Friday, May 22, 2009

WHO And A Quest For A Disease-Free World

The World Health Assembly, the supreme decision-making organ of the World Health Organisation (WHO) concluded its 58th session recently. More than 2,200 people from WHO’s 192 member states, non-governmental organisations and other observers attended the meeting. A controversy over the participation of Taiwan in the Assembly nearly marred it. For the umpteenth time, apparently on the direction of China, a permanent veto-enjoying member of the United Nations Security Council, Taiwan was refused an observer status.

China had in a submission made to the Assembly objected to the acceptance of the request of Taiwan to be given an observer status, claiming that Taiwan is not a sovereign entity but an indivisible part of the mainland China. The Assembly under the presidency of Elena Salgado, the Minister of Health and Consumer Affairs of Spain, after a long and careful deliberations on the health condition of the region which once threatened the whole world with SARS epidemic, politely voted to reject China’s request.

The commencement speeches at the opening ceremony highlighted the Assembly’s passion to see in no distant future a disease-free world. WHO Director-General, Dr. Lee Jong-Wook, encouraged delegates to determine the best ways to bring available health solutions to everyone who needs them while the president of the Republic of Maldives and guest speaker of the Assembly, Maumoon Abdul Gayoom, spoke on the recent devastation caused by the tsunami and the continuing efforts to reconstruct homes, communities and lives.

Bill Gates, billionaire owner of the Microsoft and co-founder of the Bill & Melinda Gates Foundation, addressing the Assembly in person for the first time announced an additional donation of $250 million towards solving some of the world’s health problems especially in Africa and developing countries. The Money brings to $450 million the amount Gates has committed to his Grand Challenges in Global Health Programme project created few years ago. Grand Challenges in Global Health Programme project is a sort of competition intended to entice the world’s foremost scientists, researchers and inventors into finding groundbreaking solutions to health problems.

Ann Veneman, the Executive Director of UNICEF, while stressing the importance of child survival in a world where almost 11 million children die before their fifth birthday eulogised the naming of the Vienna Philharmonic Orchestra as WHO goodwill ambassador.

A landmark achievement of the Assembly was the adoption of the revised International Health Regulations which govern national and international response to disease outbreaks. “This is a major step forward for international health. These new regulations recognise that diseases do not respect boundaries. They are urgently needed to help limit the threats to public health”, said Jong-Wook.

The revision of the International Health Regulations has been under way for several years. The original one agreed to in 1969 was designed to help monitor and control five serious infectious diseases viz Cholera, Yellow fever, Smallpox, Relapsing fever and Typhus. The new one will govern a broader range of public health emergencies of international concern including emerging diseases like Swine flu. The purpose of the International Health Regulations is to ensure the maximum protection of people against the international spread of diseases while minimising interference with world travel and trade. It includes a list of diseases such as Smallpox, Polio and SARS whose occurrence must be notified to WHO and also a matrix for countries to decide whether other incidents constitute public health events of international concern.

Also a new global partnership aimed at improving public health decision-making, through better health information was approved and adopted by the Assembly. Tagged, “The Health Metrics Network” (HMN), the partnership comprising of countries, multilateral and bilateral development agencies, foundations, global health initiatives and technical experts will increase the availability and use of timely reliable health information by catalysing the funding and development of core health information systems in developing countries.

“Today despite the efforts of many countries, regional and global partners, there are significant gaps in the health information that is available to policy makers and health practitioners. In some areas of the world, even basic facts such as a person’s birth, death and cause of death are not recorded”, said Jong-Wook.

The Health Metrics Network will work to close this gap by helping countries improve their ability to gather this vital health information”, he added.

Another major highlight was the approval of the proposed programme budget for 2006-2007, which includes a four percent increase in the Regular Budget and the establishment of the World Blood Donor Day as an official annual event to be celebrated every June 14. The Assembly in adopting the date noted that it reached the agreement in order to raise awareness and promote voluntary blood donation globally. The theme for the first edition is “Celebrating Your Gift Of Blood” and will highlight true stories of people whose lives have been changed by blood.

The day will be celebrated across the globe with one city representing the fulcrum of activities. London the capital of the United Kingdom was chosen for the first edition remembrance as a result of what the Assembly described as ‘capital of a country, which has a solid tradition of collection of safe blood supplies by relying on voluntary unpaid donation’. The day will provide the global community the opportunity to raise awareness on the need for blood and blood donors. Over 80 million units of blood are donated every year around the world but only 39 percent is collected in developing countries where 82 percent of the global population live.

A reliable supply of safe blood is essential for scaling up health at several levels particularly for women and children. For instance, more than half a million women worldwide die every year from complications related to pregnancy and child birth, 99 percent of them in developing countries. Haemorrhage, accounting for 25 percent of the complications is the most common cause of maternal deaths. Up to 70 percent of all blood transfusions in Africa are given to children with severe anaemia due to malaria, which accounts for about one in five of all childhood deaths in Africa.

Reviewing progress made so far in Polio eradication, the Assembly identified what needs to be done to interrupt the final chains of wild-type Poliovirus transmission world-wide by the end of the year. According to WHO six countries are hot spots for the virus in the world and they include India, Pakistan, Afghanistan, Egypt, Niger and Nigeria. They have to be tackled. Of all these, Niger and Nigeria have the highest rate. Nigeria is actually leading.

On the issue of HIV/AIDS, the Assembly welcomed the progress made so far in scaling-up treatment and care within a co-ordinated and comprehensive response even as it underlined the urgency of Smallpox vaccine reserves and research on the Smallpox virus. Nigeria with more than 3.7 million people living with HIV and AIDS still has an unenviable record of being the third highest nation with HIV and AIDS victims in the world after South Africa and India.

Similarly the 58th Assembly also addressed the issue of increasing cases of multi-drug resistant Tuberculosis and worsening morbidity and mortality among HIV-positive Tuberculosis patients by adopting a resolution on sustaining financing for Tuberculosis prevention and control. The resolution called on member states to set up collaboration between TB and HIV programmes and to integrate the prevention and control of TB in the mainstream of their health development plans.

Recognising that too many people suffer and die in crises and disasters as a result of untreated and often preventable health problems, the World Health Assembly adopted another resolution on health action in crisis and disasters with particular emphasis on the earthquakes and tsunamis of December 26, 2004. The resolution 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 even as it urged member states to formulate disaster preparedness plans and pay more attention to gender-based violence as an increasing concern during crises.

To address the more than one million preventable deaths caused by malaria each year, the Assembly agreed on a resolution to step up efforts to fight the disease. “Malaria remains the infectious diseases that takes more lives of children in Africa than any other, three times as many as HIV infection”, said Ann Veneman, the Executive Director of UNICEF.

According to a recent WHO report, in 2003, some 350 to 500 million people worldwide became ill with malaria, a slight revision of the estimate of 300 to 500 million annual cases that WHO has used since 2000. Against that backdrop the Assembly called on WHO to intensify its collaboration with member states to reach internationally agreed malaria control goals, including the possibility of WHO undertaking bulk purchase of insecticide-treated nets, anti-malarial medicines and vitamin A supplements when people are immunised.

Responding to the rising level of cancer worldwide, the World Health Assembly agreed to promote a cancer prevention and control strategies for all member states. “It is the second leading cause of death. More than 20 million people are living with cancer and seven million people die annually. The incidence of cancer is on the rise in both developing and developed countries as a result of increased exposure to cancer risk factors such as tobacco use, unhealthy diet, physical inactivity as well as some infections and carcinogens. A rapidly ageing population in many countries is also a contributing factor”, the Assembly noted and therefore called for an improved cancer prevention measures, better early detection and treatment and increased palliative care.

On the much-hyped Millennium Development Goals, the Assembly adopted a resolution on “Accelerating the achievement of the internationally-agreed health-related goals including those contained in the Millennium Declaration”, urging developed countries to make efforts to scale-up official development aid to 0.7 percent of gross national product and called on African countries to fulfil the commitment made at the African Summit in Abuja 2001 to allocate 15 percent of their national budgets to health.

Infant and young child nutrition was also discussed leading the Assembly to adopt a resolution calling on member states to continue to protect, promote and support exclusive breastfeeding for the first six months of a baby’s life as a global public health recommendation. Member states were urged to inform health care workers, parents and other care givers on the best practices for preparation, use and handling of powdered infant formula in order to minimise health hazards even as it warned them to be cautious of the fact that powdered infant formula may contain pathogenic micro-organisms and therefore should be prepared and used appropriately.

The 58th Assembly also deliberated passionately on the hydra-headed issue of the international migration of health personnel, particularly highly trained and skilled health personnel moving from developing to developed countries. Against this backdrop a resolution was adopted requesting the WHO Director-General to strengthen WHO’s programme on human resources for health. It was unanimously agreed that the issue of development of human resources for health would be the theme of the 2006 World health Report and World Health Day 2006 and would also be a key area of work in WHO’s General Programme of Work for the period 2006-2015.

The Assembly noted that the countries from which these health personnel are emigrating from have already started experiencing a drain in their health sector and raised an alarm that if nothing is done to halt the trend, it would not only hinder the countries’ quest to achieve the Millennium Development Goals (MDGs), but also increase drastically their disease burden.

WHO had earlier noted that Africa which has 25 percent of the global burden of disease boasts a meagre global health workforce of 1.3 percent. About 23,000 qualified academic professionals emigrate annually to Europe and America in search of the proverbial Golden Fleece. Nigeria has the highest rate of international migration of health personnel in Africa. Newly registered doctors declined from 1,750 in the year 2000 to 800 in 2002, a 60 percent reduction. By 2002, Nigeria had a nurse population ration of 1:20,700 compared with the WHO recommendations of 1:1000.

A resolution on disability was also approved by the Assembly which is aimed at substantially improving the lives of some 600 million people living with disabilities. It also gave a substantial time to the issue of Iodine Deficiency Disorder (IDD) which is a leading cause of brain damage in childhood and therefore called for renewed efforts to eradicate the problem in member states with a higher incidence of iodine deficiency. A lack of iodine intake during pregnancy and early childhood results in impaired cognitive and motor development in young children. The solution to IDD is simple and cost-effective as iodine can easily be added to table salt.

Though iodised salt intake is essential for healthy growth and development, the excess intake of the substance is also a major contributory factor to the increasing incidence of high blood pressure while low intake could result in goitre and low Intelligent Quotient (IQ) especially in growing children and other similar diseases like cretinism (reduced growth), dry skin, constipation, still births and miscarriages.

1 comment:

  1. The original of this article titled 'WHO's search for a disease-free world' was first published by the Guardian Newspapers of Nigeria on Thursday June 9, 2005.