Global Trends by Martin Khor
Monday 30 May 2005
Blurb: In the past two weeks, the World Health Assembly (the supreme body of the World Health Organisation) debated a wide range of health problems ranging from malaria and bird-flu to how to deal with public health emergencies, and disasters like the tsunami. Decisions were taken on some of these major global health problems.
The World Health Assembly is an interesting event for those involved in medical and health issues. As the premier meeting of the World Health Organisation, it brings together Health Ministers, senior officials and NGOs to review major health problems.
This year’s Assembly on 16-25 May in Geneva was attended by 2200 people. It discussed and took decisions on topics ranging from specific diseases such as malaria and influenza pandemic to how governments should to deal with health emergencies, ineffective medicines and health financing.
The highlight was the adoption of the International Health Regulations (2005) which spells out obligations by countries and the WHO 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.
The Regulations guide governments on how to decide when a health emergency has occurred, and oblige them to build the capacity to respond to it. They also have to provide information promptly to the WHO, which can issue recommendations on measures that have to be taken, aimed at minimizing the spread of the disease to other countries.
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 Irsrael 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’s Director General 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 countries to develop national plans for preparing for pandemic-influenza to limit health impact, and asked the WHO to solve the global shortage of influenza vaccines, and to assess the use of antiviral-medication stockpiles to contain an influenza outbreak.
A related resolution on biosafety noted that the containment of microbiological agents and toxins in laboratories is critical to preventing outbreaks of diseases such as SARS, and urged countries to review safety of the laboratories and promote biosafety laboratory practices.
Another resolution, on health action in crises and disasters (such as the Asian tsunami) urged countries to have disaster preparedness plans called on WHO to provide early warning of disease outbreaks, and tackle water and sanitation problems.
The WHA recognized the increasing threat posed by antimicrobial resistance, and called for action through the rational use of medicines. Resistance by bacteria and viruses to existing drugs is rising faster than the development of new drugs, and current effective medicines for infections cannot keep pace.
It called on countries 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 promote the rational use of medicines.
On malaria, which causes a million preventable deaths annually, the WHO is to work with countries to reach malaria control goals, including through WHO undertaking bulk purchases of insecticide-treated nets and antimalarial medicines.
The WHA discussed the rise of multidrug-resistant tuberculosis, and worsening morbidity and mortality among HIV-positive TB patients. It asked countries to set up collaboration between TB and HIV programmes and to mainstream TB prevention and control in health development plans.
The Assembly also focused on the rise of the cancer epidemic, now the second leading cause of death, with over 20 million living with cancer and 7 million dying annually. The WHO attributes this epidemic to increased exposure to tobacco use, unhealthy diet, physical inactivity, some infections and carcinogens.
A resolution on cancer called for improved cancer prevention measures, better early detection and treatment, and increased palliative care. The WHO will develop a cancer prevention and control strategy to help countries address this growing crisis.
On infant and young child nutrition, the Assembly asked countries to promote exclusive breastfeeding for the first six months of a baby's life as a global public health recommendation. They were also urged to promote best practices for preparation and use of powdered infant formula to minimize health hazards, and to inform the public 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 poliovirus transmission worldwide by the end of this year. The Assembly also noted the progress made in scaling-up treatment for HIV/AIDS.
More than 1000 million people will be over 60 years old by 2025 and this will double by 2050. The WHA reviewed implementation of WHO's policy on ageing and adopted a resolution on promoting active and healthy ageing.
The WHA also called on countries 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, with WHO giving support.
The meeting discussed iodine deficiency disorder (IDD), a leading cause of brain damage in childhood. 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 alcohol-linked health problems, caused by rising consumption, and excessive drinking among young people. Harmful alcohol use 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 WHO to help countries evaluate the impact of changes in health-financing systems on health services as they move towards universal coverage.
At the closing ceremony, WHO Director General Lee Jong-wook again warned that “we have a 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 said the secretariat will work to follow up on them.