Report Of Dr Shigeru Omi, Regional Director for the WHO Western Pacific Region
Fifty-fifth Session of the WHO Regional Committee 13 to 17 September 2004, Shanghai, China
Last year I began my statement by reviewing one of the most dramatic and frightening public health events to have hit the Western Pacific Region in recent decades: the 2003 SARS outbreak. This year another emerging disease, avian influenza, struck several Member States in our part of the world.
Our Region has received international recognition for the way it responded to these two new diseases, but there is still room for improvement. Whether we like it or not, more disease outbreaks that threaten global health lie ahead. National governments, regional organizations such as the Association of South-East Asian Nations, or ASEAN, and WHO need to take a careful look at how we can respond to them even more effectively.
Tomorrow we shall review outbreak response in the Region and the revision of the International Health Regulations. Then on Wednesday we will have a ministerial round table on international cooperation in the face of public health emergencies. These will be an excellent opportunity for us to identify our strengths and weaknesses and to plan for the challenges that lie ahead.
Let me begin this process by telling you how we at WHO have been scrutinizing our role. As you know, the Western Pacific Region is one of WHO's six regions. WHO's regional arrangements, which involve the regions working in concert with WHO's Headquarters, are embodied in its constitution. They are unique among UN agencies and they have served the Organization well.
But, as we have seen with SARS and avian influenza, diseases do not respect borders. That is why we in the Western Pacific Region need to work even more closely with our colleagues in the South-East Asia Region. Improved collaboration between our two regions will have global implications. Many of the emerging global threats to health begin in Asia - if we can nip them in the bud here, the whole world will benefit.
I have already started an extensive dialogue with the Regional Director of WHO's South-East Asia Region, Dr Samlee, aimed at strengthening our joint approach to emerging health threats. I have also chosen biregional cooperation - which permeates many elements of our work - as one of the underlying themes of this introduction to my annual report.
As in previous years, time constraints force me to limit myself to only a small part of WHO's work. For a more complete picture, please turn to the full report, which is document WPR/RC55/2.
In December 2003, the Republic of Korea reported the first outbreak of avian influenza H5N1 in poultry. By February 2004, eight Asian countries had confirmed H5N1 outbreaks in poultry. The total number of countries is now is nine. More than 100 million chickens and ducks died or were culled. In humans, there have been 39 reported cases and 28 deaths, although we believe that further cases went undetected. This high mortality rate indicates the devastating potential of the virus if human-to-human transmission should take place.
Despite aggressive control measures, there have been more outbreaks of avian influenza in recent months, some with human cases. The virus is proving more difficult to contain completely than we had initially thought. It is still circulating and we have to anticipate more human cases.
We have a long battle ahead and, if we are to succeed, we will have to think afresh about our strategy. For example, animal health has not traditionally been seen as part of WHO's mandate. We can no longer afford to take that view. Both avian influenza and SARS originated in animals, as did other recent emerging pathogens, such as the Nipah virus in Malaysia in 1999. We can be virtually certain that more zoonotic diseases will continue to emerge. With this in mind, we are preparing a biregional strategy with WHO's South-East Asia Region to combat outbreak-prone diseases, in full consultation with WHO Headquarters. This document will include a significant component on the production and marketing of animals for food. All our work in this area will be coordinated with our partners, such as the Food and Agricultural Organization and the World Organisation for Animal Health.
SARS and avian influenza outbreaks have demonstrated that the revision of the International Health Regulations that has been taking place over the last few years is going to play a central role in coordinating the regional and international response to disease outbreaks.
Because of the Western Pacific's experience with SARS and avian influenza, the first regional consultation on the revision of the IHR took place at our Regional Office in Manila in April of this year.
This extremely valuable meeting supported the adoption of the public health emergency approach, supplemented by a disease list. It also made notable recommendations on national focal points and on the need to take account of both national sovereignty and global health security issues. The recommendations of the Western Pacific meeting, together with those from other regions, will be reviewed and incorporated by an intergovernmental working group meeting in November this year. The final draft will be presented to the World Health Assembly in May 2005. However, the IHR will only be as strong as Member States' commitment to report important public health events promptly and their capacity to detect and respond decisively to outbreaks.
Before leaving communicable diseases, please allow me to mention our work together to fight tuberculosis and HIV/AIDS.
In 1999, the Regional Committee declared a "tuberculosis crisis" in the Region and in the same year we created a "special project" called Stop TB. The special project has been working closely with all of you to achieve the very ambitious targets that you set for the end of 2005.
First, I would like to share with you the good news:
The Western Pacific is the only WHO region to have attained a treatment success target of 85%.
At the same time, the percentage of the Region's population with access to directly observed treatment, short-course, or DOTS, has risen from 58% in 1998 to 77% in 2002.
In reviewing the achievements of the past five years, I would particularly like to congratulate our host nation, China, for the considerable progress it has made. More than 90% of China's population now has access to DOTS. More than 40% of China's estimated infectious TB cases are now detected, and more than 90% of them are successfully treated. The recent State Council meeting on TB control is a clear sign of the commitment of the government of China to win the fight against tuberculosis.
We can take pride in the progress we have made, but our major concern is the fact that we are still a long way from our regional target of a 70% case detection rate. The rate in 2002 was only 40%, although preliminary data for 2003, which we will address in more detail later this week, indicate a significant improvement in this figure. Nevertheless, the bottom line is that we have to take urgent measures to improve the detection rate significantly.
The HIV/AIDS epidemic in the Region is a time bomb.
Papua New Guinea has joined Cambodia in the list of countries in the Region experiencing a generalized HIV/AIDS epidemic. Meanwhile in those countries with a significant burden of HIV/AIDS cases, the number of individuals developing AIDS continues to increase.
Therefore, the Western Pacific Region is working hard to reach the targets of the "3 by 5" Initiative launched by the Director-General. In all the countries with priority needs, we are either in the process of appointing a member of staff to work exclusively on 3 by 5 or we have already done so.
I would also like to emphasize that prevention remains the key to controlling the epidemic and we are committed to targeted interventions such as condom promotion and harm reduction.
Let me now move to noncommunicable diseases, or NCD. Although NCD prevalence rates continue to rise almost everywhere, we can point to very significant progress in the fight against one of the major causes of disease in the Region: tobacco.
I am proud to say that the countries of the Western Pacific Region have led the world in their support for the WHO Framework Convention on Tobacco Control. The Convention closed for signature on 29 June and by that date all Member States from our Region had signed. The Western Pacific was the only WHO Region to achieve this feat.
Countries from our Region now represent 34% of the countries that have gone one step further and ratified the Convention. I would like to congratulate those countries that have already ratified the Convention and to urge all other countries to follow their lead as soon as possible.
The rise of NCD, accidents and injuries and mental health problems show how important it is to address upstream causes of poor health. This is the thinking behind the Healthy Cities initiative. Our host city, Shanghai, for example has a very strong Healthy Cities programme. I am pleased to report to you that late in 2003 an Alliance for Healthy Cities was formed. In June this year I visited Macao, China, to take part in the ceremonies to celebrate Macao's entry into the Alliance. I was enormously impressed by the public participation and dedication I saw there.
The same principle applies to the Healthy Islands initiative in the Pacific, which has been growing in strength every year. Early this year a Healthy Islands Communication Network was organized among NCD coordinators, in line with the Tonga Commitment that was adopted by the Pacific Ministers of Health at their meeting in Tonga in March 2003.
One major obstacle to the achievement of health in the Western Pacific is that many sick people cannot get the medicines they need. Until we resolve this issue, we will continue to record large numbers of completely unnecessary illnesses and deaths in our Region.
What are we doing about this?
At this session we will be presenting, for your endorsement, a draft regional strategy on improving access to essential medicines.
One particularly alarming problem facing our Region is the recent growth in sales and distribution of counterfeit medicines. This is an issue that we have to address now. We have already been working closely with WHO's South-East Asia Region, particularly in the Greater Mekong countries, to improve surveillance, awareness, and collaboration between health and pharmaceutical sectors. We have also been collaborating with law enforcement agencies so that they address this issue more forcefully. To support these efforts, we are developing a biregional intensified alert system that will allow rapid dissemination of information about counterfeit medicines.
As with other health issues, it is the poor who suffer most from the proliferation of counterfeit drugs. Over the last few years we have sharpened our focus on the links between poverty and health, not just in relation to essential drugs, but across the whole range of our technical cooperation with countries. We are increasingly attempting to approach health as a means of combating poverty by, for example, addressing the financial barriers the poor face when seeking medical help. To break these down, we have supported the development of community-based health insurance projects in the Lao People's Democratic Republic and Viet Nam, as well as supporting social health insurance in a number of countries.
Now, I would like to mention two specific requests made by the Regional Committee at last year's session.
In resolution WPR/RC54.R2, you asked me to work with Member States to improve the quality of care, taking into account psychosocial factors.
That was a very significant request - and one that I shall do my very best to fulfill.
Whenever the opportunity has presented itself, I have raised this issue with ministers and other senior health policy-makers in our Region and at international meetings. Those discussions revealed a broad consensus that, while due recognition has been given to the great contribution made by the biomedical approach to health, insufficient attention has been paid to the psychosocial factors affecting health outcomes. We will therefore be drafting a position paper for your discussion and comment. The paper will reflect the very significant work that has taken place in this area in recent years. Because of the similarities in our cultural contexts, I propose that this should be another joint project of the South-East Asia and Western Pacific regions.
Before closing, please allow me to mention another request in last year's resolution. You asked me to seek the views of Member States on the form and content of my annual report. Over the past year, I have held many very constructive conversations with ministers on how we can make the report even more valuable. There was broad agreement on two main issues. First, the value of the annual report would be greatly enhanced by expanding its geographical scope so that it presents a picture of the Asia-Pacific instead of just the countries in the Western Pacific Region, while continuing to acknowledge the special circumstances of small island countries, especially those in the Pacific. Second, at a time when WHO is trying to reposition health at the heart of the development process, the report should try to broaden its appeal so it reaches journalists, professors of public health, their students, and other partners in the development process. It should aim to provide more in-depth analysis and to become a reference work of enduring value. I would be happy to provide more details on how we intend to address these issues when the floor is open. Mr Chairperson, Ladies and gentlemen, as I mentioned at the beginning of this speech, the world is becoming smaller, more complex and, in terms of emerging diseases, more vulnerable. We must change with it, building on our many past achievements and readying ourselves for what is to come.
The Western Pacific Region has an excellent track record - thanks to the leadership of the ministers of health of your countries and to the hard work of your colleagues. Working together we have met all the challenges squarely and unflinchingly and I am convinced that we will meet future challenges in the same spirit. Let us get the job done together.