TWN Info Service on Health Issues No. 8

WHA ends with many resolutions on global health

The recent WHA in May adopted a raft of resolutions that had impacts on public health worldwide.

They cover a range of subjects from influenza pandemic preparedness; disaster preparedness plan; multidrug-resistant TB and HIV programme; international migration of health personnel and the deteriorating health conditions of Palestinians in the occupied territories.

The resolutions called on both the member states and the WHO to develop policies and support efforts in the areas of concern.

This report was published in the South-North Development Monitor (SUNS) of 26 May 2005.

With best wishes
Evelyne Hong

By Martin Khor
Geneva, 25 May 2005

The World Health Assembly (WHA) ended its 58th session Wednesday after having adopted resolutions on topics ranging from specific diseases such as malaria and influenza pandemic to how to achieve the Millennium Development Goals.

The highlight of the nine-day meeting, attended by 2,200 people including Health Ministers and health officials as well as NGOs, was the adoption of the International Health Regulations (2005) which spells out obligations by the World Health Organisation's member states and its secretariat, as well as procedures, on responding nationally and internationally to public health emergencies of international concern. The IHR will come into force in two years.

Other important issues discussed were the imminence of an avian influenza pandemic, the threat of resistance to anti-microbial medicines, and the prevention and treatment of malaria, tuberculosis, HIV/AIDS and cancer.

The WHA's most controversial issue was the proposal by a WHO scientific committee to allow new research involving genetic engineering of the remaining stocks of the smallpox virus that the WHA has allowed two laboratories (in the US and Russia) to hold.

Many countries voiced concern over the proposal and asked for a review of the proposed research. However, the WHO secretariat issued a press release that implied that four of the five research activities proposed had been approved by the WHA members, while one activity (transferring genes from the smallpox virus and inserting them into other pox viruses) would be reviewed.

The most politically charged issue was the deteriorating health conditions and humanitarian crises facing the Arab population in the occupied Palestinian territory. A resolution expressing concern on the situation, asking Israel to halt its practices affecting the Palestinians' health, and asking WHO to take several actions, was adopted by majority vote after a heated debate.

The WHO Director General Dr Lee Jong-wook warned that "avian influenza was the most serious health threat the world is facing today". Other WHO officials at a briefing session warned that an imminent influenza pandemic could make over a billion people sick, hospitalize 28 million and kill up to 7 million.

A WHA resolution called on Member States to develop and implement national plans for pandemic-influenza preparedness and response that focus on limiting the health impact and economic and social disruption. Countries were asked to consider developing domestic flu-vaccine production capacity and increase vaccination coverage of people at high risk.

Countries were also asked to "take all necessary measures during a global pandemic to provide timely and adequate supplies of vaccines and antiviral drugs, using to the full the flexibilities contained in the Agreement on Trade-Related Aspects of Intellectual Property Rights."

The resolution also asked the WHO Director-General to seek a solution to the current global shortage of influenza vaccines, and to assess the feasibility of using (and developing an operational framework to use) antiviral-medication stockpiles to contain an influenza outbreak and slow its international spread.

In a related resolution on biosafety, Member States noted that the containment of microbiological agents and toxins in laboratories is critical to preventing outbreaks of diseases such as SARS, and adopted a resolution to enhance laboratory safety. It urged member states to review safety of the laboratories, promote biosafety laboratory practices and develop plans for laboratories to comply with biosafety guidelines. The WHO was asked to support countries improve biosafety and containment of microbiological agents and toxins.

Another resolution, on health action in crises and disasters (with emphasis on the earthquakes and tsunamis of 26 December 2004) urged Member States to formulate disaster preparedness plans and called on WHO to provide early warning of disease outbreaks, improve access to clean water and sanitation, and increase the availability of health care for people's physical and mental health.

The WHA also recognized the increasing threat posed by antimicrobial resistance, and adopted a resolution to improve its containment, particularly through the rational use of medicines. Resistance is increasing faster than the development of new drugs and current effective medicines for infections cannot keep pace. The resolution noted that the strategy for containing antimicrobial resistance has not been widely implemented.

It called on Member States to develop an integrated approach to contain resistance, to encourage the appropriate use of antimicrobial agents, and monitor the use of these agents and the level of resistance occurring. It also urged WHO to strengthen its role in containing resistance, establish surveillance and patient education systems, and promote the rational use of medicines.

On malaria, which causes a million preventable deaths annually, the WHA called on WHO to intensify its collaboration with countries to reach internationally agreed malaria control goals, including the possibility of WHO undertaking bulk purchases of insecticide-treated nets and antimalarial medicines.

The WHA recognized the increasing cases of multidrug-resistant tuberculosis (TB), and worsening morbidity and mortality among HIV-positive tuberculosis patients. It adopted a resolution on sustaining financing for tuberculosis prevention and control, calling on Member States to set up collaboration between TB and HIV programmes and to mainstream TB prevention and control in their health development plans.

Another resolution welcomed a new Global Immunization Vision and Strategy to implement national immunization programmes during 2006-2015. The aims are to achieve greater vaccination coverage and equity in access to immunization, and to include other interventions, including insecticide-treated nets and vitamin A supplements when people are immunized.

The WHA discussed the growing incidence of cancer, which is the second leading cause of death, with over 20 million living with cancer and 7 million dying annually. The rise of the cancer epidemic is attributed by WHO to increased exposure to tobacco use, unhealthy diet, physical inactivity, some infections and carcinogens.

A resolution was adopted to promote national cancer prevention and control strategies. It called for improved cancer prevention measures, better early detection and treatment, and increased palliative care. As an important new initiative, the WHO will develop a cancer prevention and control strategy to help countries address this growing crisis.

The Assembly adopted a resolution on internationally-agreed health-related goals including those in the Millennium Declaration, urging developed countries to scale-up aid to 0.7% of GNP and African countries to fulfil their 2001 African Summit commitment to allocate 15% of their national budgets to health. It also called for immediate action on the crisis in human resources for health and ensuring better health of the poorest people in countries.

A separate resolution promoting the health of women, newborns and children, urged Member States to accelerate national action towards universal access and coverage with maternal, newborn and child health interventions, through reproductive health care.

On infant and young child nutrition, the Assembly adopted a resolution asking countries to promote and support exclusive breastfeeding for the first six months of a baby's life as a global public health recommendation. Countries were also urged to inform health care workers, parents and other caregivers on the best practices for preparation, use and handling of powdered infant formula in order to minimize health hazards and that powdered infant formula may contain pathogenic microorganisms and must be prepared and used appropriately.

The Assembly reviewed progress made so far in polio eradication and identified what needs to be done to interrupt the final chains of wild-type polio virus transmission worldwide by the end of this year. The Assembly also noted the progress made in scaling-up treatment and care within a coordinated and comprehensive response to HIV/AIDS.

The Assembly also addressed the issue of international migration of health personnel, particularly highly trained and skilled health personnel moving from developing to developed countries. A resolution on this issue asked the WHO to strengthen its programme on human resources for health. The human resources issue will be the theme of the 2006 World Health Report and World Health Day 2006.

More than 1,000 million people will be over 60 years of age by 2025, the vast majority in the developing world, and this figure is expected to double by 2050. The World Health Assembly reviewed the progress made regarding implementation of WHO's policy framework on ageing and also adopted a resolution on strengthening and promoting active and healthy ageing.

The WHA adopted another resolution calling upon Member States to promote the rights and dignity of people with disabilities; support community-based rehabilitation; and include a disability component in national health policies and programmes. WHO will support Member States in these efforts.

The Assembly took note that iodine deficiency disorder (IDD) is a leading cause of brain damage in childhood and called for renewed cooperative efforts to eradicate the problem. A lack of iodine intake during pregnancy and early childhood results in impaired cognitive and motor development in young children. WHO estimates 2 billion people are at risk of becoming iodine deficient. The solution to IDD is simple and cost-effective as iodine can easily be added to table salt.

The WHA discussed health problems associated with alcohol, caused by rising consumption, and excessive drinking among young people. The harmful use of alcohol now results in 4% of the global burden of disease as a causal factor in more than 60 diseases, including cardiovascular disease, mental disorders, road traffic injuries and death, and high-risk behaviours. WHO will develop policies on this.

A resolution on sustainable health financing and universal coverage and social health insurance urged the Director-General to provide support to Member States to evaluate the impact of changes in health-financing systems on health services as they move towards universal coverage.

At the closing ceremony, Dr Lee Jong-wook again warned that "we have little time left to prepare for a pandemic" and urged countries to prepare for it, pledging secretariat assistance. He said the Assembly had adopted many resolutions that had profound effects for global health and added that the secretariat will work to follow up on them.