedicated to implementing the IHR (2005), if all public health events of international concern were to be followed and communicated properly. WHO, as in the draft resolution, was requested to further support States Parties in the establishment of national surveillance and response systems as well as for capacity at airports, ports and ground crossings. In addition, more frequent reporting on progress of IHR implementation was requested. Several amendments were suggested to the draft Resolution (EB122.R3) and will be incorporated into a Conference Paper, to be published and circulated among Member States later this week.
Pandemic influenza: This topic has been on the agenda of the World Health Assembly since 2005, and it was the first issue tackled in the technical and health committee this year. In its update, WHO reported on the attempts of the Member States to resolve the issue about virus sharing and the equitable sharing of virus sharing benefits, such as a pandemic influenza vaccine. This work has been carried on through Intergovernmental Meetings (IGMs) on pandemic influenza. These meetings, coordinated by WHO, engage senior health officials and scientists from Member States to wrestle with issues and propose solutions (often put in the form of resolutions to Health Assembly). Today, WHO reported on the results of the latest IGMs and its interim virus tracking mechanism. Member States clearly expressed a sense of urgency. Protecting global health security, it was suggested, demanded Member States constructively participate in a process to finding sustainable, equitable solutions in such areas as virus sharing, stockpile development and broader pandemic preparedness. Some Member States suggested that the next IWG be the last.
International Health Partnership (IHP): This morning, delegates from Australia, Finland, Madagascar, Nigeria and Sweden joined WHO Director-General Dr Margaret Chan to sign a commitment to the International Health Partnership (IHP). The IHP is a coalition of the health donors - countries and agencies -- and a number of developing countries whose objectives are to make more money available for health and make health action on the ground more effective. It sets up compacts or agreements between donors -- who commit to long-term funding for health -- and recipient countries which commit to action to address the Millennium Development Goals and to using the funds effectively.
Global health workforce: The severe shortage of health workers across the world has been identified as one of the most critical constraints to the achievement of health and development goals and has led to resolutions at three consecutive World Health Assemblies (2004, 2005 and 2006). As a result, the Global Health Workforce Alliance (GHWA) was created in May 2006 as a common platform for joint research and action. The GHWA commissioned the world's leading associations of health and hospital professionals to produce the first-ever joint guidelines on incentives for the retention and recruitment of health professionals. The guidelines were unveiled today at the World Health Assembly.