World Health Assembly
Pandemic influenza resolution adopted after long debate

The World Health Assembly (WHA), the ultimate decision- making body of the World Health Organisation (WHO), gathered in Geneva from 14-23 May and adopted a record number of resolutions regarding global public health. Two key resolutions were agreed in the last minutes after long debate. These related to pandemic influenza preparedness and, public health, innovation and intellectual property.

More than 2,400 people from WHO's 193 Member States, nongovernmental organisations and other observers attended the meeting.

Regarding pandemic influenza, the WHA passed a last minute resolution, “Sharing of influenza viruses and access to vaccines and other benefits” which restates the general principles of the necessity of sharing both in the preparations for an influenza pandemic and the benefits that will flow from improved international cooperation and preparation, such as greater quantities of and equitable access to H5N1 and pandemic vaccines.

The debate of this issue centred on whether countries could claim intellectual property rights to viruses within their borders. Indonesia, in particular, and its supporters initially refused to share virus information from within their borders with the WHO, saying that they wanted to ensure they would have equitable access to any vaccine developed from their virus. They were concerned that only the wealthy countries would have adequate access to what would likely be an expensive vaccine.

In her closing remarks, the WHO director-general, Dr Margaret Chan, told the delegates: “All countries need to be aware of their obligations under the revised International Health Regulations (IHR). When collective security is at stake, public opinion can carry great weight. After very considerable discussion, you have adopted a resolution on the sharing of influenza viruses and access to pandemic vaccines and other benefits. I want to underscore the importance of this decision. My responsibilities in implementing the IHR depend on this sharing.”

The resolution requests WHO to establish an international stockpile of vaccines for H5N1 or other influenza viruses of pandemic potential, and to formulate mechanisms and guidelines aimed at ensuring fair and equitable distribution of pandemicinfluenza vaccines at affordable prices in the event of a pandemic.

The resolution also tasks an interdisciplinary working group with drawing up new Terms of Reference (TORs) for the WHO Influenza Collaborating Centre Network, and its H5 reference laboratories, for the sharing of influenza viruses. The new TORs will take into account the origin of influenza viruses going into the WHO Global Influenza Surveillance Network, and will make their use more transparent.

Resolutions

The following is a summary of some of the key resolutions passed by the WHA.

Budget

The Assembly approved a budget for 2008-2009 of US$4.2 billion, an increase of nearly $1 billion from the previous year and the largest ever budget approved for the organisation. For the first time, this budget is part of a six-year strategic plan for the WHO, which Member States also adopted at the Assembly.

Malaria

The Assembly passed a resolution to intensify access to affordable, safe and effective antimalarial combination treatments, to intermittent preventive treatment in pregnancies, to insecticide treated mosquito nets, and indoor residual spraying for malaria control with suitable and safe insecticide. Member States requested that donors adjust their policies so as to progressively cease to fund the provision and distribution of oral artemisinin monotherapies, and to join in campaigns to prohibit the marketing, distribution and use of counterfeit antimalarial medicines.

Tuberculosis

All Member States were urged to develop and implement long-term plans for tuberculosis (TB) prevention and control, in line with the WHO Stop TB Strategy. The aim is to half TB deaths and prevalence by 2015.

Polio


Indigenous polio survives in parts of only four countries. Member States resolved to step up their efforts to eradicate the virus swiftly, while taking steps to minimise the risk of its international spread. The issue of financial constraints was raised and there was a call for the international donor community to fill the current $540- million global funding gap, which is jeopardising the 20- year, $5.3-billion initiative.

Gender


The Assembly adopted a resolution on integrating gender analysis and actions into the work of the WHO. Member States are required to include gender perspectives such as disaggregation of data based on sex in all publications and reports.

Use of medicines

A resolution on rational use of medicines promotes an integrated, health systems approach to promoting more appropriate use of medicines – specifically, national multidisciplinary bodies to monitor medicines use and promote rational use.

Health promotion

The WHA passed a resolution urging Member States to increase investment in, and strengthen efforts towards health promotion as the cornerstone of primary health care and a core function of public health.

Trauma care


A resolution on emergency trauma care systems draws the attention of governments to the need to strengthen pre-hospital and emergency trauma care systems (including mass casualty management efforts) and describes a number of steps governments could take.

Research strategy

Member States approved a resolution and reiterated the importance of a coherent research strategy for the WHO which will help to disseminate the outcomes of research and its utilisation in decision- and policymaking for more effective health policies.

Leishmaniasis

Member States approved a resolution on the control of leishmaniasis. Member States were urged to encourage research on leishmaniasis control, to identify appropriate and effective methods of control of vectors and reservoirs and find alternative safe, effective and affordable medicines.

Workers health

The Assembly endorsed the Global Plan of Action on Workers' Health, which aims to devise policy instruments on workers health and protect and promote health at the workplace.

Non communicable disease

A resolution urges Member States to strengthen national efforts in noncommunicable disease (NCD) prevention and control and also calls for an action plan for the prevention and control of NCDs to be presented to the 61st WHA next year.

Alcohol


The Assembly held lengthy discussions on public-health problems caused by the harmful use of alcohol. Delegates agreed that the issue will be discussed again at the WHO Executive Board in January, 2008.


Occupied Palestinian Territories
Suffering at its worst

Based on a report by UNRWA (‘United Nations Relief and Works Agency’ for Palestine Refugees in the Near East), the WHA, at their annual meeting in Geneva in May, adopted a resolution on the occupied Palestinian territories (oPt) that expresses concern over the continuous deterioration of the health and economic conditions of the people of oPt and affirms the need for universal coverage of health services while recognising that the acute shortage of financial and medical resources is jeopardising access of the population to curative and preventive services. The WHO was requested to continue to provide the necessary technical assistance to meet the health needs of the Palestinians. The UNRWA report says “2006 has seen a continuation of violence, loss of life and by far the worst levels of suffering since the occupied Palestinian territory was plunged into a severe humanitarian crisis in September 2000”.

UNRWA report

A brief summary of the report follows.

Figures from the Palestinian Central Bureau of Statistics show that in the latter half of 2006, subsistence poverty (affecting those who cannot afford or can hardly afford the basics of survival) was 23% and that 56% of all households in the occupied Palestinian territory are living below the poverty line.

Although food is available, food insecurity is a major issue with some 34% of the population considered to be food insecure. In all respects the refugee population is most severely affected.

Poverty is one of the most important determinants of health and invariably leads to general malnourishment, micronutrient deficiencies, stunting in children, increased mortality and morbidity of high-risk groups, and weakened population immunity. In addition, increased poverty prevents those who suffer from noncommunicable diseases, such as diabetes and hypertension, from purchasing medications and continuing their treatment, with consequent negative outcomes. Mental disorders continue to be of major concern in the occupied Palestinian territory.

The Ministry of Health budget has been severely curtailed and consequently the delivery of health services. Also, the inability to pay salaries has resulted in a prolonged health worker strike in the West Bank.

Immunisation coverage with primary and booster vaccines is below target due to movement restrictions. In the West Bank, there are currently 37 primary health facilities, 23 health centres and 14 health points, serving approximately 720,000 registered refugees, 26% of whom reside in camps. The ratio of primary health care facilities per 100,000 registered refugees is 5.3 and the number of doctors per 100,000 individuals is 9.8 – an improvement from 2005, but still far below international standards.

In 2006 UNRWA set up a clinic in the village of Beit Surik, north-west of Jerusalem. Prior to this the 30,000 inhabitants of this area used to visit the health centre in Jerusalem Old City, but this is no longer accessible due to Israel’s construction of the separation wall. Mobile health teams have been in operation since 2003 with the aim of relieving some of the burden on the health system and providing access to health services in locations affected by closures, checkpoints, and the separation wall.

The teams offer a full range of essential medical services, including immunisation, control of communicable and noncommunicable diseases, and first-aid treatment for conflict-related injuries. During 2006 five mobile teams operated in the West Bank, attending to patients in 135 localities in the areas of Bethlehem, Hebron, Jenin, Nablus and Jerusalem.

The only hospital run by UNRWA in the five fields is in Qalqilya. Secondary and tertiary care is otherwise provided through contracted hospitals. Currently there are four hospitals in Jerusalem, one in Ramallah, two in the Nablus area and three in the Hebron area, which are under contract with UNRWA. Access is not completely free of charge, as in the case of primary health care.

In 2006 a total of 17,572 people were referred for secondary and tertiary care, a marked increase from 14,559 in 2005 and 12,856 in 2004.

Psychological trauma

Armed conflict, severely restricted movement and prolonged curfews are sources of acute psychological stress for Palestinians, both adults and children. The signs of stress, particularly among children, are readily apparent. UNRWA has assigned counsellors to schools and health centres throughout the occupied Palestinian territory under its emergency psychological counselling and support programme. UNRWA says it is also seeking to enhance cooperation with other partners within the framework of the national mental health plan developed by the Ministry of Health in collaboration with WHO, which assisted in establishing community mental health centres in Ramallah, Hebron and Gaza.

Challenges

In the report UNRWA says it is confronting enormous difficulties brought on by economic suffocation and relentless violence.

“Despite an overwhelming desire to be economically productive and self-sufficient, the refugee population cannot, under the current conditions, support itself or rebuild its communities. The main challenge to UNRWA during the crisis has been to prevent the breakdown of essential services while addressing development needs with an emergency budget that has been seriously underfunded for more than four years.

“One of the major consequences of the current crisis in the occupied Palestinian territory, is that it has gradually diverted international support to the Palestinian people away from development assistance towards emergency response. This change was inevitable under conditions of a near-collapse of the economy, exhaustion of coping mechanisms, destruction of infrastructure, stunting of civil society institutions, damage to publicsector functions and services and implementation of strict separation and closure policies.”  

                                  
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