TWN Info Service on Health Issues No. 1

World Health Assembly opens with calls for more health financing

By Martin Khor
Geneva, 17 May 2005

The World Health Assembly (WHA) opened Monday with speeches by the President of Maldives Maumoon Gayoom and Microsoft founder Bill Gates, both urging that more funding be given to health to reduce global health inequities.

World Health Organization Director-General Dr Lee Jong-wook warned that although health was at the centre of the Millennium Development Goals (MDGs), progress towards meeting them was not reassuring. He and President Maumoon warned about the impending avian flu pandemic, which could kill many millions if measures are not taken now.

Among the highlights on the agenda of the Assembly, which will end on 25 May, are the achievement of health-related MDGs, revision of the International Health Regulations, and health action in relation to crises and disasters.

In view of the avian flu problem, the item on pandemic influenza preparedness and response will also be a closely-followed item, as will the issue of scaling up treatment of HIV/AIDS. The Assembly will also discuss controversial proposals to allow genetic engineering experiments on remaining stocks of the smallpox virus.

At the opening plenary session, the President of the Assembly, Spanish Health Minister, Ms. E. Salgado, highlighted two issues that will occupy the Assembly: assessment of the attainment of health-related MDGs, and the adoption of a revised draft of the International Health Regulations.

The revised regulations, which will replace the 1979 regulations, had been discussed for two years and were finalized late night on 13 May. They pertain to prevention and control of international spread of disease, particularly in relation to transport, travel and trade.

WHO Director-General Dr Lee Jong-wook, in his opening speech, said that health issues are at the centre of the MDGs, yet the translation of those goals into reality is very far from completion, and progress towards them was not reassuring.

Unless there are major changes in the very near future, the targets for reducing child mortality will not be achieved by 2015, warned Dr. Lee. Although the coverage rates in some areas rose as planned, "we have not yet seen improvement in health indicators. In some areas death rates have actually risen due to extreme poverty and epidemics." The technical knowhow exists to do what is needed for global health, but "we have not yet found ways to apply it on a large enough scale."

Dr Lee added that the rise in funding for health development was encouraging, having risen steeply, but was still a small fraction of what is needed. "We have at least begun to overcome lack of resources, one of the biggest obstacles to meeting MDG targets."

He cited the Framework Convention on Tobacco Control (which has entered into force with 64 contracting parties) as a "shining example" of negotiation ensuring that knowledge leads to action.

He mentioned the launching in March of the Commission on Social Determinants of Health which will define and confront major underlying causes of ill-health in the

21st century; and the Commission on Intellectual Property which will present its findings to next year's WHA.

On specific diseases, Dr Lee mentioned the campaign to treat 3 million HIV/AIDS patients by end-2005. He said the milestone of 700,000 people on treatment was passed last December but did not reveal what the present level of achievement was, except to say that the next progress report is due in June.

On tuberculosis (TB), the treatment success rate reached 82% but case detection is still lagging at 45%. In Africa, the HIV epidemic is fuelling TB resurgence.

On malaria, which kills over a million people annually, under-investment in control activity has accelerated drug resistance and excluded whole populations from protection. The new artemisinin-based combination therapies and insecticide-treated nets are effective and WHO is preparing a major initiative based on these.

He ended by warning about avian influenza, which he described as "the most serious health threat the world is facing today". While the timing cannot be predicted, "rapid international spread is certain once the susceptible virus appears."

He said this was a grave danger for all people in all countries, adding that the magnitude can be gauged by the 20-50 million deaths from the Spanish flu epidemic in 1918.

Dr Lee added that there is time to prepare for the next global pandemic. "When this event occurs, our response has got to be immediate, comprehensive and effective."

The President of Maldives, Maumoon Abdul Gayoom, made an eloquent plea for international cooperation to come to the aid of small countries like his, which were threatened by natural disasters such as the recent tsunami and the effects of climate.

He gave a wide-ranging panorama of the health problems and crises facing the world. He said the tsunami directly affected one-third of the people of the Maldives, with two decades of development and the equivalent of 62% of the Gross Domestic Product washed away. An early warning system alone isn't enough, what is needed is a strategy for people to find refuge once the alert is sounded.

Though substantial funds have been committed for recovery and reconstruction, he feared the promised aid would take too long to materialize, with particularly slow reaction in aid for repairing water and sewerage infrastructure and the clearing of debris and waste.

He highlighted the need for treatment for HIV/AIDS and drug-resistant TB, and warned that globalization, travel and trade were rapidly spreading infectious diseases. While the challenges of dealing with old diseases like malaria, TB and cholera remain, the emergence of new pathogens such as SARS and avian flu were equally worrying.

He warned that the avian flu could transform into a new pandemic strain against which human beings have no immunity, and such a pandemic could kill over 100 million people.

Localised health hazards are equally more devastating, he added, citing that one in five persons in the Maldives is a thalassaemia carrier. Bone marrow transplantation, the only permanent cure, is not available locally. The cost of treatment is projected to consume over 40% of per capita health expenditure in 50 years, if preventive steps are not taken.

President Maumoon Gayoom also stressed the importance of the environment, citing that over 5 million children die annually from illnesses caused by the environment they live in. He pinpointed the health effects of global warming, which could kill the corals and starve the Maldives of fish supplies, and would increase vector-borne diseases, lead to more virulent forms of tropical diseases and poison water aquifers and soil with excess salination as the seas rise.

Bill Gates, speaking in his capacity as founder of the Bill and Melinda Gates Foundation, said the world is failing billions of people as governments in rich and poor countries are not putting enough funds in health, while the private sector is not developing vaccines needed in developing countries as they could not afford to buy them.

The story, however, is changing, he said, with the application of more scientific research on treating diseases such as pneumonia, malaria, sleeping sickness and AIDS, giving examples of projects funded by his Foundation.

Delivery and distribution of medicines were also important, and he urged that the design of medicines be shaped by the needs of delivery, for example, by developing a pill to be taken once a month instead of AIDS patients who now have to take three pills a day.

Gates said governments in rich countries must match resources to meet the scale of the problem, governments in developing countries should increase the share of their budgets going to health, and all countries should increase research on diseases that claim the most lives, while scientists should design inventions with delivery in mind.

Earlier, the Assembly proceedings were held back by consideration of the issue of whether to place on the agenda the issue of whether Taiwan could be accepted as an observer in the WHA.

Chad and Malawi supported placing the issue on the agenda, arguing that the WHO would lose credibility if it marginalizes small and weak members.

Pakistan spoke against the proposal. China said the WHA had repeatedly rejected the request of a few countries that Taiwan should take part as an observer. It said that to admit Taiwan as an observer would be against the UN Charter, UN General Assembly and WHA resolutions and the WHA rules of procedure on observer status. It added that China would safeguard its sovereignty and would not allow anyone to conduct secession activities through the WHA.

The Assembly decided not to include this issue on its agenda