140th Session of WHO Executive Board

Achievements and challenges in public health

The annual address of the WHO Director-General to the executive board is always a good measure of the current state of affairs in global public health. Middle East Health publishes an edited version of Dr Margaret Chan’s speech on January 23 in Geneva.

The World Economic Forum (in January) identified rising income and wealth inequality as the most significant trend that will shape global development over the next 10 years.

In a world facing considerable uncertainty, international health development remains a unifying force and a solid reference point for delivering fair social outcomes under the 2030 Agenda for Sustainable Development.

Key WHO achievements over just the past few months illustrate the range of our work and its impact on the lives of people, especially vulnerable groups.

At the start of this year, WHO and the US National Cancer Institute published a landmark report on the economics of tobacco and tobacco control. At nearly 700 pages, this is a definitive assessment, prepared by more than 60 authors and peer-reviewed by an additional 70 experts.

Tobacco control
You will have seen the headlines. “Smoking costs the global economy more than $1 trillion yearly.” “Smoking will soon kill more than 6 million people worldwide each year.”

The report shows how tobacco control, including significant tax increases on tobacco products, can save lives while also generating revenues for health and development.

As documented, the economic losses caused by smoking far outweighs global revenue from tobacco taxes, estimated at nearly $270 billion in 2013-2014.

If all countries raised cigarette taxes by about 80 cents per pack, annual tax revenues could increase by 47%, amounting to an additional $140 billion per year.

The overarching conclusion is stark: tobacco control makes good economic sense and does not harm economies. The evidence is abundant and compelling. It ought to put an end to one of the tobacco industry’s most frequent and effective arguments.

Ministers of health are convinced by the evidence. I ask you to be vocal in persuading ministers of finance, trade, foreign affairs, and others not to be swayed by industry’s false claims.

It takes courage to issue reports that antagonize powerful economic operators. Economic power readily translates into political power.

It falls to WHO to do this. If we fail toaccept this responsibility, we will never make sufficient progress against lifestylerelated noncommunicable diseases.

Health inequalities
Health inequalities are often aggravated by the high price of medical products.

In September 2016, WHO and industry groups announced new financing arrangements, in line with industry practices, that will sustainably finance the WHO Prequalification Programme from now into the future.

The programme is one of our most successful initiatives. It has transformed the market for public health vaccines and other medical products, making supplies more abundant and predictable, and prices affordable.

In addition, the new financing model is designed to ensure equity among manufacturers, with provisions included to enable small manufacturers that meet quality safety and efficacies standards to enter the market on an equal footing with large companies.

More good news for affordable medicines came the next month, when WHO released a report documenting dramatic price reductions for a revolutionary cure for hepatitis C infections. Strategies used include price negotiations, local production, and licensing agreements that promote competition among generic manufacturers.

As noted in the report, price reductions have made treatment possible for more than 1 million people living with chronic hepatitis C infection in the developing world.

Authoritative data
WHO is widely respected as a source of authoritative data, a watchdog of evolving trends, and a force that can shape these trends through partnership.

Last September, WHO released country air quality estimates showing that 92% of the world’s population lives in places where air pollution levels exceed WHO limits.

That same month, WHO announced an end to the largest emergency vaccination campaign against yellow fever ever undertaken in Africa. A crisis was averted.

More good news came in November, when WHO statistics showed that measles immunization over the past 15 years has spared more than 20 million young lives. That good news contrasts sharply with the hundreds of measles deaths that are still occurring every day.

And, of course, our annual reports on the HIV, tuberculosis, and malaria situations made headlines, with the best news coming from the shrinking malaria map.

The achievement that brought the most joyful headlines came at the end of last year, when WHO published final trial results demonstrating that the new Ebola vaccine confers nearly 100% protection. Several media outlets covered the vaccine results as the year’s most uplifting news.

We have by no means defeated this re-emerging disease, but when the next outbreak inevitably occurs, responders will not be empty-handed. I thank our many partners, countries who supported that clinical trial, including thegovernment and people of Guinea, for making this happen.

Outbreaks and emergencies response
In the first nine months of 2016, WHO responded to major emergencies in 47 countries. The Mosul humanitarian operation in Iraq has been the largest and most complex.

WHO has given the research community a shortlist of especially worrisome pathogens with epidemic potential.

The R&D blueprint, developed in response to lessons learned during the Ebola outbreak, has been immediately applied to expedite the development of new medical products for Zika virus disease. It aims to cut the time needed to develop and manufacture candidate products from years to months.

A new $500 million coalition to develop vaccines ahead of epidemics was announced during the World Economic Forum. It draws on the WHO list of priority pathogens, and benefits from the normative support and expedited procedures set out in the R&D blueprint. In this way, WHO’s work catalyses targeted priority investments.

As a contribution to the global health emergency workforce which is very important to many countries, the initiative for building up a strike force of emergency medical teams has moved forward quickly. Through this initiative, international preparedness to provide clinical care during emergencies has been structured and standardized.

The requirements for WHO verification 140th Session of WHO Executive Board and registration are high. Having the competence of an emergency team peerreviewed and verified is a source of great national pride. Many countries have already done that and many countries have registered. This is life-saving capacity building at its best. It is rapidly making order out of a situation historically prone to chaos.

The best-documented success story is the Pandemic Influenza Preparedness, or PIP, Framework. The Framework was set up in 2011 as a bold and innovative preparedness tool that puts virus sharing and benefit sharing on an equal footing.

To date, legally binding agreements have secured access to around 350 million doses of vaccine to be delivered, as they roll off the production line, during the next influenza pandemic.

Partnership financial contributions from industry for which I am grateful have been invested to build surveillance, laboratory, regulatory, and other capacities in developing countries.

This is a ground-breaking model for partnership with the private and nongovernmental sectors to ensure greater fairness in global public health. It is also a model for global solidarity that addresses critical policy, operational, and capacity barriers ahead of an emergency.

The world is better prepared for the next influenza pandemic, but not at all well enough.

I am asking all countries to keep a close watch over outbreaks of avian influenza in birds and related human cases. Just since November of last year, nearly 40 countries have reported fresh outbreaks of highly pathogenic avian influenza in poultry or wild birds.

The rapidly expanding geographical distribution of these outbreaks and the number of virus strains currently cocirculating have put WHO on high alert. For example, the H5N6 virus causing severe outbreaks in Asia is a new strain created by gene-swapping among four different viruses.

Since 2013, China has reported seasonal epidemics of H7N9 infections in humans, now amounting to more than 1,000 cases, of which 38.5% were fatal.

The latest epidemic, which began in late September 2016 and since December has shown a sudden and steep increase in cases. In two clusters, WHO could not rule out limited human-to-human transmission, though no sustained transmission has been detected to date.

As required by the International Health Regulations, all countries must detect and report human cases promptly. We cannot afford to miss the early signals.


Tobacco control can save billions of dollars, millions of lives

Policies to control tobacco use, including tobacco tax and price increases, can generate significant government revenues for health and development work, according to a new landmark global report from WHO and the National Cancer Institute of the United States of America. Such measures can also greatly reduce tobacco use and protect people’s health from the world’s leading killers, such as cancers and heart disease.

But left unchecked, the tobacco industry and the deadly impact of its products cost the world’s economies more than US$ 1 trillion annually in healthcare expenditures and lost productivity, according to findings published in The economics of tobacco and tobacco control. Currently, around 6 million people die annually as a result of tobacco use, with most living in developing countries.

The almost 700-page monograph examines existing evidence on two broad areas:

  • The economics of tobacco control, including tobacco use and growing, manufacturing and trade, taxes and prices, control policies and other interventions to reduce tobacco use and its consequences; and
  • The economic implications of global tobacco control efforts.

“The economic impact of tobacco on countries, and the general public, is huge, as this new report shows,” says Dr Oleg Chestnov, WHO’s Assistant Director-General for Noncommunicable Diseases (NCDs) and mental health. “The tobacco industry produces and markets products that kill millions of people prematurely, rob households of finances that could have been used for food and education, and impose immense healthcare costs on families, communities and countries.”

Globally, there are 1.1 billion tobacco smokers aged 15 or older, with around 80% living in low- and middleincome countries. Approximately 226 million smokers live in poverty.

The monograph, citing a 2016 study, states that annual excise revenues from cigarettesglobally could increase by 47%, or US$ 140 billion, if all countries raised excise taxes by about US$ 0.80 per pack. Additionally, this tax increase would raise cigarette retail prices on average by 42%, leading to a 9% decline in smoking rates and up to 66 million fewer adult smokers.

“The research summarized in this monograph confirms that evidence-based tobacco control interventions make sense from an economic as well as a public health standpoint,” says the monograph’s co-editor, Distinguished Professor Frank Chaloupka, of the Department of Economics at the University of Illinois at Chicago.

The monograph’s major conclusions include:

  • The global health and economic burden of tobacco use is enormous and is increasingly borne by low- and middleincome countries (LMICs). Around 80% of the world’s smokers live in LMICs.
  • Effective policy and programmatic interventions exist to reduce demand for tobacco products and the death, disease, and economic costs resulting from their use, but these interventions are underused. The WHO Framework Convention on Tobacco Control (WHO FCTC) provides an evidence-based framework for government action to reduce tobacco use.
  • Demand reduction policies and programmes for tobacco products are highly cost-effective. Such interventions include significant tobacco tax and price increases; bans on tobacco industry marketing activities; prominent pictorial health warning labels; smoke-free policies and population-wide tobacco cessation programmes to help people stop smoking. In 2013-2014, global tobacco excise taxes generated nearly US$269 billion in government revenues. Of this, less than US$1 billion was invested in tobacco control.
  • Control of illicit trade in tobacco products is the key supply-side policy to reduce tobacco use and its health and economic consequences. In many countries, high levels of corruption, lack of commitment to addressing illicit trade, and ineffective customs and tax administration, have an equal or greater role in driving tax evasion than do product tax and pricing. The WHO FCTC Protocol to Eliminate Illicit Trade in Tobacco Products applies tools, like an international tracking and tracing system, to secure the tobacco supply chain. Experience from many countries shows illicit trade can be successfully addressed, even when tobacco taxes and prices are raised, resulting in increased tax revenues and reduced tobacco use.
  • Tobacco control does not harm economies: The number of jobs dependent on tobacco has been falling in most countries, largely due to technological innovation and privatization of once stateowned manufacturing. Tobacco control measures will, therefore, have a modest impact on related employment, and not cause net job losses in the vast majority of countries. Programmes substituting tobacco for other crops offer growers alternative farming options.
  • Tobacco control reduces the disproportionate health and economic burden that tobacco use imposes on the poor. Tobacco use is increasingly concentrated among the poor and other vulnerable groups.
  • Progress is being made in controlling the global tobacco epidemic, but concerted efforts are needed to ensure progress is maintained or accelerated. In most regions, tobacco use prevalence is stagnant or falling. But increasing tobacco use in some regions, and the potential for increase in others, threatens to undermine global progress in tobacco control.
  • The market power of tobacco companies has increased in recent years, creating new challenges for tobacco control efforts. As of 2014, 5 tobacco companies accounted for 85% of the global cigarette market. Policies aimed at limiting the market power of tobacco companies are largely untested but hold promise for reducing tobacco use. Dr Douglas Bettcher, WHO Director for the Prevention of NCDs, says the new report gives governments a powerful tool to combat tobacco industry claims that controls on tobacco products adversely impact economies. “This report shows how lives can be saved and economies can prosper when governments implement costeffective, proven measures, like significantly increasing taxes and prices on tobacco products, and banning tobacco marketing and smoking in public,” he adds.


Date of upload: 18th Mar 2017

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