OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 128
SIXTEENTH WORLD HEALTH ASSEMBLY
GENEVA, 7 - 23 MAY 1963
PART II
PLENARY MEETINGS Verbatim Records
COMMITTEES Minutes and Reports
WORLD HEALTH ORGANIZATION GENEVA
December 1963 The following abbreviations are used in the Official Records of the World Health Organization:
ACABQ Advisory Committee on Administrative and Budgetary Questions ACC Administrative Committee on Co- ordination BTAO Bureau of Technical Assistance Operations CCTA Commission for Technical Co- operation in Africa CIOMS - Council for International Organizations of Medical Sciences ECA Economic Commission for Africa ECAFE - Economic Commission for Asia and the Far East ECE - Economic Commission for Europe ECLA - Economic Commission for Latin America FAO Food and Agriculture Organization IAEA International Atomic Energy Agency ICAO International Civil Aviation Organization ILO - International Labour Organisation (Office) IMCO Inter -Governmental Maritime Consultative Organization ITU - International Telecommunication Union MESA - Malaria Eradication Special Account OIHP Office International d'Hygiène Publique OPEX Programme (of the United Nations) for the provision of operational, executive and administrative personnel PAHO - Pan American Health Organization PASB - Pan American Sanitary Bureau SMF Special Malaria Fund of PAHO TAB Technical Assistance Board TAC - Technical Assistance Committee UNESCO - United Nations Educational, Scientific and Cultural Organization UNICEF - United Nations Children's Fund UNRWA - United Nations Relief and Works Agency for Palestine Refugees in the Near East UNSCEAR - United Nations Scientific Committee on the Effects of Atomic Radiation WFUNA - World Federation of United Nations Associations WMO - World Meteorological Organization
The designations employed and the presentation of the material in this volume do not imply the expression of any opinion on the part of the Director- General concerning the legal status of any country or territory or of its authorities, or concerning the delimitation of its frontiers.
PRINTED IN SWITZERLAND The Sixteenth World Health Assembly, held at the Palais des Nations, Geneva, from 7 to 23 May 1963, was convened in accordance with resolution WHA15.28 of the Fifteenth World Health Assembly and resolution EB30.R9 of the Executive Board (thirtieth session).
The proceedings of the Sixteenth World Health Assembly are published in two parts.
The resolutions, with annexes, are printed in OfficialRecords No.127. The records of plenary and committee meetings, list of participants, agenda and other material are contained in the present volume.
Index: page 415
CONTENTS
Page
List of Delegates and other Participants 1
Officers of the Health Assembly and Membership of its Committees 18
Agenda 19
VERBATIM RECORDS OF THE PLENARY MEETINGS
FIRST PLENARY MEETING,Tuesday, 7 May 1963, at 10 a.m.
1. Opening of the Session 23
2.Address by the Representative of the Secretary -General of the United Nations 26
3. Address by the Representative of the Conseil d'Etat of the Republic and Canton of Geneva 26 4.Appointment of the Committee on Credentials 27
5. First Report of the Committee on Credentials 27
6. Election of the Committee on Nominations 31
SECOND PLENARY MEETING,Tuesday, 7 May 1963, at 4 p.m.
1. First Report of the Committee on Nominations 32
2. Second Report of the Committee on Nominations 32
THIRD PLENARY MEETING,Wednesday, 8 May 1963, at 10 a.m.
1. Presidential Address 33
2.Adoption of the Agenda and Allocation of Items to the Main Committees 35
3.Programme of Work 35 4. Second Report of the Committee on Credentials 36
5.Reports of the Executive Board on its Thirtieth and Thirty -first Sessions 36
6.Report of the Director -General on the Work of WHO in 1962 37
7.General Discussion on the Reports of the Executive Board and the Report of the Director - General on the Work of WHO in 1962 40
8.Announcements 46 - V - Page FOURTH PLENARY MEETING, Wednesday, 8 May 1963, at 2.30 p.m.
1. Appointment of the Director -General and Approval of his Contract 47 2. General Discussion on the Reports of the Executive Board and the Report of the Director - General on the Work of WHO in 1962 (continued) 48
3.Announcement concerning the Procedure for Elections to the Executive Board 57
FIFTH PLENARY MEETING, Thursday, 9 May 1963, at 9.30 a.m.
1. General Discussion on the Reports of the Executive Board and the Report of the Director - General on the Work of WHO in 1962 (continued) 57
2.Presentation of the Darling Foundation Medal and Prize. 77
SIXTH PLENARY MEETING, Thursday, 9 May 1963, at 4 p.m.
1. Admission of New Associate Members : Mauritius and Kenya 78
2. General Discussion on the Reports of the Executive Board and the Report of the Director - General on the Work of WHO in 1962 (continued) 81
SEVENTH PLENARY MEETING, Tuesday, 14 May 1963, at 2.30 p.m.
1.Third Report of the Committee on Credentials 93
2. First Report of the Committee on Administration, Finance and Legal Matters 93
3. General Discussion on the Reports of the Executive Board and the Report of the Director - General on the Work of WHO in 1962 (continued) 94
EIGHTH PLENARY MEETING, Tuesday, 14 May 1963, at 9.20 p.m.
1. General Discussion on the Reports of the Executive Board and the Report of the Director - General on the Work of WHO in 1962 (continued) 119
NINTH PLENARY MEETING, Wednesday, 15 May 1963, at 9.40 a.m.
1. Election of Members entitled to Designate a Person to Serve on the Executive Board 135
2. General Discussion on the Reports of the Executive Board and the Report of the Director - General on the Work of WHO in 1962 (continued) 138
3. Announcements 145
4. Statements by the Delegates of Algeria and Portugal 145
TENTH PLENARY MEETING, Thursday, 16 May 1963, at 9.30 a.m.
1. Reports . of the Executive Board on its Thirtieth and Thirty -first Sessions, and Annual Report of the Director - General on the Work of WHO in 1962 (continued) 146
2. First Report of the Committee on Programme and Budget 147 - VI - Page ELEVENTH PLENARY MEETING, Saturday, 18 May 1963, at 9.30 a.m.
1. Second Report of the Committee on Administration, Finance and Legal Matters 148
2. Third Report of the Committee on Administration, Finance and Legal Matters 149
3. Second Report of the Committee on Programme and Budget 149
TWELFTH PLENARY MEETING, Wednesday, 22 May 1963, at 9.30 a.m.
1. Report by the General Chairman of the Technical Discussions 150
2. Third Report of the Committee on Programme and Budget 152
3. Fourth Report of the Committee on Programme and Budget 152
4. Fourth Report of the Committee on Administration, Finance and Legal Matters 152
5. Announcement concerning Closure of the Session 153
THIRTEENTH PLENARY MEETING, Thursday, 23 May 1963, at 9.30 a.m.
1. Expression of Condolence on the Death of Dr S. Syman, Delegate of Israel 153
2. Fourth Report of the Committee on Credentials 153
3. Fifth Report of the Committee on Programme and Budget I 54
4. Sixth Report of the Committee on Programme and Budget 154
5. Fifth Report of the Committee on Administration, Finance and Legal Matters 155
6. Review and Approval of the Reports of the Executive Board on its Thirtieth and Thirty -First Sessions 156
7.Announcement 156
FOURTEENTH PLENARY MEETING, Thursday, 23 May 1963, at 4.30 p.m.
1. Tributes to the Late Dr S. Syman, Delegate of Israel 156
2. Statement by the Delegate of Rwanda 156
3. Closure of the Session 157
MINUTES OF MEETINGS OF COMMITTEES
Page Page General Committee Committee on Programme and Budget First Meeting 163 First Meeting 169 Second Meeting 164 Second Meeting 172 Third Meeting 164 Third Meeting 178 Fourth Meeting 165 Fourth Meeting 189 Fifth Meeting 166 Fifth Meeting 196 Sixth Meeting 166 Sixth Meeting 198 Seventh Meeting 167 Seventh Meeting 210 Eighth Meeting 167 Eighth Meeting 218 Ninth Meeting 168 Ninth Meeting 225 - VII - Page Page Committee on Programme and Budget Committee on Administration, (continued) Finance and Legal Matters
Tenth Meeting 231 First Meeting 324 Eleventh Meeting 241 Second Meeting 328 Third Meeting 335 Twelfth Meeting 257 Fourth Meeting 343 Thirteenth Meeting 268 Fifth Meeting 351 Fourteenth Meeting 282 Sixth Meeting 358 Seventh Meeting 366 Fifteenth Meeting 296 Eighth Meeting 379 Sixteenth Meeting 308 Ninth Meeting 391 Seventeenth Meeting 315 Tenth Meeting 403
COMMITTEE REPORTS Page Committee on Credentials 406
Committee on Nominations 407
General Committee 408
Committee on Programme and Budget 408
Committee on Administration, Finance and Legal Matters 409
Committee on Administration, Finance and Legal Matters to the Committee on Programme and Budget 410
Index 415
- VIII - MEMBERSHIP OF THE HEALTH ASSEMBLY
LIST OF DELEGATES AND OTHER PARTICIPANTS
DELEGATIONS OF MEMBER STATES
AFGHANISTAN Mr O. GARCÍA PIÑEIRO, Counsellor, Permanent Delegates: Mission of Argentina to International Organi- Dr A. R. HAKIMI, Director -General of Health zations in Geneva Services,MinistryofPublicHealth(Chief Delegate) AUSTRALIA Dr A. GHANI AFZAL, Director, Kabul Tuberculosis Delegates: Centre Dr W. D. REFSHAUGE, Director -General of Health, ALBANIA Commonwealth Department of Health (Chief Delegates: Delegate) Dr S. KLosI, Director, Hospital Clinic No. 1, Tirana Mr R. W. FURLONGER, Permanent Representative of (Chief Delegate) Australia to the European Office of the United Dr B. PREZA, Head, Clinic for Nervous Disorders Nations Dr R. C. WEBB, Chief Medical Officer, Australia House, London ALGERIA Delegates: Alternates: Dr M. S. NEKKACHE, Minister of Health and Popula- Dr C. W. PHILLIPS, Medical Director, Migration tion (Chief Delegate) Office of the Australian Embassy in the Nether- Mr C. TALEB, Director, International Organizations lands Division, Ministry of Foreign Affairs Dr C. W. RAMSAY, Medical Officer, Department of Dr M. DJEGHRI, Director of the Minister's Office, Health Ministry of Health AUSTRIA Delegates: Alternates: Dr M. E. EL- KAMAL, Inspector General of Public Dr K. SCHINDL, Director -General of Public Health, Health, Ministry of Health Federal Ministry for Social Affairs (Chief Dele- gate) Dr A. ZIROUT, President, Public Health Commission Dr R. HAVLASEK, Ministerial Secretary, Federal of the National Assembly Ministry for Social Affairs Mr K. AKOUCx TAYEB, Rapporteur, Public Health Commission of the National Assembly Adviser: Mr M. KERMIA, President, Algerian Red Crescent Mr H. GLEISSNER, Deputy Permanent Representative Mr A. BOUDERBA, Chief, International Relations of Austria to the European Office of the United Department, Ministry of Health Nations BELGIUM ARGENTINA Delegates: Delegates: Dr J. F. GOOSSENS, Secretary- General, Ministry of Dr V. V. OLGUIN, Director, International Health Public Health and Family Welfare (Chief Delegate) and Welfare Relations, Ministry of Social Welfare Dr M. KIVITS, Medical Adviser, Ministry of Foreign and Public Health (Chief Delegate) Affairs, Trade and Technical Assistance - 1 - 2 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Mr J. DE CONINCK, Assistant Counsellor; Chief, Dr HLA MYINT, Medical Officer, Sao San Htun International Relations Department, Ministry of Hospital, Taunggyi Public Health and Family Welfare
Advisers: BURUNDI Mr E. LOTZ, Permanent Delegate of Belgium to the Delegates: European Office of the United Nations Mr A. M. BAREDETSE, Minister of Public Health Mr M. J. P. HOULLEZ, Deputy Permanent Delegate (Chief Delegate) of Belgium to the European Office of the United Mr I. MAGEREGERE, Director in the Ministry of Nations Public Health
BOLIVIA Advisers: Delegate: Dr F. LANDRAIN, Medical Adviser, Ministry of Dr F. TORRES -BRACAMONTE, Director -General, Na- Public Health tional Public Health Service Mr J. YANSENNE, Attaché, Ministry of Public Health
BRAZIL CAMBODIA Delegates: Delegates: Dr P. PINHEIRO CHAGAS, Minister of Health (Chief Dr THIOUNN -THOEUN, Physician,Hôpitalde Delegate1) l'AKS (Chief Delegate) Dr A. DE MENDONÇA E SILVA, Director -General, Dr KADEVA HAN, Chief, Technical Bureau, Ministry National Health Department2 of Public Health Dr M. MAGALHAES DA SILVEIRA, Director, Health Planning Division CAMEROON Alternate: Delegates: Dr M. BELCHIOR, Ministry of Health Dr S. P. TCHOUNGUI, Minister of Public Health and Population (Chief Delegate) Dr J. C. HAPPI, Director of Public Health, East BULGARIA Delegates: Cameroon Dr K. IGNATOV, Minister of Public Health and Dr G. G. DIBUE, Director of Medical Services, Welfare (Chief Delegate) West Cameroon Dr D. ARNAUDOV, Chief, Department of Inter- national Relations, Ministry of Public Health and CANADA Welfare (Deputy Chief Delegate) Delegates: Mr G. GAVRILOV, Acting Permanent Representative Dr B. D. B. LAYTON, Principal Medical Officer, of Bulgaria to the European Office of the United International HealthSection,Department of Nations and the International Organizations National Health and Welfare (Chief Delegate) Alternate: Mr S. F. RAE, Ambassador; Permanent Represent- ative of Canada to the European Office of the Mrs 1.SPASOVA, Ministry of Public Health and United Nations (Deputy Chief Delegate) Welfare Dr A. D. KELLY, General Secretary, Canadian BURMA Medical Association Delegates: Alternate: Dr PE KYIN, Director of Health Services (Chief Dr G. MAILLOUX, Immigration Medical Officer, Delegate) Berne Dr HAN TUN, Officer on Special Duty, Ministry of Health Advisers: Mr W. E.BAUER,FirstSecretary, Permanent 1Until 10 May. Mission of Canada to the European Office of the
2Chief Delegate from 10 May. United Nations MEMBERSHIP OF THE HEALTH ASSEMBLY 3
Miss L. GAUTHIER, Second Secretary, Permanent CONGO (Brazzaville) Mission of Canada to the European Office of the Delegates: United Nations Mr R. D. KINZOUNZA, Minister of Public Health and Population (Chief Delegate) Dr B. TcHIKoUNZI, Director, Department of Endemic CENTRAL AFRICAN REPUBLIC Diseases Control Delegates: Mr P. MARADAS -NADO, Minister of Public Health (Chief Delegate) CONGO (Leopoldville) Dr J. A. L. SAUGRAIN, Director, Department of Delegates: Endemic Diseases Control Mr P. BOLYA, Minister of Public Health (Chief Delegate) CEYLON Mr E. NGANDU, Secretary -General, Ministry of Delegates: Public Health Mr B. F. PERERA, Ambassador of Ceylon to the Federal Republic of Germany (Chief Delegate) CUBA Delegates: Dr V. T. HERAT GUNARATNE, Deputy Director of Medical Services Dr C. M. MARTÍNEZ REYES, Regional Director of Public Health, Province of Las Villas(Chief CHAD Delegate) Delegate: Dr M. BALY BALM, Director, Department of Health Dr J. GOURTAY, Director, Department of Endemic Education Diseases Control Dr P. NOGUEIRA RIVERO, Director, Department of International Relations CHILE Delegates: Alternate: Dr A. L. BRAVO, Chief, Technical Department, Dr Coralia PANEQUE, First Secretary, Permanent National Health Service (Chief Delegate) Mission of Cuba to the European Office of the Dr J. A. GONZÁLEZ GONZÁLEZ, Medical Adviser, United Nations and other International Organi- Ministry of Public Health zations in Geneva
Adviser: CHINA Delegates: Mr E. CAMEJO- ARGUDÍN, Ambassador; Permanent Delegate of Cuba to the European Office of the Mr P. N. CHENG, Ambassador; Permanent Repre- United Nations and other International Organi- sentative of China to the European Office of the zations in Geneva United Nations (Chief Delegate) Dr C. K. CHANG, Director, Department of Health Administration, Ministry of Interior CYPRUS Dr H. WEI, Dean, College of Medicine, National Delegate: Taiwan University Dr V. P. VASSILOPOULOS, Director -General, Ministry of Health Adviser:
Mr H. C. KIANG, Second Secretary, Permanent CZECHOSLOVAKIA Mission of China to the European Office of the Delegates: United Nations Dr J. PLOJHAR, Minister of Health (Chief Delegate) COLOMBIA Dr J. VYSOHLÍD, Deputy Minister of Health Delegares: Dr B. DOUBEK, Head, Secretariat of the Minister Dr S. RENJIFO, Minister of Public Health (Chief of Health Delegate) Dr A.ESCOBAR- BALLESTAS, Secretary -General, Alternate: Ministry of Public Health Dr L. HANDL, Ministry of Foreign Affairs 4 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
DAHOMEY Dr H. DANNER, Ministerial Counsellor, Federal Delegate: Ministry of Health Dr Z. S. GANGBO, Technical Adviser, Ministry of Health, Population and Welfare Advisers: Dr W. RoKEN,FederalMedicalAssociation, Adviser: Stuttgart Dr A. QUENUM, Professeur agrégé in Histology and Dr H. LoFFLER, Director of Public Health, Hamburg Embryology Professor W. KoLL, Director, Medical Research DENMARK InstituteoftheMax -Planck Gesellschaft, Delegates: Gottingen Dr Esther AMMUNDSEN, Director - General, National Mr H. VOSSHENRICH, Counsellor, Federal Ministry Health Service (Chief Delegate) of Health Dr O. ANDERSEN, Professor at the University of Mr H. C. VON HARDENBERG, Ambassador; Per- Copenhagen (Deputy Chief Delegate) manent Observer of the Federal Republic of Germany to the European Office of the United Mr J. H. ZEUTHEN, Permanent Under - Secretary of State, Ministry of the Interior Nations; Permanent Delegate to the International Organizations in Geneva Advisers: Mr T. SCHMITZ, Consul of the Federal Republic of Dr C. JACOBSEN Germany in Geneva Mr F. NIELSEN, Assistant Chief of Section, Ministry of the Interior FEDERATION OF MALAYA ECUADOR Delegates: Delegate: Mr ABDUL RAHMAN BIN HAJI TALIB, Minister of Dr J. A. MONTALVÁN C., Director, National Institute Health (Chief Delegate) of Hygiene Dr M. DIN BIN AHMAD, Director of Medical Services ETHIOPIA Delegates: Mr Y. M. C. HON, Deputy Permanent Secretary, Mr A. RETTA, Minister of Public Health (Chief Ministry of Health Delegate) Alternate: Mr H. SEBSIBE, Director -General, Ministry of Public Dr L. W. JAYESURIA, Deputy Director of Medical Health Services Dr A. WOLDESEMAIT, Medical Practitioner, Princess Tsehai Haile Selassie Hospital FINLAND Delegates: FEDERAL REPUBLIC OF GERMANY Professor N. PESONEN, Director -General, National Medical Board (Chief Delegate) Delegates: Dr A. P. OJALA, Chief, Public Health Division, Dr Elisabeth SCHWARZHAUPT, Federal Minister of National Medical Board Health (Chief Delegate') DrJ. STRALAU,MinisterialDirector,Federal Secretary: Ministry of Health (Deputy Chief Delegate 2) Mr E. HEINRICHS, Attaché, Permanent Delegation Dr Maria DAELEN, Director, International Relations of Finland to the International Organizations in Section, Federal Ministry of Health Geneva Alternates: FRANCE ProfessorE. G. NAUCK, Director,Institute of Delegates: Tropical Medicine, Hamburg Professor E. J. AUJALEU, Director -General of Public 1 Until 9 May. Health, Ministry of Public Health and Population 2 Chief Delegate from 9 May. (Chief Delegate) MEMBERSHIP OF THE HEALTH ASSEMBLY 5
Dr J. S. E. CAYLA, Inspector- General, Ministry of GREECE Public Health and Population Delegates: Dr L.P. AUJOULAT, Former Minister;Chief, Dr T. KATSACOS, Director, Health Service, Depart- TechnicalCo- operationService,Ministryof ment of Athens (Chief Delegate) Public Health and Population; Director, National DrJ.ANASTASSIADES,ConsultantPsychiatrist, Centre for Health and Social Education Ministry of Social Welfare Advisers: Dr R. SOHIER, Professor of Hygiene, Faculty of GUATEMALA Medicine, University of Lyons Delegate: Dr P. M. BERNARD, Technical Adviser, Ministry of Mr A.DUPONT- WILLEMIN, Consul -Generalof Co- operation Guatemala in Geneva; Permanent Representative Miss E. BAUDRY, Chief, International Relations of Guatemala to the European Office of the Office, Ministry of Public Health and Population United Nations and the International Labour Miss N. TRANNOY, Secrétaire d'ambassade, Per- Organisation manent Mission of France to the European Office of the United Nations and Specialized Agencies GUINEA in Geneva Delegate: Miss J. BALENCIE, Assistant Secretary at the Ministry Dr O. KEITA, Director of the Minister's Office, of Foreign Affairs Ministry of Public Health and Social Welfare Miss C. CARIGUEL, Senior Officer, International Relations Division, Ministry of Public Health HUNGARY and Population Delegates: Dr I. SIMONOVITS, First Vice -Minister of Health GABON Delegates: (Chief Delegate) Dr J. B. BIYOGHE, Director of Public Health (Chief Dr D. FELKAI, Envoy Extraordinary and Minister Delegate) Plenipotentiary Dr J. -P. MARTINAZZO, Inspector, Department of Dr Z. SZABO Endemic DiseasesControl;Chief,Technical Secretary: Office, Ministry of Public Health Mr J. R.EGos, Third Legation Secretary, Permanent Mission of Hungary to the European Office of the GHANA United Nations Delegates: ICELAND Dr C. O. EASMON, Surgeon in Chief, Ministry of Delegates: Health (Chief Delegate) Dr S.SIGURDSSON, Director -General of Public Dr J. N. ROBERTSON, Principal Medical Officer, Health (Chief Delegate) Ministry of Health Dr J. SIGURJÓNSSON, Professor of Hygiene, Univer- Dr J. Adjei SCHANDORF, Member of the Medical and sity of Iceland Dental Board of Ghana, and of the Council of the Ghana Medical Association INDIA Alternate: Delegates: Mr H. A. H. S. GRANT, Ambassador; Permanent Dr Sushila NAYAR, Union Health Minister (Chief Representative of Ghana to the European Office Delegate) of the UnitedNations and theSpecialized Dr K. NAGAPPA ALVA, Minister of Health, Govern- Agencies in Geneva ment of Mysore Dr A. L. MUDALIAR, Vice -Chancellor, University Adviser: of Madras Miss A. V. A. WooD, First Secretary, Permanent Mission of Ghana to the European Office of the Alternate: United Nations and the Specialized Agencies in Dr M. S. CHADHA, Director -General of Health Geneva Services 6 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Secretary: Dr J. D. HOURIHANE, Deputy Chief Medical Adviser, Dr N. JUNGALWALLA, Deputy Director -General of Department of Health Health Services ISRAEL Delegates: INDONESIA Delegates: Mr I. RAFAEL, Deputy Minister of Health (Chief Dr Hurustiati SUBANDRIO, Deputy Health Minister; Delegate) Director, Bureau of Foreign Affairs, Department Dr S. SYMAN, Director -General, Ministry of Health of Health (Chief Delegate) Dr D. BRAKHOTT, District Health Officer, Ministry Dr H. WIKNJOSASTRO, Professor of Obstetrics and of Health, Central District Gynecology, Faculty of Medicine, University of Advisers: Indonesia Dr Tova YESHURUN -BERMAN, Member of the Adviser: Executive Council of the Sick Fund, Tel Aviv DrR. SUNARIO, FirstSecretary,Indonesian Mr E. TAVOR, First Secretary, Permanent Delegation Embassy in Switzerland of Israel to the European Office of the United Nations
IRAN ITALY Delegates: Delegates: Dr E. RIAHY, Minister of Health (Chief Delegate) Professor N. SANTERO, Under - Secretary of State, Dr A. T. DIBA, Under - Secretary of State for Public Ministry of Health (Chief Delegate) Health and Parliamentary Affairs (Deputy Chief Mr F. P. VANNI D'ARCHIRAFI, Ambassador; Per- Delegate) manent Representative of Italy to the European Dr H. MORSHED, Director -General of Public Health Office of the United Nations (Deputy Chief Delegate) Advisers: Mr U. DE LEONI,Director - General and Chief, Dr M. ROWHANI, Director - General of Medical and InternationalRelationsService,Ministryof Health Services, National Iranian Oil Company, Health Teheran Alternates: Dr H. BASSEGHI, Director, Health Department of the Plan Organization Professor S. CRAMAROSSA, Director -General, Public Health and Hospitals Section, Ministry of Health Mr S. GOLESTANEH, FirstSecretary, Permanent Delegation of Iran to the European Office of the Professor G. A. CANAPERIA, Chief Inspector -General, Ministry of Health United Nations and the Specialized Agencies Mr B. FENZI, Embassy Counsellor; Deputy Per- manent Representative of Italy to the European IRAQ Office of the United Nations Delegates: Mr L. PINTUS, Head of the Secretariat of the Under- Dr S. AL- WAHBI, Director of International Health, Secretary of State, Ministry of Health Ministry of Health (Chief Delegate) Professor F. PETRILLI, Director, Institute of Hygiene, Dr F. H. GHALI, Assistant Dean, Baghdad Medical University of Genoa College Dr R. VANNUGLI, Office of International and Mr I. T. KITTANI, Minister Plenipotentiary; Per- Cultural Affairs, Ministry of Health manent Representative of Iraq to the European Office of the United Nations Advisers: ProfessorB.BABUDIERT,IstitutoSuperioredi Sanità, Rome IRELAND Delegates: Professor A. CORRADETTI, IstitutoSuperiore di Sanità, Rome Mr T. J. BRADY, Assistant Secretary, Department of Health (Chief Delegate) 1 Dr Syman died during the session - on 22 May. MEMBERSHIP OF THE HEALTH ASSEMBLY 7
Professor P. SCROCCA, Member of the Superior LAOS Health Council Delegates: Professor F. TOFFOLI, Istituto Superiore di Sanità, Dr O. SOUVANNAVONG, Adviser to the Ministry Rome of Public Health (Chief Delegate) Dr C. S. SAIGNAVONGS, Director, National Maternal IVORY COAST and Child Health Service Delegates: Dr B. N'DIA KOFFI, Minister of Public Health and Population (Chief Delegate) LEBANON Dr H. VARLET, Director- General of Public Health Delegates: Dr P. DELORMAS, Technical Adviser in the Minister's Dr H. H. JALLOUL, Director of Preventive Health Office, Ministry of Public Health and Population Services, Ministry of Public Health Dr E. WAKIL, Director of Medical Care, Ministry of Public Health JAMAICA Delegates: LIBERIA Dr H. ELDEMIRE, Minister of Health (Chief Delegate) Delegates: Dr A. A. PEAT, Chief Medical Officer, Ministry Dr E. M. BARCLAY, Director -General, National of Health Public Health Service (Chief Delegate) JAPAN Dr J. -B. TITUS, Adviser, National Public Health Delegates: Service; Director, Preventive Medicine Bureau Dr T. OMURA, Director, Public Health Bureau, Ministry of Health and Welfare (Chief Delegate) LIBYA Mr K. CHIKARAISHI, Counsellor, Permanent Delega- Delegates: tion of Japan to the International Organizations in Geneva Dr A. BISCHTI, Minister of Health (Chief Delegate) Mr Y. SAITO, Counsellor and Chief Liaison Officer, Dr A. ABDULHADI, Ministry of Health International Affairs, Ministry of Health and Dr M. MAGHUR, Ministry of Health Welfare Advisers: Alternate: Dr A. H. TURGUMAN, Ministry of Health Mr N. TAKIZAWA, FirstSecretary, Permanent Delegation of Japan to the International Organi- Mr A. BADI, Ministry of Health zations in Geneva LUXEMBOURG JORDAN Delegates: Delegate: Dr L. MOLITOR, Director of Public Health (Chief Dr K. A.SHAMI, Director of PublicHealth, Delegate) Ministry of Health Mr I. BESSLING, Permanent Delegate of Luxembourg to the European Office of the United Nations KUWAIT Dr E. DUHR, Inspector of Public Health Delegates: Mr A. M. THUNAIN, Minister of Public Health (Chief Delegate) MADAGASCAR Delegates: Mr Y. J. HIM, Under - Secretary of State, Ministry of Public Health (Deputy Chief Delegate) Dr J. RAVOAHANGY -ANDRIANAVALONA, Minister Of Public Health and Population (Chief Delegate) Dr A. AL- RASCHIED, Paediatrician Dr A. C. ANDRIAMASY, Minister Plenipotentiary, Adviser: Ministry of Foreign Affairs Dr A. K. EL- BORAI, Chief Medical Officer, Ministry Mr J. ANDRIAMALALA, Ministry of Public Health of Public Health and Population 8 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
MALI Mr M. AMOR, Ambassador of Morocco to Switzer- Delegates: land Dr S. DoLO, Minister of Public Health and Social Mr A. EL KOUHEN, Director of the Minister's Affairs (Chief Delegate) Office, Ministry of Public Health Mr A. SANGARÉ, Counsellor, Embassy of Mali in France Alternates: Dr M. SENTICI, Director of Technical Services, MAURITANIA Ministry of Public Health Delegates: Mr M. FERAA, Director, Research Bureau, Ministry Dr B. BOCAR ALPHA, Minister of Health, Labour of Public Health and Social Affairs (Chief Delegate) Mr M. TouRÉ, Ambassador of Mauritania to the Federal Republic of Germany NEPAL Delegate: Dr D. BAIDYA, Director of Health Services MEXICO Delegates:
Dr A. LÓPEZ SÁNCHEZ, Envoy Extraordinary and NETHERLANDS MinisterPlenipotentiary;Director - General of Delegates: Administration, Ministry of Health and Welfare ProfessorP.MUNTENDAM, Director -General of (Chief Delegate) Public Health (Chief Delegate) Professor M. VELASCO- SUÁREZ, Director -General Dr R. H. J. KRUISINGA, Director of Scientific of Neurology, Mental Health and Rehabilitation, Research andPlanning,MinistryofSocial Ministry of Health and Welfare Affairs and Public Health (Deputy Chief Delegate) Dr A.Ríos -VARGAS,Director,Angel Gavifio Research Hospital Advisers: Professor J. H. DE HAAS, Head, Department of Social Hygiene, Netherlands Institute of Pre- MONACO ventive Medicine, Leyden Delegates: Professor A. T. L. M. MERTENS, Professor of Social Mr H. SouM, Minister of Monaco in Switzerland Medicine, University of Nijmegen (Chief Delegate) Miss A. F. W. LUNSINGH MEIJER, Deputy Per- Dr E. BoÉRI, Commissioner- General for Public manent Representative of the Netherlands to Health (Deputy Chief Delegate) the European Office of the United Nations Mr J. -C. MARQUET, Conseiller juridique du Cabinet Miss J. SCHALIJ, Department of International Health de S.A.S. le Prince de Monaco Affairs, Ministry of Social Affairs and Public Health
MONGOLIA Delegates: NEW ZEALAND Delegates : Dr G. TUVAN, Minister of Public Health (Chief Delegate) Dr H. B. TURBOTT, Director -General, Department of Health (Chief Delegate) Dr Peljegin DOLGOR, Chief Surgeon, Ministry of Public Health Mr B. D. ZOHRAB, Permanent Representative of New Zealand to the European Office of the Mr N. IsoGT, Expert at the Ministry of Foreign United Nations Affairs
MOROCCO NICARAGUA Delegates: Delegate: Dr A. KHATIB, Minister of Public Health (Chief Dr O. AVILÉS, Director of Administrative Services, Delegate) Ministry of Public Health MEMBERSHIP OF THE HEALTH ASSEMBLY 9
NIGER PANAMA Delegates: Delegates: Dr H. KOUKA, Minister of Labour and Public Dr B. GONZALEZ Ruiz, Minister of Labour, Social Health (Chief Delegate) Welfare and Public Health (Chief Delegate) Dr J. KABA, Chief Medical Officer, Public Health Mr R. E. CUCALÓN ICAZA, Assistant Director, Service Official Protocol Service
NIGERIA PARAGUAY Delegates: Delegate: Dr M. A. MAJEKODUNMI, Federal Minister of Dr D. F. LOFRUSCIO, Director, First Health Region, Health (Chief Delegate) Acting Director - General of Health, Ministry of Mr B.C. Oxwu, Minister of Health, Eastern Public Health and Social Welfare Nigeria (Deputy Chief Delegate) Dr O. B. ALAKIJA, Acting Chief Medical Adviser PERU to the Federal Government Delegate: Dr C. QUIRÓS SALINAS, Director -General of Health, Alternates: Ministry of Public Health and Welfare Mr C. O. LAWSON, Permanent Secretary, Federal Ministry of Health Dr S. E. ONWU, Director of Medical Services and PHILIPPINES Permanent Secretary, Ministry of Health, Eastern Delegates: Nigeria Dr C. S. GATMAITAN, Under - Secretary for Health and Medical Services (Chief Delegate) Dr O. ADENIYI- JONES, Medical Officer of Health, Lagos Town Council Dr R. T.CAtvos, Under - Secretary forSpecial Health Services Secretary: POLAND Mr J. E. T. PECKU, Assistant Secretary, Federal Delegates: Ministry of Health ProfessorF.WIDY- WIRSKI, DeputyMinister, Ministry of Health and Social Welfare (Chief Delegate) NORWAY Delegates: Professor B. GORNICKI, Rector, Academy of Medi- Dr K. EVANG, Director -General of Health Services cine, Warsaw (Chief Delegate) Dr M. KACPRZAK, Professor at the Faculty of Medicine, Warsaw Dr J.BJ6RNSSON, Deputy Director -Generalof Health Services Alternates: Dr A. STRoM, Dean of the Faculty of Medicine, and Professor K. RowINSKI, Head of the Department of Professor of Social Medicine, University of Oslo PaediatricRadiology,Warsaw Academyof Medicine; DeputySecretary,Department of Alternate: Medical Sciences, Polish Academy of Science Dr 0. JONASSEN, County Commissioner of Health, Mr K. SZABLEWSKI, Second Secretary, Permanent Stir- Tróndelag Representation of Poland to the European Office of the United Nations
PAKISTAN Delegates: PORTUGAL Dr M. S. HAQUE, Director- General of Health, and Delegates: Joint Secretary, Ministry of Health, Labour and Dr P. M. SOARES MARTINEZ, Minister of Health Social Welfare (Chief Delegate) and Welfare (Chief Delegate) Dr T. M. NIAZ, Deputy Director -General of Health, Dr A. DA SILVA TRAVASSOS, Director -General of and DeputySecretary,Ministryof Health, Health, Ministry of Health and Welfare (Deputy Labour and Social Welfare Chief Delegate) 10 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Dr M. A. DE ANDRADE SILVA, Senior Inspector of Alternate: Health Overseas Mr R. NEAGU, Third Legation Secretary, Ministry of Foreign Affairs Alternates: Dr A. A. DE CARVALHO SAMPAIO, Senior Inspector of Health and Hygiene RWANDA Delegate: Dr F. J. P. PINTO DE BALSEMXO, Secretary to the Minister of Health and Welfare Mr M. GASHAKAMBA, Director, Kigali Hospital Advisers: Advisers: Dr F. DE ALCAMBAR PEREIRA, Permanent Represen- Dr F. X. VANDERICK, Adviser to the Ministry of tative of Portugal to the World Health Organi- Health zation Mr J. MBONYIMANA, Legation Secretary, Brussels Dr A. H. DE ALMEIDA COELHO- LOPES, Consul - General of Portugal in Paris SAUDI ARABIA Delegates:
REPUBLIC OF KOREA Dr R. ALSAYED ALY, Adviser to the Ministry of Delegates: Health (Chief Delegate) Dr Chung Kun PARK, Director, Bureau of Medical Dr H. KRIMLY, Director of Quarantine, Jeddah Affairs, Ministry of Health and Social Affairs Airport (Chief Delegate) SENEGAL Dr Sang Tae HAN, Senior Medical Officer in charge Delegates: of International Health, Ministry of Health and Mr D. COLY, Minister of Health and Social Affairs Social Affairs (Chief Delegate) Mr Soon Kun CHUNG, First Secretary, Permanent Delegation of the Republic of Korea to Inter- Dr L. DIALED, Deputy Director of Public Health, national Organizations in Geneva and Office Ministry of Health and Social Affairs of the Permanent Observer to the European Dr H. BA, Chief Medical Officer, Cape Vert Region Office of the United Nations Alternates: Mr B. N'DIAYE, Ambassador; Permanent Represen- REPUBLIC OF VIET -NAM tative of Senegal to the European Office of the Delegates: United Nations and the Specialized Agencies in Switzerland Professor TRAN DINH DE, Secretary of State for Health (Chief Delegate) Mr A. N'DIAYE, Secrétaire d'ambassade Dr LE CUU TRUONG, Director -General of Health and Hospitals SIERRA LEONE Mr NGUYEN VAN THINH, First Secretary, Embassy Delegates: of the Republic of Viet -Nam in the Federal Mr D. L.SUMNER, Minister of Health (Chief Republic of Germany Delegate) Dr D. E. BOYE- JOHNSON, Deputy Chief Medical Officer, Ministry of Health ROMANIA Delegates: Mr M. A. O. FINDLAY, Acting Permanent Secretary, Dr S. IOAN, Deputy Minister of Health and Social Ministry of Health Welfare (Chief Delegate) Dr P. SGINDAR, Director of the Secretariat and of SOMALIA International Relations, Ministry of Health and Delegates: Social Welfare Mr ABDIRAHMAN HAM MOOMIN, Under - Secretary Dr M. ALDEA, Deputy Inspector -General, Ministry of State, Ministry of Health, Veterinary Medicine of Health and Social Welfare and Labour (Chief Delegate) MEMBERSHIP OF THE HEALTH ASSEMBLY 11
Mr A.F. ABRAR, Chief,Health Department, Dr M. TOTTIE, Medical Officer, National Board of Ministry of Health, Veterinary Medicine and Health Labour Alternates: Dr A.S. IBRAHIM, Medical Officer, Demartino Professor G. BIóRCc Hospital Mr C. LIDBOM, Head of Division, Ministry for SOUTH AFRICA Social Affairs Delegates: Mr C. H. VON PLATEN, Ambassador Extraordinary Dr C. A. M. MURRAY, Regional Director, State and Plenipotentiary; Permanent Representative Health Services, South Transvaal Region (Chief of Sweden to the European Office of the United Delegate) Nations and other International Organizations in Geneva Mr C. H. TALJAARD, Ambassador Extraordinary and Plenipotentiary of South Africa in Switzer- SWITZERLAND land Delegates: Mr I. J. MARAIS, Principal Administrative Officer, Dr A. SAUTER, Director, Federal Public Health State Health Department Service (Chief Delegate) Dr P.KÜRSTEINER, AssistantMedicalOfficer, Federal Public Health Service SPAIN Delegates: Mr F. PIANCA, Legal Officer, International Organi- Professor J. GARCÍA ORCOYEN, Director - General of zations Division, Federal Political Department Health (Chief Delegate) Alternates: Mr J. M. ANIEL -QUIROGA, Minister Plenipotentiary; Dr C. FLEURY, Chief, Infectious Diseases Section, Permanent Delegate of Spain to the International Federal Public Health Service Organizationsin Geneva Dr J. -P. PERRET, Assistant Medical Officer, Federal ProfessorG.CLAVERO DEL CAMPO,Director, Public Health Service National School of Health Advisers: Alternates: Professor M. SCH. R, Director, Institute of Preven- Mr L. ARROYO AZNAR, Deputy Permanent Delegate tive and Social Medicine, University of Zurich of Spain to the International Organizations in Dr O. JEANNERET, Assistant Medical Officer, Youth Geneva Health Service, Department of Education of the Mr M. DE VILLEGAS Y URZÁIZ, Embassy Counsellor, Canton of Geneva Permanent Delegation of Spain to the Inter- national Organizations in Geneva Secretary: Mr J. J. ARBOLI DES VALLS, Embassy Secretary, Miss A. -M. DURING, Federal Public Health Service Permanent Delegation of Spain to the Inter- national Organizations in Geneva SYRIA Delegates: SUDAN Dr A. ARAFEH,Secretary -General,Ministry of Delegates: Health and Public Assistance (Chief Delegate) Dr A. KHALIL, Acting Under - Secretary, Ministry Dr Dia E. CHATTY, Director of International Health of Health (Chief Delegate) Affairs (Deputy Chief Delegate) Dr MAHGOUB HAMZA, Province Medical Officer of Dr Y. SAYEGH Health, Port Sudan. TANGANYIKA Delegates: SWEDEN Mr S. A. MASWANYA, Minister for Health (Chief Delegates: Delegate) Dr A. ENGEL, Director -General of Public Health Dr C. V. MTAWALI, Permanent Secretary, Ministry (Chief Delegate) of Health 12 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
THAILAND UNION OF SOVIET SOCIALIST REPUBLICS Delegates: Delegates: ProfessorP. SANGSINGKEO, Director -General, Department of Medical Services, Ministry of Dr S.V. KURASOV, Minister of Health of the Public Health (Chief Delegate) USSR (Chief Delegate) Dr P. CHANDAVIMOL, Deputy Director -General, Professor V. M. ZDANOV, Director, Institute of Department of Health, Ministry of Public Health Virology of the USSR Academy of Medical Sciences Mr S. VEJJAJIVA, Chief, International Health Divi- sion, Office of the Under - Secretary of State for Dr G. A. NOVGORODCEV, Chief, Department of Public Health External Relations, USSR Ministry of Health Alternates: TOGO Delegates: Mr P. S. KOSENKO, Assistant Chief, Department of Dr VOVOR, Ministerof PublicHealth (Chief International Economic Organizations, USSR Delegate) Ministry of Foreign Affairs Dr J. AMORIN, Deputy Director of Public Health DrJu.P.LISICYN, Deputy Director, Semasko Instituteof Public Health Organization and History of Medicine, Moscow TRINIDAD AND TOBAGO Advisers: Delegate: Professor Z.I.JANUAKEVICUS,Rector, Kaunas Dr L. M. COMISSIONG, Chief Medical Officer, Medical Institute Ministry of Health and Housing Mr V. S. POZARSKIJ, Counsellor, Permanent Repre- sentation of the USSR to the European Office TUNISIA of the United Nations Delegates: Dr R. M. STARKOV, Member of the Editorial Board Ambassador of Tunisia to Switzer- of Medicinskaja Gazeta land; Permanent representative of Tunisia to the Mr A. D. ALESIN, Senior Inspector, Department of European Office of the United Nations and the External Relations, USSR Ministry of Health Specialized Agencies (Chief Delegate) Dr D. D. VENEDIKTOV, Adviser, Representation of Dr A. R. FARAH, Director, National Tuberculosis the USSR to the United Nations, New York Institute Dr M. BAHRI, Medical Inspector; Chief, Hospitals Section, Secretariat of State for Public Health and UNITED ARAB REPUBLIC Social Affairs Delegates: Adviser: Dr M. H. EL BITASH, Under - Secretary of State, Mr R. Azouz, Chief, External and International Ministry of Public Health (Chief Delegate) Relations Section, Secretariat of State for Public Professor M. A. ABBASY, Dean, High Institute of Health and Social Affairs Public Health, University of Alexandria Dr H. M. EL -KADI, Director of International Health, and Technical Director of the Minister's TURKEY Office, Ministry of Public Health Delegates: Dr N. H. FISEK, Under - Secretary of State, Ministry Adviser: of Health and Social Welfare (Chief Delegate) Mr M. F. ABDEL BARR, Legal Adviser, Ministry of Dr T. ALAN, Director -General of International Public Health Relations, Ministry of Health and Social Welfare
UNITED KINGDOM OF GREAT BRITAIN UGANDA AND NORTHERN IRELAND Delegate: Delegates: Dr I.S.KADAMA, Chief Medical Officer and Sir George GODBER, Chief Medical Officer, Ministry Permanent Secretary, Ministry of Health of Health (Chief Delegate) MEMBERSHIP OF THE HEALTH ASSEMBLY 13
Mr J. M. LISTON, Medical Adviser, Department of Dr A. E. I IKLI, Medical Consultant, Division of Technical Co- operation International Health, United States Public Health Service, Department of Health, Education and Mr H. N. ROFFEY, Assistant Secretary, Ministry of Welfare Health Mr J. WACHOB, United States Mission to the Euro- Alternates: pean Office of the United Nations and other Sir Kenneth COWAN, Chief Medical Officer, Scottish Organizations in Geneva Home and Health Department Mr S.H. WHALEY, Vice -President for Health Dr L. H. MURRAY, Principal Medical Officer, Sciences, University of Arkansas Medical Center Ministry of Health Dr C. L. WILBAR, Secretary of Health, Pennsyl- vania Department of Health Advisers: Mr C. P. SCOTT, Permanent Representative of the Mr G. A. TESORO, United States Mission to the United Kingdom to the European Office of the European Office of the United Nations and other United Nations Organizations in Geneva Mr J. D. MILLER, Deputy Permanent Representa- Secretary: tive of the United Kingdom to the European Mr W. G. MURPHY, Office of International Con- Office of the United Nations ferences, Department of State Secretary: Miss M. I. BRABANT, Ministry of Health UPPER VOLTA Delegate:
UNITED STATES OF AMERICA Dr P. LAMBIN, Minister of Public Health and Population Delegates: Dr L. L. TERRY, Surgeon General, United States VENEZUELA Public Health Service, Department of Health, Delegates: Education and Welfare (Chief Delegate) Dr D. CASTILLO, Assistant to the Director of Public Mr N. M. MCKITTERICK, Director, Office of Inter- Health, Ministry of Health and Social Welfare national Economic and Social Affairs, Depart- (Chief Delegate) ment of State Dr G. FIGUEROA, Assistant Medical Officer, Inter- Dr J. WATT, Assistant Surgeon General; Chief, national Health Section, Ministry of Health and Division of International Health, United States Social Welfare Public Health Service, Department of Health, Education and Welfare Adviser: Mr H. APONTE, First Secretary, Permanent Delega- Alternates: tion of Venezuela to United Nations Organi- Mr H. B. CALDERWOOD, Office of International zations in Geneva Economic and Social Affairs, Department of State Dr C. L. WILLIAMS, Chief, International Relations WESTERN SAMOA Division, United States Public Health Service, Delegate: Department of Health, Education and Welfare Dr J. C. THIEME, Director of Health Advisers: Mr J. E. FOGARTY, House of Representatives YEMEN Mr M. R. LAIRD, House of Representatives Delegate: Dr J. Z. APPEL, Vice -Chairman, Board of Trustees Mr A. A. MOHANNY, Director-General, Ministry of of the American Medical Association Health 14 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
YUGOSLAVIA Dr H. KRAUS, Director, Federal Institute of Public Delegates: Health Mr M. MARKOV16, Secretary for Public Health and Advisers: Social Welfare, Federal Executive Council (Chief Mr S. goá, Counsellor, Permanent Delegation of Delegate) Yugoslavia to the European Office of the United Professor R. GERIC, Deputy Secretary for Public Nations and Specialized Agencies in Europe Health and Social Welfare (Deputy Chief Delegate) Mrs V. VLAHOVIC, Second Secretary, Secretariat of State for Foreign Affairs
REPRESENTATIVES OF ASSOCIATE MEMBERS
KENYA 1 Dr N. R. E. FENDALL, Director of Medical Services
MAURITIUS 2 Mr J. G. FORGET, Minister of Health and Reform Institutions Dr B. TEELOCK, Principal Medical Officer, Ministry of Health
OBSERVERS FOR NON -MEMBER STATES HOLY SEE manent Observer of San Marino to the European Rev. Father H. M. DE RIEDMATTEN, Adviser, Inter- Officeof the United Nations, and Permanent national Catholic Organizations Centre, Geneva Delegate to the International Agencies in Geneva Dr J. ROGGO, Director, Fribourg State Institute of Mr J. MUNGER, Counsellor, Office of the Permanent Hygiene and Bacteriology Observer of San Marino to the European Office SAN MARINO of the United Nations, and Permanent Delegation Mr G. FILIPINETTI, Minister Plenipotentiary; Per- to the International Agencies in Geneva
OBSERVERS ORDER OF MALTA Mr E. DECAZES, Legation Counsellor; Deputy Delegate Mr A. KocH, Ambassador; Permanent Delegate of of the Order of Malta to International Organizations the Order of Malta to International Organizations in Geneva in Geneva Dr R. TOLEDO, Medical Adviser
REPRESENTATIVES OF THE EXECUTIVE BOARD Dr M. K. AFRIDI, Chairman of the Board Dr A. NABULSI, Chairman, Standing Committee on Administration and Finance
REPRESENTATIVESOF THE UNITED NATIONS AND ITS AGENCIES
United Nations Mr N. G. LUKER, External RelationsOfficer, Mr G. PALTHEY, Deputy Director, European Office European Office
1 Admitted to associate membership on 9 May 1963 (reso- United Nations Children's Fund lution WHA16.4). 2 Admitted to associate membership on 9 May 1963 (reso- Sir Herbert BROADLEY, UNICEF R epresentative lution WHA16.3). in the United Kingdom MEMBERSHIP OF THE HEALTH ASSEMBLY 15
UnitedNationsReliefand Works Agency forPalestine Mr J. LEMOINE, International Organisations Divi- Refugees in the Near East sion Dr S. FLACHE, Director of Health Mr M. PARANHOS DA SILVA, International Organi- sations Division United Nations Special Fund Mr R. ETCHATS, Representative in Europe Dr M. PAVLOV, Occupational Safety and Health Division Permanent Central Opium Board and Drug Supervisory Body Mr L. ATZENWILER, Secretary, Permanent Central Food and Agriculture Organization Opium Board and Drug Supervisory Body Mr N. CRAPON DE CAPRONA, Liaison Officer, Intel:- national Agency Liaison Branch, Programme Office of the High Commissioner for Refugees Liaison Division Mr F. SCHNYDER, High Commissioner Mr F.H. TOWNSHEND, LiaisonOfficer, Food Mr J. ASSCHER, Chief of theSecretariat Standards Programme,InternationalAgency Liaison Branch Technical Assistance Board Mr G. G. WATTERSON, Liaison Officer for Africa, Mr R. ETCHATS, Representative in Europe Programme LiaisonDivision
International Labour Organisation Universal Postal Union Dr R. A. MÉTALL, Chief, International Organi- Mr F. A. HOFMAN, Deputy Director sations Division Mr R. BARRIENTOS PÉREZ, Adviser
REPRESENTATIVES OF INTERGOVERNMENTAL ORGANIZATIONS
Commission for Technical Co- operation in Africa International Committee of Military Medicine and Pharmacy Mr J. -P. SARRAUTTE, Head of Publications Office, Général - Médecin J. VONCKEN, Secretary -General London League of Arab States Council of Europe Dr A. T. SHOUSHA, Supervisor, Health Department Mr M. PFEFFERMANN, Chief, Public Health Divi- sion United International Bureaux for the Protection of Industrial Property, Literary and Artistic Works Intergovernmental Committee for European Migration Mr R. WOODLEY, Counsellor, Head of Industrial Dr C. Scnou, Medical Officer Property Division
REPRESENTATIVES OF NON -GOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO
Central Council for Health Education International Association of Microbiological Societies Dr A. J. DALZELL -WARD, Medical Director Professor R. H. REGAMEY
Council for International Organizations of Medical Sciences International Association for Prevention of Blindness Professor R. CRUICKSHANK, President Professor D. KLEIN Dr P. -A. MESSERLI, Executive Secretary Dr F. AMMANN
International Air Transport Association International Committee of Catholic Nurses Mr R. W. BONHOFF Miss G. VAN MASSENHOVE, Secretary- General Dr Viola DE RIEDERER International Association of Logopedics and Phoniatrics Miss CHARLES - ROQUES Professor L. CROATTO, President Dr Jules -Marie HEYMANS Dr S. SMITH, General Secretary Sister L. M. RoGÉ 16 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
International Committee of the Red Cross International Society for Rehabilitation of the Disabled Mr F. DE REYNOLD, Chief, Liaison Service Miss A. E. MOSER Mr P. BASSET International Union of Architects International Confederation of Midwives Mr W. F. VETTER Miss H. PAILLARD International Union against Cancer International Conference of Social Work Dr J. F. DELAFRESNAYE, Director, Geneva Office Mrs K. KATZKI International Union for Child Welfare International Council of Nurses Miss A. E. MOSER, Deputy Secretary - General MISS A. G. S. CLAMAGERAN, President Miss C. JACOT Miss G. DE LANGENHAGEN Miss A. C. SHER, Assistant General Secretary International Union for Health Education Mr H. ENNES, President International Council of Societies of Pathology Dr L. P. AUJOULAT, Secretary -General Professor E. A. UEHLINGER Mrs A. M. KAPLUN -LE MEITOUR
International Dental Federation International Union of Local Authorities Dr C. L. BOUVIER Mr F. COTTIER Professor L. J. BAUME
International Federation of Gynecology and Obstetrics International Union of Pure and Applied Chemistry Professor H. DE WATTEVILLE, Secretary - General Dr R. MORE, Secretary - General Professor W. GEISENDORF Dr E. THEISS Dr R. BORTH International Union against Tuberculosis InternationalHospital Federation Professor E. BERNARD, Secretary- General Mr D. G. HARINGTON HAWES, Director -General Dr J. HOLM, Executive Director
International League against Rheumatism International Union againstthe VenerealDiseases and the Professor A. ROBECCHI Treponematoses Professor F. DELBARRE Professor G. A. CANAPERIA, Secretary -General Dr M. TOTTIE International Leprosy Association Dr J. M. LISTON International Water Supply Association
International Paediatric Association Mr L. MILLIs, Secretary -General Professor G. FANCONI, Secretary- General League of Red Cross Societies International Society of Blood Transfusion Mr H. BEER, Secretary -General Professor R. FISCHER Dr Z. S. HANTCHEF, Medical Director Miss Y. HENTSCH, Director, Nursing Bureau International Society of Cardiology Mr K. SHANKER NIGAM, Director, International Professor P. W. DUCHOSAL, President Relations Bureau Dr P. BUSSAT Medical Women's International Association International Society for Criminology Dr Vera J. PETERSON, Honorary Secretary Professor J. BERNHEIM Dr Anne AUDÉOUD- NAVILLE MEMBERSHIP OF THE HEALTH ASSEMBLY 17
Permanent Committee and International Association on Occupa- World Federation of United Nations Associations tional Health Dr T. MARTI Mrs.R. J. M.BONNER Dr J. DELÉTRA World Federation of the Deaf DrC.MAGAROTTO, Secretary -General World Medical Association World Federation for Mental Health DrJ.MAYSTRE DrF.CLOUTIER, Director Dr AnneAUDÉOUD-NAVILLE World Union OSE DrK. SODDY Mr M. KLOPMANN World Federation of Occupational Therapists Mrs A.C.Glyn OWENS, Honorary Assistant Secre- tary- Treasurer World Veterinary Association MissA. -M. ROLLIER Dr M. LEUENBERGER 18 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
OFFICERS OF THE HEALTH ASSEMBLY AND MEMBERSHIP OF ITS COMMITTEES
President: General Committee Dr M. A. MAJEKODUNMI (Nigeria) The General Committee was composed of the Vice -Presidents: President and Vice -Presidents of the Health Assembly Professor R. GERIá (Yugoslavia) and the Chairmen of the main committees, together with delegates of the following Member States : Dr Sushila NAYAR (India) Cambodia, Canada, Congo (Leopoldville), Dahomey, Mr ABDUL RAHMAN BIN HAJI TALIB (Federation France, Indonesia,Iran,Israel,Mexico, Sweden, of Malaya) Tanganyika, Union of SovietSocialist Republics, Secretary: United Kingdom of Great Britain and Northern Ireland, and United States of America. Dr M. G. CANDAU, Director -General Chairman: Dr M. A. MAJEKODUNMI (Nigeria) Committee on Credentials Secretary: Dr M. G. CANDAU, Director -General The Committee on Credentials was composed of delegates of the following Member States : Australia, MAIN COMMITTEES Bulgaria, Canada, Cyprus, Federation of Malaya, Ghana, Madagascar, Nepal, Peru,Spain, Sweden Under Rule 35 of the Rules of Procedure of the and Syria. Health Assembly, each delegation was entitled to be Chairman: Dr B. D. B. LAYTON (Canada) represented on each main committee by one of its Vice -Chairman: Dr A. ENGEL (Sweden) members. Rapporteur: Dr A. ANDRIAMASY (Madagascar) Programme and Budget Secretary: Mr F. GUTTERIDGE, Chief, Legal Office Chairman: Dr V. V. OLGUIN (Argentina) Committee on Nominations Vice -Chairman: Dr S. P. TCHOUNGUI (Cameroon) The Committee on Nominations was composed of Rapporteur: Dr M. SENTICI (Morocco) delegates of the following Member States : Argentina, Secretary: Dr P.M. KAUL, AssistantDirector - Cambodia, Congo (Leopoldville),France, Gabon, General India,Iran,Israel,Jamaica,Lebanon,Mexico, Morocco,Netherlands,NewZealand,Nigeria, Norway, Romania, Thailand, Tunisia, Union of Soviet Administration, Finance and Legal Matters Socialist Republics, United Arab Republic, United Kingdom of Great Britain and Northern Ireland, Chairman: Mr I. T. KITTANI (Iraq) United States of America, and Venezuela. Vice -Chairman: Dr J. VYSOHLíD (Czechoslovakia) Chairman: Dr A. L. MUDALIAR (India) Rapporteur: Dr A. L. BRAVO (Chile) Rapporteur: Mr M. FERAA (Morocco) Secretary: Mr M. P.SIEGEL, Assistant Director - Secretary: Dr M. G. CANDAU, Director- General General AGENDA' [A16 /1 - 1 March 1963] 1.PLENARY MEETINGS
1.1 Opening of the session
1.2 Appointment of the Committee on Credentials
1.3 Election of the Committee on Nominations
1.4 Election of the President and the three Vice -Presidents
1.5 Election of the Chairman of the Committee on Programme and Budget
1.6 Election of the Chairman of the Committee on Administration, Finance and Legal Matters
1.7 Establishment of the General Committee
1.8 Adoption of the agenda and allocation of items to the main committees
1.9 Review and approval of the reports of the Executive Board at its thirtieth and thirty -first sessions
1.10Review of the Annual Report of the Director -General on the work of WHO
1.11 Admission of new Members and Associate Members
1.12Election of Members entitled to designate a person to serve on the Executive Board
1.13Director -General 1.13.1Appointment of the Director -General 1.13.2Approval of contract
1.14Présentation of the Darling Foundation Medal and Prize
1.15Approval of reports of main committees
1.16Closure of the Sixteenth World Health Assembly
> 2.COMMITTEE ON PROGRAMME AND BUDGET
2.1 Election of Vice -Chairman and Rapporteur
2.2 Review and approval of the programme and budget estimates for 1964 2.2.1Examination of the main features of the programme 2.2.2Recommendation of the budgetary ceiling 2.2.3Detailed review of the operating programme
1 Adopted at the third plenary meeting. - 19 - 20 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
PROGRAMME MATTERS
2.3 Report on development of the malaria eradication programme
2.4 Smallpox eradication programme
2.5 Continued assistance to newly independent States
2.6 Organizational studies by the Executive Board 2.6.1Measures for providing effective assistance in medical education and training to meet priority needs of the newly independent and emerging countries 2.6.2Methods of planning and execution of projects (report on progress of organizational study)
2.7 Consideration of the eleventh report of the Committee on International Quarantine
2.8 Clinical and pharmacological evaluation of drugs
CO- OPERATION WITH OTHER ORGANIZATIONS
2.9 Decisions of the United Nations, specialized agencies and the International Atomic Energy Agency affecting WHO's activities (programme matters)
2.10United Nations Development Decade
2.11Joint FAO /WHO programme on food standards(Codex Alimentarius): report of the Joint FAO /WHO Conference on Food Standards
2.12Developments in activities assisted jointly with UNICEF
2.13Extension of the agreement with UNRWA
3.COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS
3.1 Election of Vice -Chairman and Rapporteur
3.2 Consideration of establishment of Legal Sub -Committee
3.3 Supplementary budget estimates for 1963
3.4 Review of programme and budget estimates for 1964 relating to : 3.4.1Organizational meetings 3.4.2Administrative services 3.4.3Other purposes 3.4.4Text of the Appropriation Resolution for the financial year 1964
WORLD HEALTH ASSEMBLY
3.5 Selection of the country or region in which the Seventeenth World Health Assembly will be held AGENDA 21
FINANCIAL AND ADMINISTRATIVE MATTERS
3.6 Assessments for 1962 and 1963 of new Members
3.7 Scale of assessment for 1964
3.8 Review of the financial position of the Organization
3.8.1 Financial report on the accounts of WHO for 1962, report of the External Auditor, and comments thereon of the Ad Hoc Committee of the Executive Board 3.8.2Status of collection of annual contributions and of advances to the Working Capital Fund 3.8.3Report on casual income 3.8.4Status of the Assembly Suspense Account
3.9 Malaria Eradication Special Account
3.10Malaria eradication postage stamps
3.11 Headquarters accommodation :progress report
3.12Accommodation for the Regional Office for Africa
3.13 [Deleted]
3.14Meetings of the Regional Committee for Africa
3.15 [Deleted]
3.16Appointment of the External Auditor
3.17Contract of the Director -General
3.18Report on amendments to the Staff Rules, as confirmed by the Executive Board
CO- OPERATION WITH OTHER ORGANIZATIONS
3.19Decisions of the United Nations, specialized agencies and the International Atomic Energy Agency affecting WHO's activities (administrative, budgetary and financial matters)
3.20United Nations Joint Staff Pension Board 3.20.1Annual Report of the United Nations Joint Staff Pension Board for 1961 3.20.2 WHO Staff Pension Committee : appointment of representatives to replace members whose period of membership expires
VERBATIM RECORDS OF THE PLENARY MEETINGS
FIRST PLENARY MEETING
Tuesday, 7 May 1963, at 10 a.m.
President: Dr S. V. KURASOV (Union of Soviet Socialist Republics) later: Dr CASTILLO (Venezuela)
1.Opening of the Session systems. The events of the past year have confirmed the timeliness and importance of the resolution adopted The PRESIDENT(translation fromtheRussian) : Fellow delegates, ladies and gentlemen, to me, as at the Fifteenth World Health Assembly on the role of the physician in the preservation and promotion President of the Fifteenth World Health Assembly, of peace.Our moral and professional duty impels falls the honour of opening our Sixteenth Assembly. us to intensify our activities for the prevention of war It is my pleasant duty to greet the representatives of the Canton and City of Geneva -as always our and the development of friendly co- operation and well- being among peoples. hospitable hosts. I should like also to welcome in our midst the representatives of the Secretary - General of The past year has been marked also by the con- the United Nations, the specialized agencies, and the tinuing break -up of the colonial system, although this intergovernmental organizations. process is not yet complete.The decision on this I would also welcome the honourable delegates of matter taken at the fifteenth session of the General the Member States of the World Health Organization, Assembly of the United Nations has not been fully the representatives of Associate Members, and the carried out. I am saying this here, in this international observers from non -Member States.I am happy to medical forum, to people belonging to the most congratulate and greet the representatives of the humane of professions, who more than anyone else Republic of Algeria, Rwanda, Burundi, Uganda, are interested in the liquidation of the remnants of Jamaica and Trinidad and Tobago, which have colonialism, which is one of the main sources of bad become Members of our organization during the past health. year. The mighty movement of national liberation that has May I also greet the members of the Secretariat caught up the bulk of the population of the world of the World Health Organization, headed by its is a powerful factor for development, with immense Director -General, Dr Candau, whose work has won significance for better health.The peoples of the him sincere respect and has added to the stature of developing countries are seeking ways of achieving our organization. swifter economic and cultural progress. They will be The past year has been a year of great international able to solve their problems, including those of the events. As you know the world was on the brink of a health services, only when they have won economic new destructive war. The peoples have set high store as well as political independence. There is no longer by the constructive policy of mutual agreement, which any doubt that the improvement of the health services led to the liquidation of the crisis in the Caribbean and the strengthening of public health are impossible and was made possible mainly by the initiative of the without radical social and economic changes. Government of the Soviet Union.Peace was saved New social forms and the movement for the main- and maintained.Once again this has shown with tenance and promotion of peace are important con- great force and starkness the importance of peace, of ditions for the further progress of science.Mankind peaceful co- operation, and of the peaceful co- existence has entered upon a new epoch of scientific develop- of States and peoples with different social and political ment. To an ever greater degree science is becoming a - 23 - 24 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II productive force in society and is opening up ever staff, information that is giving rise to serious anxiety wider prospects for the utilization of truly limitless and concern.According to WHO calculations, at resources for the well -being of the people and for social least twenty years would be required to bring the and economic progress. numbers of doctors in African countries up to even a The outstanding achievements in natural science and minimum level.In view of this, the existing trend in technology, and research into intra- atomic relation- some countries towards making the procedure for the ships and cosmic space, have prepared the ground acceptance of foreign medical diplomas more com- for new exploits.The world is on the threshold of plicated is difficult to understand. It would seem to us epoch- making discoveries in biology, made possible advisable to settle this problem with the least possible by the collective work of scientists in all countries. delay.In view of the extension of co- operation in We are convinced that the successes in the natural medical matters between different countries, the time sciences will be just as significant as the achievements hasobviously cometowork outinternational in mastering cosmic space, thelatest outstanding standards and requirements for medical teaching example of which has been the group flight of the institutions, and an initiative by WHO and other Soviet cosmonauts Nikolaev and Popovic. internationalorganizationstosolvethisurgent Public health authorities are faced by the urgent problem would be met with approval task of how to make the fullest possible use of the To return to the need for a different approach to the achievements of medicine to protect and improve the health requirements of different countries, it should be health of the people. noted that this principle in general is the basis of The main health problems facing the world at the WHO's work Only a strict assessment of all the moment are not the same everywhere. It may be said actual needs and possibilities with regard to the health that there are at least two stages in international services in the various countries can serve as a basis health problems, one characteristic of economically for planning the long -term and year -by -year activities developed countries and the other of developing and of WHO.It is essential to develop co- operation in emerging countries. health matters more widely, not substituting for it, or These problems require different approaches if they limiting it to, the mere furnishing of assistance.For are to be solved.I have in mind the need for a more this purpose, it is desirable that the utmost possible careful,realistic and practicalanalysis of health use should be made of such forms of activity as inter - problems under the particular economic conditions State and, in particular, inter -regional programmes, obtaining in different countries and, based on this, the including the exchange of research and teaching staff working out of a more differentiated approach to the and of scientific literature, while preserving the natural provision of assistance. Thus,for economically and traditional forms of WHO assistance to economic- developed countries, where acute epidemic infectious ally less developed countries.Obviously it would be diseases have now been largely eliminated, the main advisable to study the Organization's possibilities problem is the control of such diseases as cancer, with a view to assigning to it the function of co- cardiovascular diseases, the diseases of old age, virus ordinating the assistance furnished by the economically diseases,venerealdiseases,alcoholism,and -that developed countries that are providing specialists, scourgeof modern society- nervous and mental equipment, drugs, etc. disorders.Problems connected with the provision If we are to obtain a more precise idea of the methods of medical services for the elderly are becoming of and ways of providing assistance, and its nature and ever greater importance. Meanwhile in the developing volume, and consequently tosolvethedifferent and emerging States the basic problem for the health problems faced by the health services throughout the services is still, as before, the control of infectious and world, there is no doubt that the most careful and parasitic diseases. realistic analysis, calculation and evaluation of the A most important problem, on the solution of Organization's resources are needed.Meanwhile, as which the future success of health work depends, isconvincingly demonstrated by many yearsof is the training of national staff. This problem is a very experience of WHO activities, a number of important topical one for all countries of the world.It is parti- measuresareundertakenwithoutasufficiently cularly acute however, in the developing countries, thorough, complete and flexible assessment of the where many years of colonial rule have resulted in an possibilities of carrying out what is planned.The acute shortage of medical and auxiliary staff.An experience of all international organizations and of investigation carried out in the last few years in Africa, individual countries, and the facts quoted during the where the largest number of countries that have discussion of the plan for the United Nations Develop- recently become independent are situated, has pro- ment Decade, show that there is an ever wider rift vided information on the numbers of health- service between the constantly increasing requirements of FIRST PLENARY MEETING 25
States -and indeed of whole regions -in the develop- primarily borne in mind is the rate of growth of the ment of their health services, and the existing resources budget. Analysis of the figures shows that the annual available for meeting those requirements.In view of increase in the WHO budget exceeds the rates of this, no illusionary ideas that WHO's possibilities growth of the national income of a number of are limitless should arise among Member States. countries.It should also be mentioned that it is only One of the most striking examples of the contradic- the regular budget that is increasing, while the means tions and difficulties that can arise is the experience in derived from other sources are either remaining at implementing the malaria eradication programme. their previous level or decreasing. The Organization rightly considers this to be one of All this forces us to reflect seriously on the ways in the most important problems, and one that requires a which the Organization is developing, for the con- speedy solution.In view of this, it is quite under- tradictions of which I spoke earlier are unfortunately standable why in the initial plans it was envisaged that increasing rather than decreasing and may lead to malaria eradication work in the greater part of the disillusionment. world would cover a period of roughly ten years. In order to develop WHO activities in a more planned However, failure to calculate correctly the actual fashion and to increase the effectiveness of its work, it possibilities both of the Organization and of its is essential to keep constantly in mind and to analyse Member countries, and also the scientific, technical carefully all the trends in its activities and all the and organizational difficulties that have been en- methods of carrying out those activities.For this countered, have resulted in this programme still being reason the organizational study on methods of plan- far from completion at the present time. In addition, ing and execution of projects begun by the Executive its planning for the future is very problematical.In Board appears very promising. This study, if correctly this connexion, the constant increase in the volume organized, will doubtless help to make the Organi- of the Organization's activities in connexion with the zation's work more effective at less cost.It may also community water supply programme is also a matter contribute to a realistic review of certain tendencies in of concern. This is a complex national and financial WHO's work. problem, which WHO should approach only in the One of the ways in which the effectiveness of WHO's role of an expert organization. activities can be increased is to use the experience and These examples bear witness to the fact that WHO working methods of all those countries of the world is paying exceptional attention to some problems, thatinarelativelyshort period have achieved while weakening its activities in other and no less considerablesuccessintheirnationalhealth important directions. This is eloquently proved by the services. increase of morbidity from such menacing infections An important prerequisite if the Organization is to as the treponematoses, bilharziasis, the filariases and carry out fruitful and successful work is that it should the venereal diseases, and also by the slow and be representative in character.I am dealing with this insufficientlyeffectivecampaign againstsmallpox question last, but there is no doubt as to its extreme -the possibility of an epidemic outbreak of which importance.The World Health Organization is an in the near future is in, the opinion of the specialists, not organization with a very wide membership, but beyond the bounds of probability. nevertheless a number of countries are still not taking Failure to assess the real possibilities of the Organi- part in its work.Thus, the universality of WHO is zation and an inadequately differentiated approach to still far from being complete. health problems are leading to a weakening of WHO's The future allows us to anticipate a further extension efforts in some directions, efforts that should be aimed and invigoration of WHO's work. In this connexion, at fulfilling the Organization's basic function -the an agreement on general and complete disarmament co- ordination and planning of international health and the switching over of the resources spent on work. Recently, as has been noted, WHO has shown armaments to peaceful construction would allow the a tendency to move away from itsinternational health problems of the peoples of the whole world to co- ordinating function and transform itself into an be solved, and solved radically. It was with this appeal organ for the provision of technical, operational and that the General Assembly of the United Nations material assistance. In this way the Organization is in adopted its resolution on general and complete disar- some instances taking over functions that are not mament and the declaration on the switching over proper to it, but belong to other organizations and of resources released as a result of such disarmament institutions.This tendency will inevitably lead in the to peaceful development.It is the task of WHO, as a final analysis to contradictions between the Organi- specialized agency of the United Nations, to give full zation's planned activities and its resources. support to these decisions and to put them into As regards this incompatibility, what should be practice. 26 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
In conclusion, I consider it my duty to emphasize measures that will enable us to accommodate other that the Constitution of WHO defines health as a state important conferences in the Palais des Nations while of complete physical, mental and social well- being. your Assembly is in progress.Here I would like to Consequently the Organization cannot sheer away say how much the Secretary -General of the United from a decision on all these problems. It cannot stand Nations and the Director of the European Office aside from the strivings of humanity to maintain and have appreciated the understanding and sympathetic strengthen peace and to raise the level of prosperity attitude shown by Dr Candau and his colleagues in of the peoples. WHO. Without ever forgetting their responsibilities A lessening of international tension is the guarantee to the World Health Assembly, they have done every- of the further success of WHO's work.However thing possible to facilitate our task and at the same time WHO must go further, and must in every way extend to ensure the smooth progress of your work. international co- operation in all spheres and areas. This session marks the fifteenth anniversary of the It is only under conditions of peace and co- operation World Health Organization.I think that during this that our organization will be able to carry out its Assembly you will be more occupied in preparing for lofty aims and help in the attainment by all peoples the future than in recalling the past.Nevertheless of the highest possible level of health. we are justified in looking back. As a layman I would not venture to speak of the contribution you have 2.Address by the Representative of the Secretary - made to the advancement of medicine and public General of the United Nations health in the world; but you are also a specialized The PRESIDENT (translation from the Russian) :I give agency of the United Nations and, that being so, I may the floor to the representative of the Secretary -General permit myself to pay a tribute to all you have done, of the United Nations, Mr Georges Palthey. both as regards theory and in the field of practical achievement, to implement the axiom on which your Mr PALTHEY, Deputy Director of the European Organization is based and which is proclaimed in the Office of the United Nations (translation from the preamble to the Charter of the United Nations, French) : Mr President, Director -General, ladies and namely, that health is an essential part of the dignity gentlemen, U Thant, the Secretary - General of the and worth of the human person. United Nations, has asked me to welcome you to It is in this spirit, Mr President, that I reiterate my Geneva and to the Palais des Nations. good wishes and those of the Secretary - General for It may seem paradoxical that I am called upon to the success of the Assembly we are opening today. perform this duty when the Palais des Nations is also the headquarters of the World Health Organi- The PRESIDENT(translation from theRussian) : zation; but I imagine that most of you are already Thank you, Mr Palthey. thinking of the new building you are having con- structed which, according to the plans, will be a 3.Address by the Representative of the Conseil d'Etat worthy and magnificent addition to the group of of the Republic and Canton of Geneva buildings overlooking the lake of Geneva, buildings The PRESIDENT (translation from the Russian). I give which in the course of the years have become an the floor to the President of the Conseil d'Etat of the impressive manifestation of international activities Republic and Cantonof Geneva, Mr Charles throughout the world. Duchemin. Some of you may be visiting Geneva for the first time, but those of you who have been coming regularly Mr DUCHEMIN, President of the Conseil d'Etat of forseveral years willcertainly have noticed the the Republic and Canton of Geneva (translation from increase in and the extraordinary variety of the inter- the French) : Mr President, ministers and delegates, national meetings held in this city, mostly at the Palais I have the great honour of extending to you, on behalf des Nations. The expansion of these activities is an of the federal, cantonal and municipal authorities, encouraging sign of vitality, but it also raises practical a very cordial welcome to Geneva on this fine spring problems when we come to draw up the calendar of day, on the occasion of the opening meeting of the conferences and allocate the necessary rooms for each Sixteenth World Health Assembly. You are aware, meeting. Each year the pressure increases, and 1963 Mr President,ladies and gentlemen, how happy is particularly difficult in this respect.Every effort Geneva and Switzerland are to welcome the many has been made to ensure that your deliberations will international institutionsthat meetinourcity. be affected as little as possible by the difficulties with I should also like to stress how proud we are to which circumstances may confront us.Nevertheless, welcome here the ministers of health and eminent we have had to ask your Secretariat to take certain medical men who are seeking through your organi- FIRST PLENARY MEETING 27
zation to bring about the attainment by all peoples of and I call on the Rapporteur, Dr Andriamasy, to read the highest possible level of health. its report. Ladies and gentlemen, you meet once a year to draw Dr Andriamasy (Madagascar), Rapporteur of the up a balance sheet of the fight against disease, and we Committee on Credentials, read the first report of that are all well aware of the very considerable results committee (see page 406). already obtained in a little under sixteen years. And so, to the representatives of the 117 Member countries The ACTING PRESIDENT (translation from the Spanish) : of this organization of yours, which is so important Thank you, Dr Andriamasy. Are there any comments because of its objective and in whose activities more on the report that has just been read out ? I call on the than two thousand people are taking part, the federal delegate of Albania. and the Genevese authorities wish to convey all their Dr KLosI (Albania) (translation from the French) : best wishes for the success of your work. Mr President, the delegation of the People's Republic of Albania feels bound to draw the attention of the The PRESIDENT (translation fromtheRussian) : Thank you, Mr Duchemin. Assembly to the fact that, in its report, the Committee on Credentials has once again evaded a most im- portant issue : that of the representation in our organi- 4.Appointment of the Committee on Credentials zation of the People's Republic of China whose place, The PRESIDENT (translation fromtheRussian) : owing to the machinations of the United States of We now come to provisional agenda item 1.2 : Appoint- America, is occupied by the representatives of the ment of the Committee on Credentials. Rule 23 of the Chiang Kai -shek clique, who are traitors to their Rules of Procedure reads as follows : people and represent only themselves. The delegation of the People's Republic of Albania A Committee on Credentials consisting of twelve delegates of as many Members shall be appointed protests most vigorously against the unlawful exclusion at the beginning of each session by the Health of the great Chinese people, which numbers nearly seven hundred million, from the work of the World Assembly on the proposal of the President.This committee shall elect its own officers.It shall Health Organization -in contempt of that people, examine the credentials of delegates of Members in defiance of the efforts that have been made for years and of the representatives of Associate Members at every session by the delegations of several Member and report to the Health Assembly thereon without States, and in spite of the continual protests of a large number of leading progressives throughout the world. delay. Any delegate or representative to whose It admission a Member has made objection shall be also protests against the injustice done to the seated provisionally with the same rights as other Democratic People's Republic of Korea, the Demo- delegates or representatives, until the Committee craticRepublicof Viet -Nam, and the German Democratic Republic, by denying them the right to be onCredentialshasreportedandtheHealth represented at this Assembly; we consider it high time Assembly has given its decision. to put an end to this situation, which is unjust, arbitrary In accordance with the powers conferred on me by and harmful to the cause of our organization, by that rule, I propose that the Committee on Credentials granting the delegations of those countries the place should consist of the following twelve Members : that is theirs by right. To refuse the People's Republic Australia, Bulgaria, Canada, Cyprus, Ghana, Mada- of China the place that belongs to it in this organization gascar, Malaya, Nepal, Peru, Spain, Sweden, and is an open and flagrant violation of the principle of Syria. universality, which is one of the basic principles of Are there any objections to the list put forward for WHO. your consideration ?There are no objections ?It is Everyone is aware that the reasons why the People's adopted. Republic of China has not yet been admitted to the The members of the Committee on Credentials are World Health Organization are purely political. They requested to meet forthwith.The meeting will be result from the aims and intrigues of the United States suspended for an hour -and -a -half. of America, which is pursuing its policy of aggression The meeting was suspended at 10.40 a.m. and resumed and provocation against the People's Republic of at 12.15 p.m., under the chairmanship of Dr Castillo. China. The United States of America has never given up its plans for war and expansion.It still hopes to re- establish its domination over the free and sovereign 5.First Report of the Committee on Credentials Chinese people and to regain control of the immense The ACTING PRESIDENT (translation from the Spanish) : wealth of China.That is the purpose of the armed The Committee on Credentials has completed its work occupation of Taiwan, which is an integral part of 28 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Chinese territory, the transformation of that island The Republic of China is one of the sponsors of into a base for aggression against China, the strengthen- WHO and has been a loyal Member of this organi- ing and expansion of a network of military bases round zation.The communist regime, as you know, on that country, the continual provocations against the the mainland of China isbut a Soviet creation People's Republic of China,thesystematic and imposed on my people against their will by force. continued violation of its territory, and the pressures It maintains its precarious hold by suppression of my exerted by the United States of America on other people at home and by aggression against its neigh- Members of the Organization in order to prevent bours.It is a thoroughly discredited regime.As China, by means of voting procedure, from taking its evidence, in May of last year the world witnessed rightful place in the international organizations. the largest mass flight of my people into the adjacent There is no doubt that the American plans against areas of Hong Kong and Macao -the largest mass China, which are built on sand, will fail as they have exodussincethe Hungarian revolution of 1956. failed in the past. One quarter of the world's popula- Therefore it has no right to speak on behalf of the tion lives in the People's Republic of China.The Chinese people. success achieved by this great people in the field Mr President, my delegation supports the report of public health, its age -old experience of this subject, of the Committee on Credentials. I would also request the many health problems with which China is con- that the statement which I have made be entered in cerned and, finally, the contribution which it can make the record of this meeting. to our organization will make it possible to fill the The ACTING PRESIDENT (translation from the Spanish) : great gap in the operation and effectiveness of WHO Thank you.I give the floor to the delegate of the as soon as China takes its rightful place in the Organi- Philippines. zation. The delegation of the People's Republic of Albania Dr GATMAITAN (Philippines) :Mr President and hopes that the World Health Organization will finally fellow delegates, the Philippine delegation announces cease to serve the ends of the cold war pursued by the its unqualified support of the stand taken by the im- imperialist Powers and that, respecting the principle mediately previous speaker against the unseating of of universality embodied in its Constitution, it will Nationalist China in this Assembly. It feels that, since give their rightful place to the legitimate represen- the delegates from free China have been the only tatives of the Central Government of the People's recognized Chinese representation since the organi- Republic of China and exclude from our organization zation of this Assembly, any attempt to modify or, the persons sent by the Chiang Kai -shek clique.It much less,change this representation would un- also hopes that the necessary measures will be taken doubtedly confuse the situation. to admit the Democratic People's Republic of Korea, Moreover, it is the considered opinion of the Philip- the Democratic Republic of Viet -Nam, and the pine delegation that this body is a highly specialized German Democratic Republic. one, whose main function centres on the discussion of health and medical matters; hence, matters outside The ACTING PRESIDENT (translation from the Spanish) : this particular field should properly be referred to Thank you.I give the floor to the delegate of China. agencies more competent and more qualifiedto Mr CHENG (China) :Mr President, I resent the tackle this issue, namely the United Nations General statement made by the communist representative Assembly in New York. of Albania, questioning the right of my delegation to represent China and the Chinese people. We consider The ACTING PRESIDENT (translation from the Spanish) : the statement as entirely out of order. Thank you.I give the floor to the delegate of the USSR. The government which my delegation has the honour to represent is the only legally constituted government Professor ZDANOV (UnionofSovietSocialist of China.It represents and speaks for the Chinese Republics) (translation from the Russian) : Mr Pre- people in the United Nations, in the specialized sident, fellow delegates, the Soviet delegation has agencies, and in all intergovernmental organizations. listened with satisfaction to that part of the report of The General Assembly of the United Nations on theCommitteeonCredentialsin whichthe 30 October 1962 decisively rejected a Soviet proposal new Members of the World Health Organization to unseat my delegation in that organization. We are were mentioned, namely, the Republic of Algeria, confident that this Sixteenth Assembly of the World Burundi, Rwanda, Trinidad and Tobago, Uganda, Health Organization will not wish to consider a and Jamaica. The Soviet Union, as is known, has political issue which has already been settled by a always been in the forefront of those fighting for more competent body. the independence of the peoples. Today we are happy FIRST PLENARY MEETING 29 to extend cordial greetings to these new Members of would breed confusion and would infact conflict the World Organization. Our organization has with the standard practices observed by the specialized become more all- embracing and more representative. agencies over the years. At the same time, some countries arestillnot Since the Government of Albania has now raised represented among us. I have in mind in particular the the issue, however, my Government wishes to em- German Democratic Republic, which fulfils all the phasize that the Government of the Republic of China requirements for membership of the World Health and only the Government of the Republic of China is Organization.This State has a highly developed entitled to representation in this and other United economy, science and culture.It could give sub- Nations bodies. This position accords with that taken stantial assistance to the World Health Organizaton by the General Assembly as recently as 30 October in the common struggle for the health of mankind. 1962 when, by a vote of 56 against, 42 in favour and I do not wish to enter into polemics with previous 12 abstentions, it rejected a Soviet -sponsored resolution speakers, but would like only to say that the Soviet to replace the representatives of the Republic of China delegation supports the protest made by the delegation with Chinese communists in all organs of the United of the Bulgarian People's Republic in the Committee Nations. on Credentials and considers that there can be no The ACTING PRESIDENT (translation from the Spanish) : room at this lofty gathering for the representative of Thank you. The delegate of Viet -Nam has the floor. the supporters of Chiang Kai -shek.Only a represent- ative appointed by the Central Government of the Mr NGUYEN VAN THINH (Republic of Viet -Nam) People's Republic of China can be the lawful represen- (translation from the French) :Mr President,the tative of China in the World Health Organization so- calledsocialist countries make propaganda on and at this Assembly. every occasion.The question of the admission of communist China to our organization was raised at The ACTING PRESIDENT (translation, from the Spanish) : the last Assembly; it would be better not to raise it Thank you.I give the floor to the delegate of the again. We maintain our point of view, which is that United States of America. only the Republic of China, whose delegates are here Mr MCKITTERICK (UnitedStates of America) : among us, can represent the whole of China in this Mr President, the United Statesregretsthatthe organization. Sovereignty and representation are representatives of the Albanian Government have indivisible and it would be unjust to have among us seen fit to use this podium for purposes of purely representatives who do not represent the Chinese political and propaganda matters. The positions people, and who respect neither the Charter of the of our governments on the question of Chinese repre- United Nations nor the rules of our organization. sentation have been enunciated quite clearly in the The communist leaders of China, far from being con- political organs of the United Nations. As recently as cerned with the health of the people under their October 1962, the General Assembly devoted seven control, think only of aggression against their neigh- meetings to a discussion of this issue.Repetition of bours and of manufacturing nuclear weapons for these positions here serves no purpose other than to destruction, not for construction. The peaceful aims interrupt our proceedings. of the World Health Organization will never be As the most representative United Nations body respected by the communist leaders of China. Must having political responsibilities, the General Assembly we therefore admit these saboteurs ?It is not for is particularly well qualified to judge the issue of political reasons that the Chinese communist leaders Chinese representation.Furthermore, by its reso- are not admitted and should not be represented here, lution 396 (V) in 1950, the General Assembly speci- but mainly for humanitarian reasons. fically recommended that itsattitude " should be As to the representation of the Viet -Nam com- taken into account in other organs of the United munists, you know, Mr President, ladies and gentle- Nations and in the specialized agencies " in the event men, or perhaps you have read in the Press of the latest that conflicting claims over the right to represent a events in our country. You must be convinced that the Member State become the subject of controversy in aggression always comes from North Viet -Nam and the United Nations. My Government believes, there- that we are living under the constant threat of aggres- fore, that the specialized agencies having technical sion, which is not only perpetrated by North Viet -Nam, terms of reference should not involve themselves in but is also supported by communist China. debates on the complex and highly charged political Hence I maintain that the objective of communist question of who should represent China in the United China is not a peaceful one, but is above all to carry Nations, but should leave it to the General Assembly on propaganda and infiltration everywhere. This to decide the substance of this issue. To do otherwise infiltration will have been successful if the Chinese 30 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Communist leaders come and take their place among By virtue of the proclamation of the People's us. Republic of China in 1949, all the rights of China in the The Republic of Viet -Nam is a member of forty - international arena belong tothat same Central one international organizations, including the World Government of the People's Republic of China, which Health Organization, the International Labour Organi- is the only lawful representative of the Chinese people. sation, the Food and Agriculture Organization, and To prevent the lawful representatives of the Chinese UNESCO. We are now recognized de jure by seventy people from occupying a place in the World Health countries, whereas North Viet -Nam has so far been Organization that belongs to them by right can only recognized only by the communist countries of the undermine the prestige of that organization. Political eastern bloc. prejudices must be left aside and account must be I thank you for your attention. taken of obvious facts. The whole territory of China, The ACTING PRESIDENT (translation from the Spanish) : with its 600 million inhabitants, is -apart from the Thank you. The delegate of Czechoslovakia has the island of Taiwan -under the control of the Central floor. Government of the People's Republic of China. Our Dr PLOJHAR (Czechoslovakia) (translation from the delegation considers that the World Health Organi- zation should not submit to political influences at French) :Mr President, allow me to remark with regret, as I have done several times in recent years, on variance with its Constitution and the development of the absence of delegates of the People's Republic of international co- operation, and rejects the legality of China, the only possible and valid representatives of the so- called credentials of the Chiang Kai -shek clique. the Chinese people. The ACTING PRESIDENT (translation from the Spanish) : For years now, a nation of 700 million people has Thank you. The delegate of the Republic of Korea been refused the right to be represented in an organi- has the floor. zation whose Constitution and whose very title give it an international character. We are all fully convinced Dr Sang Tae HAN (Republic of Korea) : Mr Pre- that the objective and the work of our organization sident and fellow delegates, we have heard the delegates are highly humanitarian; but it is difficult for us to of Albania, the USSR, Czechoslovakia and Romania, who are trying to inject into this Assembly a political speak of humanitarian rules when hundreds, millions of Chinese mothers and children remain beyond the question. As we all know, this is nothing new. It has reach of our organization and are unable to benefit beenrepeated innumerable timesbeforeinthis Assembly and in other international organizations, from its services and the effectiveness of its assistance. The non -participation of the People's Republic of particularly the United Nations. China in the work of the World Health Organization I wish again to remind you that communist China considerably hampers that work, whereas the active and North Korea are the very communist regimes collaboration of all the countries of the world would which attacked the innocent Korean people in 1950, enable us to obtain results even more beneficial to the in an unprovoked aggression against my country and health of mankind. the United Nations forces, communist China having been condemned as an aggressor by the General The ACTING PRESIDENT (translation from the Spanish) : Assembly of the United Nations in 1951.And it Thank you. The delegate of Romania has the floor. still remains an aggressor. In the opinion of my delega- Dr IOAN (Romania) (translation from the Russian) : tion it would be a great mistake to give serious con- Mr President, the delegation of the Romanian People's sideration to the seating of communist China, North Republic does not recognize the so- called credentials Korea, North Viet -Nam and East Germany in any of the Chiang Kai -shek clique.The only lawful branch of the United Nations.Furthermore, the Government of China, enjoying the trust and support injection of such a highly political matter into this of the Chinese people, is the Central Government of World Health Assembly is another attempt to disturb the People's Republic of China, with its seat in the and impair the proceedings of this meeting. capital of China, Pekin. Within a comparatively short In the judgement of my delegation, China is legitim- period the Chinese people, which has made a great ately represented by the democratically and legally contribution to the development of human civilization constituted Republic of China in this Assembly and and culture, has achieved considerable successes in in other United Nations organizations, fulfilling its all spheres of activity. The successes won in the domain obligations with honour and with distinction and con- of culture by the People's Republic of China, its tributing towards the work of this organization.In economic and social achievements, and its important conclusion, Mr President, the remarks made by the role internationally, are now recognized even by the previous speakers are highly political in nature and enemies of the Chinese people. therefore completely out of order. FIRST PLENARY MEETING 31
The ACTING PRESIDENT (translation from the Spanish) : approval by the United Kingdom representatives of Thank you.The delegate of Cambodia has the floor. reports of credentials committees is now well known and it will not be restated here in future.I wish to Dr THIOUNN -THOEUN (Cambodia) (translation from place on record, however, that this does not and will the French) :Mr President, the delegation of the Kingdom of Cambodia fully approves the views not mean any change in the significance of the vote cast. expressed by the delegation of Albania.The Royal Government of Cambodia, under the clear -sighted The ACTING PRESIDENT (translation from the Spanish) : direction of HRH Prince Norodom Sihanouk, has Thank you.That statement will be included in the since 24 July 1958 recognized the Government of the record.The delegate of Norway has the floor. People's Republic of China as the sole representative of China. WHO would play its full part as a World Dr EVANG (Norway) : Mr President, fellow delegates, Health Organization if it recognized the rights of a the position of my Government in relation to the issue government which in fact rules over 700 million under discussion has been stated and restated on many people. occasions and I have therefore just taken the floor to The ACTING PRESIDENT (translation from the Spanish) : associate myself with the statement of the delegate Thank you. The delegate of Cuba has the floor. of the United Kingdom, which exactly gives the position also of my Government in this matter. Dr MARTÍNEZ REYES (Cuba) (translation from the Spanish) :Mr President,the delegation of Cuba The ACTING PRESIDENT (translation from the Spanish) : supports the statement made by the delegation of Thank you.The meeting will be suspended for a Albania and does so for humanitarian reasons, not for minute. political reasons as some delegations have stated. Can Dr Kurafov resumed the presidential chair. an organization which declares, in Article 1 of its Constitution, that its objective is the attainment by all peoples of the highest possible level of health be 6.Election of the Committee on Nominations said to be fulfilling its task when it has no represen- The PRESIDENT (translation fromtheRussian) : tatives from a quarter of the world's population ? Can Item 1.3 of the provisional agenda- Election of the anyone deny the enormous progress inphysical, Committee on Nominations. This item is governed by mental and social well- being -which is our idea of Rule 24 of the Rules of Procedure of the Health health -made by the Chinese people under its new Assembly, which reads : regime of freedom ? We therefore urge that the The Health Assembly shall elect a Committee Chinese people be represented in our organization, on Nominations consisting of twenty -four delegates whose standing will thereby be enhanced. of as many Members. The ACTING PRESIDENT (translation from the Spanish) : At the beginning of each regular session the Thank you.Are there any further comments ? President shall submit to the Health Assembly a If no other delegate wishes to speak, I shall now list consisting of twenty -four Members to comprise submit the report of the Committee on Credentials a Committee on Nominations. Any Member may for your consideration; if there are no further com- propose additions to such list. On the basis of such ments the report will be considered as approved. The list, as amended by any additions proposed, a vote delegate of the United Kingdom has the floor. shall be taken in accordance with the provisions Sir George GODBER (United Kingdom of Great of those Rules dealing with elections. Britain and Northern Ireland) : Mr President, fellow In accordance with this rule, a list has been drawn delegates, I wish to put on record that my delegation up of twenty -four Member States, which I submit to voted for the report of the Committee on Credentials the Assembly for its consideration.I would mention solely on the ground that the credentials concerned that, in compiling thislist,I was guided by the are, consideredasdocuments, in order. This approval regional distribution at present existing in the Executive should not be taken as implying recognition of the Board, which also consists of twenty -four Member authorities by whom the credentials are issued. States. A statement similar to this has been made on behalf The following MemberStatesareproposed : of the United Kingdom delegation in respect of the Argentina, Cambodia, Congo (Leopoldville), France, credentials of China whenever this Assembly, or any Gabon, India, Iran, Israel, Jamaica, Lebanon, Mexico, organ of the United Nations or a United Nations Morocco,Netherlands,NewZealand,Nigeria, specialized agency, has approved the report of its Norway, Romania, Thailand, Tunisia, Union of Soviet credentials committee. The limited significance of the Socialist Republics, United Arab Republic, United 32 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Kingdom of Great Britain and Northern Ireland, of the Committee on Nominations, also states that : United States of America, Venezuela. " The proposals of the Committee on Nominations Are there any additions to this list ? No additions. shall be forthwith communicated tothe Health I consider the list approved. Assembly ". The Committee on Nominations will meet imme- I should like to close the meeting at this point. diately after the closure of the plenary meeting. The next meeting will be at 4 p.m. As delegates know, Rule 25 of the Rules of Procedure of the Health Assembly, defining the terms of reference The meeting rose at 1.10 p.m.
SECOND PLENARY MEETING
Tuesday, 7 May 1963, at 4 p.m.
President:Dr S. V. KURASOV (Union of Soviet Socialist Republics) later: Dr M. A. MAJEKODUNMI (Nigeria)
1.First Report of the Committee on Nominations 2.Second Report of the Committee on Nominations The PRESIDENT (translation fromtheRussian) : The PRESIDENT : I would like to invite the Assembly The first item on our programme of work is the first to consider the second report of the Committee on report of the Committee on Nominations. This report Nominations. The Rapporteur of the Committee on has been circulated to the members of the Assembly. Nominations, Mr Feraa, will read that report. I call upon Mr Feraa to read out the first report. Mr Feraa (Morocco), Rapporteur of the Committee Mr Feraa (Morocco), Rapporteur of the Committee on Nominations, read the second report of that com- on Nominations, read the first report of that committee (see page 407) . mittee (see page 407). Election of the President Election of the three Vice -Presidents The PRESIDENT (translation fromtheRussian) : The PRESIDENT : Thank you, Mr Feraa. Thank you, Mr Feraa. You have heard the second report of the Committee In accordance with the provisions of Rule 76 of the on Nominations. Are there any observations ? In the Rules of Procedure no ballot is required, since there is absence of any observations, the Assembly accepts the only one cand;date. It is proposed that the Assembly report of the Committee on Nominations and the approve the Committee's recommendation for the three Vice -Presidents who were recommended for election of the new President.(Applause) election are hereby duly elected. (Applause) Would Dr Majekodunmi kindly come up to the rostrum. The President thereupon invited the threeVice - Presidents to take their seats on the rostrum. Dr Majekodunmi took the presidential chair. The PRESIDENT :Ladies and gentlemen, I wish to Election of the Chairmen of the Main Committees express my appreciation of the honour which you have done my country by electing me as President of the The PRESIDENT : Dr Olguín of Argentina has been Sixteenth World Health Assembly.The Assembly recommended by the Committee on Nominations to has always conducted its business in a spirit of mutual be the Chairman of the Committee on Programme and understanding and comradeship, and I wish to assure Budget. Are there any observations ?The appoint- you that I shall do my best to ensure that this tradition ment of Dr Olguín is ratified by the Assembly. is maintained.I hope to make a fuller address to the Mr Kittani of Iraq has been nominated as Chairman Assembly tomorrow.Meanwhile we shall proceed of the Committee on Administration, Finance and with the business of the Assembly this afternoon. Legal Matters. Are there any observations ?In the THIRD PLENARY MEETING 33 absence of any observations, Mr Kittani of Iraq is Britain and Northern Ireland, and United States of hereby appointed Chairman of the Committee on America. Administration, Finance and Legal Matters. Are there any observations ? In the absence of any observationsthesecountriesareherebyelected Election of the General Committee members of the General Committee of this Assembly. The PRESIDENT :The Committee on Nominations The General Committee will meet today at 4.45 p.m. has recommended for election under Rule 31 of the The next plenary meeting will be held at 10 o'clock Rules of Procedure of the Assembly the following tomorrow morning in this hall. membercountries :Cambodia,Canada,Congo Ladies and gentlemen, that is all for today and the (Leopoldville), Dahomey, France, Indonesia, Iran, Assembly meeting is finished. Israel,Mexico,Sweden,Tanganyika,Unionof Soviet Socialist Republics, United Kingdom of Great The meeting rose at 4.25 p.m.
THIRD PLENARY MEETING
Wednesday, 8 May 1963, at 10 a.m.
President: Dr M. A. MAJEKODUNMI (Nigeria)
1. Presidential Address contribution tothe advancement of science has The PRESIDENT : The Assembly is called to order. brought immense benefit to mankind. Dr Kura§ov has Distinguished delegates, ladies and gentlemen, may of course built on to the firm edifice bequeathed by I thank you once again for the singular honour you distinguished past Presidents of our Assembly, whose have done me by electing me to this exalted office of contribution to the work of our organization has made President of the Assembly.I regard my election not it the most successful of the United Nations specialized only as a personal honour but also as a measure of the agencies; but can we ever forget the efficiency and tact esteem in which the members of this Assembly hold with which Dr KuraKov conducted the affairs of the my country, Nigeria, and indeed the whole continent Fifteenth World Health Assembly and the opening of Africa.It is now only three years since Nigeria meeting of the Sixteenth ?With his efficiency was became a full Member of this organization and the combined such modesty and good humour that the fact that you have seen fit to do us such signal honour Assembly was able to accomplish its task very smoothly by this appointment is a recognition of Nigeria's and an atmosphere of cordiality and comradeship contribution to the cause of world peace in general and prevailed amongst all delegates throughout the session. to the work of the World Health Organization in Next I wish to pay tribute to the Director -General, particular.This act of the Assembly will serve as a his assistants, the Regional Directors, and the other stimulus and encouragement to the newly emergent members of his staff, whom we hardly see or hear of but States of Africa, all of which have been making rapid whose industry and devotion to duty has made possible strides in the provision of facilities designed to promote thecourtesy,thoroughness andefficiencywhich the health and happiness of the peoples of our vast characterize the work of the World Health Organi- continent. zation. I should like at the outset to pay a deserved tribute Finally, I salute the large army of doctors, specialists to a number of persons who have helped the work of in various scientific fields, and the medical auxiliaries, this organization and have contributed to the success who in their various spheres of activity under the of the objectives to which we are dedicated.Firstly, auspices of the World Health Organization endeavour I wish to pay a tribute to my immediate predecessor in to bring to countless millions of people all the world office, Dr S. Kuraov, Minister of Health of the Union over the advantages of modern medicine. These are of Soviet Socialist Republics, President of the Fifteenth the people who carry on the lofty objectives of the World Health Assembly, who is himself a distinguished World Health Organization and without whose efforts medical scientist and a citizen of a great country, whose all our deliberations would be in vain. 34 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
It would be presumptuous of me to attempt to begin to think increasingly of providing this aid in the educate this distinguished audience about the aims and form of assistance in the establishment of training objectives of the World Health Organization; but it is institutionsinthese territories. Such institutions not out of place to remind you, distinguished delegates, would not only produce the much -needed trained indi- atthe commencement of a new Assembly, of the genous personnel who are better equipped to cope supreme objectives of our organization, which is with local problems, but they also tend to raise the dedicated to the eradication of disease and human standard of medical care in the countries in which suffering and to bringing health in its broad sense they are established. within reach of all persons on the globe. A great many In Nigeria, apart from the medical school of the men and women have dedicated their lives to this University of Ibadan, which has been operating worthy cause, and it behoves us as worthy successors efficiently during the past fourteen years, we have only to continue their unfinished task and to bend our last year established a medical school in Lagos with energies to the realization of the objectives of our an admission of about thirty students. It is planned to organization. develop this school within the next few years to cope The subject for the technical discussions this year with an annual intake of two hundred students.In is " Education and training of the physician for the addition, we plan to establish three more medical preventive and social aspects of clinical practice ". schools, so that at the end of this decade we hope to be In the past many important subjects have been con- able to train at least a thousand doctors annually from sidered in technical discussions. Unfortunately, it has our own medical institutions.Although the capital been more the exception than the rule for recom- andrecurrentexpenditureonthisenterpriseis mendationsarising from these discussions to be staggering, we believe this approach in the long run translated into action. We would be making a singular to be the most economical, and the most beneficial for contribution to the work of the Organization if a developing country, where thesevereshortage delegates undertook here and now to ensure that those of trained personnel makes any effective planning recommendations which emanate from the technical impossible. discussions that will be held at this session are given Our organization has set for itself a Herculean task, very serious consideration and implemented wherever whose coverage is global and whose motive force possible in their various countries. humanitarian.It is a task which transcends political It would not surprise me if during the technical boundaries and ideological loyalties.Because of the discussions it became apparent that, at least as far gigantic nature of this task, the challenge it offers us as the developing countries are concerned, the whole is very great indeed.But the greater the challenge, concept of a division between the curative and the greater must be our resolve. preventive functions of a physician in clinical practice If we cast our minds back on what this organization has to be abandoned.In my country, over the past has done during the fifteen years of its existence, we years, various efforts have been made to reorganize shall feel proud of our achievements in the various the medical services in order to bring to an end this fields; indeed, we might be tempted to pat ourselves on division between curative and preventive medicine, the back and relax. That would be a mistake. Although which had proved both wasteful and impracticable. we have legitimate reason to be happy at our achieve- Recently,plans have been completed for a pilot ments, yet at the beginning of this Sixteenth World scheme which would provide complete integration of Health Assembly I wish us to address ourselves to the medical and health services on a basis of total coverage challenge now facing us.In vast areas of the world of the population of Lagos, thecapitalof the today malaria, malnutrition, typhoid fever, smallpox, Federation of Nigeria.I venture to suggest that this tuberculosis, pneumonia and a large host of endemic approach will offer the most economical and realistic diseases take a heavy toll of human life. There are also means of providing adequate medical coverage for an large areas of the world in which the infant mortality under -developed country, having regard to the in- rate is alarmingly high. In many countries the number adequacies of both human and material resources. of medical and paramedical staff is appallingly small This brings to mind the severe shortage in most in comparison with thesizeof the task tobe developing countries of medical and paramedical accomplished. There are also large areas where even personnel. The assistance given by the World Health elementary preventive measures are not within the Organization to these countries in the provision of reach of a large proportion of the population. much -needed skilled staff, equipment and advice has This catalogue of inadequacies is not a reflection indeed saved millions of lives and brought relief to on the activities of the World Health Organization, many more. But if medical aid to developing countries which itself has done so much to spotlight these in- is to prove of lasting benefit, the Organization must adequacies, but a measure of the magnitude of the THIRD PLENARY MEETING 35
unfinished task to which our organization must now appearing under the two main committees be allocated re- dedicate itself.We must face this challenge in a to these committees as indicated in the provisional spirit of brotherhood and of sacrifice -brotherhood, agenda. Concerning the items appearing on the because the days are gone for ever when a nation can agenda of the plenary proper which have not yet been live in isolation and become oblivious of the suffering disposed of, the General Committee suggested that of others; we can no longer ask the ancient question, items 1.10, 1.12, 1.14, 1.15 and 1.16 be dealt with in " Am I my brother's keeper ? ". The interdependence plenary. of all parts of the globe has now become such an With regard to item 1.11, Admission of new Members unassailable reality that in the field of health it would and Associate Members, the General Committee noted be true to say that the whole world must either swim that the application for admission of Kenya had not together or sink together. been received at least thirty days before the opening ' Of course, the mere feeling of brotherhood is not of the session of the Assembly, as provided for in the sufficient to accomplish our objective : we must also second paragraph of Rule 113 of the Rules of Pro- accept our challenge in a spirit of sacrifice. The task cedure. In order to allow consideration of the request which we have set before us can only be accomplished for admission during the Sixteenth Assembly under if financial and other resources are forthcoming.In item 1.11of the agenda, the General Committee this connexion, I would invite Member States to recommends that the Assembly suspend the application examine carefully the list showing the annual contri- of the second paragraph of Rule 113, as Rule 119 of the butions of various Members; it will be seen from such Rules of Procedure allows it to do, provided that notice a close examination that the well -to -do Member of the intention to propose this suspension has been States are really bearing the brunt of the burden of the communicated twenty -four hours before the meeting Organization. I would therefore like to pay a tribute to at which the proposal is to be made. This means that the generosity of the wealthier Member States, and on tomorrow afternoon we shall take up consideration behalf of every one of us thank them for their con- of suspending the rule in question, in view of the tinued generous contributions, which have made the admission of Kenya to associate membership under work of the World Health Organization possible. item 1.11. Finally, I wish to appeal to all Member States to Withregardtoitem1.13- Director -General, ensure that we continue to face our task in a spirit of appointment and approval of contract -the General friendship.Let us work unceasingly until we bring Committee recommended that this item be considered every square inch of the globe within the humanitarian in private plenary session today at 2.30 p.m. fold of the World Health Organization.By setting The General Committee further decided to recom- ourselves this goal and working assiduously towards mend to the Assembly that it approve the agenda, its achievement we shall continue to live up to the with the deletion of items that are no longer necessary. reputation of our organization, which has been widely These items are : 3.13, Housing of staff of the Regional acclaimed as the most successful of the United Nations Office for Africa; and 3.15, Working Capital Fund. organizations. Is the Assembly prepared to adopt the agenda, taking Ladies and gentlemen, I thank you very much indeed into account the recommendations of the General for the courtesy of listening to me so patiently. Committee ? In the absence of remarks or comments, the agenda is adopted.' 2.Adoption of the Agenda and Allocation of Items to the Main Committees 3.Programme of Work The PRESIDENT :The next item on the agenda is 1.8- Adoption of the agenda and allocation of items The PRESIDENT :Hours of work.The Assembly to the main committees. should be informed that the General Committee The General Committee at its first meeting yesterday decided that the hours of work should be as follows : considered the provisional agenda as prepared by the plenary meetings, 9.30 a.m. to 12 noon and the same Executive Board, which was sent to all delegates sixty for the main committees ; main committees, 2.30 to days before the opening of the session.This agenda 5.30 p.m.; General Committee, 12 noon or 5.30 p.m. has been prepared in such a way as to indicate the according to circumstances. Does the Assembly agree proposed allocation of items to the Committee on with this proposal ? Programme and Budget and to the Committee on In the absence of any comments I take it that the Administration, Finance and Legal Matters. The Assembly agrees. General Committee decided to recommend to the Sixteenth World Health Assembly that the items ' See p. 19. 36 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Award of the Darling Foundation Medal and Prize. Board at its thirtieth and thirty -first sessions.I give I wish to inform the Assembly that the General the floor to the representative of the Executive Board, Committee confirmed the tentative arrangement made Dr M. K. Afridi. by the Director- General for the presentation, on Thursday 9 May at noon, of the Darling Foundation Dr AFRIDI, Chairman of the Executive Board : Medal and Prize to Dr Martin Young.I take it that Mr President, distinguished members of the Assembly, thisrecommendationisalsoacceptabletothe ladies and gentlemen, allow me, Mr President, in my Assembly ? personal capacity, to congratulate you on your appoint- Technical discussions. The General Committee ment to this high office first, before I take up the recommends that the technical discussions be held as discussion of the reports.It is a matter of great satis- foreseen on Friday 10 and Saturday 11 May, as already faction to us all that your unanimous election to this indicated in the Journal.Detailed arrangements for high office has not only been accepted but received these discussions are contained in document A16/ with gratification by everyone in this Assembly. Technical Discussions /3. Persons wishing to take part I have the honour to present to the Assembly the in these discussions are reminded that they should hand reports of the thirtieth and thirty -first sessions of the in their registration forms not later than 2 p.m. today. Executive Board, which were held in the Palais des Delegates wishing to participate in the general Nations, Geneva, from 29 to 30 May 1962 and from discussionontheDirector -General'sreportare 15 to 28 January 1963 respectively.The detailed requested to announce their intention to do so, accounts of these sessions are contained in Official together with the name of the speaker, to the assistant Records Nos. 120, 124 and 125, to which the two main to the Secretary of the Assembly, Mr C. Fedele. committees of the Assembly will doubtless be making Whenever available, advance copies of speeches should reference during their deliberations.My colleague, also be handed to Mr Fedele in order to facilitate inter- Dr Nabulsi, and myself will be on call to present pretation and transcription of the proceedings. the views of the Executive Board on the items under I shall now adjourn the Assembly for twenty minutes discussion.At this stage, therefore, it will suffice if and during this recess the Credentials Committee will I confine myself to a brief survey of a few of the meet to examine a few credentials which have been important problems which the Board reviewed during received since yesterday. You will remember that the the two sessions. Credentials Committee is composed of Australia, As the Assembly is aware, the present Board had Bulgaria, Canada, Cyprus, Ghana, Madagascar, Fede- been assigned the somewhat unusual task of under- ration of Malaya, Nepal, Peru, Spain, Sweden, Syria. taking twoorganizationalstudiessimultaneously, The Assembly isadjourned for twenty minutes. namely " Measures for providing effective assistance in medical education and training to meet priority The meeting was suspended at 10.35 a.m. needsof thenewly independentand emerging and resumed at 11 a.m. countries "; and, secondly, " Methods of planning and execution of projects ".Both these studies evoked 4.Second Report of the Committee on Credentials considerable discussion in the two sessions, which The PRESIDENT : The Assembly is called to order. brought forth many useful and concrete suggestions. I will call on Dr Andriamasy, the Rapporteur of the The views of the Board on the first -named study Committee on Credentials, to introduce the second are incorporated in the report that will be considered report of this committee. by the Assembly under agenda item 2.6.1.In regard Dr Andriamasy (Madagascar), Rapporteur of the to the second study, namely " Methods of planning and Committee on Credentials, read out the second report execution of projects ", despite full and prolonged of that committee (see page 406). discussion the Board was not wholly satisfied with its coverage of the subject- matter. As a consequence, the The PRESIDENT : Thank you, Dr Andriamasy. Board felt that it would be in the interest of the Organi- We have heard the report of the Committee on zation if the study were passed for completion after Credentials. Are there any comments ? In the absence further deliberation at its next session.In arriving at of any comments, the Assembly accepts the report of this decision, the Board was influenced not only by the Committee on Credentials. the intrinsic importance of the subject itself, but also by the realization of the possible impact of the study 5.Reports of the Executive Board on its Thirtieth and on the future policy and programme of the Organi- Thirty -first Sessions zation. The PRESIDENT : We can now take up item 1.9, The Board reviewed the Director -General's report on Review and approval of the reports of the Executive continued assistance to newly independent States, and THIRD PLENARY MEETING 37 endorsedhisarrangementsforthe provision of The Board once again stressed the need to devote assistance to national health planning, education and increased resources to the control of disease and the training, and operational staff.This matter, brought improvement of health, with particular reference to up to date, will come again before the Assembly the United Nations Development Decade. under agenda item 2.5. As I said before, these matters, although now briefly After reviewing the malaria eradication programme, alluded to, will come up for detailed discussion later. the Board expressed its satisfaction with the progress In commending Official Records Nos. 120, 124 and so far made in this field of activity, but felt that it 125to the Assembly for its review and approval, I had now become necessary to assess once again, and in should perhaps mention that, with the exception of a the light of prevailing conditions, not only the full . few items, there was hardly any major divergence of cost of the global programme but also the likely opinion on most subjects.The major section of the annual expenditure of the Organization for the next report therefore reflects the concerted views of the five years. members. The chief virtue of these reports lies in the The Board dealt with the appointment of the fact that, taken by and large, the views expressed Regional Director for the Americas and of the therein are unaffected by extraneous considerations Regional Director for South -East Asia, and decided to and are based almost entirely on individual pro- re- appoint Dr A. Horwitz and Dr C. Mani respectively. fessional experiences. It is indeed heartening to observe A review of the procedure for the nomination of the that the Board has been able to maintain its tradition regional directors was also considered desirable, and of independence and has respectedthepersonal the Director - General was accordingly requested to character of the views of its members. The tempo and study this issue and to report to a future session of the direction of the growth of the Organization that has Board. I will have occasion to refer to the decision of taken place over the past fifteen years thus vindicates the Board relating to the nomination for the post of the profitable nature of this admirable principle, which Director - General of the World Health Organization the Organization has consistently followed with such when the Assembly takes up the consideration of the signal success. agenda item 1.13. A noteworthy decision of the Executive Board was The PRESIDENT : Thank you very much, Dr Afridi. to authorize the Director -General to accept a pro- portion of the contributions of the Member States to 6.Report of the Director -General on the Work of the regular budget in the currencies of those countries WHO in 1962 where regional offices are established. The PRESIDENT : Item 1.10 of the agenda, Review of In its detailed consideration of the programme arid the Annual Report of the Director - General on the budget estimates for1964,the Board received valuable work of the World Health Organization. guidance from the Standing Committee on Administra- I give the floor to Dr Candau. tion and Finance. The Board has transmitted to the Assembly its final proposals in this regard, with the The DIRECTOR- GENERAL : Mr President, honourable recommendation that the effective working budget delegates, I have the honour to present to you my for1964in the amount of $33 716 000, as proposed by report on the work of the World Health Organization the Director -General, be approved. during1962,which is contained in Official Records The Board reviewed the subject of decentralization No. 123. This report will, it is hoped, help delegates to of United Nations activities and the collaboration of evaluate the progress made by the Organization during WHO with the regional economic commissions of the the last year, to identify the areas of strength or weak- United Nations.It also reviewed the decisions of the ness of its action, and to clarify the major issues which United Nations, the specialized agencies, and the will have to be faced in the years to come. In briefly International Atomic Energy Agency affecting WHO's introducing this document, Mr President, may I make activities. Resolutions were adopted commending a few comments on the problems which appear to me the co- operation of the Organization with the Com- to be of special importance in this, the Organization's mittee on Housing, Building and Planning of the fifteenth year of activity. Economic and Social Council; on the Expanded Pro- Our recent experience of work in the newly emerging gramme of Technical Assistance, with special emphasis nations further underlines the need constantly to on assistancetogovernments inestablishingor re- assess and improve the ways and means we have revising national health plans; and on the points been using up till now to promote and improve the raised by the Ad Hoc Committee of Ten established education and training of medical and allied per- under Economic and Social Council resolutions 851 sonnel. The requirements we have to meet in this vital (XXXII) and900 (XXXIV). matter are indeed vast. The ideal solution might well 38 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II be to combine all the methods that have proved certain types of personnel and to surpluses of others, effective in raising the quantity and the quality of and thus defeat to some extent the very purpose which medical personnel, increase the number of fellowships training programmes are intended to serve. granted for both undergraduate and post- graduate Another broad question that recurs whenever the studies abroad, and assist in establishing teaching co- ordination of different aspects of international institutions in each country both for full professional assistance to developing countries is considered is the training and for the training of auxiliaries. Un- interdependence of health and of the other social and fortunately, there are budgetary restrictions on the economic components. As the Assembly knows, the extent and forms of assistance which WHO can importanceofthiscloserelationshiphasbeen provide. What is even more important, the financial constantly emphasized by WHO. It is of particular and manpower resources of the developing countries importance to bring this principle home to all people make it imperative for them -and for WHO, on whose who have any responsibility in drawing up the blue- guidance they rely -to take every care to ensure that prints for the new patterns of orderly economic and the national and international means available are used social development.They must not be allowed to in the most economic and efficient way.It is for this forget that the health of a people is one of its main reason that I believe that the time has come to review sources of wealth and that no community can ride to the methods and techniques employed to raise the prosperity on the back of an unhealthy population. standards of medical education and training.In so In reviewing in this Assembly the results of our work doing we must ask ourselves : How can we best help in 1962 and in previous years, we might usefully reflect countries, not only to undertake ad hoc training on some of the facts and figures which illustrate the activities, but also to establish plans for the progressive need for intensifying the battle for health if the other development of their teaching staffs and institutions worlds of economic and social development are to be in the light of their present possibilities and the fore- conquered. seeable needs ? The list of health conditions that have a crippling Another matter which deserves to be discussed fully effect on a country's national economy is unfortunately is the place and role of a well -prepared cadre of much too long. It includes the communicable diseases, auxiliary personnel in the developing health services a still present although preventable menace, especially of many countries now suffering from an acute shortage to children, and also the health hazards of middle life, of fully trained medical staff.Let me say in this to which the stress and strain of modern modes of connexion that the contribution that auxiliary health living are important contributing factors. personnel can make to the efficacy of health services, While there is no need in this gathering to dwell upon always provided that there is effective supervision by the great tasks which lie ahead of us, it might help us a fully qualified staff, has been recognized, even in to approach them with humility and an even greater countries where medical facilities are at a relatively sense of purpose if we remember that, despite undeniable high level. progress, some of it recorded in the report before you, The necessity to train auxiliary personnel is not there are today in the various parts of the world close confined to the health field, but applies to many other on 380 million human beings still exposed to malaria fields which are the concern of our sister agencies without the defence offered by eradication schemes; in the United Nations family. This was clearly brought there are probably even now over ten million sufferers out during the United Nations Conference on the from leprosy and more than four - and -a -half million Application of Science and Technology for the Benefit from yaws; and there are possibly 400 million victims of the Less- Developed Areas, which was held last of trachoma, 200 million who suffer from filariasis February in Geneva.In particular, the meeting and twenty million from onchocerciasis. In addition, devoted to the new systems of vocational teaching and itisestimated that in endemic areas bilharziasis apprenticeship stressed some of the very same concepts affects, at one time or another in their lives, almost that have been underlying our own thinking on the half the population. We cannot even attempt to give best use that can be made of auxiliary personnel. In figures for the intestinal infections or for tuberculosis, all fields the lack of general education in a great number all of which are consumers of health, and even of countries is one of the biggest handicaps in finding destroyers of life as well. more and better -suited candidates for training.It is The economic, industrial and agricultural experts, also recognized that fact -finding and planning are two busily engaged in drawing up plans for the economic essential prerequisites for the best possible utilization rehabilitation of the less developed countries, must of the scarce human resources which are at our know that this mass of disease, for the most part disposal, and that haphazard and uncoordinated preventable, is endemic in the very areas which they training schemes might lead to critical shortages of are trying to develop.They and the governments THIRD PLENARY MEETING 39
they serve have to realize that, unless the major com- priate research.The same is true of the chronic municable diseases are brought under control and the degenerative diseases.For instance, a comparative health of the population considerably improved, there study of a great number of as yet unexplored variations is no hope of creating the cadre of technicians and in the prevalence and incidence of cancer, coronary scientists who, we have been repeatedly told, are the thrombosis, hypertension, rheumaticdiseases and real wealth of every nation.Improved medical diabetes may provide new approaches to the epidemio- care throughout life, and measures that can cut short logy and treatment of these still puzzling diseases. the length of illness and restore the worker rapidly In these matters and many others which are of to his normal efficiency, are of value to the economy concern to world health, WHO must increasingly act in that they maintain the production force of the as a centre for arranging scientific meetings on specific country at the highest level. subjects, and for conducting or co- ordinating studies Investment in health is synonymous with investment which, if undertaken simultaneously in several places, in development. Perhaps the most convincing demon- may yield important results in a relatively short time stration of this can be found in environmental sanita- and bring us closer to the solution of certain out- tion, so essential to the raising of the general health standing problems. standards of a population. Quite considerable amounts The Assembly will be happy, I am sure, to note the of money will be needed in the coming years to provide very extensive co- operation we have continued to adequate water supplies to the urban and rural com- receive from scientists all over the world.This is munities of three -quarters of the world.Important reflected in their growing participation in a number capital investment will be required to remove what of scientific meetings during thelastfiveyears. is perhaps the greatest danger to the health of 85 per Altogether, during the period 1958 -1962, 804 scientists, cent. of the world's population, namely, the lack of representing the foremost authorities in their respective facilities for the disposal of excreta.There are other fields and coming from all parts of the world, attended vital aspects of environmental health which will have eighty -seven meetings at WHO's invitation. We are to be attacked with more vigour :food hygiene, particularly grateful to those renowned scientists who housing, the control of air and water pollution, to have served or who are serving on our Advisory mention only a few. Who can doubt that the money Committee on Medical Research for the invaluable invested in these essential services will be repaid a guidance they have given to our programme of hundred -fold in terms of the economic progress and research. prosperity for which they pave the way ? The assistance given by the Advisory Committee Another vital sector of WHO's work in which sub- and the numerous WHO scientific groupsisan stantial progress has been achieved is the stimulation extension of the valuable help WHO has been receiving and co- ordination of international medical research. from thousands of dedicated research workers in- The report on the 1962 activities bears witness to the vestigating health problems in universities and research quite remarkable advances made by the intensified centres throughout the world. programme established as a result of a resolution The WHO research programme has consistently adopted by the Eleventh World Health Assembly. taken advantage of all the means at its disposal to May I say, Mr President, that many important develop- increase the exchange of scientific information and the ments in the last five years have confirmed the wisdom training of research workers. of the 1958 Assembly's belief that further impetus However, what we have done so far is inadequate to needed to be given to the Organization's research meet the challenge that confronts us as a result of the activities.Indeed, the more we progress in the fight rapidity of scientific advance today and the growing against disease and in the promotion of positive health, complexity of the research problems to be solved. the more we become aware of the fact that, despite the In addition to our endeavours to apply new knowledge considerable efforts being made in various countries effectively, we must now search for fresh approaches to solve some of the enigmas of modern medicine, and methods to cope with the fundamental health and lack of knowledge is still the greatest handicap that bio- medical problems that are pressing upon us. WHO our Member States have to face in pursuing many of can no longer evade its great responsibilities on issues their public health programmes. which are of immediate concern to the present genera- Today medical research has become an indispensable tion and which may determine the future of mankind. and powerful arm of WHO in practically all its major Let me cite a few examples. programmes.It is indeed clear that the global attack There are the great potential dangers of chemical on malaria, venereal diseases, non -venereal trepone- contamination of air, water and foodstuffs that are matoses, tuberculosis, cholera, trachoma and so on inhaled or ingested by large population groups. We cannot advance rapidly unless supported by appro- must watch the possible ill- effects of the new medica- 40 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II ments and biological products given to or inoculated but another step towards the objective of universal into millions of people each year throughout the membership which must be attained if WHO is to world. The recent thalidomide disaster, the problems make itsfullestcontribution tothehealth and of industrial wastes and pesticides are cases in point. happiness of the men and women it was created to We are almost totally ignorant of the somatic and serve. genetic effects on cells of many of these substances and This year the Red Cross celebrates its Centenary and it is therefore urgent that the fundamental problem today, all over the world, is Red Cross Day. May of chemical mutagenesis and toxicity be given the I therefore, Mr President, take this opportunity to highest priority at every level of research. pay a tribute, in the name of the Organization, to the In connexion with this and other problems, there truly remarkable work the Red Cross has carried out is a most urgent need for the creation of a world in bringing, often under the most difficult conditions, centre for communications and information on health immediate help and succour to millions of victims of research.The effective functioning of such a centre conflicts and of natural disasters. The Red Cross has requires the application of the latest techniques, in- translated into reality the moral principles of universal cludingelectronicmachineryforthereception, solidarity. All those who, today, are dedicating assimilation, storage and retrieval of pertinent inform- themselves to the battle against disease and suffering ation on research.The past collaboration of various are deeply indebted to the generous mind and the high research authorities throughout the world with WHO, ideals of Henry Dunant, " the man in white ", whose giving unique access to the information required, dream led to one of the most admirable humanitarian ensures the successful operation of such an under- crusades in history. WHO is proud of the close and taking. fraternal partnership it enjoys with the Red Cross. Can we pretend that we have even begun to take No one has better described the similarity between our advantage of the remarkable advances in mathematics, organizations than Henry P. Davison, the founder of physics and engineering for a true scientific study, in the the League of Red Cross Societies, when he assigned laboratory and in the field, of both communicable and to the Red Cross the task of relieving, " not the non -communicable diseases ? Little is the progress we suffering of one people alone, but of attempting to have made in combining these disciplines with those arouse all peoples to a sense of their responsibility of biology and the social sciences which are necessary for the welfare of their fellow beings throughout the forrational and integrated health planning and world ".May the noble work of the Red Cross public health practice on national and international continue in the centuries to come. scales, as well as for the study of the problems of aging, human reproduction and mental health. The PRESIDENT : Thank you, Dr Candau. All I am saying is that the time is here for a radical re- appraisal and perhaps an equally radical extension of our efforts in health research.This calls for a 7.General Discussion on the Reports of the Executive comprehensive study of those health problems of Board and the Report of the Director -General on major importance to the world as a whole which are the Work of WHO in 1962 not likely to be explored adequately by purely national The PRESIDENT : Before giving the floor to the first efforts. And should these studies clearly indicate the speaker, I wish to recall that the Fourteenth World need for new approaches by WHO to basic and applied Health Assembly, in its resolution WHA14.51, decided research on the bio- medical and social problems I have that at World Health Assemblies one debate only referred to, then it is my assumption, Mr President, should be devoted totheconsiderationof the and I hope the Assembly will agree with me, that we Annual Report of the Director -General and that this should prepare ourselves for such endeavours, so that debate should be in plenary meeting, provided that the the present and future generations cannot hold us to physical facilities permit this.Consequently, micro- account for having failed to do so. phones have been installed at the tables of delegations. The Assembly will be glad to note that, since the Should the Assembly so decide, delegates could speak Fifteenth World Health Assembly, the membership from their places.Are there any objections to this ? of WHO has increased to 117 Members and one It is so decided. Associate Member. In welcoming to this Assembly our I give the floor to the delegate of Tanganyika. new Members -Algeria, Burundi, Jamaica, Rwanda, Trinidad and Tobago, and Uganda -may I also greet Mr MASWANYA (Tanganyika) :First of all, let me the delegates of Hungary, and express our satisfaction congratulate you, Mr President, on your election to that their Government has decided to resume active this high office.I am sure that, with the assistance of participation in the work of our organization. This is the Vice -Presidents elected at the same time, you will THIRD PLENARY MEETING 41 guide this Sixteenth World Health Assembly to a their best to provide rural health centres, but, although successful conclusion. the scheme was started over five years ago, only thirty On 10 May 1962, while attending the Fifteenth World such centres are operating, out of a total requirement Health Assembly at which Tanganyika was represented of approximately 200.It is becoming increasingly as a full Member for the first time, my predecessor as obvious that the tempo of the progress will remain Tanganyika's Minister for Health thanked all Member very slow unless the central Government comes in countries for approving my country's application for with substantial capital grants -which, unfortunately, full membership. He also assured the Assembly that is not possible at present.Nevertheless, my Ministry Tanganyika as a full Member would at all times abide regards the rural health centre project as a vital one, by the articles of the Constitution which she had and I am now planning to approach certain individual accepted, and that she would always co- operate to countries and voluntary organizations seeking their the best of her ability in furthering the work of this help.To complete the remaining 170 rural health great international organization.Since then, Tan- centres will require a sum which is too large for a ganyika has become a Republic within the British country like Tanganyika. But I am sure, Mr President, Commonwealth, and today it is my privilege to lead the you will agree with me when 1 say that this sum is delegation at the second Assembly of Tanganyika as very small for the more developed Member countries, a full Member, and its first as a Republic. or the World Health Organization. No request for I should like to congratulate the Director- General assistance in this project has been submitted to the on his excellent and very informative report on the Organization, because we are told the Organization activities of our organization.I should also like to does not go in for such projects; and in view of the take this opportunity to say a few words about the importance of the scheme I must say this sort of answer needs of my country. is regarded in my country as most unsatisfactory and Last year, my predecessor mentioned the natural discouraging. adversities such as famine and flood which disrupted Whilst on the subject of rural health centres, I should ine economy of the country to such an extent that like to take this opportunity to express my people's development in the field of public health had almost gratitude to UNICEF for the help given to us by this come to a standstill owing to shortage of funds. He United Nations specialized agency in the form of also said that, in spite of these misfortunes, the people transport, equipment, dried milk and drugs for every of Tanganyika were united and determined to go rural health centre we have been able to build, and for ahead with the three -year development plan, which the supply of textbooks and other teaching equip- was the first step in our fight against the country's ment to our training centres for nurses, midwives threemain enemies -namely,ignorance,disease and auxiliary medical personnel. This agency's aid has and poverty.Owing to lack of funds, many of The recently been extended to cover the activities of the smaller projects included in the plan are being initiated CommunityDevelopmentDivisionofanother or even completed through voluntary communal ministry.I see that UNICEF is represented at this turn -outs, in which all sections of the population Assembly, and I should like to thank its representative, participate. and say that I hope their good work will continue to The aim of my Ministry is to provide a balanced expand not only in Tanganyika, but also in all the curative and preventive health service throughout other under -developed parts of the world. the country. On the curative side, our aim is to provide Last year my predecessor referred to the shortage one hospital bed per 1000 of the population, and one of fully qualified doctors in Tanganyika, and he said rural health centre for every 50 000 people. Each health that by modern standards the country required ten centre would, in addition to providing curative services, times more doctors than it had then.In spite of serve as a nucleus for local public health measures such considerable assistance received under special technical as health education and maternal and child welfare aid schemes from the British and Israeli Governments, services. To achieve this in a country like Tanganyika, the position has not improved, and it is not likely where just over nine million people are scattered over to improve in the very near future.This difficulty an area exceeding 360 000 square miles, is no easy has prompted my Ministry to launch an ambitious matter. A start has been made and, with the help of the training scheme at Dar es Salaam to augment the wider British Government, a number of up -to -date hospitals East African training scheme for doctors at Makerere have recently been built; but there are still many University College in Uganda. The minimum qualifica- districts that are either without hospitals at all, or tion for admission to the Medical School in Dar es have hospitals which are so out -moded that their Salaam istwelve years of basic education, with replacement is long overdue. emphasis on science subjects during the last two years, Local authorities have done, and are still doing, but a number of the students in the first intake have 42 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II had fourteen years' school education. The course will in the area has been promised by the World Health last six years, in accordance with WHO standards. Organization, but so far there is no sign of the project's Our thanks are due to the Rockefeller Foundation, implementation, although it appears in the current which has provided all the equipment for the anatomy budget. It is my sincere hope that the authorities con- and pathology laboratories, and isfinancing the cerned will see to it that its implementation is not Director of the School for five years, to the London delayed any further.The Israeli Government, under School of Hygiene anf Tropical Medicine, which has a special technical aid scheme, has established an eye seconded one physician, and to the Swiss Tropical diseases treatment centre in Dar es Salaam, which Institute in Basle, which has seconded a biologist from September 1963 will be headed by a high- to the School. It is hoped that WHO will provide two ranking specialist from Israel;itis my Ministry's more clinical tutors as promised. We are also grateful desire that the WHO -sponsored eye diseases survey to the British Government and the World Health should also be launched as soon as possible and in Organization for financing a number of our doctors consultation with the Israeli specialist. who are taking post -graduate courses abroad. I must now turn to a very disturbing feature of the In the field of public health, we have not done as modus operandiof the World Health Organization much as we would have liked -again because of lack as it affects Tanganyika.I hope, Mr President, you of funds. Last year, my predecessor referred to schemes will forgive me for what I am going to say, as I feel such as the WHO -sponsored smallpox eradication that, unless complaints of this nature are made known, scheme, which had to be shelved because the Ministry matters cannot be put right.I have already referred could not raise its share of the cost, amounting to some to the rigid rules governing aid from this organization, US $120 000, and in his address he appealed to the and I should like to state again that, in certain deserv- Assembly for a relaxation of the existing regulations ing cases, these should be relaxed to enable impor- so that certain deserving schemes could be implemented tant projects to be implemented, even if the country even if the receiving country was unable to contribute concerned is unable to raise its share of the costs. financially.Smallpox is still with us, and it would The second point I should like to raise in this appear that the World Health Organization will do connexion is the question of the sending of an expert nothing unless my Ministry can raise its part of the by WHO to a country requesting aid, as a prerequisite cost.This isverydisturbing.Tuberculosis is in- to that aid being granted. Experts are always welcome, creasingly becoming a menacing problem and, although but to make their visits a prerequisite to the granting my Ministry is doing its utmost to combat it, con- of aid can hardly be justified.The various medical siderable help from outside is still necessary. problems facing Tanganyika, for instance, have been We in Tanganyika realize that major schemes such studied off and on by various experts since the days as malaria eradication are beyond our means, and that of Robert Koch, before the First World War. As a they are likely to remain so for some considerable result, there is detailed documentary information about time. As malaria is still the major cause of morbidity most of the major problems, and what we want is and mortality in the country, we can only hope for the financial assistance to enable us to tackle them. Where time being to achieve a certain amount of transmission a problem is not well understood, then we ourselves control by using such methods as medicated salt. A will specifically ask for it to be surveyed. We regard pilot project of this nature has successfully been the surveying of all problems before aid is granted, in concluded in one area in Tanganyika, thanks to WHO's spite of many of these problems having been studied providing the drug chloroquine for medicating the in the past, as unnecessary duplication.We have salt supplied to the area, and plans are in hand for instances where an expert has spent a week in the launching a similar but larger project in another area country and, on returning to Geneva, has submitted of the country, provided the World Health Organi- unfoundedcriticism,andhas recommended the zation will supply the drug and the field officer. One appointment of another expert to study the problem large region in Tanganyika is seriously affected by eye more closely and submit a recommendation.I must diseases leading to blindness. An eye diseases survey emphasize again that many of the main public health THIRD PLENARY MEETING 43 problems in Tanganyika have already been studied at attracted away by the Organization, and that all the one time or another by experts, and what is needed implications of such offers are understood. now is the money to implement the recorded recom- Mr President, I should like to emphasize again that mendations of these experts, and not more surveys, the aim of the World Health Organization should be except where the problem concerned is not under- to set a minimum standard of health, and then to stood. assist all the developing countries in achieving that The third point I want to raise is in connexion with standard, whether the countries themselves are able to the recruitment of experts. The World Health Organi- contribute towards the costs or not.Unless this is zation normally recruits its experts from the more done, I do not see how the present disparity in life developed countries, but occasionally such recruitment expectation and in death -rates can be removed or is made from a country like Tanganyika, and no con- reduced. sideration is given to its effect on the country con- I thank you, Mr President, for giving me this cerned. We have an example of a medical officer who opportunity to speak to the Assembly on behalf of was given every opportunity, at great expense, to the Government and people of Tanganyika, and I must specialize in nutrition, so that he could eventually also thank my fellow delegates for listening to me so organize a good nutrition unit to serve the whole patiently. country. After a number of years, and when he was The PRESIDENT : Thank you, Mr Maswanya. just beginning to gain international recognition and I wish to inform the Assembly that the time of closure Tanganyika was beginning to reap the fruits of the of the meeting this morning was fixed for 12 noon, trainingfacilities his placed at disposal, he was in anticipation of a meeting of the General Committee. attracted away by a colossal salary offered by the Since the General Committee is not meeting today, it World Health Organization. If the aim of the World is proposed that the Assembly should continue sitting Health Organization is to promote the health of all till 12.30, if that is acceptable to the delegates.This people, why was this man attracted away, causing a will enable more speakers to contribute to the debate complete breakdown of what had taken him more on the Director -General's Report this morning. than five years to organize ?If the World Health Is that acceptable to delegates ?Then we shall Organization appreciated his good work in the field of nutrition, why, having been recruited by the continue till 12.30.I recognize the delegate of Israel. Organization, was he not allowed to remain in Tan- Mr RAFAEL (Israel) : Mr President and fellow dele- ganyika to continue his work there ? The matter did gates, once again we are assembled here for delibera- not end here. Recognizing the importance of nutrition, tions on the betterment of the health of man throughout my Ministry selected another medical officer interested the world. The World Health Assembly has by now in nutrition, and gave him the same facilities to train become an annual forum to forge and hammer out himself as had been given to his predecessor. Within policies in an effort to apply the advances of medicine a few months, he, too, was approached by WHO, and to people the world over, to integrate health into the was offered employment as an expert. I am glad to say process of economic and social development.Let that, as a result of a protest from my Ministry, me therefore first congratulate the very distinguished the offer was not followed up, and the officer concerned Federal Minister of Health of Nigeria, Dr Majeko- is still with us. dunmi, on his election as President of this year's I should like to impress upon this Assembly that Assembly.I should like to extend my best wishes for instances such as the ones I have quoted tend to make success in his high office.I should also like to con- countries like my own, which are struggling to build gratulate the Vice -Presidents and Committee Chairmen on their election. up an effective establishment of useful staff, begin to It is obvious that the emergence of so many new wonder about the intentions of the World Health Member States in recent years should have left a Organization.Our countries are poor and cannot considerable imprint on both the structure and the solve their public health problems without external orientation of the Organization, creating a certain help. We cannot, therefore, be expected to train future measure of ambivalence. While the more sophisticated experts for other countries before we are in a position health problems of veteran Member States are by ro to meet our own needs.I have ventured to mention means forsaken, a great deal of attention and resources these points in order to call the attention of the WHO are devoted to the fundamental problems of the new, authorities and the Assembly to their existehce. I hope developing countries.This is how it should be.Just that in future there will be full consultation between as economic assistance by the great powers to the the WHO authorities and the countries concerned smaller States is essential in order to try to keep the before officers employed by developing countries are balance between countries which form one world, in 44 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II the field of health such aid is even more imperative. is not a prerogative of big and wealthy nations. Not It is by now a truism that health is indivisible, just as only have the smaller nations no less a degree of the peace is indivisible. intellectual curiosity of the inquiring mind; in many We are now in the third year of the Development cases they also have at their disposal trained research Decade, ar l it is our hope and prayer that the various workers and skills to apply their faculties, if only programmes now in different stages of preparation will funds were available.I make a plea to divert some of take shape and be put into operation for the benefit the research work in progress under the sponsorship of those countries most in need of them. Development of the Organization to those countries. This, it would involves mobilization of resources and manpower.It appear, is justified for the sake of research itself and is the declared policy of my Government to share its its universal character. experiences and know -how in the development of It was a wise decision indeed to select the subject materialand human resourceswithdeveloping of education and training of the physician for the countries. Within the limitations given, Israel, a small preventive and social aspects of clinical practice as the developing country herself, considers it her duty to topic for this year's technical discussions.While the offer assistance where assistance is welcome in a variety comparatively small group of public health physicians of areas and fields of endeavour, including medicine and the even smaller group of public health oriented and health. clinicians are well aware of the impact of the social Ever since the Marshall Plan was launched for the sciences on medicine, and while the prevention of rebuilding of Europe following the Second World War, disease is a basic tenet of public health, clinicians of all the concept of assistance, both bilateral and multi- descriptions still tend to neglect and disregard the social lateral, has undergone changes.It is now recognized and preventive aspects of medical practice. Thus, a rift that aid is justified and effective if it serves as an enzy- threatens to develop which ought to be avoided by matic activator, as it were :in other words, nations all means, and the best means of doing so appears to should be helped to help themselves.One cannot be to imbue the medical student as well as his clinical therefore over -estimate the importance of training and teachers from the beginning with the proper apprecia- education.It is gratifying to note the over -riding tion of the preventive and social aspects of clinical consideration given by the Organization to the training practice.I do hope the outcome of the technical and education of health personnel at all levels.The discussions will point out the ways by which this can increasing number of fellowships awarded is evidence be achieved. that this policy meets a real need. I am glad to report Let me now turn to a problem on the agenda that has that my country, . recognizing thechallenge,has recently become very acute.I refer to the control responded in accordance with its limited means.In of new pharmaceutical materials, to which the thali- co- ordination with the World Health Organization, domide disaster has given additional weight. We are survey and planning teams and advisory and operative well aware of the legislative complications involved in assistance have gone out to various countries in Africa this respect in the various countries, of pressures and Asia, while fellowships have been granted to exerted by the pharmaceutical industry, and of the health personnel for training and study in Israel, both speedy rise in the number of pharmaceutical items, at undergraduate and post -graduate levels, with the but, to avert the possibility of the recurrence of a express purpose of trying to educate them for leader- similar disaster, safeguards must be devised that would ship in their respective countries.It is this leadership ensure both the potency and safety of new drugs. which should enable countries to help themselves. With all due respect to the legislative sovereignty of We all feel, I believe, that there is room for closer Member States, surely the World Health Organization co- operation in an effort to reach a break -through in is called upon to take the initiative in this field. People research in the malignant diseases, and this is but one throughout the world expect the Organization to instance of many where initiative is badly needed. provide leadership in such a vital matter, and they There is no need to dwell at length upon the all - will duly appreciate it if it is forthcoming important aspects of research.Ever since the World Fellow delegates, the partnership between the World Health Assembly decided several years ago to intensify Health Organization and the Food and Agriculture its efforts in this area, and to promote still further Organization has found suitable expression in the collaboration between national research institutes and theme of this year's World Health Day. The appalling laboratories, there has been an upsurge of research state of malnutrition, " hidden hunger ", and even activity in different fields, such as cardiovascular manifest hunger, in many countries and among large disease, cancer, nutrition, vector control, radiation populations calls for urgent and extensive action. health, human genetics, etc.Yet it seems to me that Freedom from hunger is one of the essential freedoms the Organization ought to bear in mind that research of mankind. Our ancestors, the fathers of our ancient THIRD PLENARY MEETING 45
culture, already knew that hunger is worse than the the residue of political doctrine which here and there sword, basing their knowledge on the bitter experience still hampers some of the day -to -day work.Thus of fugitives from war, as recounted in the lamentations we shall be able to show other organizations a good of Jeremiah : " They that be slain with the sword are example of full and sincere international co- operation. better than they that be slain with hunger ".It is Let this change of heart begin in our organization. shameful indeed for this era, the era of tremendous The wise and very competent leadership of Dr Can- scientific conquests, that, side by side with ostentatious dau, who has won the appreciation of all of us by his wealth and the steadily rising standard of living, outstanding capabilities, has been secured, much to millions go hungry, and women and children suffer our delight, for five more years.I wish to extend to from severe malnutrition.Knowing this, can we Dr Candau my most sincere wishes fora fruitful con- remain inactive ? tinuation of his work; his abilities as an outstanding In this forum one need not emphasize the correlation and highly competent leader and his vision will enable and interdependence between the state of nutrition him, I am sure, to direct the Organization to higher and the state of health. Our organization, which has goals for the benefit of the health of man. In doing so, taken upon itself to fight disease, to improve the health Dr Candau may be assured of the support of all men of man, and to lengthen his span of life, cannot remain of good will. We shall all lend him a helping hand so indifferent in the face of this problem. I feel that, if the as to secure his success and the success of our organi- Organization should initiate action, itis bound to zation. succeed. The PRESIDENT : Thank you, Mr Rafael. I recognize The ancient sages of Israel over two thousand years ago taught us that, in regard to food, all men are the delegate of the Netherlands. equal, and no distinction may be made between saint Professor MUNTENDAM (Netherlands) : Mr President, and sinner, for they were mindful of the admonition fellow delegates, I would like to begin the few observa- of the prophet Isaiah :" Is it not lawful to deal thy tions that I intend to make at this moment by con- bread to the hungry ? " and they commentèd :" To gratulating you, Mr President, on your appointment .give at once and without delay, for it is due to him to the chairmanship of this Assembly. We have once because he is hungry ".It is our duty to apply this more come together from all parts of the globe to admonition on an international scale: Supplying food have our annual exchange of ideas and experiences on for the needy should bear down barriers and partition health matters in our respective countries.I might walls between races and nations, religions and political almost call it a family gathering -the large and world - concepts. embracing family of health workers -and it is a great Care for the health of the people is linked with the pleasure to see you in the Chair and to work and live effort to raise productive capacities. Their inter- in this gathering under your leadership. dependence is obvious.I may mention in all modesty Our family is growing every year. We see many old that my own country has demonstrated that a deter- friends with whom we have bonds of lasting friend- mined effort as well as the application of science to ship, but there are also several new delegates, represent- agriculture can render a country not only self -sufficient ing countries that have recently been admitted to the as far as food supplies are concerned, but even enable World Health Organization. To these new Member it to export agricultural produce, despite paucity of States I would like to extend a most hearty welcome. basic material resources such as water. What we and It gives us great satisfaction that they have come to others have succeeded in doing can be done elsewhere our family, and that we shall have the good fortune to too. work together with their delegates during our stay Let me conclude by emphasizing that the multi- in Geneva. farious activities of the World Health Organization Mr President, I take this opportunity to say a few are greatly appreciated by all of us.The Director - words to the delegation of the Republic of Indonesia. General's Annual Report provides ample evidence of In recent years there have been differences of opinion the constant expansion of activities, of improvements between our two delegations with regard to the status in planning and implementation. But we ought not to and name of New Guinea. We are very happy that remain content with the existing scope of activities. The these differences of opinion now belong to the past, and superior moral strength of our organization and its I wish to express my great satisfaction with this state mission among the nations make it capable of attain- of affairs. ments which no other organization can equal. Let us There is a real danger, Mr President, that repeating set our goals higher, even though at first glance they every year words of praise for the Director -General may appear distant, difficult and even unrealistic. We and his staff may become monotonous, and that shall reach them if we join forces. Let us do away with the force of these words will diminish in relation to 46 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II the frequency with which they are spoken.I will try for the quality of our future health services, and our to escape this danger and, thinking of the proverb universities and training institutions of today must be " A bon entendeur demi -mot suffit ", I will not add adequately provided for the demands of the future. any more compliments to those already made.1 am As a point of special interest, I may mention investiga- convinced that the Director -General will understand tions concerning the problem of having the family this " half -word " of compliment of my delegation, doctor maintain his central place in health care. which is wholly meant. It is clear that, in planning, financial matters are of Every year before 1 come to this Assembly I am in primary importance, and we must see to it that health the habit of reading once again the Constitution of the has its proper place in the economy of the country. World Health Organization, and of keeping two points We believe that health will, in the future, have an of the preamble well in mind namely, that govern- increasing share of the national incomeit will no ments are responsible for the health of their peoples, longer be the balancing post as so often was the case and that what one State achieves in the field of health in the past. is also of value for all other States and their peoples. Another important subject is planning in the wide From these paragraphs of the preamble, I take the field of environmental health.Adequate supply of liberty of saying a few words on recent health develop- drinking -water in the Netherlands is hampered by ment in my country.I will limit my remarks to the industrialization, with its pollution of some of the subject of planning, for two reasons. First, because this European rivers that have their lower courses in our is an important activity of my Government, and country.Air pollution is a problem of increasing secondly, because in this age in which society, science importance -and so is housing, in the country with the and technical achievements are developing so force- greatest density of population in the world. All these fully, health planning is of the greatest importance for are problems not only of physical health, but also of the health care of our people in the near and farther mental health. future. These are the main points I wanted to bring to the In our planning we see certain priorities. The attention of this Assembly. Needless to say, planning first one I want to mention is social security, even and research are to be seen as one and inseparable. though this is not a subject of direct concern to WHO. None of the elements of health planning I have Between social security and health there is a strong mentioned can be used as materials for the future interaction.Without health, no security; but also without security, no health.In my country health building of health policy if they are not placed on the foundations of research. insurance comes under the Division of Public Health of the Ministry of Social Affairs and Public Health Mr President, my delegation is aware of the fact and is not, as in some countries, under the Ministry of that in many countries the problems are more serious Labour or some other ministry.I consider this a than in the Netherlands, that for millions of people the satisfactory arrangement.In the past year a number question of life or death is the all- important one. The of important Billson socialsecurity have been theme of World Health Day 1963 has again reminded introduced in Parliament by the Minister of Social us of this.If I have taken the liberty of speaking of Affairs and Public Health, and in the near future more the situation in a prosperous country, I have done so are to come, among others a Bill that will provide on the basis of another paragraph of the preamble of coverage for the chronically ill and the physically and WHO's Constitution, which says that " the extension mentally handicapped.Until now, care for these to all peoples of the benefits of medical, psychological groups has been mostly a matter of social assistance and related knowledge is essential to the fullest attain- and not of social security, which they need more than ment of health ". This is the reason why a prosperous anybody else. people should plan for the future in a way that will A second problem of great importance is planning enable it to make contributions to the attainment of for future needs in health personnel and in building that ultimate goal, real world health. and equipment.It is not an easy task to plan, for The PRESIDENT : Thank you, Professor Muntendam. instance, the provision of hospitals as regards size and differentiation, but perhaps even more difficult is the prognosis as regards the need for doctors with various 8.Announcements qualifications and for paramedical personnel. We are now being confronted with the prognosis of fifteen The PRESIDENT :Before I adjourn the meeting, years ago, which was probably not correct and has I wish to remind delegates that this afternoon, at not taken into account the rapidly increasing demands 2.30, a private plenary meeting will be held to consider for health care. Planning in this field is a first condition item 1.13- Appointment of the Director - General and FOURTH PLENARY MEETING 47
approval of his contract.The General Committee representative of the United Nations admitted ex recommends that the following should have access officiotothe meeting, the representatives of the to the meeting : the delegates of Member States, their specialized agencies should be authorized to be present. alternates and advisers; the representatives of Associate Is the Assembly in agreement with this recom- Members; the representatives of the Executive Board.; mendation ?Itisso decided.The Assembly is and those members of the Secretariat whose presence adjourned until 2.30 p.m. is judged necessary by the Director -General. The Gene- ral Committee also recommends that, apart from the The meeting rose at 12.30 p.m.
FOURTH PLENARY MEETING
Wednesday, 8 May 1963, at 2.30 p.m.
President: Dr M. A. MAJEKODUNMI (Nigeria)
1.Appointment of the Director -General and Approval AUTHORIZES the President of the Sixteenth World of his Contract Health Assembly to sign this contract in the name of the Organization. The meeting was held in private from 2.30 to 3.40 p.m., and resumed in public session at 4 p.m. The PRESIDENT :Thank you. The PRESIDENT : The Assembly is now meeting in Dr Candau, it gives me very great pleasure to inform public. The meeting is called to order. you of your reappointment. You have been Director - I will read to you the resolution which has just been General of this organization for the past ten years and adopted at a private meeting of the Assembly, con- your term of office has been marked by the rapid cerning the appointment of the Director - General by growth of the Organization in both influence and 95 votes in favour, none against and no abstentions : prestige.I am extremely happy that you have been reappointed and I congratulate you very warmly. The Sixteenth World Health Assembly, I wish you many more years of useful service to this On the nomination of the Executive Board, organization. REAPPOINTS Dr M. G. Candau asDirector - The DIRECTOR- GENERAL : Mr President, honourable General of the World Health Organization. delegates, it is with no little emotion that I have listened to your expression, Mr President, of confidence in me The Assembly also adopted in private session a and I would simply wish to thank all of you for it. resolution approving the Director- General's contract, The resolution which you have just adopted is to me which I shall now ask the Deputy Director -General to also a mark of your appreciation of all my colleagues read to you. on the staff with whom I have had the privilege of working for these last thirteen years.With such Dr DOROLLE, Deputy Director -General: colleagues, and with the knowledge that I can continue The Sixteenth World Health Assembly, to rely on the wise and tolerant guidance of the World Health Assembly and the Executive Board, I look I.Pursuant to Article 31 of the Constitution and Rule 106 of the Rules of Procedure of the World forward to the opportunity of serving the World Health Assembly, Health Organization for a further term. Thank you very much. APPROVES the contract establishing the terms and conditions of appointment, salary and other emolu- The PRESIDENT :I give the floor to the delegate of ments for the post of Director -General; and Brazil. II.Pursuant to Rule 110 of the Rules of Procedure Dr CHAGAS (Brazil) (translation from the Spanish) : of the World Health Assembly, Mr President and delegates, first of all I wish to express 48 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II the deep satisfaction of my country at the reappoint- makes it possible to eradicate not only diseases, but ment of Dr Marcolino Gomes Candau as Director - also poverty, provided that the task is undertaken in General of the World Health Organization.It is the the same spirit as pervades the activities of this organi- tradition of the World Health Organization to choose zation. its staff not according to their nationality but according If it is possible to prevent disease it must also be to their value, their knowledge, their scientific author- possible to adopt measures that will banish forever ity, their merits, and the qualifications and aptitude the spectre of hunger and poverty that haunts mankind. they have shown. Any other method would be most The course of the fight against stagnation of the peoples harmful to this great organization and to the efforts is in the hands of those who direct the great labora- it is making to eradicate the diseases and suffering tories from which emerge the wonderful drugs that which threaten, persecute and afflict mankind.The save so many human lives. criterion for selection is thus a rigorous one and The work of WHO would be easier if there were also constitutes a further reason why all Brazilians should a world organization to combat poverty and back- be proud to see one of our compatriots receive such wardness, instead of mere charitable acts which are repeated demonstrations of confidence in his personal generally lacking in political determination and con- worth. This is the third time that Dr Candau has been tinuity.While awaiting a widening of man's mental entrusted with this arduous and delicate task which, horizons that will enable him to consider the world while it affords him an opportunity of serving a drama with more greatness of spirit, I salute those generous humanitarian cause, also demands certain who are working to reduce the physical sufferings of sacrifices such as the one he made not long ago by the human race in an organization which, besides its renouncing the post of Minister of State in the many other merits, has performed the inestimable Brazilian Government, which would have been a service of heralding by its success the advent of better fitting conclusion to his work for the public good. days full of new hope for humanity. My presence at this Assembly is evidence not only The unanimity of Dr Candau's election is a good of the solidarity of the Government of President omen and provides convincing proof that the nations Joâo Goulart with the illustrious Brazilian who has can co -exist when they are animated by common just received this great honour; it also shows the ideals, and that men can understand one another enthusiasm, confidence and high esteem of Brazil for when faced with the fundamental problems of their the World Health. Organization, with whose founda- destiny. tion at the San Francisco Conference is indissolubly In the name of Brazil I thank you all for this election, linked the name of another eminent health expert and which shows us how great would be the unity and compatriot of ours : Dr Geraldo de Paula Souza. strength of a world in which there was less hostility The World Health Organization is a leader in inter- and more understanding. national work not only because of its methods and The PRESIDENT : Thank you, Dr Chagas. procedures, but also because of the principles of human solidarity underlying its endeavours, which we hope to see fully realized when there no longer exists, 2.General Discussion on the Reports of the Executive between scientific knowledge and other sectors of what Board and the Report of the Director -General on we might call the world of the spirit, that void which the Work of WHO in 1962 (continued) is the result of the unequal development of mankind - The PRESIDENT : We now resume the general dis- on the technical side and on the moral and spiritual cussion of items 1.9 and 1.10.I recognize the delegate side. of Germany. If the work of this organization serves as an example to human society to avert the danger of a world war, Dr SCHWARZHAUPT (Federal Republic of Germany) the prospect of which grows more horrible with every (translation from the French) :In thefirstplace, day that passes, and to fight resolutely against the evils Mr President, I should like to congratulate you on your of under -development, we can be proud of having election to this highly responsible post. At the same inaugurated a really new stage in the history of time I would convey the greetings of my Government mankind. An atomic war seems inconceivable today, to the Director -General and his colleagues. It gives me but there is another war which we cannot ignore : great pleasure to be able, for the first time, to take the the war against under -development.Many of the floor at a plenary assembly of the World Health problems with which the World Health Organization Organization.The work the Organization has done is dealing result from this evil which, like endemic so far has deeply impressed me, and I have followed diseases, can be cured by means already within with admiration the steady international progress made everyone's reach. Modern technical development in the complex field of health. FOURTH PLENARY MEETING 49
First, I want to thank the Director - General and his applies to air pollution in the same way as to noise colleagues for the remarkable report on the work of liable to cause harm or inconvenience. I believe that a WHO in1962; Ishall confine myself to a few points joint effort on the part of all countries affected by this which appear to me vital. problem would produce a more speedy solution. The In his introduction to the Annual Report the experience gained by theindustrializedcountries Director -General draws attention to the importance could help the developing countries to avoid mistakes of the United Nations Development Decade.That when setting up their industries by taking appropriate programme emphasizes first and foremost the fact that measures at the right time. the improvement of health in the world is the pre- During the past year the Federal Government also requisite for raising standards of living. The Federal paid a great deal of attention to developing the water Government has accepted this view and has prepared supply system and to preventing water pollution. a multiple programme of bilateral health assistance. Nearly90per cent. of the population is now supplied This bilateral assistance is guided exclusively by the with piped water.Water pollution is one of the un- wishes of the various countries concerned.For the desirable consequences of technical and economic carrying out of health projects in the developing development.In recent years we have passed severe countries, the work of WHO, with its wealth of legislation against pollution, in particular in connexion experience, has served as an example. The Federal with the use of detergents harmful to water. Government isat present carrying out more than I should like to say how particularly grateful we 120health projects for the benefit of developing are for the work of the Joint Expert Committee on countries. In addition to major health matters -such Food Additives.This is a joint committee of dis- as the control of communicable diseases, environ- tinguished pharmacologists and toxicologists from all mental health, and maternal and child health -the over the world that meets to make a scientific appraisal, training and further training of doctors and auxiliary from the health point of view, of foreign substances medical personnel appear to us to be of overriding added to foodstuffs. Since the technical and economic importance for the developing countries. importance of these additives is steadily increasing, a In this connexion, the questions referred to in critical medical appraisal in the interests of the con- Chapter6of the Director -General's Annual Report sumer is becoming more and more urgently needed. seem to us to indicate the right road. We agree that it The scientific publications of this group of research would be wise to give extensive support to the establish- workers provide a valuable basis for legislation on ment of institutions providing basic training, such as foodstuffs, in all countries of the world. health institutes and schools for nursing and laboratory I should not like to conclude my statement without personnel.The Federal Government is providing a also mentioning aproblem that I have especially at steadily increasing number of fellowships for the heart, namely, the control of pharmaceutical products. further training of doctors and auxiliary medical Events that have occurred in connexion with a certain personnel, particular stress in the matter of specialized drug have shown us all, with cruel clarity, that the training being laid on tuberculosis control, tropical detection of dangers to health arising from medica- medicine, and laboratory techniques. ments isa problem of the utmost importance, a The remarkableprogressachievedinmalaria problem which scientists from all over the world eradication that has been reported by the Director - must endeavour to solve. Even though scientific proof General has impressed me very much.For this of the teratogenic effects of thalidomide has not yet important work the Federal Government has made, been produced, it may nevertheless be regarded as this year again, a voluntary contribution in money and highly probable that a causal relation exists between kind to the value of DM250 000,or US$62 500. the absorption of thalidomide by the mother and the The problems of air and water pollution are of developmental disorders in the embryo. These occur- increasing importance.Studies of health statistics rences, which are frightening for all of us, have shown are revealing with ever- increasing clarity the harmful that our knowledge of the dangers of this kind that effects of the pollution of the air by gases and dusts. may arise from medicaments is not yet sufficient to Practical measures of protection are necessary to enable us to say for certain what all the effects of new safeguard the health of the population.In principle, therapeutic substances will be. anyone responsible for polluting the air should be In the Federal Republic of Germany eminent required to take all technically feasible measures to scientists have drawn up directives in the field of reduce such pollution to the lowest attainable pro- pharmacology, requiring all substances whose effects portion. German legislationisbased upon this are not generally known to undergo in future toxico- principle.New installations ought to be authorized logical and pharmacological examinations. Directives only if they do no harm to the surrounding area. This are now being prepared for the clinical testing of such 50 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II pharmaceutical products.In future no medicament the attainment by our people of national sovereignty may be offered for sale unless the manufacturer has and independence. previously provided proof that all the examinations The Algerian people, which has passed through a and checks which, according to the most recent long period of physical and mental tribulation, will scientific discoveries, are capable of detecting possible not fail to make its contribution, however small that injuriouseffects,have actually beencarriedout. contribution may be, to any activity undertaken to Pharmaceuticalspecialitiescontainingsubstances help all those who, throughout the world, are still whose effectsare not generally known are only living a life of humiliation, racial segregation, destitu- registered if the findings of these examinations suggest tion and hunger.We shall not rest until the true that inall probability the administration of the representatives of all peoples are finally sitting in pharmaceuticals in question is not dangerous to the this Assembly.We shall devote ourselves to an patient and that the secondary effectsliewithin untiring endeavour to enable co- operation between therapeutically permissible limits. all men of good will effectively to serve the cause of I am particularly glad to see that, in the Director - mankind. General's report on the work of WHO, it has been Everyone knows that a majority of the people in the suggested that activities in this field should be inten- world are still suffering the pains of poverty, hunger sified and that the World Health Organization is and disease.Praiseworthy though the work done by prepared to have directives for the testing of medica- the United Nations and its specialized agencies - ments drawn up by a committee of pharmacologists the World Health Organization in particular -has from all parts of the world who are authorities on the been, the amount still remaining to be done is enor- subject. It goes without saying that the Federal mous.I want to emphasize that, however great the Republic is ready and willing to place the experience efforts made,thesafeguarding of health in the and knowledge of its scientists at the disposal of that developing countries can only be real and effective to important mission. the extent that the social, economic and political structuresof thosecountriesundergo profound The PRESIDENT : Thank you, Dr Schwarzhaupt.I change. No valid health policy, no programme, now give the floor to the delegate of Algeria. however all- embracing, can be carried out effectively in these countries in the absence of sufficiently strong Dr NEKKACHE (Algeria)(translation fromthe national cadresand, above all,unlessthereare French) : Mr President, ladies and gentlemen, allow adequate guaranteesensuringa minimum living me on the occasion of the Sixteenth World Health standard for all. Assembly to convey to you the sympathetic greetings The problem of health cannot be separated from and of the Government of the Democratic and Popular treatedindependentlyof thetotalityof human Republic of Algeria and of the Algerian people, which problems that confront the most under -privileged has just emerged from its long colonial eclipse. peoples.We believe therefore that the problem of I should like to congratulate Dr Majekodunmi on safeguardinghealthisprimarilyamedico -social his election as President of the Sixteenth World Health problem, which requires a combination of educational Assembly, and Dr Candau on his reappointment to the work, economic progress and the speeding up of the post of Director- General of the World Health Organi- training of cadres. Accordingly, as soon as we became zation. independent we concentrated all our efforts upon Algeria is taking part in the work of the World increasing the number of schools and centres for Health Assembly for the first time. It is a great honour medical, paramedical and administrativetraining. for me, and an inestimable pleasure, to head the first In addition, mass health education campaigns were delegation of the Algerian Government to the World launched to get the people to co- operate in carrying Health Assembly.I should like you to know how out hygienic and preventive measures. We are at last gratifying it is to us, after long years of struggle and in process of building up a health organization and hope, to join your ranks and to take part in your un- infrastructure suited to the particular circumstances of remitting efforts to ensure that every day there is a our country and capable of providing medical aid for further improvement in the lot of mankind. all, even in the most remote rural areas. We cordially thank the Assembly for the sympa- But at the same time as thus preparing for the future, thetic message it has conveyed to us through the inter- we are having to solve serious social problems resulting mediary of its President. We would take this oppor- from seven years of war and the medical and technical tunity once again to thank and to express our profound vacuum left by the mass emigration of medical and gratitude to all those who have been unsparing in their paramedical personnel. After 2 July 1962, the departure efforts to help us in our fight for national liberation and of 2200 doctors and 2700 male and female nurses left FOURTH PLENARY MEETING 51
144 hospitals without administrative and technical Uganda :malaria,tuberculosis,leprosy,sleeping staff. Add to this the existence of an uprooted, scattered sickness, and onchocerciasis are some of the major and re- grouped population, continually on the move causes of morbidity in the country. in search of attention or work; their health being thus The pilot project of malaria eradication organized by more vulnerable, the need for rapid medico -social the World Health Organization in Kigezi District has action on our part was made urgently necessary. produced some encouraging results, and also WHO As is the case in all developing countries, the results experts are soon going out to Uganda to assist in aimed at in Algeria are long -term. Consequently we problems of onchocerciasis. feel that WHO's assistance to us ought chiefly to take I hope this great international organization will the form of giving us the benefit of the Organization's continue to assist my country in these and other experience and help to enable us to put our pro- projects.In the past we have channelled requests for gramme on a realistic basis. We firmly believe that the assistance through the Government of the United World Health Organization, displaying its customary Kingdom of Great Britain and Northern Ireland. spirit of solidarity, will give suitable and effective I must also take this opportunity to thank that govern- assistance to all peoples in the endeavour to bring ment for guiding my country to full independence about an era of peace, well -being and health in the peacefully and for enabling my country's delegation world. to take its place in this Assembly on an equal footing. Mr President and fellow delegates, once more thank The PRESIDENT : Thank you very much, Dr Nekkache you very much for the great honour you have done my I recognize the delegate of Uganda. country. Dr KADAMA (Uganda) : Mr Chairman, on behalf of my country and the Government of Uganda, I wish The PRESIDENT : Thank you, Dr Kadama. I recognize to congratulate you on your being elected President of the delegate of Bolivia. the Sixteenth World Health Assembly in the year Dr TORRES- BRACAMONTE (Bolivia) (translation from 1963.I wish you the best of luck in conducting the the Spanish) :I should like to begin by expressing my Assembly's business. Ialso wish to congratulate congratulations to the President on his election and to Dr Candau on being reappointed Director -General Dr Candau on his well- deserved reappointment, my of the World Health Organization for the third cordial greetings tothe illustriousrepresentatives time. of public health from all countries, my sincere thanks Mr President and fellow delegates, first of all I must to our Director -General for his magnificent work and apologize because it was not possible for my country, the valuable assistance he is giving my country, and Uganda, to be represented at the Fifteenth World my thanks to the great Swiss nation for the generous Health Assembly, during which it was nominated hospitality it is extending to us. for associate membership.I must therefore take this The report on health problems in Bolivia has been opportunity to thank you all for the honour you submitted under the ten -year plan and I will not tire have bestowed upon my country.I would also you by repeating even a summary of it, which would like to thank the Government of the United Kingdom necessarily be incomplete.I will rather put forward of Great Britain and Northern Ireland for sponsoring for your kind attention a few ideas to supplement my country's application for associate membership. that official document. Since the Fifteenth World Health Assembly was held, A far- reaching revolutionary movement is on foot my country has attained full independence and it is in the world, shaking the traditional foundations; now my privilege to represent her at this Assembly and history is moving at a pace never seen before; and to thank you again, this time for admitting my modern medicine no longer confines itself to curing country as a full Member of this organization. I diseases or even to preventing them -the objective is would like to assure the Assembly that Uganda, as a to eradicate suffering and want. The sage of Cos was full Member, will at all times observe the articles of the not speaking in vain when he said that " the doctor Organization's Constitution, which she has accepted, philosopher is the equal of the gods ". and will abide by them. It is astonishing to think what the world would be My country is very small and her resources are like if all human beings were educated for brotherhood limited, but her peoples are united and determined to instead of being prepared for individual or collective go ahead in the fight against disease, which is one of the competition.There are enough resources and know- country's major enemies.In view of our limited ledge in the world to provide food, clothing and housing resources, however, we need a considerable amount for everyone.But men have forgotten the simple pre- of aid from external sources to enable us to fight disease cepts of the great teachers of all times and our egoism more effectively.Many diseases are prevalent in prevents us from realizing this beautiful dream. 52 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The demonstration of human brotherhood given Board, the Director -General's Annual Report, and the by health workers, in their efforts to improve the budget estimates for 1964. My delegation has pleasure living conditions of our peoples, encourages us to in commending the report of the Executive Board, think that we are witnessing the birth of a civilization which is the fruit of a detailed study on the part of the that will be all the more beautiful in being more Board of the questions referred to it, which it discussed humanitarian.Thus will be fulfilled the idea of the in a down -to -earth and frank manner at its thirty -first Englishstatesman William Gladstone, who said session.The records of that session show how im- that the day would come when the doctors, as the portant those questions were, and the satisfactory champions of the ideal of human concord, would nature of the Secretariat's replies in most cases. become the leaders of the nations. We consider the Director -General's Report on the Work of WHO in 1962 a valuable document, the The PRESIDENT : Thank you, Dr Torres -Bracamonte. opening part of which deals with matters of exceptional I recognize the delegate of Syria. importance in respect of their scope, and of their repercussions on the programme in years to come. Dr ARAFEH (Syria) (translation from the French) : The Director -General stresses in the Report that Allow me, Mr President, cordially to congratulate Member States have complied with a large number of you on your election as President of the Sixteenth previous recommendations made by the World Health World Health Assembly. Your ability, your sense of Assembly for raising the level of health. We hope that fair play and professional standing will, I am certain, the Organization and its regional offices will be able be valuable to us. to make their contribution towards achieving the aim of these special recommendations. We take this Gentlemen, everyone, in every part of the globe, opportunity to express our firm belief that social and welcomed the setting up of this organization in 1948 economic problems deserve special attention in the and had great hopes of it as a guiding force and a pursuit of the aim in view. There is a profound con- source of support for the solution of health problems. nexion between socio- economic and health problems. The Organization has become what the nations hoped : Health and social problems are,in our opinion, its responsibilities have increased, itsservices have related matters which cannot be separated and, expanded and its budget grown. It is indeed mankind's accordingly, can only be solved together, within the dream, in the matter of world health, come true. It has framework of an overall plan.We hope that the solved a great number of local and common problems, Organization and its regional offices will devote still it has dealt with certain urgent situations, and has more attention to social and economic problems in triumphed over and over again.It has set itself to considering action on health questions. No plan that find the answer to the most intricate and obscure the Organization may propose for solving a health Consequently the world's belief in it has questions. problem concerning the health of the community can grown and become increasingly firmly established. get to the root of the matter unless the social and The progress made by theOrganization and economic problem that is part and parcel of it is dealt its steady development are due to two things :the with at the same time. noble and realisticprinciples of itsConstitution, The 1964 budget figure is only 7.42 per cent. higher and the influence of Dr Chisholm and Dr Candau. than that for 1963. This is a moderate increase in view Dr Chisholm, with his learning, his devotion to duty of the services rendered by the Organization in all the and his moral sense, mapped out the work that was to developed and developing countries.We hope that be done during the period of the Organization's the budget for next year and future years will be much foundation.Dr Candau employed his vigour and more generous, so as to enable the Organization to intellect to impel the Organization forward. Both men attain its objectives in the field of the improvement of possessed boundless ability and allowed nothing to health in the world. Retrenchment is no longer to be stand in their way but financial and budgetary con- thought of :it would prevent us from ever achieving siderations. Dr Candau, already well known as a man the improvement we hope for.In connexion with the of great ability, has given proof of even greater powers budget estimates, we have pleasure in saying how as Director -General.I take this opportunity, on my much we appreciatethe emphasis theDirector - own behalf and on that of my delegation, cordially General lays on training, research, the dissemination to congratulate Dr Candau on the trust the entire of scientific knowledge, and the exchange of inform- world places in him and on the respect in which he is ation; these, together, represent the correct approach held. to a radical solution of health problems. Accordingly Fellow delegates, our delegation has read with we hope that the Organization will lay more emphasis great interest the most recent report of the Executive on fellowships in education, training and research, in FOURTH PLENARY MEETING 53 order to attain the objective laid down in its Constitu- of programmes toaccelerate the progress in the tion. developing areas of the world. It is a task of supreme I should not like to let slip this opportunity of importance and one of the main trends in the work expressing our appreciation of UNICEF's participa- of the World Health Organization. We are grateful tion in various projects and of its steady support within for the exemplary efficiency and the devotion of the its budgetary limits. We are most gratified to learn Director -General and the WHO governing bodies in that the UNICEF Executive Board has adopted the endorsing a ten -year programme designed to help Director -General's proposals, which will involve a developing countries to build the health of their newdepartureinUNICEF'spolicyregarding peoples. It was an unequivocal and clear stand of the children's needs :in future UNICEF will deal with Fifteenth World Health Assembly, on a problem so all aspects of them. The new fields covered by UNICEF vitally important, when it shared in the view that aid -such as education, vocational training, urban governments should aim during the decade at 10 to projects,social welfareservices and other youth 15 per cent. yearly increase in the funds allocated for services -deserve special attention by this Assembly, nationalhealthservices. TheDirector - General especially those problems concerning children and cleverly touched in the introduction to his report on adolescents within the framework of general national otherdifferentand important pointsconcerning planning. We welcome this new development in training and education, fellowships, genetic research, UNICEF's policy, and look forward to benefiting from virology, immunology and chronic diseases. it when UNICEF is ready to make an exploratory The first chapter in the Report manifests how study of children's needs in our country. considerable progress was made in the malaria eradic- ation campaign in many parts of the world. The The PRESIDENT : Thank you, Dr Arafeh. I recognize campaign has been conducted with energy and patience the delegate of Kuwait. and has reached the consolidation phase in many areas, where intensive surveillance is under way.In Dr EL -BORAI (Kuwait) : Mr President, Mr Director - a number of countries where malaria eradication General, distinguished fellow delegates, it is indeed programmes have not been implemented, the speeding - my very great privilege to congratulate you, Mr Pre- up of the pre- eradication programmes isalready sident, warmly and add my tribute on behalf of my forcing its way. We hope that we can do more - country and delegation on your well- deserved election and we must do more -in the field of malaria eradic- to the high presidency of this Assembly.I am sure ation to bring life to our fellow men and to relieve that your wide knowledge and vast experience, together human suffering. with your outstanding personality,will guide the It again attracted keen interest when the Director - Sixteenth World Health Assembly through its con- General, in the second chapter of the Report, spoke troversial problems towards our common aim, and about the communicable diseases.If these diseases that you will direct our deliberations towards the are to be successfully controlled we must not relax realization of the objectives which are expected by all. our efforts, particularly in strengthening epidemio- I would like on behalf of my country and delegation logical services and training the personnel necessary to offer my cordial congratulations to the Director - to continue day -to -day control.This control is of General, Dr Candau, on his new appointment and prime concern and is one of the compelling problems on the remarkable work accomplished by the Organi- of our time, which can be overcome by superior forces. zation during 1962, through which it has extended its I would like to take this opportunity to refer to the activities and strengthened its relations with various fact that progress in the global effort to eradicate countries. smallpox, although it has been slow, yet is provocative At the end of the first paragraph in the introduction of thought, and my delegation hopes that itwill to his report there is a very attractive note, clarifying progress in the near future with gigantic strides. the policy of the Organization, echoing the words Very little or slow progress appears to be achieved of the Secretary -General of the United Nations in by the Organization in respect of trachoma.This saying :" The widening of man's horizons through disease is now one of the chief public health problems education and training, and the lifting of his vitality in my country, as in others.Although the Regional through better health, are not only essential pre- Office intends to assist us with an epidemiological conditions for development, they are also among its survey of communicable eye diseases and subsequently major objectives ". with a pilot control project, yet I wish again to appeal In the introduction to this comprehensive report it is a to the World Health Organization to act more forcibly pleasure to note also that the outstanding characteristic and vigorously on this disease in countries where it of the work during 1962 was the intensive preparation prevails. 54 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The Report strikes an annoying note on rickettsial My Government is very much pleased to learn diseases, in pointing out that insecticides, although oftheimportantdevelopmentsthatoccurred effective in the control of epidemic typhus, have not in1962 to improve the environmental health and been so successful in the control of other rickettsial public health services in many communities and the infections, especially those transmitted by ticks and efforts that have been undertaken to raise the standard mites. Attention should be paid to this problem and of education and training and to promote and protect a special programme ought to be prepared to deal the health of the population. with the matter. Let me refer, Mr President, to another notable The antituberculosis work which was carried out in activityof the World Health Organization :the some countries was admired.I would like on this importance given to planning. I find it appropriate to occasion to draw attention to one of the most mention that we in Kuwait established a council for disturbing problems in my country, the problem of health planning which came to the conclusion that tuberculosis.(Anything I venture to put forward in we should develop a pattern of health services of our my speech is nothing but a complete acceptance by the own and which proved very fruitful, and I find it Kuwait delegation of the great work done by the reasonable to give a brief account which is sum- World Health Organization, as shown in the Report of marized as follows. A clinic is set up in each village the Director -General, in its second chapter.) It is our or each quarter of the city.These clinics are staffed top health problem in Kuwait, and scientific progress by an adequate number of doctors and auxiliary and advances in recent years have made it possible to medical staff, and provided with good equipment. consider the eradication of this disease our expected The basic service offered there is medical care, which successful goal. The picture is not as clear as it appears forms part of an integral local health programme. to be with other diseases, such as smallpox, and The number of doctors depends entirely on the popula- perhaps we shall have to wait a little more before tion of the district which the clinic serves. It is expected results can be proved with certainty; but the medical that a district of 12 000 should have four doctors in armoury that we already have makes an effort at its clinic.Our forty clinics, which work four hours eradication quite promising.The domiciliary treat- in the morning and two hours in the afternoon, are ment of tuberculosis by chemotherapy, which is evenly distributed to provide coverage of the whole centred around our chest clinics, the non -shortage of population and are sited so as to be easily reached by tuberculosis beds in our sanatoria, and the introduc- the patient. tion of BCG vaccination will help us to achieve good The generous way the patients were dealt with, and results. We consider in our country that any irresolu- the unlimited right given to them to go from one clinic tion or hesitation in respect of the regional office to another, even in one day, made us think of an project for tuberculosis control in Kuwait which we attractive remedy for this defect through which time, have embarked upon would have an adverse effect money and effort were lost.Legislation concerning upon all our health programmes. Indeed, the senior health registration of the whole population has been adviser of the Regional Office deserves our most issued. Every family isregistered at the nearest cordial thanks and we will never forget the great clinic to its dwelling; it is not allowed to be treated efforts and patience of this man.I should like to anywhere. Every member has got his personal health place on record the thanks and appreciation of the card.The patient goes to the clinic and shows his Kuwait Government to the Regional Office for the card, which bears a special number, against which excellent work that has been done in the field of tuber- he is given his special sheet of treatment. The collec- culosis and the great help that is generously granted tion of the family sheets is put in one file. The personal to us. health card gives some very important information : Venereal diseases and treponematoses come under it shows the blood group, the Rh sensitivity data, another item in the Report of the Director -General. chronic diseases, susceptibility to uraemia, and other It is mentioned very frankly that more internationally important data.If the patient requires the help of co- ordinated research is needed, as well as improved a consultant, he is turned over to him with a special methods and techniques for epidemiology, diagnosis card adapted for this purpose.The patient at the and therapy. The long hope of mankind in the war consultant's clinic is either hospitalized or sent again against these diseases lies ultimately with medical to the family clinic with the necessary note. research. As the World Health Organization plays an Still we do not stop at this limit.We choose a increasingly important role in stimulating,guiding central clinic from among every three or four clinics and co- ordinating medical research,alladvanced and call it the combined health unit. We have got countries should lend their active support for this eleven of these; they work twenty -four hours a day. matter. The basic health services offered at these combined FOURTH PLENARY MEETING 55 health units include an ordinary clinic for the district supreme organ of all who fight for human health and concerned. Specialized branches of medicine, such as human life, should take an unequivocal and declared eye, dental, maternity and child health services, with stand on a problem so vitally important as peace or preventive and environmental sanitation services, are war, life or death, and support by all means in its also offered for the district of the aforesaid three or power the demand for the banning of nuclear weapon four clinics.There is a very close link between the tests and for general and complete disarmament, and combined health unit on the one hand and health and should in some way or other declare the idea of the social education on the other.All emergency cases, speediest possible conclusion and discontinuance of all wherever their dwelling, are allowed to visit these nuclear tests. The Organization is fully entitled to do combined units for first aid, where there is a fully this and it is its duty to do it, on account of the equipped first aid centre. Distant clinics and combined disastrous effects of such tests on human health.It is units are equipped with wireless sets. We are hoping something that complies with the tasks and objectives that this new way of registration, with its clinics and laid down in the Organization's Constitution. combined units, will be directed eventually to the full In conclusion let me say that it is the earnest wish utilization of modern environmental and public health of my delegation that the World Health Organization services, including medical care for the attainment of continue in command against the forces of disease, the highest possible level of health and happiness of to climb to the summit of fulfilment, and to serve the the population of Kuwait. happiness of mankind. Mr President, distinguished fellow delegates, at the Mr President, I would pay on behalf of my delegation end of the last world war, with the burdened and our tribute to the Director -General, Dr Candau, heart- broken world holding its hands up in prayer for and his associates and Secretariat, who have carried peace and security, our organization was developed out this work with great efficiency, fortitude and a not only as a scientific instrument but also as an very high degree of skill; and add our very real embodiment of high hopes.It announces peace appreciation and admiration for the most excellent and co- operation instead of war and division, brotherly work accomplished by these distinguished people. loveinsteadofhatred,constructioninsteadof We are anticipating and looking forward to more destruction.The creation of our organization was a beneficial results. great humanitarian act, an act of faith in a better life for mankind through the great progress in science. The PRESIDENT : Thank you, Dr El- Borai. I recognize What is the role of this science ?Is it serving the the delegate of Iraq. peace and happiness of man, or is it rising up to enslave him ? Is science seeking to plant in the hearts of people Dr AL -WAHBI (Iraq) : Mr President, fellow delegates, a new hope or a horrible nightmare ?Our great allow me to take this opportunity to convey the problem isthe humanization of technology and greetings of the Republic of Iraq and those of its science.We highly esteem the work of the World delegation to you and to express our congratulations Health Organization for the protection of the health on the occasion of your election to the presidency of of mankind against the hazards of ionizing radiation the Sixteenth World Health Assembly.I am certain and atomic energy and for asserting its influence and that, with your leadership and guidance, the delibera- authority in this sphere. We deplore most vehemently tions and labours of this session will be brought to a the fact of continuing to disregard and defy the over- happy and successful conclusion.We also wish to whelming will, not only of the people who are more congratulate the three distinguished Vice -Presidents directly concerned and subjected to perils of radiation on their election. and fall -out, but also of the entire world community. We have the privilege this year of welcoming to our The peace-loving policy of our government and ranks new Members who, through patience, devotion other governments acts as a palliative measure against and sacrifice, have taken their rightful places in this the enemy of health -the radiation hazards resulting august body.They are Algeria, Rwanda, Burundi, from nuclear weapon tests.I presume to think that Uganda, Jamaica, and Trinidad and Tobago. To the only way of ridding ourselves of the dreadful threat them all I extend my sincere congratulations. to the present and future generations through the We all look forward and pray that at future increasing pollution of the atmosphere by radioactive Assemblies of this organization delegates of each and fall -out is the total discontinuance of all tests of nuclear every country representingfreeand independent weapons of any kind.It seems to me that radioactive nations will share in the benefits and services of this fall -out cannot be controlled by man : any measure is world -wide institution.It is then, and then only, futile.In the opinion of the Kuwait delegation it is that the name of " World Health Organization " essential that the World Health Organization, as the will truly express its meaning. 56 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
This year 1963 marks the hundredth anniversary of the quickest ways and means our organization should a great humanitarian organization, the Red Cross, pursue to attain its objective. Perhaps a high- standard with which our organization has had most cordial group of experts, with the help of the Secretariat, could and fruitful association and co- operation. It gives me study the situation -in the light of the new develop- pleasure to extend our congratulations, greetings and ments in the world and the knowledge and experience good wishes on this occasion to the League of Red of this organization that I have mentioned -and report Cross and Red Crescent Societies, the International their findings, with observations and recommendations, Committee of the Red Cross, and to Red Cross and to the Executive Board and subsequently tothe Red Crescent populations wherever they may be, and Assembly. wish them all success in their endeavours. I am only putting forward this idea as a suggestion Our Director- General, Dr Candau, has made it a for the Director- General and his colleagues to consider. habit to present the Assembly every year with a most We consider the Development Decade as an opportunity comprehensive, factual and inspiring Annual Report tostimulatenationalhealthadministrationsin on the activities and accomplishments of the World planning long -term programmes, with the assistance Health Organization. This year's report is a singularly of the World Health Organization and other organi- interesting one, full of very detailed data.I wish zations within the United Nations family, to strengthen to thank him and his collaborators for this valuable their national health services. I welcome the statement document and for the efficient manner in which it that the World Health Organization is prepared to has been prepared. provide assistance in the formulation or revision of We are happy to note the close relationships and plans for the balanced and orderly development of health the co- operation that exist within this family of the services during the Decade. Sound national, scientific World Health Organization.Referring to Annex 10 and practical planning is most urgently needed.I am to the Director -General's Report, we notice that half pleased to endorse the statement that the experience the professional staff comes from five Member. States. of the technically more developed countries has to be We firmly believe that the principle of equitable geo- adjusted to the conditions and situations prevailing graphical distribution is an important factor in the in the developing countries. healthy growth and efficiency of our organization. Although great progress has been made in the fight We are all aware of, and are proud of and grateful against communicable diseases, there is still a long way to the Organization for the assistance it has rendered to go in conquering these scourges.Stress should be to the Member countries, especially the newly emerging laid on eradication whenever technically feasible, and and developing nations.But it is very obvious that that should continue to be on the priority list in many if we are to succeed in keeping up with the present countries. fast and dynamic progress of the world, and in coping I am happy to learn that the Director- General has withitsever -increasing needs, we shall have to given rural health a top priority in the process of accelerate our own pace. Throughout the short and strengthening national health services. My Govern- successful existence of our organization a vast treasure ment attaches great importance and is paying a great of knowledge and experience has been accumulated deal of attention to rural health.Since more than which we must use for guidance in our future 75 per cent. of our population live in rural areas, it is endeavours and undertakings. evident that a high priority must be given to this The administrative and executive machinery that problem. The tripod to success is : (1) careful, detailed we have built is one which all should be proud of. and long -term planning, based on scientific data, and During the course of the past fifteen years,this the allocation of funds to execute it; (2) the setting up Assembly and the Executive Board sessions have of adequate administrative and technical machinery listened to and taken note of wise words and ideas of to implement these plans and the training of the neces- vision that can rightly serve as a guide for the policy sary personnel at all levels, to ensure success; (3) inter- of our institution in implementing its programme and national co- operation, assistance and the exchange of fulfilling its goal and its ideas. A vivid example could knowledge and experience to overcome the difficulties be taken from Official Records Nos. 111 and 119 that confront us. of theFourteenth andFifteenth World Health Rural health projects should be planned in such a Assemblies, in the more recent of which are the way as to be able to assimilate and integrate malaria recorded speeches of our friends and colleagues, eradication projects, combined with sanitation and Dr Karl Evang and Professor Zdanov (Official Records health education of the public.Our organization is No. 119, pages 68 and 102 respectively). called upon more than at any time to assist in this It seems to me that now is the most opportune time important undertaking. To organize a set -up of this to reflect and to study the best, the most efficient and calibre warrants the creation of a special department FIFTH PLENARY MEETING 57
at the central and regional levels of the World Health the Republic of Iraq, to express to our organization my Organization. country's profound and sincere gratitude for the The acute shortage of qualifiedspecialists and admirable and precious services it is rendering. properly trained health personnel makes it necessary The PRESIDENT : Thank you, Dr Al- Wahbi. to give medical education and training the highest priority in our programmes.WHO's assistance is required, first, in the establishing or strengthening of 3.Announcement concerning the Procedure for Elec- already existing medical education institutions within tions to the Executive Board the country; secondly, in the establishment of regional The PRESIDENT : I have an important announcement educational institutions, where Member countries of to make on the election of Members entitled to the region share similar environmental, cultural and designate a person to serve on the Executive Board. health problems; and, thirdly, by awarding fellowships In conformity with Rule 97 of the Rules of Procedure, abroad. at the commencement of each regular session of the I am grateful to the Director -General for giving Health Assembly the President shall request Members prominence to parasitic diseases in general and bil- desirous of putting forward suggestions regarding the harziasis in particular. Communicable eye diseases and annual election of those Members to be entitled to especially trachoma have a deserved special mention. designate a person to serve on the Board to place their Mr. President, I would like to remind the Assembly suggestions before the General Committee. Such of resolution WHA14.56, adopted by the Fourteenth suggestions shall reach the Chairman of the General World Health Assembly, on the subject of " Radiation Committee not later than forty -eight hours after the health, including protection of mankind from ionizing President has made the announcement in accordance radiation hazards, whatever their sources ". However, with this Rule. since 24 February 1961 when this resolution was I therefore invite delegates to submit suggestions adopted, I am sorry to say that some Member States concerning these elections not later than Monday of our organization, after having ignored the wish morning, 13 May, at 10 a.m., and the General Com- of the peoples of the world, resumed atomic tests, mittee will draw up its recommendations to the especially in the Algerian desert against the wish of Assembly with regard to these elections at the meeting the Algerian people. My Government wishes to place it will hold on that same day, Monday, 13 May. on record its condemnation of all nuclear tests, Suggestions should be handed to Mr C.Fedele, whatever the countries conducting them. Assistant to the Secretary of the Assembly. I hereby declare the meeting closed. In closing, I would like to take advantage of this occasion to say that I make it my duty, as delegate of The meeting rose at 5.30 p.m.
FIFTH PLENARY MEETING
Thursday, 9 May 1963, at 9.30 a.m.
President: Dr M. A. MAJEKODUNMI (Nigeria) later: Dr Sushila NAYAR (India)
1.General Discussion on the Reports of the Executive will be closed at noon.I have forty -four speakers Board and the Report of the Director -General on on my list, and I would again like to request you to be the Work of WHO in 1962 (continued) brief so that we can finish our discussions on these The PRESIDENT : The meeting is called to order. items of the agenda today. Before the resumption of the general discussion on I now have pleasure in calling upon the delegate items 1.9 and 1.10, I wish to announce that I intend of Chile. to close the list of speakers at noon today. Are there Dr BRAVO (Chile) (translation from the Spanish) : any objections ? In the absence of objections the list Mr President,Director- General,fellowdelegates, 58 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II ladies and gentlemen, before making a few brief peoples of the continent, both to their physical and to comments on the magnificent report submitted to the their social environment, has created a state of conflict Sixteenth World Health Assembly by the Director - which has been increasing for some years and now General, I should like, on behalf of the Government represents a pressing challenge to the ideas by which of Chile, to extend my greetings to the six new countries the peoples of western civilization have been governed. that have joined the World Health Organization this Faced with the complex of the causes stated, and year, two of which- Jamaica, and Trinidad and others of which we are unaware, the economists of Tobago -are in our region of the Americas.It is a our time have tried to find a solution for the problem matter of great satisfaction to us to see these new of social conflict by means of economic development arrivals and to vote for their admission, since we alone.This approach, however, revealed the inter- consider that every new country which joins our ranks dependence of health, education and the economy, represents a further step towards the universality of and it became increasingly clear that health and health protection to which we attachso much education had to be considered as essential parts of importance. the process of economic and social development. I should also like, Mr President, to congratulate It is now agreed that the problem of development you and the Vice -Presidents, under whose skilful should be approached as a harmonious and indivisible leadership I am sure this Assembly will be able to whole.It is due to the National Health Service of reach decisions to the advantage of everyone. Finally, Chile that our country has adopted this view, since the I also wish to convey the sincere congratulations of health service has maintained for many years that the Chilean Government and, in particular, of this economic development as the sole means of achieving delegation to the Director- General for his well- merited social adjustment is not enough. unanimousre- electionby the Members ofthis The central idea of modern planning is to achieve Assembly which, in electing him in this manner, has rationalizationof decisions and co- ordination of confirmed the policy he has followed, one which has activities.This entails careful prior selection of well - given the work of this organization a realistic and defined objectives and the drawing up of plans and progressive direction and a character in keeping with programmes, together with the evaluation and em- modern scientific and technological progress. ployment of the necessary resources for their execution. It gives us great satisfaction to read the Report of It also means including the activities of the private the Director -General, which places all the emphasis sector in the system which governments establish in in the Organization's activities on what we consider, order to make the most of the national potentialities in the economic and social plans of our Government, and to achieve rapid economic and social progress. A to be the very essence of public health work. In the plan for economic and social development isthe Latin American countries thereis now enormous concrete form in which a development policy is put into concern and anxiety over economic and social develop- effect.It must consequently fix economic goals and ment.The wish to enjoy higher standards of living objectives, and social goals and objectives. has come to create a permanent state of social tension, In accordance with these ideas, we would say that with deep repercussions on human relations.The health planning means the prior establishment of a factors which aggravate this social tension are many general government policy on health, which constitutes and complex. In the last twenty years the populations a veritable declaration of principles on what the of the Latin American countries have increased at an government wishes to do during a given period. average annual rate of 2.4 per cent. thus showing up During this period plans, programmes and projects the shortage of resources. This impressive increase in must reflect that policy, it being understood that health population, which has not been accompanied by a rise planning should follow the development of the real in the level of per capita income, has resulted in situation in the country and adjust its estimate of increased poverty among the largest groups.The results to that development. maldistribution of that income has aggravated the The field of planning is not entirely new to us.In situation even further. recent years we have worked to programmes and Directly linked with the problem of poverty in estimates for those programmes -we have called them Latin America are its inadequate health conditions, " functional "budgets -which wearegradually which include chronic malnutrition, insanitary housing, improving in the light of our experience. deplorable environmental sanitation, high incidence of Since 1960 we have made progress, with a better infectious and contagious diseases, high mortality, knowledge of the approximate inventory of the relatively short expectation of life, and insufficient resources at our disposal and a better estimate of the productivity of the adult population. people's health requirements, which we are now The evident ecological maladjustment of most of the satisfying in the light of the real needs of the country, FIFTH PLENARY MEETING 59 and with a more accurate estimate of the ideal levels document published in the Public Health Papers of care it would be desirable to attain.We have series, in the beginnings of which I had the honour and obtained authorization and are preparing the necessary the pleasure of co- operating closely with the author, organization for a planning unit that can count on Dr Brian Abel- Smith.I refer to the study carried out all available resources for the fulfilment of its task. in six countries on public health costs and sources of We have taken part in all the planning congresses, finance, which was published in English under the title seminars, meetings and courses held in our country Paying for Health Services. This document established and on the American continent, and we are actively a system of accounting for health expenditure which represented in the central and provincial planning could be used by many national health authorities in bodies set up by the Government. We have understood presenting the objective information always wanted the language of the economists and they in turn have by economists.Let us hope that it will be given the understood ours. We believe we have reached agree- widest possible circulation and translated intoall ment on what we ought to do, and we are now in the working languages of the Organization. the most difficult stage -that of determining how best It is not only the shortage of economic resources to do it. that limits the execution of our programmes. The lack, We are also aware that whatever our future action, of qualified personnel to undertake the planning, it must be undertaken immediately, with the available execution and evaluation of health programmes may resources and the experience, bad or good, that we often be a more serious obstacle. The Director - have gained. We cannot go on setting up pilot centres General has done very well to direct the efforts of and discussing theory in the face of the harsh reality WHO towards the training of personnel, a matter to that our countrymen are dangerously exposed to which he calls attention in his Annual Report.It illness and death. is not only the number of our staff that is important. This mutual understanding between health workers It is also necessary that each one of them should have and economists, besides opening up new possibilities professional training and acquire a mental attitude of action for us, imposes new obligations; and just that isconsistent with the modern conception of as we have taught the economists to think in biological health care; that is to say, we need doctors, nurses and and social terms, so we too have an obligation to other personnel who regard the individualasa think of public health projects from the point of view gregarious being, a member of a family living in a of efficiency and economy. We have no right to ask community, and we require them to see the problem for further resources until we can show that we are of health and disease from a preventive and social making effective use of those we already have :nor viewpoint. can we ask our national economies for a financial We are accordingly glad that the technical discussions effort for health purposes that is greater than the at this Assembly are to deal with " education and wealth of the country can support or greater than we training of the physician for the preventive and social are technically able to invest. aspects of clinical practice ". In this connexion, Chile, We doctors have a certain tendency to forget the in particular, could not remain silent regarding the balance that must be maintained between the cost magnificent assistance we are receiving from the Pan of projects and their yield in terms of health.It is American Sanitary Bureau which, with the assistance understandable that this should be so, since the doctor of UNICEF in the training of nurses, is collaborating and especially the health worker live with human very closely with our Government in training the suffering and want and have a very close view of the personnel we need. dramatic disproportion that always exists between the In conclusion, Mr President, I hope that these enormous needsandtheshortageofavailable trends I have referred to in the Director -General's resources, Report will be accentuated in the future and reflected In this co- ordinated work with the economic planners in all the activities of the Organization. Many other we have much to gain and we can show objectively comments could undoubtedly be made, but for the that many health problems have causes of an economic sake of brevity I will confine myself to what I consider and social character that are not strictly medical. to be the salient features of the Report. But we must also be prepared to have the courage to postpone certain projects when it is shown that their The PRESIDENT :Thank you, Dr Bravo.I now cost is greater than the results to be expected and the recognize the delegate of Madagascar. financial burden is greater than our economies can bear. Dr RAVOAHANGY -ANDRIANAVALONA (Madagascar) In this connexion, Mr President and fellow delegates, (translation from the French) : Allow me first of all, I should like to draw special attention to the excellent Mr President, to express my delegation's warm con- 60 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II gratulations on your election as President of the Royal Afghan delegation allow me to congratulate the Sixteenth Assembly. President most sincerely on hiselectiontothe Mr President, fellow delegates, we meet again here presidency of the Sixteenth World Health Assembly. to work together, to compare our experience, and to I would also congratulate with pleasure the Director - renew our realization of the basic truth that health General on his reappointment. is the most precious of all possessions. I feel it also a great privilege to congratulate the The Health Assembly is, of course, often the occasion Director - General on the occasion of the presentation for brilliant speeches; but you will forgive me if I say of his very sound report on the Work of WHO in only a few words to show our great interest in all the 1962.I would associate myself with the other delega- activities of the World Health Organization. For my tions in paying a tribute to the efforts and achievements part, I listened with great interest to the masterly of the Organization in raising the level of health in the report by the Director -General, whom I wish to con- world. The excellent Annual Report of the Director - gratulate most sincerely. You will pardon me if I General is certainly evidence of the great achievements devote special attention to the part of the Report made every year, and we can see that WHO is pro- dealing with WHO activities in our region of Africa, gressing towards the final goal. The budget prepared the economic, social and political development of by the Director -General covers all aspects of health which is, as you know, in full swing. We are indeed on a global basis, and we are happy to see that the fully aware of the many problems to which such programme will be continued in 1963 -in the same development must necessarily give rise, and the mere way, I am sure, as it has been implemented in other fact of trying to face them until such time as they can years. be overcome justifies us in paying a sincere tribute to Mr President, the Royal Afghan delegation lays most WHO and itsadministration. emphasis on the importance of communicable diseases As regards more particularly the Republic of Mada- to the vast majority of the people of the world. The gascar, whose delegation I have the honour to lead problem is still of highest priority and is of prime today, speaking as Minister of Health and Population concern to national health administrations. Smallpox, I can assure you that we shall show as much determin- tuberculosis, trachoma and parasiticdiseasesare ation in trying to raise the level of health of our people only a few of the problems for many countries, in- as we showed in gaining the political independence of cluding my own.The Royal Afghan delegation our country.Our aim is to conserve and make the emphasizes a quite considerable increase in the World best use of our human potential and, faced with an Health Organization's assistance in the control of explosive increase in population, our main activities smallpox,tuberculosisandothercommunicable consist in control of the major endemic diseases, diseases and important steps towards the eradication maternal and child care, and an increase of our of smallpox. hospital capacity.In adopting this aim we are con- I should like to give you a brief summary of the vinced that health is a natural stage on the road activities undertaken by the Ministry of Health. Our towards that harmonious world in which peace and country shifted activities over from malaria control brotherhood will prevail and each country will play (which was initiated in 1948) to eradication in 1957, its proper part in the concert of nations, which is enforced in 1958. The total malarious population of often spoken of with more emphasis than sincerity, Afghanistan is 4 325 000 out of which 4 235 000 are but to which we Madagascans aspire with all our in the attack phase, and 87 271 in the consolidation faith and with all our hearts. phase. The malaria transmission season is relatively I said I would speak briefly, Mr President, and I short and the proved and the suspected vectors are reserve the right to speak again in the committees in susceptible to DDT, the insecticide being used in our due course. Before concluding, however, allow me to malaria eradication campaign.This, together with express my Government's best wishes for the success the adequate necessary funds placed at the disposal of our work, to which my delegation will contribute of the malaria eradication services, makes the future in every way it can. prospectsof malariaeradicationinAfghanistan bright, and we expect to achieve eradication by the Dr Nayar (India),Vice -President, took the pre- end of 1969. sidential chair. The campaign against tuberculosis in Afghanistan The ACTING PRESIDENT : Thank you, Dr Ravoahangy. was started in 1958, when the tuberculosis control I call on the delegate of Afghanistan. andtrainingcentrebeganoperationwith the help of WHO. We are thinking of extending the Dr HAKIMI (Afghanistan) : Mr President, ladies and use of tuberculin tests and BCG vaccination, and in gentlemen, honourable delegates, on behalf of the particular of applying them toallschoolchildren FIFTH PLENARY MEETING 61 throughout the country.To provide tuberculin and we are maintaining two mobile units to carry out this BCG vaccine is a serious problem for us.Con- work. One of the units is stationed in Kabul Province siderable difficulties have stood in the way of our and the other in Shibarghon Province.The Kabul getting such supplies.We would like the World unit has been placed at the disposal of the WHO Health Organization to come to our aid by supplying smallpox consultant. tuberculin and BCG vaccine, which Afghanistan Afghanistan has as its aim the eradication of small- does not produce itself. pox from the country.In achieving this aim the The trachoma pilot project.Two medical officers services of a WHO consultant are being made use have been trained in India; a statistician and a health of :at the present moment, he is engaged in developing educator are being deputed to India for training under a pilot project to work out the methodology, techniques WHO fellowships. We have already started a pilot and organization for the purpose.This project is project with our own medical officers.We would being established in a part of Kabul to begin with. request the early assignment of a WHO trachoma - Afghanistan has so far been using smallpox lymph tologist to assist us with this work. (wet vaccine).In certain parts of the country the One of the obstacles in the way of rapid expansion temperature is too high, with inadequate communica- of health services in Afghanistan, as in many other tions and lack of adequate facilities for refrigeration, countries, is the lack of adequate numbers of properly for such a vaccine to be efficiently used. Accordingly trained personnel of different categories to man the we are hoping ultimately to resort to freeze -dried services. Hence the Government of Afghanistan rightly vaccine. Afghanistan would appreciate any help that decided to establish an Institute of Public Health WHO could give to make available to us sufficient in Kabul, in close collaboration with the World quantities of freeze -dried vaccine to help us in carrying Health Organization and UNICEF, with the following out our smallpox eradication programme. For aims :first, training of paramedical personnel; second, carrying out the eradication programme effectively, training of medical specialists in different branches of other assistance in the way of transport etc. would also public health; third, carrying out of research on be required, which we hope the international agencies problems of public health importance. On 20 August will be in a position to arrange. 1962 the Institute of Public Health started functioning In the future we propose to use the national malaria in a new building.It is an attractive modern three - staff engaged in the malaria eradication programme storeybuilding,witha commodious auditorium for carrying out vaccination in the course of their having seating capacity for over five hundred persons. work, particularly of surveillance. We will take care It is beautifully furnished and has all modern con- that this additional duty does not affect their legitimate veniences. The Institute has at present the following work of malaria eradication.To support the main- departments : environmental sanitation, health educa- tenance phase of the malaria programme we have tion, biochemistry, microbiology, epidemiology and to depend upon the existing rural health services, statistics, maternal and child health, and administra- but unfortunately in Afghanistan we have not yet tion. On the staff there are both national and inter- developed an infrastructure, and in a situation like national experts. UNICEF equipment, supplies and ours we will have to build up our future rural health transport estimated to cost $70 000 will soon arrive. services in certain areas out of the malaria eradication Approved training and research programmes have been programme personnel. started.It is hoped that the Institute will soon con- To meet the acute shortage of medical personnel in tribute richly, not only to the progress of public health, the country, we are starting a second medical college but also to national progress as a whole. in Ningrahar Province.Students from the Eastern Smallpox.In Afghanistan we have at times out- Province find it difficult to come to Kabul for further breaks of smallpox throughout the country.There education.In order to make use of that material we appears to be a specific periodicity of three- to four - are setting up training facilities, including a rural year cycles.The highest incidence is during the college, in that area.We would need all assistance winter months. We have made primary vaccination from WHO to establish this college. compulsory in Afghanistan.We produce our own In conclusion, I wish to state and declare the readiness smallpox vaccine lymph at our Vaccine Institute. of the Royal Afghan delegation to extend any co- WHO assistance to strengthen and upgrade the said operation that would make the work of the Assembly Institute has been obtained in the past; even at present fruitful. We hope that our contributionto the we have a WHO expert working at the Institute. Our deliberations of this Assembly will be accepted as a present activities are being carried out by our medical token of co- operation and solidarity.It goes without officers,sanitarians and vaccinators, through our saying that all of us gathered here expect that the work health centres in the provinces.In addition to that, of this august body will once again set an example of 62 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II international understanding and co- operation. We than in isolation. There is still a lot more ground to be hope that with the efforts of all the delegates who are covered, but I am sure that with this new approach working in this hall we shall be able to establish much more will be accomplished in the shortest one day a world in which there will be peace, health possible time and at less expense. and prosperity for all. It is not my intention to picture at length the health The ACTING PRESIDENT : Thank you, Dr Hakimi. care services in my country, but I cannot allow this I call on the delegate of Sierra Leone. opportunity to pass without making the best use of it. Sierra Leone, as you all may no doubt know, enjoyed Mr SUMNER (Sierra Leone) : Mr President, Director - the reputation of being the white man's grave in General, fellow delegates, I bring you greetings and the eighteenth century. Thanks, however, to modern felicitations from our Prime Minister, the Right tropical medicine the present century has shown this Honourable Sir Milton Margai, and the people of ghastly reputation to be a thing of the past. However, Sierra Leone. I also bring you the personal greetings as I said earlier on, there still remain a great number of the Minister for External Affairs, the Honourable of scourges which continue to take their toll.The Dr John Karefa- Smart, who is a well known per- infantile mortality rateisvery high -about 124.6 sonality among members of this august Assembly. per thousand. The health care services for the pro- This is the first time that I am participating in the motion of environmental sanitation and personal deliberations of this Assembly and, with the other hygiene are very inadequate and fall far short of the members of my delegation, I feel an occasion of pride needs of the country. The hospital services are also in the opportunity that has been afforded to our very inadequate; and added to all this there is an country, as an accredited and full Member of the acute shortage of doctors and medical auxiliaries. World Health Organization, to be able to make its There is only one doctor to every 30 000 of the own contribution to the very vital role the Organization population, and large areas exist in the country where is playing in raising world health standards, particu- medical facilitiesare either grossly inadequate or larly in the developing countries of Africa. The vista non -existent.These obvious inadequacies definitely beyond the horizon is brim -full of hope, and. with lower theefficiency of our people and adversely renewed determination we press forward. affect the economic development of the nation. I must, at this juncture, take the opportunity of In 1939, a unit was established to combat an out- congratulating Dr Majekodunmi of Nigeria on his break of sleeping sickness in the provinces. This unit election as President of this Assembly. My delegation was later developed into the Endemic Diseases Control feels very proud of this signal honour which has been Unit and with the assistance of WHO, UNICEF and paid to Africa as a whole. theBritish Leprosy Relief Association has been Our congratulations also go to Dr Candau on his combating, amongst other endemic diseases, yaws and reappointmentasDirector -General. Hisselfless leprosy.As a result of these campaigns, sleeping devotion to duty and his unfailing interest in furthering sickness and yaws have been almost completely the cause of public health throughout the world have eradicated in Sierra Leone. Another significant result been a source of inspiration to all of us. We wish him is that because the teams were able to operate in the greater heights of attainment in the future. remote areas of the country, the benefits of modern Sierra Leone has been privileged to work with the methods of treatment were brought home to thousands World Health Organization since1956, when she of the population, with a consequent increase in the was admitted as an Associate Member.Between demand for hospital and other public health services. 1956 and 1961, when she was admitted as a full and My Government hasendeavoured,withinits accredited Member, she received and continues to resources and with outside aid, to improve and expand receive valuable assistance from the Organization in the health facilities to meet the growing demands on the struggle to combat the diseases which are taking the various existing services, but there isstill a lot a deadly toll of our population and so weakening the more to be done. We appreciate that greater emphasis economic development of the country.I shall not must be placed on environmental sanitation and health attempt to cataloguethe endemic and epidemic education of the public, so that greater success can diseases which harass our people. Much has been said be achieved at less expense.Increasing attention is about them. The present policy of the Organization in therefore being paid, and more funds are being organizing regional campaigns against some of the devoted, to this aspect of public health. We are aware endemic diseases is commended.Disease knows no that any development or expansion of our health care internationalbarriers,andwhereneighbouring services depends entirely on the availability of funds, territories suffer from the same affliction it is prudent both from local and outside sources, and on the deter- to tackle the problem on a collective basis rather mination of priorities, taking into consideration other FIFTH PLENARY MEETING 63 competing demands on the available resources. Our have pledged ourselves to service, not only within the task is not an easy one.It calls for detailed objective ambit of our immediate environment, but to distant planning and for the marshalling of all the resources lands in every corner of the globe.It is only by so at our disposal in order to achieve our goal. Prompted doing that as Member States, we shall be fulfilling the by this, we have produced a ten -year development obligations which we have willingly accepted in the plan for the health care services, copies of which have Constitution of WHO. been made available to the Regional Office in Brazza- In passing I must take this opportunity to express ville and the headquarters here. We feel that this plan, thanks and appreciation to those Member States ambitious as it may seem, represents the basic health that have answered the clarion call for assistance in needs of our country and should therefore be brought raising public health standards in the developing to your notice.In general, the plan envisages an countries. Many more privileged and advanced nations extensive health care service available to all in town can offer substantial financial and technical aid outside and country alike, with a teaching hospital at the top. the scope of WHO, and I make bold to offer a challenge It is proposed to develop improved hospital facilities to them. My Government must of necessity launch throughout the country, with a network of rural health an appeal to all interested nations to give financial centres where the predominant feature will be the and technical aid so as to implement our plan of integration of curative and preventive medicine. The development of the health care services of Sierra training of medical and paramedical staffisalso Leone.It is impossible to embark on this Herculean given great importance, as the successful prosecution task all on our own, because our local resources are of the various improved services envisaged in the plan most inadequate to reach the goal set for the improve- will depend on the availability of adequate and trained ment of the personal and environmental health services. personnel. The estimated cost of the plan is £ 30 million We feel that it is on the basis of genuine humanita- (or $84 million), spread over a period of ten years. rianism that donor nations must feel it their responsi- Mr President, fellow delegates, it is but right that bility and moral obligation to offer the necessary help the needs of Member States should be brought here to improve the health of our people. We feel that our for the information of all. This is the place where the appeal for help must not fall on deaf ears.Having world, as a single unit irrespective of race, colour or now prepared a plan of development for the health creed, or any ideology, is represented with allits care services of our country, we earnestly wait for the complexities, to marshal in unison all its resources necessary assistance from all donor nations and, in against the common enemy of mankind -disease. keeping with the genuine spirit of the World Health As I said earlier on, disease knows no international Organization, we remain confident that our appeal for barriers.It affects the great in like manner as it does financial and technical aid will not be in vain. the small, and the World Health Organization stands Mr President, Director -General, fellow delegates, supreme in that it unites all the nations of the world I thank you for having given me a listening ear and under a single banner of warfare against that common I pray that all our deliberations while here assembled enemy. Never before has there been an international will be crowned with abundant success. institution with such singleness of purpose both in Long live the World Health Organization !Long theory and practice as the World Health Organization, live international co- operation for the attainment by and the hope is cherished that the example we are all peoples of the highest possible level of health ! setting may lead to an equally easy solution of the many problems which confront the world today. The ACTING PRESIDENT : Thank you, Mr Sumner. The urgent need for great improvement of the The delegate of Cyprus, Dr Vassilopoulos. public health services in the newly emergent nations Dr VASSILOPOULOS (Cyprus) : Mr President, fellow of Africa cannot be overstated.In the struggle to delegates, it gives me great pleasure to offer my con- maintain a complete equilibrium in the physical, gratulations on your election to preside over the mental and social state of our people, the co- operation Sixteenth Health Assembly. I am confident that of every Member of this Assembly is a vital necessity. under your guidance the many problems that lie ahead Apart from the efforts of the Organization, the strong at this meeting will find their solution. must be prepared to help the weak so that man, I take this opportunity to express my Government's in whatever part of the globe he finds himself, can and my own warm congratulations to Dr Candau on enjoy the privileges of the ideals which the Organi- his reappointment to the high post of Director -General zation has set itself to achieve throughout the world. of WHO. It also gives me great pleasure to join the No one can afford to sit in complacency regardless of previous speakers and congratulate the Director - the health conditions in other parts of the world, be General on his excellent Annual Report for the year that far or near.As member of a united front, we 1962, which gives us a clear idea of the magnitude of 64 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II the work accomplished by the Organization and of the pilot project has already been put in operation with progress made in its efforts to promote the health of the assistance of WHO and UNICEF. peoples all over the world.It is gratifying to note in Cyprus has indeed reached a standard of health that report that emphasis is given to such important comparable in many respects to that of some European projects as malaria eradication, control of communic- countries.The pillars on which our present health able diseases, improvement of environmental sanita- is founded are the environmental (including climatic) tion, etc., which may rightly be considered as the conditions, which are fairly good; our nutritional pillars on which the edifice of health in the developing standards, which are fairly high; and the efficiency of countries can be founded. Further, the education and our health services. training programme may turn out to be the most In the field of curative services we provide general rewarding of all the activities of the Organization in hospitals in all main towns.The one operating in its drive to help the developing countries to build their Nicosia has advanced to such a high level of efficiency health services. as to be recognized by the Royal College of Physicians In its relatively short lifetime the World Health as an approved hospital for purposes of residential Organization has laid the basis for a reasonable training and also by the Royal College of Physicians expectation that within the foreseeable future centuries- of Edinburgh for purposes of training before admission old diseases, which are a formidable foe of the pro- to the fellowship examinations. sperity and civilization of the peoples in many parts In addition to the Government institutions there of the world, will be controlled and eventually elimin- are several private hospitals.The ratio of beds in ated. general hospitals, both government and private,is Each country has its own public health problems, 2.7 per thousand population.If we include the total although these may be of the same nature in some number of hospital beds for all purposes, this ratio becomes 4.1 per thousand population. countries.The method of approach, however, may In the very differ from one country to another. Cyprus has been near future these ratios will be increased as new fortunate in being almost free from serious public hospitals are under construction. The ratio of doctors per thousand population is1: health problems :indeed, none of the quarantinable 1403, which may be termed highly satisfactory. epidemicdiseasesexist,norinfactanyother formidable disease. Malaria has been eradicated The improvement and extension of the rural health long ago and a maintenance service has been in opera- services is proceeding slowly but steadily through the tion since that successful conclusion to prevent the substitution for the old- fashioned rural dispensaries re- establishment of transmission. Trachoma has been of more elaborate rural health centres. The goal is to almost eliminated by itself, thanks to the raised bring the preventive and curative services close to the standard of living of the people and the improved homes of the people living in the rural areas. A system environmental sanitation.Yet both these diseases of public assistance is in operation through which people with small means are entitled to free medical were very prevalent until one or two decades ago and were among the main obstacles to the prosperity of treatment at the government medical institutions, and the people. this includes drugs, hospitalization, x -rays, laboratory tests etc. True, Cyprus is protected by a sea border all around, It may be concluded from the above that due con- which minimizes the risk of the spread of diseases sideration has been given to the health of the people from the neighbouring countries; thisisanother as an integral part in the overall drive for the socio- favourable factor in the maintenance of our health economic development programmes, but it should not standards. Vigilance, however, becomes all the more be assumed that we have no public health problems. important and necessary as the present international There are several public health projects awaiting traffic grows more and more dense and fast. implementation, but priority had to be given to those On the whole the common infectious diseases are related to education and training and to others which not of such severity and prevalence as to cause anxiety are within the present economic potentialities of the or to be considered as public health problems. country. Mention should be made, however, of hydatid disease, For the time being we are experiencing some diffi- which is still prevalent, and of leprosy, which although culty owing to the shortage of non -medical and sub - of very low incidence has not so far been eradicated. professional personnel.To remedy this difficulty, a Expert advice for the control of these conditions has nursing school was established a few years ago which been obtained from WHO and special projects for is now housed in a modern building donated by the their extermination have been prepared and are due to Nuffield Foundation. A WHO tutor was generously begin shortly.In regard to tuberculosis, a control assigned to organize the programme of training; she FIFTH PLENARY MEETING 65 is assisted by two qualified Cypriot tutors. There are hydatidosis, tuberculosis, leprosy, malaria mainten- two courses of instruction for nurses, one of three ance, mental health, health education and nursing, years' duration and the other of two years'.The and have favoured us with their valuable recommend- three -year course is based on the syllabus of the ations.Numerous fellowship have been granted in National Council of Nursing in the United Kingdom nursing education, education and training, mental and successful candidates are eligible to obtain the health,publichealthadministration,tuberculosis State Registered Nurse certificate, after spending a control, and laboratory technology. A tuberculosis fourth year in a nursing school in the United Kingdom. control project has been started with the joint assist- It may be observed that no mention is made of the ance of the World Health Organization and UNICEF. training of medical students.In fact there are no It is gratifying to place on record the assurance given universities or other institutions for higher education to us by these and other organizations that they will in Cyprus. Nevertheless there is no shortage of stand by our side in our efforts to raise the standard doctors. What we actually require at present are more of health and the standard of living of our people. specialists in the various branches of medicine. I wish to take this opportunity to express the The above gives on broad lines the picture of the gratitude of my country for the keen interest shown existing services, but it may be of interest to touch also by the Director -General, Dr Candau, and the Regional on some of the future developments.A five -year Director, Dr Taba, in all our public health problems. development programme has been prepared and We are not merely recipients of direct assistance; embodied in the general development programme of we are also recipients of the knowledge and research the Government. We are fully aware of the concept of the more fortunate Members. We are doing our that health cannot be dissociated from other socio- best to adjust their experience to the local conditions economic development programmes.It is our firm and to draw from the vast treasury of modern health belief that the raising of the socio- economic standard techniques those which are likely to have a practical of living of the general population can bring about value in my country. more lasting results in the health of the people than any other factor, and vice versa that the lifting of the The ACTING PRESIDENT :Thank you, Dr Vassilo- vitality of the population through better health is an ponlos.I call on the delegate of the Congo (Leopold- essential pre- condition for economic development. ville), Mr Bolya. One of thespecificobjectives of thefive -year Mr BOLYA (Congo, Leopoldville) (translation from development programme is to improve the provincial the French) : Mr President and fellow delegates, it is hospitals, particularly at the specialist level, effecting with the greatest pleasure that my delegation congrat- in this way a decentralization of services that will ulates the Federal Minister for Health of Nigeria, prove beneficial to the people living in the rural areas. Dr Majekodunmi, on his election as President of the Another specific objective of this plan is the extension Sixteenth World Health Assembly.The election to a and the improvement of the rural health services post of international importance not only honours through the establishment of rural health centres, your country of origin, Mr President, it is also someth- which will replace the old rural dispensaries and will ing of which all Africa can be proud. My delegation bring both the curative and preventive services close is equally glad to convey its sincere congratulations to to the homes of the people living in the rural areas. Dr Candau on his reappointment as Director -General A third objective of this plan is the construction of of our organization.This unanimous reappointment new hospitals or the replacement or extension of is the greatest tribute that could be paid to a man existing ones. A new mental hospital, a psychiatric whose devotion to the cause of humanity, whose unit and apsychiatric wing have already been generosity and energy, are concealed by his great constructed.Two more out -patient clinics at Nicosia modesty.You will all be aware that certain names are under construction.Plans for a separate matern- are very closely connected with the history of my ity hospital and for a children's hospital have also country, and that is why my delegation especially been prepared. thanks all the delegations present at this Sixteenth For the promotion and the extension of our health World Health Assembly for the recompense given to services in general, and for the implementation of our Dr Candau, which the Congo alone could not have five -year development programme in particular, we given him. have obtained valuable assistance from the World On behalf of my country, I thank the Director - Health Organization, UNICEF, the Council of Europe General for the excellent Report he has submitted to and other international organizations and foreign us.Indeed, the Congo keenly appreciates the efforts governments.Expert WHO advisers made a thorough made by the Organization during the past year to help tsudy of some of our problems on the spot, including the various governments to raise the health level of 66 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II their peoples.For over two years my country has had ville are strongly supported by the Government and the advantage of valuable medical assistance from the the training of doctors is going so well that we can Organization.In this connexion, it is a pleasure to count on having 400 Congolese doctors by 1970. me to review what has been achieved since, in response As to auxiliary medical personnel, our medical schools to the appeal by the Secretary -General of the United in various parts of the country have never had so Nations in July 1960, the World Health Organization many students.The medical training instituteat sent an advisory team to the Congo medical author- Leopoldville alone, not to mention the other schools, ities.Thanks to the particularly enlightened under- now has 341 students. standing of the Director -General and the sincere and With regard to the supply of drugs and medical loyal collaboration of the chief representative of WHO equipment, various measures have been taken to when faced with our medical problems, the Organiz- facilitate the import of drugs, taking advantage of the ation has greatly contributed to maintaining and economic and political unity which the country has improving the health of the peoples of the Congo. just achieved.In collaboration with WHO experts, In two years an enormous amount of fine work has a list of the drugs to be ordered will be drawn up, been done.Today, over one hundred and eighty with a view to systematic supply of the country's needs doctors have been recruited by the Organization, not Several plans and projects, drawn up in collabor- counting the advisory team; but we must continue ation with WHO experts, are in progress for combating our efforts and improve on them.Our country has the main endemic diseases and for health education. the privilege of possessing a remarkable network of We are making arrangements to obtain the necessary hospital institutions of all kinds.It has over 82 800 equipment for them. beds in 3060 hospitals, maternity clinics and dispens- Beforeconcluding,MrPresidentandfellow aries belonging to the Government and to charitable delegates, I must refer, on behalf of my Government, missions and organizations, which were formerly to the Government of Belgium - some of whose served by 761 doctors.These remarkable facilities nationals left the Congo in circumstances of which are there, but of the 761 doctors only 400 remain, you are aware -and convey to it the gratitude of our many of whom are absorbed by medical teaching and people for the agreement on medical co- operation administrative duties.We must make a great effort it has just concluded.I mustalso mention the to conserve our health capital which is now threatened Danish Government and thank it for its assistance. by a shortage of doctors - a shortage that would My thanks are also due to UNICEF, which gives cause the suspension of many curative and preventive financial support to several of our medical activities. services. The list of countries that have aided the people of the After the Congo gained its independence, the hurried Congo to whom we owe a debt of gratitude, and whose departure of foreign medical personnel confronted representatives are present here, could be further it with three urgent and important problems :the extended;Iwill confine myself torepeating my recruitment of doctors to provide for the operation of country's sincere thanks to all their governments for existinginstitutions,theacceleratedtrainingof the moral, material, political, and diplomatic support national medical staff to provide our own cadres, and they have given us in surmounting our crisis with all the supply of drugs and medical equipment.What its difficulties.Now that that crisis has been sur- have we done to solve these problems ? mounted, the Congo intends to assume with dignity Fortunately we obtained medical personnel and its obligations as a sovereign State in the concert large -scaleassistance from the Organization; our of the nations. country then concluded, in full sovereignty, an agree- ment for medical co- operation with the Belgian The ACTING PRESIDENT :Thank you, Mr Bolya. I call upon the delegate of the Republic of Korea, Government.Another such agreement has just been signed with the Kingdom of Denmark.Our appeal Dr Chung Kun Park. in this field was favourably received by the Swiss Red Dr Chung Kun PARK (Republicof Korea) : Cross, which placed at our disposal a complete team Mr President, distinguished delegates, on behalf of of doctors, nurses and laboratory technicians, who my Government and the Korean delegation, I am are still working in the Congo. privilegedtoextend my . congratulationstoyou, As regards the training of our cadres, thanks to the Mr President, on your election to the high office of assistance of WHO we have sent over 130 assistants President of this Assembly.It is my further privilege médicaux to European universities for further train- to join the previous speakers in appreciating the ing; fifty -five of them will return to the Congo at the excellent and comprehensive Report presented by end of this year with their medical degrees.The Dr Candau, which shows us clearly and fully the Congolese Universities of Lovanium and Elisabeth- problems our organizationisdealing with.Our FIFTH PLENARY MEETING 67 thanks and tribute also go to the Regional Director attainment of a higher level of health for the people. for the Western Pacific and the Secretariat for all their This project, with WHO experts, will no doubt ensure interest and assistance and fortheco- operation the up- grading of the health services.As the in- between my Government and the World Health adequate number of health personnel will make it Organization. impossible for our progress to continue at the same Having read the Report with keen interest, the speed as thç expansion of the health services, the delegation of the Republic of Korea wishes to express training of health personnel constitutes an essential itsappreciation fortheever -increasingassistance part, on which the Government is placing emphasis WHO has rendered to us in the development of local by undertaking extensive in- service training of all health services and the training of health personnel, types of health personnel. as well as in the control of major communicable I have just mentioned only a part of the progress diseases such as tuberculosis, leprosy and malaria. achieved in public health in Korea and I should like Under the able guidance of the WHO malaria team, to conclude my statement by paying a high tribute the pre- eradication project is under way throughout to the active role of the World Health Organization, the country, with the combined efforts of the Korean UNICEF and other international organizations, which Government and the local practitioners.In part- have contributed greatly to the well -being of the icular, spraying operations have been launched in the Korean people. focus areas, aiming at the eradication of this age -old scourge in the near future, in step with the world -wide The ACTING PRESIDENT :Thank you, Dr Chung eradication campaign. Kun Park. Icall upon the delegate of Ethiopia, It is my pleasure to report to this Assembly that Mr Abebe Retta. much progress has been made in the control of tuberculosis, which constitutes one of the major health Mr RETTA (Ethiopia) : Mr President, it is a great problems in Korea.About a million tuberculosis honour for me to convey the greetings of my Govern- patients are a most serious and challenging problem, ment to this Assembly, the Director -General of the and therefore every possible effort is being made to World Health Organization, and all his collaborators. bring it under control.During the year under review, My delegation's sincere felicitations go to the leader about a hundred thousand patients were given proper of the delegation of Nigeria on his appointment to medical care through domiciliary treatment.With the presidency of this august body; similarly, I would the guidance of the WHO experts, more technical express congratulations to the Vice -Presidents and the details are being worked out in order to apply the other elected officers of the Assembly.Special tribute method best suited to the local conditions for effect- isdue to Dr Candau, Director -General, for his ive control. reappointment as the Director - General of the World Another major health problem is leprosy.Of the Health Organization, which office he has filled with large number of patients, only 20 per cent. are being signaldistinction.Itismost gratifyingtothe accomodated in institutions.The Government has Ethiopian delegation to see the list of Member States adopted domiciliary treatment for medical care and admitted to this World Health Organization, and it the law has been revised toabolish compulsory is with a very special sense of pleasure that my isolation. The non -infectious patients capable of delegation extends a warm welcome to Algeria, to working are being placed under resettlement projects Burundi, to Rwanda, to Trinidad and Tobago, to for self -support, and also some are sent home. Uganda and to Jamaica.To all of them we extend In spite of the considerable achievements in the our best wishes. control of major communicable diseases in parallel It was a long time ago that I had the honour of with the improvement of sanitation, in order to meet once attending the World Health Assembly, and in the demands of sound public health programmes the theintervening period many developments have Government has embarked upon the establishment taken place with respect to the organization of health of all types of basic local health facilities at all levels. services -in my country likewise.I would like to After a survey had been conducted in 1962, jointly say how appreciatively the work of the World Health with WHO and the United States Agency for Inter- Organization has been followed by the Imperial national Development as a second phase of the Ethiopian Government. We have seen how the evaluation and analysis of the health situation in Organization has consistently grown in stature and Korea, the Korean Government, upon receipt of importance to the point where, with a few exceptions recommendations by the experts, launched a pro- to that universality of the Organization's membership gramme for strengthening the local health services, which Ethiopia would wish to see, it now truly sets with emphasis on one selected model province for the the pattern for all and co- ordinates the world's health 68 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II progress and, in doing so, puts into practice the national Development, established the Gondar Public principles laid down in the WHO Constitution. Health College and Training Centre.The purpose of My delegation,havingstudiedtheDirector - this training centre was to provide the country with General's Annual Report forlastyear,warmly a cadre of three main types of health workers who, congratulates him on his insight and most admirable operating in teams, would render curative as well as presentation. My country appreciates most sincerely preventive services to the rural population, following the guidance and assistance which the World Health themotto," Health protectionforall ".This Organization has offered and is continuing to offer to concept, it was soon realized, involves the develop- Ethiopia, and equally expresses its warmest thanks to ment of a system of decentralized, generalized health UNICEF for its readiness and helpfulness in generous- ly assisting most of our health programmes. services.It was considered that, at least to start with, the best way to distribute such services would be I would now like to sketch some of Ethiopia's main through a network of health centres, with additional health and medical problems and some of the ways health stations around.Each health centre is design- in which we have been trying to solve those problems. Ethiopia's principal health and medical problems are ed to serve a population of about fifty thousand shared with most of the under -developed countries, persons and to supervise the work of about ten health and especially with Africa -the proof of this is what stations, which would in turn serve a population of we have been hearing just now. We all face enormous about five thousand each. problems of development, with associated limitations The key personnel at the health centres being of finance and technical personnel.For example, established in Ethiopia are, first, the health officers, about 90 per cent. of the illnesses occurring in my who are secondary- school graduates and who have had country are communicable and therefore preventable an extensive and intensive training lasting four years by the application of known methods of public health in the principles of public health practice and in the practice.We are aware of the high wastage of child diagnosis and treatment of the commonest types of life due to defective hygiene, archaic systems of ailments to be found in Ethiopia.Second, community feeding which exacerbate any malnutrition that may nurses, who are eighth -grade graduates or above and already exist, and intestinal infections.In addition who receive three years' training in all matters concern- to these serious threats to the lives of our children, ing family health, with particular emphasis on the who in the last analysis constitute the hope and the health of mothers, expectant mothers and children ; future of the nation, I should mention a few of the they are also thoroughly trained in normal midwifery other health problems which affect, by and large, the practice.Third, sanitarians, who are also eighth - population :malaria, tuberculosis and, to a lesser grade graduates or higher and who are trained for extent, venereal diseases, communicable eye diseases, three years at Gondar; they are of course trained in smallpox, leprosy, etc. the principles of environmental sanitation, with special We have always had the Organization's approval emphasis on rural sanitation, development of safe and support of our programme and active encourage- water supplies, suitable methods of excreta disposal, ment towards the carrying out of various mass pest control, and general improvement in the sanit- campaigns -tuberculosis is an example. The ationof theenvironment.Each of thesethree Organization has agreed upon a list of priorities in categories are well prepared to use health education dealing with such problems, and experience has methods and techniques in their daily contact with plainly indicated that there is only one first priority the people they serve. for countries which lack basic health services :this The other paramedical workers that we train to priority is the training of the various medical and work in hospitals, health centres and health stations paramedical personnel capableof manning such are dressers, medical laboratory technicians, hospital services. pharmacy technicians, and X -ray technicians.In the In Ethiopia we have been aware of this priority and near future a medical school is planned to be establish- have been trying to deal with it satisfactorily. To tackle ed in Addis Ababa. this problem some young Ethiopians are being sent At present the health officers, community nurses abroad to study medicine and related subjects.Every and sanitarians are operating in some fifty health year more students are enrolled in nursing and other centres. WHO has provided us with a team consisting paramedical training schools.It was only in 1953 of a public health physician, a sanitary engineer, and that the Government, with the assistance of WHO, a public health nurse, to assist in supervising and UNICEF and the United States Agency for Inter- guiding the team workers in the health centres. FIFTH PLENARY MEETING 69
In summarizing the modest training programme in diagnosed in Ethiopia for the first time in 1960. This, Ethiopia, particular mention should be made of the it is interesting to note, occurred in regions which in fact that every effort is being made to train Ethiopians the 1954 survey had been found to be free of yellow - to fill all positions in the infrastructure of the generaliz- fever virus.In 1960 there developed in this area - ed health services.These include not only rural mainly in a province called Gamu -Goffa -an epidemic health centres, but provincial health departments, which led to many hundreds of deaths. Mass vaccina- hospitals, etc.In this effort great assistance is being tion was immediately initiated in infected and threat- received from WHO, UNICEF and friendly govern- ened areas, with assistance from WHO and several ments, with the result that it is hoped that all such friendly nations and organizations.The epidemic positions may be filled by properly qualified Ethiopians has passed but the vaccination is still going on in in the not too distant future. susceptible areas. However, owing to general interest When the World Health Organization in1955 intheunsolved problemsofthisquarantinable decided upon a policy of eradicating malaria from the disease and its spread (various vectors, animal reser- globe in ten years, the Ethiopian Government agreed voirs,etc.)the World Health Organization has with this policy and adopted it.Since that time it generously supported the Government in a yellow - has been acting with this in view, starting with pilot fever research programme.This programme has projects in selected parts of the country, organization already given and is continuing to give most valuable of the necessary administrative infrastructure, etc., all results, not only about yellow fever but also about assisted by WHO, UNICEF, and /ortheUnited other related viruses which seem to exert an inter- States Agency for International Development. A study ference phenomenon effect upon the clinical picture of these pilot projects by world experts led to the of yellow fever in some patients and perhaps upon conclusionthatmalariaeradicationwasinfact the appearance of epidemics. This study is continuing feasible in Ethiopia. A training institute for malaria and may open up new horizons in the epidemiology workers was therefore established in Addis Ababa. of yellow fever. An order to provide for malaria eradication was Another research project which we hope may have issued in 1959 and a semi -autonomous organization far -reaching consequences, not only for the develop- called the Malaria Eradication Service, assisted by a ment of public health in Ethiopia but in other similar Malaria Advisory Board at inter -ministerial level, countries also, is entitled the " demonstration and was created. We are hopeful of continued assistance evaluation project ".This project is being carried and therefore of success in this field. out with assistance from the United States Agency Tuberculosis may be considered as perhaps second forInternational Development (thereisanother in seriousness of our problems, after malaria, in similar project, with special emphasis on nutrition, Ethiopia.It seems to be gaining more and more which is receiving assistance from the Government headway,owingtoincreasingurbanizationand of Sweden). The purpose of the demonstration and greater mobility of the population. In order to deal evaluation project is to evaluate the effects of the with this situation the Government, supported by rural health centres established under the programme WHO and UNICEF, as early as 1953 commenced previously mentioned and manned by the health a BCG vaccination campaign. A tuberculosis de- centrestaff.The evaluation methods being used monstration and trainingcentrewas opened in involve the establishment of base -line data concerning Addis Ababa in 1959 and is working successfully. the epidemiology of various diseases in Ethiopia and Here an attempt is being made to tackle the problem their relationship with the socio- cultural and ecological by the application of sound principles of public aspects of the environment.Subsequently, once the health practice, that is :short hospitalization, big base -line data have been obtained, the same areas turnover of infectious cases, active case -finding and will be studied in a few years' time to see what changes early treatment, domiciliary treatment and follow -up, have been caused by the establishment of these health health education, BCG vaccination, measures for the centres. improvement of social welfare, etc.Antituberculosis When stressing the development of generalized workers are being trained at this centre and it is being health services, we have laid particular emphasis on used to provide a short intensive course in tuberculosis the fact that man is governed by his social environ- control forallhealth centre personnel, including ment, which has a determining role in human health. doctors.Similar centres are being established in Therefore, the need for mutual links between health other regions of the country. measures on the one hand and economic, social and A few words ought perhaps to be said about yellow nutritional measures on the other, have been given fever, since the epidemic in south -western Ethiopia serious consideration.This consideration, we feel, is in 1960 aroused general interest.Yellow fever was in keeping with the principles of the World Health 70 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Organization, our dedication to which I would like of the vectors of that disease, and also the work on to reaffirm, for it is only through this dedication that bilharziasis.With regard to the latter disease, it is we may hope eventually to realize these objectives : indeed vitally important to prevent the danger of " the attainment by all peoples of the highest possible its propagation in the area of 1500 square kilometres level of health " -for all and everybody through whose irrigation and cultivation have been made universal solidarity. possible by the construction of the great dam on the Dez. The ACTING PRESIDENT :Thank you, Mr Retta. 1962 has been an important year for my country. I call upon the delegate of Iran, Dr Riahy. Under theenlighteneddirection of His Imperial Dr RIAHY (Iran) (translation from the French) : Majesty, far -reaching economic and social reforms Mr President and fellow delegates, the honour of have been introduced, which are sure to have lasting speaking before this Assembly is accompanied by effects on public health.The participation of the the great pleasure of congratulating you, Mr President, workers in the profits of industrial undertakings, and on the choice it has just made in asking you to direct theagrarian and otherreforms,by raisingthe its deliberations.I should also like to pay a tribute economic level of the workers, will make it possible to the ability of Dr Kurasov, whose clear and accurate to widen the scope of health activities and thus give summaries made it possible to compare viewpoints the people a more direct interest in public health that sometimes differed and helped us to reconcile problems.This concern with health education is them.I also welcome and congratulate the delegates also reflected in the step taken by my Government of of the new Members -Algeria, Burundi, Jamaica, making young men who have had a secondary educa- Uganda, Rwanda, and Trinidad and Tobago - which, tion do a period of work on the land during their in coming to swell the large family of the World military service.After special training, they are also Health Organization, take us a step further towards called on as teachers to give health advice to rural its universality. populations.It should also be pointed out that the As every year, the report submitted by the Director - new rights acquired by women in Iran enable them General on the Organization's work tells us exactly to contribute much more effectively to the social life what has been done during the past year and shows of the country. the satisfactory continuity of the efforts being made This great advance, however, cannot be accom- in the world to improve the health situation.With plished without planning, the need for which is now this progress it is only right to associate Dr Candau becoming urgent.In the public health sector, the -whom I congratulate once again on his unanimous third five -year plan, which is now in progress, directs reappointment -and all his staff, whom I thank most our efforts mainly to means of action offering multiple sincerely on behalf of the Iranian Government. possibilities -development of environmental health, I do not intend to dwell on all the points referred establishment of rural medical centres, and drawing to in the Director -General's Annual Report, but I up of comprehensive integrated programmes.All should like to stress particularly the importance of these activities raise a number of problems, for the the education and training of medical and auxiliary solution of which we hope to be able to call on inter- personnel, the shortage of which is a problem for national assistance. We thank the Regional Office most countries.We consider that the training of for the Eastern Mediterranean for having responded sufficient numbers of qualified medical and health favourably to our requests, and we hope that it will personnel is the best way of promoting the develop- continue to give us effective assistance in the work ment of national public health services. The opinions we have undertaken. expressed and the recommendations made at the This year, unfortunately, Iran was struck by a regional conference on medical education held at terrible disaster -the earthquake which, over a wide Teheran in the autumn of 1962 will, I am sure, con- area, destroyed many villages and killed over 10 000 tribute to the progress of this programme in the people. I cannot close this statement without express- Eastern Mediterranean and in other regions. ing the sincere thanks of my Government for the We also greatly appreciate the research activities, magnificent solidarity shown in the face of distress on which depends the choice of the means to be used by peoples, governments and national and interna- against certain communicable diseases that can still tional assistance organizations. The people of Iran only be fought by expensive methods of limited were extremely touched by this mark of friendship, application.For instance, the Government of Iran and I take this opportunity of expressing my gratitude is following with great interest the research work to you all.Thank you. being done, both in the laboratory and in the field, on the chemoprophylaxis of malaria and the control The President resumed the presidential chair. FIFTH PLENARY MEETING 71
The PRESIDENT : Thank you, Dr Riahy.I recognize and the supervision of mental cases once these are the delegate of Greece. registered. As I do not wish to take up too much of your time, Dr KATSACOS (Greece) (translation from the French) : I will conclude this list of national achievements by Mr President, fellow delegates, on behalf of the expressing the hope that the collective efforts we are Government and the delegation of Greece, I wish making as an organization concerned with world to convey to Dr Kurasov, the President of the Fifteenth health may be crowned with success.This is not World Health Assembly, our most sincere thanks for only a hope :it also represents a duty, since the most his work as President last year, and to Dr Maje- marked characteristic of our era is the fact that all kodunmi our warmest congratulations on his election countries of the world benefit collectively from the as President of the Sixteenth Assembly.I also wish achievements of science, just as they are together to take this opportunity of addressing to Dr Candau, exposed to the danger of collective destruction. the Director -General of the World Health Organiza- tion, my most cordial congratulations on his excellent The PRESIDENT : Thank you, Dr Katsacos.I now Annual Report, which deserves nothing but praise. recognize the delegate of Czechoslovakia. Congratulations and thanks are also due to the Dr PLOJHAR (Czechoslovakia)(translation from Secretariat and all the staff for their systematic and the French) :Mr President, ladies and gentlemen, efficient work, which is reflected in the achievements fellow delegates. Allow me to congratulate you most of the Organization. cordially, Mr President, on behalf of the Czechoslovak In Greece last year, as every year, our attention was delegation, on your electionas President of the concentrated on the key sectors of public health, that Sixteenth World Health Assembly.I am sure that is to say social health, environmental health, and the under your direction the work of this Assembly will education and training of medical and paramedical be entirely successful. personnel. Our Assembly is meeting again in Geneva, the In the field of social health, I should like to stress city towards which the eyes of the whole world have the progress made in regard to mental health. Two been turning for many months, in anxious expectation years ago mental health was brought within the of positive results from the discussions on the most framework of public health.Our dispensaries have urgent problem of our time :general and complete clinics that provide out -patient consultation services disarmament.For that is a key problem on which and advice to families the untiring efforts for peace of the whole world should In environmental health, it can be said that a general be concentrated. advance has been made in the last few years. Typical In a world in which there are still hundreds of results are the almost complete eradication of malaria millions of people suffering from hunger and malnutri- and the great reduction in trachoma and other com- tion, in which tens of millions of adults are without municable diseases. Mention may also be made here employment or regular means of support, in which of the establishment of an experimental health unit tens of millions of children cannot go to school, and (pilot area) in Thessaly, with the assistance of UNICEF, in which science still has to carry on a difficult fight which provides the means of transport and medical against insidious diseases, it is inconceivable that the equipment, and WHO, which takes part in training efforts of workers, the talent of engineers, and the the medical and paramedical personnel by awarding genius of scientists should be wasted on creating the fellowships and helps in the technical execution of the means of destruction and disaster. We are firmly project through its consultants. The plan of opera- convinced that the World Health Organization, in tions was approved in 1959 and the programme full accordance with the great humanitarian objectives provides for the complete organization of the area laid down in its Constitution, should become the during the years 1961 to 1964, based on the joint ardent advocate of appeals rousing humanity to action of three main services :the national rural carry on an unremitting struggle against all instigators health insurance and protection service, the health of military adventures. centres, and the hospital of the unit's regional centre. I should like now to make at least a brief assessment Finally, as regards the training of medical personnel, of the major activities of the World Health Organiza- I may mention the advanced courses for doctors from tion during the period it has been under the direction rural regional hospitals that were introduced four years of Dr Candau. I wish especially to thank the Director - ago; and the inclusion of mental health in the syllabus General for the understanding he has shown through- for visiting general nurses, so that they can work out that period regarding the urgent needs of all as members of the psychiatric team, in particular for Member countries, including Czechoslovakia. Never- the detection of mental cases, simple psychotherapy, theless, although our overall assessment of the work 72 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II of WHO is favourable, that does not mean that we activein eighteen developing countries.We are cannot see the defects that make its work very difficult. willing to receive doctors from those countries for By that I mean, in the first place, that recently the post -graduate training in the different branches of activities of the Organization have become unduly medicine, or to receive students at the newly establish- extensive. More and more new projects have been ed 17 November University. added that do not always correspond to the funda- The World Health Organization has already done mental and principal objective of WHO. The natural great and valuable work in co- ordinating epidemiologic- result of this is that the budget of the Organization al and virological research on influenza and its virus. We is increasing both vertically and horizontally, a fact hope that this systematic work will soon be successful with which the Czechoslovak delegation is in entire and that the dangerous epidemics of influenza which disagreement.Itisthereforenecessaryforthe from time to time cause such losses to health and Organization to give careful consideration to the to the economies of all countries will be mastered. justification of all its projects, their scope and the It is naturally important at the present time that methods of carrying them out, with a view to securing it should be possible, by international co- operation maximum efficiency and economic management of with the World Health Organization, quickly to its work. control, by case -finding and preventive action, a I should like to inform the Assembly briefly of the whole series of other diseases, or at least the most results and successes achieved by the Czechoslovak important of them, among therespiratory virus health services during the past year.A further infections. decrease in mortality, particularly infant mortality Mr President, we have been able to welcome to our which is now 22.5 per thousand, puts Czechoslovakia session this year some new Members, and the Hun- among the countries with the lowest mortality rates. garian People's Republic, which has resumed active Perinatal mortality, which is now only 20.7 per membership. We are sincerely glad at the prospect thousand in our country, is the lowest in the world. of co- operation with these countries and we are. Cases of disease and mortality from infectious diseases, convinced that the Organization can only gain by it. including tuberculosis, have ceased to be the main It must be pointed out, however, that the lack of causes of illness and invalidity.The prevalence of representation of practically one -third of the popula- certain contagious diseases such as diphtheria, whoop- tion of the world is a serious hindrance to the work ing- cough, etc., has substantially decreased.Other of our organization, which could achieve even better diseases, such as scarlet fever, are no longer serious. results with the collaboration of all countries. In 1963 Czechoslovakia maintained the exceptionally On behalf of the Czechoslovak delegation, I wish favourable position in regard to poliomyelitis that to assure you, Mr President, that Czechoslovakia is was achieved as a result of the nation -wide vaccination willing, in the future as in the past, to discharge with live oral vaccine in 1960, in the second half of responsibly and consistently all the fundamental and which year, for the first time in our country's history, important duties devolving upon it as a Member of there was not a single new case of this disease. This this organization. In the future, therefore, the Czecho- favourable position has now continued for three slovak delegation is prepared to give its full support years. We know that poliomyelitis is not one of the to all proposals designed to secure maximum success . main problems in medicine; but we think that in in the work of our Organization, but especially to view of its effects, and the practical possibility of secure that success with the maximum efficiency. finally abolishing at least one of the diseases afflicting I wish every success to the proceedings of the Sixteenth mankind, it deserves attention by the World Health World Health Assembly. Organization. The PRESIDENT : Thank you, Dr Plojhar. At the very time when impressive scientific successes I now recognize the delegate of Ireland. are being achieved in various branches of medicine, hundreds of millions of people living in colonial or Dr HOURIHANE (Ireland) : Mr President and fellow developing countries are still suffering from malnutri- delegates, the item under discussion comprises both tion and serious contagious or parasitic diseases. the reports of the Executive Board and the Annual In view of this situation the Czechoslovak Socialist Report of the Director -General.Of the former, I Republic is endeavouring, in consonance with the shall say no more than to congratulate Dr Afridi on tasks of the World Health Organization, to assist the his very clear presentation of the Board's proceedings developing countries not only materially but also by during the year of his chairmanship.After such a sendingstaff,either through the World Health masterly presentation there is really very little left for Organization or under bilateral agreements. At the delegates to say about it.In any case, from a more present time, 278 Czechoslovak health workers are practical point of view, several of the matters which FIFTH PLENARY MEETING 73
he reported on will be coming up, seriatim or piecemeal, remarks on the rising incidence of infective hepatitis in the work of the committees. The Annual Report suggest that we are unlikely, as it were, to run short of the Director -General gives a lucid account of the of infectious diseases for a considerable time in the work of the Organization during 1962.I propose future.The results of the epidemiological investiga- to refer to only a few points which strike me on tion into infective hepatitis planned for 1963 will be reading the Report. awaited with interest. Malaria eradication of course has a less intimate The question of bilharziasis, too, again illustrates interest for us, in whose country the disease does not the nature of the difficulty of making progress with occur, than for those from other countries where the particular diseases without increasing the risksof problem of malaria is a major and an immediate one. others. I say this inasmuch as the increasing provision In reading the Report, however, I must confess to a of such desirable things as water supplies, dams and certain sense of uneasiness about both the present irrigation undertakings brings with itthe risk of position and the future prospect.It is rather like climbing a mountain, where it seems that the next increasing the incidence of bilharziasis and other crest ahead really must be the summit, but when you diseases that depend on water for their propagation. get to it you find a new prospect of continuing climb There are a few other matters in the Director - stretching away into the distance.In the malaria General's Report which I should like to mention, in eradication programme, as the years go by,the particular in regard to education and training, but position seems to become ever more complicated and they will be coining up as separate matters in the if, as it now appears, it is going to be necessary to main committees, and it will perhaps be preferable to have a more or less elaborate health service as an talk about them there rather than spend time on infrastructure to hold on to the position when malaria them in plenary session. has been eradicated, then it will indeed be many years I shall therefore end by complimenting Dr Candau before the task is accomplished, and a single country on his Report under discussion and also by offering which slackens its efforts can create a host of difficult- him my heartiest congratulations on his appointment ies, not only for itself but for its neighbours. In this to a new period in his exalted office. May I at the context, the original estimates of about five years same time, Mr President, convey to you my heartiest for total eradication are now seen to have been congratulations on the distinction conferred upon you terribly mistaken ones.I should like to mention,. by the delegates of this Assembly who have unani- for the benefit of delegates who may not have seen it, mously elected you to preside over their discussions. an excellent and remarkably clear article on malaria eradication which appeared in the British Medical The PRESIDENT : Thank you, Dr Hourihane.I now Journal two weeks ago -27 April, to be exact;it recognize the delegate of the Philippines. seemed to me a model of its kind, with the added merit, if I may say so, of its commendable brevity. Dr GATMAITAN (Philippines) :Mr President, dis- In that section of the Director -General's Report tinguished fellow delegates, on behalf of the Philippine which deals with communicable diseases, it is disap- delegation, I should like to extend to you, Mr Pre- pointing to note the continued increase of both sident, our warmest greetings and felicitations on syphilis and gonorrhoea practically everywhere, more your election as President of the Sixteenth World especially when the etiology is so closely related to Health Assembly. We are confident that under your crass individual human folly, unlike the position as able guidance and leadership this Assembly will regards other widespread diseases, such as malaria achieve its objectives for the current session.I should or tuberculosis.The commonly reported risein like also to convey my delegation's congratulations incidence of venereal disease amongst teenagers must to Dr Candau on having been unanimously re- elected be a source of grave and particular concern : a fourfold Director -General for a third term.Verily,it isa increase in ten years is mentioned. The mention in vivid and tacit expression of the implicit confidence the Report of the idea of an immunizing agent to of the delegates in his excellent performance of his control gonorrhoea in special groups is an interesting bounden duties and functions as Director -General one, and one would wish to hear more about it. of this international health organization. As with malaria eradication, so with communicable Mr President, I take pleasure in conveying to you, diseases generally, as quickly as dramatic progress to Dr Candau and the staff members of the World is made in one direction new prospects of danger Health Organization, and to the distinguished delegates seem to open up in another.In this context, the here present, the warm greetings of the President of the 74 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Republic of the Philippines, Dr Diosdada Macapagal, has been religiously observed. We sincerely appreciate and his wish and expectation that, through the their efforts. leadership of the Organization,allthe countries There are other matters which we of the Philippine represented here will forge ahead towards the attain- delegation would wish to report on, or participate ment by all our peoples of prosperity and longevity, in the discussion of, but we elect to discuss them at through improved standards of health. the appropriate time -when we consider them under We who are in the health service in the Republic the pertinent items of the agenda. of the Philippines have never been so fortunate as Mr President, I wish to express to you once more we are now under the leadership of the incumbent my appreciationforhavingthisopportunityto President, Dr Macapagal. For the first time in the address this Assembly. long history of our health service, the Government The PRESIDENT: Thankyou,Dr has laid emphasis on the role, value and significance Gatmaitan. of health in the socio- economic development of the I recognize the delegate of Romania. country.As he aptly puts it,political stability is DrIOAN(Romania) (translation from the Russian) : dependent upon economic progress, and, in turn, Mr President, fellow delegates, ladies and gentlemen, economic progress is dependent upon the attainment of may I, on behalf of the delegation of the Romanian the highest level of health by the people. And so it is Peoples'Republic, congratulate Dr Majekodunmi that, under this leadership, health has been given on his election as President of the Sixteenth World high priority in the formulation of public policies in Health Assembly. our country. Ishould like to take this opportunity alsoof To this end, emphasis has been given to the control congratulating Dr Candau on his reappointment as of communicable diseases, which, up to now, have Director -General, and on hisvery sound report, been the cause of the greatest wastage in manpower which illustratesall the aspects of the activities of in our part of the world. Improvement of environ- our organization in 1962. mental sanitation, and, more specifically, the provision We should like to mention that almost all sections of safe water supplies and the proper disposal of of the Report emphasize the importance of one factor waste and garbage, have been given increasing atten- on which the success of all health measures depends, tion and support.Decisive actionis now being namely, the need to establish and develop a system undertaken to eradicate malaria in our frontier areas, of basic andspecializedmedical andsanitation where people have started to settle in pursuit of services. Despite the fact that this need is universally better opportunities in life.Cholera El Tor, which recognized, it is obvious from the Report, and also ravaged our country in 1961 and the early part of 1962, from the discussions that took place at the thirty - isalmost completely eradicated.Thanks tothe first session of the Executive Board, that this postulate assistance our Government has received from WHO has not always been taken into account and that some and UNICEF, this scourge has now been brought work has been started that cannot be brought to under control, and its complete eradication is not completion unless basic medical and sanitation services far from realization in the very near future.The are in existence. reported outbreaks of smallpox epidemics in various Taking this need into account, some members of the countries surrounding the Philippines have given us Executive Board suggested that in all health work much concern, and for this reason our Government attention should be concentrated on problems of undertook a massive six months' campaign of im- setting up basichealthestablishments,and that munization against smallpox. The immunized level malaria eradication work cannot be recommended of our population is now more than 60 per cent. for countries whose medical and sanitation services I am pleased to report to you, Mr President, that, have not reached a certain level.The Expert Com- up to this time, there has been no reported case of mittee on Malaria, which met in 1962, emphasized smallpox in the Philippines.This may well serve as that the success of malaria eradication measures, to a an example of what an intensive immunization large extent and at all stages, depends on close and campaign could do to prevent the entry of the infec- constant co- operation between all the general health tion into the country.But of course it would be services on the one hand and the specialized malaria short -sighted on our part to attribute our successes eradication service on the other. solelytoourefforts. Ishouldtotakethis In the Romanian People's Republic the network of opportunity to acknowledge the efforts being made special malaria eradication establishmentsset up by the various health services of the countries around fourteen years ago has been of great use in helping us us, where the necessary vigilance for the prevention to reach the stage of consolidating the successes of the further spread of the disease to other countries achieved under the plan foreradicating malaria FIFTH PLENARY MEETING 75
throughout our country, in close co- operation with establishments -regardless of the disease for which and with the close assistance of the basic health the patient has sought advice -must consider the services. possibility of a precancerous condition being present. During thelast few years,having successfully In cases in which cancer is suspected, they must send solved the task set before them, the malaria eradication the patients to special oncological establishments. establishments have been dealing with work connected The same procedure must be followed by the basic with other aspects of medical parasitology.At the medical establishments in regard to the majority of same time the basic health services have assumed diseasesthatconstituteparticularlyacutehealth responsibility for keeping under observation areas problems at the moment since, despite the adequate that have passed into the maintenance stage. development of the specialized services, the latter The example we have quoted of the work of the can only cover the cases they detect -and these form basic and specialized health services in regard to a very small proportion compared with the number malaria and medical parasitology indicates how we of cases discovered in the basic establishments and assess the position and plan health measures by stages, sent for appropriate treatment depending on material and technical conditions and in From this point of view the work of the basic accordance with the general plan for the economic and services must be considered within the framework social development of Romania. of out -patienttreatment andactiveprophylaxis. Having correctly assessed the need for an improve- For a successful solution of all these numerous and ment in the technical level of our basic medical and technically diverse questions,general practitioners sanitationservices,without whichnotasingle must have an excellent professional training and specialized service could count on being completely must periodically undergo instruction on particular successful, we have reached the stage at which the problems and on the latest methods of investigation whole territory of Romania, in town and countryside and treatment.Without continuous training and alike,is now covered by an extensive network of a continuous renewal of knowledge, and without medical and sanitation establishments,staffed by an acquaintance with thelatestachievementsof physiciansand medium -grademedicalworkers, medical science and techniques, general practitioners whatever the difficulties and special features of the cannot deal with their various health tasks. locality concerned. In the Romanian People's Republic medical students It is not without interest that 35 per cent. of our gain anearlyacquaintance withpractical work doctors are working in rural areas. A contribution through their probationary period in various hospital to this result has been made by measures to provide departments, where they work first as externes and then better material conditions for medical and sanitation as internes.During this latter period they live at the staff by paying them a higher salary in view of the hospital or the out -patient establishment concerned. special working conditions involved.It should also Their interest in professional training even after they be noted that the salaries of medical staff in out- have graduated from the medical faculty is sustained patient establishments are higher than those of hospital by our system of promoting medical staff, which is staff, while those on special mission, or taking part in based on tests and competitive examinations for work that is of particular urgency at the given time, further degrees and for particular posts.It is an receive double pay. interesting fact that, during the last five years, 16 000 Numerous convincing examples could be quoted, doctors have taken tests and competitive examinations from various sectors of medical and sanitation work, of this kind. showing the need for a network of basic and specialized The effective training of general practitioners, and establishments working along particular lines. If, the bringing of their knowledge in other spheres up to among such problems as the detection and treatment a modern scientific level, are made necessary also of tuberculosis, cancer or cardiovascular disease, we by the constant changes in the pattern of morbidity take only cancer -we are all the more convinced of the in various areas. need for a well -organized health network. Surveys carried out to determine the state of health Now that the early diagnosis of cancer is one of the of the population indicate that there is a big gap chief methods of controlling the disease, it is essential between what is detected and registered by the basic that all medical workers in out -patient establishments services and what can be discovered in the same area servingthepublicshould pay attentiontothe by teams consisting of several specialists.Effective possibility of the presence of a tumour when they are training of general practitioners, and the continuous establishing a diagnosis.In view of this, in the raising of their level of knowledge, is ensuring that Romanian People's Republic the physicians in the this gap is reduced.Scientifically based surveys of the basicmedicalestablishmentsandinspecialized state of health of the public, carried out by teams of 76 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II specialists in " model " districts representing five per steps to relax international tension and promote the cent. of the population of the country, have confirmed peaceful co- existence of all peoples and the preserva- the reduction of the gap in those areas where general tion of peace throughout the world. practitioners in the basic services have been given The PRESIDENT : Thank you, Dr Ioan. better professional training. In pursuance of the decision taken at the beginning Inconclusion, without belittlingtheroleand importance of both the basic and the specialized of the plenary meeting this morning, the list of speakers medical establishments, we have tried to emphasize who will contribute to the discussion on this item is the points which the Director -General and some now closed. I would ask the Deputy Director -General members of the Executive Board touched upon in to read to you the list of speakers who are expected to speak. connexion with the essential nature and importance of The delegate of Upper Volta has the floor. the basic services, and also to illustrate the position in Romania and indicate what measures have been taken Dr LAMBIN (Upper Volta) (translation from the in this respect. French) : Mr President, I only wish to be put down on At the same time, we consider it useful to emphasize the list of speakers. the importance of studying all the aspects of health planning in order of priority and also the significance The PRESIDENT : Upper Volta will be added to the of departments of planning, this being a prerequisite list of speakers who are vet to speak.The delegate of for the correct and effective planning of measures to the United States of America has the floor. improve the utilization of manpower and material Dr TERRY (United States of America) : Mr President, resources and to increase the effectiveness of health we simply wish to make the same request, in case our measures at the lowest possible cost. name is not on the list. The experience that we have gained in this sphere over the last fifteen years, during which we have The PRESIDENT : The delegate of Senegal has asked achieved great successes in developing the medical for the floor.I think it would be more convenient if and sanitation services and a rapid improvement in the delegates will allow the Deputy Director -General to stateof health of the population, confirms the read the names of those who are yet to speak and, if advisability of including health plans in a country's their names are not on the list or they have not taken general plans for economic and cultural development. the trouble to inform the Secretariat, we shall accom- On the basis of what has been said above, we are modate them by putting their names on the list. becoming even more convinced that the success of Dr DOROLLE, Deputy Director- General: Mr Pre- measures to improve the state of public health depends, sident, you had forty speakers, two have been added, in the first place, on the economic and cultural develop- and I have just seen that a third one has expressed a ment of the country concerned.It depends also on a wish to be added. So the list is now : India, Jamaica, continuous rise in the living and cultural standards of the United Kingdom of Great Britain and Northern the peoples. This economic and social development of Ireland,Albania,New Zealand,Peru,Poland, countries and improvement in the living standards of Thailand, Argentina, Bulgaria, United Arab Republic, the population is unthinkable without the liberation Pakistan, Mongolia, Indonesia, Cameroon, Viet -Nam, of peoples still politically and economically dependent, Hungary,Yugoslavia,Tunisia,Austria,Jordan, without freeing them from the fetters that shackle their Federation of Malaya, Portugal, Somalia, Lebanon, initiative and creative work, without freeing mankind Spain, Paraguay, Trinidad and Tobago, Union of from the threat of a new world war, without stopping Soviet Socialist Republics, Libya, Burundi, Cuba, the armaments race and releasing the sums spent on it Ghana, Central African Republic,Saudi Arabia, for raising economic and cultural levels and improving Nepal, Guinea, Nigeria, China, Senegal, Upper Volta, the health of the peoples. United States of America; and I have just noticed that In view of all that has been said above, we consider Ecuador wants to be added. that the World Health Organization and the doctors The PRESIDENT :I take it that South Africa, Yemen of the whole world, striving to achieve the aim set and Sudan wish to be added. The list is. now closed. forth in the Constitution of the World Health Organi- I should like once again to appeal to delegates to zation -the attainment by all peoples of the highest make their contributions very brief : we have two hours possible level of health -must take the lead in all this afternoon -it is proposed that we resume at four measures to promote the economic and social develop- o'clock and sit until six o'clock -and it is obvious ment of the peoples, participate in the campaign that we cannot exhaust the list today. We shall make against the threat of a new world war, help to achieve time sometime next week to continue the discussion general and complete disarmament, and support all on this item.But I certainly wish to stress that it FIFTH PLENARY MEETING 77 would be very helpful to the Assembly if Members He is at present Associate Director for Extramural would make their contributions very brief indeed. Programmes of the National Institute of Allergy and Infectious Diseases at Bethesda, Maryland. Dr Young's 2.Presentation of the Darling Foundation Medal earlier work was connected with parasitology, parti- and Prize cularly with the biology of Plasmodium species.For some years he was closely associated with the treatment The PRESIDENT : We now come to the presentation of of neurosyphilis by the use of malariotherapy. He has the Darling Foundation Medal and Prize.I will call also carried out detailed studies on the epidemiology on the recipient of this medal and prize to come to both of induced malaria infections and of imported the rostrum. Dr Martin Young. infections which were found in veterans returning from It is now my very pleasant duty to make the pre- overseas service. He is probably best known for his sentation of the eighth award of the Darling Founda- work on the chemotherapy of malaria, and more tion Medal and Prize. The Darling Foundation Com- particularly for his studies on the development of mittee, on the advice of the Expert Committee on resistance of malaria parasites to drugs.In addition Malaria, is entrusted with the task of selecting a to the experimental and research work which Dr Young recipient for this award for outstanding achievement has carried out, he has applied his knowledge of in the pathology, etiology, epidemiology, therapy, malaria in field work in Liberia and in India. Dr Young prophylaxis or control of malaria. has made nearly one hundred contributions to the It should be recalled that the periodical presentation literature on malaria, covering almost all aspects of the of this award is associated with the paying of honour disease.He is an outstanding research worker with to the memory of Dr Samuel Taylor Darling, whose vast experience, who has developed our knowledge premature death by a motor accident cut short a long of malaria in a great many aspects. career devoted to research into the epidemiology and Dr Young, it is with great pleasure that I present pathology of malaria and the biology of the vector. you with this medal and prize.Accept my congra- Dr Darling was on a mission organized by the Malaria tulations. Commission of the League of Nations when his tragic death occurred, in 1925. Amid applause, the President handed the Darling Foundation Medal and Prize to Dr Young. There have been ten previous recipients of this award -all malariologists of great renown.The first was Colonel S. P. James in 1932; the second award Dr YOUNG : Mr President, Dr Candau, distinguished was made in 1937 to Professor N. H. Swellengrebel; delegates, esteemed colleagues and friends, I am indeed in 1951 the third award was made jointly to Dr P. C. C. fortunate and highly honoured to receive the Darling Garnham and Professor H. E.Shortt; Dr G. R. Foundation Medal and Prize.For a malariologist Coatney and Professor G. MacDonald were the it symbolizes the summit of professional recognition. recipients of the fourth award, made in 1954. Dr P. F. I am aware that this award carries with it an extra Russell received the fifth award in 1957, and Dr E. measure of distinction and significance because it is Pampana the sixth in 1959. In 1961 the award was administered by an international agency with the made jointly to Sir Gordon Covell and Dr Arnoldo well- defined objective of attaining the highest possible Gabaldón. level of health for people everywhere.It is especially In April 1962, the Expert Committee on Malaria appropriate that the control and eradication of malaria submitted to the Darling Foundation Committee the around the globe remains one of the foremost goals of name of Dr Martin Dunaway Young for the eighth the World Health Organization.The international award of the Darling Foundation Medal and Prize. co- operative venture against diseases such as malaria In January 1963, the Darling Foundation Committee is highly significant from a health viewpoint; but it considered the Expert Committee's recommendations, may have an even greater significance in demonstrating and unanimously decided that the medal and prize man's willingness to work with his fellow man for should be awarded to this distinguished malariologist, the common good of all. The latter has been doubted who has been a continuous contributor to the know- too often. ledge of malaria since 1937, and who has explored I was fortunate to be able to work in the field of practicallyall phases of the subject, with special malaria, and especially to work with experimental reference to chemotherapy, parasitology and epidemio- human malaria. The use of malaria for the treatment logy. of neurosyphilis has been a uniquely fruitful procedure. Since 1937 Dr Young has worked in the National It has extended the livesof many thousandsof Institutes of Health of the United States of America. syphilitic patients and at the same time has developed 78 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II a tremendous amount of knowledge about malaria. diligence, malaria workers can eliminate one of the Thus, a disease has been used to fight both another main diseases from the world. disease and itself. My predecessors in this award have made truly During my twenty -six years of malaria experience, lasting contributions to the knowledge of malaria. I have seen mysteries of the malaria life -cycle revealed, That you have chosen to add my name to the roster important epidemiological facts gained, new drugs of that illustrious company fills me with a solemn and developed, and revolutionary procedures evolved for reflective pride.Throughout my lifeI have been the killing of the insect vectors.As a result of this privileged to enjoy warm professional and personal new information,it appeared that the tools and associationswithoutstandingscientistsof many methods were available for the possible extinction of nations.I wish to acknowledge the unsparing help malaria -but now, both the parasites and the vectors and support I have received over the years from the have learned to resist. people with whom I have worked.I am particularly Chemotherapy is now recognized as an important grateful to the staff members of the Malaria Laboratory part of the attack and consolidation phases of malaria in Columbia, South Carolina, and to the South eradication programmes. However, the appearance of Carolina State Hospital, for without their willing and drug- resistance could be a serious threat; new and enthusiastic co- operation much less of significance better antimalarial drugs are needed. would have been accomplished. Although much has been accomplished, much more For myself, and on behalf of all of those who made remains to be done. The problems to be solved are it possible for me to receive this distinguished award, difficult : there is a continual need for research and for I thank you most sincerely.(Applause) international co- operation if the goalof, malaria The PRESIDENT : The meeting is now closed. eradication is to be achieved. Nevertheless there is no doubt that, with ceaseless efforts and intellectual The meeting rose at 12.20 p.m.
SIXTH PLENARY MEETING
Thursday, 9 May 1963, at 4 p.m.
President: Dr M. A. MAJEKODUNMI (Nigeria)
1.Admission of New Associate Members :Mauritius A16/2, in which the Director -General informs the and Kenya Assembly that he received on 29 January 1963 an The PRESIDENT : The Assembly is called to order. application for associate membership in the World Delegates will recall that at our third plenary Health Organization, made on behalf of Mauritius meeting, on Wednesday, I indicated that the General by the United Kingdom of Great Britain and Northern Ireland. Committee recommended thesuspensionof the This application, dated 21 January 1963, application of the second paragraph of Rule 113 of has been made within the time -limit provided for in the Rules of Procedure. Rule 119 allows the Assembly Rule 113 of the Rules of Procedure. The text of the to do so, provided that a notice of the intention to application isset out in the document before the propose the suspension be communicated not less Assembly. than twenty -four hours before the meeting at which Does the Assembly agree to admit Mauritius to the proposal is to be made. Therefore, you can now associate membership of the World Health Organiz- take up the proposal to suspend the rule in question, ation? If so, I propose that the Assembly should with a view to the admission of Kenya to associate adopt the following resolution : membership.Isthe Assembly in agreement with The Sixteenth World Health Assembly this proposal to suspend the rule ? In the absence ADMITS Mauritius as an Associate Member of the of any objection I take it that the Assembly approves World Health Organization, subject to notice being the suspension of the second paragraph of Rule 113. given of acceptance of associate membership on I should like to draw your attention to document behalf of Mauritius in accordance with Rules 115 SIXTH PLENARY MEETING 79
and 116 of the Rules of Procedure of the World gentlemen, I should like to begin by thanking you, Health Assembly. Mr President, for your kind words of welcome and the wish you have expressed in regard to my country. Any comments ?In the absence of comments, the I hope Mauritius will prove worthy of it.I should resolution is adopted. also like to thank the United Kingdom for having Ishouldalsoliketo draw your attention to proposed the admission of Mauritius to the World document A16/3,inwhich theDirector -General Health Organization as an Associate Member, and the informs the Assembly that on 24 April 1963 he received other Member States for having adopted that proposal. an application for associate membership in the World I hope you will forgive me if, in the first place, I Health Organization made on behalf of Kenya by the take some pains to inform you of the whereabouts United Kingdom of Great Britain and Northern of my country, for it is not only foreigners who some- Ireland.The text of this application is also before times find difficulty in locating the island of Mauritius the Assembly. on a map of the world. One of the treasured posses- Does the Assembly agree to admit Kenya to sions of the city of Port- Louis, our capital, is the associate membership of the World Health Organi- envelope of an official letter from the late Queen zation ? If so, I propose that the Assembly adopt the Alexandra of England, addressed to the Municipality following resolution : of Port -Louis, Mauritius, West Indies.Honi soit The Sixteenth World Health Assembly qui mal y pense. ADMITS Kenya as an Associate Member of the Look at a map of southern Africa and the neigh- World Health Organization, subject to notice being bouring parts of the Indian Ocean and you will find, given of acceptance of associate membership on some 500 miles east of Madagascar, a group of small behalf of Kenya in accordance with Rules 115 and islands, the Mascarenes, and among them an island 116 of the Rules of Procedure of the World Health a little larger than the others -my country, your new Assembly. Associate Member, Mauritius.Discovered by the Portuguese in the sixteenth century, named by the Any comments ?In the absence of any comments, Dutch who occupied it in the seventeenth century, the resolution is adopted. given its character by the French in the eighteenth I would like to take this opportunity of welcoming century, administered since 1810 by the English, and the new Associate Members, Mauritius and Kenya, adopted as their homeland by people from Africa, and I would also like to express the hope that it will India and China, this small island, with its depen- not be long before they become full Members of our dencies,the islands of Rodrigues, Diego Garcia, organization. Agalega and St Brandon, supports a population of I now give the floor to the delegate of the United 750 000.It is a miniature United Nations, in which Kingdom of Great Britain and Northern Ireland. people live and work in concord, aspiring to indepen- dence, a place in the sun. Sir George GODBER (United Kingdom of Great Like all developing countries, Mauritius has many Britain and Northern Ireland) :Mr President and problems, but the most acute and urgent of them all fellow delegates, it gives the delegation of the United is one which, paradoxically, is due to the very genero- Kingdom great pleasure to accept associate member- sity of the World Health Organization. Whereas other ship on behalf of Mauritius and of Kenya. The United less favoured countries are still striving to eradicate Kingdom acceptsresponsibilityforensuringthe malaria, we have succeeded in eradicating the disease, application of Articles 66 to 68 of the Constitution of largely thanks to the assistance given by WHO, with the World Health Organization with regard to them. the result that there has been a dramatic decrease in May I now congratulate Mauritius and Kenya on mortality and an increase in fecundity, and a con- becoming Associate Members and add the personal sequent increase in the population of nearly 50 per cent. welcome of my delegation to our colleagues Mr Forget in little more than a decade.In other words, the and Dr Teelock of Mauritius and Dr Fendall from organization of health in our country has caused a
Kenya. We wish them all success in their work in the massive rise in our numbers, and this population. Organization. increase has now become a threat to the very health which produced it.Unlike our neighbours in Africa, The PRESIDENT : Thank you, Sir George.I now we have no free space for this excess of inhabitants. call on the representative of Mauritius. We have to solve our problem as islanders whose natural frontier is the sea.We are determined to Mr FORGET (Mauritius)(translation from the succeed but we know, alas, that an enormous effort French) : Mr President, your Excellencies, ladies and will be required. 80 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Already anaemia, caused mainly by malnutrition, with limited trained manpower available, a rapidly has become our biggest health problem, and things may expanding population, and with innumerable and be expected to get worse before over -population is urgent requirements in the fields of curative, preventive dealt with and the population is stabilized at a level and promotive medicine, the task is not easy.The our resources can maintain. In the struggle before us problem is not so much what to do as how to do it we look confidently to the World Health Organization within these limitations. for help, not only help to improve nutrition and Bearing all these factors in mind, we have attempted maternal and child care, but also perhaps help with to lay the foundation of a sound public health the birth control campaign, the success of which is of vital importance for our future. administration by concentrating upon the basic rural health unit -namely, the rural health centre -of which However, the giving may perhaps not be all on one we now have some 160; this is but a third of our side; for, small as we are, we have already, I think, primary objective of one such centre to each four or contributed an amount disproportionate to our size five thousand families : for we believe that the overall to human knowledge and universal culture :our effectiveness of our national health service must contribution ranges from the dodo and the giant ultimately depend upon the efficiency of this basic tortoise to the charming tale of Paul et Virginie and the massive intellect of Brown -Séquard, pupil and health unit.This is the foundation upon which the friend of Claude Bernard, the father of neurophysio- edifice and superstructure of our health service is built. logy, who is held in honour today in all centres of This consists, in addition to the health centres, of scientific learning. 366dispensaries,twenty -threecottagehospitals, thirty -two district hospitals and health units,five And I conclude, Mr President, by saying to you provincial centres and hospitals, and a national that it is as much with pride as with gratitude that the hospital complex providing a full range of modern small island of Mauritius takes its place as an Associate Member of the great World Health Organization. facilities and consultative services, supplemented by mission, voluntary and private effort. There are now The PRESIDENT : Thank you, Mr Forget.I now call 1.2 beds per 1000 population and the cost of the health upon the representative of Kenya. services is just short of £5 million per annum, amount- ing to some 2 Or cent. of the gross domestic product. Dr FENDALL (Kenya) : Mr President, distinguished Over the years onchocerciasis has been eradicated, delegates, ladies and gentlemen, my Minister has plague, epidemic relapsing fever, and yaws reduced to asked me to express his sincere regret that his heavy negligible proportions.We are currently mounting ministerial duties at this period in Kenya have pre- campaigns against tuberculosis, leprosy, trachoma, vented him from attending in person on this auspicious tetanus, poliomyelitis and other prevalent diseases occasion for Kenya, to hear the admission of Kenya through vaccines and chemoprophylactic drugs. There toassociate membership of the World Health are also measures to improve environmental sanitation, Organization and to express his thanks. water supplies, housing, maternal and child health, He has requested me on his behalf to express to you and nutrition. We are also in the process of building the deep gratitude and appreciation of the Govern- up our malaria pre- eradication programme. ment and people of Kenya for the honour you have But still we have much to do.Our progress in bestowed upon us by this admission to associate developing these health services would have been much membership. We are grateful also for the graciousness slower and less effective had it not been for the expert of the Assembly in waiving the deadline stipulated in advice and material assistance that we have received Rule 113 of the Rules of Procedure, so as to enable from other nations and international organizations. Kenya's application to be considered at this Assembly. I welcome this opportunity to express our thanks, in We are very conscious of the needs of our people in particular to the Government and people of the United sickness and for better health, and over the past years Kingdom, to the World Health Organization, and to we have tried to develop a service that is in intimate the United Nations Children's Fund, for their con- contact with them at all times : a service through which tinuous and generous help for many years. their daily wants can be met, whilst at the same time In conclusion, Mr President, I also take this oppor- providing a means through which an attack on the tunity of thanking the United Kingdom and its underlying causes of ill- health can be mounted. With delegationvery warmlyforsponsoringKenya's a population of some 8 670 000 (of whom 95 per cent. application for associate membership of the World are rural inhabitants), with limited financial resources, Health Organization, and of assuring you of our SIXTH PLENARY MEETING 81 support of both the spirit and the principles of the In India we have given a good deal of thought to World Health Organization. this problem.Almost all medical colleges have a department of social and preventive medicine to give The PRESIDENT : Thank you, Dr Fendall. a preventive bias to undergraduate training.I must confess, however, that we are still far from success. 2.General Discussion on the Reports of the Executive So long as curative medicine continues to enjoy Board and the Report of the Director -General on a higher status, as is the case at present, no amount the Work of WHO in 1962 (continued) of training and talks will wean away the young doctors The PRESIDENT : The Assembly will now continue from the curative approach.It is necessary to have a the discussion on items 1.9 and 1.10. Before giving the common cadre of services and give the same status floor to the delegate of India, who is the first speaker in emoluments to the specialists in public health and on my list, I should like to inform the Assembly that medicine, surgery, etc.Then alone will this idea of I have received a request from the delegate of Ceylon, integrated public health in medical services be given who would like to be included in the list of speakers. practical shape. As this list has already been closed, may I have the There is an urgent need to check too early speciali- approval of the Assembly to reopen it ? In the absence zation. A man or a woman must become a good all - of any objection I take it that the Assembly agrees to round physician before he or she takes to speciali- reopen the list.Are there any other speakers who zation. This is all the more important for a developing would like to seize this opportunity of adding their country, where facilities for consultation may not be names to the list ? easily available.It will be most useful to train every Since there are no other speakers the list is now doctor to be first a good family physician whose job . closed.I now have forty -seven speakers on my list, it is to prevent sickness and promote health and, and I would like once again to appeal to delegates when sickness does appear in spite of his best efforts please to be brief in their comments on the subjects to prevent it, to treat the sick.If he chooses to under discussion. specialize later, he will do much better than the man I now have pleasure in calling on the delegate of who goes in for specialization without this kind of India. background.It may be a good idea to prescribe general practice for a number of years before speciali- Dr NAYAR (India) : Mr President, the Indian delega- zationispermitted, and to develop international tion wishes to join in felicitating you on your election standards in this respect. to this high office; and may I say that the way in which A number of doctors are sent abroad for speciali- you have been conducting the deliberations of this zation under the auspices of WHO or other inter- august Assembly has fully justified our unanimous national agencies. I think it would be a good idea for choice. Please accept our hearty congratulations. WHO to insist that a minimum number of years, say I wish to congratulate Dr Candau, too, on his three to five, should be spent by the scholar, on his reappointment as Director -General of WHO for the return home, on the job for which he or she was third time. We all know that the problems of health trained; and also that the parent government should are above politics; it is, however, not always easy to provide him with the necessary tools on his return keep politics out. The Director -General's unanimous to enable him to use the skill that he may have acquired re- election is a telling testimony of his success in during his training abroad. This will prevent awkward steering clear of all political controversy and his able situations, wherein on the one hand a government handling of the problems of the health situations facing trains a person for a certain specific job, but as soon as WHO. I offer him our hearty felicitations. he returns he has more lucrative offers and is lost to the The Indian delegation also extends a warm welcome job for which he was trained; on the other hand there to the new Members, full and associate, who have are many examples of men trained for highly skilled joined our famility. jobs being posted to a district hospital or a primary A number of speakers, including yourself, Mr Presi- health centre without any opportunities to use their dent, have high -lighted the need for the integration of newly acquired skills. the curative and preventive aspects of medicine, in the The problem of shortage of trained personnel has interests of economy as well as of efficiency in the forced attention on the training of auxiliary personnel. execution of national health programmes.I am in The content of the training and the role of the medical wholehearted agreement with this view, and I am glad auxiliaries has to be very carefully considered lest that the technical discussions will focus attention they, in their turn, add to the ranks of the quacks, of on the training programmes for preparing young whom there are already too many in several developing doctors for this type of work. countries. The shortage of doctors is made much worse 82 SIXTEENTH WORLD HEALTH ASSEMBLY, PART H by maldistribution, so that it is much worse in the large populations in certain parts of the country. We villages than in the cities.Life in the villages is hard, are grateful to WHO foritshelp in mobilizing and doctors and nurses are reluctant to serve in rural international assistance for these programmes. areas.Better housing and better emoluments may It is a well known fact that it is much more effective help, but the real solution lies in early development so to try and eradicate certain diseases from the world that the villages have better sanitation, better roads, than to prevent their importation into one's own educational facilities, and so on.Health plans must country. I hope, with the success of smallpox eradica- form part of the overall socio- economic planning. tion, it will no longer be necessary to have vaccination An important reason for the reluctance of the doctors certificates checked by the port health authorities to serve in the rural areas, however, which is often in different countries.I hope, with the completion of overlooked, is the intellectual starvation that a young malaria eradication, that WHO can do something doctor has to face when he serves in the villages.I for the eradication of yellow fever, which is a constant think there is an urgent need to work out a pattern cause of anxiety to us.It is no pleasure for us to have for linking up the medical colleges with the primary to enforce quarantine measures against our friends health centres so that the doctor in the rural area is not coming from yellow -fever areas, but we have the cut off from scientific medicine and so that through vector and we cannot take the risk of the yellow -fever him the benefit of modern medicine can reach the man virus being introduced into the country, because if it at the periphery in the interior villages. comes it can spread like wildfire. I know the magnitude I was very glad to hear from the Director - General and the complexity of the problem of yellow fever, that WHO isgiving much more thought to the but I do hope that it will receive serious attention ere problems of environmental sanitation, supply of good long. drinking -water, and disposal of waste.I think it is time for us to set some kind of a target date for the The fight against communicable diseases requires a regional effort and I must compliment the regional supplyofsafe,protecteddrinking -waterforall peoples of the world, and I hope the United Nations offices of WHO on the excellent work that they are Development Decade will give concentrated attention doing in this field. I hope the fight against tuberculosis to this problem.The problem of water supply is and leprosy will receive more attention with the closely related to the problem of drainage, and the two discovery of effective domiciliary treatment, which has must go together.The developing countries are so made it possible to think in terms of comprehensive anxious to have industrialization that often industries control programmes for these diseases. The problem are set up without adequate arrangements for the of the supply of drugs for these programmes has to be disposal of industrial waste.The problem of river faced. Plants for the production of the necessary drugs will have to be installed in different countries pollutionisassuming a dangerous magnitude in certain areas where people still drink river water. The and I hope that WHO will think of doing so on a regional basis. dangers are obvious and must be checked. The disposal The problem of filaria is causing us of excreta, both animal and human, poses problems much anxiety. Effective drainage seems to be the only of such magnitude that the Director -General, in his real remedy, but drainage schemes are very expensive. speech, declined to comment on the extent of the Any help and advice that WHO may have to offer in incidence of gastro -intestinal diseases resulting from this field will, I am sure, be gratefully received. this one cause. We cannot fight communicable diseases WHO deserves our thanks and compliments for unless there is a concerted drive against insanitation, selecting for the theme of the year " Hunger- Disease including health education and inculcation of sanitary of millions ", thus concentrating national and inter- habits amongst the people of all countries. national attention on the problem of hunger, both WHO deserves our congratulations for the excellent naked and hidden.The important role played by job it is doing for the eradication of malaria. As the undernutrition and malnutrition in the field of health, malaria eradication campaign is drawing to a success- especially with regard to mothers and children, is ful conclusion in several countries, it has become well- known. The expanded nutrition programme very urgent to work out a pattern of health service is an excellent example of co- ordinated action between which can look after the maintenance phase of malaria international agencies such as FAO, UNICEF and as well as any other eradication campaigns, and this WHO, and inter -departmental co- ordination within pattern should be within the means of the country the national governments. concerned. We in India have taken up smallpox The problem of nutrition naturally brings one to the eradication along with the malaria eradication pro- problem of population. I am glad that WHO has begun gramme. We have also taken up campaigns for the to take an interest in this problem from the point of control of trachoma and goitre, both of which affect view of research in the physiology of reproduction.I SIXTH PLENARY MEETING 83 hope it can think of extending its interest to the larger in order to determine which method is likely to prove problems too. most economical and most effective. Health and The problems of food additives and food adulterants medical facilities, in order to produce results in the are other causes of serious concern. We do not know form of improvement all round, must be within the the long -range effects of some of the food additives. reach of the masses of men and women all over the It is much safer to avoid additives wherever possible : world who are today too poor to pay for these services. the less we interfere with nature the better.Where Povertybreedsill- healthandill- healthprevents interference is necessary, certain precautions become people from producing wealth and improving their imperative. Take, for instance, the use of insecticides economic and social conditions.This is a vicious for crop protection.It is important to work out circle, and a way must be found to break it. measures for avoiding the health hazards inherent in The importance of overall planning cannot be over- such use.Then there is the problem of accidental emphasized in this respect.Care must be taken, contaminationoffoodbyinsecticidesduring however, that as the total outlay on a country's transport.I think WHO must work out foolproof successive plans increases, the proportion of expend- regulations for the transport of insecticides to guard against accidental contamination. Contamination iture on health and welfare keeps pace and is not can also take place by the use of empty insecticide sacrificed to the needs of the so- called productive tins for carrying articles of food--resulting in disaster. sectors of the plan. WHO might perhaps make a I wish WHO would also lay down regulations for the studyand recommend optimum proportionsof disposal of empty insecticide containers. expenditure in these different sectors in order to ensure maximum and speedy development. The problem of spurious and sub - standard drugs is another serious problem. It is necessary that all those The genetic changes produced by nuclear fall -out who produce drugs should have adequate facilities for have been much talked about and with good reason. proper testing, stabilizing and processing before drugs The developed countries have to face the problem of are released for consumption within the country or nuclear waste, which can be as dangerous as nuclear are allowed to be exported.It is a well -known fact fall -out. The dangers of atomic radiation have that often drugs that are not considered fit for con- rightly engaged the attention of thinking men and sumption within the country are allowed to be exported women in all countries. In this connexion it might be to other countries.This is too bad.Trade names mentioned that the hazards of chemical and bacterio- given to drugs have resulted in a multiplicity of names logical warfare, which are well known, should not be for the same drug, causing confusion to the consumer. overlooked.The use of such diabolical weapons as WHO might consider how far patents in drugs and nuclear, chemical and bacteriological weapons should foods are justifiable. In my humble opinion the profit be outlawed for all time. motive, which is the basis of patent law, should not be Women, as mothers, are naturally most concerned allowed to operate in this field.Patents in drugs and want peace and prosperity for their children. are tantamount to secret formulae which used to be May I be permitted to mention that I am happy to handed down from father to son -a practice which has find several delegations in this Assembly led by been censured by scientific medical, circles in no un- women, but I am a little disappointed to find that in certain terms. the secretariat and directorate of WHO women are I welcome the remarks of the Director -General in not to be found in senior positions.I think the per- connexion with the need for greater collaboration in formance of WHO, impressive as it is, will improve international research and the proposed institute for still further if women are allowed to play a greater the exchange and dissemination of information. Efforts part in its activities, at all levels, in the pursuit of an must be made, however, to reduce the gap between era of peace and prosperity for all mankind. research and the application of the results of research. This will involve research into methods of health May I, in conclusion, submit that in the ultimate administration and their reform.I was very glad to analysis the only sure remedy against the hazards of hear from more than one delegate of the importance warfare of any kind lies in the promotion of mental of social security in the context of health plans.I health and hygiene. Men and women healthy in body endorsetheview expressed by theNetherlands and healthy in mind will never resort to war; they will delegate that social security and welfare should go instead use modern science and technology for the together, and I recommend that WHO might undertake development of the resources of this world for peace a study of the present practice in different countries and prosperity for all mankind. May the efforts of 84 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
WHO enable us to see such a change of attitudes and I consider it most essential and basic if there are the dawn of a new era of sanity in our own lifetime. any future plans for success as regards the health of the world; and I speak really very feelingly about The PRESIDENT : Thank you very much, Dr Nayar. the health of my country, which is a small one.I feel I now recognize the delegate of Jamaica. that unless these basic problems are investigated Dr ELDEMIRE (Jamaica) : Mr President, honourable and studied...as I said, by its omission from the delegates, it is with great pleasure and deep satisfaction document, I thought it important.I would have that on behalf of the Government of Jamaica my preferredtohaveseenanintensedemographic delegation also sees it fit to add our quota of congra- study made and I would certainly ask the World tulatory remarks to you, sir, and we wish you success Health Organization if such a study could be made in in your term of office. We would also like to express my country, because we consider the problem a our gratitude to the outgoing President and to the grave one. delegates who specifically named my country and The second point I would like to make is only to welcomed us as a new Member of this very august re- emphasize what the Report has in it about rural body; and we would like also to express our apprecia- water supply. As a doctor andpolitician, Mr Pre- tion to the United Kingdom Government, which sident, I find this the most heart -rending request of a sponsored our application for membership. people in 1963: I have been touched time and time To come to the Report that has been laid before us, again in my travels throughout my country when they we would like to congratulate Dr Candau on the ask : " Could we please get water to drink ? " In 1963, productionof averyable,concise andall -en- Mr President. compassing document; and I think it is very fitting that As a young nation we are looking forward to con- yesterday his reappointment was a unanimous one.I tinued participation with you with hope and courage, think it is very fitting in view of the regard which we and I can give you the assurance that the Government feel for him, and we wish him continued success. of Jamaica will play its part in the future to its fullest. Mr President, this is not really the time when I The PRESIDENT : Thank you, Dr Eldemire. I now call intend to go into any of my country's programme on the delegate of the United Kingdom of Great details. In fact I hope that elsewhere, sometime during Britain and Northern Ireland. this conference, I shall have ample opportunity of going into these, of which I have many. I would like, Sir George GODBER (United Kingdom of Great however, briefly to make just two observations arising Britain and Northern Ireland) : Mr President, many out of the Report that has been laid before us. One speakers have expressed the universal satisfaction in point I would like to say a little about because of its this Assembly over your election.I want to add only omission, and the other by virtue of its particular that it has given the greatest pleasure to the delegation interest to my country and my people. of the United Kingdom, and that no better choice The first point on which I would like to speak very could have been made. briefly is a point that is controversial in some places Fellow delegates, I wish also to record our delight and can be considered tricky in others; and I would that Dr Candau has 'agreed to continue as Director - like to speak about it by telling you that my country General. The Assembly could not have devised a more is a very small one geographically -only about 4000 auspicious beginning to our work. square miles, with a population of one and three - The Director -General's Report worthily continues quarter million people. Our infant mortality rate has the series and I want only to develop one point, and dropped from over a hundred per thousand to forty - that briefly.Dr Kurasov referred to the differing content of health programmes of Member States : on seven per thousand in the last fifteen years, and there will the one hand the overwhelming preoccupation of many be a further decrease in the years to come; our birth -rate developing States -and of course of the WHO pro- is forty -two per thousand, and our general death rate grammes in those States -with the control of com- is only a little over ten per thousand. So you will see municable disease by mass programmes; and on the that every year in the Dominion of Jamaica we have to other, the diminishing relative importance of com- find teachers, doctors, nurses, dentists, food, houses municable disease in developed countries and the pre- and hospital beds for an ever -increasing number of ponderance of concern with personal medical services individuals, totalling 70 000 more a year.And it for chronic and degenerative diseases.Priority must is very interesting to note that, although the country's be accorded in our work to meeting the needs of population has doubled over the past thirty years, the developing countries, especially by helping in the capital city, Kingston, has doubled its population training of health staff and controlling communicable in the past seventeen years.I make this point because disease. Yet the vitality of the Organization depends SIXTH PLENARY MEETING 85
upon itsparticipation also in the rapid scientific at least one approach to this problem in the course advances in medicine, and it has a special function in at Edinburgh, but with special reference to hospitals. helping rapid international dissemination of know- In Britain, last year and this, ten -year plans have been ledge. The President emphasized that preventive and produced for the development of hospitals and of home curative services are now so interdependent that any care.The promotion of those plans is not solely a plan for health care must cover both if it is to succeed medical concern; but both developments need the right with either.And the Director -General mentioned in type of medical administrator.Fellow delegates, it is his introductory remarks the difficulty of assessment time we gave thought to the training of our successors, of needs, the importance of an overall plan for health and to fitting them to do better than we have done. service in a country, and the need to train staff. Both Methods of organization of health services vary with points were mentioned by the delegates of the Nether- the central and local government patterns of different lands and India, and the delegate of Sierra Leone has countries, but the services themselves have much described how this has been done in his own country. common content. The Organization might well press Health services are indeed part of a pattern of social on the exchanges of experience in training of planning service of much wider scope, and the health officer and staff between countries, mentioned in the section on planner of the future must be much more than a public health administration of Chapter 4 of the technical expert in preventive or curative medicine. Report. The expert committee planned for 1964 faces He must be able to fit his own programme into the a most important opportunity, and I look forward to general programme of national development, and its report. therefore he must be trained for this responsibility. We all know that clinical medicine is rapidly becoming The PRESIDENT : Thank you, Sir George. I now call more specialized -a fact which has led in Britain to on the delegate of Albania. greater emphasis on the role of the general practitioner Dr KLosi (Albania) (translation from the French) : as the continuing adviser of the family and the means Mr President, ladies and gentlemen, allow me to of securing both ordinary treatment and access, if convey, on behalf of the delegation of the People's required, to specialized forms of medical care.Yet Republic of Albania, the greetings of the public health neither general practitioner nor specialist can be workers of our country to the Sixteenth World Health expected to be the planner of orderly development of a Assembly and, through the Assembly, to wish WHO balanced service. success in its noble role as protector of the nations' Paradoxically, the least developed medical service health.Allow me on this occasion to congratulate lapses most easily into concentration of effort on Dr Majekodunmi, Minister of Health of Nigeria, on specialist service in hospitals, without the background his election as President of this Assembly and to wish of home care upon which the efficient use of specialist him every success in his new office, and also to con- service depends.Mere lack of trained staff causes gratulate the Director -General, Dr Candau, on being that. unanimously reappointed to that responsible post. The schemes of epidemic control or eradication of a We greet the representatives of the heroic Algerian particular disease cannot achieve final success unless people which, after long years of struggle for liberation, a peripheral system of health services is provided. has attained independence, also the representatives That is why the emphasis on rural health services of Rwanda, Burundi, Uganda, Jamaica, and Trinidad seems to me so fully justified. This in turn means that and Tobago, which have become Members of our the country or regional plan of orderly development is organization in the course of the past year. We note much more important than the episodic campaign with regret, however,' that this humanitarian and against this or that disease. universal organization still does not include among its If we are to have effective planning, we must train Members the People's Republic of China -that great men in the right way to do it.The traditional public peace -loving people constituting nearly a quarter of health training, evolved over many years,isstill mankind, which has now many achievements to its oriented largely towards preventive medicine as a credit in the field of health. The seat which rightfully speciality. That is a necessary element, but we do belongs to the People's Republic of China should not also need to prepare selected men for the future tasks be allowed to be occupied by a person who in reality of the organization of medical care. We cannot leave does not and cannot represent the great Chinese to chance the selection and the experience of the future people. We consider that participation of the People's planners. The Regional Office for Europe has made Republic of China is essential and that the People's 86 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Republic of China would make a very valuable con- meant a slight increase in infection, but measures were tribution to the attainment of the Organization's taken in time and the situation was stabilized. aims. Apart from the vaccinations administered in 1962 for We have listened with close attention to the state- various other diseases, nearly 500 000 people were ment made by the Director- General, Dr Candau, on vaccinated or revaccinated against smallpox, because the work of WHO in 1962. Unfortunately on 3 May, cases of that disease have occurred in recent years in the day we left Albania, the Report on the Work of various European countries. WHO in 1962 had not reached us, so that it has not In our country out -patient medical care is entirely been possible for us to give it thorough consideration. free of charge and hospital care also is entirely free Regarding the work of our organization, allow me of charge for socially insured persons and all members to suggest that in future it should devote more atten- of their families. This means that a large number of tion to the urgent problems of countries that have just people undergo medical examinations, and it is con- regained their freedom, where disease still claims a sequently possible to detect cases in time and to treat host of victims, despite the acceleration in the develop- with a greater likelihood of success the pre- morbid ment of these countries.The training of higher and initial forms of disease.At the same time this national medical cadres would be a great help to represents a valuable preventive measure for the those countries. We also consider that the Organi- control of disease.In 1962, out -patient medical care zation should do all it can to ensure that the latest increased by 16.9 per cent., and the percentage is discoveries in medicine do not remain a monopoly further increasing daily.In addition, we are now of the more advanced countries, but are made available sending doctors to large industrial and agricultural to all mankind. undertakings, so as to enable the workers and peasants to have medical examination and care at their place In 1962, in our country also, along with the develop- of work. ment of culture and of the economy, special attention Special attention is being given to maternal and child was devoted to the people's health, and we have a care.Deliveries in maternity hospitals are free of series of achievements to our credit in this field. Thus, charge, and mothers are legally entitled to three whereas in 1961 we had only one doctor to 3000 people, months' paid holiday, part taken before and part we now have one to 2600. The annual increase in the For children up to one year of age number of doctors has enabled us to extend medical medicaments prescribed by doctors for out -patient care to the broad masses of the people and to improve treatments are supplied free, while all children up to the standard of the attention they receive. This increase four years of age, without exception, are admitted in the number of doctors has also enabled us to increase to hospitals free of charge whether or not their parents the number of specialists and to expand our system of are employed by the State. health institutions by increasing the number of beds In addition to all I have already mentioned, special in them.Thus in 1962 we managed to increase the attention has been devoted to the problem of hygiene number of beds to 5.64 per 1000 population. Further- in towns and in the countryside. All the social organi- more, by a special decision of our Government, medical zations, particularly the Albanian Red Cross, also aid is rapidly being brought to the villages so that the take an active part in this work. In the health institu- rural population enjoy the benefit of it directly.In tions of our country, and in particular in the teaching 1966 the entire rural population of our country will hospitals of the Faculty of Medicine, new methods have skilled medical assistance on the spot. of treatment and prevention are now being used. Among the achievements of our medical profession, Pulmonary and cardiovascular surgeryis making mention should also be made of achievements in the fresh advances every day and is being increasingly control of communicable diseases such as tuberculosis, employed. brucellosis, dysentery, epidemic hepatitis, diphtheria, All these achievements in public health are not due etc. In the control of those diseases, side by side with solely to the expansion and improvement of the heath social preventive and curative measures, a major part services : they are also due to the improved physical, has been played, in the case of epidemic hepatitis in economic and cultural conditions which the population particular, by the large -scale use of gamma -globulin, now enjoys. The credit is therefore in the final analysis which we are now making inside the country. due to our People's Government. In regard to the malaria eradication programme, in In conclusion allow me, Mr President, to thank the area in the attack phase, transmission was com- WHO, itsDirector- General, Dr Candau, and the pletely checked in 1962 and we have had no new cases. Director of the Regional Office for Europe, Dr van In the area that has reached the consolidation phase de Calseyde, for the help they have given us this year, some foci of malarial infection were found, which and to wish our Sixteenth Assembly every success. SIXTH PLENARY MEETING 87
The PRESIDENT : Thank you, Dr Klosi.I recognize vaccine spaced at six, seven and twelve months of the delegate of New Zealand. age.This cautious start gave us experience with the vaccine and in the problems of storage and distribution Dr TuRBOTT (New Zealand) :The New Zealand of supplies within the country. The response rate was delegationexpressesitsgreatpleasureatyour about 80 per cent, and there were no reports of appointment, Mr President, and its deep happiness, complications.This was a very fortunate result for Dr Candau, at your reappointment as Director - us, for during this same year the apparent protection General. In the report under discussion, on the from Salk vaccine failed, and we had 214 cases. Work of WHO in 1962, the Director -General is to be So in April 1962 we made the first mass extension congratulated on a record of wise direction and to other groups, beginning with the pre -school and achievement. schoolchildren :of an estimated total of 780 000 This annual report shows a reduction of about children, 727 148 received two doses, at six- to eight- 65 per cent in the reported world poliomyelitis cases week intervals, of a Canadian trivalent mixed Sabin between 1954 and 1960. We in New Zealand share in vaccine.It was then decided to offer the vaccine to this reduction, and our experience in the use of both the remainder of the population.It was recognized Salk and Sabin vaccines is likely to be of interest to that the arguments in favour of extending beyond other Member States. the age of forty years were mainly personal rather Vaccination using the Salk vaccine commenced in than epidemiological, but it was appreciated also that New Zealand in September 1956, when a small supply to exclude those over forty years would introduce a of that vaccine, sufficient only for the nine- year -olds, considerable administrative complication. Accordingly, became available.Thereafter, as supplies of vaccine vaccination was offered without any restriction on became more plentiful, eligibility was extended until age, but pre- campaign announcements placed emphasis by 1959, vaccination was offered to all between the on the importance of the protection for those up to ages of six months and twenty -one years.In May forty years.1 166 292 persons received first doses in 1961supplies became freelyavailabletoprivate September 1962, and 1 111 114 took the second dose medical practitioners, and there was then some further in November, inspiteof reportsof temporary extension of the use of Salk vaccine among the adults suspension of the use of the Sabin vaccine in Canada who had not been eligible under the Health Depart- and the United States of America.Approximately ment's scheme. By the end of 1960, in the age -group 80 per cent of our total population have received the 0 -16 years 71 per cent had received three injections Sabin vaccine, and approximately 97 per cent in the of Salk vaccine; about 60 per cent of all ages up to 25 younger age -groups of all children up to school - years had received two or more (mostly three), leaving age. We have now finished with mass polio injections; and over 25 years there was a poor adult vaccination. Our continuing programmeisto response of about 10 per cent. An injection campaign vaccinate infants under twelve months of age with among adults is never popular. What was accomplished three doses of trivalent vaccine, rather than the two did have an apparent effect in our population of two of the mass campaign, as this on- coming group has and a half million people. no history of Salk vaccination. I have to bore you with a few figures so that you The Canadian vaccine was tested for potency. The can follow my story.Here is our incidence of polio- doses administered in the campaign were adequate in myelitis since 1946: 1946-112 cases; 1947-130; titre strength.Blood samples from 400 children 1948-917; 1949-346;1950-70;1951-27; during the children's campaign were tested for anti- 1952-890; 1953-403;1954-43;1955-703; body levels, the first sample before the first dose of 1956-897; 1957-63;1958-57;1959-16; oral vaccine, and the second some six weeks or later 1960-4; 1961-214; 1962, January to March-4, after the second dose. Half the paired sera were sent April to December - 0; 1963, January to the present to the Connaught Laboratories for testing, and the date - 0. remainder were tested in New Zealand. The reports As the total population response to the offer of Salk showed, following two dosesof trivalentSabin vaccine had been unsatisfactory, on the advice of the vaccine, that responses to types 1 and 2 were equal Epidemiology Advisory Committee of our Board of and excellent, and, while that to type 3 was somewhat Health we started using the Sabin vaccine in August less, this was also satisfactory. 1961 - at first only for infants under twelve months The proof of the pudding lies in the eating :since of age. We offered a three -dose course of trivalent the Sabin vaccine was first used in mass fashion, now 88 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II over a year ago, there has not been a single confirmed co- operative application, world -wide, of the swiftly case of poliomyelitis in New Zealand. developing modern technology of health. The heart of WHO's work today, however, is its The PRESIDENT : Thank you, Dr Turbott.I now technical assistance to Member governments in disease recognize the delegate of the United States of America. control programmes by way of provision of advice, educational material, professional help, and even funds Dr TERRY (United States of America) : Mr President, -theso-called development programmes, which seek friends and distinguished colleagues,itisa great to raise the level of health and the level of vitality privilege for me to greet, on behalf of my Government, simultaneously.In his excellent annual review, the the nations represented at this Sixteenth World Health Director -General reported that WHO had participated Assembly. My delegation deems it an honour to in 817 health projects in 143 countries in 1962.He join with the other nations of the world in working also noted that " it is widely accepted today that health towards a solution of our mutual health problems. is important if human resources are to be utilized Our goal- better healthfor people everywhere - rationally " and is a prime requisite for achieving the can be met only through high resolve, increasing harmony, a sense of lasting dedication, and con- aims of the United Nations Development Decade. centrated effort. In his opening address before this Assembly, our On behalf of my delegation and myself, I wish to President stated that an objective of the World Health congratulate our new President; I am sure he will Organization is the eradication of disease.This is a preside over the important business of this Assembly lofty aim indeed, and we must do everything within in a thoughtful and effective manner.I look forward our power to work toward its attainment. to a very productive session under his leadership. How do we go about this task ?First, there is a And may I extend my appreciation to our immediate fundamental need for more research. My Government past President, Dr Kurasov : well qualified by many attaches great importance to the search for new know- years of interest and experience in international health, ledge on behalf of better health.Knowledge gained he discharged the exacting task of his office with through research is the corner -stone of all of our work. thoroughness and distinction. Although we know much about such ancient illnesses All of us here, as we exercise responsibility for as leprosy, for example, the world still awaits a simple presenting our country's views before the Assembly, and effective cure. The causes and remedies of cancer, must of necessity take a clear, hard look at WHO pro- heart disease, and many other chronic illnesses still grammes and policies.For my part, I did not find elude us.As we gain increasing mastery over the such a look disappointing.Quite the contrary. The major communicable diseases, we must do everything World Health Organization is a dynamic vehicle for we can to ensure that the lives which are thereby international co- operation in the age -old battle against spared and lengthened are also rewarding and pro- disease and for a better life.The decisions we take ductive.Some of the villages of today, concerned here, and the work which follows these decisions, with their basic sanitation, will become the cities of tangiblyaffect the health of millionsof human tomorrow, with allthe concomitant problems of beings. In the fifteen years of its existence, WHO has atmospheric and water pollution, occupational and started, or has extended and made successful, a host highway accidents, and the increased tensions of urban of far -reaching activities : a world -wide epidemic intel- life. We need to know more about the immediate and ligence system; a system of international quarantine long -range effects of these environmental stresses on which helps control disease at its source and protects health. We have few answers to any of these problems, the travelling public; the standardization of biological and until we begin to get these answers our efforts to products; the organized exchange of health personnel prevent and control many diseases will remain limited. to broaden the technical outlook and stimulate the In this connexion, it was my great pleasure, just imagination of health leaders; the supplementation two months ago, to license the new measles vaccine of public health activitity in countries where itis for production and use in the United States.This inadequate; the development of minimum standards significant achievement was the result of individual of acceptable public health work that can be applied scientific research, the developmental work of the on a world -wide basis ; the education and training of pharmaceutical industry, and the co- operative effort professional health personnel; the creation of expert of many organizations in the field- testing programme. committees and international conferences on special We owe a particular debt of gratitude to the Govern- subjects. These activities represent the organized ment of Upper Volta which set up, under the leader- SIXTH PLENARY MEETING 89 ship of Dr Lambin, field trials in the areas of that spraying operations have been replaced by surveillance. country where measles is a very serious problem. We Another great stride is that 13 million people have are currently working with other African countries been added to the total of those living in areas where to develop plans for the use of the new vaccine, in malaria is considered to be eradicated. order to make full and prompt utilization of this Malaria eradication is complicated today, as you important scientific advance. know, by the resistance of mosquitos to the insecticides In this, as in other developments, there is need for being usedagainst them :apparently,thehabit speeding up the application of new knowledge to the patterns of the insects have been altered so as to enable problems in the field and at the bedside. The results of them to avoid exposure.This set of cirumstances research must be effectively applied in an organized calls for several things.There is need for additional way. Eradication of smallpox, for example, has evaluation of the tools we are using to combat malaria, suffered delays because of problems related to the and for research in developing new techniques, and we organization and application of existing knowledge. must give consideration to new patterns of co- opera- tion with a variety of specialists and agencies.We It is one of the hard facts of life that health resources, know, for example, that the type of housing in which especially manpower resources, are always in short people live has a great deal to do with the effectiveness supply. This is true even in the wealthier countries; it of insecticides.Dwellings and housing developments is overwhelmingly true in the developing countries. should be planned in such a way as to facilitate We must, of course, step up our training of health malaria eradication.In some cases, this requires a manpower, and I am happy to note that this is the revolutionary change in construction methods that are subject of our technical discussions this year. centuries old, and such a change in turn requires a The dream of better health for most of the world's highly successful programme of adult education. Thus, people can be realized only through a concentrated housing specialists and educators are indispensable attack in the areas of preventive medicine and com- to the solution of what is essentially a health problem. munity health. Only through prevention -the applic- Here is an opportunity for co- ordination to which ation of what is already known -can we ease signi- the World Health Organization should give serious ficantly the world's burden of disease.I hope that the attention. precedent of the Americas, under the leadership of The world, while being so interdependent, is still a the Pan American Health Organization, in setting large place. WHO makes use of a decentralized target dates for the eradication of specific diseases and regional structure to an extent which I believe is the attainment of specific objectives, can be pursued by unique in international organizations. This decentral- all the nations of the world. ization has considerably strengthened WHO as an One problem that can be focused on immediately instrument through which nationsco- operate for is the provision of adequate and safe water supplies. health. Through the regional offices and committees, Water is essential to life.It can sustain and enrich WHO is brought closer to the needs of the people of our existence. At the same time, it can be the vehicle Member countries, and they closer to WHO. The for infections and illness. Pure, safe water can prevent health leaders of the various areas of the world and the disease for millions of the world's people. Moreover, WHO staff serving those areas are good friends and the amount of human energy expended in getting work closely together in defining needs and planning clean water should not have to be greater than the programmes in health. return.In today's world, people should not have to Moreover, the decentralized regional structure makes carry water laboriously by hand or on their backs possible more flexibility and experimentation in WHO when the means are at hand to bring it to their com- programmes. An example of the worthwhile develop- munities. Adequate water supplies for everyone ment is the establishment of the Institute of Nutrition throughout the world should have a high priority in of Central America and Panama. Under the aegis of our health planning for the future. the Pan American Health Organization, and supported Another problem on which we can focus our largely by the Central American republics, this Institute resources most profitably is malaria. With the know- has attained a world -wide influence in nutrition. To ledge available today, malaria can be eliminated from me, it is significant that this project was sparked off by the face of the globe.This has been shown by the the smaller rather than the larger countries of the experience of many countries.The most spectacular Americas. advances have been achieved in India, where 148 We ordinarily think of regionalization in geographic million people are now living in protected areas, where terms. The example I have just cited, however, might 90 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II be termed programmatic regionalization -the pooling under Dr Candau's direction, have been years of of resources and funds to accomplish a specific job notable accomplishment.I am looking forward to within an area.Other health problems are subject the next five years with high anticipation as we con- to the same kind of approach. The regional offices of tinue our work on behalf of better health for all WHO are now in a position to take the lead in mankind. developing special projects and programmes to meet the special needs in those areas. The PRESIDENT : Thank you, Dr Terry.I now call upon the delegate of Poland. The scope of the work of WHO, which was brought into question by the distinguished President of last Professor WIDY- WIRSKI (Poland) (translation from year's Assembly in his address on Tuesday, is indeed the French) :Mr President, ladies and gentlemen, a broad scope and one which demands constant I should like to begin by heartily and sincerely con- review and evaluation to make sure that the administra- gratulating you, Mr President, on behalf of the Polish tive capacity of the Organization is not stretched delegation, on your election as President of our beyond its limits. Certainly, we should not try to feed Assembly.I am sure that with you as our President into the regular budget of WHO too many new the debates will be as fruitful as those under the programmes and projects and thereby invite admin- presidency of Dr Kurasov.I should also like to istrative indigestion.But the record of WHO is congratulate our colleagues who have been elected distinguished precisely because it has absorbed new Vice -Presidents of the Assembly. and important work and remained perhaps the best The Report on the Work of WHO now before us ordered of the specialized agencies within the United shows how our organization is steadily developing, and Nations system. The men and women of WHO, drawn the great things it has achieved. I should like also to from all the world's cultures, have acquired and are stress the personal contribution made by Dr Candau and constantly acquiring new skills and experience, not the striking ability he has shown in the performance just in narrow specialties, but in the very real and of his onerous task as Director- General of our organi- challenging business of finding and applying new zation, and to congratulate him on his reappointment knowledge to the pressing health problems of our to that most responsible post. time. It is not just what is learned in the research work My delegation has studied with special attention the of WHO that distinguishes this organization :itis documents dealing both with theOrganization's also what is learned in the way of training technicians present work and with its programme and budget. and administrators, and what is learned in direct We attach great importance to the work of the application of knowledge through such programmes Advisory Committee on Medical Research set up to as malaria eradication.One could not begin to go assist the Director -General, a committee -upon which about assessing the real possibilities of WHO without we have a representative -which guides the Organi- accepting the interdependance of experience gained zation's increasing activities in the application of the in research, training and direct operations. We should results of scientific research. not be misled by the labels placed on the various We shall, in particular, give our support to WHO aspects of WHO's work :they are all part of an projects to study in each country the organization increasinglycoherentandincreasinglyimportant and operation of different systems and forms of health whole. protection. In our opinion, the use of the experience In conclusion, Mr President, I should like once gained by countries that have succeeded in building up again to express my appreciation to the Director - their own system of national health protection and, in General on his excellent Report on the activities of particular, by countries which, having set out to WHO last year.It offers heartening evidence that build up a health service under extremely difficult WHO is indeed taking the bold and decisive action conditions and frequently from scratch, have now which is characteristic of a dynamic organization. attained a very high level, would be highly profitable And I should like to record my pleasure at the to the developing countries and especially to those opportunity for casting my vote for our new Director - that are experiencing serious difficulties in health General. We followed the rules of parliamentary protection. These countries are confronted today, as procedure meticulously, but the record of our ballots our own country was hardly twenty years ago, with a was crystal clear. This is a tribute to two things : the problem of fundamental importance, namely, the unity of professional opinion that motivates this training of their own national cadres.The Director - Assembly, and the recognition of eminent and illustr- General himself has stressed the exceptional im- ious leadership.I congratulate Dr Candau upon his portance and urgency of this question. Until such time reappointment, and I congratulate this Assembly on as the problem is solved, the developing countries are the wisdom of its decision. The last ten years of WHO, entitled not only to assistance for the training of their SIXTH PLENARY MEETING 91
own cadres, but also to immediate assistance with to methods of financing that will enable greater use to elementary health protection.Poland is taking an be made of the potentialities of assistance possessed by active part in tackling the problem, and numbers of countries that are already making a contribution. Polish doctors are at present working in various This would have the effect of distributing aid more African countries. equitably and of making the burden easier to bear than The control of communicable diseases, in particular by the contributions of the Member States.Such malaria control, in which the Organization is actively forms of activity exist already, and a development in engaged, is making increasing demands. Tuberculosis that directionisperfectly feasible;ithas indeed control also is a world -wide problem. Maternal and already been achieved by certain organizations, such child welfare, problems specific to the highly in- as UNICEF and others. dustrialized countries, and degenerative diseases, call Mr President, these brief observations on points of for programmes of preventive work on a world -wide principle that I have ventured to make on behalf of scale.The world's needs in the matter of health my delegationinconnexion withtheDirector - protection are immense. It is unnecessary to show how General's Report in no way affect our delegation's much mankind could benefit from the immense acceptance of the Report on the Work of WHO resources that would become available as a result of submitted to us. disarmament, if those resources could be devoted to health problems.Is it right that WHO should take ThePRESIDENT: Thank you, Professor Widy -Wirski. no stand in a matter of this importance ? And is it I now recognize the delegate of Thailand. right that it should refrain from drawing on the ProfessorSANGSINGKEO(Thailand) : Mr President, experience of countries whose health services have fellow delegates, my delegation wishes to express the attained a very high level of development, such as the most cordial congratulations to you, Mr President, German Democratic Republic and other countries ? on your election to this high post of President of the Despite the fact that the population's state of health Sixteenth World Health Assembly. We are certain is inseparably bound up with the country's economic that under your competent guidance the session will level and living conditions, the tasks involved in be crowned with success. Allow my delegation also to practical and direct assistance in the field of health to join our fellow delegates in sincerely congratulating the countries concerned are immense and will become Dr Candau on his reappointment as Director -General. steadily greater.It is impossible not to agree with On studying the Director -General's Report we are the distinguished delegate of Tanganyika that unless immediately impressed by the wide field of action, direct assistance is given at once to the countries that continually being extended, in which WHO is carrying need it, the gulf between them and the economically on its work so effectively, and by how much gratitude more developed countries will not only fail to decrease we owe to WHO, which in the period of thirteen years but will on the contrary grow larger.In view of this has done much fruitful work for the health of the situation, priority ought increasingly to be given to Thai people. The achievements of some projects organizing activities on the spot as part of a general have been so impressive that public health officials programme (such as the malaria eradication pro- now begin to talk loudly and proudly about eradic- gramme), on a world -wide scale and at the regional ation : not content with the primary objective of merely level alike.Activities, however sound, for training, reducing the incidence of a disease to the controllable standardizing and co- ordinating local services, are level, eradication has now been set as an ultimate goal ceasing to be enough.This is shown by the urgent for many disease -fighting projects. world needs in the health field becoming apparent The malaria campaign, launched in 1949, has brought after large numbers of countries and nations have the malaria death -rate down to only 24.5 per 100 000 opened up the road to their own development. in 1961; the actual number of deaths in 1961 was Mr President, all this confronts the Sixteenth World fewer than 6900. This means that at present more than Health Assembly and particularly its Executive Board 50 000 lives are saved from malaria every year.At with the need for taking basic decisions on the problem present malaria has ceased to be the No. 1 killer in of the methods and structure of the Organization. Thailand. If the full -scale implementation of the The annual increase of the Organization's budget, malariaeradication programme isassured,itis by itself, will be no more than a palliative -a heavy certain that malaria will be wiped out from Thailand burden, but not enough to enable us to carry out the within the next six to eight years. tasks required of the Organization. The Polish delega- The mass campaign against yaws was initiated in tion considers that, if the principle of direct activities 1950, and has progressed so rapidly and dramatically within the framework of programmes is accepted, and that now it is not too easy to find a case of yaws -even such activities are expanded, we must have recourse in a village that ten years ago was full of yaws 92 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II gases.During 1952 -1956, when the mass campaign Some other things also deserve mention here. We was in full operation, one million cases were treated are at present on the threshold of economic, social at the rate of 200 000 per year.According to the and health improvements, but there are many countries most recent survey, out of 6 300 000 people examined, in the world facing rapid population growth.The only 469 infectious cases were detected. current population trends have important economic The horror of plagueisalmost forgotten,as and social implications, which will affect the struggle Thailand has been free from this dreadful disease for against hunger and poverty and will finally lead to ten years. As regards cholera, it struck Thailand again poorphysical andmentalhealth. Important in 1958 and 1959, after being absent for eight years, economic progress has been made in South -East Asian and caused many deaths. Fortunately; it was promptly countries in recent years, but the rapid population and completely wiped out as soon as the present increase has in many cases absorbed the major part of Government had assumed the responsibility :the it, with the consequence that significant improvements epidemic was brought to an end within a short time, in levels of living have barely been accomplished. and no cholera cases have been reported since. The attainment by all peoples of the highest possible A scheme for the total eradication of smallpox has level of physical and mental health is the aspiration now been undertaken, aimed at vaccinating and of the governments and peoples of every country. revaccinating at least 80 per cent of the whole popula- We feel that the attainment of this objective is linked tion within three years.It is hoped that the freeze - closely with economic and social development and dried smallpox vaccine produced locally at the rate of must be developed by the strenuous efforts of WHO 2.5 million doses per year will assist the services in and within the framework of mutual co- operation achievingsuccessfuleradicationofsmallpoxin with the other specialized agencies. The World Federa- Thailand. tion for Mental Health is also giving this matter In addition to the mass campaigns already men- detailed consideration.Integration of activities with tioned, the Ministry of Public Health also has many other agencies is really necessary. other projects on hand concerning control of tuber- Lastly, I wish to assure you, Mr President, of my culosis, leprosy, venereal disease, filariasis, trachoma, Government's continuing interest in and support for and rabies. For the promotion of positive health and the Organization in its global task, and offer my very health services, the Ministry of Public Health has best wishes for the success of this Sixteenth World initiated and strengthened several projects concerned Health Assembly. with maternal andchildwelfare,schoolhealth services, nutrition promotion, health and sanitation, The PRESIDENT : Thank you, Professor Sangsingkeo. public health nursing, nursing services, mental health, I now call on the delegate of Argentina. and vital, health and hospital statistics. Last December Dr OLGUIN (Argentina) (translation from the Span- Thailand had the honour of serving as the host country ish) : Mr President, Director -General, fellow delegates, for the WHO South -East Asia regional seminar on ladies and gentlemen, the delegation of Argentina hospital statistics.We learned some interesting and wishes to take this opportunity of expressing its great valuable things about the initiation and organization satisfaction at taking part in the Sixteenth World of modern medical recording systems.At present Health Assembly. On behalf of our Government we modern hospital statistics systems have been set up in greet the Member States that have recently joined the many hospitals in Thailand. Organization and wish them welcome. Before concluding, I should like to place emphasis The responsibilities of the World Health Organi- on the contribution being made by WHO to pro- zation, which has been joined in the course of its grammes for the training of health personnel. In this existence by the States, the human groups that depend way the Organization is playing a primary role in the on its assistance and effective work for health in the improvement of health services.I do believe that widest sense, are increasing with the constant develop- professional training, with advice from effective WHO ment of ideas, discoveries and technical possibilities. experts -if WHO would pay increasinglycareful Its Assemblies are the highest forum for the inter- attention to considerations of recruitment and selec- national discussion of world health problems. tion -are the foundations on which any health pro- We should like to draw attention to the work gramme designed to protect the lives of the population accomplished by the previous Assembly, to wish the must rest. They should always have a very important greatest success to the Assembly now in progress, place in WHO's activities.Mr President, may I and to convey to you, Mr President, our congratula- emphasize again that good training and selection of tions on your election to the important post with which personnel in recruitment -problems of men and their you have been entrusted. We also congratulate the minds -are the things that count in all activities. other officers of the Assembly, and especially the SEVENTH PLENARY MEETING 93
Director -General on his reappointment, which is a meetings that are held make it possible to discuss and recognition of his merits and his work as leader of the adopt important decisions on the action to be taken. Organization. In so doing we attach fundamental importance to In his Annual Report to the Assembly the Director - health planning with a view to unity of objectives and General has described the activities of the Organization action; to the strengthening of health services; to the in 1962. We regard this valuable document as a faithful training of technical personnel at professional and account of theextensive programme now being other levels; to the eradication of malaria; to inten- carried outallover the world,inthe form of sifying the control of communicable and chronic harmonious and coherent projects bound together diseases; to medical research; to problems of nutrition, by international co- ordination, showing the importance water and environmental health;toprojectsfor of the work done and the problems to be faced. It is a ensuring the well -being of rural populations ; to medical document which, reflecting ideas and trends, represents assistance; and, finally, to other matters, the enumer- the experience gained during the continuing campaign ation of which would constitute a complete and for health in the world. unified health plan. At the present time, when the efforts of mankind are The matters dealt with in the Director -General's united in joint action with the great hope of bringing Report will be considered individually during the the world to a stage of real development, the con- discussions in the appropriate committees. tribution of the human element and of the level of The Argentine delegation wishes to congratulate health of the peoples is 'a basic factor.There is thus the Director -General and the Organization on the tremendous significance in the work undertaken in work accomplished and described in the Report, consonance with the aims of the United Nations at a stage which marks a further step forward in the Development Decade, and the Punta del Este Charter progress of mankind :it wishes every success to this and the Alliance for Progress in America, under Health Assembly which is taking place in the Palais whose programme an important meeting of health des Nations, so closely associated with the great ministers was held this year. This meeting, organized events of the world, and under the traditionally by the Pan American Sanitary Bureau, made it hospitable skies of Switzerland. possible to examine the major health problems of the continent, to outline a policy for their solution, and to The PRESIDENT : Thank you, Dr Olguín.As it is reaffirm the importance of health in economic and now almost 6 o'clock this debate will be continued in social development. plenary session at a later date, to be decided by the In this desire for joint action by our countries we General Committee. The meeting is adjourned. are carrying out important projects in the various branchesof healthwork, and theinternational The meeting rose at 6 p.m.
SEVENTH PLENARY MEETING Tuesday, 14 May 1963, at 2.30 p.m. President: Dr M. A. MAJEKODUNMI (Nigeria) later Professor R. GERIá (Yugoslavia)
1.Third Report of the Committee on Credentials The PRESIDENT : The Assembly is invited to approve this report. The report is approved. The PRESIDENT : The first item on our agenda this afternoon is the adoption of the third report of the 2.First Report of the Committee on Administration, Committee on Credentials.The Rapporteur of the Finance and Legal Matters Committee, Dr A. C. Andriamasy, is invited to come The PRESIDENT : The next item on our agenda is the to the rostrum to read the report. adoption of the first report of the Committee on Dr Andriamasy (Madagascar), Rapporteur of the Administration, Finance and Legal Matters.This Committee on Credentials, read out the third report report is contained in the document that you will have of that committee (see page 407). found on your table when you arrived. In accordance 94 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II with Rule 52 of the Rules of Procedure this report, not 1964, and that you will allow Dr Bravo to begin having been distributed twenty -four hours in advance reading from part II.Are there any objections ? of this plenary meeting, will be read out aloud. The Dr Bravo, will you please proceed with part II. Rapporteur of the Committee on Administration, Dr Bravo read out part II of the resolution in section 6 Finance and Legal Matters, Dr A. L. Bravo,is of the report (Scale of Assessment for 1964). invited to come to the rostrum and read the report. Dr Bravo (Chile), Rapporteur of the Committee on The PRESIDENT : Does the Assembly agree to adopt theresolution for Administration, Finance and Legal Matters, read out on thescaleof assessment the preamble and section 1 (Financial report on the 1964 ? In the absence of any comments, the resolution accounts of WHO for 1962, report of the External is adopted. Auditor, and comments thereon of the Ad Hoc Com- We have now to adopt the report as a whole, but mittee of the Executive Board) of the first report of that before we do so, I should like to draw your attention once again to the resolution on the Supplementary committee (see page 409). budget estimates for 1963.The Rules of Procedure The PRESIDENT : Is the Assembly willing to adopt the provide that this should be passed by at least a two - resolution on the Financial Report on the accounts of thirds majority. May I take it that it is the wish of the the World Health Organization for 1962, the Report Assembly that it should be recorded that these supple- of the External Auditor, and comments thereon of the mentary budget estimates for 1963 were unanimously Ad Hoc Committee of the Executive Board ?In the adopted ? Any comments ?It will be so recorded. absence of any comments, the resolution is adopted. Now we have to adopt the report as a whole. Are Dr Bravo read out section 2 of the report (Supple- there any comments ?The first report of the Com- mentary budget estimates for 1963). mittee on Administration, Finance and Legal Matters is adopted. The PRESIDENT : Does the Assembly agree to adopt the resolution on the supplementary budget estimates 3.General Discussion on the Reports of the Executive for 1963 ?In the absence of any comments, the Board and the Report of the Director -General on resolution is adopted. the Work of WHO in 1962 (continued) Dr Bravo read out section 3 of the report (Assessments The PRESIDENT : We will now continue the general of new Members for 1962 and 1963). discussion on items 1.9 and 1.10, and I would like to take this opportunity to appeal to the delegates The PRESIDENT :Does the Assembly adopt the please to be brief, so that we can have as many resolution on the assessment of new Members for speakersaspossible contribute tothe discussion 1962 and 1963 ? In the absence of any comments, the under this item before the close of the plenary meeting resolution is adopted. this afternoon. Dr Bravo read out section 4 of the report (Addition to I give the floor to the delegate of Bulgaria. Schedule A to the Appropriation Resolution for the .financial years 1962 and 1963). Dr IGNATOV (Bulgaria) (translation from the Russian) : Mr President, ladies and gentlemen, I should like to The PRESIDENT : Does the Assembly agree to adopt associate myself with the congratulations addressed the resolution on the addition to Schedule A to the to the President and Vice -Presidents of our Assembly Appropriation Resolution for thefinancial years and wish them success in their responsible work. 1962 and 1963 ? In the absence of any comments, the It is a pleasant fact that in the period between the resolution is adopted. Fifteenth and Sixteenth World Health Assemblies Dr Bravo read out section 5 of the report (Accom- countries which have won their independence -such as modation for the Regional Office for Africa). Algeria, Burundi, Rwanda, Trinidad and Tobago, Jamaica and Uganda -have become full Members The PRESIDENT : Does the Assembly agree to adopt of WHO. The Bulgarian delegation extends to them this resolution on accommodation for the Regional its cordial greetings and wishes them every success Office for Africa ?In the absence of any comments, in our joint work and in the further development and the resolution is adopted. strengthening of the health services in their countries. Before the Rapporteur reads the next resolution, We have read with great interest the Report by may I express the hope that the Assembly will spare Dr Candau, the Director -General, and agree with his the Rapporteur from reading the lengthy listof evaluation of the successes achieved during the past Members and percentages appearing under part I of year in providing health services for the people of our theresolutiononthescaleofassessmentfor planet.Obviously an important role in the achieve- SEVENTH PLENARY MEETING 95
ment of all these successes has been played by the thisrise in morbidity are due to changing moral fruitful work of the World Health Organization, by standards of behaviour. The underlying causes of these national health services, and by the tireless efforts diseases are profoundly social in character, and for of millions of medical workers. that reason it is extremely important that governments One example of such successes is the fact that in and national health services should take systematic India, in malaria eradication, the consolidation phase and purposeful steps to ensure the carrying -out of a has been reached in areas with a population of over combination of control measures. The co- ordinating 148millionpersons. Similarsuccessesagainst role of the World Health Organization is of exceptional malaria have been achieved in other countries in importance in ensuring the more effective and better - Europe, America, the Eastern Mediterranean, and the planned use of the resources of other Member countries Western Pacific.There have also been a number of for the successful solution of this problem. successes in the control of tuberculosis and other It seems to us that the planning of programmes is communicable diseases. WHO's work in conducting not being based on a sufficiently thorough analysis a number of valuable courses, seminars and symposia of the actual position as revealed by the results of on various fundamental problems of thehealth previous work.After such an important statement services has also been extremely useful.They have on venereal diseases as that made in the Director - made an important contribution, through the exchange General's Report, there is still no apparent emphasis of experience between public health administrators on this problem in the programme for 1964. and other specialists from various countries, towards For the same reason the problem of cardiovascular enabling them to improve their work and to put to diseases, which is so important for all countries, is use the achievements of their colleagues in other still not finding its due place in WHO programmes, countries. It will be very useful if these forms of work even in the programmes for 1964. The same may be are extended and more widely utilized. said of virus diseases (including epidemic hepatitis), We consider it necessary to draw attention to some of malignant neoplasms, and of those important aspects of the work of the World Health Organization factors in the epidemiology of a number of diseases - and first of all to the problem of planning and the water supply, sewage disposal, etc. effectiveness of the measures carried out. A typical Accordingly the distribution of budgetary resources example is malaria, and I shall therefore quote it once does not appear to be entirely happy. These resources again. Malaria eradication has been planned and are not apparently being concentrated on the most carried out for many years now but the results are important problems, and for many years now there nevertheless not yet commensurate with the attention has been no particular change in this respect. In paid to the problem and the large expenditure. In connexion with the budget we should like to draw our opinion, one of the reasons why malaria eradica- attention also to the following fact. Between 1961 and tion is not sufficiently effective is that WHO relies mainly on the work of its own officials and does not 1964 the budget of the Organization will have grown make sufficient use of the staff and resources actually from $19 780 488 to $33 716 000, i.e., by an average and potentially available in the Member countries. of 23.5 per cent per year.In our opinion this rapid Thus those countries are left to play a somewhat and exceptionally large rise in the budget is not com- passive role in regard to the implementation of WHO mensurate with the annual expansion of the pro- programmes in the various regions.In our opinion grammes of the Organization.Meanwhile, as can WHO uses the same approach with regard to the be seen from WHO's figures, a number of countries solution of other basic problems. For that reason the had notpaidtheir membership contributions by expected results are not always achieved and sometimes 31 December 1962, and some have been even failed to even unfavourable situations develop. pay them for several years. The Director -General's statement in his Report with We must emphasize that during the last few years regard to venereal diseases and certain other diseases the number of WHO staff has greatly increased; is an example of this.It is really very disturbing that however it is not by a continuous increase in numbers in seventy -six out of 105 countries and territories a rise that a consistent improvement in WHO's work will in morbidity from early syphilis has been noted, and in be achieved, but by a high degree of specialization and fifty -two out of Ill a rise in morbidity from gonorrhea competence among staff members, an improvement in also, and that in some countries the percentage of organization, and the active participation of Member venereal disease in the 15 -19 age -group was twice as States. In this respect the co- ordinating and planning high in 1960 as in 1950. We ought hardly to agree work of WHO is extremely responsible and important. with the assertion that many of the factors leading to It should be greatly developed and improved. 96 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Mr President, ladies and gentlemen, allow me to tell sent them over 500 medical workers during the last this responsible Assembly of some achievements of few years, under the terms of bilateral agreements. the health services in Bulgaria. Finally, I should like to express the gratitude of Over eighteen years ago, such diseases as malaria, our delegation to the Director -General and his staff tuberculosis and a number of other infectious and and to the Director of the Regional Office for Europe parasitic diseases were widespread in Bulgaria and for the work carried out in Bulgaria and for the claimed not a few victims.Many people became visits made by responsible members of headquarters invalids; general and infant mortality rates were high; and regionalofficestaff. This has enabled our the mean expectation of life was fifty -two years. The specialists in the Ministry and in the health services basic reason for this unfavourable health position to learn from the experience of other countries and to was the difficult material situation of the people and share their own experience with them.We shall the poorly developed network of healthservices. continue to strive in the future, to the best of our During the comparatively short period between then strength and possibilities, to carry out the tasks set and now, theauthorities have givenexceptional us by WHO. attention to the health of the workers, their safety at The Bulgarian delegation wishes theDirector - work,and theirprotectionagainstdisease. An General and his staff still greater success in their extensive network of health services has been establish- exceptionally responsible work and noble efforts, so ed, with a large number of medical staff (one doctor that the World Health Organization can make an to every 675 persons). even greater contribution to the maintenance of the A number of important sanitation and hygiene health of mankind, to its happiness, and to peace and measures have been taken which have considerably friendship between the peoples. improvedthewater -supplyandsewage -disposal services. As a result it can be said today that there is The PRESIDENT : Thank you, Dr Ignatov.I now no malaria in Bulgaria.Morbidity and mortality call on the delegate of the United Arab Republic. from tuberculosis have been reduced several times Dr EL BITASH (United Arab Republic) : Mr Pre- over,as has infant mortality. There were only sident, fellow delegates, it gives me great pleasure, isolated cases of poliomyelitis in 1962; this was the Mr President, on behalf of my delegation, to express result of mass immunization with live vaccine. Fresh oursincerecongratulationson your unanimous venereal infections are recorded very rarely and the election to preside over this Sixteenth World Health endemic foci left over from the past are on the point Assembly and to wish you the best of luck and of being finally cleared up. Morbidity from a number success.We are sure that you will gracefully and of infectious diseases has been reduced to sporadic smoothly conduct our deliberations in a most efficient cases. The mean expectation of life according to the and constructive manner. We also wish to extend our latest calculations is sixty -eight years. gratitude to our host country, the Swiss Government, In the next ten years, as part of the plan for the and the charming people of this beautiful city. general development of Bulgaria, an extensive plan My delegation, on behalf of my country, wishes also for the further development of the health services will to extend its whole- hearted welcome to our new also be carried out. Important problems will be tackled colleagues who recently joined our organization as in connexion with the improvement of the living and Members or Associate Members.I cannot miss this working conditions of the working people, and the opportunity of paying my country's tribute of deep protection of the water, soil and air from pollution respect and admiration to the gallant and brave due to the rapid development of industry. Problems of people of our sister country, Algeria, which suffered preventive medicine and the physical development and for the past seven years the most painful, horrible and physical toughness of the population will be more devastating war, which they bravely fought for their successfully dealt with and on a larger scale.In liberty and which they won at last, because they were addition, the number of hospital beds will be almost fighting for the right cause. We are very happy to doubled.This will make it possible to solve such welcome today their honourable delegates, who have serious problems for the specialized services as the at last taken their rightful place among the free eradication of tuberculosis, the control of cardio- nations of our shaking and restless world :a world in vasculardiseases,malignantneoplasms,psycho - which fear and hatred are emphasized by the attitude neurological disorders, etc. of the big nations, who are racing to possess the most In line with our understanding of the role to be destructive nuclear weapons and who, instead of played by Members of WHO in giving medical spending astronomic amounts of money to improve assistance to the newly liberated countries, we have the living conditions of the people, spend it on nuclear SEVENTH PLENARY MEETING 97 experiments and in their attempts to reach the moon, which is most suitable in remote areas where proper as if we had already explored all the resources and means of storage are inadequate. secrets of our world.More than once, resolutions In the field of tuberculosis control, the evaluation have been passed at previous World Health Assemblies of a pilot project that was conducted in my country asking the great powers to refrain from such nuclear is being carried out by a committee of responsible tests; but tests are still conducted, exposing our world and specialized staff in the universities and the Ministry and the people to the dangers of radiation and fall -out of Health. Certain recommendations have been and endangering the life and existence of our children. established and BCG vaccination on a wide scale is We, who are responsible for the promotion of the being recommended. health of all the peoples of this world, must take some Trachoma control is being conducted also in a pilot positiveactionagainstsuch inhumanpractices. project, using various drugs.Aureomycin ointment Mr President, in discussing item 1.10 of the agenda, and sulfa compounds are being tested.Mothers in Imust congratulate the Director -General on the rural areas are taught how to use such ointment and, efficiency of the work achieved during the past year, even in primary schools, intelligent children can be 1962, and which is presented to us in the comprehensive taught how to apply it to their fellows. Encouraging report,Official RecordsNo. 123 of our organization. results are obtained in areas where health education Few of its items need to be discussed.The first is measures are carried out. malaria eradication, but I have already referred to The bilharziasis control pilot project which is being that in the Committee on Programme and Budget and conducted in some parts of the Delta, and which is there is no time here to repeat such things, so I will sponsored by WHO and materiallyassisted by go to the other parts of the Report. UNICEF, isprogressing ina promising manner This malaria eradication programme necessitates and an evaluation of the results will be ready in the the training of staff to fill the new units of the rural near future.The training centre attached to this health services, and some of our training centres are project will soon start to receive candidates from ready to receive candidates from countries in the various parts of the world. Eastern Mediterranean Region and other regions, as I wish here to refer to the generous help UNICEF we are doing now.Moreover, my Government has is giving to our rural health centres, especially in the already participated in the training of candidates from form of equipment and drugs for conducting thorough various parts of the world, and ten per cent. of our child care in an efficient way. places in universities and higher institutes are reserved As regards the medical help which is urgently needed for students from friendly countries in Asia and Africa. for the recently independent and developing countries, The programmes of training in our medical schools I wish to state here that, although my country still are now under reconsideration and two recent seminars falls short of fulfilling its requirements in trained have been held, one in Alexandria and the other in personnel, both medical and paramedical, we have Cairo, where all those concerned, from the different already offered an appreciable number of our doctors universities and the Ministry of Health, met to take and sanitarians to help our neighbour countries and an active part in the rearrangement of such pro- those who need help.Several hundreds of them are grammes. now carrying on their responsibilities in a most In the field of combating other diseases, I would human and efficient way. I have to state here that the refer to the country -wide campaign that has been acute conditions arising from the lack of trained conducted against poliomyelitis since April 1962, using personnel in such recently independent and developing Sabin vaccine orally.This campaign is progressing countries are the responsibility of those nations which in a satisfactory manner and all children between were occupying those countries.I may refer here to the ages of one and five are vaccinated in their homes the words of our colleague, the chief delegate of or in the various health centres.Vaccination against Algeria, who mentioned in his speech that 4000 of the diphtheria has been obligatory since last year through- medical and paramedical staff who were working in out the country. Smallpox has already been eradicated, thehospitalstherewere withdrawn immediately and general vaccination against this disease is con- after the independence of his country. This is nothing ducted every four years. New -born children have to but a most inhuman attitude and it should not have be vaccinated within the first three months. Smallpox happened. vaccine is prepared in large amounts in our labora- Many other items still remain to be discussed in the tories, and I am very happy to state that my country appropriate committees but, before ending my words, is ready to supply large amounts of this vaccine to I wish very sincerely, on behalf of my delegation, to other countries when they need it.We are also congratulate Dr Candau on his reappointment as arranging to increase our production of dried vaccine, Director -General of our organization.The result of 98 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II the voting gave a true idea of his efficiency and unique are being made to provide maximum assistance, within personality. the limited resources of the Organization, to the Lastly, I wish to add my voice to that of the chief developing countries of the world. This assistance acts delegate of India and appeal to our colleagues, the as a stimulus to these nations to enlarge the scope honourable delegates present here who are responsible of their health programmes.The resources at the for the various health services in their countries, to be disposal of the national health authorities in most of so kind as to take the necessary measures to enforce the developing countries are not great enough to the international quarantine regulations by advising, permit substantial expansion of their programmes or even forcing, their people who plan to go abroad in public health. In the case of Pakistan, the national to possess the valid vaccination certificates required economy is still far from the take -off stage where any for the various countries they are planning to visit. substantial increase in the. funds allocated for the This would avoid a lot of embarrassment to themselves national health service could be expected. There is an and to the governments of those countries, for if urgent need, therefore, for the assurance of assistance when they arrive there they fail to present such on a long -term basis to the various programmes in necessary valid certificates, they expose themselves such countries. to the unpleasant measures taken under such circum- The potentialities for helping to improve health stance. standards in the developing countries are great.It may have been true in the past that some countries The PRESIDENT : Thank you, Dr El Bitash.I now did not possess the capacity to fruitfully absorb more call on the delegate of Pakistan. aid, but during the past three or four years they have made concerted efforts in this direction and I can say Dr HAQUE (Pakistan) : Mr President, distinguished with confidence that many countries, including my delegates, ladies and gentlemen, it gives me great own, have reached the stage where new and extensive pleasure, Mr President, to offer to you felicitations health programmes, including research activities, can on behalf of my delegation on your election to the be successfully implemented. high office of President of the Sixteenth World Health We have embarked on a fourteen -year phased Assembly. Your unanimous election to this office is malaria eradication campaign, and a rural health a tribute to your devotion tothe principles the programme which envisages the establishment of Organization stands for and the esteem in which you 3000 rural health centres in twenty -five to thirty years. are held.I am certain that under your guidance this The malaria eradication programme is to cost about Assembly will successfully fulfil the task which it has 520 million rupees, out of which over 140 million set for itself. dollars are required for the import of foreign supplies. As this is the first occasion for me to address this We are very grateful for the assistance received from Assembly on behalf of my country, I take this oppor- WHO and other agencies, mainlyinthe form of tunity of reiterating the faith of my country in the advisers and fellowships and some equipment. We fruitful work of international co- operation in which have obtained loans from abroad to embark on our this organization plays so eminent a part. programme, in view of the emphasis rightly placed by I would also like to extend my congratulations to the Director -General on the malaria eradication pro- Dr Candau on his reappointment as Director- General gramme being a time -limited effort and constituting of WHO. His unanimous election for a further term a world -wide undertaking in which each country must of office is an indication of the faith every Member take into account not only its own situation but also nation has inhis professional and administrative those of its neighbours. These loans have added to the abilities and his qualities of head and heart. burden of our already hard -pressed national economy. I would also like to put on record the deep satis- If this programme fails owing to lack of funds it will faction with which the Government of Pakistan has indeed be a major setback to the WHO campaign of noted the great strides taken by WHO during the past malaria eradicationallover the world -a tragic ten years, under the leadership of Dr Candau and his situation at which this Assembly should be even more team of dedicated colleagues. The Annual Report of concerned than we are.It is an urgent problem and the Director -General gives us a comprehensive survey deserves earnest consideration. of the activities of the Organization during 1962.It Our ruralhealth programme has now gained clearly outlines what has been accomplished and momentum and is making satisfactory progress. With indicates future programmes, particularly in the light the ultimate object of providing the entire country of the decision to make maximum efforts during the with a network of rural health centres in the next Development Decade of the United Nations. twenty -five to thirty years, provision for 600 centres It is a matter of great satisfaction that special efforts during the third five -year plan is being made. To ensure SEVENTH PLENARY MEETING 99 the best possible service, the health personnel to be I would also like to pay special tribute to Dr Taba, appointed to these rural health centres are being made the Regional Director for the Eastern Mediterranean to undergo comprehensive pre- service and in- service Region, and to express my Government's gratitude training. To man all these centres, our need for well - for his appreciation of our problems and prompt trained and auxiliary staff isgreat, and we have attention to our needs.I wish him greater success in already started schools for the training of health and his untiring endeavours during the years to come. laboratory technicians.Five training centres in each This Assembly has got off to a good start by taking region of the country have been established, in selected unanimous decisions on two very important issues. health centres, for in- service training and refresher Let us hope that the same spirit of co- operation will courses. prevail throughout its deliberations. According to the proposed programme, the villages where health centres will be established will also be The PRESIDENT : Thank you, Dr Hague.I now call provided with safe water for human consumption. on the delegate of Mongolia. This problem of the provision of sufficient quantities Dr TUVAN (Mongolia) (translation from the Russian) : of potable water for domestic use is only one of the Mr President, ladies and gentlemen, I should like to hundred other health needs of the rural areas.To begin by congratulating you, Mr President, on your name a few, we have smallpox and cholera, two major election to your high office.I also wish to congra- communicable diseases,against which eradication dulate Dr Candau on his reappointment to the high campaigns are in progress.To control tuberculosis, and distinguished post of Director -General of the leprosy and trachoma, national projects are under World Health Organization. implementation. For a rural health programme to be We have much pleasure in congratulating the new successful, all these programmes must develop side by Members of our Organization, and wish them success- side, and we hope that in the near future all these ful co- operation with WHO. projects will be integrated with the rural health I have listened with great interest to the far- ranging programme. We have been promised adequate support and informative Report of the Director -General.It for this programme by UNICEF but we believe that, shows how much WHO's activities and international for successful implementation, a far more concerted relations have increased in scope. effort will be required wherein WHO, with its immense Our country is a comparatively new Member of the technical resources, can assist us to a great extent, Organization, but we are fully aware of the great especially in the training of medical and paramedical value and effectiveness of WHO's activities. personnel. Thanks to the care devoted to it day in and day out To meet the need for well- trained personnel, we by our Government, our public health services have have established an institute of post -graduate medical made considerable progress in the course of the past studies and a college of nursing at post -graduate year. During that year 10 per cent. of the total state level.Post -graduate courses in paediatrics are also budget was allocated for public health purposes. planned to start this autumn in the children's hospital In 1962 the birth -rate was 44.6 and the death -rate at Karachi. These institutions, we hope, will not only 10.2 per thousand; thus the population increase was train students from our country but, with WHO 34.4 per thousand, i.e., 4.4 more than in 1961.In support, will be able to provide facilities at least to 1962 there were eleven doctors and a hundred hospital our region. beds per 10 000 inhabitants. I have briefly mentioned some of our problems just The public health services in our country not only to show the magnitude of the issues involved where changedquantitativelybutalsoimprovedcon- health facilities have to be organized for a population siderably in quality. There was a great improvement of nearly a hundred million. We fully recognize and in our doctors'qualifications;specialized medical appreciate the extremely useful work of WHO during care services were made even more accessible to the the past few years and the invaluable assistance it has rural population; and a large number of specialized given to Member countries; and we hope that, during and combined hospitals were built in rural areas. the coming years, our need will be more thoroughly Our delegation's participation in the work of the assessedandacomprehensiveprogrammefor Fifteenth World Health Assembly and of the fifteenth assistance on a still larger scale will be evolved.I do session of the Regional Committee gave us an oppor- hope that countries which are in the fortunate position tunity to gain a close acquaintance with WHO's of being able to extend help will continue to be in work; while the visit of Dr Mani, the Regional sympathy with the rising expectations of the people Director, and his colleagues to our country provided who are not so fortunate at present. Mr President, them with an opportunity of familiarizing themselves health is a commodity which is indivisible. with our public health arrangements. Dr Mani and loo SIXTEENTH WORLD HEALTH ASSEMBLY, PART II his colleagues put in a great deal of work, and we Regarding the reports of the Executive Board on its hope that they obtained an idea not only of our public thirtieth and thirty -first sessions, and regarding the health system and the way it is organized, but also of Report of the Director -General on the Work of WHO the work of our hospitals, out -patients departments in 1962, I have the pleasure to state my great admira- and laboratories, and of our medical staff and the tion for the work which has been accomplished during state of our people's health. the past year. They visited a large number of medical institutions It is again on behalf of the Indonesian Government and educational establishments in our capital and in and people that from this floor I express my deepest some other parts of the country.As a result, we gratitude for all the assistance extended to Indonesia believe that Dr Mani and his colleagues saw the by the World Health Organization and, not least, for advances we have made in public health, and in its support and understanding in one of our major what fields we require help from WHO.After his national disasters, the eruption of the Gunung Agung visit the Regional Office proposed that the amount volcano in Bali. During this recent disaster Indonesia of WHO assistance previously envisaged for our was also given assistance and support by many country should be doubled. Accordingly in 1963 and friendly nations of the world.May I request the 1964 we shall be receiving assistance, in the form of delegations of those countries to convey the deeply teams and laboratory equipment, for the control of felt thanks and gratitude of the Indonesian people to some of the diseases widespread in our country.In their specific governments.There is an old Dutch addition, WHO is providing us with some fellowships saying which, translated into English, runs as follows : for our doctorsinspecial branches of medicine " When one is in trouble one comes to recognize one's essential for the further development of our public friends ".The paradise island, Bali, is now expe- health services. riencing a major emergency.It will take us many We wish to thank our Regional Director and the years to resettle the quarter of a million people who Director - General of WHO for having understood the have been affected. needs and requirements of our country forthe Mr President, there is another island of our archi- development of its public health services. pelago I would now like to mention in connexion with In conclusion, we trust that our country will make the work of the United Nations. Just a few days ago its contribution to the improvement of world health West Irian was returned to the fold of the Indonesian and to international co- operation within the frame- Republic, after having been temporarily administered work of the World Health Organization. by the United Nations for the duration of seven months.In the field of health the United Nations The PRESIDENT :Thank you, Dr Tuvan.I now temporary executive administration has successfully call upon the delegate of Indonesia. coped with a an outbreak of cholera in one of the least accessible regions of the island. The transfer of Dr SUBANDRIO (Indonesia) : Mr President, most sovereignty of West Irian to the Republic of Indonesia distinguished gathering,firstof all,I would like, has been successfully carried out through the offices Mr President, to convey the most sincere congratula- of the United Nations. Thus the island Republic of tions of the Indonesian Government and people on Indonesia has regained full independence, so that your election asPresident of the World Health the main purpose of the national revolution has been Assembly for the current year. We have noted with achieved at last. In this respect I would like to thank great satisfaction that a son of the African continent the chief delegate of the Netherlands for his words of is presiding over this illustrious body, assisted by the congratulation and for his expression of friendship. three Vice -Presidents, two of whom hail from the Indonesia, as a so- called non -committed country, Asian continent, namely India and Malaya, while the is pursuing the friendship of other nations regardless third one is a representative of a European country, of the political or social economic system these Yugoslavia. We also congratulate Dr Candau on his countries adhere to. Indonesia is non -committed reappointment asDirector -General of the World in the sense that it does not belong to any military bloc Health Organization. inthe battle of nations for world supremacy. Militarily We wish all of you great success in your under- speaking, Indonesia is not taking sides, by conviction taking. We have put all our confidence and faith in that that is the best way to contribute to the preserva- your team for the progress of the work of the World tion of world peace. But on the other hand Indonesia Health Organization. To the outgoing President, isnotindifferent,orso- calledneutral,towards Dr Kurasov of the Soviet Union, who carried out his certain principles.As regards these, Indonesia is a work magnificently during the past year, we extend our fighting nation for which there is no journey's end. most sincere thanks. Indonesia has no compromise for colonial domination SEVENTH PLENARY MEETING 101 or any other form of suppression of one country by governments. One aspect of the problem, though, I another without the consent of the majority of its would like to mention.There has been much talk people. The humiliations and sufferingsof the recently about the so- called population explosion in colonial past have been so deeply felt that anti - these developing countries.May I point out that, colonialism has become the life -blood of the political according to the statistics, population growth in highly aspirations of the Indonesian people as a whole. These developed countries is less than in under -developed, aspirations we relentlessly pursue all the world over. unindustrialized regions ? Surely industrialization It is in the light of these aspirations that I would like and the provision of the amenities of life have some- to welcome the latest Members and Associate Members thing to do with it. As the saying goes : " In order to of the great family of the World Health Organization avoid population explosion, give the people electric in our midst.It is in the light of these aspirations light in their homes and let them enjoy reading books, that aspects of Indonesian foreign policy are to be cinemas and other recreational means.Then they judged. will not go in for large families any more ". But this The principles to which Indonesia adheres are two is a picture of a developed country, which makes of the five foundation principles of the State, the imperative the conclusion that trying to develop a PanchSila,namely, humanitarianism andsocial country also means averting the hateful and fearful justice.Humanitarianism calls for the brotherhood population explosion. of man; and social justice recognizes the right of every In conclusion, Mr President, I would like to thank individual to the pursuit of happiness, to shelter, to the Director - General for his encouraging remarks on food and clothing, to education and health. the assimilation of communicable disease control Mr President, it is in the light of these aspirations programmes into rural health services, giving " the that the Indonesian delegation judged the work of highest priority... to malaria eradication, since it is the World Health Organization in 1962.Humanita- a time -limited effort and constitutes a world -wide rianism and social justicerecognizetheexisting undertaking in which each country must take into anomalies which prevail in our world today.It is an account not only its own situation but also that of its anomaly that among the nations of the world where neighbours." 1Regarding some particulars of the are found the greatest concentration of population, Indonesian malaria eradication programme, the work as for instance in Asia, Africa and Latin America, is nearing the consolidation phase in Java, Madura, conditions prevail of disease, poverty and ignorance. Bali and South Sumatra, thus covering two -thirds The Indonesian delegation noted with great satis- of the total population of some ninety -seven million faction that the World Health Organization's pre- people. It has now become highly imperative to extend occupation during the past year has been to alleviate the programme to nearby islands of Indonesian Borneo some of these prevailing conditions. A vote of thanks (Kalimantan), the islands situated east of Bali, Central goes to the more privileged countries for their assist- and North Sumatra, etc., to protect the precious ance, support and understanding, not least for the results in Java and the other regions which have been amount of material and skill they have put into the achieved up to now.With WHO assistance, plans programme. Where an attempt can be made in inter- have been drawn up to build a rural health infra- national co- operation for the benefit of mankind, structure in Kalimantan which we have submitted to it is truly in the work of the World Health Organi- UNICEF forassistanceduringtheimmediately zation, which is founded on the concept that health coming period. The malaria eradication programme up is an indispensable element in general development. to now has been executed with the assistance of the As is written in the introduction to the Director - United States and WHO in the areas mentioned. General's Report :" Convinced of the fact that the I would like to take this opportunity to thank the protection and improvement of health must underlie Government of the United States of America and the any activity which aims at raising standards of living, World Health Organization for the assistance given WHO's governing bodies endorsed a ten -year pro- so far, and I would like to invite them to continue it gramme designed to help developing countries to in Kalimantan with the same fervour and the same build the health of their peoples ". conviction of giving service to mankind.I would As for the developed countries, one might wonder, imagine that both the Philippines and the administra- would it make sense to take part in this great tions of Sarawak, Brunei and North Borneo would adventure ? Would it serve any of their own purposes ? welcome the determination of the Indonesian Govern- Mr President, it is not for this body to answer these ment to undertake malaria eradication in the Kali- questions. The reply is readily made in the Economic mantan region, since these countries in their own and Social Council and other bodies, as well as in the trade and commerce departments of thespecific 10ff. Rec. Wld Hlth Org. 123, wiii. 102 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II regions have made considerable progress in malaria to this problem, which is a crucial one for the world eradication -up to the consolidation phase in Sarawak. today. As concluding remarks, I would like to mention, First I would mention the adoption of the resolution Mr President, that it should be one of the principles on the Development Decade, calling upon the Member of extending foreign aid in any development pro- States of the United Nations and Members of its gramme that it should be given only if and when the specialized agencies to make every effort and take country is ready for it and determined to execute vigorous action to accelerate the development of the the programme at whatever cost. developing countries. The decisions relating to the Decade set out in detail The PRESIDENT : Thank you, Dr Subandrio.I now the aims to be achieved and the tasks to be performed call on the delegate of Yugoslavia. under the ten -year programme.Although the reso- lution primarilydealswith the economic action Mr MARKOVIá (Yugoslavia) (translation from the required to attain those aims, obviously account must French) : Mr President, allow me on behalf of the also be taken of all the other factors that contribute delegation of the socialist Federal Republic of Yugo- to their attainment, and first and foremost of the slavia cordially to congratulate you on your election human factor. It is the human factor which is the link as President of the Sixteenth World Health Assembly, between the economic and the social in the field of and to say that we are quite sure that under your development, and which is responsible for the inter- direction our Assembly will carry out successfully dependence of economic and social factors as we the difficult and onerous tasks that lie before it. understand it. Allow me also to take this opportunity to con- But the Decade cannot be a success without the gratulate and greet the new Members of our organi- efforts of the developing countries, and the resources zation, who are among us today for the first time. at their command are inadequate for dealing with the It gives me particular pleasure to hail the arrival of innumerable problems that confront them. We are the Algerian Republic, for in welcoming the represent- all aware of this and must not be surprised if, the atives of the new Algeria here we are saluting in their situation being what it is, some priority items are person a people which has obtained its freedom and obliged to yield precedence to others. independence after a long, hard struggle and which is Similarly, the Decade certainly cannot materialize now making great efforts to build up its country. without the participation of the international com- I would also welcome the accession to membership munity. By that we mean not just financial aid, but of the Organization of the newly independent States also radical solutions.In the present state of affairs of Burundi, Rwanda, Uganda, Jamaica, and Trinidad economic development, industrialization, investment - and Tobago. in short, the material basis of the developing countries Mr President, ladies and gentlemen, the past twelve -and consequently social development, cannot be months have seen the steady progress of decolonization achieved unless a change takes place in the conditions and the liberation of many colonial peoples. During prevailing today in international relations. this year also the peoples of the developing countries In this connexion the Cairo Conference (which was that have just attained independence have been called attended by the representatives of thirty -six countries, upon to make big efforts to achieve the economic most of them in process of development, and which emancipation without which real independence is considered vital problems relating to the economic impossible. situation of the peoples of those countries) and the It has also been a year whose keynote has been United Nations decision to convene an international the endeavours made by the international community conference on trade and development are also events to find the necessary ways of helping these States to of great moment. They are, in point of fact, the first speed up their development. We are all of us aware steps towards implementing the Decade. We should that the big problems arising from their backward like to express our appreciation of the decision to economies are impeding harmonized development and convene a conference of this nature and to wish the consequently the stabilization of international rela- conference every success, because we are sure that tions.Seen in this light, the struggle in which the without concrete decisions and without international developing countries are engaged is also a contribution measures the Decade is in danger remaining a to peace, since peace cannot be maintained for very dead letter. long in a world of economic inequality. Mr President, it is by now a customary practice for Allow me in this connexion to refer to some of the our organization, at its Assemblies, to evaluate the events during the past year that reflect the determina- ground covered and the results achieved, to take tion of the international community to find a solution stock of the experience that has been gained and to SEVENTH PLENARY MEETING 103 make recommendations for future work. As a member proposes, but also in respect of all WHO's other of the great United Nations family, the Organization activities.Although all these programmes are pre- has associated itself with the endeavours the various pared with the greatest care, after a detailed analysis countries are making to further the development of the of the problems and needs, we cannot always be sure less developed countries.It is only logical therefore that the stress has been placed on what is really that, after having assessed the results of the Organi- essential.To do so we should have to evaluate the zation's activities, we should examine those activities work that has been done and the programmes that to see how far they are contributing to that funda- have been carried out, to assess their real value, and mental task. to ascertain whether the resources employed have in Looking at the prospects opened up by the basic fact been used to the best advantage.When we trend of our organization, we note with pleasure the examine the programme and budget of the Organi- predominance of the idea that economic and social zation we really try to adopt the most effective and development must be planned as a whole, an idea which realistic programme, but we are not always sure after- finds expression both in the text determining the World wards that the programme has produced the results Health Organization's contribution to the Decade and we expected of it. in the programme for 1964. We are witnessing a steady increase in our organi- In this context, the policy of creating an infra- zation's budget, an increase that is desirable in so far structure of health services is warranted and most as it reflects a real extension of our activities and thus understandable.The policy represents yet a further contributestotheOrganization's dynamism and step in the endeavours the Organization is making to to its ability to adapt itself to present needs. But the give the developing countries the health services they increase involves very large sums of money, whose so badly need. The creation of a health infrastructure appropriation is only warranted if we are certain that in the developing countries requires first and foremost everything has been done to effect all reasonably personnel, and we quite agree that the improvement feasible economies and to ensure that the funds are and further training of national cadres is a task of the administered as efficiently and as soundly as possible. highest importance. The more detailed analysis and evaluation of expend- We also entirely agree with the Director -General iture made periodically will certainly provide us with when he says that the World Health Organization has all the information required to determine whether hitherto concentrated in its aid to the developing or not a particular item is really warranted. Evaluation countries on giving direct and emergency assistance should accordingly assume increasing importance as to health cadres, in view of those countries' situation a working method of our organization. in that respect. We believe however that the time has Research occupies, and rightly occupies, an im- come to lay greater stress on the other forms of aid portant place in the Organization's activities -activities the Organization can give in that connexion.The which, as is well known, are orientated towards current main aim of our long -term policy in this field ought problemsaffectingprimarilyallthedeveloping to be to set up, in the developing countries themselves, countries : which, in our view, is right and necessary. the basic institutions necessary for enabling them to Such an orientation will help us to solve more speedily train their own cadres.WHO has already done and effectively the serious problems that arise in the something towards this.But we think that a great developing countries, so it would perhaps be desirable deal more could be done, both by the Organization to develop and intensify our work in that direction. encouraging bilateral co- operation and by Member This, of course, does not mean that the other health States playing a greater part through the Organization. problems thatconfront modern man should be My Government is prepared to make its contribu- neglected, and the Organization is in fact encouraging tion in this field, a contribution which is likely to a number of research projects in what is known as consist of carrying out, in collaboration with WHO, modern pathology (cardiovascular diseases, cancer, the project for setting up a faculty of medicine at radiation, etc.).In our opinion the main function of Belgrade, with instruction in French for medical the Organization in this field should be to co- ordinate students from French -speaking countries; and the the work and to publicize its findings. If the contribu- project for assisting and supporting a faculty to be set tion of the developed countries were to enable the up in one of the developing countries where facilities amount of money allocated to research to be increased, for so doing exist, even if they are extremely limited. the Organization would be able to do more and cover We unreservedly support the idea of a periodic a wider range. evaluation of the ground covered and of the work done Inresearch,Yugoslavia hasestablishedcloser by the Organization -not only in respect of the collaboration with WHO, and this has had valuable fellowshipprogrammeastheDirector -General results. Among them mention should be made in the 104 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II firstplaceof experiments with typhoid vaccine, a stop to tests that are endangering the life of millions research on diarrhoeal diseases, and work on the use of people on our planet. Although certain difficulties of a vaccine, produced in Yugoslavia, against measles. have arisen at the moment, it is our hope that they will We should like to emphasize, in this connexion, that be overcome in the very near future. we are prepared to co- operate in research work in Secondly I should like to refer to the disarmament other fields, as far as lies within our power. problem, which engages our attention at each of our During the past year my Government has, as in Assemblies, on the subject of which we have adopted previous years, been co- operating fruitfully with WHO several resolutions, and whose solution would make headquarters and with the Regional Office in carrying it possible for us to obtain funds for carrying out our out a series of projects to solve certain problems that health programmes and for extending them to the confront our health services.We must not omit in entire world. A policy of co- operation and peaceful this connexion to mention WHO's contribution to coexistence is the only realistic road we can take if malaria eradication in our country, thanks to which we wish to avoid war and nuclear catastrophe.It is eradication has reached the consolidation phase in through co- operation and peaceful coexistence that Yugoslavia. The assistance given by the Organization we could achieve this disarmament, which would give to solve certain other problems and to improve, by us sufficient resources to secure the eradication not means of fellowships, the training of our health only of malaria but of all diseases rife anywhere in the personnel has provided a valuable spur to the develop- world. We should then have available to us in- ment of our health services.We are, moreover, exhaustible resources for raising living standards, spending large sums to meet health requirements : for securing environmental sanitation, and for solving in 1962 the funds allocated for health work represented a host of other problems with which the world and 5.5 per cent of Yugoslavia's national income.We mankind at large are confronted today. That is why realize this imposes a heavy burden on the community, we feel that the World Health Assembly ought to but our needs in the health field make the expenditure take this opportunity to declare itself in favour of necessary, and it is consistent both with the planned disarmament as a factor in the struggle for the peace development of our health services and with the and prosperity of the world. development of our socialist system. In conclusion, Mr President, allow me to thank the We have introduced some innovations into our Director -General, Dr Candau, for what has been health service that are peculiar to our system, for achieved in the past year, and cordially to congra- example self -management and self -financing -which tulate him on his reappointment. We should like, in ensure the direct participation of the broad masses that connexion, to say how glad we are that he will of the population in the running of the health services, remain at the head of the Organization's administra- anincreasing amount of helpin solving health tion in the years immediately ahead. problems from the people's own initiative, a sounder The PRESIDENT : Thank you, Mr Markovié.I now and more economical management of health institu- recognize the delegate of Cameroon. tions, and a more efficient utilization of public money. Dr TCHOUNGUI '(Cameroon) (translation from the We began to apply the new system to the organization French) : Mr President, fellow delegates, on behalf of of the health service two years ago, on a basis of new the Government of the Federal Republic of Cameroon legislation in this field; the results have been favourable and of my delegation I should like, in the first place, and we are at the disposal of anyone who may wish to to congratulate Dr Majekodunmi on the triumph of utilize the same system. his unanimous election as President of the Sixteenth Mr President, I should like, at the risk of repeating World Health Assembly. This election, Mr. President, some ideas and views I expressed during the discussions which I welcome with the most lively satisfaction, is a last year, to mention in this connexion two problems tribute not only to your abilities and to your country which preoccupy the present -day world and which are but also, and above all, to the African Region to linked with the problems of life and human health. which you belong and to all the States that have The first is the problem of radiation and nuclear recently attained independence.In the course of explosions, which our Assembly has already been your address you indicated the way and the spirit discussing for years. In regard to this we feel obliged in which you intend to direct our work. Thus we to remark that the negotiations now taking place here know from the outsetthattheproblems which in Geneva would inspire high hopes if the responsible the developing countries have at heart will occupy circles in the world realized the efforts that are being the leading place which they warrant in our organ- made by millions of workers, together with millions ization. of health workers, scientists and research workers - With your permission, Mr President, I should also if they realized the effort that is being made to put like to congratulate Dr Kurasov, the President of the SEVENTH PLENARY MEETING 105
Fifteenth World Health Assembly, on his work during when it asked the Minister of Health to review the his term of office and to thank him for it. He directed health situation in Cameroon, as a prelude to the our discussions at all times with great efficiency, and establishment of a reasonable national health plan the conciseness of his statements enabled the Organi- that it would be technically possible to carry out on zation and its Secretariat to do useful and constructive our own budget. It was consequently a great pleasure work. Now that he is leaving the presidential chair to me to find these views expressed by the Director - I should like him to take back to his country with him, General: no valid health action is possible without after this session, the sincere thanks of my delegation. prior long -term planning.I may say that Cameroon I should also like to take this opportunity to con- is not the only State that has realized the need for this gratulate and welcome to our ranks the new Member prior stock -taking; many other African. States have States, Algeria, Jamaica, and Trinidad and Tobago. realized it too.Moreover we are not starting from And allow me particularly to congratulate the delega- scratch : the African nations as a whole already possess tions of the new Member States of the African Region, a health infrastructure in respect of curative and the sister States of Rwanda, Burundi and Uganda, to preventive medicine -a perfectly sound, if incomplete, which I convey the fraternal greetings of my Govern- one -left them by the colonial powers : but obviously, ment and my delegation. the tendency to expand of the big institutions already
Mr President, when I asked for. the floor during the existing must be checked, since their expense is such discussion opened after the Director -General presented that it can no longer be met out of our national his Annual Report, I particularly wanted to take the budgets. opportunity of congratulating Dr Candau and his This necessary stock -taking will enable us to find the colleagues on the remarkable, well- documented and faults in our health system and to remedy them; and factual statement he has presented to us. The renewal it will enable us, I am sure, to move not so much in of his term of office for a further five years is a source the direction of a hypertrophic development of fixed of real gratification to us.I am particularly grateful institutions but rather towards more profitable long- tothe Director -General for havingsaid,inthe term objectives such as the control of communicable Introduction, that the work of the World Health diseases, maternal and child welfare, and the improve- Organization and the specialized agencies during the ment of nutrition and sanitation. present decade must take the form of an intensive The Health Assembly isasking governments to preparation of programmes to speed up the progress increase their health budgets by between ten and and economic growth of the developing regions of the fifteen per cent annually during the Decade. I cannot world, and we thank the Organization for having of course commit myself on this point, but there is one approved a ten -year programme for helping the thing I can assure you of, namely, that there will be developing countriestogivetheir populations a a better utilization, by my country's Department of satisfactory standard of living. Health, of the funds made available to us. There are a very large number of these countries Though our health equipment is relatively satis- in the Organization; most of them recently gained factory, the same does not apply to medical and para- independence and are now parties to the Constitution. medical personnel, who are too few in number and It is they who will be called upon to decide how this above all not sufficiently highly qualified; we are grate- ten -year programme is to be carried out. Looking at ful to WHO for having drawn up a well- balanced the list of Members and Associate Members of the programme of vocational education and training for Organization we see that, since 1960, some thirty new both professional and auxiliary personnel. We thank nations (twenty of them African nations), i.e. a quarter WHO for the fellowships it is giving us for training our of this Assembly, have become independent and, on personnel, but allow me to remind you, as I did last attaining independence, have become Members of the year, of our need to train them locally. Organization. We are fully aware of our duties The Federal Republic of Cameroon still aims at towards the Organization, but we are also aware of establishing, in Cameroon University, a faculty of our rights and of the part we must play in it.The medicine open also to students from neighbouring non - aligned countries must participate closely in the republics ;it is not unreasonable to hope that, of the administration of the Organization and in carrying out 250 or so students who now leave our secondary programmes of which they themselves, in very many schools every year (the figure will rise to 500 during cases, will be the beneficiaries.They represent a the next five years), one in ten will take up medicine. force not to be ignored. The recruitment and efficiency of our nursing and But ought we to embark on a health programme midwifery schools will be improved. We also want to without preparation ?I do not think we should, and set up as quickly as possible a public health school to my Government fully realized that we ought not to train, no longer sick -nurses, but public health nurses 106 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II capable of managing rural centres and equipped to municablediseases,environmentalhealth,health carry on healtheducation,maternalandchild education, etc., can be incorporated into this new welfare, as well as hygiene and sanitation work, in organization to the great benefit of the whole of the short trained for preventive medicine, upon which the country's rural population. health development of our countries depends. Take themalariaeradication programme,for That, Mr President, is the contribution Cameroon example. Until the beginning of 1962 the fact that the wants to make to the Decade's health programme for rural population was scattered and on the move the under -developed countries.We expect a great createddifficultiesfor DDT -sprayingoperations deal of the World Health Organization, but we should which, because of the insecurity inevitably created by like the Organization to know that it can, and should, subversive warfare, were sometimes insurmountable. count also on our co- operation. Fortunately for over a year now, thanks to the strategic hamlets, the population has been concentrated within The PRESIDENT : Thank you, Dr Tchoungui.I now well- defined areas; periodic spraying is now therefore call on the delegate of the Republic of Viet -Nam. more thorough, and health education,whichis Professor TRAN DINH DE (Republic of Viet -Nam) essential for the programme's success, has become (translation from the French) : Mr President, ladies and easier.Since the beginning of our eradication pro- gentlemen, I should like on behalf of the Viet -Nam gramme in1958, despite the insecurity, we have delegation to associate myself with the delegates who succeeded in reducing the malaria rate in the zones have congratulated the President of the Sixteenth of high endemicity north of the capital from 7.4 per World Health Assembly and the Director -General of cent to 1.13 per cent in 1962. When the organization the Organization on their election.I have closely of the strategic hamlets is complete, the rate will drop studied the excellent Report on the Work of WHO in still further and may very probably approach zero. 1962 presented by the Director -General. Allow me to I mention all this to show you the very good account congratulate him, and all the WHO staff, on the efforts to which we can put this organization of strategic they have made in compiling the Report. hamlets in carrying out our health programmes I was most interested to learn that the United The participation of the population in the admin- Nations and its specialized agencies have co- ordinated istration and collective work of the hamlet, in a new the preparation of programmes whose aim isto spirit of democracy and self -sacrifice for the common accelerate the progress of the developing countries good, is helping to raise the social and cultural level during the present decade.Since the improvement of of the people living in rural areas. The result will be health is essential to the socio- economic development an improvement in the health and well -being of the of these countries, we hope that this joint effort on the individual at all social levels. part of different international institutions will help Mr President, I have ventured to tell you about one the advance of health in the world. aspect of the health reforms carried out a year ago in Regarding my own country, the Republic of Viet - our country because I believe it will interest you to Nam, I am glad to see that these principles are in know of the efforts that are being made by a people harmony, in their broad lines,with our present such as ours, which has to cope at once with back- national policy in rural areas, where nearly 80 per wardness, partition, and subversive warfare. cent of the population live.For over a year, in a I have read with great interest the part of the spirit of democracy and of respect for the human Director -General's Report dealing with training of the individual and inspired by a sense of responsibility medical profession. I know that WHO attaches capital to the community, the rural population of Viet -Nam importance toa solution of the problem of the has been preparing itself to live in strategic hamlets shortageof doctors inthe developing countries; of between 1000 and 2000 inhabitants.The object I submitted my ideas on this subject at the Fifteenth of forming these strategic hamlets is not only defence World Health Assembly and I set them out in greater against subversion from North Viet -Nam but also, detail in a letter addressed to the Director -General in and mainly, to ensure that the people enjoy their January 1962.I hope in the forthcoming discussions constitutional rights and that they participate in the on the programme to have an opportunity to set forth social and economic development of the hamlet. once again my proposal that WHO should act directly Our Department of Health can turn this new organi- as a co- ordinating authority for the recruitment and zation of strategic hamlets to very good account for training of teaching staff for the future medical schools protecting the health and raising the standard of living of the developing countries. This programme will no of the rural population. Health programmes such as doubt cost a considerable amount, but I am certain those for malaria eradication, maternal and child that it will be money well invested if we think of the welfare, control of tuberculosis and of other com- ultimate aim of improving the health of all mankind. SEVENTH PLENARY MEETING 107
ThePRESIDENT : Thankyou,ProfessorTran syphilis has practically ceased to occur : in 1962 there Dinh De.I now call on the delegate of Hungary. were altogether two early syphilis cases. During the present five -year plan, one of our main Dr SIMONOVITS (Hungary) : Mr President, first of tasksconsistsinstrengthening our fightagainst all my delegation and myself wish to congratulate tuberculosis.The Tuberculosis Act recently enacted you on your election to this high office.I wish to by the Hungarian Parliament affords every facility congratulate Dr Candau, too, on the occasion of his for liquidating tuberculosis as a mass disease in our unanimous re- election as Director -General of the country within a relatively short time -we think, World Health Organization, and on his excellent within ten years.The tuberculosis mortality rate at Report. present is still 2.9 per 10 000. It is a very great honour for me to have the oppor- The significance of training has repeatedly been tunity to greet the Sixteenth World Health Assembly emphasized, both in the documentation and the in the name of the Hungarian People's Republic. contributions to the discussion.In Hungary, num- This is, moreover, also a personal pleasure for me, bering ten million inhabitants, about 17 000 doctors sinceI am inthe favoured position of having are active; that means that now we have an average participated as a delegate of my country in the work of one physician for every 585 inhabitants.In the of the first two World Health Assemblies following course of the last three years we laid down the network the establishment of WHO. of organized medical post -graduate training. The The Hungarian Government and the workers of the reform of medical training is now in course.Very health servicesin Hungary highly appreciate the great attention is being devoted to the training of our activities of WHO. We firmly believe that the health immediatefellowworkers -the nurses,assistants of our nations can be protected and continually and district nurses. We have established several new improved by mutual effortonly,thisidea being research institutes. clearly expressed in the Constitution of the World In the field of public health, our results are based, Health Organization. And this holds equally true in among others, on the fact that the medical sciences have the fight against contagious diseases, the menace been at a relatively high level since the end of the last of cardiovascular diseases, cancer, and so on.An century. The Hungarian Government considers as one effective fight against them requires co- ordination of of its most important tasks, today also, to further effort.May I cite, in this respect, a very striking increase the level of scientific work in Hungary and to example.In Hungary we experienced an extensive adapt in practice the results obtained both abroad poliomyelitis epidemic in 1957 and 1959 that we were and in Hungary. able to liquidate only with international assistance. Hungary's history shows, however, that a developed The first attack was conquered by Salk vaccine from health service in itself does not suffice for assuring Canada, while the second one was fought down with good public health conditions.During this Health Sabin tumakov vaccine from theSoviet Union. Assembly, too, many delegates have stressed the Thus, Hungary is one of the first countries where, importance of social circumstances.Also in my with internatonal help, this frightful illness has been country the continuous increase in the population's liquidated. living standards has played a decisive role. This In the Director -General's opening address, as well constitutes the basis of our work of prevention. as in a considerable part of the contributions to the Our results are, furthermore, due to our efforts for discussion, great stress was laid on the tasks to be extending our internationalrelations. Currently, fulfilled by the Member States of the World Health Hungary is represented in about forty international Organization concerning the amelioration of health medical associations.In 1962 nearly 10 per cent of services in the less developed countries. Mr President, ourphysicians -1500physicians - participatedin in proportion to its abilities, the Hungaran people is various conferences and study trips abroad, 700 of always ready to take a share in this work. them in the western countries. May I be permitted to say, in the light of the above I have spoken about the health conditions of my ideas, a few words about the health condition of my country because our aim is -in accordance with the country. One of the most important tasks falling to Director -General's opening remarks -to contribute, WHO is the fighting down of malaria.But, as the in the spirit of the World Health Organization's Indonesian and other delegates emphasized today, it Constitution and to the extent of our modest possi- is a very difficult, but not impossible, task.In many bilities, to the assistance given to countries that ask countries, as in Hungary too, this disease does not for this help.It is a great honour to us to be able to occur any more.The other great disease, syphilis, assistother nations in improving their respective can likewise be fought down.In my country early health services. Hungarian physicians are working at 108 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II present in several countries. Thus a team of nineteen Organization's work, a clear, exact and comprehensive Hungarian doctors went to Algeria recently.The idea of which isgiven in the Director -General's Hungarian Government will be glad to undertake, in excellent Report. We were glad to see in Dr Candau's accordancewiththeDirector -General'sReport, remarkable introduction to the Report that, in the similar tasks in the future as well. review it provides of the Organization's praiseworthy It is a particular pleasure for us that our country is activities, sight is not being lost of improvements that being visited by a growing number of foreign physi- need to be made in programmes already in operation cians, who are contributing thereby to raising the and in the endeavours to co- ordinate the various standard of Hungarian medicine. forms of assistance. What has been achieved is indeed Mr President,I would like to thank you most encouraging, but an immense amount still remains to sincerely for my having been allowed to give this short be done. Nothing but an enormous effort of human statement on the situation of public health in my co- operation and solidarity can enable us to face the country to the World Health Assembly, this largest future with confidence. My delegation entirely agrees and most important international organization of with the Director -General on the need for planning public health.On behalf of my Government I wish health activities in each country in relation to the to make the promise that all of us will aim at our active actual state of affairs in that country, its ability to participation in the work of the Organization. make sacrifices for health, and the foreign aid available Professor Geric (Yugoslavia), Vice -President, took to it. the presidential Chair. It is indeed, within the framework of a general development plan that my country has undertaken a The ACTING PRESIDENT (translation from the French) : large -scale health programme phased over ten years. Thank you, Dr Simonovits.I call on the delegate of Thus, since the Fifteenth World Health Assembly, we Tunisia. haveorganizedseveralcampaignsagainstcom- municable diseases, and in particular, for the sixth Mr CHELLI (Tunisia) (translation from the French) : timeinTunisia,anationalcampaignagainst Mr President, fellow delegates, allow me in the first trachoma. Emphasis is laid in the Director -General's place to perform the pleasant task of congratulating Report on virology, it being recommended in parti- you most cordially, Mr President, on behalf of my cular that studies involving several disciplines should delegation, on your election by unanimous vote as be undertaken on trachoma in a few selected regions. President of the Sixteenth World Health Assembly. It is an especial source of gratification to me to be in This brilliant election shows the esteem in which the a position to say that Tunisia, a country in which Assembly holds you and the respect it has for the trachoma was rampant and which has undertaken country you represent. It gives my delegation particular and has been organizing control of this scourge for a pleasure, because this is the first time that the represen- number of years now, will perhaps make a most tative of a newly independent African country has been useful contribution in the field of virological research called upon to be the President of this august Assembly. on trachoma, thanks in particular to the work being I should also like to take this opportunity cordially done with WHO assistance at the Tunis National to congratulate the representatives of Algeria, Burundi, Ophthalmological Institute.This institute appears, Mongolia, Rwanda and Tanganyika, countries which moreover, to be performing a regional function in in the course of the past year have joined the large the matter of training and demonstration, in connexion family of the World Health Organization. My delega- with the search for more effective forms of treatment tion had occasion at previous sessions to deplore the for this disease. absence of Algeria from this Assembly, and it is a As regards child welfare, under a compulsory, free veryspecialpleasure,therefore,to welcome the antipoliomyelitis vaccination campaign covering the presence among us of representatives of that sister whole of the Republic, over a million children from country of the Maghreb. We are convinced that the one to ten years of age have been vaccinated. Other presence among us of representatives of these new campaigns for the control of communicable diseases, Members will effectively help to speed up the work in particular tuberculosis, have been carried out with undertaken, under the Organization's auspices, to free the utmost vigour during the past year. Other the under -privileged peoples of the world from disease campaigns again, which were started several years and stimulate our efforts to secure for those peoples ago, have come to an end and thanks to them we have the enjoyment of the right to health, which is one of the now seen the last of smallpox and typhus. fundamental rights of mankind. World Health Day, the theme of which this year was The enjoyment of this right to health, Mr President, the struggle against hunger, provided us with an has been well served during the past year by our opportunity to evaluate the work that is being done by SEVENTH PLENARY MEETING 109
the Government to increase the amount of, and to work of the Development Decade seems to us to have improve and rationalize, human nutrition.It also real prospects of success. This is due in large measure gave us an opportunity to intensify our activities for to the wisdom, vigour and self -sacrifice displayed by spreading nutritional education, and to bring up to Dr Candau in preparing and carrying out our organi- nearly 200 000 the number of people receiving assist- zation's programmes.I should like to pay him a ance under the food aid programme launched nearly tribute and to congratulate him very sincerely on two years ago. behalf of my delegation on hisr eappointment as All these campaigns have been carried out in Director -General to continue the work he has so collaboration with the national organizations, and brilliantly begun. with the generous and effective support of the World Health Organization and of the joint committees of The ACTING PRESIDENT (translation_ from the French) : Thank you, Mr Chelli. I call on the delegate of Austria. thatorganization and otherspecializedagencies, particularly that with UNICEF. Dr SCHINDL (Austria) : Mr President, fellow dele- The encouraging results of these campaigns have gates, may I first of all, on behalf of my delegation, not, however, blinded us to the necessity of daily congratulate you, Mr. President, on your election. preventive work in order to ensure a healthy popula- We are very pleased that the Minister of Public tion. Accordingly my Government decided, in agree- Health of an African State has consented to shoulder ment with the country's doctors, to establish the the heavy burden of presiding at the Sixteenth World principle of full -time work in the hospitals. This Health Assembly.We are convinced that he will enables the doctors to fulfil their social functions in guide our considerations in a very successful and perfect harmony with the other vital elements of the effective manner. nation. Our aim is to improve the quality of the care Furthermore, may I express our appreciation to the given in hospitals, to enable more patients to be treated Director - General for his excellent and comprehensive at less cost, and to prepare our hospitals for providing Annual Report.His unanimous reappointment was national medical education, which we are organizing an overwhelming manifestation of confidence. in collaboration with WHO. This operation is being It gives me great satisfaction to declare that my carried out under our development plan and is co- country fully agrees with the health policy of the ordinated with the other national activities. World Health Organization, guided by the Director - My delegation would mention in passing that the General.There are two reasons for that.On the constantly renewed efforts of my Government to one hand, we are very well aware that, particularly improve the quality of medical care and to bring it regarding public health, we are all sitting in the same within the reach of the large majority of the destitute boat, as health is indivisible.For example, we are sectorsof thepopulationareconstantlybeing not secure from the dangers of smallpox as long as hampered, I might even say handicapped, by the this is not eradicated all over the world. On the other ever -accelerating rate of increase of the population hand, my country has to return all the help given by which is, in consequence, a major source of anxiety so many countries after the Second World War. For to my Government. instance,withoutthishelpitwould have been The foregoing is a short survey of our contribution impossible to reach a percentage of infant mortality to international action to relieve mankind from disease below 3 in such a short time. and to come nearer to attaining our goal, namely, In Austria the first oral mass vaccination against that of securing enjoyment of the right to health. At poliomyelitis has been completed by carrying out the the international level, we have been glad to see that fourth vaccination with triple vaccine of all three international opinion is daily becoming more aware of types. About 70 per cent of all children and juveniles the importance of health programmes for development and nearly one -third of the whole population has been and for improving the lot of man. We enthusiastically vaccinated.There were no cases of poliomyelitis welcomed the convening of the United Nations Con- among the vaccinated and less than a tenth of cases ference on the Application of Science and Technology amongst the non -vaccinated,compared with the for the Benefit of the Less Developed Areas.The previous years, in 1962 and the first quarter of 1963. leading place given to health questions by that con- A hundred and twenty -three coincidental casés were ference cheered us and encouraged us to redouble our reported. Each of these cases was thoroughly examined. efforts to attain the goals we have set ourselves. The result proved by the Central Sanitary Advisory My delegation is convinced that it is within the Council was that all cases but two or three could be power of mankind to attain these goals.The inter- clarified as not being caused by vaccination. Only in national action that is being taken by WHO in concert these two or three cases were the neurological sym- with the other specialized agencies within the frame- toms probably caused by vaccination. Of these, one 110 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II case is now in a good state of convalescence. No case facilities and of the health problems. Following such died.It is a ratio of one to one million vaccinated. an assessment these countries should be given the The good result of the vaccination encourages us to necessary aid to develop an orderly and well -stabilized continue the vaccination of new -born children in the efficient health service.In the absence of a major years to come. health hazard or epidemics with high mortality rates The examination for military service of male juveniles thatnecessitateimmediateintervention,sucha uncovered a second wave of goitre in our country. development should be started prior to or at least The surgeons had the same experience by relapses with the introduction of individual health programmes. after strumectomies. The cause was known to be lack A second point I should like to mention is in regard of iodine in food and water in many regions of our to fellowships and training.The importance of this country.Fifty years ago the psychiatrist Wagner- activityin developing countries cannot be over- Jauregg introduced iodine as an additive to kitchen emphasized. No doubt the teaching a fellow gets in the salt; but the people purchasing kitchen salt had to ask DPH or similar courses in well -developed countries specially for iodized salt. The consumption of iodized is very useful, as it helps him to learn new things and salt was falling year by year. As a result of this situa- opens his mind to new ideas and concepts; but how tion we again got many cases of goitre. Now, on the much of this is applicable to his country?Perhaps basis of the new law coming into force this year, people more consideration should be given to the establish- purchasing kitchen salt have to ask expressly for salt ment of training courses dealing specifically with without iodine,otherwisetheygetiodizedsalt. problems of newly developing countries, preferably Furthermore, special arrangements can be made to within the region, where countries more or less face iodize salt for bread baking and so on, in areas where the same problem. goitre is endemic. We hope to halt this second wave Mr President, in Jordan the utmost consideration of goitre in this way. is given to health programmes. The malaria eradica- In the mortality statistics of Austria accidents are tion programme isprogressing steadily and satis- increasing to a great extent.Therefore we have to factorily. Already most parts of the country are in the look for new methods in the struggle against accidents. consolidation phase.Since April this year a major The draft penal code provides that everyone is obliged district of Jordan has been put in the maintenance to give first aid on the occasion of an accident. There- phase. The tuberculosis control programme and the fore everyone has to learn to give first aid in the right maternal and child health services are being expanded. way. For this purpose, a mass campaign is under way A few weeks ago a trachoma control pilot project under the patronage of the Federal President in my was started, and a school health programme is being country, with the challenge : " Learn to help : first aid organized.The new vaccine and serum centre is decides ". expected to start its production in August this year. All this work was made possible by aid received from The ACTING PRESIDENT (translation from the French) : the World Health Organization and UNICEF. Also Thank you, Dr Schindl.I call on the delegate of valuable technical and financial aid was received from Jordan. the Government of the United States of America, Dr SHAMI (Jordan) :May Icongratulate you, through its Agency for International Development, Mr President, on your election to the Presidency of to support these programmes and to develop other this Assembly.I wish to congratulate Dr Candau on health services.Therefore, I would like to express his reappointment as Director - General of the World our thanks and gratitude to them all.In this con- Health Organization, and also to welcome the newly- nexion, I must not fail to mention the valuable work admitted Members. UNRWA is carrying out in the field of health for the IhavestudiedtheDirector -General's Annual Palestine refugees in Jordan, and I would like to Report with great interest and would like to make a express our thanks and gratitude to UNRWA. few brief remarks.I noticed with great satisfaction the importance given to the development of health The ACTING PRESIDENT (translation from the French) : Thank you, Dr Shami.I now call on the delegate of services as a whole. Most of the developing countries the Federation of Malaya. suffer from shortage of funds and lack of skilled and trained personnel. One faces the problem of how to Dr DIN BIN AHMAD (Federationof Malaya) : make full use of the available trained personnel and Mr President,distinguisheddelegates,ladies and to develop health services with the utmost economy. gentlemen, may I first of all offer the apologies and The World Health Organization could be of great regrets of the chief of the delegation for his absence assistance in encouraging and helping such countries today, as the honourable minister had to leave Geneva to carry out a proper assessment both of available suddenly.I have now the honour and pleasure of SEVENTH PLENARY MEETING 111 leading this delegation, and first of all therefore, on of a network of health centres has been devised in behalf of my delegation, I thank the Assembly for the particular for the rural areas, where attention has honour accorded my country,theFederation of been lacking in the past. The results have been more Malaya, in the high office of one of the Vice -Presidents than gratifying, as is shown by the falling infant at this Sixteenth World Health Assembly. mortality rate in recent years. This emphasis, however, My delegation also wishes to associate itself with will not leave the urban areas unattended or neglected. the many congratulatory and complimentary remarks Tuberculosis, in recent years a major killer in my already made by various speakers on your appoint- country, is now on the defensive, thanks to the intensive ment, Mr President, the appointment of the Vice - efforts made through the national tuberculosis control Presidents, of the Chairman of the two main com- campaign.This campaign, started two years ago, is mittees, and the reappointment of the Director - fast gaining momentum and in it emphasis is on : General, which is most deserving.My delegation's (a) the staff training programme; (b) the BCG vaccin- warm welcome is extended also to the new Members ation drive; and (c) case -finding measures. In malaria, at this Assembly. our eradication pilot project, which started in 1960, The following remarks and comments which I is now reaching its concluding stage. Thus far it has propose to offer you are but brief and passing reviews progressed satisfactorily. My Government will soon of the progress made in some of the more important have to consider its implementation on a nation -wide health activities in my country, a country which is basis, bearing in mind the various technical, admin- comparatively small -it has a population of about istrative and financial implications of such a very seven million only, in an area covering 51 000 square important and expensive scheme.The control of miles. The annual recurring expenditure on the filariasis,despite staff problems, has been further medical and health services amounts to 33 million intensified, and we are now determining the actual gold dollars, which is about 10 per cent of the national extent of this disease in the country. On the subject budget. In common with many countries, we are now of yaws, the campaign we started some years ago has in the middle of our second five -year government now reached the stage of clearing pockets of resistance; programme, under which the Government has set and the integration of this campaign into the rural aside 50 million gold dollars for the medical and health health service programme proper is on the way. services. Whilst undernutrition and malnutrition are com- My Government has accepted the importance of paratively light in Malaya, the importance of the qualified and trained personnel of all categories as subject of food and nutrition is constantly advanced crucial for the future development of our medical and to the population, and through health education stress health services, and accordingly top priority has now is laid on a proper balanced diet at all ages.It is been given to the training of all types of medical and pleasant to remark here that with the vigorous effort paramedical personnel.A new medical school has to improve living conditions, particularly in the rural just been established in our capital, Kuala Lumpur, areas, the response from the people has been most where the first intake of forty medical students has encouraging.I believe this is the experience of many just been made. Ultimately it is anticipated that the developing countries where, as in our country, the faculty will produce about a hundred doctors a year. demand is for more and more medical services.This WHO will, I am sure, be following this venture with poses a problem which perhaps the Director -General interest and perhaps it will assist actively in its develop- and theSecretariat may have to look into very ment through the coming years. My delegation looks seriously.The solution, I can assure them, will not with interest, very deep interest, to the subject selected be easy. for the technical discussions during this Sixteenth Mr President, in conclusion, I would like to express World Health Assembly, since a new medical school the thanks and gratitude of my Government to WHO such as ours will benefit considerably from the pro- for meeting the various requests made by my country, ceedings and recommendations made at these discus- to UNICEF for their valuable assistance in the various sions. country projects, and last but not least to the many Preventive medicine has assumed an important place friendly countries that have assisted us in various already in many countries, where positive results have ways. been demonstrated. The urgent attention of my Government has been drawn to this aspect, and it The ACTING PRESIDENT (translation from the French) : Thank you, Dr Din bin Ahmad. I call on the delegate believes that, in the long run, the expenditure of the medical and health services of a country could be of Somalia. reduced substantially through preventive health work. Mr ABDIRAHMAN HAJI MOOMIN (Somalia) : Mr Pre- On this concept the programme for the construction sident, Excellencies and fellow delegates, it is a great 112 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
honour for me to convey the greetings of my Govern- Despite technical assistance from Italy, the United ment and my delegation on the honour bestowed on Arab Republic, the Union of Soviet Socialist Republics you, Mr President, by being elected unanimously and other friendly countries, we urgently require to the presidency of the Sixteenth World Health doctors, nurse -midwife tutors, and sanitary engineers. Assembly.I feel happy to congratulate Dr Candau It is our earnest hope that we shall get more WHO wholeheartedly on the occasion of his reappointment operational staff, as our resources at present are far to the high office of the Director- General of this too meagre to get such services. organization, an office in which he has served efficiently Somalia is proceeding with the malaria pre- eradica- for the last ten years. Dr Candau deserves my delega- tion programme.It will take some time before we tion's high tribute for the excellent Report submitted comply with its requirements but we shall be striving by him for the year 1962.My congratulations are to the best of our ability. May this august Assembly also extended to the Vice -Presidents and the Chairmen bring about full and substantial co- operation with our of the main committees. neighbours, Ethiopia and Kenya, in the preparation The World Health Organization, as you are aware, of our fight against malaria.It is most gratifying was assisting us even before our attaining inde- to note that, with WHO assistance, it has been possible pendence.Since then, it has been making notable to go ahead in malaria pre- eradicationactivities contributions in the training of health personnel, despite UNICEF's withdrawal from thisproject. communicable disease control, and maternal and We earnestly hope that UNICEF will reconsider its child health programmes. You will be happy to know policy and before long will be assisting us with that WHO has actively assisted in national health transport and supplies in this great undertaking. planning.The first five -year health plan, 1963 -1967, In conclusion, my country wishes to pay a tribute which has been accepted in principle, is being imple- to the Director -General and the staff of WHO, and mented. The plan lays proper emphasis on the pre- especially to Dr A. H. Taba, our Regional Director, ventiveaspects. Malaria, tuberculosis and com- who has always shown the greatest sympathy towards municable disease control, together with maternal our problems. and child health and vital statistics, are to be integrated On behalf of my delegation, I sincerely welcome to in the basic health services.Efforts are in hand for this happy family of WHO the following new Member work on environmental sanitation. States : Algeria, Burundi, Jamaica, Rwanda, Trinidad and Tobago, and Uganda, and also Kenya and Our country lacks doctors and trained medical Mauritius as Associate Members. personnel, and the situation is all the more aggravated by lack of good roads and transportation. It is under- The ACTING PRESIDENT (translation from the French) : standable that a medical school will not be possible for Thank you, Mr Moomin.I call on the delegate of the Somali Republic for some years to come.At Lebanon. present, we are training our doctors mainly in Italy and some in the United Kingdom and in other friendly Dr JALLOUL (Lebanon) :Mr President, Director - countries like the Union of Soviet Socialist Republics. General, honourable delegates, may I have the honour Our friends are providing us with generous assistance of saying a cheerful " Hello " to everybody at this and we are indeed most grateful to them. You will Assembly and, with the fewest of words but with appreciate that besides training in Europe we would utmost conviction and sincerity, may I congratulate like our doctors to be trained in the countries of our warmly all of you who have been elected in this Health region, as the social and cultural environment is not so Assembly, and may I salute all the new Member different.In view of this we would welcome place- Statesand Associate Members who joinedthe ments from our friends the United Arab Republic, Organization this year. Pakistan, Sudan, Lebanon, Iraq and Iran. We have I am not going to make any prelude of eulogy or read with great interest the document on the " Educa- praise in my speech; I share the views and feelings of tion and training of the physician for preventive and all the speakers who preceded me. Nor am I going to social aspects of clinical practice ".It seems that the discuss in this Assembly what ought, in my opinion, WHO- assisted projects, both in our country and in the to be discussed perhaps elsewhere.I am going to be countries of the Region, can provide valuable orien- as objective and practical as possible. tation to our returning medical graduates. We have all read the Annual'Report of the Director - We are indeed thankful for the WHO team that General, which presents the work of the World Health will be coming to assist us in national health planning. Organization in 1962, and I am sure that everyone No health plan can be implemented in the absence of who reads it is fascinated by the effort and hard pains adequatetrainingstaff andoperationalexperts. that were taken in order to give us an accurate and SEVENTH PLENARY MEETING 113 precise picture of the achievements and anticipations selves, the Lebanese delegation expresses its hopeful of the Organization.However,I would liketo wishes to better ends for all humanity. emphasize from the very beginning that, in spite of all The President resumed the presidential chair. the hard pains and efforts of this organization for the welfare and health of humanity, we are still far from The PRESIDENT :Thank you, Dr Jalloul.I now attaining the goal of the good health and well -being recognize the delegate of Spain. of all the people on this planet. Who is responsible Dr CLAVERO DEL CAMPO (Spain) (translation from for this ? the Spanish) : Dr Majekodunmi, my delegation wishes The answer lies in our own selves. How much are to express its congratulations on seeing you elected to we losing every year in spending money on unuseful direct the debates of this Assembly.To be always purposes ?I am not going to point out any one un- successful in our choice of a President at the beginning useful purpose, because we all know them very well and of our work has become a tradition among us and is we all try to find excuses forthese unnecessary an excellent omen.1 should also like to express to expenditures.Yet if we could save that money and Dr Candau my delegation's satisfaction that he has use it for the health of the people through the different undertaken to remain at the helm of our ship for world agencies, our lives on this earth would be much another few years; he is bringing it safely towards happier and safer. that ideal harbour, which progressively recedes into We are all here, under the roof of one of the halls the distance as our ambitions increase. of the Palais des Nations, representing the agents Our prospects are favourable; the Organization responsible for the health of the people in our has had fifteen years of flourishing and prosperous countries, and we represent almost all the nations. life, its membership is growing steadily, its budget Hence let ús ask ourselves the following questions : increasing at a similar rate, and its projects and Do all our people get the right nutrition ? Do all of activities constantly expanding. At this stage of our them get the necessary medical and health facilities ? work we have eliminated all mutual distrust in health Do all our children get the right care, whether pre- matters by our international legislation; we have ventive or curative ? Do all pregnant mothers get the opened our land, sea and air frontiers to traffic as right prenatal and post -natal care ? Do all the people though in defiance of communicable and quaran- drink pure and safe water ?Do all our rural areas tinable diseases; we are stating intentions and using have adequate health and medical facilities ? Do we terms which a few years ago would have seemed have enough health personnel to render health services exaggerated and rash. We aspire to eradicate diseases to our populations ? Do we have the right personnel from which mankind has suffered for thousands of to render the right services ? Are the budgets appro- years; we aspire to eradicate endemic diseases, to pull priated for the ministries of health in all our countries them up by the root so that there will be no possibility sufficient ?Could we control all the communicable of recurrence. diseases ?Have we solved all the health problems In many branches of preventive medicine we have of our urban areas ?I doubt very much if the most also changed our health tactics. We do not wait for developed countries can say " yes " to each of these the patient, we go out and look for him, because we questions and to other similar health questions. expect to make our diagnosis before the appearance of Are we to depend upon the World Health Organi- any visible symptoms.In many branches of health zation to solve all those problems for us ?Are we to work we have substituted positive action for passive appeal to the great powers on this earth to forget their surveillance. Finally, these few aspects of the develop- hatred and their egoism and replace them by the love ment of our tactics show that there is a trend to make of humanity and tolerance among peoples and nations; the whole population take part in a work of national or are we to depend upon ourselves and use our own collaboration and understanding. human judgement and full capacities ?I think all of It should recognized that this work is being carried those are needed if we are to build a happier future on at a time when great discoveries and technical on this earth.And it is this voice, the voice of the developments are giving incalculable assistance to World Health Organization, that can influence the our science, which is an applied science. But we must peoples and the powers of the world to co- operate also recognize the extraordinary growth of our needs : on these lines. new nationalities and new peoples have emerged which Dear Dr Candau, your task is not an easy one; call for our assistance with urgency and enthusiasm, nor is that of the honourable delegates. Longing for because they wish to solve their health problems a closer and more extensive co- operation in the rapidly. coming years between the Member States and the The economic and social development, to which Organization and among the Member States them- the progress of our health work owes so much, also 114 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II brings us trials and creates adverse factors that we importanceinnormalcircumstances,but which have to eliminate.The multiplication of industries, becomes important under disaster conditions.To the changesinthestructureof agriculture,the judge from its reports, the Committee on International displacement of social groups andothersimilar Quarantine hardly concerns itself with this disease. happenings, result in a redistribution of the population We are glad to see, however, from the Director - within the national territory. We all know that the General's Report that the importance of the problem health services must anticipate and adapt themselves is recognized and that he proposes to draw up a to these changes if they are not to be overwhelmed. special programme for its solution. Environmental health continues to be a fundamental In conclusion, without taking up too much of your problem in all countries, especially those in process time, I should like to make a few remarks on polio- of development. myelitis.Although this is a disease which has a low The work of the World Health Organization is morbidity rate, we all know its emotional importance certainly highly complex :it now comprises117 and tragic effects and the difficulty of rehabilitating countries and it may be said to be faced with 117 patients.We are very favourably impressed by the different health situations, as many governments, and publication of the results obtained in many countries, innumerable health plans. WHO is not a substitute for including the Union of Soviet Socialist Republics, national activities; it is not a world ministry of health Cuba, Czechoslovakia, Germany and Switzerland. and consequently, as is only natural, it must pay These countries have used live oral vaccines, preferably attention to the wishes of all these health administra- the Sabin strains.The technical simplicity of this tions and try to satisfy their different needs.This is method of immunizing the community seems to justify the reason for the multiplicity of its programmes and, the hope that this disease may be eradicated. Never- to some extent, a dispersion of its efforts.But the theless itis pointed out in the Director -General's Organization also has programmes of world -wide Report that many technical problems remain to be scope, of co- ordinated international action, relating settled before uniformly safe and effective vaccines to measures against communicable diseases. can be finally developed. In view of this difficulty we It must be recognized that, in spite of all these consider it would be most advisable to have a technical successes,in many casesepidemiologyhasnot report by a committee of experts who would obtain progressed beyond the time of Pasteur, and infectious the opinions not only of laboratory workers, but also diseases still play a predominant part in the world : of health administrators who have directed national malaria, trachoma, tuberculosis, leprosy, bilharziasis campaigns in their own countries. and yaws claim millions of victims ;other diseases, Finally, we wish to draw attention to a further such as smallpox, have yet to be eliminated and some, reason for our gratitude to the World Health Organi- such as poliomyelitis, have a tragic and emotional zation, namely, that with its help Spain has succeeded aspect. Although in the European Region we are free in eradicating malaria two years before the date set from the pestilential diseases, we believe that their in the programme. elimination should be an international commitment of We wish Dr Candau the " state of complete physical, high priority for the World Health Organization. mental and social well -being " which is his funda- We are the successors of the Office International mental right.We are sure that, God willing, the d'Hygiène Publique and we have a duty to continue greatest success will be achieved under his administra- and expand its activities and projects. More intensive tion. assistance must be given to the countries where there The PRESIDENT : Thank you, Dr Clavero.I now are still smallpox foci.This humanitarian assistance recognize the delegate of Paraguay. is more effective and more rewarding than the efforts we are making in our own countries.If we have the Dr LoFRUSCIO (Paraguay)(translation from the means to eradicate this endemic disease, our task as Spanish) : Mr President, fellow delegates, ladies and health workers is to plan and to apply them. The day gentlemen, in rising to speak for the first time before we eliminate smallpox, our international prestige will this great Assembly as delegate of the Republic of be increased and we shall be considered capable of Paraguay, I have the great honour most sincerely to greater achievements.We are thus fully satisfied congratulate the President of the Sixteenth World with this aspect of the work accomplished by WHO HealthAssembly onhiswell- deservedelection. and we hope that it will continue and grow. To Dr Candau, the Director -General of the World We have already expressed our opinion on other Health Organization,I wish to convey our great occasions regarding the need for the World Health interest in his excellent Report on the Work of WHO Organization to devote more attention to measures in 1962.I take advantage of this opportunity warmly against typhus, a disease that may seem of no to congratulate Dr Candau and Dr Horwitz on their SEVENTH PLENARY MEETING 115 reappointment to their high offices. At the same time into which the country is divided.At the executive Igive my respectful and cordial greetings toall level, the Government now has a technical planning delegates, with especial congratulations to those of secretariat which is hard at work on the study and the new nations who are joining us to strengthen the co- ordination of objectives and the allocation and immense efforts of the World Health Organization. execution of projects.Paraguay maintains the best I am deeply touched by the kindnesses received from possible relations with its neighbour countries for the members of Swiss government departments, whose implementation of health programmes of common hospitality is bound to promote friendship. interest. I also wish to express my congratulations on the In the committees in which I shall have an oppor- efficient organization of this Assembly and my best tunity of speaking, Iwill try to explain our pro- wishes for the success of its deliberations. grammes in detail in connexion with the agenda items Mr President, Paraguay is experiencing a period under discussion. of peace and progress never known before; so much has never been done for public health, in so short a The PRESIDENT : Thank you, Dr Lofruscio.I now recognize the delegate of Trinidad and Tobago. time, as under the present Government. Programmes are being regularly carried out, at the rate and on the Dr COMISSIONG (Trinidad and Tobago) : Mr Pre- scale provided for; special attention isstill being sident, the Director -General inhisaddress made given to the expansion and multiplication of integrated mention of the fact that the country which I have healthservices -preventive,welfare,and hospital the honour to represent has recently been admitted services in remote areas, particularly the frontier to full membership, and welcomed us to the Organi- zones. At the same time, new units are being set up zation. Other speakers from the floor have also inthe settlement areas, under the highway and expressed similar sentiments.May I now therefore agricultural reform programmes, which are the pillars be permitted to thank the Director -General and those of the national economy, and the programmes already countries for their expressions of welcome and the carried out are being consolidated.In addition to United Kingdom for sponsoring our application. the efforts of the Government, the effective collabor- On behalf of Trinidad and Tobago I pledge accept- ation of local communities in solving health problems ance of the aims of WHO and our intention to adhere as quickly as possible is also worthy of praise. to its ideals. We are a very small country, but what The international organizations, which are direct we lack in size we hope to make up for in enthusiasm. witnesses of the progress made in our health pro- Under dynamic and informed leadership, and with grammes, are still giving Paraguay their invaluable true recognition of the principles of democratic govern- co- operation in the form of technical and economic ment, this little country hopes to take its proper place assistance, as well as equipment and supplies, which on the world stage. we appreciate at their true value. Our sincere gratitude Trinidad is at the crossroads between North and goes tothe World Health Organization andits South America. This inevitably means, if I may mix Regional Office for the Americas, the Pan American metaphors somewhat, that we are subjected to many Sanitary Bureau, to UNICEF and FAO, and to the cross -currents in health matters.Not only are we United States International Co- operation Administra- exposed to the risk of the introduction of diseases tion working through the Inter. American Co- operative prevalent in other countries, but we are also affected Public Health Service.With all these organizations by another type of cross -current. Traditionally we are we are working increasingly effectively and closely. wedded to United Kingdom standards and patterns In connexion with the programme of the Alliance of medical services but, because of our geographical for Progress, established by John F. Kennedy, the position, we are subjected to United States and illustrious President of the United States of America Canadian influences.For example, in accordance and which sets new objectives for the development with our UnitedKingdom background, we are and well -being of the Americas, Paraguay has drawn trying to develop our domiciliary midwifery service, up its emergency programme, and studies for the long- but the maternity wards of our hospitals are grossly term programmes are well advanced. overcrowded by mothers who insist on having their As from this year we have introduced a system of babies in hospital.Moreover, our WHO nursing " functional "budgeting,withco- ordinatedpro- advisers come from the United States or Canada, grammes and activities which certainly offer magni- where the normal practice is for babies to be delivered ficent prospects.With this modern system of func- in hospital or, if in the home, by medical practitioners. tional budgeting, the Ministry of Public Health and These nursing advisers, therefore, have not had the Social Welfare has been able to carry out the admini- training in obstetrical nursing or domiciliary midwifery strative decentralization of the four health regions that we would require. 116 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
But these conflicting influences bring with them the world. Your elevation, apart from being a significant advantage that we are in a position to choose the best landmark in the history of our sovereign status, should of both worlds and to evolve for ourselves a public inspire those still under the yoke of colonialism to health structure thatistailor -made to meet our intensify their struggles to throw off the chains of peculiar needs, much in the way that Canada has been colonial rule, without which they can never have the able to do. We understand that the Canadian health opportunity to dream and realize their dream as code owes its enlightened excellence to the fact that, Nigeria has done, thanks to the good sense of judge- quite deliberately, they were prepared to discard ment of this Assembly. tradition in favour of examining the health laws of all Mr President, permit me also to extend to the the major countries of the world and incorporating Director -General, Dr Candau, on behalf of the intheir own code the features of each considered to Nigerian delegation my congratulations on his well - be best suited to their needs.This is why, when the deserved re- appointment, his thought- provoking report, World Health Organization agreed to provide us and the ever- mounting successes which the World with an adviser to assist in the remodelling of our Health Organization is recording in all parts of the health laws, we specifically requested a Canadian world, particularly in the developing countries of Asia, consultant. We are most grateful to the World Health Africa and Latin America.This unqualified demon- Organization for acceding to this request, to our big stration of confidence should spur him to greater sister and good neighbour Canada for releasing the efforts and achievements in the years that lie ahead. legal adviser to their Ministry of Health, and to Mr We in Nigeria are aware of the great gap that exists R. E. Curran, Q.C., for doing a most excellent job. between the high standards of health services in the Finally, Mr President, I should like to add my congratulations to those already offered to both richer and more advanced nations of the world, and yourself and Dr Candau.As regards yourself, Dr the low and grossly inadequate standards available in Majekodunmi, may I be permitted to make reference to the emerging nations such as ours. It is our irrevocable the close ties of race and valued friendships between determination to do all in our power to revolutionize your country and mine, which make your election not only our health and other social services, such as to this high office a matter not only for pleasure but education, but also our economy, in order to give also of great pride to us. meaning to our political independence and catch up with the older and more advanced nations.Since the The PRESIDENT : Thank you, Dr Comissiong. I attainment of independence, less than three years ago, recognise the delegate of Nigeria. we have been able to establish four new universities and a new medical school. New hospitals and health Mr Oxwu (Nigeria) : Mr President, fellow delegates, centres are being built and older ones are being modern - may I, Mr President, offer you, on behalf of the nized. Young Nigerians are are being trained locally Nigerian delegation and people, my sincere congrautl- in our institutions and in all parts of the world, to ations on your election to the presidency of the supply the trained manpower we are lacking. Our six - Sixteenth World Health Assembly, and express to the year development programme aims at giving Nigeria World Health Organization my country's gratitude for the great leap forward economically and socially. This this honour done to her in particular, and to Africa in planemphasizesthreemainpriorities,namely : general.I have no doubt in my mind that you will agriculturalandindustrialrevolution;education, discharge your duties creditably, to the glory of especiallyscience;andhealth,includinghealth Nigeria and to demonstrate that the confidence of this education.We recognise that hunger and malnutr- Assembly was well placed by your choice which was ition create conditions favourable to disease -a sick unanimous. Your election, I venture to assert, reflects person is incapable of creative employment and is the goodwill of the Member States towards Nigeria and a liability to his community -and mass education, is tantamount to an endorsement of Nigeria's policy including health education, will eradicate ignorance of friendship and goodwill towards all nations. With which can be responsible for the attack and spread of this encouragement, I can assure this august and certain diseases. humanitarian body that Nigeria will not only continue But in spite of the fantastic efforts we are making to to give unflinching support to, and co- operation with improve the health of our forty million people, we, the United Nations and all its specialized agencies, of in common with other developing countries, have been which the World Health Organization is one, but will encountering great handicaps.Our people are im- intensify its efforts to foster world peace and concord patient for progress and better health.We lack the and play its part always in the crusade to eradicate funds and sufficient numbers of trained personnel in disease, ignorance, hunger and malnutrition in the these transitory years, and time is against us. We are SEVENTH PLENARY MEETING 117 at war with the formidable forces of malaria, tuber- are exported from their countries are thoroughly tested culosis,blindness,smallpox, cerebrospinal menin- and passed before they can be exported outside the gitis, leprosy, trypanosomiasis, and other endemic and country of manufacture. WHO and UNICEF jointly epidemic diseases common in the tropics. It is here can also assist the governments of the developing that I want to place on record the great debt of countries to mount, equip and staff test laboratories gratitude that we owe to WHO, UNICEF, and the to ensure that the quality of the drugs that are imported Governments of the United Kingdom, the United into these countries conforms to the internationally Statesof America, and theFederal Republic of accepted standards. Germany for the various aid they have so far been I suggest also that the World Health Organization able to give and promise to give us in our fight against give consideration to the desirability of giving financial disease.I believe and hope that these bodies and assistance directly to the governments of the developing countries can still do more and that other more for- countries to enable them to execute approved health tunate countries, in a position to assist, will come to projects. our rescue in this our greatest hour of need.Infant Finally, I appeal to all the rich and developed nations mortality is still high in Nigeria compared with the to give most careful consideration to the contents of the rate in the developed countries, our child and the Director -General's introductory remarks to his maternal care facilities are still inadequate, and the 1962 Annual Report to the World Health Assembly expectation of life is below that which obtains in the and to the United Nations, and to appreciate the im- richer and more developed nations. portance of giving health higher priority than at With assistance, we can bring about improvements present in their national schemes for aid to the new that will have great effects for good.The mighty nations, since good health is the bed -rock upon which nations of the world spend billions on nuclear weapons alone other worth -while developments can progress and the production of rockets and astronauts that and succeed. will land on the moon and Mars and establish mili- tary bases there, from where they can destroy mankind The PRESIDENT : Thank you, Mr Okwu. I now call if and when they wish. The best scientific talents of on the delegate of Libya. the world are directed to research in and production of nuclear weapons and moon rockets, while millions Dr BISCHTI (Libya) : Mr President, fellow delegates, die of starvation, malnutrition and disease in the it is my privilege to have the opportunity of addressing poorer parts of the world.I suggest that the World your honourable Assembly during its sixteenth annual Health Organization, through the United Nations, meeting. On this happy occasion I am glad to present, take steps to negotiate with these powers an interest - on behalf of myself and my delegation, my real free loan of 25 per cent of their single -year budgets congratulations to the new President on his election for nuclear arms and rocket productions, to be invested to this honourable post. This election is a well- deserved in the work of WHO and UNICEF. honour conferred upon a brilliant African personality Mr President, I feel in duty bound to draw the atten- and on his great country, Nigeria.I am delighted tion of this world body to an important aspect of the also to welcome all the new Members, especially many problems the emerging nations have to confront Algeria, whose heroic struggle for freedom is unique in their efforts to improve the health of the masses in modern history.As for the reappointment of of their people, which I would like to be investigated. Dr Candau, I would rather congratulate ourselves on The first is that drugs and equipment imported into having him reappointed, as his presence at the head these poor countries are sold at fantastically exorbitant of our organization is a security for its full success prices, out of all proportion to the cost of production. and growth. Trade in pharmaceuticals in the developing nations is Mr President, fellow delegates,I am pleased to largely in the hands of foreign trading firms who, inform you that my country, being aware of the ever - through various trade controls and monopolistic increasing responsibilities and activities of the World practices, ensure that their prices remain very high. Health Organization, has raised its annual contribu- Secondly, concern has lately been expressed that tion to the regular budget to the amount requested substandard drugs are being dumped into the drug by WHO.I hope that our contribution in the next markets of the new countries, where clinical test years will increase according to the rate of growth of facilities either do not exist at all, or are grossly the activities of WHO. inadequate. In this respect, I would like to remark with satis- I therefore suggest that the World Health Organi- faction the achievements realized by the World Health zationrequestthe Member governments of the Organization during the last year. The tribute to this exporting countries to ensure that the drugs which success is duly paid to WHO staff and their experts. 118 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The annual reports of the Director- General and the Mr BAREDETSE (Burundi)(translation fromthe Executive Board concerning these achievements are French) : Mr President, ladies and gentlemen, at the most accurate and enlightening. opening of this statement, which I shall do my best Allow me to inform you very briefly of some events to make clear and brief,I want to acquit myself of which took place in Libya during last year and early some agreeable duties.In the first place, I should this year, because of their relevance to health and like to thank the World Health Organization for sanitation. having admitted the Kingdom of Burundi to full In the first place, I would like to inform you that membership of the Organization, on 22 October important constitutional amendments took place in 1962.On 1 July 1962 my country, under the firm Libya, by which the federal system is abolished and a and enlightened guidance of its King, His Majesty unified system established.This change, apart from Mwami MwambutsaIV,attainedtonational the fact that it is a realization of a national ideal long sovereignty, with rejoicing indeed but also in an aspired to, constitutes a political reform whose benefits atmosphere of calm and dignity. This gave a proof of will be felt in every field.For example, in our field our political maturity to the world -which had been of healthallsanitaryservices,institutionsand put on the alert by the arduous discussions in the establishments are now under the effective control Trusteeship Council before the event. of the Ministry of Health; consequently the co- opera- Next, Mr President,Ishould like cordially to tion between the World Health Organization and the congratulate you on your elevation to the exalted other international organizations on the one hand, post with which this Assembly has entrusted you. The and the Ministry of Health on the other, will be more masterly, tactful and authoritative manner in which effective and more felt by our people. you are directing our discussions amply testifies to Another event of importance is our five -year plan, the wisdom of the choice made by the delegations which will start in the second half of this year. In this present.Dr Candau, you have been unanimously plan, paramount importance is given to the develop- re- elected to the post of Director -General of the ment and raising of health standards in Libya, with World Health Organization.That unanimity is a special stress on environmental sanitation, housing, striking proof of the confidence we have in you. We health education, and training of technical personnel. congratulate you and hope that this new term of A third important event which happened last office will enable you to carry out new projects for February was the earthquake of Barce.I mention it the benefit of the less fortunate peoples. here only to thank collectively all the friendly countries I must not conclude these introductory remarks which gave us prompt aid during that catastrophe. without paying a tribute to Belgium, which left my Mr President, fellow delegates, I am going to allude country aninfrastructureof medicalinstitutions very briefly to our main health problems, which are : (hospitalsanddispensaries) andisstillmaking shortage of technical personnel, tuberculosis,tra- doctors and trained technicians available to us.It choma, and high infant mortality rate. To deal with is my hope that this aid will increase, and particularly these problems, my Government is carrying out various that more doctors will be sent out to us, for the programmes, projects and campaigns, most of them current shortage of doctors is our main worry. in co- operation with our Regional Office, UNICEF, I have the honour, gentlemen, to be the head of the and other friendly organizations. delegation of independent Burundi at this Sixteenth My delegation wishes to stress the importance of the World Health Assembly.I should like to take this preparation of trained personnel, both medical and opportunity of thanking the World Health Organi- paramedical, undergraduate and post -graduate; any zation, and particularly theBrazzaville Regional help or advice given to my country in this respect will Office as well as UNICEF, which did not wait for be greatly appreciated. In our present stage of develop- our admission to full membership before starting to ment, we are more in need of fellowships for post- give us their assistance in the field of maternal and graduate study in the various medical and paramedical child welfare. As early as September 1961 we received specialities. UNICEF assistance for equipping new medical and Before I close I would like to thank our Regional public health schools; the curricula of the schools have Office for the special attention itis paying to my been revised in accordance with WHO's directives, country, and to thank all the international organi- so as to take into account the important concept of zations that are helping Libya in her various pro- preventive medicine. grammes of development. My best wishes to you all. Immediately the country became independent, an advisory team consisting of a public health consultant, The PRESIDENT :Thank you, Dr Bischti.I now a public health nurse and a sanitary engineer were sent recognize the delegate of Burundi. out by WHO headquarters at Geneva. The function EIGHTH PLENARY MEETING 119 of the team was to assess the country's requirements In addition, now that our secondary schools are and to make recommendations for a programme training a sufficient number of young people amply of assistance. qualified to take an ordinary full university course, it Let me now run briefly through the various WHO would be desirable for WHO to continue to make projects in Burundi. We are expecting at any moment fellowships available to us for training the national a paediatrician and a sister tutor, to take part, along- cadre of doctors, pharmacists, dentists and other side the existing teaching staff, in the training of our technicians that the country urgently needs.Itis public health auxiliaries.We are expecting at the also essential that the higher cadres should be backed end of the year a sanitary engineer to carry on the up by fully qualified staff.It is a matter or urgency, training of sanitarians already begun by thefirst therefore, to organize further training courses to advisory team.At about the same time, Burundi is enable our best people to make a more thorough to be visited by an advisory team whose function it study of radiology, laboratory techniques, anaesthesio- will be, among other things, to study conditions for logy, ophthalmology, pharmacology, dentistry, and an antituberculosis campaign. The malaria pre - public health.I make an urgent appeal for help in eradication project that was under discussion had to this connexion, not only to the World Health Organi- be deferred to 1964 for budgetary and staffing reasons. zation, but also to all countries that may be willing, Concluding the list, I want to thank the Director - in their generosity, to give us bilateral assistance. General for having made available to my Government Until such time as our national cadres are trained, it fellowships for nine assistants médicaux to study for is essential that we be sent a certain number of medical their medical degrees in France. practitioners to fill the vacant posts in hospitals which, Be assured, gentlemen, that my country realizes to although fully equipped, lack doctors.This is the the full how much help it is being given by the World most pressing problem we have tosolve, and its Health Organization.But the help falls very far solution lies in your hands. short of meeting, even in part, the immense needs of My Government counts on your understanding and our working population. Many scourges of different assures you of our trust in you and of our gratitude. kinds are still endangering health : suffice it to mention The PRESIDENT : Thank you, Mr Baredetse. malaria and the rickettsioses (which are raging with We will meet in this hall tonight at 9 to continue a hitherto unknown virulence), tuberculosis,ver- the general discussion. The meeting is now adjourned. minoses, malnutrition, etc. Systematic control of these scourges is a matter of urgency. The meeting rose at 6.5 p.m.
EIGHTH PLENARY MEETING
Tuesday, 14 May 1963, at 9.20 p.m.
President: Dr M. A. MAJEKODUNMI (Nigeria)
1.General Discussion on the Reports of the Executive 1962 and of the headway that has been made in the Board and the Report of the Director -General remarkable task he has undertaken. We realize that on the Work of WHO in 1962 (continued) this task must sometimes be fatiguing, but it is thanks The PRESIDENT :The meeting is called to order. to the great efforts he has made and to the construc- We shall continue discussion of items 1.9 and 1.10. tive spirit he has shown that it has been possible I recognize the delegate of Cuba. to obtain the results described in the Report. Dr MARTÍNEZ REYES (Cuba) (translation from the Allow me also respectfully to greet our President Spanish) : Mr President, fellow delegates, I should like and our Vice -Presidents; they will, we are sure, with on behalf of my delegation very warmly to congra- their wide knowledge of the problems with which tulate the Director -General on his reappointment, and we shall be dealing, direct our work effectively and on his excellent Report -in which he has given a enable us to reach conclusions that will make a useful detailed description of the Organization's work in contribution to the promotion of health in the world. 120 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Ipresent my fraternal greetings to the outgoing man of the future. This means doing away once and President, who directed the work of the last Assembly for all with the lamentable shortcomings that used most capably. We thank the Swiss Government and to be the order of the day in public health matters the inhabitants of this beautiful city of Geneva for in our country.The Revolutionary Government is the cordial welcome they have given us, and we wel- accordingly tirelessly applying itself to developing come here our brothers who represent the countries the public health services and to promoting the that have just become Members of the Organization. advance of science.Cuba has now 0.9 doctors per We should like to take up a few of the points 1000 inhabitants; 60 per cent of the doctors (about mentioned by the Director -General in his Report, to 4000) are employed by the Ministry of Health. The show what the Cuban Revolutionary Government has Revolutionary Government is, in addition, convinced achieved in the field of public health.The island of that in order to carry out the public health plans, more Cuba is114 500 square kilometres in area,1200 and better professional and auxiliary personnel are kilometres long and from 40 to 200 kilometres wide. required.It accordingly in 1962 opened the Medical It has a population of 7 134 044. The budget for the School at the University of Oriente Province; this current year is 2 093 560 093 pesos (a peso is worth School, together with the Medical School in the about a dollar), 126 052 867 of which, or 6.02 per cent, capital, will produce by an early date enough doctors are allocated to public health. We may mention, to to satisfy the needs created by the implementation of give a standard for comparison, that in 1958 the budget our development plans. A present some 3400 Cubans, of the Ministry of Health was only 20 582 965 pesos, all holding fellowships given by our Revolutionary which means that expenditure on public health has Government, are studying medicine. risen from 3.25 to 15 pesos a head between 1958 In regard to the nursing services, the Revolutionary and 1962. Government was confronted with an extraordinary All the delegates present will realize that a six- shortage that made it impossible to meet even the fold increase in the budget in four years makes it 1958 demand.It has opened three new schools of possible to promote a host of public health activities nursing and increased the intake of students in the of different kinds which either did not exist in our seven already existing; as a result, 1000 certificates country before or used to get pigeonholed in bureau- were awarded during the last three years and 1800 cratic bodies that in no way corresponded to the students are at present taking the courses in the ten needs and wishes of our people. schools now open. The number of hospitals, for example, has risen During the period in which this educational pro- from 87 in 1958 to 146 in 1962, with a total of 27 464 gramme was being carried out, we created a body beds, apart from the beds in nursing homes and other of auxiliary nurses, 2000 in number, scattered through- institutionsformerly managed by mutual benefit out the island; we envisage training 2000 more in the societies, which now come under the Ministry of next three years. This has meant entirely reorganizing Health.These bring the total up to 38 199 beds; the schools and providing them with the necessary in addition to which there are 5512 beds in old peoples' funds and teaching staff. We hope by 1966 to have homes and day nurseries.Thus the grand total of made good more than 60 per cent of the present beds is 43 711, or 5.4 beds per 1000 inhabitants -or shortage. At the same time we have trained 200 public approximately four beds per 1000 inhabitants in health administrators, 130 sanitation workers, 120 general hospitals excluding sanatoria, leper hospitals dental assistants, 50 nursing instructors, 350 X -ray and mental homes. With the new hospitals that are technicians, 80 statisticians,30 mental nurses, 80 to be built we shall certainly have some five hospital nurses for premature infants, and other paramedical beds per 1000 inhabitants in 1966. personnel. Altogether,3800auxiliariesof these In connexion with hospitals, we should like to categories have obtained their certificate in two and emphasize the importance our Revolutionary Govern- a half years and more than 4000 are at present receiving ment attaches to rural areas :it has set up thirty -eight this vocational training. hospitals in rural areas, situated both in the most Another thing I should mention is the child welfare remote plains and in the most inaccessible hills of work we are doing :children represent our country's our epic Sierra Maestra -which was the glorious future.The Ministry has begun to attack the main theatreof our liberating revolution- hospitalsin causes of infant mortality in Cuba, namely premature which thousands of Cubans are today receiving birth, gastro- enteritis and respiratory diseases. In the medical attention they never before enjoyed in the second half of May a campaign against gastro- course of our history. A revolution like ours -that enteritis is to be launched throughout the island. A is, a real revolution -must set about creating all the large variety of factors are involved, but it is certain conditions necessary for the gradual emergence of the that the action we shall be taking with the means EIGHTH PLENARY MEETING 121
available to us will bring about a marked decrease are grounds to believe that this type of the virus has both in morbidity and mortality. Our gastro- enteritis suffered cross -inhibition with type II, the dominant mortality rate -43.3 per 100 000 inhabitants -is low strain, since the results obtained with type II of the compared with that in other countries in Latin virus are in every respect satisfactory. America or Asia, but none the less we consider it Only a few weeks ago the first vaccinations of the unduly high. second campaign were carried out, with bivalent Both in this and in other branches of preventive vaccine (T -2 and T -3) and univalent vaccine (T -1); medicine we are making every effort to create a sound 2 201 164 people have been vaccinated already, and basic administrative machine.Since 1961 we have the second vaccinations are probably being carried founded seven health and epidemiology centres, two out at this moment. I may say that the results of the in the most easterly province and one in each of the first campaign could not be more satisfactory.The other provinces, and also a virology centre.Each average incidence used to be 200 to 250 new cases a epidemiology centre is responsible for superintending year, with outbreaks of over 400 cases every four or the carrying -out of national projects in the small five years.Since May 1962, i.e. a few weeks after localities within its province.The centres deal with the vaccination campaign began, not a single case environmental conditions, study diseases and decide has been reported in the whole of Cuba. upon ways of preventing them, with the help of We are carrying out tuberculosis control by the various governmental departments -the Departments following means :intradermal BCG vaccination in of Environmental Health, Labour, Education, Food, all clinics and use of lyophilized vaccine in schools, HealthEducation, and Epidemiology -and of a throughout the entire country; X -ray case -finding, bromatological and bacteriological laboratory. They organized with increasing efficiency with the aid of also co- ordinate their activities with those of other improved equipment; increased medical care and official bodies :the National Commission for Aque- development of out -patient treatment.I would add ducts and Drains, the Ministry of Works, the National that we have 3871 beds for tubercular cases and aim Institute of Agrarian Reform, etc.By means of the at having 6000 by 1964.Lastly, mention should be centres, vaccination against diphtheria, tetanus and made of the economic and social aspects of this whooping -cough is being intensified; those diseases struggle, which is not simply a matter for the Ministry are still so serious in Cuba that they have been of Health, but a battle that is being fought by the responsible for 2732 deaths in the last eight years. A Revolution itself, which has carried out the agrarian national campaign was carried out from 15 October reform, raised wages, increased the masses' purchasing 1962 to 22 February 1963 to finish off what was done power, abolished -in a single year, by means of an in 1960, 1961 and the first half of 1962:1 425 900 exemplary crusade -the illiteracy that we inherited complete vaccinations with the triple vaccine have from colonialism, and recently promulgated a social been effected.In the last two years 2 500 000 people security law providing for contributions to relieve were immunized against typhoid fever. We are not workers who contract tuberculosis.All these things relaxing our vigilancewith regard tosmallpox, are playing a role of fundamental importance, and they despite the fact that our country rid itself of that will shortly reduce tuberculosis morbidity, which now disease over forty years ago. stands at 0.8 per cent. in individuals over fifteen years Another big undertaking in preventive medicine of age. that should be mentioned is the large -scale campaign Realizing that the problem of health is a highly our country has carried out against poliomyelitis; complex one, and one of the greatest human import- the Assembly heard Dr Escalona's report on this ance for the Revolution, Cuba is carrying out its two last year, which gave full details about a mass vaccin- big campaigns with the help of WHO and the Pan ation campaign by the Sabin -Cumakov method, in the American Sanitary Bureau.Of these, the malaria course of which 2 300 000 children under fifteen years eradication programme is proceeding as forecasted. of age were immunized, i.e. 87.5 per cent. of the child Although malaria is not a very serious problem, the population.The evaluation of this campaign, made campaign is being pursued vigorously, as everyone with the help of Dr Karel 2á26ek of the Prague knows, and it is permissible to hope that in three or Institute of Epidemiology and Microbiology, showed four years Cuba will have freed itself from malaria that in the samples studied before the vaccinations in the same way as, in the field of education, it has there was only a small percentage of individuals freeditself from illiteracy.InregardtoAëdes protected by antibodies, in particular type II anti- aegypti control, mention should be made of the fact bodies, and mainly in the under -six age -group. Since that a new four -year agreement has just been signed administration of the first dose it has been found that with the Pan American Sanitary Bureau, and a million the results obtained with type I were mediocre; there pesos a year have been allocated for the agreement's 122 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II implementation.By 1962 over 20 300 square kilo- inspired with a spirit of enthusiasm and patriotism, metres, of the country's 114 500, had already been see to the carrying out of all the Ministry's recom- covered. mendations. I should also like to say a few words about the This is our country's best disciplined army, and sewerage and water supply plan being carried out by like the people as a whole it is fighting solely for the the Ministry of Works, also the plan for extending well -being of its families, for the building of a juster water -supply and sewagedisposalsystems.The society, for the ideals of peace, for a better world. former plan, covering a five -year period, will involve Our people is thus defending its right to self- determin- an expenditure of 50 000 000 pesos, and result in ation and consolidating its freedom and sovereignty, 126 centres of population being provided with a which are endangered by a grievous threat that is proper water supply; in addition, sewers are to be obliging us to use part of our resources for the built for seventeen other centres, involving an ex- defence of our land and preventing us from devoting penditure of 47 000 000 pesos.Improvement of the them exclusively to improving our own living con- water supply in 154 other centres of population is ditions and the world's health.This right of our also contemplated, costing 68 000 000 pesos, and people to work and to build its future is still being a improvement of the sewer system of thirteen centres, target for attack on the part of forces which, carried representing an investmentof 43 000 000pesos. away by egotism and hatred, are trying to hamper the Thanks to this, and to the new towns which will performance of this peaceful task.Still ringing in make new industrial enterprises to spring up in our this Assembly hall is the sound of the words with land, and which will be provided with these basic which our delegation, at the last session, denounced public services, we hope that our country's fifty years the plot that was being hatched to expel Cuba from of neglect will be amply made up for in the next thePan American HealthOrganization. That fifteen years. monstrous plan was unanimously rejected by the All this work has been greatly facilitated by the delegates at the Minneapolis Conference, who refused reforms that have been carried in the structure of the to permit such a violation of the Constitutions both Ministry. The features of the new system are decentral- of PAHO and of WHO. ization at the administrative and executive levels, and Notwithstanding this, a meeting of health ministers centralization at the top. Four sub -departments have was convened only a few days ago by the Director of been set up :Medical Care, Hygiene and Epidemio- the Pan American Sanitary Bureau, without Cuba. logy, Economy and Planning, and Medical Supplies. The purpose of the meeting was to consider the most In addition, the Ministry has taken over all the health pressing problems and to decide upon a line of action servicesthat were previously provided in adis- for the immediate future in regard to communicable connected way by independent or semi -independent diseases,sanitation -especiallywatersupplyand bodies under the municipalities, other ministries and sewage disposal -control of infant and neonatal administrations,theUniversity,socialinsurance mortality,improvement of nutrition,trainingof schemes, and similar institutions dependent on private personnel, and general improvement of health services : enterprise. Despite serious initialdifficulties, the in short, to deal with vital matters.And this is problem has now been solved and health work is happening without Cuba's being present, just because more efficient. that programme is backed by an organization whose Our campaigns havealsoenjoyed thewhole- main objective is to launch an unprovoked assault hearted support of the masses, which have been against our country. brought in to take a direct part in carrying out public No, gentlemen, one must speak out.Let this health programmes.In each people's organization organization tell you what it wants to do, let its there is an officer responsible for health matters.In proposal be studied to see if it is reasonable or not, other words, each Revolutionary Defence Committee, and let the means for studying it be provided; but the Federation of Cuban Women, the Union of the Members of WHO must not allow their course Young Communists, the National Association of of action to be dictated to them.For the World Small Farmers, the peasants' associations, the workers' Health Organization was set up for collaboration trade unions, etc. each have their own health delegate, between States and it is ridiculous -I repeat, ridiculous who gives effective help to the Ministry in connexion -to try to exclude one of its Members from health with health work. The Ministry has set up a People's programmes thatarebeingcarriedoutinthe Health School for these organizations, which has Americas and to cold -shoulder the competent Ministry trained 3000 instructors, who in their turn have of this country in order to satisfy the demands of a organized seminars in their respective localities for the servile and decadent political body whose initials, training of 120 000 health workers.These workers, OAS, do not stand for Organization of American EIGHTH PLENARY MEETING 123
States any more, but for Organization for Aggression fight against communicable diseases, to co- ordinate against States. Once again, with undaunted tenacity, its activities and bring them to a successful termination. we raise a protest -composedly but with firmness, My delegation feels that, at this stage of WHO's respectfully but with force.Nothing will stop our activities, and in view of the existing financial situation, advance,nothingwillweaken our faithor our closer consultations with the other agencies, not only enthusiasm :we shall go on fighting in the World at the planning stage but in field work, would promote Health Organization to secure respect for its prin- maximum utilizationof thefinancial and other ciples and to realize its ideals.At home we shall resources of the various organizations. My delegation strive for peace and the welfare of mankind; we shall is happy to note that the Director -General has drawn go on fighting diseases one by one, we shall check attention to the role which planning and evaluation epidemics, we shall reduce our mortality, and thus can play in national ministries of health as an effective Cuba will, honestly and with steadfastness of purpose, way of utilizing present and future resources for make its contribution to the aim of WHO, namely, the health needs. well -being of the whole world.While doing this we There are reasons to think, from a study of the shall not drop our guard, and we shall hold ourselves Director -General's Report, that the health problems in readiness to repulse any kind of aggression with the of the future might be more complicated, more battle -cry " Cuba or death ". persistent and perhaps much more difficult to solve. In finding ways and means to meet the challenge and The PRESIDENT : Thank you, Dr Martínez Reyes. to find answers to these problems, national efforts I now recognize the delegate of Ghana. alone may not be adequate. My delegation is therefore Dr EASMON (Ghana) : Mr President, distinguished most happy to learn of the maximum co- operation delegates, it is a great pleasure for my delegation to that WHO receives from scientists all over the world congratulate Dr Candau on his reappointment to the for the promotion of health and knowledge in general. post of Director -General of the Organization for My delegation welcomes WHO's intensified efforts another term of office, and to pay tribute to his in medical research, since it is our belief that this will excellent Report on the Organization's many activities help to provide people throughout the world with in the field of public health. facilities to prevent and control diseases generally My delegation extends to you, Mr President, its and especially those which have proved elusive. congratulations on your unanimous election to the The misfortune and misery which thalidomide has presidency of this Sixteenth World Health Assembly. brought to many homes and families call for positive We extend to you our full support and co- operation measures to control drugs. To this end my delegation in the discharge of the duties of your high post, feels thatgovernmentsin drug -manufacturing which we consider a tremendous tribute to you countries,pharmaceuticalcompanies,and WHO personally, to your country in particular, and to should demonstrate the leadership necessary.If the Africa in general. confusion and dangers to which unrestricted pharma- The Report of the Director -General has indicated ceutical preparations will expose man are to be the trends in the world's progress towards better averted, drug control must be tightened. Legal health and the needs of our different countries. Our provision in respect of new pharmaceuticals should delegations have already given much thought during not be lax, since governments have a responsibility our deliberations to the role that our respective for the health of their peoples. health services on the one hand, and international The shortage of trained medical personnel is an co- operationwith WHO andotherspecialized important health problem in the developing and agencies on the other, can play to further progress emerging States and is being acutely felt today. With towards the attainment of the objectives of WHO. the interplay of health education, the raising of social The notable achievements of WHO in 1962 have standards, and economic advancement through indu- been due, in the opinion of my delegation, to the strialization, this shortage, in the absence of training tenacity of purpose of the Organization, co- operation facilities, will be more acutely felt.For this reason by Member States, and above all the participation of my delegation endorses the education and training Member States in the cost incurred in discharging the programme of WHO, sinceitoffersa practical work of WHO during the year under review.It is, approach to the manpower shortage of the developing however, apparent from the preamble to the Director - countries.In view of the considerable benefit whch General's Report that the lack of adequate funds is Ghana hasderived from WHO- assistedtraining the limiting factor which isaffecting the work of centres in Ghana, my delegation finds great satisfaction WHO. My delegation feels that something should with WHO's education and training programmes, be done about this to enable the Organization, in its because they are indispensable to the development of 124 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II good national health services. My Government will Presidents of this Assembly, also Dr Kurasov and the continue to seek WHO's advice and co- operation whole line of Presidents of the Assembly before him. for the training of much -needed health personnel. Dr Candau, the distinguished services you have As far as the African Region is concerned, there is rendered mankind asDirector General of WHO no doubt that, if the doctors of today or of the future have been sufficiently extolled by the speakers before and any other paramedical personnel areto be me for my delegation warmly to welcome your properly orientated towards preventive medicine, their reappointment. We are sure that in your five years training should be provided within their own or of office you will guide the Organization with your related physical,social and cultural environment. accustomed skill and impartiality. We believe that itis in this way that the proper Mr President, it has become a mere commonplace integration of preventive, curative and rehabilitative to speak of the fundamental part WHO is playing in medicine can be achieved.This orientation will not the advance and the harmonious development of all be easy for the older medical schools in developed the countries in the world.Permit me to say, never- countries, but should not be impossible for the new theless, that after the two world wars which laid this medical schools which are being established in Africa, planet waste and cost the nations of the world millions if given proper guidance by WHO. of dead and ten years of blood and tears, suffering If I now turn my attention to environmental mankind sees in our organization a beacon of hope, sanitation for a few brief comments, it is because my on account of its peaceful objective and the promise delegation feels that environmental sanitation is an it has made the world that all diseases shall be eradi- outstanding problem in many parts of the world. cated from the face of the earth.Such a beacon of The unsolved problems of environmental sanitation hope is particularly needed because the danger of a in certain countries are the cause of much morbidity world war has not been removed once and for all : and mortality.Help in this field, through WHO's I may mention by way of example certain aggressions activities, will improve the social, economic and health against small peace -loving countries, the unleashing standards of millions of people, especially in the in certain parts of the world of racial hatred in its developing and emerging countries. most despicable and degrading form, and the domi- The improvement in the health situation in the nation of certain countries, particularly in Africa, by developing and emerging countries, notwithstanding foreign powers. You will also remember the recent the complexity and variety of their conditions, should bombing of the peaceful little Senegalese village of be fostered since it will help to achieve the objective Boumak by Portuguese aircraft. that we all urgently desire to attain -the attainment Mr Director General, my delegation has read with by all peoples of the highest possible level of health. the greatest interest your excellent Report on the In conclusion, Mr President, please allow me, on Work of WHO in 1962 in the various continents. In behalf of my delegation, to wish the work of the Africa, WHO is protecting from mass diseases nearly Sixteenth Health Assembly everysuccess. My 156 million people belonging to twenty -sixStates. delegation and my country will do everything possible Despite the scattered nature of the population and to contribute to the accomplishment of the Organi- despite, in some cases, the modest means at WHO's zation's noble mission -the struggle against disease disposal, the efficient organization of its services and and misery. the skill of its technicians and research workers have enabled real progress to be made inour newly The PRESIDENT : Thank you, Dr Easmon.I now independent countries. call on the delegate of Senegal. Senegal is one of the countries that frequently call Mr COLY (Senegal) (translation from the French) : upon the Organization for help with the development Mr. President, fellow delegates, allow me on behalf of their national health services. A few months ago of my Government warmly tocongratulatethe we were visited by a WHO tuberculosis consultant. Minister of Health of the Federation of Nigeria on A sanitary engineer and an environmental health and his election to the office of President of the Sixteenth sanitation expert, both from WHO, are working World Health Assembly.His election is at once a in Senegal at the moment. It would take up too much reward for the consistent efforts Nigeria has at all time to enumerate here all the multifarious aspects of times made to promote peace, and a recognition of the assistance we are receiving from WHO. that country's contribution to our organization's My country attaches great importance to health and progress. But at the same time it is a tribute paid, not social matters.This is clearly shown by our current only to Nigeria, but also to the whole of Africa.I four -year plan. The aims of this plan as regards health hould like,in addition, sto congratulate the Vice- and socialactivitiesare the improvement of the EIGHTH PLENARY MEETING 125 people's health conditions, particularly in rural areas Like most countries in Africa. my coùntry still where 80 per cent. of the Senegalese live, the training suffers from a shortage of medical personnel, despite of personnel and intensification of research, and the the assistance France is giving us and the praiseworthy creation of the necessary conditions for rapid develop- efforts of our Faculty of Medicine.We have only ment by increasing the amount of preventive and 135 doctors for a population of 3 100 000. educational work. Not only medical and paramedical We have, at Dakar, a blood transfusion centre which personnel, but also all the national services, are taking is one of the largest in West Africa. The research done part in this work. there may enable us eventually to discover more about With WHO assistance we have built a pilot centre at certain haemopathies. This centre is performing Khombole, which has a variety of functions.I shall very valuable services, not only for Senegal, but also confine myself to mentioning a few : training of para- for neighbouring countries. medical personnel, and health education of the public This brief review of our activities in the health and asregardswater,environmentalandhousing social field would be even less complete than it is sanitation. already if I omitted to say a few words about the Food In the control of communicable diseases, Senegal and Nutrition Research Centre at Dakar. This and its neighbours have set up a joint body for the centre, which we share with neighbouring countries, control of the major endemic diseases.There is no is run by distinguished research workers. In a world need to point out the importance of such a body. in which hunger is working such fearful havoc, the At the national level, our Service for the Control of importance of the centre's work is obvious. Major Endemic Diseases, which may be regarded as Mr President, fellow delegates, thank you for your a department of this body, nevertheless does not kindness in listening to my statement. I hope that our function separately from our other public health organization, which has already done so much in the services; it is of very great importance for us, because, struggleagainstunder -development andpoverty, although trypanosomiasis has almost been wiped out will continue to pursue that course which is so full in Senegal and the incidence of smallpox has been of hope for mankind. reduced to a few isolated cases a year, there still The PRESIDENT : Thank you, Mr Coly.I now call remain several major endemic diseases against which on the delegate of the Central African Republic. we are obliged to take energetic measures. Mr MARADAS -NADO (Central African Republic) First and foremost there is malaria, which is rife (translation from the French) : Mr President, fellow everywhere. We have already studied in great detail delegates, on behalf of my Government and of my a malaria pre- eradication programme, and have begun delegation I should like, first of all, to greet all the to carry it out in a pilot zone of 100 000 people. The new Members among us. results obtained are' most encouraging. We shall Mr President, I have much pleasure in congratulating persevere with this and in 1964, thanks to the assistance you on your election as President of this Assembly. promised by WHO and to the further development of Not only you and your Government are to be con- our health infrastructure, our malaria campaign will gratulated :your election is a great honour done to be far advanced. the whole of Africa. Tuberculosis has been spreading alarmingly in I should also like to express my pleasure at the Senegal. Some 8 per cent. of the population is tuber- reappointment of Dr Candau to the post of Director - cular. The percentage of tuberculin reaction shown by General of the World Health Organization. the cutireaction is as follows : 10 per cent. in the zero I have studied with great interest the Director - to five age -group; 37 per cent. in the five to ten; General's Report on the Work of WHO in 1962. 50 per cent. in the ten to fifteen; and 70 per cent. in the The Report shows not only that the targets set last fifteen to twenty age -group. year have been attained, but also that the Organi- About 38 000 people have leprosy.We still have zation's new orientation will make possible a better with us bilharziasis, syphilis, trachoma, meningitis utilization of resources and a greater amount of and measles.Our Service for the Control of Major assistance to the developing countries. EndemicDiseasesisruthlesslyattackingthose My country, like other States, is still afflicted with diseases. numerous communicablediseases. Consequently Our maternal and child welfare services have made health is not satisfactory and a large number of new strides in recent years.Their many activities, endemo- epidemic diseases remain despite a big medical which are integrated with those of the general health effort made by the Government, and the setting up of services,includepreventiveandcurativework, 200 new first -aid dispensaries.Equipment and an sanitation work, and social work. increase in the number of curative centres cannot 126 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II provide a satisfactory solution to these problems : South America and Asia, there was a considerable they call for concerted action on the part of several increase in poliomyelitis infection in 1960 and 1961, ministries.Improvement of public education, of the and that this was also noted in some countries of national economy, and of rural equipment is also Europe.This probably will be a stimulus to many essential, to raise the country's level of health.In countries to consider urgently setting up vaccination the meantime, mass preventive medicine will, as before, programmes. protect the people from the most dangerous endemo- We noted with due concern the significant persistent epidemic diseases.The World Health Organizaton increase in the incidence of venereal infections during has already given us, in this field, assistance that we the latter years and look forward to urgent con- appreciate. sideration being given to this alarming health and Another of our weaknesses is shortage of skilled social problem. We noted the assistance given to the personnel, and we are grateful to WHO for any control and eradication of communicable diseases, assistance it may give us to help make this shortage bilharziasis and other parasitic diseases, and tuber- good. More centres for the training and further culosis; and to the research on leprosy, which may training of auxiliary personnel must be set up in bring improvement in control.We also noted the Africa.Visits by experts can be valuable if they take research in progress on cancer, the leukaemias and the local conditions in our countries into account. cardiovascular diseases, and we noted with satisfaction Lastly,assistancemustnotbeunsystematic : the work on trachoma control and research, the co- ordinationof programmesisessential.Their strengthening of national and international action co- ordination ought to be sufficiently flexible to make for the eradication of smallpox, and the favourable allowance for certain urgent special circumstances. assistance from UNICEF to this programme as well The long time that is sometimes taken to send out a as to others. mission in connexion with granting of aid should also My country, with the assistance of WHO, is at the be reduced;Ihave tuberculosis and bilharziasis present time planning a five -year project for the particularly in mind promotion of all health matters, both in the curative Such, Mr President, are the ways in which health and the preventive field. We have all heard from the could be improved in my country. We realize that distinguished delegate of the United States of America the effort is largely one which we must make ourselves, that an antimeasles vaccine has been licensed there. but we hope that the World Health Organization will I hope that this vaccine may help in eliminating the help us in the most speedily effective manner. heavy mortality among the children of some countries. About seventeen years ago the ratio of physicians The PRESIDENT :Thank you, Mr Maradas -Nado. to population in my country was 1: 50 000.At the I now recognize the delegate of Saudi Arabia. present time, it is about 1: 12 000; and in five years' Dr ALSAYED ALY (Saudi Arabia) : Mr President, time itis expected to be significantly ameliorated. distinguisheddelegates,I would like to take this This will be accompanied by a relative increase in the opportunity, Mr President, to express my very sincere number of technicians and auxiliary medical personnel. congratulations, on behalf of my Government and Seventeen years ago we had one hospital bed available my delegation, on your election as President of the for every 16 000 people; now we have one hospital Sixteenth World Health Assembly.It is a further bed for every 1600.Curative and preventive units privilege to join the previous speakers in congratulating are well scattered over all the country.It is planned the Director -General on his excellent and admirable to raise the number of these units to 600 within the Report. My delegation also extends a hearty welcome coming few years. In the field of prevention, to which to Algeria and to all new Members and Associate special attention has been given by my country Members. lately through the assistance of WHO, we shall have My country views with great interest the praise- in the near future sixty of these preventive units in worthy progress made by WHO and the problems all parts of the country. raised, as they appear in the Report of the Director - Realizing the existence in our region of the common General, concerning the activities and research into problem of shortage of medical and auxiliary health some of the most important health problems on the personnel, the Government of Saudi Arabia, through part both of the developing countries and of those the assistance of WHO, is going to increase the number enjoying high social economic and health standards. of training and teaching institutes all over the country, These problems include the resistance of important in order to have as many of its nationals as possible vector anopheles to insecticides and the drug resistance specialized in various medical and health fields.A of Plasmodium falciparum in some areas.It has also project for establishing a medical college is under been mentioned that, in many countries of Africa, study.Thanks to WHO assistance, we were able to EIGHTH PLENARY MEETING 127 establish two nursing schools, and itis planned to units, and a big team of doctors and technical personnel gradually increase the number of these institutes. headed by the Minister of Health, are all offered by An institute for research on endemic diseases will be my Government to serve the pilgrims from all countries. established with the assistance of the United States Every year during the pilgrimage season, the Ministry Naval Medical Research Unit No. 3. of Health studies one of the main problems in collabor- Our problem No. 1 is malaria, and my Government ation with WHO. During the 1962 pilgrimage, the is participating in the world -wide eradication campaign subject of study was heat diseases, and the effect of under the wise guidance of WHO. A survey was these on the human body. During last year's Regional successfully completed by the end of 1961.In the Committeemeeting,heldinRiyad,exhaustive next two years, attention will be given to the develop- discussions were held on the same subject.At the ment of the rural health infrastructure, which will present time a second subject is being studied with the take over the full responsibility of keeping the country assistance of WHO and FAO in the pilgrimage zone, free from malaria by the time the programme reaches namely, the conservation of meat resulting from the its maintenance phase. ritualsacrificeof animals during the pilgrimage. With the assistance of WHO, a number of health Thus we are arriving at a suitable solution of such projects will very soon start in my country, namely, a sanitary and nutritional problem. a public health laboratory, a tuberculosis control Lastly, I can do no better than quote the words of pilot project, and basic public health and medical the Secretary -General of the United Nations :" The care services. For the last project, WHO will provide widening of man's horizons through education and fifteen international advisers specialized in the various training and the lifting of his vitality through better health and medical fields, with the main object of healtharenotonlyessentialpre- conditionsfor improving planning, administrative and supervisory development, they are also among its major object- services in the provincial general health administration ives ". and in the development of integrated and co- ordinated over -all basic health services. The PRESIDENT :Thank you, Dr Alsayed Aly. I now recognize the delegate of Nepal. Realizing thatstandards of healthareclosely linked with the economic and social structure of Dr BAIDYA (Nepal) : Mr President and distinguished thecommunity,severalcommunity development fellow delegates, on behalf of the Royal Nepalese centres have been established, in which the services delegation to the Sixteenth World Health Assembly, of agricultural, social, educational and health experts I take this opportunity of congratulating you on your are directed towards raising the standard of health election to the presidency of this Assembly, and the and towards social and economic betterment. Health more so because you represent one of the developing registration has been introduced into these centres, countries of the world.I am confident that under as well as maternal and child care.Environmental your wise guidance this Assembly will come to a sanitation and sanitary housing planningisalso satisfactory and successful conclusion, as in the past. being carried on in these centres. Ten of the centres The World Health Organization has completed have been established, and it is planned to raise them fifteen years of humanitarian service dedicated to the to sixty in the very near future.This culminated improvement of health standards throughout the recently in the implementation of the social security globe. It is true that the target envisaged has not been law.Treatment is completely free of charge to any reached, but on the whole there is no doubt that the inhabitant of Saudi Arabia. When very special common epidemic diseases,which used to have treatment is deemed necessary, which it would not devastating effects upon human lives in the past, have be possible to carry out in the country, the patient become milder, so to speak; and even if they occur, is sent abroad anywhere where he might obtain any the mortality rate is not so high as it used to be in the relief from his sufferings. past.The World Health Organization should really I feel I should say a few words on the campaign be thanked for making the developing countries against illiteracy.Last year it was estimated that my conscious of public health since, before the inception Government was erecting one school every three days. of this organization, public health was of significance Since my Government has taken all the responsibility only in the developed countries. for the sanitary control of the Mecca pilgrimage, it Now to have a good and well -planned public gives its full attention to the promotion of health health service in a country like mine, we must be facilities,curative and preventive,forthe yearly able to train medical personnel in our own country, congregations which the pilgrimage zone hasto in local surroundings and circumstances, so that as accommodate during the Haj ritual performances. soon as they pass out of the medical institute, they Sanitary foundations, hospitals, health centres, mobile will better be able to adapt to the natural and difficult 128 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II conditions prevailing.I am pleased to inform you programme. We have in Guinea a quinine factory that WHO has already taken a keen interest in this and vast cinchona plantations.But at present we matter and has sent an expert consultant to probe have only the means to make locally twelve tons of into the possibility of starting a medical college as quinine,costing 5000 Guinea francs a kilogram - early as possible, and a report has already been though we sell it abroad at 4000 francs a kilogram. submitted by the expert.Hence I appeal to all the With help from WHO we should be able to supply privileged and developed countries to assist us in the low -cost quinine to all the neighbouring countries, construction, equipping and staffing of a medical since the potential output of the Sérédou factory is college, in whatever form possible, and at the same well over thirty tons a year. time request this organization to help us in this I should also like to draw the attention of this direction, so that our dream may be fulfilled and we honourable Assembly to the slowness of WHO's may thus be able to progress in contributing towards procedures.The newly independent countries have the common goal as set up in the Constitution of pressing needs.Pressing needs call for speedy pro- our organization cedures, otherwise assistance arrives too late and when May I thank our outgoing President, Dr Kurasov it arrives no longer corresponds to the needs, with a and, at the same time, congratulate our Director - consequent break in the continuity of the aid pro- General, Dr M. G. Candau, on his reapppintment for gramme.I suggest that WHO's assistance procedure another term. I am sure that his unanimous re- election be simplified. is due to nothing but the devoted zeal with which I cannot conclude without drawing attention to the he has worked for this organization in raising the consequences to health of apartheid in South Africa. health standards of the people throughout the world. Instead of modifying its system and making it demo- There is no doubt that, under his direction, this cratic, the South African Government, taking its organization of ours will go on from strength to segregation policy to further lengths, has just made strength in eradicating the dreadful diseases from the regulations excluding Africans from towns and con- world, thus making it possible for all people to live fining them to the outlying suburbs and to reserves healthily up to a ripe old age. where indiscriminate crowding and lack of sanitation Before I close, let me thank the Regional Director expose them to epidemics.There is no point in and his staff for all the co- operation and help they recommending health measures or eradication pro- have rendered in the different projects. grammes if in certain countries the people cannot enjoy the benefit of them. Apartheid must be done away The PRESIDENT : Thank you, Dr Baidya.I now with, because it constitutes, in one part of Africa, a recognize the delegate of Guinea. major brake on WHO's health policy of eradicating Dr KEITA (Guinea) (translation from the French) : diseases. Mr President, distinguished delegates, I shall be brief I cordially congratulate the President on his election in view of the President's request and of the fact to his high office, Dr Candau on his brilliant reappoint- that a number of points have already been dealt ment to the post of Director -General, and also the with by other speakers.However, I should like, in Vice -Presidents; and I wish every success to the World connexion withtheDirector -General'simportant Health Assembly, the supreme forum of medical Report, a most valuable document, to draw the atten- science devoted to the cause of health in the world. tion of this august Assembly to two fundamental The PRESIDENT : I now points that are of special concern to my country. Thank you, Dr Keita. In regard to smallpox control, my Government is recognize the delegate of China. making a big effort to convert the Kindia Pasteur Dr CHANG (China) :Mr President and fellow Institute. This institute, which used to produce delegates, on behalf of our delegation, I wish to extend dried smallpox vaccine, is in the course of being my congratulations to you, Mr President, on your converted to make lyophilized vaccine complying election to this high office and to Dr Candau on his with the standards recommended by WHO. My reappointment as Director -General of this organi- country would be very glad to receive assistance as zation. speedily as possible from WHO in the form of experts My delegation has been carefully studying the and equipment, for when it is converted the Kindia Annual Report presented by the Director -General. Pasteur Institute will be able to produce twenty It shows that excellent work has been accomplished million doses a year of lyophilized smallpox vaccine, by Dr Candau and his colleagues.In studying the which can be used in neighbouring countries for Report, we noted with appreciation that the World carrying out the smallpox eradication campaign. Health Organization,inco- operation with other The second point concerns the malaria control agencies, has made a great effort in carrying out EIGHTH PLENARY MEETING 129 education and training programmes to help Member our WHO family has been enlarged by the presence States in the advancement of national health pro- among us of new full Members - Algeria, Rwanda, grammes. Our Government is very grateful to WHO Burundi, Uganda, Jamaica, and Trinidad and Tobago - for assisting us in this respect. and of two Associate Members -Mauritius and Kenya. In regard to the progress of health work in my This is yet another proof of the universal character of country, I would like just to mention a few points our organization. I bid all these new Members most very briefly. In recent years our Government has made cordially welcome. efforts to strengthen local health services in the town- Next, I should like to tell you, Mr Director- General, ships and villages.All the specialized health pro- how highly we esteem you and how much we appreciate grammes (including the malaria eradicationpro- the abundant energy you put into your work and your gramme) have been integrated into the general health devotion to the cause of suffering mankind. What we services and, furthermore, the health services have think of you is shown by the fact that our Assembly now become an integral part of the community has unanimously, by secret ballot, elected you for a development programme in most of the prefectures. further term of office.We are happy and proud to Our experience is that the people's participation in have a man of your quality at the head of our organi- the planning of their own health is essential to the zation.I have great pleasure in including all your success of any health project. colleagues, at every level, in the foregoing remarks We also noted from the Annual Report that about yourself. remarquable progress has been made in the world- The Director -General's excellent Annual Report wide malaria eradication programme.In our country places at our fingertips the whole complex of WHO's the malaria surveillance scheme has been implement- activities throughout the world. Every year there are ed since 1958.The total incidence of malaria remains more and more programmes and the Organization's low :sixty -seven cases were detected in the last year. work expands.Yet many countries, particularly the The surveillance scheme has been strengthened now. countries that have recently become independent, have During the year, the whole country was divided into vast needs and they are impatient to have those needs four areas and various measures for active case - met. The present budget of WHO is still unable to detection were applied, with different intensity accord- meet all requirements.In the name of international ing to the residual potentiality of each area.Aside solidarity I appeal to the developed countries to con- from the presence of 984 public health institutions tribute generously to the Voluntary Fund for Health and agencies, 5000 private clinics and 2300 elementary Promotion or to give the young independent countries schools,thepassivecase -detectionnetwork was bilateral aid. strengthened along with the progressive establish- With your permission, Mr President, I should like ment of voluntary malaria detection posts.Up to to make some remarks on the sections of the Report the end of December of last year, 2000 voluntary dealing with communicable diseases and medical collaborators were participating in the programme research. WHO recently took various measures to and the system is still growing. encourage the organization of a co- ordinated cam- In closing my remarks, Mr President, I wish to paign against smallpox in a large area of West Africa. assure you of our continuing interest and close co- We welcome this step. In view of the fact that public operation with the World Health Organization and health problems are frequently identical in many other Members in the work of world health. African countries, itis incumbent upon WHO to launch a series of co- ordinated campaigns against The PRESIDENT : I now Thank you, Dr Chang. epidemics and endemic diseases. Only by that means recognise the delegate of Upper Volta. can these scourges be overcome. Dr LAMBIN (Upper Volta)(translation from the You are aware that there is in Africa what might be French) :Mr President, distinguished delegates, my called a "meningitis belt ", situated between latitudes delegation has much pleasure in sincerely and cordially 8° and 16° North and extending from the Atlantic congratulating you, Mr President, on your election tothe Red Sea, where cerebrospinal meningitis as President of the Sixteenth World Health Assembly. epidemics rage every year during the dry season.In While your election is an event of which your country 1962 there were 2422 cases of cerebrospinal meningitis can justly be proud, it is at the same time a source of in my country and 348 deaths from that disease. And great pride to Africa, particularly black Africa.I these are only the figures for a mild epidemic. Rational should accordingly like to thank our august Assembly preventive measures against cerebrospinal meningitis, for this mark of confidence.I wish also to congra- both in its sporadic and in its epidemic forms, must tulate the three Vice -Presidents. rest upon firm scientific foundations and these at Allow me, Mr President, to say how glad I am that present are lacking. 130 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
We consider that research bodies should be set up a country that is strong and rich, but one where love, in the large towns in the "meningitis belt ",They brotherhood and charity reign supreme -in short, a would study the percentage of carriers during and country that helps to banish disease, poverty and between the epidemic periods, and fluctuations in that hunger, without attaching conditions. percentage, and also variations in individual immunity and in the immunity of various populations to the The PRESIDENT :Thank you, Dr Lambin. I now meningococcus and any fluctuations that may occur recognise the delegate of Peru. in the organism's virulence and resistance; undertake Dr QUIRÓS (Peru) (translation from the Spanish): Mr research on active immunization methods with a view President, fellow delegates, it gives me great pleasure toobtaining aneffectivevaccine; promote new most cordially to greet, on behalf of the Peruvian therapeutic methods; and, lastly, study preventive delegation, the distinguished delegates of all the coun- chemotherapy. A WHO expert has already carried tries in the world represented here, the Director - out a number of missions in connexion with the disease General of the World Health Organization, and the in the area in question, and we hope that concrete technical and other staff who are so efficiently helping results will very shortly be forthcoming. him to carry out his exalted duties; lastly, I should like I now, Mr President, come to measles, the most to congratulate you, Mr President, on your well - deadly disease among children in my country.The merited election. mortality rate is from 25 to 50 per cent., according to There is no denying that health is fundamental to the severity of the epidemic.With help from the the economic and social development of nations, United States of America in the form of personnel, since it enables the basic element that constitutes at vaccines and equipment, we have successfully con- once the source and the ultimate goal of production, cluded a large -scale measles vaccination campaign namely man, to maintain maximum physical, mental throughout the entire country.Never has a vaccin- and social efficiency. Consequently, apart from its ation campaign been greeted with such enthusiasm by deeply human significance, health has an essential our population.By means of a preliminary pilot practical value, in so far as it enables peoples living in vaccination project, involving 700 children, the various every latitude to attain the state of harmony and postvaccinal reactions were studied and found to be happiness which they desire, harmless.Armed with these preliminary results we Once again we who are specialists in health matters, had no hesitation in launching the big campaign from every region of the world, are met together here, already referred to, involving children from seven prepared tostrive sincerely and disinterestedly to months to four years of age : between 6 November attain our most cherished ideal :that of combating 1962 and 5 March 1963, i.e. in four months, all the poverty, ignorance, disease and death with the weapons villages were covered, and 731 713 children were vac- that civilization and scientific progress have placed in cinated.I am already in a position to say that the our hands. incidence of measles has dropped dramatically, and All of us, I am sure, are eager to bring our exper- the constant fear of measles by which families were ience and knowledge to this Assembly so that our dogged is now a thing of the past.I should like, on fellow men may benefit from them and in order that, behalf of the people of Upper Volta, and especially through the World Health Organization, we may help on behalf of the mothers, to tell the United States of to share out fairly among all the peoples of the world America how deeply grateful we are for its effective, the blessing of that highest attainable standard of speedy and valuable help which is responsible for health which our Constitution declares to be one of snatching thousands of innocent children from the the fundamental rights of every human being. jaws of death. We place reliance on the World Health Organization Continuing my expressions of thanks, I want par- which has consistently, since its foundation, done such ticularly to thank UNICEF for the generous help it fruitful work, and we are convinced that the great is giving us with leprosy control and in the implemen- world powers must place reliance on it too if they tation of our maternal and child welfare programmes really want peace and happiness -and if they are and of our social and health education programmes. prepared to share with us the material and scientific And I should like to make a very special point of benefits that it has been their privilege to be able to expressing our warm and heartfelt thanks to France secure before ourselves. for the substantial help it has always unstintingly Accordingly we attach fundamental importance to given us. the annual expansion of the Organization's programme I shall conclude, Mr President, distinguished dele- and budget, which enables the Organization to give gates, by commending to your attention the following ever -increasing help to the countries that most need it. words, for you to ponder on : A great country is not The fears which have repeatedly been expressed about EIGHTH PLENARY MEETING 131 the steady increase of the budget and the expansion of In regard to the malaria eradication programme, we the programme resulting from itare, in our view, realize that the task is a long -term one, but we feel that unfounded. For if one compares Member States' con- the World Health Organization and the various coun- tributions with the sums they invest every year in their tries must in no way relax the efforts they are making own health programmes and in other similar activities, to make eradication a reality; for malaria is such an one sees that their contributions are insignificant beside obstacle to economic and social development in the the benefits which all these States without exception whole world that efforts must be concerted to secure derive in one way or another from the existence of the its early eradication. World Health Organization and what they obtain The smallpox eradication programme is also, is our indirectly through the Organization or through other view, a matter of great urgency, because smallpox has bodies for multilateral or bilateral co- operation. One serious national and international repercussions, and it has only, for example, to look at the resolution adopt- could perfectly well be wiped out if governments so ed by the Technical Assistance Committee authorizing desired. The fact that this disease ceased to occur in the allocation of funds in 1963 to see that the only our country eight years ago enables us to say this United Nations specialized agency receiving more categorically. funds than the World Health Organization is FAO - Another programme of fundamental importance an organization whose programme has, in some mea- which we consider ought to be intensified immediately sure, a basic relevance to health in so far as hunger is is the environmental sanitation programme. We feel recognized to be a world disease.It is true that the that it is the duty of the Organization to interest same does not apply to the United Nations Special countries, other international agencies and finance - Fund, but we are sure that that situation will easily be providing organizations in this work and ensure that rectified if the World Health Organization continues to it obtains the attention it deserves, especially in the do as it is doing at present and conceives its prog- developing countries. ramme in the context of integrated economic and social The programmes concerned with biological stand- development plans. ardization, scientific research, public health services, In regard to the budget, the Executive Board has and meetings of expert committees deserve our com- clearly made a very thorough analytical study, for mendation for the progress they have made. which it deserves our-sincere congratulations. We feel To sum up, Mr President, we believe that multi- however that it would be helpful if future budget lateral co- operation programmes like that of the World estimates of WHO were presented functionally, i.e. by Health Organization are the most profitable, the most programmes, with a clear indication of the order of logical, the most effective and the most acceptable, and priority, so as to enable the reader to see as exactly as that they accordingly deserve our unreserved support. possible what are the Organization's aims. The PRESIDENT : Thank you, Dr Quirós.I now call The need to utilize efficiently the resources available for health programmes, both national and internation- on the delegate of Ecuador. al, makes their sound planning within the framework Dr MONTALVAN (Ecuador) (translated from the of integrated economic and social development plans Spanish): Mr President, fellow delegates, I wish first essential. We consequently read with great interest the of all to say that when I asked for the floor in the twenty- seventh report of the Administrative Committee general debate on this subject I did so chiefly because, on Co- ordination of the Economic and Social Council, having arrived a little late for the commencement of the which outlines a scheme for overall planning of eco- Assembly's work, I wished, on behalf of my Govern- nomic and social development, and in particular the ment and on my own account, to congratulate most following passage : warmly both the distinguished delegate of Nigeria on The ACC would agree that there may be need for his election as President of this Assembly, and Dr concentration of effort and resources in fewer fields, Candau on his reappointment to the post of Director - and that the participating agencies should continue General of the World Health Organization.As I to discourage and advise against requests for pro- explained previously, I was unable to be present when jects of technical assistance in fields of secondary these appointments were made, otherwise I should importance in the countries concerned. have added my own to the unanimous vote. But I now wish to express my hearty approval of the decisions Accordingly we feel that the World Health Organi- taken by my fellow delegates to this Assembly. zation ought to intensify the training of national and Turning now to the Director -General's Report, I international planners and employ this dynamic and I think it would be idle to dwell on the wonderfully effective technique, which can be applied to prog- successful directidn of the past year which that report rammes of any type, in its own programme. reveals, for, even if the tributes paid by all those who 132 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II have spoken before me from this platform were not I feel that in this sector of its activities, as in all enough, the unanimity of the Director -General's re- others, the World Health Organization should ensure appointment proves beyond any shadow of doubt that that its co- operation with the various countries is the Assembly unreservedly approves his work. always directed at strengthening the authority and Like its predecessors, the Report has an introduc- prestige of the national public health administration tion in which the Director -General reviews the general that need so much support, especially in countries problems of world health and gives the broad lines where, to say the least, the political authorities are not along which the work of the World Health Organiza- health -concious. tion is proceeding; it expresses ideas which show a Among other aspects of the Report, great satisfac- perfect understanding of the problems existing today tion is to be derived from the details regarding fellow- and guarantee the soundness of the measures adopted ships and the emphasis placed on the development of for their solution.These introductory paragraphs training of medical and auxiliary staff, and from those reveal the Director -General's dynamic approach to concerning scientific research infieldsof special health problems in the different parts of the world; interest to public health, upon which future progress each year these problems are presented, together with undoubtedly depends. In this connexion, I shall con- proposed solutions based on technical developments fine myself to mentioning the unhoped for oppor- and the social, economic and even political conditions tunities which research on radiation and its applic- in the world, and the Organization's activities are ation to public health might offer us.Consider, for adapted to the prevailing needs and circumstances. example, how useful it could be in malaria eradication On this occasion, for example, emphasis is placed on campaigns if more and better use could be made of the idea of planning -an essential element today in all methods for sterilizing male anophelines through rad- health activities. There is reference also to the efforts iation; this might enable us to achieve malaria eradica- tion in another way, returning to our old dream of being made by the World Health Organization to help exterminating the vectors. countries to prepare plans for the organization and I do not propose, during this long discussion, to development of long -term public health programmes make detailed comments on any part of the Director - related to the general plans for economic and social General's Report, not even the very interesting refer- development which many countries are preparing and ences to communicable diseases.I would, however, with which health programmes are so closely linked side by side with my warm commendation and apprecia- that they may be said to form an integral part of them. tion, make a reservation, as I did last year, with regard This stresses what seems to us, the people concerned to trypanosomiasis : in the Report, mention is made of with public health, more or less an axiom, for it is im- the disease only in so far as it affects part of the African possible to achieve or even to plan properly the Region, omitting all reference to Chagas' disease, economic and social development of a people unless which affects two- thirds of the Region of the Americas, adequate plans have been made previously -or, at least, and, in fact, bears the name of a famous compatriot of are made simultaneously -for the protection of that the Director -General, people's health, since health is the basis and aim of all Neither do I propose to describe, and still less to progress and development. give a full account of, the development of public health However, since the Director - General expressly refers activities in my country in the year covered by the to the case of America and the resolutions of the Punta Report. I shall confine myself to mentioning a few of del Este Charter -which aims at stimulating the eco- the programmes in which we have benefited from in- ternational assistance -from the World Health Organ- nomic and social development of the peoples of Latin ization, PAHO, UNICEF, or the UnitedStates America -I should like to say that, in my opinion, it is Agency for International Development, through the unrealistic to think of drawing up ten -year plans for Inter -American Co- operative Service of Public Health. health (or indeed for any other kind of activity) in the Aëdes aegypti and yaws having been eliminated some developing countries which are at present in a state of years ago, we have maintained an intensive campaign ferment, whose condition in five years' time it is im- for the eradication of malaria -with the help of a con- possible to foresee, whose political and administrative siderable increase in the budgetary allocation.Our stability is unfortunately not lasting, and where circum- country was among the first in America to commence stances completely beyond their control may have a a malaria eradication campaign, and in spite of dif- tremendous effect on their economy, or on their social ficulties of various kinds we have now succeeded in and political organization -quite apart from the alarm- establishing consolidation areas which it was not pos- ing instability which is a feature of the whole world sible to mention in the Annual Report. The city of today. Guayaquil -with a population of more than 500 000- EIGHTH PLENARY MEETING 133 is in one of these areas; previously malaria was a veri- Dr Candau as Director -General of the Organization, table scourge in that city.An extensive rural area in and adds its own congratulations. the Province of Manabí is also in the consolidation In response to your appeal, Mr President, my state- phase. The campaign for the eradication of smallpox ment will be brief. To anyone not acquainted with con- is drawing to its close : by the end of this year the ditions in the African Region, it is indeed difficult to whole territory of the Republic will have been covered. appreciate the many varied and, in some instances, We have started a programme for the elimination of almost insurmountable difficulties- geographical, edu- leprosy, and we have persevered with all the means at cational, financial, lack of trained personnel, etc our disposal in the fight against tuberculosis which we with which the health authorities have to contend. hope also to see eradicated.In regard to venereal However, it is evident from a study of that portion of diseases, although the conventional control methods the Director -General's Report dealing more specifi- are continuing, and progress is being made with cally with the African Region that not only is the respect to syphilis, there is a constant increase in Regional Office fully cognizant of the many problems resistant strains of Neisseria -which means the res- and has endeavoured, within the limitations imposed urgence of a problem which seemed to have been by manpower and financial shortages, to deal with the solved. most pressing of these but -what is equally important, Recently, and under the direction of the Epidemi- sir -the health authorities are fully alive to their coun- ologyDepartment of theNationalInstituteof tries' needs and are making every endeavour, with the Hygiene, we began a pilot campaign against Chagas' assistance of WHO, to embark on programmes whose disease, and we hope that this will provide us with combined ultimate aim is to provide, as a priority, a the key to the elimination of this important endemic healthy environment, using this term in its broadest disease in some parts of the country. With regard to context, for all peoples in this region. As one speaker our general health services, we are making a great has said, no country can afford to live in isolation from effort to extend them steadily,and we are now its neighbours.Indeed, such a policy holds as much launching a demonstration programme in one pro- danger for the neighbours; and for this reason inter- vince with the full collaboration of the Pan American national co- operation in the field of health is essential. Health Organization. The honourable delegate of Sierra Leone has drawn Environmental sanitation is one of our main pre - attention to the fact that lack of manpower, of tech- occupations-in particular, water supplies and sewage nical knowledge, and of money are serious limiting disposal; in addition to the works already completed, factors in the campaign against those conditions some with the help of the Inter -American Co- operative which adversely affect the health of peoples, and has Service of Public Health, others are now proceeding, appealed to the more favourably placed nations for and there is a plan to cover sixty -eight population financial and technical aid to the developing nations. centres. International co- operation, to which the honourable In addition to the activities I have already mentioned, delegate also referred, in every sphere of health is the National Institute of Nutrition is extending its work recognized as an essential prerequisite, more especially and there is now the National Institute of Housing in Africa, which has more than its fair share of the which has begun to build large numbers of economy major endemic diseases, if these diseases are to be houses for the lower- income groups.It will be seen eradicated or even controlled.My Government is therefore that our efforts to serve the community are fully conscious of the need for co- operation in health inspired by a real social sense -or rather, we would say, matters, and, as an indication of its desire to co- by a sense of humanity. operate, has offered to make available the services and knowledge of its technical experts, some of whom The PRESIDENT : Thank you, Dr Montalván.I now have been members of WHO expert advisory panels. call on the delegate of South Africa. The honourable delegate of the United States has drawn attention to the importance of research.In Dr MURRAY (South Africa) : Mr President, delegates, no region does this apply more than in the African ladies and gentlemen, on behalf of my delegation, I Region, in which there is a wide range of pathological congratulate you, sir, most warmly on your election to conditions, afflicting man and his domestic animals, the high and responsible position you now occupy. which require investigation.Furthermore, with the
Your election is an honour, not only. for the country ever -increasing tempo of urbanization and industrial- you represent, but for all the peoples of the African ization, and its inevitable effect on disease patterns, Region. incidence of various diseases in different population My delegationjoinsthoseothers who have groups, and so on, the need for research becomes expressed their pleasure at the reappointment of increasingly urgent. Unfortunately, research facilities 134 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II are few. South Africa is fortunate in having institutions Mr President, my fellow delegates, we gather here such as the South African Institute for Medical in this august Assembly to discuss problems of health Research, the Poliomyelitis Research Foundation, and confronting each Member State and at the same time the Onderstepoort Veterinary Laboratory, at which we speak with great pride and admiration of man's continuous research is being carried out in the fields continuous and remarkable victory against disease. of cancer, cardiovascular diseases, and a variety of But, speaking about my country, Yemen, I can only other diseases of human and veterinary importance - say with great regret that disease still scores a victory to mention a few of the lines of research being pursued. against man and will continue to do so for some time At these laboratories various vaccines are also pre- to come.The story of my country is the story of pared. Much of the work is being carried out at the many other countries in the world today which, by request of the World Health Organization, to which virtueof theirsocio- economic structure,climatic my delegation wishes to appeal for assistance in the and geographic conditions, remain unable to join establishment of additional research institutions in other nations in their march towards a better life. other parts of the African Region, and which are We have just realized in Yemen that we are burdened urgently needed. with a heavy heritage of poverty, ignorance and Finally, my delegation joins those who have wel- disease. We have so many problems in the area of comed and congratulated the delegations of those health that we do not know where or with what to countries that have been admitted as Members and begin, in view of the technical and financial difficulties Associate Members of this organization. we are facing. What exists now in the country, in the Mr President, specific reference has been made to my area of health, is far from the level offering even the country.It is a great pity that certain delegations minimum medical care to the people in the urban are unable to refrain from introducing political issues areas. The people in the remote sections of the country, into the deliberations of what hasalwaysbeen constituting a large segment of the population, remain regarded as a non -political, technical organization; an easy prey to a number of morbid diseases, namely more especially when the statement reflects ignorance smallpox, malaria, tuberculosis, trachoma, bilharziasis, of the actual position. leprosy and many others. What the Ministry of Health hopes to do, beginning The PRESIDENT : Thank you, Dr Murray. I now call this year, is :first, to conduct a general survey and on the delegate of Yemen. evaluation of the existing health problems; secondly, to attempt to raise the sanitation standards by the Mr MOHANNY (Yemen) : Mr President, please allow provision of adequate and safe drinking -water supplies me to express my warm greetings and sincere con- in both the urban and rural areas and to provide gratulations on behalf of the people and Government better methods of human waste disposal and control of the Yemen Arab Republic on your election as the of insects having public health significance; thirdly, President of the Sixteenth World Health Assembly, to improve and expand the existing health services and to wish you the best of success in your new high and extend such services to the rural and far -reaching office. regions of the country, which have been deprived in To the Director -General I offer my highest respectful the past of the right to benefit from medical care. admiration for his very successful leadership.I sin- It has become evident in many countries that poor cerely consider it a great victory for the Organization sanitary conditions, which are certainly today the to have again the man who in the past has done so by- product of social, religious and economic factors, much, with a high degree of devotion and dedication, play a major and significant role in the dissemination to make the Organization an effective instrument in and propagation of a number of communicable the promotion of world health. Now, with the exten- diseases.Therefore, it is my hope that the countries sion of his service, I am quite sure he will lead the mostintimatelyassociatedwithsuchsanitation Organization to further marvellous achievement. problems may join me in this belief that intensive On this occasion I would like to pay tribute to all, andextensivesanitationprogrammes should be inside and outside the Organization, who have con- instituted and should merit the highest priority in the tributed to make it the symbol of hope and a great national government plans to improve the health of manifestation of man's glorious work to make our the people. world a healthier, happier and more secure one. Mr President, I would like to draw to the attention I also would like to pay tribute to those nations which of the Assembly, and particularly of the Director - have gone far beyond the frontiers of their countries General and his staff, that special attention should to other nations with a genuine desire to help, especially be given to countries, of which my country is one, that in the areas of health. are starting now to make long -range plans for nation- NINTH PLENARY MEETING 135 wide health improvements; and that they should be level and to develop a framework for health activities assisted to the fullest extent possible in their attempt in which they can incorporate, or rather absorb, to secure the financial means and technical guidance any technical or financial assistance offered to them. necessary for the implementation and extension of such I conclusion I would like to stress the fact that we health improvement programmes.It would be of are suffering chronically indeed from an acute shortage considerablevaluealsotothosecountries,and of medical and specialized health personnel, and it is especially to the ones that have a similar socio- my great hope that the Organization will consider economic structure, to have closer association and expanding the programme being offered to my country exchange of ideas and information through regular in respect of medical and paramedical staff in order to periodic seminars and meetings during the stage of meet our most pressing and urgent needs. planning and execution of such programmes; for Mr President, the health situation in my country is I believe the way chosen to solve health problems is a great challenge to the mind, will and determination influenced to a great extent by the socio- economic of man; but we accept this challenge, and we think pattern of countries. that before our days are over we shall have had laid I would like to put before the Assembly also, and down for the next generation the proper foundation for the consideration of the Executive Board and the for a healthier, happier and more secure life. Director -General, the problem of under -developed The PRESIDENT : Thank you, Mr Mohanny. countries -which, in my opinion, should secure more The meeting is adjourned. help from the Organization. But they do not, because of not being able to attain the needed technical staffing The meeting rose at 11.20 p.m.
NINTH PLENARY MEETING
Wednesday, 15 May 1963, at 9.40 a.m.
President: Dr M. A. MA.IEKODI NMI (Nigeria)
1.Election of Members entitled to Designate a Person much I appreciate being included in the list of candidates to Serve on the Executive Board for the Executive Board. I wish to thank the members The PRESIDENT : The meeting is called to order. of the General Committee who have supported our The first item on our agenda is item 1.12; Election candidature. of Members entitled to designate a person to serve Considering, however, that there are too many on the Executive Board.Document A16 /10, which candidates from the European Region, and all the was distributed twenty -four hours before this meeting, candidates have many mutually friendly countries contains thereport of the General Committee,' whose delegations are in a difficult position now in giving the list of twelve Members drawn up in accord- choosing two of the four countries, we have decided ance with Rule 98 of the Rules of Procedure of the to withdraw our candidature on behalf of other Health Assembly. In conformity with the same rule, countries, especially the Netherlands. the General Committee has recommended, from I also wish to take this opportunity to express my among the twelve Members nominated, the eight gratitude on behalf of my delegation to the countries countries which, in the Committee's opinion, would which encouraged us and promised their valuable provide, if elected, a balanced distribution of the support for our election.I hope they will understand Board as a whole.I give the floor to the delegate of our reason, and will keep their interest in our election Turkey.Will the delegate of Turkey please come to to the Executive Board next year. the rostrum. The PRESIDENT : Thank you, sir.I now recognize Dr FISEK (Turkey) : Mr President, fellow delegates, the delegate of Australia. on behalf of the Turkish delegation, may I say how Mr FURLONGER (Australia) : Mr President, I have 1 See p. 408. asked for the floor before the vote on this item takes 136 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II place, in order to withdraw the name of my country, The Board shall consist of twenty -four persons Australia, which appears among the twelve countries designated by as many Members.The Health whose names have been transmitted to the Assembly Assembly, taking into account an equitable geo- by the General Committee. graphical distribution,shallelectthe Members Australia was not represented in the General Com- entitled to designate a person to serve on the Board. mittee where the nomination of Members entitled to Each of these Members should appoint to the Board designate a person to serve on the Executive Board a person technically qualified in the field of health, was made, and there was thus no opportunity for us who may be accompanied byalternatesand to withdraw at that time. We are very grateful indeed advisers. to those who nominated and supported us in the Article 25 : General Committee, and I should like to thank them now for this expression of confidence in us. However, These Members shall be elected for three years on looking at the list of the eight Members recom- and may bere- elected,providedthat of the mended by the General Committee, in document twelve Members elected at the first session of the A16 /10, my delegation fully agrees with the Com- Health Assembly held after the coming into force mittee that this list is designed to give a balanced of the amendment to this Constitution increasing distribution to the Executive Board as a whole, and, the membership of the Board from eighteen to in these circumstances, we feel that it will assist the twenty -four the terms of two Members shall be for Assembly in making its choice if we withdraw the one year and the terms of two Members shall be for Australian candidature.I therefore request, Mr Pre- two years, as determined by lot. sident, that, in putting to the vote the list in docu- I would point out, Mr President, that the second part ment A16 /10, you will be good enough to delete the of this article is no longer applicable.The relevant name of Australia. part of Article 25 reads as follows : " These Members shall be elected for three years and may be re- elected ". The PRESIDENT : Thank you. With the withdrawal of On page 119 of the same volume, Rule 96 of the Turkey and Australia, we now have ten candidates. Rules of Procedure of the Health Assembly : The election will be held by secret ballot.Let me remind you of the names of the eight members whose At each regular session of the Health Assembly, terms of office expire at the end of this year :in the the Members entitled to designate persons to serve African Region, Ghana ; in the Region of the Americas, on the Board shall be elected in accordance with Argentina; in the South -East Asia Region, Thailand; Articles 18 (b), 24 and 25 of the Constitution. in the European Region, Iceland and the United Kingdom of Great Britain and Northern Ireland; in Rule 98, on the same page : theEasternMediterraneanRegion, Jordan and The General Committee, having regard to the Pakistan; in the. Western Pacific Region, Korea.I provisions of Chapter VI of the Constitution, to will now call on the Deputy Director - General to read Rule 96 and to the suggestions placed before it by the articles of the Constitution and the Rules of Pro- Members, shall nominate, and draw up a list of, cedure which apply to the voting : that is, Articles 18(b), twelve Members, and this list shall be transmitted 24 and 25 of the Constitution, and Rules 96, 98, 99, to the Health Assembly at least twenty -four hours 100, and possibly 101, of the Rules of Procedure of the before the Health Assembly convenes forthe Health Assembly. purpose of the annual election of eight Members to be entitled to designate a person to serve on the Dr DOROLLE, Deputy Director - General (translation Board. from the French) : the articles and rules of procedure The General Committee shall recommend in such to which you have referred, Mr President, are to be list to the Health Assembly the eight Members found in the 13th edition of Basic Documents. which, in the Committee's opinion, would provide, if elected, a balanced distribution of the Board as First of all, on page 6, Article 18 (b) of the Consti- a whole. tution : Rule 99, also on page 119 of Basic Documents: The functions of the Health Assembly shall be :. . . (b)to name the Members entitled to designate a The Health Assembly shall elect by secret ballot person to serve on the Board; from among the Members nominated in accordance with the provisions of Rule 98 the eight Members On page 8, Article 24 of the Constitution reads as to be entitled to designate persons to serve on the follows : Board.Those candidates obtaining the majority NINTH PLENARY MEETING 137
required shall be elected.If after five such ballots have been distributed with eight spaces on them. one or more seats remain to be filled no further Please write the name of a country in each space. iR ballot shall be taken and the General Committee The countries will be called to the rostrum in the shall be requested to submit nominations for English alphabetical order. I wish to appoint Mr Brady candidates for the seats remaining to be filled, in of Ireland and Dr Castillo of Venezuela to act as tellers. accordance with Rule 98, the number of candidates You will observe in document A16 /10 that Australia so nominated not exceeding twice the number of and Turkey are included in the list recommended by seats remaining to be filled. Additional ballots shall the General Committee, but, as you have just heard, be taken for the seats remaining to be filled and those Australia and Turkey have withdrawn their candida- candidates obtaining the majority required shall be tures. It will not therefore be necessary for any elected. Member present to vote for them. Hence, as I read If after three such ballots one or more seats remain out, there are now ten candidates. However, if to be filled, the candidate obtaining in the third Australia or Turkey is included in a ballot paper it ballot the least number of votes shall be eliminated will not be nullified, since those two names are on the and a further ballot taken and so on until all the list recommended by the General Committee. seats have been filled. In any ballots taken under the provisions of this Will Mr Brady of Ireland and Dr Castillo of Rule no nominations other than those made in Venezuela please come to the rostrum. accordance with the provisions of Rule 98 and this The two tellers took their places on the rostrum. Rule shall be considered. The PRESIDENT :Has each delegation received a Rule 100 : ballot paper ?Would those who have not received For the purpose of elections in accordance with any ballot paper please draw my attention to the fact. Rule 99 Members shall vote in any ballot for that You will now be called to the rostrum in the English number of candidates equal to the number of alphabetical order. seats to be filled and any ballot paper failing to comply with this Rule shall be null and void. A vote was taken by secret ballot, the names of the following Member States being called in the English Rule 101 : alphabetical order. If in elections under Rule 99 two or more can- Afghanistan, Albania, Algeria, Argentina, Austra- didates obtain an equal number of votes in such lia,Austria, Belgium, Bolivia,Brazil,Bulgaria, circumstances as would render it uncertain which Burma, Burundi, Cambodia, Cameroon, Canada, candidates or candidates would be eligible to fill Central African Republic, Ceylon, Chad, Chile, any seat or seats, the votes cast for such candidates China,Colombia,Congo(Brazzaville),Congo shall be declared inconclusive, and, subject to the (Leopoldville),Cuba,Cyprus,Czechoslovakia, provisions of Rule 99, further ballots taken as Dahomey, Denmark, Ecuador, Ethiopia, Finland, necessary. France, Gabon, Federal Republic of Germany, I have just read, Mr President, the articles and Rules Ghana,Greece,Guatemala,Guinea,Hungary, of Procedure you wish to bring to the attention of the Iceland, India, Indonesia, Iran, Iraq, Ireland, Israel, Assembly. Italy, Ivory Coast, Jamaica, Japan, Jordan, Republic of Korea, Kuwait, Laos, Lebanon, Liberia, Libya, The PRESIDENT : Thank you, Mr Deputy Director - Luxembourg, Madagascar, Federation of Malaya, General. Mali,Mauritania, Mexico, Monaco, Mongolia, Now, to avoid misunderstanding I should like to Morocco,Nepal,Netherlands,New Zealand, emphasize that eight names must be chosen from the Nicaragua,Niger,Nigeria,Norway,Pakistan, following ten proposed by the General Committee : Panama,Paraguay,Peru,Philippines,Poland, Brazil, Indonesia, New Zealand, Sierra Leone, Mali, Portugal, Romania, Saudi Arabia, Senegal, Sierra Netherlands, Norway, Iran, Morocco and Libya. Leone,Somalia,South Africa,Spain,Sudan, Therefore, only those Members whose names I have Sweden, Switzerland, Syria, Tanganyika, Thailand, just read out should be voted for.Ballot papers Togo, Trinidad and Tobago, Tunisia,Turkey, which contain more or less than eight names of Uganda, Union ofSovietSocialistRepublics, countries, or which contain the names of countries United Arab Republic, United Kingdom of Great not included on the list of ten just read out and recom- Britain and Northern Ireland, United States of mended by the General Committee will be considered America, Upper Volta, Venezuela, Republic of null and void. To make it easier for you, ballot papers Viet -Nam, Western Samoa, Yemen, Yugoslavia. 138 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The PRESIDENT : Have all the delegations been called 2.General Discussion on the Reports of the Executive Pto the rostrum ?If so, then I will call a recess.It is Board and the Report of the Director - General on difficult to fix its duration, but you will be summoned the Work of WHO in 1962 (continued) by the ringing of the bell. The PRESIDENT :We now continue the general The Assembly will now go into recess. discussion on items 1.9 and 1.10. I give the floor to the The meeting was suspended at 10.25 a.m. and resumed delegate of the Union of Soviet Socialist Republics. at 11.35 a.m. ProfessorxZDANOV (Union ofSovietSocialist Republics) (translation from the Russian) : Mr Pre- The PRESIDENT : The meeting is resumed. The result sident, fellow delegates, first of all I should like, on of the voting for the election of Members entitled to behalf of the delegation of the Soviet Union, to designate a person to serve on the Executive Board congratulate Dr Majekodunmi on his election as is as follows : President of our Assembly, and Dr Candau on his Number of Members entitled to vote 108 reappointment to the post of Director -General of the Number absent 2 World Health Organization.The Soviet delegation Abstentions Nil hasstudiedwithinteresttheDirector -General's Report and has followed all the plenary debates, and Papers null and void 1 Total number of Members voting 105 also the report of Dr Afridi, the representative of the Executive Board. Number required for simple majority. 53 The year 1962 was characterized by an expansion The names of the Members elected and the number of the work of the World Health Organization.In of votes polled for each are as follows : some directions the Organization became more active; in particular, a greater amount of assistance was given Brazil 102 to countries which recently obtained independence, Indonesia 100 the volume of scientific research increased, and con- New Zealand 99 siderable attention was given to the training of per- Sierra Leone 97 sonnel.One positive aspect of the Organization's Iran 92 work was a continued extension of intergovernmental Norway 91 and inter -regional activity. In 1962 considerably more Netherlands 89 aid was given than in previous years in connexion with national public health planning as part of general Mali 86 plans for social and economic development in various These eight Members have obtained the necessary countries.In this field a great deal of attention was majority and are elected.I propose therefore that the given to evolving methods of work suited to specific Assembly adopt the following resolution : conditions. There were, in particular, definite achievements in The Sixteenth World Health Assembly, theEastern Mediterranean and WesternPacific Having considered the nominations of the Genera Regionsinintegratingtuberculosiscontrolpro- grammes with the work of the general public health Committee, services. In theSouth -East Asia Region much ELECTS the following Members asMembers attention was devoted to integrating the work of in- entitled to designate a person to serve on the Board : patient and out -patient establishments.Experience Brazil, Indonesia, Iran, Mali, Netherlands, New of work in that region, as also in certain countries Zealand, Norway and Sierra Leone. of America, shows that the effectiveness of out -patient establishments and hospital wards can be increased Are there any comments on the resolution ? In the by twenty -five per cent. absence of any comments, the resolution is adopted. With regard to the strengthening of national health I ask the tellers to accept my thanks. services, the work of WHO in 1962 largely took the Since the thirty- second session of the Executive form of assistance in the training of national staff, Board opens on 27 May 1963, we have not very since the lack of trained personnel is one of the most much time left.The Members just elected will be serious obstacles to the extension of medical care.In formally notified by the Director- General of their 1962 WHO gave this question considerably more election, and they are requested as soon as possible to attention than in previous years.Although a larger indicate the names of the persons they wish to designate number of fellowships were awarded by the Organi- to serve on the Executive Board. zation in 1962, there was a very serious miscalculation, NINTH PLENARY MEETING 139 as the Director -General admits : a considerable number morbidity still remains at a high level, and in 1962 of students who had been granted WHO fellowships 62 094 cases were recorded. Despite the fact that the dropped out before they completed their training, so Soviet delegation has repeatedly raised the question that some of the Organization's resources were wasted. of the need to intensify smallpox eradication measures, Very serious attention must accordingly be given to and despite the fact that this question was the subject preventingthishappening infuture -which will of special discussion at the Fifteenth World Health mean raising standards for the selection of students Assembly, at which an appropriate resolution was and supervising their trainingIt is difficult to see, adopted, no very noticeable change for the better in particular, why very little part is being taken in the has taken place. The fact that a rise in the incidence medicaltrainingprogrammeby UNESCO -an of smallpox in African countries was observed in organization that could play a much greater part in 1961 and 1962 should arouse serious concern. There the international training of staff of all kinds. is no doubt that the Organization's approach to the Another very important question, in our view, is the problem of smallpox eradication must be radically international control of pharmaceutical preparations, changed and that measures for eradicating the disease which was referred to in the Director -General's Report. should be intensified. The dramatic events that occurred in connexion with I shall not go into the question of malaria, simply thalidomide preparations reveal the need for stricter because we have already had an opportunity to express control of many preparations :these are frequently our views on that subject in the Committee on Pro- offered for sale by firms without sufficient testing gramme and Budget. One thing, however, is clear- beforehand.It is to be hoped, therefore, that the and that is that the future prospects of this programme recommendations of the WHO Executive Board, which are giving rise to serious concern, misgivings and specially discussed this matter in January, will be anxiety. implemented as speedily and completely as possible, In 1962 the Organization devoted much attention in order to prevent damage by pharmaceutical pre- to scientific research on various problems of public parations to people's health. health and medicine.Numerous meetings of expert As well as certain achievements, the work of the committees, scientific groups, conferences and seminars Organization in 1962 also showed some substantial were convened on this aspect of the Organization's shortcomings. A number of long -term projects failed work. Inaddition, the Organization spent very to yield the results anticipated and only partially considerable sums of money on contractual research attained their objectives.It is alarming to note that work and on the award of fellowships to research morbidity from some infections that the Organization workers.This money came both from the Organi- has been attempting to control or to organize the zation's regular budget and from the Special Account control of, for many years, far from decreasing has for Medical Research.Although the stimulation of actually shown a tendency to increase.This applies research by the World Health Organization is highly first and foremost to morbidity from filariases and necessary, certain misgivings are felt as to whether in bilharziasis, which increased considerably in 1962 in certain cases the Organization is not paying too much connexion with the expansion of irrigation work. The attention to, and spending too much money on, rise in the amount of venereal disease is ominous. In research based on national institutions in countries 1962 syphilis increased in 76 countries out of 105, and that could very well carry out the research without gonorrhoea in 52 out of 111.Although from 1948 WHO's help.As a result we are to some extent to 1962 inclusive about 285 million people were losing sight of the Organization's function, under its examined and treated for yaws, there are still some Constitution,ofactingasaninternationalco- 100 million people living in areas where there is no ordinating and planning centre for medical research. regular yaws control and where the population is A fact that is attracting attention and giving rise to exposed to the risk of infection. concern is that the Organization's budget for 1962 was Although poliomyelitis morbidity inthe world about five million dollars, or 26 per cent. larger than has decreased by 65 per cent. during the last few years for 1961.In addition, the 1962 budget considerably as a result of the use of preventive inoculations, the exceeded the figure provided by the Fourteenth World decrease was only 25 per cent. in Asian countries, Health Assembly for that year. Although the World while in Africa and in certain countries in South Health Assembly in resolution WHA14.17 approved America the incidence of the disease increased by an effective budget for 1962 of US $23 607 180, the 10 per cent. amount was increased by varioussupplementary Smallpox eradication measures in the endemic areas estimatesto US $24 863 800,i.e.,itwasfinally of Africa and Asia are being implemented very slowly $1 256 620 higher than the total originally laid down. and not effectively enough.As a result smallpox Such an increase in the budget, over the sum voted 140 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II when the budget was originally approved, is un- To return to the question of assistance to emergent doubtedly undesirable. States, I should like to emphasize that, in addition Inthisconnexion the organizational study of to voluntary contributions, considerably more use methods of planning and execution of projects, begun should be made of such sources as the Expanded in pursuance of a decision of the Fifteenth World Programme of TechnicalAssistance,theUnited Health Assembly, is of great interest.There are a Nations Special Fund, and UNICEF resources. There number of examples -in particular those I have already are very steady and solid sources, but clearly so far mentioned, and including some from the Director - they have been too little used by the World Health General's Report for 1962 -which confirm the need Organization. for an organizational study on this question.The One of the perequisites for the work of the Organi- study will facilitate the more economical and effective zation to be successful is that its degree of universality use of the Organization's resources.The resources should be as high as possible.The Secretariat at released by these savings c .n be used for expanding headquarters and the Director -General should pay the Organization's activities and in particular for most serious attention to observance of the principle assisting the countries that have recently obtained of equitable geographical representation in appointing independence. WHO staff.Citizens of countries which have recently obtained their independence, and citizens of socialist The rendering of assistance to the newly independent countries, the numbers of whom in the WHO Secre- countries is rightly one of the main features of the tariat are still not proportionately high enough, should Organization's work.In planning a programme of be drawn into the work of the World Health Organi- assistance to these countries many methods can be zation, particularly at headquarters, on a wider scale. used.One of them is a study of the experience of Gentlemen, mankind greeted with satisfaction the countries which have achieved considerable success declaration adopted by the seventeenth session of the in building up their own health services.Another is General Assembly of the United Nations on the the exchange of teaching staff and students between the conversion to peaceful needs of the resources released countries which have recently acceded to independence by disarmament.The carrying out of general and and countries that have established effective health complete disarmament will open up wide possibilities services, and so on. of achieving the basic objective of the World Health The Soviet Union, apart from the help it gives Organization, as proclaimed in its Constitution :the through the World Health Organization,renders attainment by all peoples of the highest possible. considerable assistance to new and developing States level of health. The arms race is swallowing up im- on the basis of bilateral agreements. The building of mense resources which could be used for the develop- hospitals and schools, the sending of specialists and ment on the widest scale of health services throughout field teams, the provision of drugs, insecticides and the world, and particularly in the economically less vaccines, the sending of teachers and the reception of developed countries.An agreement on general and students, all these constitute a far from complete complete disarmament would make it possible to set list of the forms of Soviet assistance to and co- opera- aside large material and financial resources for the tion with many countries of Africa, Asia and America. health needs of Africa, Asia and Latin America, and Forexample,theSovietGovernmentannually would also open up the widest prospects for a true provides in the medical faculty of the Lumumba flourishing of medicine and education and for multi- University between 100 and 150 fellowships for young lateral co- operation between scientists of all countries people from Africa, Asia and America to study to and peoples. become doctors. The Government of the USSR has In view of the importance of systematic research on provided smallpox vaccinefor mass vaccination all aspects of this matter with a view to assisting campaigns in large countries like India, etc. Member States, particularly the economically less - Sometimes some curious incidents occur.At the developed, countries, it would be advisable to take the request of the Minister of Health of one African necessary steps within the competence of the World country we were preparing to send a group of surgeons Health Organization to work out a plan for the on a long -term mission, but suddenly received an development of the health services when general and abrupt refusal, on the grounds that the country complete disarmament is put into effect. already had enough doctors !Obviously there were The World HealthOrganization,notingwith non -medical considerationsof some sortbehind satisfaction the measures taken by the United Nations this refusal.I do not believe that there can be two with a view to strengthening peace and international forms of surgical technique -one communist, the co- operation,prohibitingatomicweaponsand other capitalist. developing international trade and other forms of NINTH PLENARY MEETING 141 co- operation between countries and peoples, should I recall that the fifteenth century Portuguese seafarers again raise its voice in favour of a speedy decision on were the first to establish a link between the peoples these fundamentally important matters and appeal to of the Mediterranean civilizations and those of the health workers throughout the world to promote a West Coast of Africa. And so we Portuguese (being further extension of international co- operation. not only Europeans but also Africans -- indeed, perhaps more African than European) are moved that the The PRESIDENT :Thank you, Professor 2danov. Federal Minister of Health of that great country, I now call on the delegate of Sudan. Nigeria, should be the President of this Assembly. Dr KHALIL (Sudan) : Mr President, distinguished May I, Mr President, offer you my compliments and fellow delegatse -Sir, I wish to congratulate you on my best wishes for the future and progress of your behalf of my country and delegation on your election beautiful country, of which I have such pleasant as President of the Sixteenth World Health Assembly, memories. and also your able Vice -Presidents. I heartily welcome I would express the same good wishes to all Member the newly -elected Member countries. To Dr Candau countries,especially newly independent countries, I wish to offer warm and sincere congratulations on with which the Portuguese Government and people hiswell- deserved unanimous reappointment. My firmly hope to maintain friendly relations and close delegationwishestorecordappreciationtothe collaboration.In the course of her history, Portugal Director -General, his assistants and staff, and to the has been obliged more than once to defend her inde- members of the Executive Board, for the excellent pendence, and she is thus well able to appreciate the exposition of their comprehensive reports. price and value of freedom. It is nevertheless regrettable I wish also to thank Dr Taba and the staff of the that the representative of a neighbouring country to Eastern Mediterranean Region for their sincere and Portugal should have taken advantage of his position loyal co- operation and assistance. in this Assembly to refer to a frontier incident that has already been dealt with by the Security Council: The PRESIDENT : Thank you very much, Dr Khalil. from this one can draw only one conclusion -the I now recognize the delegate of Portugal. bad faith of a government that refused the Portuguese Dr SOARES MARTINEZ (Portugal) (translation from proposal for the setting up of a commission of inquiry. the French): Mr President, fellow delegates, I am But I shall say no more on this subject. greatly honoured to represent my country at the Mr President, I have just learned that the Portuguese World Health Assembly.I have good reason at the delegation is in a position to bring to the attention of moment to be deeply moved, and my task is, therefore, this Assembly the existence and contents of a WHO an especially pleasant one. report on the health situation in the larger Portuguese In particular, I would refer to the fact that I am provinces.I feel bound to mention the objectivity representing here my country, whose ancient traditions and accuracy of this report- further evidence of the of charity, humanity, and constant struggle against high standard of the Organization's work. The report suffering, pain and poverty have greatly influenced prepared by WHO, dealing with the health situation recent achievements in the field of health- achieve- in the three big Portuguese overseas provinces, is to ments that follow on the firm determination to obtain be published in the very near future, so that it can be the best possible level of material well- being. Moreover, read by those delegates whom it might particularly this material well -being is the essential means of interest. But the importance of this document for the obtaining the best results in the moral development informationitprovides on my country'shealth of peoples -a fact that must never be forgotten by policy -in accordance with the principles of the World social institutions, lest all the work done in other Health Organization -leads me to try to summarize spheres become useless or even harmful. the main points of this report prepared by the Organi- The spirit that has inspired the Portuguese social zation's experts. welfare institutions during the centuries is now bearing According to the authors of the report -and in this the World Health Organization along towards its summary Ishall use as far as possible the same goal; this spirit, essentially humanist, is at present wording as they themselves used -the Portuguese leading to a firm and close bond between all peoples authorities have everywhere done all they could to who are conscious of their interdependence since they provide the experts with all necessary help for the areincapable,individually,of solving thebasic fulfilment of their task.They were thus able to see problems of the day which now are on a continental both the better, and the more modest aspects, without scale. anything being hidden from them. Mr President,I should also like to express my Accordingly, the WHO experts were able to report pleasure at your election as President of this Assembly. that the Portuguese overseas territories have health 142 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II services good enough to be taken as examples; that the problem of training health staff -a problem which the local people have full confidence in the health everywhere is an extremely serious one. A few months services;thatintheseterritoriesthe regulations ago universities were set up in Angola and Mozam- governing rural working conditions are strictly applied. bique and they will, among other things, undertake These regulations, which the experts consider as being the training of health personel. advanced, are applicable to all ethnic and cultural Not wishing to turn her back on history and tradi- groups, and provide for medical care for workers and tions, Portugal is firmly determined, in the programme their families. They also noted that the implementa- for improving health services, not to forget that she tion of the present programmes will permit of a swift, opened in Europe, in the Middle Ages, first -rate hos- substantial rise in the standard of living of the people pitals and other social welfare institutions; that in in these provinces; that these territories have well Africa, as early as the beginning of the 16th century - equipped, modern and well planned hospitals of the in 1504 -the Portuguese set up a charity hospital on very highest standard (that is the wording used by the the island of Sao Tomé; that the foundation of the experts themselves); that the network of health centres Luanda hospital dates back to 1628, and that of the makes it possible to provide first aid promptly in first hospital in Portuguese Guinea to 1646; that the nearly all parts of the territories; that the health medical -surgical school of Goa, the first medical school personnel consists almost exclusively of local people. in the East, was founded in 1844. Nor will Portugal The WHO team was able to attend public vaccination forget that the Institute of Hygiene at Lisbon, founded meetings during which people of the black, white, in 1899, is one of the oldest in the world. and yellow races, and Indians -the words used by the experts -queued together; it was able to see that there Briefly, in the field of health, as in all other fields, is no racial discrimination in hospitals, where people Portugal will remain loyal to the basic principles she Of the black, white, and yellow races, and Indians -I has always supported; principles which are now those am still using the words of the report -are to be found of the World Health Organization and which have together in the same dormitories, side by side. always been applied in my country -in advance as it were. The general conclusion of the WHO experts was that the Portuguese overseas provinces, which are Consequently, Portugal has no difficulty in assuring the World Health Organization of her most loyal col- not well known, surprise visitors by their economic laboration : she will contribute of her experience any- and social development. There you are,fellow where and in any circumstances, always with a view to delegates. Portugal and her provinces are little known, say the WHO experts, and that in itself has allowed fulfilling the Organization's high purpose. The three great and ancient Portuguese universities have pro- ill- founded judgements to be made on my country duced scientists of international fame, among them a which, to be better understood, must be better known. winner of the Nobel prize for medicine. We have here I think customs have not changed much -that a magnificent cultural capital at the disposal of the justice and truth deserve thanks.I shall not evade World Health Organization and of all the nations of the duty of acknowledging that the objectivity that led the world, especially the developing countries. the Organization's experts to draw up a report calling I have pleasure in extending my best wishes to the attention to my country's achievements in its overseas Director -General for the fulfilment of the new mandate provinces is one more contribution by WHO to the that has just been entrusted to him in circumstances cause of peace. The World Health Organization has that show recognition of the exceptional qualities that done justice to Portugal and, in the present situation, Dr Candau has demonstrated during a long career in the significance of this extends even beyond the field of the service of health and, consequently, in the service health, since it is related to all aspects of social welfare. of the well -being of the whole world. May God always It seems that the WHO experts found only one fault be with you in the fulfilment of your difficult task, Dr of any importance in the health service in the Por- Candau. tuguese overseas provinces; namely inadequate statis- I would also express my sincerest and warmest con- tics. But they also recognized that this fault was shared gratulations to Dr Candau for his excellent Report on by all -or nearly all -the States and territories of the work of WHO in 1962. This report has been closely Africa. A further inadequacy is the shortage of health examined by the Portuguese delegation, which has not personnel, but a similar shortage seems at present to been at all surprised by its scientific standard and -if threaten nearly all countries, wherever they are. The I might say so -its social and human standard, in the new National School of Public Health which is about widest sense of the words. Familiarity with a problem to be set up in Portugal will certainly help to solve or subject is the best defence against surprise. The corn- NINTH PLENARY MEETING 143 ments made in the Report regarding health education, cutive, as well as to the other members of the Secre- the use of dangerous drugs, and malaria eradication tariat who have ably backed him. Today we congrat- were of particular interest to the Portuguese delegation, ulate him again on his reappointment to this exalted since these are amongst the present preoccupations of office by a unanimous vote. the Portuguese health services. Moreover, the varying Mr President, I should now like to confine myself mesological and climatic conditions in the Portuguese exclusively to the report, and to take a few minutes of provinces oblige our health services to deal with all the your time to make some passing comments on it : com- problems discussed in the Report, since these con- ments which we are making in the nature of general ditions make it necessary to adopt measures relating observations related to the health scene in my own both to diseases characteristic of the more developed country, which today we like to think enjoys a better areas, and to those of the developing countries. position in regard to health services than ever before. It Thank you, Mr President, and thank you, fellow is gratifying to note that the Introduction to the Report delegates, for your kind attention. brings out in clear perspective the need for correlating The PRESIDENT : Thank you, Dr Soares Martinez. I economic and social welfare work with the activities now call on the delegate of Ceylon. that are planned for the promotion of public health. We steadfastly believe in this correlation of activities Mr PERERA (Ceylon) : Mr President and fellow dele- ourselves, and have done our best to implement it in gates -while thanking you for your indulgence, sir, in our own work.It has been very rightly urged that reopening the list and permitting me to make my con- during the ensuing decade national governments should tribution to these proceedings, I wish to take this op- aim at a 10 to 15 per cent. yearly increase in the funds portunity on behalf of the Ceylon delegation, to feli- allocated for their public health services.I feel sure citate you warmly on your election to the presidential that it is a target we will all strive to achieve, however chair of this Assembly. In your understanding of the urgent our othercalls on the national exchequer ideas and problems of this organization, arid with your may be. knowledge and experience of this type of work, I have no doubt that you rank in line with your distinguished Another point in the introductory chapters of this predecessors in this office, all of whom have guided the Report that needs mention is the Director -General's deliberations of this Assembly with dignity, patience plea for special attention to the training of profes- and understanding. To the outgoing President, too, we sional and auxiliary health staff. Although this em- extend our hearty congratulations and grateful thanks phasis has been a running feature in previous Reports for a job of work well done. I should like to associate too, this year's Report blazes a new trail in that it sug- the three Vice -- Presidents in these felicitations. gests that, in addition to the conventional training Mr President, today it is most comforting to all of us given to health personnel, special training facilities are to see that this organization has established itself in the also necessary in the fundamental planning work so as confidence and esteem of all the Member countries. to ensure a broader understanding of the socio- From the tentative strivings of 1948 it has grown into economic problems that confront those who undertake the robust body that it is today, with no less than 120 the execution of health programmes. We agree with- Member nations extending their resources and col- out reservation that such training will pay dividends. laborating with this organization.One still recalls The chapter on malaria eradication, which isa with pride the results of the work done by WHO in dedicated objective of this organization, also arouses meeting the emergency health situation that arose in keen interest in my country because malaria, once the Congo soon after independence.It was a rather public enemy No. 1 in Ceylon, has virtually been difficult challenge which the Organization had to face eliminated today.It will be of interest to report that in this emergency -that of providing essential services when malaria control work with DDT spraying was to this newly- independent State under most trying first launched in 1946 we had nearly 2.8 million cases, conditions. In carrying out its task, this organization with 12 500 deaths; last year there were only thirty - proved one thing, if ever such proof was needed : the one cases, with no deaths; and in the first four months soundness of itsstructure and the maturity and of this year none at all. What this has meant for the experience it has gained in the course of its work.It economy of the island is shown by the fact that is most fitting therefore that today ,WHO has earned 1.4 million acres of land are under cultivation today - the well- deserved tribute of being referred to as the an increase of nearly 50 per cent. on the pre -1946 greatest co- operative venture for the common good. figures. We are, however, convinced that we cannot Our congratulations have also gone, from time to rest on our laurels and relax the vigilance and super- time, in ample measure, to the Director - General for vision needed to avert fresh outbreaks of malaria in his outstanding work as the Organization's chief exe- epidemic or endemic form, through infections intro- 144 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II duced into Ceylon from external sources, or through of effective eradication was the three -months to eight - the emergence in our own country of a DDT -resistant year age group of children. It was further decided that type of malarial mosquito. The health authorities have immunization of over 80 per cent. of this group would therefore maintained the minimum field personnel avert further outbreaks. All I wish to say in passing is necessary to meet all contingencies, realizing that that we require, and that urgently, no less than five vigilance is the price we have to pay for the health and million doses of this vaccine to conduct this campaign safety of our nationals. effectively. While we have achieved in this manner a substantial Of considerable interest to us also is the chapter on reduction in the death rate of our country, which has envionmental health, because nearly 40 per cent. of come down to 8 per 1000 of population, we are now morbidity in our country is related to causes that faced with the problem of the natural increase in our emanate from faulty environmental sanitation. This population consequent upon this ; today it stands at is one of the activities in public health in which both the high figure of 28 per 1000. The authorities appre- the central government and the local authorities are ciate fully the implications of this situation for our actively engaged at this moment. Ways and means economy, and are doing everything possible to deal of improving water supplies already available and also with the situation in consultation with other ministries installing new water supplies are under active con- concerned. sideration. We have also discovered that roundworm Another chapter which interests us frequently is the infestation is the chief cause of morbidity and mortality one on communicable diseases, because we have these among the pre- school age -group. As a result of pains- diseases in our country and have organized special cam- taking research we have discovered a latrine to suit paigns to combat them--e.g., antimalaria, antituber- this pre -school age -group and the conditions obtaining culosis and antifilaria campaigns. We have also found in their homes.This is known as the " water -seal " that the epidemiology unit established to assist in the type, and it is located near the house. control of diseases of the communicable varieties has With regard to other chapters -on health protection been extremely useful. In conjunction with the medical and promotion, education and training, medical re- research institute of the national health department, search, and health statistics -education and training continues to receive priority in the planning of medical this epidemiology unit has lately carried out studies in- care. We have also taken steps to see that the health to the problems of leptospirosis and for the first time statistics division and the epidemiological unit work in in the history of research work in Ceylon the causative close collaboration. The epidemiological unit is now organism of the disease has been isolated. These stud- responsible for screening all morbidity statistics re- ies,I am glad to announce, have stimulated much ceived from hospitals and other medical institutions interest among physicians, and more cases of lepto- before they are tabulated and made ready for publi- spirosis are now being diagnosed in the country. The cation by the health statistics unit. unit and the medical research institute are also study- The chapters on the work done in the different ing the arthropodborne virus infections. regions of WHO provide informative and interesting Before concluding my comments on communicable reading.Suffice it to say in passing that the South - diseases, I must dwell on the national poliomyelitis East Asia Region, to which Ceylon belongs, works as a immunization campaign, which was scheduled to begin team to solve mutual health problems, with the active this month, to eradicate the threat of poliomyelitis from and able assistance received from the Regional Office our country.Last year before this Assembly our Finally, my delegation takes delight in expressing the delegation referred to the widespread outbreak of gratitude of my country to WHO for the valued assist- poliomyelitis which hit the country, and which has re- ance it has received from the Organization in the past mained a threat ever since, making us think in terms year, which I can truthfully say has stimulated and of complete eradication of this disease. We wish to supported Ceylon's advançe on the health front.In record at this point our appreciatoin of the Regional providing us with such assistance the Regional Office Director's gesture in making available to us early the at New Delhi, under the able direction of Dr Mani, has services of no less a man than Dr Albert Sabin himself, been most co- operative and helpful. While we grate- who studied the pattern of the outbreak and esta- fully acknowledge these gestures, we earnestly hope the blished that the group to be immunized for the purposes stream of aid will continue to flow more abundantly for NINTH PLENARY MEETING 145
our urgent needs and many -sided activities on the endent countries recently admitted to the World Health health front. I say so because we, like most or all Mem- Organization. We like to think that his remarks are ber nations, pin our faith resolutely and confidently on sincere and, on behalf of the Algerian delegation, I WHO. Thank you again, Mr President, for giving me should particularly like to thank him for these words this opportunity to speak. of welcome. The PRESIDENT : Thank you, Mr Perera. However, I would take this opportunity of making We have now exhausted our list of speakers on items an urgent appeal -and I am sure that I am expressing the point of view and feeling of all African countries 1.9 and 1.10, and I should like to ask the represen- (and not only African countries, but all countries that tative of the Executive Board, Dr Afridi, if he has any love liberty and progress) -an appeal that Portugal do remarks to make. all possible to help Angola achieve independence, Dr Afridi answers "No ". Thank you, Dr Afridi. allowing her to come and join the big family of WHO We shall wait until the next plenary meeting before for the next World Health Assembly. we take up the necessary resolutions and ask the Director -General to say a few words. The PRESIDENT : The delegate of Portugal has the floor. 3.Announcements Dr SOARES MARTINEZ (Portugal) (translation from The PRESIDENT : The Deputy Director -General has the French): Mr President, I am deeply moved by the two announcements to make. thanks expressed by the Algerian delegation. Dr DOROLLE, Deputy Director -General: First, Mr With regard to the appeal made by that delegation, President, the Working Party of the Committee on I should like to state that this appeal has not been made Administration, Finance ane Legal Matters on item in vain - moreover, such an appeal would not have been made in vain, even before this meeting- because 3.8.2 (Status of collection of contributions) will meet immediately. The members of this working party are the Portuguese provinces to which the delegate of India, Iran, Ireland, Philippines, Poland, Sierra Leone Algeria referred are represented here, as they take part in all bodies appertaining to Portuguese sovereignty. and Venezuela. At 2.30 p.m. the Committee on Programme and The Portuguese National Assembly is responsible Budget will meet to consider agenda items 2.2.1 and for all Portuguese legislation, the organization of the 2.2.2 (Examination of the main features of the prog- country and its administration, and on it everything ramme, and recommendation of the budgetary ceiling). depends. During the discussion of these items by the Committee Unlike the territories legitimately wishing to achieve on Programme and Budget, the Committee on Admin- independence, the provinces of Angola and Mozam- istration, Finance and Legal Matters will not meet, bique are represented with the others in the National according to the decision of the Assembly, so as to give Assembly, and the proportion of representation is an opportunity to all members of all delegations to higher than for the departments in Europe, calculated on the basis of the people of those territories who have attend. After the completion of the work on items 2.2.1 and 2.2.2 if time permits, the two main committees the right to vote -that is, with the minimum educa- tional standards enabling them to vote; since in Por- will resume their work. tugal, as in almost any other country, one must at 4.Statements by the Delegates of Algeria and Portugal least be able to read and write in order to vote. I do not wish to go into any further details on this The PRESIDENT :The delegate of Algeria has the subject, since it is, of course, essentially a political floor. question and outside the competence of the World Mr TALEB (Algeria) :(translation from the French) Health Organization. Mr President, fellow delegates, I wanted to make a The PRESIDENT : Thank you, Dr Soares Martinez. brief statement, following the intervention of the dele- The meeting is now adjourned. gate of Portugal. During his intervention, the delegate of Portugal welcomed us -or, rather, all newly indep- The meeting rose at 12.50 p.m. 146 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
TENTH PLENARY MEETING
Thursday, 16 May 1963, at 9.30 a.m.
President: Dr M. A. MAJEKODUNMI (Nigeria)
1.Reports of the Executive Board on its Thirtieth and taking account of the comments made by the various Thirty -first Sessions, and Annual Report of the delegations in regard to the size of the budget and the Director -General on the Work of WHO in 1962 way in which it should be built up. (continued) But during the discussions many other comments The PRESIDENT : We have first to complete the work were made, for instance on the question of the policies on items 1.9 and 1.10.Yesterday we finished the of the Organization, and a few delegations, in com- discussion on these items, and the representative of menting on the policies established by the Organi- the Executive Board, Dr M. K. Afridi, has indicated zation for assistance to the developing countries, that he has no more remarks to make. made an appeal for more flexibility and for changes in I now give the floor to the Director -General. policy. The only thing I can say is that your Secretariat The DIRECTOR- GENERAL : Mr President, honourable will do the best it can to improve flexibility in carrying delegates, I should like to thank all the delegates for out the policies established by the Health Assembly, their very encouraging remarks and for the very good but that it will be for the Assembly to decide what is participationinthediscussionon theDirector - the best type of assistance it wants the Organization General's Report.Your kind words relating not to provide.I think this matter will be discussed in only to the Director -General but to the whole staff detail when theCommittee on Programme and of the Organization are very much appreciated, and Budget considersthedetailsof the programme I wish to thank you very much for them. for 1964. The comments made during the discussion of the With regard to the policy of recruitment of per- Director - General's Report may be divided into two sonnel,I think that this an extremely important parts. There have been many comments on the matter, and T should like to make a comment. We technical side of the programme of the Organization, have been making an effort to increase as much as and some comments on the administrative side.On possible, and to improve, the geographical distribution the technical side, I appreciate very much the guidance of the staff of the Organization ; and I should like to and orientation given by the different delegations make clear to the Assembly that I believe that this is during the discussion.It is quite clear that there is important not for the sake of geographical distribution general agreement on the importance of medical but because a true world organization needs to have education,theimportanceoftrainingauxiliary the participation of all cultures, and needs to have, personnel, the need for more emphasis on the control at all levels, what might be called the cross -fertilization and, if possible, the eradication of certain diseases, of the different cultures.This is the reason why we and also on the importance of the medical research make an effort to get a better geographical distribution. programme.During the discussions reference was It is however quite clear that such an improvement made not only to the present programmes of the will not be possible unless some governments are Organization in medical research, but also to the prepared to make a certain sacrifice to give us staff. need for their expansion to other fields.All this has It is very easy to get staff from certain countries, but been carefully noted by the Secretariat and will serve this does not help the Director -General to obtain the to guide us in the development of our future pro- wide geographical distribution that is desired.One grammes. delegation has complained that we try to recruit staff On the administrative side, many comments were from countries that are not prepared to give the staff. made in relation to the budget of the Organization, I should like to say that we have in the Organization and I do not think I should comment on this subject no nationals of that country at all.There was a case at the present moment, because all participated yester- with regard to which some discussion was carried day in the discussion : it is quite clear that the Director - on in 1961, but nothing has happened in the last year General has always to try to find his own way of that would justify a comment that we have been TENTH PLENARY MEETING 147 trying to get from this country staff that itis not he presented these reports to the plenary meeting. prepared to provide us with.But this gives me the The part of the Executive Board's report which deals opportunity of calling your attention to the fact with the proposed programme and budget estimates that during the last three years I have been making a for 1964 -namely Official Records No. 125, Executive great effort in different regions to obtain staff from Board, Thirty -First Session, Part II -is still under many countries, where we believe that they could consideration in the main committees. At the appro- afford to give us one or two staff members; but this priate time the Chair will propose to you the adoption has not yet proved possible.I am prepared to respect of the usual resolution which notes the reports of the the wishes of governments, but I think it is extremely Executive Board. important for the future of the Organization -if we wish to have a really world organization -for us to have a wide geographical distribution of the staff, 2.First Report of the Committee on Programme and Budget Many other points were raised during the discussion that will receive the full attention of the Director - The PRESIDENT : The second item on our agenda is General and the Secretariat of the Organization. I do the adoption of the first report of the Committee on not wish to take too much of your time; I wish only Programme and Budget, which contains the resolution to reaffirm that for me it was extremely useful and on the effective working budget and budget level for encouraging to see the interest of all the delegations 1964. This is recommended for adoption by the in giving what your Secretariat needs -guidance from Assembly.In accordance with Rule 52 of the Rules the World Health Assembly.(Applause). of Procedure this report, not having been distributed twenty -four hours in advance of this meeting, will be The PRESIDENT : Thank you, Mr Director -General. read aloud.The Rapporteur of the Committee, Now we are in a position to express an opinion on the Dr Sentici, is invited to read out the report. report which the Director- General has presented on the activities of the Organization in 1962. Dr Sentici (Morocco), Rapporteur of the Committee From the remarks that have been made and the on Programme and Budget, read the first report of that demonstration just now made by the delegates, the committee (see page 408). Chair considers that it is the wish of the Assembly The PRESIDENT :Thank you, Dr Sentici.I would to express its satisfaction with the way in which the like to remind delegates that, under Rule 70 of the programme has been planned and carried out.I Rules of Procedure of the Health Assembly, decisions therefore propose to the Assembly the adoption of the on the amount of the effective working budget must following resolution : be made by a two- thirds majority of the Members The Sixteenth World Health Assembly, present and voting. Having reviewed the report of the Director - I now put the resolution to the vote. General on the work of WHO during 1962, Will delegates in favour of the resolution please raise their cards.Delegates against the resolution 1. NOTES with satisfaction the manner in which please raise their cards. Delegates who are abstaining the programme was planned and carried out in 1962, from voting please raise their cards. in accordance with the established policies of the I will now read the result of the ballot : in favour 89; Organization; and against 8; abstentions, 1; number of Members pres- 2. COMMENDS the Director- General for the work ent and voting, 97 ; number required for two- thirds accomplished. majority, 65. The resolution is adopted by more than a two -thirds In the absence of any comment am I to take it that majority. We now have to vote on the report as a you are willing to adopt this resolution which I have whole. Does the Assembly approve the present report ? just read out? Are there any objections ? The report is adopted. The resolution is adopted. The meeting is adjourned. Now concerning the reports of the Executive Board, I wish to thank Dr Afridi again for the way in which The meeting rose at 10 a.m. 148 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
ELEVENTH PLENARY MEETING
Saturday, 18 May 1963, at 9.30 a.m.
Acting President: Professor R. GERIC (Yugoslavia)
The ACTINGPRESIDENT(translation fromthe Dr ALAKIJA (Nigeria) : Thank you, Mr President. French) : The President of the Assembly is not well I have just one small comment in regard to the last and has asked me to replace him. part, which says the External Auditor may designate May I, gentlemen, before proceeding with the work a representative to act in his absence, should the of the Assembly, say how much I appreciate the honour necessity arise.Surely such a person, to do such you have done to my country in electing its represent- important work, must designate somebody acceptable ative to act as Vice -President of this Assembly. to this Assembly -not necessarily to himself ?And At the First World Health Assembly, held in 1948 I would like to have such a phrase inserted in this in Geneva, Yugoslavia had the honour of seeing its clause, if possible. representative, Professor Andrija Stampar, preside over the Assembly -which was also a sign of recogni- The ACTING PRESIDENT(translation fromthe tion of Professor Stampar's wide contribution to French) : I call upon the Deputy Director- General. the creation and building -up of our organization. Dr DOROLLE, Deputy Director -General (translation Since then, and up to the present time, Yugoslavia from the French) : Mr President, if delegates will kindly has participated actively in the numerous Assemblies refer to the Handbook of Resolutions and Decisions, of the World Health Organization, has benefited from sixth edition, page 321 and the following pages, they its generous aid, and made its modest contribution to will see that since the First World Health Assembly, the Organization's work. the resolution relating to the appointment of the Once again, gentlemen, I thank you very warmly External Auditor has contained this clause authorizing on behalf of my country and in the name of the Mr Brunskog to designate a representative to replace delegation of the federal socialist Republic of Yugo- him in his absence. The Assembly may be assured that slavia. if Mr Brunskog found himself obliged to designate a representative, he would consult the Director -General, 1.Second Report of the Committee on Administration, and the person chosen would be of the calibre the Finance and Legal Matters Assembly is entitled to insist on. The ACTING PRESIDENT(translation fromthe French) : The first item on our agenda is the adoption The ACTING PRESIDENT(translation fromthe of the second report of the Committee on Administra- French): Thank you, Dr Dorolle. Are there any other tion, Finance and Legal Matters. In accordance with comments ?There being no further comments, the Rule 52 of the Assembly's Rules of Procedure, since resolution is adopted. this report was not distributed twenty -four hours Dr Bravo read section 2 of the report (Amendments to before this meeting it will be read aloud. The Rappor- the Staff Rules). teur of the Committee, Dr Bravo, is requested to come to the rostrum and read the second report. The ACTINGPRESIDENT(translation fromthe French) : Does the Assembly agree to adopt the resolu- Dr Bravo (Chile), Rapporteur of the Committee on tion on the amendments to the Staff Rules ? Are there Administration, Finance and Legal Matters, read the any comments ? There being no comments, the reso- preamble and section 1 (Appointment of the External lution is adopted. Auditor) of the second report of that committee (see page 410) . Dr Bravo read section 3 of the report (Selection of the countryinwhichtheSeventeenthWorld Health The ACTING PRESIDENT(translation fromthe Assembly will be held). French) : Does the Assembly agree to adopt the reso- lution on the apppointment of the External Auditor ? The ACTINGPRESIDENT(translation fromthe Are there any comments ?The delegate of Nigeria French) : Does the Assembly wish to adopt the reso- has the floor. lution concerning the selection of the country in ELEVENTH PLENARY MEETING 149
which the Seventeenth World Health Assembly will be The ACTING PRESIDENT(translation fromthe held ? Are the any comments ? There being no com- French) : Does the Assembly agree to adopt the second ments, the resolution is adopted. resolution contained in this report, relating to the Dr Bravo read section 4 of the report (Malaria appointment of representatives to the WHO Staff Eradication Special Account). Pension Committee ? Are there any comments ? There are no comments. The resolution is adopted. The ACTING PRESIDENT(translation fromthe French) : Is the Assembly in agreement concerning the Dr Bravo read section 3 of the report (Headquarters adoption of the resolution on the Malaria Eradication accommodation: progress report). Special Account ?Are there any comments ? There The ACTING PRESIDENT(translation fromthe being no comments, the resolution is adopted. French) :Is the Assembly agreed on the adoption of Dr Bravo read section 5 of the report (Malaria the resolution relating to the progress. report on head- eradication postage stamps). quarters accommodation ? Are there any comments ? There are no comments. The resolution is therefore The ACTING PRESIDENT(translation from the adopted. French) : Does the Assembly wish to adopt the reso- We now have to adopt the report as a whole. Does lution on malaria eradication postage stamps ?Are the Assembly wish to adopt the report as a whole ? there any remarks ?There being no remarks, the There being no objection, the report is adopted. resolution is adopted. Thank you, Dr Bravo. Dr Bravo read section 6 of the report (Annual Report of the United Nations Joint Staff Pension Board for 1961). 3.Second Report of the Committee on Programme and Budget The ACTING PRESIDENT(translation fromthe French) :Is the Assembly in agreement with regard to The ACTING PRESIDENT(translation fromthe the adoption of the resolution on the Annual Report French) : The third item on our agenda is the second of the United Nations Joint Staff Pension Board for report of the Committee on Programme and Budget. 1961 ? Are there any comments ?There are no I invite the Rapporteur of that Committee, Dr Sentici, comments. The resolution is adopted. to read the second report. We now have to adopt the report as a whole. Does Dr Sentici (Morocco), Rapporteur of the Committee the Assembly wish to adopt the report as a whole ? on Programme and Budget, read the preamble and Are there any objections ? The report is adopted. section 1 (Report on development of the malaria eradic- ation programme) of the second report of that committee 2.' Third Report of the Committee on Administration, (see page 408). Finance and Legal Matters The ACTING PRESIDENT(translation fromthe The ACTING PRESIDENT(translation fromthe French) : Does the Assembly agree to adopt the reso- French) : I will now ask Dr Bravo to read out the third lution Dr Sentici has just read out on the subject of report of the Committee on Administration, Finance the report on development of the malaria eradication and Legal Matters. programme ? Are there any comments ? There being Dr Bravo (Chile), Rapporteur of the Committee on no comments the resolution is adopted. Administration, Finance and Legal Matters, read the Dr Sentici read section 2 of the report (Developments preamble and section 1 (Status of collection of annual in activities assisted. jointly with UNICEF). contributions and of advances to the Working Capital Fund) of the third report of that committee (see page 410) . The ACTING PRESIDENT(translation fromthe French) : Does the Assembly wish to adopt the reso- The ACTING PRESIDENT(translation fromthe lution on activities assisted jointly with UNICEF? French) : Does the Assembly wish to adopt the first Are there any comments ?There being none, the resolution contained in the report, relating to the resolution is adopted. status of collection of annual contributions and of We now have to adopt the report as a whole. Does advances to the Working Capital Fund ?Are there the Assembly wish to adopt the report as a whole ? any comments ?There are none.The resolution is If so, the report is adopted. Thank you, Dr Sentici. adopted. The meeting is adjourned. Dr Bravo read section 2 of the report (Appointment of representatives to the WHO Staff Pension Committee). The meeting rose at 10 a.m. 150 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
TWELFTH PLENARY MEETING
Wednesday, 22 May 1963, at 9.30 a.m.
President: Dr M. A. MAJEKODUNMI (Nigeria)
1.Report by the General Chairman of the Technical non -governmental organizations registered for parti- Discussions cipation. The level of oral participation inthe The PRESIDENT: The meeting is called to order. The discussions was of the order of eighty to ninety per first item on our agenda today is the report by the cent. of those attending. General Chairman of the technical discussions. I The first plenary meeting was held on 10 May, with invite Dr Shousha to come to the rostrum and present thetraditionalopening address by theGeneral his report. Chairman, which has been circulated to delegates as document Al 6/Technical Discussions /4. The technical Dr SHOUSHA, General Chairman, Technical Discus- discussions were held on 10 and 11 May. Participants sions : Mr President, thank you for the privilege you were divided into eight groups, to each of which were have given me of presenting the report of the technical assigned a chairman and a rapporteur, with a member discussions to this august Assembly. The report has of the WHO staff as secretary.In constituting these been circulated to the distinguished delegatesas groups, an attempt was made to bring together people document A16 /TechnicalDiscussions /6Rev.lof from different regions and from different countries 17 May 1963. which had reached different stages and which had Mr President,inaccordancewithresolution different approaches in medical training. WHA10.33 of the Tenth World Health Assembly, the I am glad to report that as a result of these group Executive Board atitstwenty- eighth session, by discussions a large area of subjects was covered and a resolution EB28.R13, decided that the subject to be good deal of material was obtained for use in drawing discussed at the technical discussions this year would up the draft report which was circulated to the be " Education and training of the physician for the participants and considered in the closing plenary preventive and social aspects of clinical practice ". meeting held on 15 May 1963.After a short but The Director -General, on 30 August 1962, forwarded lively general debate, with minor amendments which to Member States of the Organization and to interested appear in the revised version (document A16 /Technical non -governmental organizations, under cover of a Discussions /6 Rev.l), the report was approved and circular letter, C.L.34.1962, a preliminary document adopted. in the form of a suggested outline, in which were Subject to your approval, Mr President, there is no summarized some of the WHO contributions to the need to read the report in full, as it has already been subject and a number of areas for discussion.It was circulated. Ishall merely indicate a number of expected that factual information on opinions relevant suggestions, arising from the second plenary meeting, to the subject would be sent by the countries, to be which are worthy of future scrutiny and analysis. summarized by WHO and presented as a working They can be considered under four headings : paper of the technical discussions.In response to (1)Problems of definition.Social medicine as a this appeal, nineteen Member States and five non- subject and as an approach requires clarification and, governmental organizations presented valuable reports. aboveall,illustration,ina number of different A background document (A16 /TechnicalDiscus - contexts. Social medicine in a developing country sions/1, of 25 March 1963) based on the summary must inevitably differ from that in a highly developed reports,was prepared by ProfessorE.Maurice country, and again the subject will be different in Backett, WHO consultant and Professor of Social areas different in demographic or other social back- Medicine and Head of the Department of Public ground; these differences need further exploration Health and Social Medicine in the University of and definition. Aberdeen. This was sent by the Director -General to Member States on 11 April this year. Our technical (2)Problems of theintegration of clinical and discussions were based on that document.About preventive medicine and medical education.A review 180 members from eighty -seven countries and eight is needed of what is meant in practical terms by the TWELFTH PLENARY MEETING 151
" integration " of subjects in medicine.Particularly Mr President, permit me to take this opportunity to the experiments that have been made in integration thank all those who have contributed to the happy should be described and evaluated. result of the technical discussions.I would like to express my great appreciation of the work of the WHO (3)Problems of teaching about the social responsi- bilities of the doctor. Several participants felt that this consultant, Professor Backett. I am indebted to was such an important subject that much further work Dr Petitpierre,our GeneralSecretary, who was responsible for all the administrative arrangements, should be done upon it.In particular, there should be a review of the extent and origins of notions about and to Professor Grzegorzewski, Director of Education the responsibilities of the physician. and Training in WHO, for his valuable help and advice. Much of the success has been due to the Group (4)Problems of WHO action based uponthe Chairmen and Rapporteurs and to all the members of technical discussions.There were several suggestions the Secretariat. To all delegates who took part in the that action should follow on these discussions.Over discussions I would like to extend my appreciation and above the suggestions mentioned in the report, and admiration for theobjectivity with which we expert committees were suggested (i)to scrutinize have approached the problem and the very valuable past and present work in the field of teaching social suggestions and conclusions they have put forward. and preventive medicine, and to give a series of guide- Permit me also, Mr President, to take this opportunity lines to the new and the old medical schools; (ii) to to express my thanks to Dr Kurasov, President of the suggest how progressive changes might be fostered Fifteenth World Health Assembly, and to the Executive at the national level. Board, for the honour they have done me in asking me Mr President,the scope and aims of medical to be the General Chairman of the technical discus- education have undergone a marked alteration within sions of the Sixteenth World Health Assembly. the last decades.These alterations are due to the The PRESIDENT :Thank you, Dr Shousha.I am fact that the social values and aims have, with the confident that I am expressing the feelings of each continued evolutionary development of society itself, member of this Assembly in thanking you most undergone marked modifications.The care of the sincerely for the outstanding way in which you have health of the people is now regarded as an issue of directed the technical discussions as General Chairman. practical policies of governments. By focusing our attention on the role of the physician The technical discussions this year have taken place as a catalyst in society, who by the harmonious at an important and decisive stage, when the theme combination of the practice of both preventive and of the training of the physician -particularly with curative medicine stimulates social consciousness at respect to preventive and social aspects -is in the all levels in the community, your discussion groups forefront of medical education. No doubt there is a have made a notable contribution to medical science good deal of world -wide dissatisfaction with both and have further advanced the noble objective of our the methods and content of medical education today - organization.In your opening address you inspired a dissatisfaction which has been proclaimed even the group with an enthusiasm for the ensuing discus- within the medical profession itself. sions and I hope that the conclusions of those debates, I think that I am expressing the feeling of many, if which you have just now summarized admirably, will I underline the great value of the technical discussions be taken into consideration by all medical educators. held during this Assembly- discussions which helped I would also like to thank the Group Chairmen and the us all to understand the most important problems of Rapporteurs for their contribution to the success of various countries, to exchange experience and to the technical discussions. enrich ourselves with new ideas, the implementation The report is now before the Assembly. Are there of which will help us all to provide still better pro- any comments orobservations ?May Iremind motion of health of our peoples. you that, as in previous Assemblies, the technical discussions, which have been held under the auspices Sir, you reminded us for the value of these technical of the Sixteenth World Health Assembly, do not form discussions when, in your presidential address, you an integral part of its work.I suggest that we take said, and I quote : " We would be making a singular note of the report, and again I thank those who have contribution tothe work of the Organization if contributed to the success of the discussions. Are there delegates undertook here and now to ensure that those any comments on this suggestion ?The delegate of recommendations which emanate from the technical the United Arab Republic. discussions that will be held at this session are given very serious consideration and implemented wherever Dr EL BITASH (United Arab Republic) : Mr Pre- possible in their various countries." sident, on behalf of the delegates who are present at 152 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II this Sixteenth World Health Assembly, I think we a whole ? In the absence of any objection I take it that have a duty to say a few words about the efficient work the Assembly agrees to adopt the report as a whole. that has been carried out in the technical discussions. Dr Shousha really conducted the discussions in the most brilliant and efficient way, and the conclusions 3.Fourth Report of the Committee on Programme and Budget which we are now examining show how efficiently was the work done. On behalf of my delegation, I wish to The PRESIDENT : The next item on our agenda is the thank him and everybody who took . part in those adoption of the fourth report of the Committee on discussions. Programme and Budget. In accordance with Rule 52 of the Rules of Procedure, this report, not having been The PRESIDENT :In the absence of other comment, distributed twenty -four hours in advance of the plenary I declare that the Assembly has taken note of the meeting, will be read aloud. The Rapporteur of the report. Committee, Dr Sentici, is now invited to come to the rostrum to read this report aloud. 2.Third Report of the Committee on Programme and Budget Dr Sentici (Morocco), Rapporteurofthe Committee on Programme and Budget, read the preamble and The PRESIDENT : The second item on our agenda is section 1 (Organizational study: measures for providing the adoption of the third report of the Committee on effective assistance in medical education and training Programme andBudget.1In accordance with Rule 52 to meet priority needsofthe newly independent and of the Rules of Procedure this report, having been emerging countries)ofthe fourth report of that com- distributed twenty -four hours in advance of this mittee (see page 409). meeting, will not be read aloud. Four resolutions are contained in this report and I shall ask the Assembly The PRESIDENT : Does the Assembly agree to adopt to approve each of them in turn. the resolution on the organizational study, " Measures Does the Assembly agree to adopt the first resolu- for providing effective assistance in medical education tion, on television influence on youth ?Any com- and training to meet priority needs of the newly ments ? In the absence of any comments the resolution independent and emerging countries " ? Are there any is adopted. comments ? No comments. The resolution is adopted. Does the Assembly agree to adopt the second reso- Dr Sentici read section 2ofthe report (Organizational lution, on the Voluntary Fund for Health Promotion : Study: methodsofplanning and executionofprojects). Medical Research ? Are there any comments ? In the absence of any comments the resolution is adopted. The PRESIDENT : Does the Assembly agree to adopt Does the Assembly agree to adopt the third reso- the resolution on the organizational study, " Methods lution, on the Voluntary Fund for Health Promotion : of planning and execution of projects " ? Any com- Community Water Supply ? Are there any comments ? ments ?No comments.The resolution is adopted. In the absence of any comments the resolution is Dr Sentici read section 3ofthe report (Continued adopted. assistance to newly independent States) . Does the Assembly agree to adopt the fourth resolu- tion, on the Appropriation Resolution for the financial The PRESIDENT : Does the Assembly agree to adopt year 1964?I recognize the delegate of the USSR. the resolution on continued assistanceto newly independent States ? Are there any comments ? No Professor 2DANOV (UnionofSovietSocialist comments. The resolution is adopted. Republics) (translation from the Russian) :Mr Pre- We now have to adopt the report as a whole. Any sident, I wished only to say that my delegation has objection to the adoption of the report as a whole ? voted against this resolution, still disagrees with it In the absence of any objection I take it that the and is against its adoption. Assembly agrees to adopt the report as a whole. The PRESIDENT : Thank you very much, Professor Zdanov. 4.Fourth Report of the Committee on Administration, Are there any further comments ? In the absence of Finance and Legal Matters any further comments I declare that the resolution is adopted. The PRESIDENT : The next item on our agenda is the We have now to adopt the report as a whole. Are adoption of the fourth report of the Committee on there any objections to the adoption of the report as Administration, Finance and Legal Matters. In accordance with Rule 52 of the Rules of Procedure
1 See p. 408. this report, not having been distributed twenty -four THIRTEENTH PLENARY MEETING 153
hours in advance of this plenary meeting, will be The PRESIDENT : Thank you, Dr Bravo. read aloud.The Rapporteur of the Committee, Does the Assembly agree to adopt the resolution Dr Bravo, is invited to the rostrum. ondecisionsof theUnitedNations,specialized agencies,InternationalAtomic Dr Bravo (Chile), Rapporteur of the Committee on EnergyAgency, affecting WHO's activities :administrative, budgetary Administration, Finance and Legal Matters, read the andfinancialmatters -- conferencearrangements ? preamble and section 1 (Decisions of the United Nations, Are there any comments ? No comment. The reso- specializedagenciesand IAEAaffectingWHO's lution is adopted. activities:administrative,budgetaryand financial We now have to adopt the report as a whole. Any matters -inter -organization machinery for matters of objection to the adoption of the report as a whole? pay and allowances) of the fourth report of that com- In the absence of any objection, Itake it that the mittee (see page 410). Assembly agrees to adopt the report as a whole.
The PRESIDENT : Does the Assembly agree to adopt 5.Announcement concerning Closure of the Session the resolution on decisions of the United Nations, The PRESIDENT :I now have to make an announce- specialized agencies and theInternational Atomic ment on a subject about which many of you have Energy Agency affecting WHO's activities : administra- asked, and continue to ask, questions.I refer to the tive, budgetary and financial matters- inter -organi- date of the closure of the Assembly.In conformity with the provisions of Rule 33, paragraph(f)of the zation machinery for matters of pay and allowances ? Rules of Procedure, the General Committee has fixed Are there any comments ? No comments. The reso- Friday morning, 24 May, as the date of closure of the lution is adopted. Sixteenth World Health Assembly. Dr Bravo read out section 2 of the report (Decisions We have concluded our work for today and the meeting is now adjourned. of the United Nations, specialized agencies and IAEA affecting WHO's activities: conference arrangements) The meeting rose at 10.10 a.m.
THIRTEENTH PLENARY MEETING
Thursday, 23 May 1963, at 9.30 a.m.
President:Dr M. A. MAJEKODUNMI (Nigeria)
1. Expression of Condolence on the Death of Dr S. one minute's silence in the memory of our friend and Syman, Delegate of Israel colleague. The PRESIDENT : The Assembly is called to order. The Assembly stood in silence for one minute. It is my painful duty to announce, with profound shock and sorrow, the death yesterday of Dr Saul 2.Fourth Report of the Committee on Credentials Syman, a distinguished delegate of the State of Israel to the Sixteenth World Health Assembly. The funeral The PRESIDENT : We now have to approve the fourth ceremony is taking place during this morning, which report of the Committee on Credentials. The Rap- accounts for the absence of the Israeli delegation. porteur of the Committee, Dr Andriamasy, is invited I have arranged for the Assembly to be represented to come to the rostrum to read the report. at this ceremony. Ishall also, on behalf of the Assembly, send messages of condolence to the Govern- Dr Andriamasy (Madagascar), Rapporteur of the ment of Israel and to the family of Dr Syman. Committee on Credentials, read the fourth report of I will now ask the Assembly to stand and observe that committee (see page 407). 154 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The PRESIDENT : Thank you, Dr Andriamasy. The PRESIDENT : Does the Assembly agree to adopt Does the Assembly agree to, approve the fourth the resolution on the smallpox eradication programme? report of the Committee on Credentials ?Are there Any comments ?No comments.The resolution is any comments ? No comments. The report is adopted. adopted. Dr Sentici read section 2 of the repon (Clinical and 3.Fifth Report of the Committee on Programme and pharmacological evaluation of drugs: standards of
Budget drugs). The PRESIDENT :The next item on our agenda is The PRESIDENT : Does the Assembly agree to adopt the adoption of the fifth report of the Committee the resolution on the clinical and pharmacological on Programme and Budget.The rapporteur of the evaluation of drugs :standards of drugs ? Any Committee, Dr Sentici, is invited to come to the comments ? No comments. The resolution is adopted. rostrúm and read his report. Dr Sentici read section 3 of the report (Decisions of Dr Sentici (Morocco), Rapporteur of the Committee the United Nations, specialized agencies and the IAEA on Programme and Budget, read the preamble and affecting WHO's activities: programme matters). section 1 (Additional Regulations of ... May 1963 amending the International Sanitary Regulations in The PRESIDENT : Does the Assembly agree to adopt particular with respect to notifications) of the fifth the resolution on decisions of the United Nations, report of that committee (see page 409). specialized agencies and the International Atomic Energy Agency affecting WHO's activities : programme The PRESIDENT : Does the Assembly agree to adopt matters ? Are there any comments ? No comments. the resolution on Additional Regulations of ... May The resolution is adopted. 1963 amending the International Sanitary Regulations in particular with respect to notifications ? Are there Dr Sentici read section 4 of the report (United Nations any comments ?No comments.The resolution is Development Decade). adopted. The PRESIDENT : Does the Assembly agree to adopt Dr Sentici read section 2 of the report (Committee the resolution on the United Nations Development on International Quarantine: eleventh report). Decade ? Any comments ? No comments. The reso- The PRESIDENT : Does the Assembly agree to adopt lution is adopted. the resolution on the Committee on International Dr Sentici read section 5 of the report (Extension of Quarantine :eleventh report ?Any comments ? No the agreement with UNRWA). comments. The resolution is adopted. The PRESIDENT : I would remind delegates that under Dr Sentici read section 3 of the report (Clinical and Rule 70 of the Rules of Procedure of the Health pharmacological evaluation of drugs). Assembly the decision on this resolution must be made The PRESIDENT : Does the Assembly agree to adopt by a two -thirds majority of the Members present the resolution on the clinical and pharmacological and voting. evaluation of drugs ?Are there any comments ? I now put the resolution on the extension of the No comments. The resolution is adopted. agreement with UNRWA to the vote.Delegates in We now have to adopt the report as a whole. Are favour of the resolution will please raise their cards. there any objections to the adoption of the report as Thank you. Delegates who are against the resolution a whole ?No objections.The report is adopted. will please raise their cards. Delegates who are Thank you, Dr Sentici. abstaining from voting on the resolution will please raise their cards. 4.Sixth Report of the Committee on Programme and The result of the voting is as follows : in favour, 84; Budget against,nil;abstentions,nil. The resolutionis adopted. The PRESIDENT : The next item on our agenda is the sixth report of the Committee on Programme and Dr Sentici read section 6 of the report (Joint FAO! Budget. Dr Sentici, will you please read the sixth and WHO programme on food standards (Codex Alimen- final report of your committee. tarius). Dr Sentid (Morocco), Rapporteur of the Committee The PRESIDENT : Does the Assembly agree to adopt on Programme and Budget, read the preamble and the resolution on the joint FAO /WHO programme on section 1 (Smallpox eradication programme) of the food standards -Codex Alimentarius? Are there any sixth report of that committee (see page 409). comments ? No comments. The resolution is adopted. THIRTEENTH PLENARY MEETING 155
I now recognize the representative of the Food and teur of the Committee, Dr Bravo, is invited to come to Agriculture Organization of theUnited Nations, the rostrum to read the report. Mr F. Townshend. Dr Bravo (Chile), Rapporteur of the Committee on Mr TOWNSHEND (Food and Agriculture Organiza- Administratian, Finance and Legal Matters, read the tion) : Mr President, in the name of my Director - fifth report of that committee (see page 410). General, may I thank you on behalf of my organization, your sister body, the Food and Agriculture Organiza- The PRESIDENT : Thank you, Dr Bravo. tion of the United Nations. Your Assembly, Mr Presi- We must first adopt the resolution, contained in this dent, has just adopted proposals which originated in the report, on the meeting of the Regional Committee for FAO for a joint programme on food standards. While Africa.Are there any comments ?I recognize the this problem is one of many others which your organi- delegate of South Africa. zation has to solve, it is one which is particularly dear Mr TALJAARD (South Africa) : Mr President, distin- to our hearts, and perhaps to our stomachs, in that the guished delegates, in the Committee on Administra- word "food" is a part of our official title. On the other tion, Finance and Legal Matters the South African hand, to tackle this problem in its aspects which con- delegation opposed the adoption of the draft resolu- cern toxicology, particularly of food additives and of tion on the question of the meeting of the Regional pesticide residues, to tackle also the problems of the Committee for Africa. The South African delegation capital hygiene questions of food standards, would be also desires to record its opposition to this resolution unthinkable without the closest co- operation of your here in the Assembly, on the following grounds :first, organization. that it contains provisions of a political character; sec- Mr President, there remain two more important ondly, that the World Health Organization, being in points. One is that in many of your Member countries essence a technical organization, is not constitutionally work on food standards lies within the competence of three or four Ministries -health, agriculture, com- competent to determine questions of a political charac- ter; thirdly, that the political action it is taking in adopt- merce, export and the like. May I express the hope ing the said provisions of this resolution constitutes that the extremely pleasant and, if I may say, effective unwarranted interference in the domestic affairs of a collaboration between our organizations will be of use Member State; and, lastly, that this action sets a most to the very large number of countries already actively interested in this programme, whether they come undesirable precedent. Having, however, recorded the South African dele- from the north or the south, the east or the west, gation's opposition to the resolution, I wish to reiter- whether they are developing countries or whether ate my statement in the Committee that South Africa they are industrialized countries. is willing to co- operate to the fullest extent with all the Lastly, the object of this programme is merely to Member States of the African Region in the vital task ensure that foods present no health risk and are mar- of promoting the health of the peoples in the Region. keted and labelled in a manner which does not mislead Accordingly, South Africa remains ready to do what- the consumer. It has not the intention -and it will not ever is possible to further the effective functioning of have the effect -of imposing a grey, drab uniformity the African Regional Organization. upon the colourful diversity of human existence, to My delegation is furthermore in agreement with the which Bundesrat Dr Wahlen of your host country, a action taken by the Regional Director and by the former deputy head of my organization, so elegantly Director - General to ensure the functioning of the referred in a speech to the Council of Europe a few African Regional Organization and the fulfilment of weeks ago. the constitutional functions of the African Regional The PRESIDENT :Thank you, Mr Townshend. We Committee for the protection of the health rights of now have to adopt the report as a whole. Are there any all populations in the African Region. objections to the adoption of the report as a whole ? No objections ?The report is adopted. Thank you, The PRESIDENT : Thank you, Mr Taljaard.Your Dr Sentici. observations will be recorded in the proceedings of the Assembly. In the absence of any further comments, the resolu- 5.Fifth Report of the Committee on Administration, tion is adopted. Finance and Legal Matters We now come to the adoption of the report as a The PRESIDENT : The next item on our agenda is the whole. Are there any objections to the adoption of the adoption of the fifth report of the Committee on Admi- report ? No objections ? The report is adopted. Thank nistration, Finance and Legal Matters. The Rappor- you, Dr Bravo. 155 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
6.Review and Approval of the Reports of the Executive 1. NOTES the reports of the Executive Board on Board on its Thirtieth and Thirty -first Sessions its thirtieth and thirty -first sessions; and The PRESIDENT : The next item on our agenda is the 2. COMMENDS the Board on the work it has per- approval of the reports of the Executive Board on its formed. thirtieth and thirty -first sessions.During our discus- Are there any comments on this resolution ?No sion on the reports of the Executive Board it was stated comments ? The resolution is adopted. that, when the main committees had finished their con- sideration of the parts of the report dealing with the 7.Announcement programme and budget estimates for 1964, I would The PRESIDENT :I now have an announcement to propose the adoption of the customary resolution make. Contrary to our previous decision the General noting the reports of the Executive Board. I should now Committee decided yesterday that the closing plenary like to propose the adoption of this resolution, which I meeting would be held this afternoon at 4.30 p.m. The shall read to you : meeting is adjourned. The Sixteenth World Health Assembly The meeting rose at 10.25 a.m.
FOURTEENTH PLENARY MEETING
Thursday, 23 May 1963, at 4.30 p.m.
President: Dr M. A. MAJEKODUNMI (Nigeria)
1.Tributes to the late Dr S. Syman, Delegate of Mr RAFAEL (Israel) : Mr President, the delegation of Israel Israel, which is still under the very shock of the sudden The PRESIDENT : The meeting is called to order. and untimely death of its head, Dr Saul Syman, is As the delegation of Israel was unable to attend our deeply moved by the expression of sympathy which you plenary meeting this morning, I should now like to were kind enough to pronounce on behalf of the offer to them, in my own name and on behalf of the Assembly and yourself.I shall not fail, Mr President, Assembly, sincere condolences on the death of Dr to convey your words to my Government and to the Syman. You will allow me, on this occasion, to recall bereaved family.Israel has lost a central figure of briefly the life and career of our late friend. its health service.The World Health Organization Dr Saul Syman was born in 1909. He studied medi- has, I believe, lost a devoted friend who never failed cine in Berlin and had lived in Israel since 1933. He worked as a general practitioner for the Workers' Sick to stand by with advice and for many years took an Fund and, in 1949, joined the Israeli Ministry of active part in its work : his own philosophy of life could Health, where he served successively as District Health not do otherwise than fit into the conception and aims Officer, Assistant. Director- General and Deputy Direc- of this organization, which are the well -being of human tor- General until 1960, when he was appointed Director beings and the furthering of ways and means which General. Dr Syman has attended all the World bring the world nearer to its goal. Health Assemblies since 1950; in 1961 he was nomin- ated by his country to serve on the Executive Board, and was elected Rapporteur of the thirtieth session of 2.Statement by the Delegate of Rwanda the Board. He was sincerely devoted to the ideals of The PRESIDENT :1 now recognize the delegate of WHO, and made a valuable contribution both as a Rwanda, who has not yet had the opportunity of delegate and as a member of the Executive Board. Dr Syman leaves a wife and a daughter in Israel. addressing the Assembly and would like to do so now. I now call on the delegate of Israel to say a few The delegate of Rwanda will please come to the words. rostrum. FOURTEENTH PLENARY MEETING 157
Mr GASHAKAMBA (Rwanda) (translation from the With regard to medical education and the training of French): Mr President, ladies and gentlemen, first of nurses and auxiliaries, my country has adopted a com- allI apologize for the late arrival of my delegation pletely new system by which technical trainingis which was due to a misunderstanding.1 am never- associated with the candidates' general education.In theless particularly happy to represent my country, so far as medical education is concerned, my country which is attending the World Health Assembly for the has definitely opted for the training of physicians in first time.I thank the Organization for having accept- Rwanda --at least in so far as training in the basic ed the Republic of Rwanda as a full Member from 7 sciences is concerned. We should be happy if WHO November 1962.On 1 July 1962 Rwanda became an could provide us with fellowships for the students who independent country and its independence was achieved will be taking courses at the Faculty of Medicine which peacefully and with dignity under the direction of its is to open at Butaré at the end of this year, and with at least one professor. President, His Excellency Mr Grégoire Kayibanda. Then, Mr President, I should like to congratulate I should like now to say a word on the health of our people. Our three main health problems in Rwanda you very warmly on your accession to the high office of are tuberculosis, malnutrition, and maleria.Tuber- President of this Assembly. The authority with which culosis worries us most. The Regional Office at Braz- you direct our debates is proof of the wisdom of the zaville has already sent us an expert to study how choice made by the delegations here present. assistance can best be given, and plans of operation Addressing myself to you, Mr Director -General, re- have already been drawn up.Unfortunately, we shall appointed by unanimous vote, I would say that the find it very difficult to meet the recurring costs of any unanimity of the vote was a measure of the confidence plan of operation in the immediate future. The same we have in you. My delegation wishes to congratulate applies to the proposed malaria pre- eradication plan. you most heartily; we are certain that under your I will sum up, gentlemen, in order not to take up any direction new work will be undertaken, and new suc- more of your time. My country looks to the future cesses achieved. with a certain amount of anxiety. While outside help is On 1 July 1962, the day of the memorable celebra- forthcoming with respect to medical education, the tion of independence, you sent us your personal situation regarding availability of drugs and scientific representative to obtain information concerning our supplies is extremely serious. I could continue in this most pressing needs. We remember the valuable advice vein for a long time and speak to you of other he gave us on that occasion -particularly the advice to serious and urgent needs in the field of health in my keep intact as far as possible the infrastructure of the small overcrowded country in the heart of Africa. My health services and the team of Belgian doctors and Government reliesupon your understanding and technicians who staffed our medical services, some- assures you of its confidence and gratitude. times in very difficult circumstances, during the period of The PRESIDENT : Thank you, Mr Gashakamba. autonomy.During the trusteeship period, Belgium provided my country with a network of hospitals and out -patient, clinics, with medical schools, nurses, and 3.Closure of the Session medical assistants, and I take this opportunity of pay- ing tribute to Belgium for what it accomplished and The PRESIDENT : A number of delegates have asked for the assistance it continues to give us with regard to to speak.I now recognize the delegate of Argentina. personnel. Dr OLGUÍN(Argentina)(translation fromthe However, now that we have our fate in our own Spanish) : Mr President, fellow delegates, dear friends, hands, times have changed. Since our recently acquired the delegations of the American countries have done independence, our people (90 per cent. of which is me the honour of asking me to repressent them at the rural), has had a truly revolutionary change of outlook rostrum of this honourable Assembly.It is with great and shown itself receptive to the progress of medicine sincerity that on their behalf and on behalf of my and modern ideas of hygiene.Our needs have thus country, Argentina, 1 express our unanimous satis- increased. We still have too few doctors and an acute faction with the meetings that are now ending -which, shortage of drugs. however, have been so regrettably overshadowed by We wish to thank WHO for its help in sending an the death of Dr Syman, delegate of Israel. advisory team of a physician, a nurse, and a sanitary Mr President, the World Health Assembly isin engineer. At the end of this year we hope to receive a itself a most important gathering.It represents opin- maternal and child health team composed of a paediat- ons, aspirations and decisions of all the countries of rician, a public health nurse, and perhaps a nurse tutor, the world united in a common ideal- -the betterment of 158 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II health; it is the result of a universal effort for the well- and your devotion to duty have served to make the being of mankind. Organization a dynamic specialized agency of the This year in particular, when WHO celebrates its United Nations. On behalf of my African colleagues, I fifteenth anniversary, as we look back along the road congratulate you, Mr Director -General, and your staff, it has travelled from the day of its inception, there can for the very able way in which this Assembly has been be no greater satisfaction than to feel ourselves an carried on. integral part of this growing family of nations united Last, but by no means least, I wish to thank delegates in a common ideal. The admission of new countries of Member States for the cordiality and understand- means that their people will be bringing their cont- ing which have characterized the debates and discus- ribution to our work and helping to maintain the sions both in the committees and plenary sessions. We necessary stimulus to life and action. We wish to con- appreciate the great interest which you have shown gratulate the Director - General on the Organization's in public health matters affecting Member States in the constant progress. African Region, and we sincerely hope that the bond of Mr President, this Sixteenth World Health Assembly international co- operation in the .field of health will represents another landmark :the subjectsithas continue to find eloquent expression in the years that dealt with have been varied, important and difficult. lie ahead. The greatest of the world's health problems have been Mr President, Director- General, fellow delegates, considered,healthpolicy and trends have been ladies and gentlemen, on behalf of the Member States discussed,importantfutureactivitieshavebeen of the African Region, I thank you once again, and we planned. The discussions have been on a high level, rest assured that the deliberations which have taken both morally and technically.Ideals and practical place during this Assembly will continue to contribute achievements have both had their place, and decisions to the attainment by all peoples of the highest possible of paramount importance have been taken. At the end level of health. of the Assembly we are strengthened by the conviction that the task has been well done, with firm agreement The PRESIDENT :Thank you Mr. Findlay. I now on final objectives; friendship and unity between the call on the delegate of India. peoples of the world have been strengthened.In all this, Mr President, a great responsibility has been Dr NAYAR : (India) : Mr President, on behalf of the laid upon you, and to the performance of your task countries of the South -East Asia Region of WHO, I you have brought qualities of character, intelligence wish to extend our greatful thanks to you for conduct- and leadership.In the name of all the delegations ing the deliberations of the Sixteenth World Assembly of the American countries, may I congratulate you in a most able and dignified manner. Thanks to your and express to you our deep satisfaction and our wise and business -like handling of the heavy agenda, gratitude. and the hard work put in by the Chairmen, Secretaries, Rapporteurs and members of the two main committees The PRESIDENT : Thank you, Dr Olguín.I now -the Committee on Programme and Budget, and the recognize the delegate of Sierra Leone. Committee on Administration, Finance and Legal Mr FINDLAY(SierraLeone) :MrPresident, Matters -we have concluded our work a day earlier Mr Director -General, fellow delegates,ladies and than was expected. Please accept our thanks and con- gentlemen, my delegation has been asked to speak on gratulations. behalf of the Member States in the African Region, I also thank the Director -General and his colleagues and I thank our colleagues for this honour which for the hard work they have done in preparing the has been conferred on my country. excellent background papers which enabled delegates To begin with, our initial thanks go to you, Mr Pre- to study the problems and make up their minds about sident, for the very able and efficient manner in which the various important issues that came up before the you have conducted the proceedings of this Assembly. Assembly. Our thanks are due to the Secretariat, the You have demonstrated in no small measure your interpreters, and the innumerable persons who have capacity for hard work and leadership -sufficient to been working behind the scenes night and day to make justify the unanimous confidence of this Assembly a success of this session. The promptness with which in electing you to the high and distinguished office the summary records and reports were prepared and of President. We are very proud of your achievement. circulated speaks volumes for the hard work put in by We also take this opportunity to express our thanks them. I wonder how much sleep they have had during and appreciation to you, Mr Director -General, and the last three weeks.I hope our gratitude and warm your staff. The great interest shown by you and your tribute might relieve their fatigue a little, for I under- team in the affairs of the World Health Organization stand they have another week of hard work before FOURTEENTH PLENARY MEETING 159 them in connexion with the meetings of the Executive With these words, Mr President, I once again thank Board and other allied matters. you and all others who have made such a success of the The delegates to the Sixteenth World Health Assem- Sixteenth World Health Assembly. bly also deserve our thanks and congratulations for the The PRESIDENT : Thank you, Dr Sushila Nayar.I very constructive suggestions made by them and the now call on the delegate of the United Kindom of constructive attitudes and spirit of co- operation which Great Britain and Northern Ireland. enabled the Assembly to have unanimity or near unanimity on so many important resolutions.The Sir George GODBER (United Kindom of Great Sixteenth World Health Assembly, Mr President, has Britain and Northern Ireland) :Mr President, this some noteworthy achievements to its credit.First, it Assembly has been very fortunate in various ways, but was, I understand, the first time that WHO has given I am sure every delegate would agree that at its very careful and detailed consideration to the problem of outset it performed an act which ensured such a result drugs and drug standards.The tragic and terribly by unanimously electing you as its President. We thank harmful results of the use of thalidomide by pregnant you, sir, for the dignity, efficiency and courtesy with women focused attention on the dangers of releasing new which you have conducted our formal proceedings. drugs for use without adequate careful experimentation Perhaps the warmth and friendliness of our meetings on for testing their pharmacological properties.The less formal occations have meant almost as much to Assembly is to be congratulated on the resolution us all.The Sixteenth President of the World Health adopted in this respect, as well as on the one regarding Assembly has been a worthy successor to the illustrious the studying of ways and means of ensuring a high figures of earlier years. May I express the thanks of the standard in respect of all drugs, whether for domestic European Region to you and your three Vice. Presi- use or for export purposes. dents, and the Chairmen of the Committees, who have played their part also with distinction. Secondly, the technical discussions this year have focused attention on a very important matter -the The Director -General and all his staff have earned training of physicians to meet the needs of our times. I once more our gratitude for their unfailing courtesy hope the report of the discussions will be carefully and helpfulness, and for the quality of the information and guidance they have supplied. This year we must studied by Member governments, and they will make surely be allowed a special expression of esteem, and, use of the ideas therein to suit their own needs and cir- indeed, affection to Dr Candau, whose acceptance of cumstances. The resolution highlighting the need for another five years of office has not only given this assisting the emerging countries in respect of training Assembly, but also the world, confidence in the future and other health needs is also a most welcome one. of the Organization. Thirdly, the resolution on the African Regional Once more, Switzerland and the Canton of Geneva Office and allied matters is a landmark in the history of have welcomed us, and we are grateful to them. WHO. If we are to work for a healthy world, we must Finally, the interpreters have been skilful, patient plan for humanity as one unit, all nations being equal and accurate, and every speaker or listener here is members thereof, and we must meet their health needs, deeply indebted to them. both physical as well as mental and emotional. The Committee on Administration, Finance and Legal This last day has indeed been saddened by the death of our friend and colleague, Dr Syman, of whom you, Matters deserves our warm congratulations on present- Mr President, and the delegate of Isreal have spoken so ing to the Assembly an excellent resolution in this res- movingly. But we are glad to have good news of the pect, dealing with the vexed problem of racial disc- progress of the two invalids among our colleagues, rimination in terms of health, and I congratulate the Dr Hourihane and Mr Saito. Assembly on the unanimous adoption of this resolution for all practical purposes. The PRESIDENT : Thank you, Sir George Godber. I Finally, I must thank the Member States of my now call on the delegate of the Union of Soviet Social- Region for the honour they have done in selecting me ist Republics. to speak on their behalf. I might mention, incidentally, Mr President, that, now that the South -East Asia Professor LDANOV (Union of Soviet Socialist Repub- Region has shown the way by having a beautiful new lics) (translation from the Russion) : Mr President, fel- building for the regional office, we are all looking for- low delegates, on behalf of the delegations of the Soviet ward to the day when the headquarters office will have Union and of a number of other countries, I should like the same facilities. to thank you, Dr Majekodunmi, for your able and suc- 160 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II cessful leadership of our Assembly. The Assembly was Shousha, and his collaborators, have been the most over -burdened with a multitude of problems. Many of stimulating and successful ones that I have attended so those problems were very complex, but nevertheless all far. delegates were able to express their opinions and con- We are fortunate to have our Director -General, Dr clusions, and in this way we have collectively taken a Candau, at the head of our administration for another number of serious and necessary decisions. term of office.This Assembly is to be congratulated I should like also to thank the Vice -Presidents of this indeed for its unanimous decision on this matter. Mr Assembly, the Chairmen of the Committees and the President, my association with Dr Candau, from the Rapporteurs, and to express particular gratitude to moment he stepped into this organization, has been on the Director- General, Dr Candau, for the efficient work all levels of the work of our institution.I think this which has ensured the success of this Assembly. qualifies me to make this statement about his unique Finally, I should like to thank the technical staff of and pleasant personality, at this juncture. the Secretariat and the translators and interpreters for Mr President, with your permission, I should like to their good technical support for our work. take this opportunity to reafirm the friendly and cor- We have before us many important and difficult dial relations that exist between us Member States of tasks, but the spirit of co- operation which has been the Region and our Regional Director, Dr Taba, and shown at this Assembly gives confidence that the his staff, and thank them for their valuable help and World Health Organization will continue to make the assistance. greatest possible contribution to the solution of health In conclusion, Mr President, it gives me great pleas- problems throughout the world. ure to extend our thanks and gratitude to you, Sir, the The PRESIDENT : Thank you, Professor Zdanov.I Vice -Presidents, the Chairmen, Vice -Chairmen and now call on the delegate of Iraq. Rapporteurs of the committees, the representatives of the Executive Board, the Director -General, Deputy Dr AL -WAHBI (Iraq) :Mr President, honourable Director -General,AssistantDirectors -General,the delegates, on this occasion I have the privilege and hon- Regional Directors, and all members of the Secretariat our to speak on behalf of the delegations of Member -those who have been with us and those who have not States of the Eastern Mediterranean Region to the been seen by us. May we always achieve success and Sixteenth World Health Assembly. happiness in our collective endeavours for better and Mr President, at the fourth plenary meeting of this even higher standards of health all over the world. Assembly I had the pleasure of congratulating you, Sir, My friends, I wish you all a happy journey home and and your Vice -Presidents on your election to your high a prosperous future. office. At that time I made the statement that I was con- vinced that under your leadership and guidance the The PRESIDENT : Thank you, Dr Al- Wahbi.I now deliberations and labours of this session would be recognize the delegate of Western Samoa. brought to a happy and successful conclusion.I am very happy to say that this has become a reality.It Dr THIEME (Western Samoa) :Mr President, dis- seemed to us old- timers that our agenda was a heavy tinguished delegates, ladies and gentlemen, as delegate and difficult one, but thanks to your wisdom and tact of the youngest Member of the Western Pacific Region it was resolved to the satisfaction of all concerned. I have the honour, on behalf of the Region, to say a Important and complicated questions were solved and few words on the closure of the Sixteenth World agreed upon in a high spirit of co- operation and com- Health Assembly. promise, living up to the tradition and prestige of our First, we are extending our congratulations to you, beloved organization.Programme matters were stu- the President of the Sixteenth World Health Assembly, died, discussed, scrutinized and decided on in a spirit of and to your Vice -Presidents, for the efficient way in fraternity and mutual understanding. We adopted the which you have carried out the difficult task of presid- highest budget in the history of our institution, indi- ing over this Assembly. Further, it is my privilege to cating the normal and healthy growth and progress we pay tribute to the Director -General and his staff for the all wish for. The problems of education and training of great effort and hard work they have performed to health personnel at all levels, and especially in con- make this Assembly a successful meeting. nexion with assistance to the newly- independent and This is my first visit to the World Health Assembly emerging and developing countries, have been rightly and I must say that it is a great experience. In a few highlighted. The old and traditional problem of com- hours we shall all be dispersed to our own countries, bating communicable diseases, with its new aspect of and I wish all the distinguished delegates "bon voyage ". eradication, has not been neglected.The technical May the results of the Sixteenth World Health Assem- discussions, thanks tothe General Chairman, Dr bly be most beneficial to all of us. FOURTEENTH PLENARY MEETING 161
The PRESIDENT : Thank you, Dr Thieme. speeded up if the necessary funds were available. The We now come to the closing of the Sixteenth World scientific knowlege and techniques required to grapple Health Assembly and, although we shall require more with these problems are already available, but the time in which to assess the achievements of this Assem- Organization will require additional funds to enable it bly, I think, even at this stage, we have every reason to to carry out all the projects requested by Member be satisfied with the results of our deliberations during States, all of which have been judged technically sound these past three weeks. There have, of course, been a and have been rated as of high priority. In this con- few disagreements, but these only help to emphasize the nexion I should like to appeal to the wealthier Members large areas of understanding which exist among all of our organization to increase their financial support delegates.Indeed, disagreements there are bound to to the Organization to enable these undertakings to be be, but we all know that, no matter what political or speedily accomplished. Inall matters concerning religious creed we embrace individually, our objec- health, the old adage,Bis dat qui cito dat -"Hegives tives are the same -that is, the promotion of the twice who gives quickly"-has a special and significant health and happiness of all peoples. If we occasionally meaning. differ in our method of approach, that simply reflects The necessity of intensifying the training of medical the measure of the impatience we all feel individually and paramedical personnel, particularly in the deve- for the attainment of the noble objective of our organ- loping countries, has again been emphasized in this ization.I, personally, have been greatly impressed by Assembly. The pharmacological evaluation of phar- the spirit of co- operation and mutual respect which maceutical preparations is a field in which it is generally pervaded all our discussions. This was possible because agreed that the World Health Organization has a vital every delegate was genuinely and sincerely seeking role to play, and our organization's responsibility in after the truth. this respect has once again been emphasized. This Assembly has taken many important decisions The technical discussions this year were well atten- which will undoubtedly give impetus to the health ser- ded and aroused considerable interest among delegates. vices of Member States. The World Health Organiza- The subject,itis true, was one reflecting the con- tion decided on the total eradication of malaria at the cern of most delegates, conscious as they are of the fact Eighth World Health Assembly, which was held in that the inadequacies in training of doctors in social Mexico City in 1955. Although certain obstacles, like and preventive medicine constitute a basic obstacle insecticide resistance among vectors and drug resis- to the development of well -balanced health services. tance among parasites, have tended to delay the One hundred and eight persons, representing eighty - eradication programme, these obstacles are happily seven countries and eight non -governmental organiza- being overcome.Global eradication of malaria can tions, took part in these discussions, which is evidence be said to be now in sight. Already, regions with over of the keen interest they aroused. 168 million inhabitants are now in the consolidation During this session our organization has moved fur- phase of malaria eradication.In all these areas where ther towards universality. The Republic of Algeria and eradication has been successfully accomplished there the States of Rwanda, Burundi, Uganda, Jamaica, and has been a drastic decline in morbidity and mortality, Trinidad and Tobago became Members of the World accomplished by a greatly accelerated level of pro- Health Organization during the past year and took ductivity and economic well- being. The eradication so part in the Assembly for the first time.Two new far achieved has already brought happiness and pros- Associate Members, Kenya and Mauritius, were also perity to many millions.It is therefore with pleasur- admitted.The Assembly has special satisfaction in able anticipation that we in Africa look forward to the seeing a Member which had long been inactive, namely accomplishment of the malaria eradication campaign Hungary, resume participation in the Organization's which is now just beginning in our region. Its success- activities.It is to be hoped that in future this univer- ful completion will usher in a new era of health and ality of our organization, which is already so remark - prosperity for our people and so enable them to con- sable, will come still closer to embrace all the nations tribute more effectively to the enrichment of human of the world, so that the Organization can truly justify civilization. its name of "World Health Organization ". Many other problems are still in the process of being When I visited the site of the headquarters building, solved. The World Health Organization campaigns for I was greatly impressed by the progress which has been the eradication of other communicable diseases like made since the foundation stone was laid by the Pre- smallpox, leprosy, tuberculosis and yaws still remain to sident of the Fifteenth World Health Assembly, Dr be accomplished.The execution of these and other Kurasov.This Assembly has already signified its health projects requested by Member States could be determination to make this building a fitting and dig- 162 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II nified home for our organization.I pray that we may I have been fortunate to have such very charming be spared not only to see it completed but also to use it and co- operative Vice -Presidents. My thanks are due for a long time for the advancement of the work of the to them for their assistance in presiding over the World Health Organization. Assembly meetings and for their support at the meet- Our organization has been fortunate to secure the ings of the General Committee. services of Dr Candau as Director -General for another I should like to thank the Chairmen and the Rap - term.As you will recall, his appointment was app- porteurs of the main committees, whose work has con- roved in plenary meeting by a secret ballot. The comp- tributed greately to the success of this Assembly. They lete unanimity with which this approval was signified is have managed their committees with such tact that in itself the greatest tribute to the services which Dr disagreements were few, as a result of which the work Candau has rendered to the Organization during the of the committees was completed ahead of schedule. past ten years in which he has been Director -General. I should like to take this opportunity to pay a deserv- I have had the opportunity of seeing Dr Candau at ed tribute to the members of the committees.I have close quarters during this Assembly, and I can fully followed the debates in these committees with great endorse the compliments which have been uniformly pride. Even the most delicate issues, which had been paid him by all delegates. I have been greatly impressed expected to arouse emotions, were approached by all by his patience, his administrative ability and his speakers with such objectivity, dignity and loftiness of exceptional versatility. view as to reflect great credit on our organization. I wish to refer now to the Deputy Director -General, Finally, I wish to say how happy I am to have had Dr Dorolle, who, although, as you will observe, sits on the honour and privilege of being President of this my left, has in fact been my right -hand man during this Assembly. This is an honour the recollection of which Assembly. Through his guidance, we have kept strictly I shall always cherish with pride.I should like to to the Rules of Procedure and observed the Cons- record once again the gratitude of my country and of titution of the Organization to the letter throughout the other newly emerging nations of Africa that you our deliberations. His knowlege of the proceedings of have honoured by my election. the Assembly is profound.I have greatly valued his I should like to wish you all a safe return to your services and the constant courtesy with which they have homes and happy reunion with your loved ones. In the been offered. I wish to thank him very much indeed for words of the old refrain, "The music is ended, but the his contribution to the success of the Assembly. I wish melody lingers on ". also to thank other members of the Secretariat staff, The Sixteenth World Health Assembly is now ended. the translators, the secretaries, who have made the work of the Assembly run so smoothly. The session closed at 5.30 p.m. MINUTES OF MEETINGS OF COMMITTEES
GENERAL COMMITTEE
FIRST MEETING Tuesday, 7 May 1963, at 4.45 p.m.
Chairman: Dr M. A.MAJEKODUNMI(Nigeria)
1. Allocation of Agenda Items to the Main Committees and at 2.30 p.m., and that the General Committee The General Committee recommended that the would meet daily, either at 12 noon or at 5.30 p.m. The Committee recommended that the Assembly Health Assembly allocate the items of the agenda as approve the programme of work for the Technical indicated in the provisional agenda, but deleting items 3.13 (Housing of staff of the Regional Office for Discussions on "Education and Training of the Phy- sician for the Preventive and Social Aspects of Clinical Africa), and 3.15 (Working Capital Fund).' Practice ", to take place on Friday, 10 May and on the With regard to item 1.11 (Admission of new Mem- morning of Saturday, 11 May. bers and Associate Members), the Committee recom- mended that the Assembly waive the second paragraph 3.Appointment of the Director- General and Approval of Rule 113 of the Rules cf Procedure of the Health of his Contract :Arrangements for the Private Assembly so as to enable it to receive the application Plenary Meeting made by the United Kingdom of Great Britain and The Committee recommended that the Assembly Northern Ireland on behalf of Kenya for admission to adopt the same procedure as that followed on a associate membership, less than thirty days before the similar occasion by the Sixth World Health Assembly opening of the Assembly. in 1953, as follows : Attendance.The meeting to be open to delegates, 2.Programme of Work of the Health Assembly alternates, and advisers of Member States, represen- tatives of Associate Members, representatives of the The Committee fixed the hours and programmes for Executive Board, members of the Secretariat desig- the meetings on Wednesday, 8 May and Thursday, 9 nated by the Director -General, the representative of May, it being understood that at the plenary meeting the United Nations, (who is entitled to be present) and on Thursday afternoon the President would, in accor- representatives of the specialized agencies. The Com- dance with Rule 97 of the Rules of Procedure, invite mittee agreed however that observers of intergovern- Members to put forward suggestions concerning the mental organizations other than United Nations agen- election of Members to be entitled to designate a person cies, and of non -governmental organizations, should to serve on the Executive Board, and to deposit such not be invited. suggestions with the Chairman of the General Com- mittee not later than 10 a.m. on Monday, 13 May. The Communiqué and announcementofdecision. The Committee agreed that at its meeting on that Monday official announcement of the decision to be made in it would draw up its recommendations concerning the publicsession and to include details of the voting. election of Members entitled to designate a person to Verbatim record. In accordance with Rule 90 of the serve on the Executive Board. Rules of Procedure of the Health Assembly, a ver- It was decided that the Assembly plenary and com- batim record to be made of the private meeting, but to mittee meetings would normally commence at 9.30 a.m. be made available only to participants in the said meeting. 1 For agenda as adopted, see pp. 19 -22. The meeting rose at 5 15 p.m.
- 163 - 164 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
SECOND MEETING
Thursday, 9 May 1963, at 6.0 p.m.
Chairman: Dr M. A. MAJEKODUNMI (Nigeria)
1.Programmeof Work of the Health Assembly ramme and Budget on the progress of the work of those two committees, the General Committee drew up the After hearingthe statements of the Chairman of the programme of meetings for Monday, 13 May. Committee onAdministration, Finance and Legal Matters and theChairman of the Committee on Prog- The meeting rose at 6.10 p.m.
THIRD MEETING
Monday, 13 May 1963, at 12 noon
Chairman: Dr M. A. MAJEKODUNMI (Nigeria)
1.Proposals for the Election of Members entitled to list in question contained only eleven names whereas the designate a Person to serve on the Executive Board General Committee was required to establish a list of The CHAIRMAN read Article 24 of the Constitution twelve countries. and Rule 98 of the Rules of Procedure of the Health Sir George GODBER (United Kingdom of Great Assembly, governing the procedure applicable to the Britain and Northern Ireland) requested that Australia election. He drew the attention of the Committee to be added to the list of suggested countries. the following four documents before it : Professor AUJALEU (France) proposed that Mexico (a)a table indicating the geographical distribution be also added. of the Executive Board by region, and giving, with the number of active The CHAIRMAN proposed that the procedure for the respecttoeachregion, submission of the General Committee's proposals to Members in 1961, 1962 and 1963, the number of the Assembly be the same as in previous years. seats on the Board in 1960 -1961, 1961 -1962 and 1962 -1963, and the theoretical number of seats on It was so agreed. the Board, obtained by multiplying the number of Professor Aujaleu (France) and Dr Layton (Canada) active Members in the Region in 1963 by 0.2087 were invited to act as tellers. (i.e. the ratio of the number of members of the A preliminary trial vote was taken by secret ballot. Board to the total number of active Members), Dr GANGBO (Dahomey) recalled that in previous together with the names of the Members whose years the question of equitable geographical distribu- term of office would expire in 1963; tion of the Executive Board seats had not generally been (b)a list, by region, of Members of WHO that taken into account. Thus, the African Region, with at were at present or had been previously entitled to present twenty -five members, had only three seats on designate persons to serve on the Board; the Board. On behalf of the African States, he wished (c)a table showing the composition, by region, earnestly to request the General Committee to re- of the Executive Board in 1962 -1963; establish a proper balance, and to recommend the (d)a list of the Member States whose names had election of the two African Member States whose been suggested in accordance with Rule 97 of the names had been suggested. Rules of Procedure of the Health Assembly. The General Committee then proceeded to vote by Professor AUJALEU (France) pointed out that the secret ballot for the purpose of establishing a list of GENERAL COMMITTEE : FOURTH MEETING 165 twelve Members to be transmitted to the Health Assem- siderations only but should take other factors also into bly. The following countries were nominated : Brazil, account -for example, the fact that certain Members Indonesia, New Zealand,Sierra Leone, Australia, had never been elected to designate a person to serve Mali, Netherlands, Norway, Iran, Morocco, Turkey, on the Executive Board. Libya. Dr GANGBO (Dahomey) observed that the remarks Mr KITTANI (Iraq) called attention to the fact that made should not obscure the fact that only Africa was there were two outgoing members from the Eastern at present at a disadvantage; he earnestly requested the Mediterranean Region, and only two countries (Iran Committee to accede to the demand he had all eady and Libya) had been proposed as candidates from that put forward. region.Moreover, Morocco which, although part of the European Region, was strictly speaking an African Mr BOLYA (Congo, Leopoldville), noting that the country, had never been entitled to designate a person African Region had only three seats on the Board as to serve on the Executive Board. compared with the theoretical number of 5.218, asso- ciated himself fully with the remarks of the delegate of Dr ENGEL (Sweden) said that, of the Members of the European Region that had been suggested, Norway Dahomey. had been elected only once -in 1948 -and for one Another secret ballot was held to establish the list of year only. The other two candidates (the Netherlands eight Members which, in the Committee's opinion, and Turkey) had been elected, one for the period would provide, if elected, a balanced distribution of 1948 -1950 and the other for the period 1949 -1951. the Board as a whole. The General Committee, in selecting eight Members The results of the voting were as follows :Brazil, tobe recommended to the Health Assembly for New Zealand, Indonesia, Mali, Sierra Leone, Norway, election, should take that into consideration, and also Iran, Netherlands. the fact that Morocco had never been elected. The PRESIDENT said that the names of the Members Sir George GODBER (United Kingdom of Great selected would be transmitted to the Health Assembly Britain and Northern Ireland) considered that in order in the report of the General Committee (for text, see to obtain an arithmetically correct distribution of seats page 408). on the Board it would be necessary to elect two Mem- bers of the African Region, one Member of the Ameri- 2. Programme of Work of the Health Assembly can Region, one Member of the South -East Asia After hearing the views of the Chairmen of the main Region, two Members of the European Region, one committees, the General Committee fixed the prog- Member of the Eastern Mediterranean Region and one ramme of meetings for Tuesday, Wednesday and Member of the Western Pacific Region. Thursday, 14, 15 and 16 May. Mr KITTANI (Iraq) was of the opinion that the Gen- eral Committee should not be guided by statistical con- The meeting rose at 2 p.m.
FOURTH MEETING Tuesday, 14 May 1963, at 12 noon Chairman: Dr M. A. MAJEKODUNMI (Nigeria)
1. Transmission to the Health Assembly of Reports of Board and the report of the Director -General on the the Main Committees Work of WHO; he proposed therefore to convene a The General Committee decided to transmit to the night meeting to begin at 9.0 p.m. and end at 11.30 p.m. Health Assembly the first report of the Committee on After some exchange of views to determine whether Administration, Finance and Legal Matters. it would be desirable to limit the time allowed for each speaker, the Committee decided not to make any 2.Programme of Work of the Health Assembly recommendation in that sense to the Assembly, and to The CHAIRMAN drew attention to the fact that many make arrangements for a night meeting of the plenary delegates still wished to take part in the general discus- Assembly. sion, in plenary session, on the reports of the Executive The meeting rose at 12.20 p.m. 166 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
FIFTH MEETING
Wednesday, 15 May 1963, at 6.30 p.m.
Chairman: Dr M. A. MAJEKODUNMI (Nigeria)
1.Transmission to the Health Assembly of Reports 2.Programme of Work of the Health Assembly of the Main Committees The Committee fixed the programme of meetings for The General Committee decided to transmit to the Friday, 17 May. Health Assembly the first report of the Committee on Programme and Budget. The meeting rose at 6.40 p.m.
SIXTH MEETING Friday, 17 May 1963, at 12.30 p.m.
Chairman: Dr M. A. MAJEKODUNMI (Nigeria)
1.Transmission to the Health Assembly of Reports Director - GeneralbytheHealthAssembly. He of the Main Committees proposed that the General Committee should consider The General Committee decided to transmit to the this question during one of its coming meetings. Health Assembly the second and third reports of the It was so decided. (For discussion, see page 168). Committee on Administration, Finance and Legal Matters, and the second report of the Committee on The meeting rose at 12.40 p.m. Programme and Budget.
2.Programme of Work of the Health Assembly Appendix
The General Committee established the programme NOTE SUBMITTED BY THE DELEGATES OF SWEDEN for the meetings on Saturday, 18 May, and Monday, AND OF THE UNITED KINGDOM 20 May.It was agreed that the Committee on Pro- OF GREAT BRITAIN AND NORTHERN IRELAND gramme and Budget should meet on Saturday after- The General Committee has noted the difficulties which arise noon if the work position made it necessary to do so. from the length of the debate on the Annual Report of the Director -General.These are due to the steadily increasing number of delegations and the natural desire of many of them 3.Procedure for the Review by the Heath Assembly to record their comments on the Report and to include relevant of the Annual Report of the Director -General: information of general interest from experience in their own Proposal by the Delegates of Sweden and of the countries.It seems neither fair nor practicable to set a precise United Kingdom of Great Britain and Northern limit to the length of each contribution. However, it does seem Ireland possible that a reasonable time for presentation of a summary could be fixed, together with permission to submit, for the record, The CHAIRMAN announced that he had received a a statement of a length chosen by the country. The full statement note submitted to the General Committee by the would appear in the verbatim record. delegates of Sweden and the United Kingdom of As there is not a suitable item on the agenda, and time in Great Britain and Northern Ireland (reproduced in plenary at this Assembly is short, the delegates of Sweden and the United Kingdom wish to suggest that the representatives of the appendix to these minutes) concerning the pro- the Executive Board to the Assembly should be asked by the cedure for the review of the Annual Report of the General Committee to raise at the coming session of the Executive GENERAL COMMITTEE : SEVENTH AND EIGHTH MEETINGS 167
Board the limitation of statements on the Director -General's If the Executive Board approves this or a similar proposal for Report in plenary at the Seventeenth World Health Assembly to submission to the Seventeenth World Health Assembly, each five minutes each, such contribution being accompanied, if the Member State might be informed well in advance so that the delegate wishes, by a more detailed written statement which may delegations will be prepared for the application of the revised be incorporated in the record of the session.It is realized that arrangements as well as any amendments to the Rules of Pro- this might make it necessary to amend Rule 88 of the Rules of cedure at the Seventeenth World Health Assembly, should the Procedure of the Assembly. Assembly so decide.
SEVENTH MEETING
Monday, 20 May 1963, at 6.30 p.m.
Chairman: Dr M. A. MAJEKODUNMI (Nigeria)
1.Transmission to the Health Assembly of Reports 2.Programme of Work of the Health Assembly of the Main Committees After having heard statements by the Chairmen of the main committees on the progress of the work of the The General Committee decided to transmit to the latter, the General Committee drew up the programme Health Assembly the third report of the Committee of meetings for Tuesday, 21 May. on Programme and Budget. The meeting rose at 6.40 p.m.
EIGHTH MEETING
Tuesday, 21 May 1963, at 6 p.m.
Chairman: Dr M. A. MAJEKODUNMI (Nigeria)
1.Transmission to the Health Assembly of Reports closure of the Health Assembly should be Friday of the Main Committees morning, 24 May. The General Committee decided to transmit to the Health Assembly the fourth report of the Committee 3.Programme of Work of the Health Assembly on Administration, Finance and Legal Matters and the fourth report of the Committee on Programme After having heard statements by the Chairmen of and Budget. the main committees on the progress of the work in the Committees, the General Committee drew up the 2.Date of Closure of the Health Assembly programme of meetings for Wednesday, 22 May. The General Committee decided that the date of The meeting rose at 6.15 p.m. 168 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
NINTH MEETING
Wednesday, 22 May 1963, at 5.30 p.m.
Chairman: Dr M. A. MAJEKODUNMI (Nigeria)
1. Transmission to the Health Assembly of Reports Rule 33 (g) of the Rules of Procedure of the Healh of the Main Committees Assembly, the General Committee was required in The General Committee decided to transmit to the general to facilitate the orderly dispatch of the business Health Assembly the fifth report of the Committee of the session; it was not required to formulate direct on Administration, Finance and Legal Matters and recommendations to the Executive Board, but by com- the fifth and sixth reports of the Committee on Pro- menting upon the suggestions submitted by the delega- gramme and Budget. tions of Sweden and the United Kingdom, it could draw the attention of the representativesof the Executive Board to the desirability of improving the 2.Procedure for the Review by the Health Assembly work methods of future Health Assemblies. Moreover, of the Annual Report of the Director -General other delegations had also expressed a wish to have the (continued from sixth meeting) subject placed upon the Executive Board's agenda. Sir George GODBER (United Kingdom of Great Britain and Northern Ireland) explained that in sub- Replying to a question by Dr AFRIDI, representative of the Executive Board, the CHAIRMAN proposed that mitting to the General Committee the joint note on the conduct of the debate on the Annual Report of the when submitting their report to the Executive Board, the Board's representatives to the Health Assembly Director -General in plenary Assembly, the only aim of the delegations of Sweden and of the United Kingdom should refer to the question of the procedure for the review by the Health Assembly of the Annual Report had been to set in motion the examination of methods for accelerating the work of the Assembly. They there- of the Director -General, and draw attention to the fore suggested that the Executive Board should exam- different opinions expressed on that subject by the members of the General Committee. ine the question. It was so decided. Dr MUDALIAR (India) admitted that it might be use- ful to limit the time allowed to speakers during the 3.Programme of Work of the Health Assembly general discussion of the Annual Report of the Director - General; he was afraid, however, that the method The General Committee established the programme proposed in the second paragraph of the joint note of meetings for Thursday, 23 May and, contrary to the decision taken on the previous day, decided that the might create difficulties since some of the written state- closing meeting of the Assembly would be held at 4.30 ments incorporated in records might be controversial. p.m. on Thursday, 23 May. Mr KITTANI (Iraq) asked whether the General Com- Before declaring the meeting closed, the CHAIRMAN mittee was required to take a formal decision on the warmly thanked the members of the General Com- proposal contained in the joint note, and whether the mittee for their active collaboration and paid a special Committee was empowered to submit suggestions to tribute to the Chairmen of the main committees who the Executive Board eoncerning the methods of work had so competently acquitted themselves of Their heavy of the Assembly. responsibilities. The DIRECTOR -GENERAL pointed out that under The meeting rose at 5.55 p.m. COMMITTEE ON PROGRAMME AND BUDGET
FIRST MEETING
Thursday, 9 May 1963, at 2.30 p.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1.Opening Remarks by the Chairman WHA15.1, subparagraphs(1),(3) and (4).Sub- paragraph(1),which contained the Committee's The CHAIRMAN expressed appreciation of the honour terms of reference, laid down that it should : done to his country by his being elected to the chair- manship. The Committee had a difficult task before it (a)considerwhethertheannualprogramme and he trusted that all its members would collaborate followed the general programme of work for a to carry it through to success. He would for his part do specific period; his utmost to merit the confidence placed in him. (b)examine the main features of the proposed He had pleasure in welcoming the delegates, in par- programme; ticular those of countries that had just become Mem (c)recommend the budgetary ceiling; bers and alsotherepresentativesof the United (d)examine the operating programme in detail; Nations, the specialized agencies and the non- govern- (e)recommendtheAppropriationResolution, mental organizations. after inserting the amounts in the sections for the operating programme, in the text of the resolution, 2. Election of Vice -Chairman and Rapporteur as recommended by the Committee on Administra- Agenda, 2.1 tion, Finance and Legal Matters. At the request of the CHAIRMAN, Dr KAUL, Assistant Director -General, Secretary, drew attention to the 4.Report on Development of the Malaria Eradication third report of the Committee on Nominations (see Programme page 407), in which Dr Tchoungui (Cameroon) and Agenda, 2.3 Dr Sentici (Morocco) were nominated for the offices The CHAIRMAN invited the Secretary to introduce the of Vice -Chairman and Rapporteur respectively. Director -General's report on the subject.' Discussion Decision: Dr Tchoungui and Dr Sentici were elected on the item would be deferred until the next meeting. Vice -Chairman and Rapporteur by acclamation. Dr KAUL, Assistant Director -General, Secretary, stated that the report was divided into two parts, 3.Organization of Work and Terms of Reference of the Committee the first containing narrative information and the second statistical data.' The CHAIRMAN said that the General Committee Since the Fifteenth Health Assembly, two notable had recommended that meetings of the Committee marks of progress had occurred in the malaria eradic- be held from 9.30 a.m. to 12 noon in the morning ation programme.First, an additional 168 million and from 2.30 to 5.30 p.m in the afternoon, with a people had passed into the consolidation phase of the short break at 11 a.m. and 4 p.m. He assumed that programme; and secondly, early in 1963 all the original that time -table would be acceptable to the Com- malarious areas of continental Europe had reached mittee. the same phase, thus achieving the aim of the co- It was so agreed. ' See Off. Rec. Wld Hlth Org. 127, Annex 8. At the request of the CHAIRMAN, the SECRETARY ' In the printed version, two tables only from the second part drewtheCommittee'sattentiontoresolution are reproduced as appendices to the report. - 169 - 170 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II ordinated plan establishedatthefirstEuropean expected that the Philippines training centre would be Conference on Malaria Eradication, held at Palermo reopened about the middle of 1963.Support to the in 1960. establishednationaltrainingcentresinEthiopia, By the end of 1962, 572 million, out of a total India, Indonesia, Iran and Pakistan had been con- threatened population of 1472 million, had been tinued and the Organization, wherever possible, had living in areas in the consolidation and maintenance given assistance in the training aspects of individual phases, which represented an increase of 44 per cent. country programmes. over the 1961 figure. The greatest increase had occurred Every effort had been made during 1962 to provide in South -East Asia, where the completion of the attack technical services appropriate to the pace attained in phase in large areas in India had brought in an the global eradication programme, but the serious additional153 million people. In the Americas, shortage of experienced personnel had made it neces- thirteen million more had entered the consolidation sary to continue the programme of extensive training phase and three million more were living in areas where courses for selected trainees.In view of the need to eradication was claimed. The increase in Europe had develop a basic rural health infrastructure to support been five million in the maintenance phase areas, and pre- eradication programmes, medicalofficerswith in the Western Pacific one million; in the Eastern prior public health experience had been given pre- Mediterranean two million more had passed from the ference for such training. The number of established attack to the consolidation phase. posts in 1962 of WHO country malaria advisory The progressincontinental Europe had been staff stood at 411; ninety -seven field projects had been impressive and the whole of the area was expected to in operation in seventy countries. be in the maintenance phase by 1965. Excellent Although the formation of a national malaria results had also been obtained in Zone I of the Region eradication service, enjoying a substantial degree of of the Americas and the situation there gave promise operational autonomy, was a prerequisite for an eradic- of the imminent achievement of eradication.Some ation programme, there had probably been a tendency active malaria foci had occurred during 1962 in in some countries for such services to become too consolidation phase areas of the Eastern Mediter- segregated from the other health branches, causing ranean Region, but that did not detract from the the officers of the general public health services to lose advanced status of the programmes in Israel, Jordan, all contact with and interest in the campaign, despite Lebanon and Syria; the large Pakistan programme its generally having first priority. was also proceeding on schedule.Ceylon was even Spraying operations had continued to be a major further advanced initsprogramme than India : tool in the attack phase; he cited facts and figures only thirty -one cases of malaria had occurred there to show the vast scale of such operations throughout in 1962 as compared with an annual total of three the world. In the consolidation phase, chemotherapy million some twenty years ago. had been used as the main antimalarial measure. Progress in general was good in the Western Pacific Medicated salt projects had been carried out in Region, though Taiwan had suffered a temporary limited areas in a number of countries; two had had setback initsprogramme when activefoci had to be terminated because administrative arrangements appeared following the importation of malaria infec- for distribution had not been entirely satisfactory. tion from abroad. The main lesson that had been learned was that all During the year the Organization had continued to sources of salt in the area covered must be replaced give high priority to training activities and had pro- by medicated salt; hence the need for co- operation vided substantial assistance with the aim of providing between all government departments and the control adequate numbers of trained staff at every level. of all commercial sources of supply. Sixteen courses had been held during the year, for Specialized courses for professional and auxiliary 260 trainees from fifty -six countries; in addition to the personnel in epidemiological methodology had been courses heldatthefiveestablished international organized to meet the need for strengthening national centres, two courses had been held in Moscow in epidemiologicalservices. The Organization had collaboration with the Soviet Government, one in recently issued a Manual on Epidemiological Evalua- English and one in French. tion and Surveillance in Malaria Eradication which A newinternationalEnglish -languagetraining would, it was hoped, contribute to the raising of centre had been opened at Lagos, Nigeria, the first standards in that sphere. course there being held in October 1962.A sister The main purposes of the pre- eradication programme training centre at Lomé, Togo, to meet the needs of were to stimulate and develop the necessary found- French -speaking African countries was planned to ations for eradication, i.e., the health infrastructure come into operation late in 1963.Further, it was and the national malaria service. He briefly outlined COMMITTEE ON PROGRAMME AND BUDGET :FIRST MEETING 171 the part to be played by both and mentioned the Physiological resistance of mosquito vectors to insec- importance of the relative timing of their achievement : ticides had continued to be reported, but the situation the national malaria service must be ready to carry in general was perhaps giving rather less cause for out its specialized role before the malaria eradication concern than had been expected. Nevertheless, double programme could be launched. resistance to the two currently used groups of insec- The progress achieved in developing pre- eradication ticides, DDT and dieldrin /BHC, would constitute a programmes was illustrated by the fact that, at the end serious setback in some programmes. Dieldrin resist- of 1962, programmes had been started or were in the ance usually progressed rapidly to the point where a planning stage in twenty -three countries in five of the highly resistant mosquito population was selected out six regions. and the insecticide ceased to be of further operational Although governments were generally agreed on the value. The position in regard to DDT resistance was soundness of the pre- eradication approach, a number very different; there was increasing evidence that the had hesitated to shoulder the substantial commitments insecticide might still be of considerable operational involved in developing country -wide rural health ser- value against several of the species affected. vices, even of the most elementary kind. It was there- In view of the possibility that resistance to chlo- fore hoped that ways would be found to assist govern- roquine might occur more frequently in foci, research ments in such work, so that the accepted goal of into the development of new chemotherapeutic agents global malaria eradication might be reached as early was a sound precaution. The Organization was there- as possible. fore sponsoring research on three groups of potential A number of European countries and the islands of agents, the 6- aminoquinolines, the pyrocatechols and Cyprus, Grenada and St Lucia had applied to be derivatives of phenyl- diamidine -urea.One problem placed on the register of areas where eradication had of practical importance in malaria immunology was to been achieved, after the necessary certification.One develop better techniques for detecting the infection major concern in maintenance areas was to prevent the and for quantitive measurement of the degree of reintroduction of malaria, and with a view to assisting acquired immunity to it. Research projects designed to in that task the Organization had begun in 1962 to investigate those possibilities were being carried out in issueperiodically,intheWeekly Epidemiological Europe and Africa and an application of the method Record, information on the epidemiological status of of fluorescent protein tracing, of exceptional interest, malaria in the world. The problem would be the main had been developed for measuring circulating antibody subject to be studied by the Expert Committee on to plasmodial infections in the African population Malaria at its session in September 1963. living in holo- endemic areas. Apart from the physiological resistance to insec- Three research developments outside the Organiza- ticides, a number of new technical problems had come tion might well have a considerable bearing on its to light, some of which had definite significance for programme. In the United States a long- acting injec- operations.Certain other technical problems might table drug, known as CI -501, had been developed. account for transmission persisting in "problem areas ", Secondly, a causal relationship had been discovered i.e. areas where regular spraying with good coverage between the gamma -globulin blood level and acquired had failed to interrupt transmission. Limited areas of immunity to malaria, in which purified gamma -globulin the kind had been reported from Mexico, Central fractions had been found to have a definite effect on America and parts of South America, Iran, Thailand, the course of malaria infection.Thirdly, investiga- Cambodia and Viet -Nam. A team for special epidem- tions into simian and animal malaria had brought to iological studies had been set up to assist in the inves- light the fact that infections in certain mosquito groups tigation of some of those problems and suggest suitable in Malaya, previously thought to be due to human methods for dealing with them. plasmodia, were in fact due to the sporozoites of Although nowhere as yet a grave obstacle to eradic- simian or animal malaria.The Organization was ation, drug resistance had been reported in isolated takingthose developments into account in its activities. areas, following the use of most of the antimalarial Two field trials of organophosphorus insecticides drugs at present available.The only proved case of were at present taking place in Africa, one on mala- resistance to chloroquine had occurred in a Columbian thion and the other on dichlorvos. The first was applied strain.However, alleged resistance in some new foci as a residual contact insecticide and the second was had recently been reported from Cambodia, Malaya strictly a fumigant.Another promising organophos- and Thailand; some evidence existed that the resistance phorus insecticide, fenthion, required further inves- might be real, and special investigations were being tigation of its toxicological effects. A carbamate undertaken. insecticide had successfully passed through all the 172 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
preliminary testing stages and was ready for trial in operation by furnishing material assistance to thirty - field conditions. three out of a total of ninety -one programmes; and the During the year considerable progress in co- ordinat- United States Agency for International Development ing programmes had been made at the inter -country had given assistance to seventeen malaria programmes level.In the Eastern Mediterranean Region, Iraq, and joined with WHO and the Pan American Health Jordan, Lebanon and Syria had agreed to develop a Organization in running the malaria eradication train- co- ordinated plan similar to that adopted in 1960 by ing centre at Kingston, Jamaica. the European Region. On the inter -regional level, con- The statusof malaria eradication programmes, ferences bringing together countries with common bor- region by region, was described in the last chapter of ders had been held at Tangier, Teheran, Yaoundé and the report and called for no further comment on his Manila. part. During the year, UNICEF had continued its co- The meeting rose at 3.30 p.m.
SECOND MEETING
Monday, 13 May 1963, at 9.30 a.m.
Chairman: Dr V. V. OLGUIN (Argentina)
1. Report on Development of the Malaria Eradication those items the Committee on Administratiion, Finance Programme (continued) and Legal Matters would not meet. Agenda, 2.3 Professor CANAPERIA (Italy) said he was still not The CHAIRMAN invited the representative of the entirely satisfied with that procedure. Executive Board to give the Board's views on the item. Dr AFRIDI, Chairman of the Executive Board, said Professor CANAPERIA (Italy), speaking on a point of that the views of the Board on item 2.3 would be found order, asked why the order of the agenda, as adopted, in Official Records No. 125, pages 74 -78. had been changed, so that the most important item of The general views of the Board on the programme business for the Committee -2.2, Review and approval aspects were embodied in resolution EB31.R31. The of the programme and budget estimates for 1964 -was main point of concern had been the question of the pre - not down for immediate discussion.There had been eradication programmes, on which the Director -General criticism in the past that the Committee's procedure had made a full statement ( Official Records No. 125, had left too little time for thorough examination of the pages 75 -77). The Board had had some doubts as to programme. which of the two main objectives of that type of Dr DOROLLE, Deputy Director -General, explained programme should be given priority, and a lengthy that, as had been decided by the Thirteenth World discussion had had taken place. After first inclining Health Assembly and as was stated in the Journal for towards priority for establishing the basic rural health the day, the Committee on Administration, Finance infrastructure, the Board had finally come to the con- and Legal Matters had first to complete its considera- clusion that there should be parallel development tion of agenda items 3.8, 3.3, 3.6, 3.7, and 3.12 before towards that objective and towards setting up the the Committee on Programme and Budget could start national malaria eradication service. its review of the programme and budget and in parti- The CHAIRMAN invited comments on the Director - cular of items 2.2.1 and 2.2.2 (Examination of the main General's report.' features of the programme and recommendation of the budgetary ceiling). That was the reason for the order Dr ROBERTSON (Ghana) said that the report was a of consideration of items.It was hoped it would be record of remarkable achievements. Nevertheless, there possible to take up on the afternoon of 15 May in the were still many hidden malaria foci and holo- endemic Committee on Programme and Budget the considera- tion of items 2.2.1 and 2.2.2. During the discussion of ' Off: Rec. Wld Hlth Org. 127,Annex 8. COMMITTEE ON PROGRAMME AND BUDGET : SECOND MEETING 173
areas in the world which were not yet ready for eradic- The programme in Yugoslavia was entering its final ation programmes. phase. During 1962 only 33 cases had been recorded, Ghana had not only maintained its interest in the all in one single area. The final phase of the operation goal of malaria eradication but had taken the fight were the most difficult, as the vigilance of the health against the disease further afield. It was happy to know services tended to decrease with the drastic reduction that its pre- eradication programme had found general in the number of cases.Hence it was essential that acceptance in West Africa and hoped that WHO would passive surveillance should be well organized so that spare no effort in stimulating and speeding up the the local health services would appreciate the need for strengthening of health services in that area to a level the requisite control measures.There had been some which would further promote the eradication pro- difficulties on that score in Yugoslavia during 1962, but gramme. It was necessary to maintain epidemiological he was confident that they would be overcome and that intelligence and to intensify reasearch to elicit new the excellent position already reached would be main- techniques that would allow a fresh approach to be tained. made. It might be useful to other countries less advanced in Much still remained to be done in finding a solution their campaigns to hear something of the problems to the difficulties that lay ahead. His delegation hoped Yugoslavia had encountered, since there should be no that the Director - General would continue his efforts false impression that eradication was easily achieved, under resolution WHA8.30 and subsequent resolutions particularly as the closest international co- operation to obtain financial contributions for the work from was needed at both the research and the admini- governmental and other sources.It welcomed the strativeleveltoovercome theobstaclestosuc- establishment by WHO of training centres in West cess.First, sustained efforts were needed in all the Africa where students could benefit from the exper- research centres to root out malaria occuring as a ience gained elsewhere in an environment like that in result of blood transfusions. It was simple to deal with which they would be employed. confirmed malaria carriers, but they could not always Since almost all the countries of the West African be picked out from a large number of voluntary donors. region were now embarking on malaria eradication The main difficulties lay in the fact that present methods programmes, WHO should take practical steps to made it practically impossible to pick out haematozoa promote inter -country co- ordination by undertaking carriers among blood donors, and that keeping blood the overall co- ordination of the various programmes. before use for seven days at a temperature of four That would lead to a profitable utilization of the degrees centigrade gave no guarantee that the para- limited funds available. sites would be destroyed. In conclusion, he asked about the future of the medi- Reintroduction of the disease from abroad was also cated salt project now in operation in Ghana, as a a problem, and Yugoslavia would accordingly support governmental decision would have to he taken soon any proposal to establish international regulations on whether or not to extend the use of medicated salt. designed to minimize that danger. Those could be sup- Secondly, was there evidence from the experience WHO plemented by national measures requiring control of had gained that eradication had been achieved through nationals returning from endemic areas. The recom- the use of that method ? He would also like to know mendations drawn up by the Second European Con- whether there was danger of drug resistance following ference on Malaria Eradication might serve as a basis the use of medicated salt. for regulations of the kind. Professor GERIC (Yugoslavia) said he was grateful Dr EL -BORAI (Kuwait) expressed satisfation at the for the Director -General's report, which gave a very striking progress made in the malaria eradication pro- clear picture of the progress made in the work of gramme.Malaria was not a health problem in his malaria eradication throughout the world.It was country, but for the past few years a certain amount of obvious that the future could be faced with optimism, control work through spraying had been carried out, despite the difficulties in regard both to the tools of subsequent to the discovery of a few anopheline foci, eradication and to the shortage of trained personnel. none of which were considered dangerous from the As the programme was terminating in one part of the standpoint of malaria transmission.Any cases of world, every effort should be made to help the remain- malaria that had occured in the country had been ing parts towards similar success in their efforts. The traced to infection from outside. developed countries among the Organization's mem- However, intensive breeding of Anopheles multicolor bership should provide greater help, both material and had been reported from lower down the Arabian Gulf, financial, to speed up the world -wide campaign and and the possible establishment of the vector in Kuwait prevent operations from dragging on indefinitely. Bay required investigation. The risk of a malaria out- 174 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II break as a result seemed to be slight, but conditions the Executive Board at its thirty -first session that the favourable to transmission of the disease might be global eradication programme was going through a created in the future through the bringing in of foreign critical stage requiring careful review of the work done labour from endemic areas. hitherto and of some of the accepted concepts. At the Government's request, the Regional Director It might be useful as a basis for guiding future action had provided an expert to survey and assess the poten- to give some account of the work done in his own tial risk, and once his report was received the position country. When the programme had first been started might be clarified. in 1949, there had been only one doctor per 5500 and In that connexion, his government was most concer- one medical assistant per 10 500 of the population in ned about the reported possibility of Anopheles steph- the rural areas.In the early years, therefore, difficul- ensi invading the territory from neighbouring countries. ties had been encountered owing to the fact that there The malaria sentinel service must be alert to prevent were barely enough specialized teams to cover all the any such development, which would introduce malaria endemic areas. The situation had been gradually im- into an area previously free of the disease. proved through the introduction of compulsory rural service for doctors and cther health personnel. At the Professor CORRADETTI (Italy) welcomed the Director - moment the rural areas had one doctor per 2070 and General's comprehensive report, which plainly showed one medical assistant per 790 of the population, and the progress made in the world -wide campaign during the number of rural health stations had risen to 2823. 1962. His first comment related to the rural health infras- It had thus become possible from year to year to tructure, which was now recognized as a prerequisite to speed up antimalaria measures through control and treatment, at the same time gradually bringing the an eradication programme.Where the rural health infrastructure was already adequate and efficient, the whole of the endemic area within the programme. malaria eradication service might go into action im- As a result of all the efforts made, no new case of naturally transmitted malaria had been recorded in mediately as an independent body. Elsewhere, however, and where pre- eradication of malaria was not yet 1962, in comparison with 350 000 recorded cases in 1949. That was proof of the effectiveness of the meas- planned, it would seem a sounder policy to begin with ures applied to date. The greater part of the formerly the organizing of the general health infrastructure as the necessary basis for subsequent eradication opera- endemic area, containing 81.7 per cent. of the total threatened population, could thus be regarded as hav- tions. Secondly, it was significant that "problem areas" ing achieved eradication, and the remaining small were now coming to light.Hitherto they had been areas had passed into the consolidation phase. In the areas now in the maintenance phase, the main masked in the general situation of widespread malaria, emphasis was being laid on surveillance work to detect and were only becoming obvious now that the disease persisting cases that might lead to further outbreaks. had been drastically reduced in many areas. The devel- opment was in fact indirect evidence of the great What was of particular importance was to integrate the work of the special malaria teams within the rural progress made in the global campaign. health services, whose task it would be to consolidate From the psychological standpoint, the programme the results obtained. To that end, passive surveillance had reached the most delicate stage. The time was past was being steadily increased; and he gave facts and for spectacular reduction of the disease, and what had figures to illustrate the scope and effectiveness of the to be faced now was a period of tenacious and united work being done. effort to achieve the main goal of eradication.The He went on to describe the work carried out by the process of eliminating problem areas might be rather special malaria teams attached to the rural health slow, but the final result, given determination on all centres; with the great reduction in the volume of their sides, could never be in doubt. The Organization was working along the right lines work on malaria, those teams were now engaging in measures against other parasitic diseases. by promoting the establishment of the requisite rural During the maintenance phase, strict and repeated health infrastructure and by providing training for the control of confirmed cases of the disease, as well as needed personnel. Its efforts in encouraging collabora- contacts, had been carried out with the object of diag- tive research on basic scientific problems were also to be nosing asymptomatic parasitaemias.The undeniable commended. The result of those basic investigations usefulness of that method had been fully demonstrated might be to reduce the time needed for the achievement by the results obtained. of full eradication of the disease throughout the world. Another problem of particular importance that had Dr ALDEA (Romania) said that the experience of emerged in the later stages of the programme was that Romania in antimalaria work supported the view of caused by infections deriving from blood transfusions. COMMITTEE ON PROGRAMME AND BUDGET : SECOND MEETING 175
A systematic control of blood donors had proved more Conditions in the various parts of Indonesia dif- or less ineffective for preventing such infection ; accord- fered greatly.Java, although comparatively small in ingly, side by side with blood testing of all donors, extent, embraced about two -thirds of the total popula- radical treatment of all suspects had been instituted. tion and had had developed health services at the time As a further stage towards diagnosing possible when the eradication programme had first been begun malaria cases, a blood test was made of any person in 1959.That programme also embraced the neigh- suffering from an unident.fied fever, and arrangements bouring islands of Madura, Bali and the southern part were made for compulsory notification of suspected of Sumatra.It was hoped that the programme would cases by telephone. Treatment was applied until con- enter the consolidation phase not later than 1964. firmation or non -confirmation was obtained. He went WHO and the United States Agency for International on to give details of the treatment used. Development had given valuable assistance over the Courses on malaria and parasitic diseases were pro- years, their combined financial aid for the whole period vided for doctors and rural health personnel and were coming to some US $30 000 000. Indonesian counter- supplemented by health education of the public, as a part funds had slightly exceeded that figure. further part of the work to prevent resurgence of the As far back as 1961, it had been realized that steps disease.Entomological investigations were also still were needed to extend the programme to the other continuing, to determine possible changes in the sen- islands, which were under -developed, and planning to sitivity of anophelines to insecticides in connexion that end was being based on the prior establishment of with their extensive use in agriculture and forestry. a network of basic health services, to stretch to the At the current stage, measures to prevent the rein- remotest areas and villages. A specific plan relating troduction of malaria from abroad were of particular to Kalimantan (Indonesian Borneo) had already been importance. As yet, no effective answer to that problem drawn up and submitted to the United Nations Child- had been found at the international level.Within ren's Fund with the object of obtaining assistance from Romania, every effort was being made through sus- that organization.In accordance with the principle tained health education to ensure the use of appro- adopted, the plan in question was designed to promote priate preventive drugs by nationals travelling to en- rural health development, although the ultimate objec- demic areas. Supplies of such drugs were provided free tive was malaria eradication.She went on to give of charge and accompanied by the recommendation details of the scope of the work envisaged under the that the person concerned should submit to medical plan. The start was being made in that island because the examination on return home. territory was surrounded by areas where malaria was Visits of foreigners from endemic areas raised a already being tackled and measures were urgently problem that required urgent action on the part of needed so as not to prejudice the progress made. WHO in order to have the requisite international Up to 1961, financing of malaria eradication opera- regulations established. tions had been based on the counterpart system. In conclusion, he recalled that Romania had given Since that date their cost was being met out of the and was continuing to give support to the general general public health budget, some 40 per cent. of eradication programme, by receiving WHO fellows for which had been allocated for that work in 1962. Arran- training. gements were in force, however, to allow of greater flexibility in the use of those funds, in view of the first Dr SUBANDRIO (Indonesia) expressed appreciation priority accorded to the work. of the report submitted by the Director -General. Indo- According to calculations that had been made, for- nesia gave unreserved support to the global eradication eign aid towards the operations envisaged in the outer programme, successful achievement of which would in islands would be required in a further amount of itself justify WHO's existence. US $30 000 000, for the supply of equipment, trans- The difficulty of the eradication task varied from port,drugs and exportservices.The equivalent country to country and even within the territory of government expenditure would be much higher.A single countries. Wherever the network of health ser- survey had already been made of the situation in vices was strong, the work was correspondingly eased; Borneo to obtain the necessary data on which to but for the developing countries such as her own, where base plans. the general economic, social and health conditions were The Government planned ultimately to integrate all poor, the difficulties to be surmounted were enormous. malaria eradication personnel, numbering at the mom- Indonesia did not, however, despair.It had accepted ent about 30 000, into the general public health services. the aim of malaria eradication as part of its general effort to raise health standards, and was convinced of Dr CLAVERO DEL CAMPO (Spain), after congratula- eventual success. ting the authors of the report, said that the malaria 176 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II eradication programme had produced remarkable "eradication" should be dropped (though that might results : malaria had been reduced in a large part of the be necessary at a later stage), but rather that it should world, and in other areas, for example Europe, it had be re- defined or clarified -as was now being done in almost entirely disappeared. The problem was a minor certain WHO publications and statements -as mean- one in Spain :in 1958 there had been little more than ing the reduction of the disease to a state where it was a score of cases, and they had been eradicated within a under complete control and the number of cases very short time. small; in some parts of the world it might be possible to But the programme had met with setbacks, chiefly eradicate it completely. in Africa and Asia, through the lack of national health One of the important problems to be faced at the infrastructures.It was vital to set up a closely integ- present juncture was the relationship between the rated network of health services in the countries con- specialist organs of the malaria eradication machinery cerned. The personnel and equipment should be used and the rural health services of the countries concerned. essentially for pre- eradication work, but they could It was well known that excellent primary and secondary also be used for other health work if urgent problems results could be obtained by specialized mobile or semi - arose. The difficulties that had arisen had caused delay mobile health services, operating under their own rules in the malaria eradication programmes, which would and authority, and that it was now WHO's policy to coger a much longer period than had originally been develop rural health services to take over in the con- envisaged. solidation and maintenance phases.It was important Mention was made in the report of the discovery in to recognize, however, that the problems now to be certain regions of types of Plasmodium falciparum faced did not concern malaria alone, but rather the big which were resistant to antimalarial treatment. During killers as a whole -the widespread communicable and the current year eight cases of imported malaria had parasitic diseases -and the extent to which they invol- been recorded in Spain ; seven had been fairly serious ved the local population and consequently the local cases of P. falciparum malaria, with three deaths. Three health services.Those diseases fell roughly into two of the cases had come from Africa. groups. The malaria eradication programme continued to be With the first group, which included malaria, small- one of the most important of the Organization's activi- pox, cholera, plague and yaws, very good primary and ties, and for that reason the national antimalaria ser- secondary results could be obtained without involving vices should form an essential part of the general public the local population: all that was asked of them was health services, but with the necessary autonomy of co- operation with vaccination and spraying teams. action. The second group, however, which included tuber- Dr EVANG (Norway) said that the malaria eradica- culosis, leprosy, diseases of mothers and children, tion programme had in many ways been a great suc- filariasis and schistosomiasis, could only be fought if cess.It had captured the imagination not only of the the local population was completely involved from the hundreds of millions suffering from the disease but also outset.The most difficult thing of all was asked of of the economists and the politicians, thereby creating them :to change their daily habits concerning food, goodwill for WHO and stimulating and helping nation- irrigation and other matters; and they were even asked al health services in setting up their own malaria eradi- for capital investment to change environmental sani- cation services. Only a real cynic could fail to be imp- tation.Unless rural health services were developed, it ressed by the historic fact, recorded in the report, that was impossible to carry on the campaign, for it had an area of the world inhabited by 168 million people already been seen in certain countries that diseases of had reached the consolidation phase. the first group had been successfully attacked, while It was clear, however, that the campaign had reached diseases in the second group had spread. That was a the cross -roads, and the time had come to take stock terrifying situation for the local population and one of the situation. which would undermine their trust in the health ser- It would be futile at the present juncture to discuss vices. whether it had been wise or not, at the outset, to choose In his opinion, the term "health infrastructure" the term "eradication" or to attempt to lay down a might well be dispensed with.It really meant a basic time -table. As long as the cost of the programme was integrated rural health service of the kind described by covered mainly by voluntarycontribution,some the delegate of Indonesia, and on which everything kind of advertising method had beennecessary. depended. Instead, therefore, of speaking of priorities, Now that the campaign had been incorporated in the it was essential to establish formally the policy that no regular programme, however, such methods were no programme for the eradication of any disease should be longer possible. He was not suggesting that the term introduced in any country until the integrated basic COMMITTEE ON PROGRAMME AND BUDGET : SECOND MEETING 177 health service existed or was planned to a stage where involving a population of 80 -90 millions, would be in it could be established. a position to enter the maintenance phase at the end of One of the great difficulties was to make the local 1963 or early in 1964, after the necessary certification population understand the importance of preventive from WHO. A special committee had been set up to medicine.Malaria and yaws were two diseases that consider the work of those units and whether existing offered an excellent way of demonstrating the link bet- health services in the areas were adequate to take over ween curative and preventive medicine, for it was im- vigilance operations in the campaign. The problem was possible to undertake the one without the other. a difficult one in a country where many areas were still without basic health services.India was certainly not Mr COLY (Senegal) said he was gratified to see from in a position to establish the requisite primary health the report that pre- eradication programmes had been centres in a few months : the Government could only established in twenty -three countries. As the report be realistic and provide skeleton services for the time rightly said, the success of antimalaria programmes being.The delegate of Norway had said that basic depended on the existence of a proper health infra- health services should be established before eradica- structure and on collaboration between public health tion programmes could be embarked upon; but he services and malaria eradication services.He would doubted whether some countries could afford to wait also like to stress the importance of co- ordinated action indefinitely until such services were established.The between neighbouring countries in establishing their best solution was surely that the eradication prog- programmes, for disease and vectors recognized no ramme and the setting up of skeleton basic services frontiers. He also congratulated WHO on its work in should proceed hand in hand. training specialized personnel : the school shortly to be Despite minor setbacks, India was making good opened at Lomé would be warmly welcomed by all the progress and the case rate of 10 per cent. in the period States in the African Region.Another subject of inte- 1953 -54 had now been reduced to one -tenth. rest in the report was the exchange of scientific workers Without being over -optimistic, he was confident that between States, which offered great benefits. It would be seen from tables A, B and C in section 1 with the present tempo of activity malaria would be of the report that the antimalaria programmes for the effectively dealt with.It should not be forgotten that African continent were not very far advanced in com- malaria, although serious, was not the only problem parison with those of other continents. If that fact was that developing countries had to contend with; the due to the lack of development of national health infra- health infrastructure had to be designed to deal also structures, it was evidence of the need for WHO to with other diseases, such as tuberculosis, smallpox and help those countries to establish a health network leprosy. His country was very grateful for the help it adequate for their needs. was receiving from WHO. He congratulated WHO on its great humanitarian work, whose effects were appreciated by all. Dr TCHOUNGUI (Cameroon) described the organi- zation and the results of his country's campaign against Dr CHADHA (India) said that, as far as his own coun- malaria since the Third African Malaria Conference, try was concerned, he had little to add to the excellent held at Yaoundé in July 1962. report. The magnitude of the problem was well known, Cameroon had been one of the first African countries for a population of 440 millions was being dealt with to launch an antimalaria campaign. The campaign had by 391 units, covering over one million people per unit. started in 1952 but had failed to eradicate the disease The national malaria eradication programme had just after six years because the rural health services were entered its sixth year. The attack phase had been com- pleted in 228.5 unit areas, where a population of 251.5 not adequate to prevent reinfestation by neighbouring million were now in the consolidation phase; in a countries of areas where transmission had been inter - further 129 unit areas it was planned to terminate upted. In 1961 there had been a reappearance of An- spraying operations, and out of those at least 100 more opheles gambiaeand a new outbreak of malaria. A would enter the consolidation phase in 1964.There plan for a two -year pre- eradication programme had were still 33.5 unit areas in the attack phase where been agreed upon by WHO on 8 December 1962 and spraying would have to be continued at least until had immediately been set on foot. The plan was in two 1964. parts :the renewal and extension of activities in the It was hoped that in the year 1964 -65, 330 units experimental zone of Yaoundé and the reinforcement would be engaged in consolidation out of the 391 units of surveillance; and a detailed and extensive prog- in operation.It was also hoped that 70 -80 unit areas, ramme for the rest of the Federal Republic. 178 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The main activities were : reinforcement of passive On the administrative side, the establishment of a surveillance; renewal and extension of spraying in the malariaeradicationprogramme presupposedthe pilot zone which would later serve as a nucleus for existence of a satisfactory administrative and health eradication in the forest zone; plans for co- ordination infrastructure and of sufficient qualified personnel; between the national malaria eradication service and those requirements were unfortunately not always met, the other public health services; training of personnel particularly in the countries most affected by malaria, locally and abroad; study and collection of epidemio- and it had been necessary to establish pre- eradication logical, social and economic data for the preparation of programmes, which, although useful and important a plan for an eradication campaign; re- organization of for the health of the population, were less effective the national malaria eradication service and strength- for the total elimination of malaria. ening of the WHO team. The financial difficulties were only too well known. The results obtained so far were as follows : approx- At the start it had been hoped to finance the whole imately 210 000 inhabitants under passive surveil- programme from voluntary contributions, but their lance;forty -twocase -findingstationsestablished; inadequacy and the need to pursue the task that had reduction of positive cases, after spraying, by half; been undertaken had made it necessary to incorporate sporozoite index reduced to zero; new cases reduced the programme by stages into the regular budget. from 830 to 153.The results were encouraging and The malaria eradication programme now represented time would show whether thedisease could be about 20 per cent. of the total budget. eradicated from Cameroon. But all those considerations should not diminish Dr KIVITS (Belgium) said he welcomed the results either optimism or courage; they should rather induce of the malaria eradication programme, as shown in a realistic attitude based on experience gained since the well- documented and objective report. The Organi- the campaign was first undertaken.The campaign zation had shown courage and optimism when it had was still WHO's first objective :that was vital both decided in 1955 to start a world programme for the for the people afflicted by the disease and for the eradication of malaria; it must not be discouraged by Organization.He had worked for many years in the vastness of the task as it now appeared or by the countries where malaria was endemic and had seen difficulties that had arisen. too many children die and too many adults with their The difficulties were of three kinds :technical, health affected and their working capacity reduced. administrative and financial. The technical difficulties, He had also seen the good effects of the elimination which had long been apparent, were mainly due to the of malaria where disinsection had been successful. resistance of certain strains of anopheles to insecticides There were long years of effort ahead -longer than and, more recently, the resistance of certain strains of had been expected at the beginning. There were other plasmodium to chemotherapeutic agents.On the important programmes too; and the question of human side, there was the difficulty caused by the priorities within the limits of financial possibilities dispersal of the population and by nomadism in would have to be very carefully considered. certain areas.Agricultural developments, too, had caused an increase in anopheles and thus in malaria. The meeting rose at 11.55 a.m.
THIRD MEETING
Monday, 13 May 1963, at 2.30 p.m.
Chairman: Dr V. V. OLGUIN (Argentina)
1.Report on Development of the Malaria Eradication complete and interesting report 1submitted to the Programme (continued) Assembly and the opening statement of the Secretary. Agenda, 2.3 It had suggested to his delegation some general points, one or two specific points, and a few questions. Professor ZDANOV (UnionofSovietSocialist Republics) said that he had studied closely the very 1 Off. Rec. Wld Hlth Org. 127, Annex 8. COMMITTEE ON PROGRAMME AND BUDGET : THIRD MEETING 179
The map showing the epidemiological assessment mented by the mass use of drugs, the auxiliary staff of the status of malaria was in some places not quite had been reinforced by an army of doctors, ento- accurate; his delegation hoped in time to see a com- mologists, sanitary engineers, and health educators; pletely correct map of the distribution of malaria and but all efforts so far had not led to the success expected. of antimalarial work throughout the world. Secondly His delegation therefore suggested that a committee his delegation had a few years ago been rather sceptical should be set up, composed of Secretariat members of the value of some of the work undertaken by WHO and malariologists from various countries, to inquire as part of the eradication campaign :some of those into the defects of the campaign and to assess the doubts had been resolved by the report before the results achieved.It would then be possible for the Committee. next Assembly to review the situation more objectively, Referfing to section 8.2. of the report he expressed assess financial and technical prospects, and suggest the hope that a shorter name would be found for the improvements. compound mentioned in the third paragraph -the Dr VASSILOPOVLOS (Cyprus) recalled that he had pamoic acid salt of 4,6- diamino- l- (p- chlorophenyl)- stated earlier in the Assembly that malaria had been 1,2- dihydro -2,2- dimethyl -s- triazine. Inthesame paragraph it was suggested that too much should not completely eradicated in Cyprus between 1945 and be expected from the use of that compound; his 1950.Since that date no new indigenous cases had delegation would be interested to know the exact been reported, but some cases had been imported. significance of that statement, as it was not very long His Government spent $100 000 a year on maintenance and surveillance work. WHO was sending a small since great hopes had been aroused by the compound. The delegation of the USSR was glad to note the evaluation team to visit Cyprus shortly with a view progress that had been made in many countries, to registering eradication for the country. particularly India and Indonesia, and welcomed the Dr MONTALVÁN(Ecuador)congratulatedthe beginning of a new approach by WHO to the problem Secretariat on the report now before the Com- in developing countries, and the concept of pre- eradic- mittee; it showed the development of the gigantic ation programmes.Soviet malariologists had always task which the Organization had assumed at the considered that malaria eradication could be neither Eighth World Health Assembly. achieved nor consolidated without the development From the series of reports issued since then it could and activeparticipationof the medicalservices, be seen how the emphasis of eradication work had particularly in Africa, where those services still showed varied in ten years.The early reports had been the effects of colonialism. optimistic,speakingof the number of sprayings There were, however, some shortcomings in the carried out and the different countries where the attack programme. The WHO Secretariat had no long -term phase had begun.Technical difficulties had then plan for an expensive campaign which moreover had appeared, such as resistance to insecticides and other been started without an adequate scientific basis. problems related to the living conditions of the Perhaps at the next Health Assembly the Director - population; resistance had also developed in some General could give delegates an approximate deadline species of plasmodia. by which eradication of malaria could be completed, Another problem now in the forefront was the need and some indications of future expenditure : that would to find the proper relation between malaria eradication enable the Assembly to assess more thoroughly what services and general public health services. The progress was being made. In that respect he shared the present report placed emphasis on the development of concern already expressed by certain delegates. basic health services, especially in rural districts, as Another essential point was the co- ordination of the a prerequisite for successin malaria eradication. malariaeradication programmesintheWestern Personally, he considered that there was need for PacificRegion, wherea number of count ies- caution in considering that problem :he did not includingthePeople'sRepublic of China -were think that the launching of an eradication pro- outside the Organization's sphere of work.There gramme should necessarily be conditional on the could not be any effective malaria eradication without existence of a health infrastructure.Experience in epidemiological co- ordination both at regional and India and in his own country showed that good results world level. could be obtained even before the basic health services By 1965 it would be ten years since the Health were developed, though health services must of course Assembly had taken its decision to eradicate malaria. be built up concurrently with the progress of the At that time everyone had expected quick results from campaign if it was ever to reach the consolidation the wide use of insecticides applied by auxiliary phase. On the other hand, the eradication campaigns personnel.Since then insecticides had been supple- that had been undertaken in some countries before the 180 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
infrastructure had been built up had proved a great vector,Anopheles gambiae,beingveryexophilic, stimulus to the development of a general health could not be controlled by insecticides.Another service. known vector, A.funestus, which was dangerous He though it would be wrong to underestimate the becauseitwas very endophilic, was very easily value of the experience that had been derived from the controlled. eradication campaign :although it had shown that As to mass chemoprophylaxis, only part of the malaria eradication was not so easy as had at first been population could be reached and there seemed no thought, eradication was none the less possible, and prospect of ever securing total coverage.None the the Organization must continue its assistance. In less, in ten years the annual number of cases of malaria many countries that had reached the final phases had fallen from over 750 000 to less than 100 000, and of eradication, the cost of malaria work remained very deaths had fallen from 2500 to about 100. The spleen high. The existence of a health infrastructure would index, which had been everywhere more than 50 per allow countries in the consolidation phase to use cent., had fallen to 15 per cent. even in the coastal experienced malaria staff for general health work. districts which were the most infected, and in most of On a point of terminology, he was doubtful about the higher districts was between 1 and 2 per cent.In the use in Spanish of the term " pre -eradication " : the latter districts, which contained one -third of the it would be preferable to speak of " programmes pre- population of Madagascar, there had been in 1961 less liminary to eradication ". than one case of malaria per thousand inhabitants. To sum up, he thought it would be wrong to wait Much of that improvement must be attributed to for the development of a complete health service before chemoprophylaxis, as was shown by the fact that embarking on eradication.The success of the yaws the parasitic index among those receiving preventive campaign in Haiti and in his own country, before treatment, even irregularly, was now 3.43 per cent, good general health services had been developed, compared with 37 per cent., among the untreated, while showed that the proper course was not to halt eradic- the respective spleen indices were 5.3 and 15.07 per cent. ation work but to continue the organization of general The health services in 1961 had discovered six cases health services at the same time. per thousand (hardly ever serious) in children attending chemoprophylactic centres and 90 cases per thousand Dr RAVOAHANGY- ANDRIANAVALONA (Madagascar) among children not treated. paid a tribute to the help that WHO had given to The experience of the twelve years of Madagascar's Madagascar in malaria eradication.His country had campaign against malaria had shown that after even in four years received a series of experts, numbering comparatively limited spraying operations the indices eight in all, who had studied the incidence of malaria of endemicity fell very rapidly.At first, thatfall and had assessed the work done. might lead to the belief that malaria could be quickly Since1949,Madagascar had been conducting eradicated, but even in the most successful cases there campaigns against malaria,by modern methods, remained foci, often difficult to detect, which could be which had wholly changed the general health situation. a source of new outbreaks as soon as control measures The special feature of the campaign in Madgascar was were relaxed. At that stage there was need for a good the combination of the use of insecticides against the surveillanceandcase -findingservicethatwould vector with chemoprophylaxis, to protect particularly examine all fever cases. Case -finding work in the higher the child population and to sterilize the most important districts of Madagascar in 1960 had produced ten part of the reservoir of infection.Chemoprophylaxis cases per 100 000, but in 1961 only two cases per had first been chosen asa provisional measure, 100 000. pending the attack on the vector, but the results had Surveillance operations in the higher districts had been so good that it had been continued and now confirmedthattheeffectiveness of work against reached more than 1 250 000 children up to the age malaria was closely connected with the health service of fifteen years, i.e. 50 per cent. of the total child infrastructure and the participation of the population. population. Each week the children received chloro- In general, it appeared that in those districts, where quine at more than 10 500 centres.The results had A..funestus was the vector, it was fairly easy to get close everywhere been material but varied greatly between to eradication.But further progress would require the different parts of the country. After ten years of better methods than were now available in the low that work transmission had not been wholly inter- country,wheretransmissioncontinuedthrough rupted in any district, except in some areas above A. gambiae. 1200 metres.The reasons were partly financial and partly operational and technical.Complete coverage Dr ADENIYI -JONES (Nigeria) said that his delegation had not been obtained in any case and the main wished to thank the Executive Board for the excellent COMMITTEE ON PROGRAMME AND BUDGET :THIRD MEETING 1 ó 1 work it had done. It also wished to pay tribute to the valuable services later in the general public health constant stimulation and encouragement that the field. Nigerian eradication campaign had received, parti- He also suggested that an attempt should be made cularly from the Regional Office for Africa and its to associate the training centres with neighbouring malaria division. He also expressed appreciation of the centres of higher learning, universities and medical trainingfacilitiesthat had been provided at the schools, so that eventually they would gain general Lagos training centre, which was one of the English - recognition, and perhaps eventually award recognized language centres in the area, and at which two courses diplomas, which would give malaria training as a whole had already been completed and a third was about to a higher standing and possibly attract more students. begin. His delegation was also looking forward to the The insecticides testing unit in Nigeria was also a establishment of a French -language centre, and hoped great stimulant to the training of staff for the local that it would be possible to establish a very definite programme. link between it and the Lagos centre. His delegation would endorse a resolution that WHO His delegation endorsed the decision toretain find ways and means of assisting governments in the present definition of " infrastructure ". Too much malaria eradication work, in view of the great need for emphasis on the rural health services was a hindrance that work and the shortage of staff and funds in many to total coverage of the population.The urban and areas. A special request had been submitted for peri -urban districts, to which the more rural parts often assistance to one region of Nigeria in regard to the looked for guidance, were extremely important in any salaries of local staff. organization of health services :he would therefore venture to disagree with the delegate from Norway, Dr BRAKHOTT (Israel) expressed his delegation's who had objected to the word " infrastructure " and appreciation of the report before the Committee.It favoured a reference to " rural services ". gave a global picture of the malaria situation through- His delegation also strongly endorsed the recom- out the world, and showed not only the efficiency of mendations made for co- ordination between neigh- WHO and its staff but also the valuable co- operation bouring countries, which was particularly important that had been established with Member countries. in Africa, as had been pointed out by the delegate of His own country was now in the maintenance phase Ghana. A sound infrastructure was important for of eradication : in the last year there had been only five malaria eradication but also had a wider use and should new indigenous cases of malaria and, of a total of be applied to the organization of health services in forty cases, thirty had been imported.The special general. Similarly,the recommendation for co- Malaria Department had therefore been integrated ordination between neighbouring regions and States with the Environmental Sanitation Department and the should not apply only to eradication work but also to staff was interchangeable. ordinary day -to -day health work in suitable geo- His delegation whole -heartedly agreed with the graphical areas. The exchange of health staff between remarks of the delegate of Norway. Malaria was only countries was also most useful, as the delegate of one of the health problems of a country and had to be Senegal had suggested earlier, and he hoped it could be considered in the light of the general health picture. extended in the future. The World Health Organization was aware of that The Nigerian delegation had noted with satisfaction fact, but it should also be emphasized to the govern- the type of training given in the malaria eradication ments concerned.WHO had indeed gone a step training school in Lagos, where special attention was further and had attempted to lay down the basic given to international planning and the need for minimum requirements in personnel for a public co- ordination between regions.His delegation had health service, and he congratulated the Organization also noted that, when selecting students, preference was on its work in that connexion.He referred to the given to candidates who had had public health training, figures contained under " Coverage of population " mostly abroad. He stressed the need for adapting their in paragraph 2.4.3. of the ninth report of the Expert later training to the circumstances of their own Committee on Malaria(Technical ReportSeries countries, and for an integrated and co- ordinated No. 243) and the suggestions in the third paragraph approach in general malaria training, particularly of section 5.2.2 of the report on the development of the as there was often no definite programme for málaria programme 1 as to the population that might be served eradication in operation in the countries the students by a single health post, and the elementary functions came from. It was possible that the students who went of such a health post. In his opinion, however, great to the Lagos training centre would later form a useful caution was necessary in laying down such guiding- link to maintain contact and interest and provide a nucleus of trained personnel; they might also give 1 Off. Rec. Wld Hlth Org. 127, Annex 8. 182 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
lines, since the staff necessarily depended largely on DrFISEK(Turkey) considered that the report before local circumstances and population density. One of the the Committee excellently described the admirable first steps required was to assist countries in as- work being done under the auspices of WHO to certaining their minimum requirements for a basic eradicate malaria from the world. He took the oppor- health service in the various areas of the country, tunity of expressing gratitude for the help being given before proceeding with a malaria eradication campaign. to his own country, whose malaria eradication pro- Once the staff requirements for a basic health service gramme was now costing between four and five million were established the shortage might prove so great dollars a year (8 per cent. of the total health budget). as to affect the timing of the malaria eradication pro- In financial terms, the help received from WHO gramme. In his view, the emphasis had shifted from represented only 1.5 per cent. of that amount but its malaria eradication to the basic health service needs, effect was relatively far greater because of the efficiency and that fact had to be taken into account, particularly of the WHO team working in the country. in planning for the United Nations Development In 1962 Turkey had had over a thousand cases of Decade.In that connexion, he felt that caution was malaria -the highest figure in the European Region. again necessary when fixing the targets for the inter- Malaria was to have been eradicated within five national Development Decade where health was con- years, ending in 1963, but that objective was not being cerned : the aim of one doctor for every ten thousand achieved.It might help other countries with their population and one nurse for every five thousand planning if he were to state the reasons. might be more than some developing countries with In the first place, plans had been based on the constantly expanding populationscould hope to erroneous belief that malaria was prevalent only achieve in ten years, and the resulting discouragement at altitudes below 1500 metres.During the last two might adversely affect their development. years cases had been found in many villages in the To sum up he suggested (1) that WHO should impress eastern part of the country that had not been included on international workers, and not only health workers, in the plans because of that assumption.Secondly, that the development of a basic health service was one the problem was complicated in some areas by the of the most important ways of dealing with the health exophilic behaviour of the vectors.It was hoped problems of a country, including malaria eradication; that new drugs such as CI 501 would help to over- (2) that every Member country concerned should come that difficulty, and his Government was at the develop, with the assistance of WHO, a basic health disposal of the Organization to co- operate in field programme defining itsspecific minimum require- trials. ments, before embarking on a malaria eradication A third reason for the failure was inadequate sur- programme; (3) that the Development Decade target veillance work. There was only one surveillance agent figures of one doctor for every ten thousand population to every ten thousand of population in the rural areas, and one nurse for every five thousand should be which was adequate where the villages were large reviewed; and (4) that a new concerted effort should enough but not where, as in the eastern part of the be made to meet the financial and man -power require- country, their average population was often under ments for establishinginthe emerging countries three hundred.Moreover, the rural health infra- those basic health services which were a prerequisite structure was inadequate in eastern Turkey, which for dealing with their grave health problems, including made itdifficult to get good results from passive malaria. surveillance.In that connexion he agreed with what had been said by the delegates of Indonesia and DrVOVOR(Togo) said that his country was just Norway about the importance of basic health services. beginning pre- eradication operations and was grateful It was true, as the delegate of India had pointed out, for the help it was receiving from WHO. that the under -developed countries could not delay The eradication of malaria would lead to an increase the launching of malaria eradication work until in the population of the countries concerned, and that satisfactory integrated rural health services had been -together with the accompanying decline in morbidity established everywhere, but it was also true that -would constitute an incentive to economic and social without good rural health services active surveillance development.However, experience had shown that would have to be continued virtually for ever.It was such development did not occur automatically but only planned within the next five years to establish in the where it was adequately planned for.In a stagnant eastern part of Turkey 1200 rural health units, each economy an increase in population did not lead to an staffed by a doctor and five or six auxiliaries and increase in resources. A number of complex factors serving a population of seven thousand. One of the were involved and called for further study. reasons for giving priority to the eastern area in that COMMITTEE ON PROGRAMME AND BUDGET : THIRD MEETING 183 development was the difficulties that had been en- intensive point of the programme seventy -five thousand countered in the malaria eradication programme. people would be employed in the malaria eradication A danger that had been referred to in plenary session service, and his Government was therefore particularly by the delegate from Mauritius was the population grateful for the assistance WHO had given. explosion that would result from malaria eradication. An autonomous National Malaria Board had been In his own country, where the natural population established to deal with general policy, finance and increase in 1945 had been 1.8 per cent. per year, it was evaluation, while the implementation of the pro- now 2.9 per cent. It was a problem to which he believed gramme was the responsibility of two autonomous the present Committee would soon have to give atten- provincial boards. For training of personnel and tion. research the programme was integrated with the work of the Malaria Institute of Pakistan. The programme Dr DOLO (Mali) observed that a fact which emerged was also integrated with the rural health infrastructure very clearly from the Director -General's excellent -though that, as had already been pointed out, was report was the extent to which Africa -and parti- rather a lose expression, as in some cases it covered larly West Africa -lagged behind the rest of the comprehensive curative and preventive services and in world in regard to malaria eradication.At the others more rudimentary curative services with control Fifteenth World Health Assembly he had already measures for specific diseases such as smallpox. expressed concern at the situation, and since then Spraying had been carried out during 1962 in both there had been no development to justify greater East and West Pakistan, protecting 6.5 million people. optimism. Following the failure of a few pilot projects Results had been good, the parasite rate in the areas the only recommendation emerging from the latest concerned dropping from between 10.7 and 29.4 per African Malaria Conference at Yaoundé had been to cent. to between 0.08 and 3.7 per cent., and the infant continue the piecemeal and empirical methods that parasite rate from 7.7 to 0.7 per cent. Epidemiological had been superseded everywhere else. assessment showed that the incidence of the vector, The main reason for that lamentable state of affairs Anopheles culicifacies, had dropped almost to zero in was of course lack of money and the inadequacy of the the sprayed villages. An incidental benefit had been a basic health services. A great effort of international big decline during the spraying period in kala -azar solidarity was therefore called for, under the auspices and filarsiasis. of WHO. Co- ordinated programmes must be launched With regard to financing, it was proposed under covering all the areas between the natural boundaries Pakistan's second five -year plan to spend on malaria of desert and ocean; for it was obvious that an inland eradication a total of 520 million rupees, including country like his own, having common frontiers with $40 million of foreign exchange.That was a large seven other States, could not plunge blindly into amount for a country with such a low per capita large -scale operations without the assurance that its income, but it was believed that the expenditure would neighbours were also taking action. be justified by the economic gain resulting from malaria He had visitedthe malariology laboratory of eradication. In that connexion, he recalled the remark Bathurst, where work was proceeding on immunization of the delegate of Norway that the world had now by gamma -globulin, and it appeared that the antibodies accepted themalariaeradication programme -an produced had a curative effect in cases of clinical optimistic view that he wished he could share, noting malaria. If that proved to be indeed the case, it offered the present tendency among some of the assisting new hope for antimalaria work in Africa. He would agencies to change their policy.If those countries therefore be grateful for any further information on the which had now reached the maintenance phase could matter. provide WHO with figures -which must surely exist Dr HAQUE (Pakistan), after congratulating the Chair- showingthefavourableimpactofmalaria man on his election and thanking the Director -General eradication on agricultural and industrial production, for his excellent report, said that Pakistan, though a it would be of great help in convincing those who late -comer in the field of malaria eradication, was held the purse- strings that the programme was a worth- faced with a gigantic problem.It had a population while investment. of one hundred million, or forty -five per cent. of the He felt that the suggestions of the delegate of Norway total population of WHO's Eastern Mediterranean regarding the definition of " malaria eradication " Region, and bore thirty -five per cent. of the Region's were rather dangerous as they might give the impres- malaria burden. During a normal year twenty -five per sion of a return to the former concept of control. cent. of the people fell victim to malaria, and during Complete 100 per cent. eradication was no doubt epidemics fifty per cent. ;there were one hundred unattainable, but if it were possible to reduce incidence thousand deaths a year from the disease. At the most to such a level that all cases could be immediately 184 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II notified, he did not think that malaria would be a concerned essentially with malaria eradicationin particularly serious problem as compared with most the continent.Two examples of successful regional other diseases. organizations of that type were the Institute of Nutri- tion of Central America and Panama and the SEATO Dr WILLIAMS (UnitedStatesof America) said Cholera Research Institute established in Pakistan. it was very gratifying to read in the excellent and com- Any such organization it was decided to establish prehensive report before the Committee that the should, of course, be associated very closely with attack phase had been completed and consolidation WHO,whichcouldprovidecertainessential started in areas inhabited by 168 million people. The administrative and fiscal services.His Government most striking progress has been achieved in India, would be glad to collaborate with such an organi- and he congratulated his fellow delegates from that zation. country. The third matter to which he would refer was one As had already been remarked, the malaria eradic- on which much had already been said, namely, the ation programme in the world had now reached relationship of the network of local health services to the stage where, although it could not be said that the malaria eradication programme. He agreed with final victory was in sight, definite progress had been the delegate of Norway that it would be desirable made.It was not a time to relax efforts, but on the to abandon the vague term " infrastructure ". He contrary to intensify them.In that general context, also agreed with the very acute observation made by he had some remarks to make about three aspects of the delegate of India that it might not be possible in the programme. present circumstances to establish local health services His first remarks concerned the very important rapidly enough to be of help in the consolidation matter of planning, to which Professor Zdanov had phase of a major malaria eradication programme. already referred. His delegation was particularly Lest anything he said be interpreted as - opposition concerned with the need to work out detailed plans, to the principle of developing adequate local health including training of staff, financing, etc., showing services, he must make it clear that it was considered when, how and in what circumstances the final goal an important objective even in his own country, was to be achieved. He understood that the Director - 35 per cent. of whose people still lived in areas where General was intending to have by the end of the full -time local public health services were not yet present year as complete an estimate of requirements available.Nevertheless, he had some reservations as possible, and he welcomed that decision. WHO regarding some of the statements made about the need was recognized as the general headquarters in the for local health services in relation to malaria eradic- world fight against malaria, and his Government was ation. very happy to co- operate with it in that role, but it The first reservation was historical and was best was essential that it should begin to think in terms of illustrated by the following instructive experience in more specific planning than up to the present. his own country. Early in the century the Rockefeller The second matter to which he wished to refer was Foundation had begun a programme to eradicate the urgency, on moral and material grounds, of hookworm in the southern states.After a few years, undertaking malaria eradication in Africa.There responsibility for eradication work had been handed were three main reasons why the problem should be over to local health services established largely under tackled without delay :firstly,it was obviously a the impetus of the programme. At the present day, tremendous health problem; secondly, it was a major local health services were operating widely throughout obstacle to economic development; and thirdly, with that region, but hookworm disease had not yet been the development of transport, no part of the world eradicated. was safe from reinfection with malaria if a major His second reservation was political. Experience in focus existed anywhere. The problem was, of course, public health development throughout the world had a very big one, both for geographical reasons and shown that the bodies responsible for appropriating because of the efficiency of the vector Anopheles funds were most ready to do so for specific, tangible gambiae, but it was all the more essential to start at objectives.Nobody had ever died of public health, once on drawing up plans for integration into the but millions of people had died of malaria. The global programme.In the light of experience, one dramatic appeal of specific disease problems was suggestion his delegation would venture to make to important in gaining the interest of appropriating the African countries was that to ensure the best bodies. utilization of scarce resources, particularly in trained His third and last reservation was administrative. manpower, they might want to consider establishing In planning health programmes, it was perhaps not some sort of regional organization or grouping to be necessary to make an irrevocable choice between the COMMITTEE ON PROGRAMME AND BUDGET :THIRD MEETING 185 general approach and the categorical, or " disease -by- Board's recommendation, such a study now appeared disease " approach.The decision must depend on likely to be realized. the individual health situation rather than on any Dr KEITA (Guinea) said that it was important that rigid principle.In countries like his own, where no single health problem affected more than about two planning should cover all countries of the same region. or three per cent. of the population, the general Malaria was a disease without frontiers, and joint action was therefore needed. approach was probablythemosteffectiveand In his country, which was not at present included in economical. But when, as often in the case of malaria, an eradication programme, use was made of the nation- a single disease had a prevalence of up to 90 per cent., generalized health personnel might lack both the al party organization, whose structure covered the specific knowledge and the dedication to a specific whole country down to the smallest village. A week in every month was devoted to intensive action that in- aim necessary for success. cluded spraying, distribution of drugs, environmental Two major conclusions therefore emerged regarding sanitation, etc., in co- operation with the public health the relationship of local health services to malaria and major endemic diseases services. Action continued eradication. In the first place, under no circumstances throughout the rest of the month under the auspices of could there be moral justification for postponing the Antimalaria League. malaria eradication until adequate local health services He emphasized the necessity of a basic health infra- were established (a principle that applied particularly structure as the starting -point for a long -term eradica- to Africa, but was valid everywhere); though it was tion programme. However, in countries where there quite legitimate, on the other hand, to use the develop- already existed services for the major endemic diseases ment of malaria eradication programmes as a means that dealt with malaria, yaws, tuberculosis, smallpox, to build up and strengthen local health services.In treponematosis, trypanosomiasis, etc., the conditions the second place, while the existence of adequate for an integration of the health infrastructure and the local health services could make surveillance easier national malaria service already existed. and cheaper, their non -existence should not be an Referring to part II of the report on the development obstacle to undertaking eradication.The necessary of the malaria eradication programme,' he noted that provision should be made for surveillance, even if it in Table 2, showing the timing of operations, there was were more expensive, and should be budgeted for a blank as regards Africa for the consolidation and when the initial plans were made. maintenance phases.Similarly, according to Table 3, D'' QUIRÓS (Peru) said that his delegation was which gave particulars of spraying operations during glad to note the progress that had been made. 1962, Mauritius and Zanzibar appeared to be the only Malaria was of tremendous national and international countries in the region in which any spraying had taken significance and had a great impact on economic and place.In the other regions, however, there was no social life. blank regarding either the calendar of operations or the The malaria eradication programme had unfortuna- spraying programme. His delegation wished to draw tely been established in a theoretical manner, based the Assembly's attention to that disturbing situation. solely on the experience of certain countries, and some It was urgent, in those highly malarious countries, to confusion had thus been caused.The idea of pre - have an eradication programme, i.e. a total programme. eradication programmes did not correspond to reality, He could not agree with the delegate of Norway that since such programmes could be spoken of in con- the word "eradication" should be dispensed with. The nexion with many other diseases. As was well known, term was apt and irreplaceable, since it was necessary the programme had two aspects :the basic health to achieve the disappearance of malaria, even if the services and malaria proper. road to be travelled was a long one. With regard to research programmes, more emphasis Dr KATSACOS (Greece) congratulated the Chairman should be placed on applied research, and on studying and Vice -Chairman on their election, and commended the epidemiology of the disease. Too much attention the Director -General for his excellent report. had often been given to the administrative aspect. Malaria had in the past been a great scourge in his With regard to the question of planning, mentioned country, which was therefore well placed to appreciate by several speakers, his delegation had, at the Four- the importance of the Organization's efforts for its teenth World Health Assembly, proposed a study - eradication. which had unfortunately not materialized -to establish A well- organized malaria service had existed in clearly the trends of the programme. Such work had Greece for several years, and complete eradication had been carried out for two years in the Americas and had yielded useful results. He noted that, on the Executive 1 Not reproduced in the printed version of the report. 186 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II almost been achieved. Insecticides were no longer used greatly appreciated.The programme had already even though the anopheles still existed. The rare cases been launched and must not be abandoned. notified -whether indigenous or imported -were isol- ated, treated with drugs such as primaquine and sub- Dr JALLOUL (Lebanon) joined in the appreciation by jected to surveillance for the necessary period to avoid previous speakers of the well- conceived report.His a recurrence of the disease. country acknowledged with gratitude the assistance given by the Regional Office in its malaria eradication Dr NOGUEIRA (Cuba) congratulated the Chairman programme. The problem of malaria in Lebanon was on his election and paid a tribute to the Director - no longer acute and was more or less confined to General for his informative report. imported cases. It was, however, recognized that vigi- In Cuba a campaign had been carried out between lance must not be relaxed through the consolidation 1935 and 1943 with the assistance of the Rockefeller phase, which was one of the most decisive stages. Out- Foundation, and had been pursued sporadically with breaks had occurred in the neighbourhood of Beirut and the help of several governments until 1959, when, in the south of the country which, on epidemiological following an agreement between the Government and investigation, had proved to have been brought in by the Pan American Sanitary Bureau, an epidemiolo- carriers from a neighbouring country who had settled gical survey had been embarked upon.Later, under in a locality where anopheles existed. The situation had another agreement between the Government and the been handled rapidly and the outbreak brought under Pan American Health Organization, eradication work control. That incident proved that in the consolidation had been begun. phase a constant threat existed, and it was necessary to Malaria was not a serious problem in Cuba, where be on the alert. the infection existed only in the eastern part of the The administrative part of the programme should be island.The programme was at present in the attack integrated with the rural and urban health activities, as phase, and the consolidation phase would be carried a joint programme with, for instance, environmental out by co- operation between the Government and the sanitation, as had been done in the Lebanon. As the Pan American Sanitary Bureau. delegate of India had pointed out, that could not be Table G at the end of section 7 of the report made done everywhere, but whenever feasibleall health reference to resistance only in Camaguey and Oriente, programmes should be dealt with as a unity, close co- but such resistance had also been met with in the operation being maintained among the different health westernmost tip of the island. activities in the same locality. With the setting up of an epidemiological service, and Dr EL BITASH (United Arab Republic) said that there the contribution of the people to the campaign, it was had been some uneasiness in some countries about the hoped to complete it before the date envisaged. final results that could be achieved.The vector in Dr BAIDYA (Nepal) associated himself with previous Egypt had proved to be an outdoor biter, and in addi- speakers in congratulating the Chairman on his elec- tion to its exophilic behaviour had begun to show high tion and in commending the Director -General and his tolerance to the chlorinated hydrocarbons, especially staff on the excellent report. in areas where such insecticides were used on a large The eradication programme in Nepal had been laun- scale in agriculture. ched with the assistance of the United States Agency When the idea of conducting a global malaria eradi- for International Development and WHO. As stated cation campaign had been launched, it had been in the report, the urgent need in his country was the thought that spraying with residual insecticides inside development of surveillance throughout the central human habitations would provide a solution, and zone, and it had been rightly pointed out that extension countries had begun to plan their programmes accor- to other zones should be undertaken only after that dingly. A few years later, however, complaints had sector had been dealt with. arisen in various parts of the world about the difficul- The real difficulty in the way of extending the pro- ties encountered, particularly in regard to development gramme was that it had notbeen possible to expand the of resistance by many vectors. health services along with the malaria eradication pro- Since 1952, pilot projects had been conducted in the gramme; the essential health infrastructure was inade- United Arab Republic in order to plan the final cam- quate owing to the difficult mountainous terrain and paign on a sound basis, and results had shown that the bad communications. There was, moreover, a dearth attack phase as then conceived was not the answer to of doctors and paramedical workers, and the steadily - the problem. A new plan had therefore been formulat- growing financial burden was a great problem. The ed, based on the rural health services, and consisting of assistance of national and international organiza- the establishment of rural health units, each to serve tions in helping the country over the crisis would be 5000 people living in one large village or in a group of COMMITTEE ON PROGRAMME AND BUDGET : THIRD MEETING 187
smaller villages located within a radius of not more went to the health service, and a large part of that than two or three kilometres from the health units. allocation had to be used for the two existing hospitals. That extensive rural health service, entailing the estab- It would be appreciated that the Government had lishment of 2500 such units, was expected to be com- not been able to undertake a pilot eradication cam- pleted within the next four years, and 500 units would paign, taking into account the other problems with function during the current year. Many training centres which it was faced, particularly the control of such had been established to train the enormous amount of diseases as meningitis, smallpox and measles. staff needed to run those units, the personnel being re- He associated himself with the remarks of certain cruited from the local population. The campaign now delegates concerning the need for co- ordinating eradic- planned was to start in 1964, beginning in areas where ation efforts in a number of States. The cases cited by the units were completed, and continuing until the the delegates of Kuwait and Lebanon demonstrated the whole country was covered in 1967. It would no doubt setbacks that could occur in a country that had under- result in a large saving in expenditure, especially on taken eradication without neighbouring countries hav- transport, both in the attack and consolidation phases, ing done so. and would also allow the continued employment of He had noted from the report that certain countries of staff after the eradication programme had been comp- low endemicity had received assistance because they leted. The units could also be used as the nucleus of had the necessary financial means for undertaking an campaigns against other diseases, and could provide a eradication project, while other highly endemic coun- weapon against epidemics and serve as centres for tries had received but slight help. He joined with the vaccination against poliomyelitis, diphtheria, and other delegates of Yugoslavia and Pakistan in expressing the communicable diseases. wish that WHO might give more attention to those He expressed his country's gratitude for the assist- countries in financial difficulties.It was important ance given by UNICEF, but pointed out that such that all those responsible for world health should re- assistance was given on a year -by -year basis. Malaria member that disease knew no frontiers. programmes were not one -year projects, and he would be glad if the representatives of UNICEF could indi- Dr WOLDESEMAIT (Ethiopia) said that malaria was cate what would happen to a programme if his organiz- still one of the major health problems in his country, ation's assistance were not approved at any time. the total population at risk being about eight to ten million. His delegation agreed with the delegate of the Dr MORSHED (Iran) said that the meetings held bet- United States that eradication schemes should not wait ween his country and neighbouring countries had prov- for health services to expand fully before being tackled. ed very successful. A number of pilot projects had been undertaken in The eradication programme in Iran had met with Ethiopia, the first having been established in 1956 by success in most parts of the country, although the the United States Agency for International Develop- problem of insecticide resistance had arisen in the ment (AID) in an area about 375 miles north of Addis southern part near the Persian Gulf, necessitating a Ababa. The same agency had undertaken two further switch to other methods such as the use of larvicides, such projects, one in 1957 and the other in 1958, and chemotherapy, medicated salt, etc.He expressed the WHO had also initiated a pilot study project in the hope that WHO, UNICEF, and the United States Awash Valley. In 1958 a group of experts had met in Agency for International Development would continue Ethiopia under the combined auspices of WHO, AID to offer their help, and associated himself with the and the EthiopianGovernment,asaresultof remarks of the delegate of the United Arab Republic whichamalariaeradicationservicehadbeen concerning the need for UNICEF assistance to he given established in 1959 as a semi -autonomous body under on a long -term basis. the Ministry of Health. The group had recognized the About 25 per cent. of his country's health budget was immediate necessity of providing a sufficient number of to be devoted to the problem. locally trained malaria personnel, and an agreement Dr KABA (Niger) said that no eradication organiz- had been reached between the Government and WHO ation at present existed in Niger. The country, which that had resulted in the establishment of a malaria was twice as large as France and had a population of eradication training centre near Addis Ababa. three million, did not yet possess an infrastructure The country had been arbitrarily divided into four capable of undertaking a task that demanded trained parts, and operations were at present being carried out personnel and a substantial budget. It could not afford in the northern region, covering an area of 400 000 to disperse the effort of its health personnel.More- square kilometres.During 1962, spraying had been over, the annual budget for that vast territory was only carried out in 282 432 premises and a population of six thousand million CFA francs, 20 per cent. of which 789 091 protected. As soon as operations were corn- 188 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II pleted in that area, it was planned to start work on the same views, but it had further felt that in certain another region. cases problems frequently arose as the direct result of There were of course many problems to be over- eradication. Consequent upon such eradication whole come : financial difficulties, shortage of trained person- territories had been opened up for development, nel to fill key supervisory posts, difficulty of communi- attracting labour that had brought with it infections cations and transportation, and the absence of basic giving rise to small foci of malaria.That was an data such as census figures, maps, etc.In spite of the example of how an area might suffer from its own suc- difficulties, however, a firm foundation had been laid, cess. and thanks were due to WHO and the other special- With regard to the observation by the delegate of ized agencies. He expressed the hope that their assist- Norway on the term "infrastructure ", many members ance would continue. of the Executive Board had also condemned the use of the term. The Board felt that the term "pre- eradic- Dr IGNATOV (Bulgaria) said that his delegation had ation programme" was inapt and in the search for a read the Director- General's report with interest.He better one the phrase "activities preliminary to eradic- expressed his delegation's satisfaction with the im- ation" had been suggested.That conformed to the mense efforts made by the Organization and with the views of the delegates of Ecuador and Spain in the great success already achieved. Committee. He associated himself with previous speakers con- Reference to the point made by the delegate of India cerning the importance of the consolidation of the regarding the danger of undue prolongation of the health services in the successful carrying out of malaria consolidation phase could be found in paragraphs (14) eradication programmes. That did not mean, however, to (16) on page 76 of Official Records No. 125.The that local health services must have priority or that the Board had realized that the situation of a country existence of public health services must be awaited be- starting a malaria eradication campaign differed from fore proceeding with the campaign against malaria. that of a country where the campaign was nearing In his own country that campaign had been going on completion. It was the concern of the latter category of for many years parallel with the development of the countries to terminate the consolidation phase as early health services network and with measures for the as possible, and the need for evolving a minimal organ- control of various other diseases. Those measures had ization able to support malaria eradication became facilitated the fight against malaria, and the disease no paramount.It was natural for those at the start of longer existed in his country. their campaign to be inclined to lean more heavily on As the delegate of the USSR had pointed out, cer- developing basic health services. The trouble perhaps tain administrative measures should be considered, and arose from the fact that an attempt was being made to his delegation felt that it would be useful to set up a find a single formula applicable to all situations. Each committee of experts from various countries to eval- country must in fact be studied separately, and the uate the programme and advise on the epidemiology of relative claims of the general health services as against malaria. As eradication advanced it became more than those of the specialized malaria service had to be work- ever indispensable to study and use more effective ed out and carefully weighed before a decision was organizational methods. taken. He was pleased to note that the Board's con- Dr CLAVERO DEL CAMPO (Spain) said that the dele- cern on the point had been justified by the amount of gate of Ecuador had raised a linguistic difficulty con- discussion it had evoked in the Committee. cerning the term "pre- eradication ", which did not The point raised by the delegate of the United properly exist in Spanish. In the Spanish documents States of America concerning zones in Africa on the the term "programas preliminares de la erradicación" same pattern as those in America had also received was used to describe the work carried out prior to attention from the Executive Board, as could be seen eradication. from paragraph 319 on page 78 of Official Records No. 125. Dr AFRIDI, Chairman of the Executive Board, said He expressed his personal agreement with the re- that he would refer briefly to a few of the remarks marks of the delegate of the United States of America which were in a general sense related to the views of the concerning the danger of postponing programmes be- Executive Board. cause of a lack of health services. With regard to the remarks of the delegate of Italy concerning problem areas, not only had the Board held The meeting rose at 5.50 p.m. COMMITTEE ON PROGRAMME AND BUDGET : FOURTH MEETING 189
FOURTH MEETING
Tuesday, 14 May 1963, at 9.30 a.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1.Report on Development of the Malaria Eradication generally and had also questioned the definition of Programme (continued) eradication. Butseveralotherdelegatesfrom Agenda, 2.3 countries where malaria had been endemic and where The CHAIRMAN, summing up the discussions at the eradication programmes were already in progress or previous day's meetings, said that the Committee had being planned had given vivid accounts of the situa- heard accounts of progress made and difficulties en- tion in their respective countries -how the eradication countered, from which it was possible to assess the programme was being implemented and what further present degree of advancement of the programme. steps were needed; interesting accounts of work and The technical, staffing and financialdifficultiesre- achievements in malaria eradication had been given by ferred to were of the greatest importance in a pro- the delegates of Ghana, India, Senegal, Indonesia, gramme of such wide scope.He invited Dr Kaul to Cameroon, Nigeria and Pakistan, and the striking fall comment on the main points of the discussion and in malaria morbidity in India was a spectacular achieve- reply to the questions raised. ment. The discussion in no way implied that there should Dr KAUL, Assistant Director -General, Secretary, be a change in the objective set by the Eighth World said that the importance of the subject could be gauged Health Assembly of eradicating malaria from the from the fact that thirty -seven speakers had taken part whole world as fast as was technically, administra- in the previous day's discussions. The divergent aspects tively and financially possible.It had been recognized of the programme had been brought out and there had that the existence of malaria in any part of the world been many important contributions. The World constituted a threat to the hundreds of millions living Health Assembly's annual review of the whole vast in areas where interruption of transmission had been programme provided an opportunity -particularly for achieved and which had reached or were nearing the Secretariat -to gain a better understanding of the eradication.Progress in eradication was being made requirements of the programme and to review its throughout the world, especially in the tropical and policies and methodology. He proposed to make his former endemic countries of Latin America and Asia : comments under six headings, as the subject as a whole there could be no turning back from the programme, was so vast : (I) the relation of the malaria eradication or malaria would re- establish itself and play havoc programme services to health services generally; the with populations who had now rid themselves of it- development and the requirements of pre- eradication for their immunity had already decreased. There were programmes; and definitions, including the controver- bound to be differences of opinion on terminology, sial term "infrastructure "; (2) planning; (3) co- ordina- definitions, the relationship of malaria eradication ser- tion; (4) evaluation, technical and financial; (5) protec- vices to general health services, pre- eradication prog- tion against the importation of malaria; and (6) an- rammes and their requirements, and the phasing of swers to specific points raised during the discussion. programmes and their financial requirements.It was On the first point, he referred to the comments at true that better terms, phrases and definitions were need- the previous meeting by the Chairman of the Execu- ed. But it should be recognized that many differences tive Board on discussions at the Board's thirty -first arose from differences in language, cultural patterns, session.Questions had been raised on terminology political conditions and administrative organization. and, while recognizing the need for better expressions Moreover, the programme was an entirely new experi- to replace such terms as "infrastructure" and "pre - ment in the public health field, for it was the first time eradication programme" commonly used in reports, a planned attempt was being made to eradicate a the Board had wisely recognized that there could be no disease from the world. There were no criteria, guid- single formula which would apply to all situations. ing -lines or precedents to help :it was a case of learn- The delegate of Norway had spoken of the relation- ing by experience. He admitted the shortcomings in ship between malaria servicesand health services terminology and assured delegates that every effort 190 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II would be made to find better terms, although it would veillance during the consolidation phase could only not be easy. be secured by deploying an army of surveillance It might be useful to consider something of the his- agents together with a network of voluntary helpers. tory of the malaria eradication programme and the The seventh and eighth reports2of the Expert Commit- development of public health services. tee dealt with surveillance operations in detail and The idea of malaria eradication had arisen out of the recognized that the stringent requirements and the high discovery in some of the more developed countries, costs involved would have to be taken care of where no where there had been several years of control opera- national public health service existed.It was impor- tions, that once interruption had been obtained mal- tant to remember that in tropical areas the factors aria vanished and parasites died out spontaneously in creating malaria were usually strong and stable, so that previously infected persons. It had therefore been con- the reintroduction of a fresh infection after eradica- cluded that the most important factor in eradica- tion could re- establish endemicity unless a thorough tion was a thorough attack phase. The importance of sentinel system existed which was capable of detecting surveillance operations after the attack phase, in order the first cases and applying the necessary remedial to detect residual foci and to certify the achievement of measures.It would be unrealistic to hope for success eradication, had been recognized from the start, but it in eradicating maleria from tropical countries where no had to be admitted that there had been an under -esti- means existed of maintaining the achievement.The mation, particularly of the administrative complexi- proper system was a well -distributed rural health ser- ties and the financial requirements of the programme. vice; but there was still confusion in the minds of many In addition, the pioneers of eradication had had to deal public health authorities on the interpretation of rural only with seasonal malaria, which was unstable and health services in developing countries.Members of easier to wipe out and therefore required less rigid the Expert Committee on Public Health Administra- surveillance.The sixth report of the Expert Com- tion had spoken of the ideal requirements for health mittee on Malarial laid down the methodology of services based on standards and principles of tech- eradication and stated that the consolidation phase nical efficiency and not on total coverage, whereas for should last for three years and should be followed by malaria eradication programmes total coverage was an a maintenance phase with thorough and repeated essential aspect : thus malaria eradication programmes scrutiny; after it had been shown that there was no in- could not be supported by or incorporated in health digenous malaria, the eradication service would be dis- services which had not proper coverage. It was doubt- banded and vigilance operations in the maintenance ful whether the existing principles, which were based on phase would be the responsibility of the regular health developed countries, could be used for guidance in department, which would add malaria to the list of developing health services, and in its ninth report3 the communicable diseases to be handled by the public Expert Committee on Malaria had endeavoured to out- health service. He then quoted in detail the comments, line a system under which malaria eradication would be in Chapter 11 of the sixth report of the Expert Commit- initiated and pursued concurrently with the develop- tee, on the relation of malaria eradication to other pub- ment of health services. Thus the need had arisen for lic health activities, in which it was stated that an eradi- new terminology which would suit a public health cation service should serve as a nucleus around which structure no longer based on standards of technical and the public health service could be built; that in many professional manpower, for it had been proved in the cases the malaria eradication programme would rep- malaria programme that operations could be carried resent the first fully efficient public health service given out under supervision without professionally qualified to the public; and that malaria eradication was not an manpower. That was why the word "infrastructure" end in itself but a step towards general public health had been introduced to describe a basic structure some- and welfare. Thus, even at the time when it was first what below the normally accepted level.It was not a laying down principles the Expert Committee had had particularly happy choice of term but nothing more the relationship well in mind. suitable had been found. He assured the Committee When the World Health Assembly had first decided that every effort would be made to find a more satis- to undertake the world programme it had been clear factory term. that programmes would have to be started in countries The Expert Committee on Malaria at its ninth ses- that were in process of development, in countries where sion had had the difficult task of evolving something the administrative structure was poor or non -existent, from nothing.It had been helped by material gar- and in countries where malaria was a vast endemic pro- nered from experience in the Organization and mater- blem. It had soon become apparent that efficient sur-
2Wld Hlth Org. techn. Rep. Ser., 1959, 162; 1961, 205.
1Wld Hlth Org. techa. Rep. Ser., 1957, 123. 3 Wld Hlth Org. techn. Rep. Ser., 1962, 243. COMMITTEE ON PROGRAMME AND BUDGET : FOURTH MEETING 191 ial prepared by a public health administrator who had Cost was an important aspect. At the Eighth World gained considerable experience in Latin America and Health Assembly, no global estimate had been pos- from visiting Albania, Morocco, Togo, Dahomey, sible; the first estimates had been made at the Ninth Ethiopia, Nepal and other countries. The Committee Assembly and were based largely on assumptions; the had approached the problem in a realistic way and in same would be true of any estimate made at the present its ninth report had laid down the role and functions time.Increased costs were undoubtedly a common of a pre- eradication programme and the basic require- phenomenon of the present time and malaria was no ments of the rural health infrastructure.It had stipu- exception : the cost of the programme was increasing lated an essential minimum organization with a net- and would continue to do so; the only problem was work of rural health posts which would deal with whether the increase was disproportionate. malaria as a first priority in developing countries where As to the question whether any term had been found the disease was prevalent.Each post should have a to replace "infrastructure ", he doubted whether such minimum of two auxiliary trained staff.Although phrases as "minimum organization level" or "rudimen- there would be a fair amount of flexibility in the way in tary health service" were adequate. What was essen- which the area should be covered, coverage of the tial was to communicate the meaning, and he would entire malarious area was essential. The Organization welcome any suggestions. With regard to "pre- eradi- was doing its best to give help and advice to every cation ", the Expert Committee on Malaria had origin- country that asked for it; in some countries it was in ally referred to the preliminary operations in the developing the minimum infrastructure and it would do malaria eradication programme, a phrase which had the same for any country that so requested, provided there was an assurance that the country concerned proved too cumbersome and had therefore been ab- breviated to the current term. would shoulder the major responsibility for develop- ment, training and finance. The second point he wished to deal with concerned planning, which was very important at country level. The delegate of Norway had suggested that another The Organization had been helping national adminis- definition should be sought for eradication. The trations to plan in accordance with their own circum- Expert Committee had defined it as "the ending of the stances and environment; and malaria had also been transmission of malaria and the elimination of the given first priority by the Health Assembly and the reservoir of infective cases in a campaign limited in Executive Board in WHO's programme for the United time and carried to such a degree of perfection that, when it comes to an end, there is no resumption of Nations Development Decade.
1 The third question concerned co- ordination, again of transmission" : it did not specifically say that the parasite must be entirely eliminated from the world, great importance.As had been stressed during the but that was implicit because of the danger of resump- discussions, co- ordination was essential in all direc- tion of transmission.The definition seemed clear tions and in every field : within States, between States enough for the time being and he did not see any need and between regions. WHO had been helping to pro- to change it. vide geographical and regional co- ordination accord- ing to political boundaries and geographical conti- It had also been remarked during the discussion that guity, and would continue to do so.Considerable progress had been slow and that ideas had changed progress had also been made with inter -regional co- since 1958.There was, however, no foundation for ordination. such a statement, for the Eighth World Health Assem- bly in resolution WHA8.30 had referred to the objec- With regard to evaluation, the fourth point, WHO had from the start of the programme helped countries tive of the world -wide eradication of malaria but had in technical and financial evaluation, through the made no mention of a five -year programme.It had regional offices and through malaria advisers and recognized that there would be a time -limit for each On the broader scale, WHO headquarters individual programme but that there could be none for teams. carried out a global evaluation each year with the help world -wide eradication.The Director -General's re- of regional advisers; and the Expert Committee on port,2which was based on reports from Member Malaria, the Executive Board and the World Health governments, showed that there were minor delays and Assembly reviewed the programme annually. Such difficulties to be faced but that the programme was reviews were essential to the progress of the programme going forward steadily without any serious setback. and were welcomed by the Secretariat. The first financial assessment was the one made in 1 Wld Hith Org. techn. Rep. Ser., 1957, 123, 4. 1959. The Executive Board at its thirty -first session had 2Of Rec. Wld Hlth Org., 127, Annex 8. 192 " SIXTEENTH WORLD HEALTH ASSEMBLY, PART II asked the Director -General for a new assessment, upon disease; other measures in use at the present time which he had already embarked in co- operation with would still have to be continued. national administrations and other agencies working Repeated visits to Madagascar of officers from the in the field. It was hoped that it would be ready early in Regional Office and from headquarters had been due 1964. to the fact that malaria was a particularly difficult The fifth question, protection against the importa- problem in that country, requiring thorough studies tion of malaria, had also not been neglected. When the prior to operational work.In addition, negotiations matter had first been studied by an expert group, it had on the plan of operations had encountered some been considered that international protection did not difficulties. The plan had had to be revised twice and at this stage call for special measures. At the present each revision had required further negotiations. It juncture, however, WHO fully recognized the need to was hoped that an agreed programme would be study the subject afresh and it was the main item on the arrived at soon. agenda of the coming session of the Expert Committee A research team working over the past five years at on Malaria. the British Medical Research Council Laboratory in Coming to specific points that had been raised, he Gambia had found a causal relationship between the recalled that medicated salt projects had been carried gamma- globulin level in the blood and acquired im- out in limited areas in a number of countries.' The munity to malaria. Purified gamma -globulin fractions two in Cambodia and West Irian had had to be had been found to have a definite effect on the course terminated because of difficulty in getting total cover- of malaria infection.That discovery might have an age. The experience gained was now being studied with important bearing on the immunology of malaria. a view to assessing the value of the method. As yet, Some work was also going on towards developing a malaria eradication had not been achieved simply by vaccine;the fundamental difficultythere was to the use of medicated salt alone.Its use was perhaps produce a culture of the malaria parasite.Investiga- therefore of more value as a supplement to other meth- tions on immunology were part of the Organization's ods. There was no direct evidence to date that the use current research programme. of medicated salt was any more likely to produce In conclusion, he trusted that he had given all the resistance to the incorporated drug than other methods explanations necessary on the evaluation of the global of drug administration. programme and that that programme would continue Attention had been drawn to the danger of trans- to have the world -wide support needed for reaching mission of malaria infection through blood trans- the ultimate goal. fusion in areas where the programme was already far advanced. Two studies were in progress with the At the request of theCHAIRMAN,DrSENTICI support of WHO, in the USSR and Yugoslavia, and (Morocco),Rapporteur,submittedthefollowing it was hoped soon to obtain more information and draft resolution for the Committee's consideration : guidance on that problem. The map showing the status of the programme The Sixteenth World Health Assembly, throughout the world had been criticized as inaccurate. Having considered the report of the Director - It was based on epidemiological data provided by General on the development of the malaria eradic- the countries themselves or, where none was available, ation programme; on information obtained from other sources such as Noting that the objectives of the co- ordinated WHO fieldofficers,regionaloffices,or published plan for continental Europe had been successfully reports.The Secretariat was concerned to provide fulfilled in that all the remaining malarious areas the most accurate information possible and would had reached the consolidation phase by the end of welcome data on which corrections might be based. 1962; The normal practice of using the code name had been followed in reference to the new drug, CI -501, Noting the outstanding progress towards eradic- in the absence of any other brief designation.The ation reflected in the millions of people shifted drug in question was now ready for field trial and it during the past year from the attack to the consolid- was expected that convincing evidence of its effective- ation phase mainly in South -East Asia and in the ness would be forthcoming. But however good it might Americas; and prove to be as a long- acting drug for chemotherapy Recognizing that some technical problems like and prophylaxis against malaria, it would still not insecticide resistance or behaviouristic changes of solve all the problems involved in eradicating the the vectors, as well as parasite resistance to drugs, may delay the progress of malaria eradication in ' SeeOff.Rec. Wld Hlth Org., 127, Annex 8, section 5.1.3. certain limited areas, COMMITTEE ON PROGRAMME AND BUDGET : FOURTH MEETING 193
1. INVITES governments to pursue with vigour the financial consideration in respect of the volume of eradication programmes to their planned conclusion work in the various parts of the world, the practica- and to collaborate with neighbouring countries bility of carrying it out and the time limits involved; on a regional basis to permit progress to be made on and (2)the following paragraph to be added at the a broad geographical area and for mutual protection end of the operative part : against reintroduction of the disease; 4.REQUESTS the Director -General to establish a 2.REQUESTS the Director -General to provide appro- competent committee consisting of representatives priate assistance for the study and solution of the of the secretariat and experts and to assign it the technical difficulties found in problem areas and task of studying the present position in regard to to pursue research into the development of methods implementation of the malaria eradication pro- to overcome the technical difficulties encountered gramme,itsachievements,shortcomingsand in malaria eradication; and prospects, including the provision of adequate staff 3. REQUESTS the Director -General to report further and finance for the programme, with a view to progress inthe malaria eradication programme preparing a report on the matter for the Seventeenth to the Seventeenth World Health Assembly. World Health Assembly. Dr EVANG (Norway) said he was in full agreement Dr MONTALVÁN (Ecuador) supported the Norwegian with the draft resolution, which reflected the remark- amendments, but felt that a similar idea should be able degree of unanimity in support of malaria eradic- inserted at the end of the preamble in some such words ation.There was, however, one point of general as : agreement which seemed to have been omitted and he Recognizing further that, in order to ensure final proposed that an additional paragraph be inserted successinthemalariaeradicationcampaigns, after operative paragraph 1, reading as follows : generalpublichealthservices,atleastof an UNDERLINES that, in countries without the admin- elementary kind, must be developed, more especially istrative and public health facilities for thefull in rural zones, to collaborate in evaluation and implementation of a malaria eradication programme, subsequently surveillance of the antimalaria work, there is need for the development, in a flexible way, the eradication services to be co- ordinated with the of a basic (minimum) local public health service, former as rapidly as possible in the consolidation which would be adequate at least to support effective- phase. ly such programmes during the consolidation and maintenance phases. Dr BERNARD (France) supported the inclusion of the paragraphs proposed by Norway and Ecuador, which The wording was more or less the same as that used seemed to him essential. He wondered, too, whether in resolution EB31.R31, with modifications designed the fourth preambular paragraph should not be to meet the concern to find common ground on the strengthened by stating plainly that technical difficulties minimum health structure required for combating and the lack of public health services would in fact malaria as a first task. prevent eradication programmes from being carried out in certain areas -areas which were by no means Dr ADENIYI -JONES(Nigeria),whilesupporting Dr Evang's proposal, feared that other delegations limited in extent, as the present wording indicated. might not be willing to go so far.He accordingly DT QUIRÓS (Peru) agreed with the ideas expressed proposed, as an alternative and more general wording, by the delegates of Norway and Ecuador. In the fourth the following : preambular paragraph, no mention was made of the INVITES governments of countries in malarious mostimportantcategoryof problemmilitating areas to recognize the necessity for the development against progress, namely epidemiological problems. of their health services on a national coverage basis. He accordingly proposed that the wording be changed to read :" Recognizing that some epidemiological Professor ZDANOV (UnionofSovietSocialist problems,insecticideresistance... "Similarly,in Republics) proposed the following two amendments, designed to express the concern felt regarding the operative paragraph 2, the words " technical diffi- culties " should at each at each mention be preceded prospectsfor completing theglobal programme : by " epidemiological and ". (1)the following paragraph to be added at the end of the preamble : Dr EL -BORAI (Kuwait) suggested that a working Recognizing that the prospects of further imple- party be set up, composed of the speakers who had mentation of the malaria eradication programme proposed amendments, to draft an agreed text for sub- throughout the world require serious technical and mission to the Committee. 194 SIXTEENTH WORLD HEALTH ASSEMBLY, PARTH
Dr NAYAR (India) said she interpreted the Norwe- time the maintenance phase was reached, in order to gian amendment as meaning that, as its malaria eradi- safeguard the results obtained.With the advances cation programme passed from the attack to the con- made in the global programme, that problem was solidation and maintenance phases, a country must do assuming ever greater proportions and his one concern everything possible to develop the public health struc- was to ensure that past work should not be prejudiced ture necessary for that work. for lack of action of the kind. He would be glad to Somewhere in the draft resolution, possibly in com- accept any change of wording that would remove doubt bination with the Soviet Union amendment, provision on the matter. should be made for WHO to supply information Dr KEITA (Guinea) noted that no specific mention to Member States on the type of minimum basic public health structure that had proved effective, so that the was made in the draft resolution of extending eradica- tion to countries not as yet covered by the global plan. experience already gained might be shared. Regardless of the status of their basic health services, Dr SUBANDRIO (Indonesia) pointed out that the those countries could not delay starting work on eradi- Norwegian amendment as it stood might be taken to cation.That point should be covered by the draft imply that the establishment of the necessary adminis- resolution. trative and public health facilities was a precondition Dr ROBERTSON (Ghana) recalled that malaria eradi- for the starting of a malaria eradication programme. cation in Africa had been relegated to a fairly late stage That would be entirely unacceptable, since the develop- because of the practical difficulties involved.Opera- ing countries wanted to make a start as soon as pos- tions there were now beginning to be measurable in sible in accordance with the means at their disposal. size, but the countries of West Africa were not yet able She accordingly proposed that the Norwegian amend- to meet the twenty -three minimum requirements for ment be modified to read : malaria eradication work laid down by the Lomé Con- UNDERLINES that, in countries without the adminis- ference two years previously.The main financing of trative and public health facilities for the full imp- operations would devolve on governments, and he lementation of the malaria eradication programme, firmly believed that no government undertaking ma- malaria eradication should be undertaken by the laria eradication would be prepared to waste the re- setting up of an infrastructure of rural health services. sources expended; every effort would undoubtedly be Professor GoRNICKI (Poland) said his delegation was made as the campaign progressed to perfect method- ready to support the draft resolution, as supplemented ology and services and to develop the general public by the Soviet Union and Norwegian amendments. health facilities needed to maintain the programme and foovercomethetransmissionof communicable Professor GERIC (Yugoslavia) endorsed the views diseases in general. expressed by the Indonesian delegate.It had proved Dr GANGBO (Dahomey) supported the remarks of possible in practice to begin an eradication programme the delegate of India, for a glance at the geographical and side by side with those operations develop grad- distribution of malaria was enough to show that the ually the basic health services needed for the later stages areas most concerned were in fact those having but the of the work. He was therefore not convinced that the beginnings of a health infrastructure. Accordingly, it Norwegian amendment corresponded to the needs of would be tantamount to leaving out the most needy the developing countries where malaria was still a prob- countries if the undertaking of an eradication campaign lem, and would support the suggestion to set up a was made subordinate to the establishment of basic working group to consider all the amendments pro- health services. The Regional Committee for Africa had posed and prepare an agreed text. reached a compromise solution in 1962 whereby coun- Dr CHADHA (India)alsoemphasized thatthe tries wishing to do so might make a start on eliminating setting -up of the basic health services should not be the disease. made aprecondition for thestarting of malaria The latest remarks of the Norwegian delegate, how- eradication work. ever, appeared to make quite clear the purport of his amendment. Dr EVANG (Norway) explained that it was in no way the intention of his amendment to advocate delay in Dr WILLIAMS (United States of America) also agreed introducing a malaria eradication programme.Ex- that doubt had now been removed; there was no inten- perience had shown that excellent results could be tion in the Norwegian amendment to lay down any obtained in the early stages without a fully developed precondition for the starting of a malaria eradication health service. The fact remained, however, that some programme It was important, however, that the reso- form of basic health service had to be established by the lution adopted should make that point plain. He sup- COMMITTEE ON PROGRAMME AND BUDGET : FOURTH MEETING 195 ported the proposal to establish a working group and or a committee of experts ?In the latter case one suggested that the representatives of Norway and already existed i.e., the Expert Committee on Malaria. India be asked to serve on it. So many amendments had been proposed that it would be necessary to establish a working group to Dr ALDEA (Romania) said that although much had arrive at a conclusion. Before that was none, he would been done in the past much still remained to be done in be grateful if the delegate of the USSR would make his eradicating malaria from the world. Adoption of the proposal clear. Soviet Union amendments would be essential in order to ensure that future efforts were concentrated and Professor 2DANOV (Union of Soviet Socialist Re directed to the right ends. publics) said that the ten -year deadline in the prog- Although the Expert Committee on Malaria was to ramme for world -wide eradication of malaria would discuss the question, he thought it important that the shortly be reached.During the ten -year period a Director -General should be asked to study the prob- number of new issues had arisen such as the possib- lem of reintroduction of malaria with a view to having ility of eradicating malaria in Africa, and technical, appropriate measures included in the International financial and personnel difficulties had been encoun- Sanitary Regulations. A provision to that effect should tered. His delegation's proposal was for an assessment be inserted in the draft resolution. to be made of what remained to be done in order to reach the goal of world -wide eradication, of the length Dr CLAVERO DEL CAMPO (Spain), referring to the of time needed and of the requirements in personnel second preambular paragraph, observed that, accor- and equipment, etc. ding to the map included in the Director -General's re- The report before the Committee failed to give a port, a number of areas in continental Europe had not clear picture, and he was therefore suggesting that the only reached but had in fact completed the consolida- results of a detailed survey be placed before the Seven- tion phase by the end of 1962. teenth World Health Assembly. Such a survey could be carried out by members of the Secretariat respon- Dr AFRIDI, Chairman of the Executive Board, said sible for the malaria eradication programme, with the he wished merely to point out that most of the points assistance of any necessary experts. raised had also been discussed by the Executive Board at its thirty -first session, and had resulted in the in- The SECRETARY thanked the delegate of the USSR clusion in resolution EB3I.R31 of the third preambular for his explanation.If the intention was to have a paragraph and operative paragraph 2.The wording detailed technical and financial evaluation report, of those two paragraphs might therefore serve as a and the means for producing it were not of serious useful basis for amending the draft resolution.The concern, he could assure the Committee that the Soviet Union amendment covered a point that the Director -General would do his best to ensure that Board had not discussed and he had therefore no com- his report to the Seventeenth World Health Assembly ment to make on it. would contain as complete an assessment of the Dr SHAMI (Jordan) said that most areas in Jordan epidemiological, technical and financial position of were in the consolidation phase, although one section the programme as it was possible to obtain in the of the country had entered the maintenance phase in intervening period. April 1963.In the absence of a well organized rural He suggested that a working party be established health service it had been necessary to place the malaria forthwith to produce an agreed draft resolution for eradication staff in the general health services, and it presentation to the Committee at its next meeting. had been impossible to achieve a noticeable reduction The CHAIRMAN proposed that the working party in costs. He would therefore support the amendment should consist of the delegates of Norway, Nigeria, the of the delegate of Norway concerning the need to USSR, Ecuador, Peru, India and Indonesia.Other develop the health services. delegates could of course participate if they wished. The SECRETARY said that he had attempted to give It was so agreed. the Committee information concerning the proposals Decision:It was agreed to set up the proposed adopted to date in evaluting and assessing the pro- working party, constituted in accordance with the gress of the programme. He was not quite sure what Chairman's proposals. kind of committee the delegate of the USSR had in mind : was it to be a committee within the Secretariat The meeting rose at 11.45 a.m. 196 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
FIFTH MEETING
Tuesday, 14 May 1963, at 2 p.m.
Chairman: Dr S. P. TCHOUNGUI (Cameroon)
1. Report on Development of the Malaria Eradication to support effectively such programmes during the Programme (continued) consolidation and maintenance phases; Agenda, 2.3 3.REQUESTS the Director -General to provide appro- The CHAIRMAN thanked the Committee for the priate assistance for the study and solution of the honour it had conferred upon him by electing him as technical difficulties found in problem areas and its Vice -Chairman. He asked Dr Nayar, as Chairman to pursue research into the development of methods of the working party set up to consider the amendments to overcome the technical difficulties encountered proposed to the draft resolution submitted at the fourth in malaria eradication; meeting, to introduce the text agreed on by the working 4.REQUESTS the Director -General to study the party. present position in regard to the implementation of Dr NAYAR (India) read out the amended draft reso- the malaria eradication programme, itsachieve- ments, shortcomings and prospects, including the lution, as follows : provision of adequate staff and finance for the global The Sixteenth World Health Assembly, eradication programme, and to submit a report on Having considered the report of the Director - the matter to the World Health Assembly as early General on the development of the malaria eradic- as possible; and ation programme; 5. REQUESTS the Director -General to report further Noting that the objectives of the co- ordinated plan progress in the malaria eradication programme to the for continental Europe had been successfully fulfilled Seventeenth World Health Assembly. inthatallthe remaining malarious areas had An attempt had been made to accommodate the reached the consolidation phase by the end of 1962; various views expressed during the previous meeting. Noting the outstanding progress towards eradic- A small change had been made in the fourth paragraph ation reflected in the millions of people shifted of the preamble.Operative paragraph 2 was a new during the past year from the attack to the con- one incorporating the amendment proposed by the solidation phase mainly in South -East Asia and in delegateof Norway, and operative paragraph 4 the Americas ; and included the amendment proposed by the delegate Recognizing that administrative and technical of the USSR. problems like inadequate health services, particular Dr ALAKIJA (Nigeria) suggested that the words epidemiological patterns, insecticide resistance or " behaviouristic changes " in the fourth paragraph behaviouristic changes of the vectors, as well as of the preamble be amended to read " changes in the parasite resistance to drugs, may delay the progress behaviour ". of malaria eradication in certain areas, The CHAIRMAN noted that that amendment was 1. INVITES governments to pursue with vigour the acceptable to the Committee. eradication programmes to their planned conclusion and to collaborate with neighbouring countries on Dr KEITA (Guinea) pointed out that operative para- a regional basis to permit progress to be made on a graph 2 related only to existing programmes, whereas broad geographical area and for mutual protection it was important first of all to start work in countries against reintroduction of the disease; that had no such programmes. He proposed that the paragraph be amended to include a reference to all the 2. RECOMMENDS, in countries without the admin- countries capable of embarking immediately upon an istrative and public health facilities for full imple- eradication programme. mentation of malaria eradication programmes, the parallel development in a flexible way of a minimum Dr NAYAR (India) said that the phrase " parallel public health service on the basis of total coverage, development " had been introduced deliberately, since COMMITTEE ON PROGRAMME AND BUDGET :FIFTH MEETING 197 it took into account countries at all the different stages DrMONTALVAN(Ecuador) said that the amendment of development with regard to the malaria eradication proposed by the delegate of Upper Volta might run programme : some had entered the consolidation phase counter to the objective in view. To await the develop- and some the maintenance phase, while others were ment of the public health services before beginning only just beginning the attack phase and yet others the attack phase would lead to delays in starting the had not begun their programmes at all. The aim of the programme. The point of the statements made in the paragraph was to enable all countries whose admin- Committee had been to lay stress on the need for the istrative and public health facilities were not yet public health services in the consolidation and main- adequate for full implementation of malaria eradic- tenance phases. He suggested that the difficulty might ationprogrammestodevelop suchprogrammes be overcome by inserting the word " especially " parallelwiththebasic minimumpublichealth before the words " during the consolidation and structure. maintenance phases ".
Dr DOLO (Mali) supported the amendment pro- DrNAYAR(India) supported the remarks of the posed by the delegate of Guinea. The word " pro- delegate of Ecuador.The whole emphasis at the gress " at the end of the fourth paragraph of the previous meeting had been that the development of preamble also implied a reference only to existing the basic health services should not be made a pre- programmes, and he proposed that it be replaced by conditionfor beginning malaria eradicationpro- " effective development ". grammes.It was possible to start the attack phase by recruiting staff specifically for that purpose, and DrTCHIKOUNZI(Congo, Brazzaville) supported the proposal of the delegate of Guinea and suggested that had been done by most countries concerned; but there must be sufficient basic services to take over that operative paragraph 1 be amended to read : " invites governments to undertake or pursue with when theconsolidation and maintenance phases had been reached. While she agreed with the inclusion vigour ". That wording would take into account those countries where malaria eradication had not of the word " undertake " in paragraph 1, she did not think it necessary to insert the word " attack " in begun. paragraph 2.Perhaps the explanations given by the TheCHAIRMANasked the delegate of India, as delegate of Ecuador and herself would persuade the Chairman of the working party, whether she had any delegate of Upper Volta to withdraw his proposal. suggestions to make in connexion with those proposals. DrEVANG(Norway) and ProfessorZDANOV (Union DrNAYAR(India) said that the amendment proposed of Soviet Socialist Republics) supported the remarks by the delegate of Mali to the fourth paragraph of the of the delegates of Ecuador and India. preamble would be acceptable. With regard to the amendment proposed by the TheCHAIRMANasked the delegate of Upper Volta delegate of the Congo (Brazzaville) to operative para- whether he could accept the proposal of the delegate graph 1, she would suggest the wording " undertake of Ecuador. and pursue " instead of " undertake or pursue ". DrLAMBIN(Upper Volta) said that if paragraph 1 TheCHAIRMANasked the delegate of Guinea whether were amended as proposed, paragraph 2 as it stood those amendments would meet the point he had would not follow logically upon it; hence his proposal raised. for the insertion of the word " attack ".He would, however, be prepared to withdraw that proposal if DrKEITA(Guinea) said that he would accept any amendment that would make the intention of the the Committee considered the amendment to para- resolution clear. A draft in rather broad terms might graph 1sufficient. create difficulties for those responsible for putting the resolution into effect.They must be enabled to TheCHAIRMANsaid that the insertion of the word " undertake "inparagraph 1 and of the word apply it without any possible misunderstanding. - " especially " in paragraph 2 would make the intention DrLAMBIN(Upper Volta) said that if operative of the draft resolution quite clear. He asked whether paragraph 1 were to be amended by the insertion of the Committee was prepared to approve it as amended. thewords" undertakeand "beforetheword " pursue ", paragraph 2 would also need amendment. DrBERNARD(France) said that, in considering the He suggested the insertion of the word " attack ", problem of malaria in most countries, and parti- before the word " consolidation " in the last clause. cularly in Africa, it had to be recognized that certain 198 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II countries had already started eradication programmes and he suggested that a reference to preliminary whereas others were not yet at that stage.It was with operations might be introduced at a convenient point. the latter category in mind that WHO had adopted The CHAIRMAN said that discussion of the draft the term " pre- eradication ".The words " invites resolution would be resumed at a later meeting (see governments to undertake and pursue with vigour " minutes of the seventh meeting, section 1). could not apply to those countries that were not yet ready to undertake malaria eradication programmes, The meeting rose at 2.35 p.m.
SIXTH MEETING
Wednesday, 15 May 1963, at 2.30 p.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1.Review and Approval of the Programme and Budget regular programmes, as well as the programming Estimates for 1964 cycle for the Expanded Programme of Technical Agenda, 2.2 Assistance and for UNICEF. Examination of the Main Features of the Programme; Chapter II related to the classification and com- Recommendation of the Budgetary Ceiling putation of the estimates.It would be noted that certain special principles for working out averages had Agenda, 2.2.1 and 2.2.2 been used and that the Board had endorsed the view The CHAIRMAN invited the representative of the of the Standing Committee that the principles and Executive Board to introduce the item. methods followed in the computation and classification of the estimates were satisfactory. Dr AFRIDI, representative of the Executive Board, Chapter III, relating to the contents and form of said that the Standing Committee on Administration presentation of Official Records No. 121, and to the and Finance of the Executive Board had proceeded main features of the proposed programme and budget to its customary detailed examination of the pro- estimates for 1964, would be of special concern to the posed programme and budget estimates for 1964, Committee at the present meeting.The summary as presented in Official Records No. 121.It had also information given of the contents of Official Records reviewed the comparative scales of assessment for No. 121 was of great value in achieving an appreciation 1962, 1963 and 1964, the status of collection of con- of the various programmes of the Organization as a tributions, the status of casual income available to whole. He drew attention to the two changes intro- help finance the 1964 budget, the financial participa- duced in the form of presentation of the proposed tion of governments in WHO- assisted projects in programme and budget estimates for 1964: the addi- their own countries, and the proposed Appropriation tion of a summary table with the title "The Regions : Resolution for 1964. The Executive Board had, on the Summary of Regional Offices and Field Activities ", basis of the report submitted by its Standing Com- and the subdivision of activities planned to be finan- mittee, carried out its own examination of the proposed ced from the Malaria Eradication Special Account programme and budget estimates for 1964, and its under two headings "Regular" and "Accelerated ". findings and conclusions were submitted in Official In its survey of the main features of the proposed prog- Records No. 125 for the consideration of the Com- ramme and budget estimates for 1964, the Board had mittee on Programme and Budget. included charts and diagrams with a view to giving He outlined the contents of the various chapters greater prominence to certain of those features. The of the Executive Board's report (Official Records review and conclusions of the Board were contained at No. 125). Chapter I related to background information the end of that chapter. He drew particular attention which the Committee would wish to take into account. to the view that had been expressed by one member of He drew particular attention to the three tables con- the Board that more comprehensive but concise infor- tained in that chapter, giving the budget cycle for the mation on the proposed programme set forth in detail COMMITTEE ON PROGRAMME AND BUDGET SIXTH MEETING 199 in the budget document should be presented at the by the regular budget, the increase in the budget estim- beginning of the volume; and also to the request made ates proposed by the Director -General for 1964 did by another member that there be appended to the in fact represent a reduction in the Organization's rate report of the Board the "Summary by purpose -of- of activities as compared with the two previous years. expenditure code, indicating percentages, of the total With regard to the Board's examination of the pro- regular budget estimates ", as it appeared in Official posed effective working budget level for 1964, he noted Records No. 121. that the amounts listed in Chapter V, paragraph 24, He would not refer to Chapter IV, which related to related to the situation prevailing at the time of the the detailed examination of the proposed programme thirty -first session of the Executive Board. Since then and budget estimates for 1964, as that would be con- some adjustments had been made in the course of the sidered in its own right at a later juncture. deliberations of the Ad Hoc Committee of the Execu- Chapter V related to matters of major importance tive Board, to which he would revert. In the course of considered by the Board. The first part contained the the general discussion in the Board, the view had been Board's comment on matters considered by it in accord- expressed that consideration should be given, when ance with resolution WHA5.62. The Board had had recommending an increase in the Organization's bud- no hesitation in giving an affirmative reply to the first get, to the economic difficulties of some Member three questions of that resolution, namely (1) whether States : the rise in the budget level was out of propor- the budget estimates were adequate to enable WHO to tion to the growth of national incomes. On the other carry out its constitutional functions, in the light of the hand, many members had indicated their opinion current stage of its development; (2) whether the annual that the proposals had achieved a sound balance programme followed the general programme of work between needs and resources. The view had also been approved by the Health Assembly; and (3) whether the expressed by other members that, while the Director - programme envisaged could be carried out during General's recommendations in respect of 1964 should the budget year. The fourth matter, namely, the broad be endorsed, due consideration should be given to financial implications of the budget estimates, with a restricting the rate of the budget increase in future general statement of the information on which any years.Following some discussion, the Board had such considerations were based, had called for more adopted resolution EB31.R30, which recommended to lengthy consideration and the Board's findings were the Health Assembly that it approve an effective work- contained under the various sub -headings of Chapter ing budget for 1964 in the amount of $ 33 716 000, as V.The questions of the scale of assessment and of proposed by the Director -General. casual income had already been considered by the Com- He then drew attention to a footnote to the resolu- mittee on Administration, Finance and Legal Matters; tion stating that the amount was subject to minor and it was currently dealing with the question of the adjustments in cost estimates,to be reported by status of collection of annual contributions and of the Director- General to the Sixteenth World Health advance to the Working Capital Fund. The figures for Assembly through the Ad Hoc Committee of the financial participation by governments in WHO- assist- Executive Board. The Ad Hoc Committee had met on ed projects in their own countries had been brought 6 May 1963 and had considered the information sup- up to date by the information contained in a docu- plied in a report by the Director - Generalregarding ment before the Committee. With regard to the other the adjustments required in respect of the increased considerations listed, the main point requiring em- costs for the headquarters building, the provision for phasis was that health projects were not expanding as services to new Members and Members resuming much as could be desired under the auspices of the active participation, and the increase in salary scales United Nations Special Fund and the Expanded Pro- for general service staff and in the payments to OIHP gramme of Technical Assistance. He drew attention to pensioners. As stated in its report,2 the Ad Hoc Com- the view expressed by one member of the Board that mittee had found the adjustments in respect of the there was a clear lack of appreciation on the part of increase in the salary scales for general services staff, national authorities of the importance of health work and in the payment to OIHP pensioners, of a man- when they formulated their requests for assistance from datory nature and the corresponding estimates there- the Expanded Programme of Technical Assistance and fore necessary. The Ad Hoc Committee had endorsed the United Nations Special Fund.The Board had the discretionary adjustments in the amount of $ 40 000 felt that all its members had a clear duty to press the for services to new Members and Members resuming matter further when they returned to their own coun- active participation; and in an additional amount of tries. In the course of the discussion one member had drawn attention to the fact that, taking into account 1 O,}7: Rec. Wld Hlth Org. 127, 158. the absorption of the malaria eradication programme 2 Off Rec. Wld Hlth Org. 127, 157. 200 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
$ 117 000 to the Headquarters Building Fund (bringing He confessed that he had indeed experienced some the total credit to the Fund to $ 500 000, as explained hesitation in maintaining the increase in the budget at in section 2 of the Director -General's report) to meet such a low rate.He had nevertheless considered it part of the increased costs of the headquarters build- necessary to take an entirely realistic view of the situa- ing. The total amount which the Ad Hoc Committee tion. There had been a large increase in the member- accordingly recommended should be added to the ship of the Organization, and above all in the number effective working budget for 1964 was $ 349 100. The of Member countries that needed help. WHO was at Ad Hoc Committee (paragraph 9 of its report) had present in a position only to give relatively little help to endorsed the Director -General's proposal to use the its new Members and there was scope for a great deal casual income available to help finance the 1964 more assistance.Nonetheless, he was obliged to take budget, the amount involved being $ 849 100. There many factors into account and had done his utmost to would therefore be no need to increase the total assess- achieve a reasonable measure of expansion.Of the ments on Member States as compared with those cal- increase, 45 per cent. would go towards field work, 33 culated for the budget level recommended by the per cent. to meet the increased statutory staff costs for Executive Board at its thirty -first session. established posts, and 10 per cent. to the medical re- The amount of the effective working budget for 1964 search programme. Most of the increase in the esti- proposed by the Director -General, and recommended mates for headquarters related to the health statis- by the Executive Board and by its Ad Hoc Committee, tical services. A modest increase had been made the was therefore $ 34 065 100. previous year, and the 1964 budget proposals provided for a second step to expand those services, in accord- The CHAIRMAN thanked the representative of the ance with the wishes of previous Health Assemblies. Executive Board for his clear statement. The thorough The development of the medical research programme study made by the Board would greatly facilitate the was of great importance and reflected much credit on the Health Assembly's task. the Organization, helping as it did to serve all count- ries in the world. WHO was not in a position to set The DIRECTOR -GENERAL said that the represen- aside a higher proportion of its funds for research, and tative of the Executive Board had provided the Com- indeed was dependent on voluntary contributions for mittee with a clear picture of the situation in respect of any intensification of the programme. There was no the programme and budget estimates proposed for 1964. doubt that the programme had been of value and he The budget proposals represented an increase of recalled a tribute paid to it by a representative of a approximately 12 per cent. over 1963. It was, however, highly -developed country, who had told him that the of the utmost importance for the Committee to appre- stimulus given to research into poliomyelitis vaccine in ciate the fact that the actual increase proposed was 1959 and 1960 had constituted a great step forward in only in the order of 7.59 per cent. The budget for 1964 that field. He fully realized that applied research was contained the final step for the transfer of malaria needed and that more field research was necessary.It eradication activities to the regular budget; those acti- was regrettable that not more than an additional vities were, of course, responsible for a large propor- amount of $ 250 000 could be set aside for research tion of the increase, the amount of approximately purposes. $ 6 000 000 being estimated for 1964 and representing The Committee would be considering the detailed the transfers for 1962, 1963 and 1964. Clearly there had programme and bugdet estimates for 1964 at a later been no change in the programme but only in the stage but it had the general outline of the Organiza- method of financing. tion's activities before it. The view had been expressed A considerable proportion of the increase in the at some stage that WHO should change its policy and budget estimates in respect of 1964 was a consequence become more flexible. While it was of course the pre- of commitments with which the Organization was rogative of the Health Assembly to come to a decision faced. Higher costs due to statutory staff increases did in the matter, it was his own opinion that it was not not represent any expansion in the work of the Organi- possible to introduce any radical changes within the zation.Furthermore, members of the Health Assem- limited budget proposed for 1964.The Executive bly who were experienced in public health administra- Board had thoroughly analysed the Organization's pro- tion would appreciate only too well that funds in 1964 gramme of work and had recommended its adoption. would buy far less than in previous years owing to the He asked the Health Assembly to consider the pro- constantly increasing cost of living.Therefore any gramme and budget estimates submitted to it and to expansion of WHO's work was tempered by that factor, provide the Organization with the possibility of con- which should be borne in mind in any criticism voiced tinuing its well -planned growth. While he was always of an unduly high increase. ready to introduce improvements, he did not think the COMMITTEE ON PROGRAMME AND BUDGET : SIXTH MEETING 201
Organization had any cause to be dissatisfied with its detail.He would therefore make only general com- past efforts. ments. He agreed with the Director -General that the expan- Mr SIEGEL, Assistant Director -General, introduced sion of WHO's activities was not only proper but indic- some of the relevant documentation that the Commit- ative of a sound organization.He welcomed the tee might find useful. degree of co- operation achieved with other bodies in He referred first to the document tin which the respect of activitiesfinanced by outsidesources. Director -General had reported on adjustments in the While there could be no doubt that the extent to which estimates for 1964 that had become necessary since the health projects benefited from such extra -budgetary Executive Board had considered the original figures in sources was dependent in the first place on the requests Official Records No. 121; detailed explanations were made by countries, the type of programme put forward given of the reasons for those changes. He drew partic- by the organizations concerned was also a decisive fac- ular attention to the appendices to the document, the tor. He stressed the desirability of introducing a form last of which 2 contained a summary table showing the of functional budgetary presentation whereby the funds total budget, income, assessments and effective work- allocated for each specific type of activity could be ing budget. clearly seen. Although the various difficulties of such a He also drew the Committee's attention to the first presentation had been mentioned, including the fact report of the Committee on Administration, Finance that advisory services would be difficult to assign with and Legal Matters to the Committee on Programme absolute precision, he maintained the view that it was and Budget (see page 410) which related to the avail indeed feasible. ability of casual income, and in which it was recom- mended that a total of $ 849 100 from casual income He also emphasized the need for WHO to intensify be used to help finance the 1964 budget. its efforts in planning activities not only for its own He called the Committee's attention to a working programme but also for the benefit of the various paper which contained the text of a draft resolution national health programmes. (see page 210) on the effective working budget and budget level for 1964, identical in form with that Dr EL -BORAI (Kuwait) said that his delegation, adopted at the Fifteenth World Health Assembly recognizing that many Member States were in urgent (resolution WHA 15.23).It would be noted that need of assistance to develop their health services, and amount of the effective working budget for 1964 that a considerable technical and financial effort was remained to be inserted in sub -paragraph (1).If the necessary to solve the problem of communicable dis- Committee agreed with the Director -General's propo- eases prevalent in under -developed countries, had in sals, which were recommended for adoption by the past years supported the budgetary increases proposed Executive Board and its Ad Hoc Committee, the by the Director- General and endorsed by the Executive figure to be inserted was $34 065 100, which appeared Board.It would do so again on the present occasion, as the adjusted figure for the total effective working and hoped that the upward trend would continue in the budget in the appendix, to which he had already future, although it was in favour of all possible eco- referred, to the Director -General's report.3 nomies that could be made by the Director -General The figures contained in sub -paragraph (3) of the and the Executive Board. draft resolution were based on the recommendations of the Committee on Administration, Finance and Legal Dr ALAN (Turkey) said that his delegation had Matters. Under Rule 70 of the Rules of Procedure, a always supported moderate increases in WHO's bud- two -thirds majority was required in respect of that get, provided that they were used to expand the field resolution. programme.He was pleased to note that 89.1 per cent. of the regular budget proposed for 1964, and The CHAIRMAN invited general discussion on the 93.05 per cent. of the total amount expected to be effective working budget for 1964. available under all sources of funds, was to be used for the operating programme.As the Director- General Dr QUIRÓS (Peru) considered that the statement had stressed, the number of Member States was con- made andthedetaileddocumentationprovided stantly increasing and their needs were enormous. had been of the utmost interest and of a clarity that Most members of the Committee were public health obviated the need for any discussion on points of administrators and were accustomed in their own coun- tries to fighting for bigger health budgets.His dele- 1 Off.Rec. Wld Hlth Org. 127, 158. 2 OffRec. Wld Hlth Org. 127, 160. gation was in favour of the budget proposed by the 3 Off: Rec. Wld Hlth Org. 127, 161. Director General. 202 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Dr WILLIAMS (United States of America) said his Government had over recent years been assisting by delegation would support the Director -General's pro- voluntary contributions.The importance of malaria posals, which it considered were the result of sound eradication needed no emphasis and it had already programme planning, but had a number of remarks to been fully discussed under item 2.3 of the agenda. make on particular points. Regarding medical research and water supplies, his Over the past five years the Organization's budget delegation would make some detailed comments under had increased at an average rate of 17.3 per cent. a year, item 2.2.3- Detailed review of the operating pro- including the amount representing the incorporation of gramme. the malaria eradication programme into the regular The other subjects to which his delegation would like budget over.the three -year period ending in 1964. The to see priority given were three in number :namely, increases for the individual years were :for 1960, 11 environmentalhealth,smallpoxeradication,and per cent.; for 1961, 12 per cent.; for 1962 (the first nutrition. He had noted that the total amount which year in the process of transfer malaria eradication to it was proposed to devote to environmental health in the regular budget), 29 per cent.; and for 1963, 21 per 1964 amounted to some 2.3 per cent. of the total cent.; while for 1964, the Director -General now pro- regular budget. Even if the additional amounts posed an increase of 12 per cent.Excluding the part expected to be available from UNICEF, the Technical attributable to the transfer of the malaria eradic- Assistance Programme and other sources were added, ationprogramme, whichcould be considered as the figure would still be below 5 per cent., which was a non -recurring increase, the percentage increase for not commensurate with the importance of environ- the three years 1962, 1963 and 1964 were 19, 11 and 7 mental health in the developing countries. respectively, and the average for the five -year period A smallpox eradication programme sponsored by was 12.5 per cent. Of the yearly average increase, be- WHO had officially been in operation since 1958, but tween 4 and 5 per cent. was due to unavoidable statu- itdiffered markedly from the malaria eradication tory costs, leaving between 4 and 10 per cent., accord- programme in being characterized by a within -country ing to the year, for true programme increases. That, focus, relatively little logistic or technical aid being he considered, was an orderly, logical and reasonable provided by WHO orother international organ- rate for WHO and represented its growing capacity izations.The total amount proposed for 1964 was to provide services for Member States. At the same $227 000, which seemed grossly inadequate even in time, however, he considered that the Organization's relation to the figures supplied to the Committee the expansion must be carefully planned, with due atten- previous year, which, if he remembered aright, had tion to priorities.Increases in future years, over and shown the world eradication programme as requiring above the statutory costs, should be devoted to the a total expenditure of approximately $100 000 000, field programme, and in that connexion he would including$10 000 000 bytheassistingagencies. shortly indicate some of the areas that would appear Frankly, he considered that technically the eradication suitable for increased attention, having in mind not of smallpox would be in many ways easier to achieve so much the budget proposals now before the Com- than that of malaria, so he would like to see the effort mittee as the programmes and budgets for future pursued with greater vigour. years. With regard to nutrition, he recalled that at the He realized that the Organization's annual pro- Fifteenth World Health Assembly his delegation in grammes were prepared on the basis of requests from the Committee on Programme and Budget had called governments, but he felt that there was room for attention to the importance of the problem of protein strategic initiative on the part of the Director -General calorie malnutrition in the pre -school child, which, and his staff, by which he meant thatit was an together with some communicable diseases such as essential part of the process of providing technical diarrhoea and measles, was probably the main cause assistance to present governments with ideas regarding of child mortality in the under -developed countries. possible lines of development, provided, of course, In view of the magnitude of that problem, the proposed that the request finally submitted reflected the govern- increase in expenditure on the nutrition programme - ment's real desires. from $258 000 in 1963 to $320 000 in 1964was far Turning to the specific areas on which he felt effort too small. might be concentrated in the future, he referred first To obtain the resources needed for an increased to malaria eradication, medical research, and com- effort in the fields he had mentioned, it would also be munity water supplies.The order in which he had necessary to take into consideration some negative listed them did not represent any order of priority factors and explore the economies that he believed and his only reason for mentioning them together were possible both in administration and in operational was that they were three fields of activity in which his work. He would therefore urge the Director -General COMMITTEE ON PROGRAMME AND BUDGET :SIXTH MEETING 203 to take a close look first at the running of headquarters He reiterated hisfull support for the Director - and the regional offices, and then at the various field General's proposed budget, but said he had feltit programmes to identify the marginal activities that his duty to call attention to the need for moderation could be reduced or eliminated. in face of the problem of arrears of contributions. In his perusal of the budget document he had had Dr CHADHA (India) observed that in any dynamic some difficulty in determining the total expenditure organization the increase in the tempo of activities proposed under certain headings.In the case of made inevitable an increase in the budget. In studying nutrition there had been no problem, but to arrive at the Director -General's proposals for1964, he had the total under smallpox he had had to go through noted that the additional expenditure envisaged was the budget country by country, while to arrive at the mainly on the operating programme and that estimates figure for medical research under the regular budget for administration and organizational meetings were it had been necessary to write to the Director -General. kept within satisfactory limits. He therefore agreed with the delegate of Peru that it The views expressed by the United States delegate would be useful for the budget to contain more figures were largely in accord with his own.It might be of a functional nature. recalled that at the Fifteenth World Health Assembly he had referred to the need for more concentration on Dr BRAVO (Chile) observed that every year, when the disease problems of the under -developed countries. the proposed budget level was discussed, there was a He also agreed that environmental health was not clash of views between those who were for expanding at an ever -increasing rate and those who called for being sufficientlystressed. If safe drinking -water could be supplied for everybody, mortality in the stabilization. His delegation considered that the tropics would immediately drop by 50 per cent. The Director - General and his staff were intelligent enough to submit a programme which could be effectively problem of protein /calorie malnutrition in children also called for a greater effort, as the United States carried out and which represented a reasonable growth. delegate had stated. Thus, the increase proposed for 1964 was reasonable in relation to the enormous health needs of the world, He therefore supported the budget proposals of the and his delegation would support it. Director -General but would like his remarks to be noted and appropriate adjustments made. However, it must be recognized that the dispropor- tion between needs and resources posed a serious Professor ZDANOV (UnionofSovietSocialist problem. The expansion of WHO's activities could not Republic) observed that the proposed budget of WHO outstrip general social and economic development. for 1964, amounting to $34 065 100, represented an The arrears of contributions owed by a number of increase of nearly 13 per cent. over the budget for countries showed that they were unable to pay the 1963.Even excluding the amounts representing the amounts assessed, for it could not be supposed that transfer of the malaria eradication programme to the their indebtedness was due to mere negligence.The regular budget, the average rate of increase over the Chairman of the Executive Board had referred to the past three years was some 14 per cent.Furthermore, opinion expressed by some Board members that the as was shown in the thirtieth report of the United increase in assessments was exceeding the increase in Nations Advisory Committee on Administrative and national incomes, but the countries in question had Budgetary Questions (reproduced in Official Records not been able to pay at all. No. 124, p.85), the expansion of WHO's budget The answer tothe problem was more careful was more rapid than that of the budgets of the other planning, which did not mean stabilizing the budget specialized agencies.For example, between 1961 and but concentrating on those projects that gave the 1963 the increase had amounted to over $10 700 000, or 56 per cent.The sum total of the budgets of all greatest return for the least expenditure. The budget the specialized agencies and IAEA amounted to should be presented by fields of activity to show more approximately $100 million, of which nearly $30 clearly which were the most worthwhile programmes. million, or about a third, represented the budget of The rapid increase in the budget during recent years WHO. At the same time, the amounts expected to be was the result of a change in policy whereby WHO available from sources other the regular budget in 1964 had ceased to be merely an advisory agency and had showed an actual decline, which meant that the main become an operating agency in the field. Serious portion of the increase fell on the contributions of consideration should perhaps be given to a return to Member States. At the thirty -first session of the Execu- the former policy, which would enable governments tive Board the Director -General had explained that the more easily to meet their obligations towards WHO - decline in WHO's share of the Technical Assistance assisted projects. Programme was due to the fact that fewer requests 204 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II were forthcoming from ministries of health than from thorough scrutiny, by the difficulty of finding the other government departments, which seemed to indi- necessary data., He therefore joined other speakers in cate inadequacies in the Organization's advisory and endorsing the suggestion of the Executive Board, on co- ordinating work, which was in fact its basic function. page 25 of its report on the proposed programme and The question was one that required serious attention : budget estimates (Official Records No. 125), that the the increase in expenditure resulting from the expan- Director -General might consider including summary sion in WHO's activities should not all be set against tables to show trends and costs of the major pro- the regular budget. It was also significant that, accord- gramme proposals. ing to the figures given in Table 10 on page 24 of Table 6 on page 21 of the Board's report showed that Official Records No. 125 (which admittedly were not the Organization's effective working budget had more based on the latest information), the estimated con- than doubled between 1959 and 1964, increasing from tributions by governments to the implementation of some $ 14 000 000 to nearly $ 34 000 000. Even taking WHO- assisted projects in 1964 was only $ 130 million, into account the transfer of the malaria eradication as compared with $ 170 million in 1963. programme to the regular budget, that was a very striking expansion. It was true that health needs in the National incomes -and the proportion of them world were immense, and that even if the budget were devoted to health work -did not show the same annual doubled again they could not be adequately met, but rate of growth as WHO's regular budget. It was there- since resources were not inexhaustible and since a fore not surprising that arrears of contributions were number of countries were having difficulty in paying increasing, and they would no doubt continue to in- their assessed contributions, it would be advisable in crease, especially as the credits granted to countries drawing up future budgets to apply the following two undertaking malaria eradication programmes were to principles : first, a thorough evaluation of the Organiz- be reduced from 50 per cent. to only 25 per cent. in ation's activities to determine which were the most 1964, and abolished as from 1965. Assessments were valuable; and secondly, the establishment of certain clearly excessive, because the countries in arrears inc- priorities, as proposed by the United States delegate. luded some that were very highly developed and, as the He would reserve detailed comments for when the delegate of Chile had pointed out, if they had not paid Committee examined the individual programme pro- it was because they were unable to. posals contained in Official Records No. 121. At the Fifteenth World Assembly a number of dele- Referring again to Table 6 of the Board's report he gations had already expressed concern at the increase noted that, while no figure was shown for 1964 under in the budget for 1963 over 1962 and had abstained the Malaria EradicationSpecial Account against from voting.Again, considerable reservations about "Regular ", there was a so- called "Accelerated" pro- the proposals for 1964 had been expressed at the thirty - gramme against which stood the amount of $ 4 360 000, first session of the Executive Board. During the pre- which he understood was to be provided by voluntary sent discussion several speakers had already sounded a contributions.He wondered whether the Director - note of alarm.It was clear that a cautious and real- General had the assurance that those funds would be istic approach was required to the question of the forthcoming, or whether the Health Assembly would budget level, and more severity in the consideration not in a few years again find itself in the position of of the detailed estimates. having to transfer that part of the programme to the His delegation would vote against the proposed bud- regular budget. get level for 1964. Dr HA QUE (Pakistan) said he fully supported the Professor CANAPERIA (Italy) said that, as he had proposed budget level.The Director -General had already remarked at previous Health Assemblies, he pointed out that the increase over the budget for 1963 found it a little difficult to form an opinion on the total consisted largely of statutory costs, leaving little over budget level when the individual items of the pro- for an increase in the programme. WHO's share in the gramme had not yet been considered.It was true that cost of national health programmes was only a small the present item of the agenda included the examina- percentage of the amount spent by the governments tion of the main features of the programme, but there concerned, but it was very important as a catalyst and too he felt hampered, despite the Director -General's stimulus. WHO was a dynamic organization and the excellentintroduction and the Executive Board's needsof itsMember countrieswereconstantly COMMITTEE ON PROGRAMME AND BUDGET :SIXTH MEETING 205
increasing. He had therefore been surprised that results, for application often proved more difficult than some delegations should speak of cutting the budget, fundamental discovery. for he would have thought that if some means could be To sum up, he was in favour of expansion in the bud- found of increasing it still further, the world, where get provided it was gradual and well -planned.The millions of people were still dying from preventable fact that WHO's budget was increasing more rapidly diseases, would be a much happier place. The Health than that of the other specialized agencies, as pointed Assembly had agreed on a programme for raising out by the Soviet Union delegate, was not necessarily health levels as part of the United Nations Develop- to be deplored, but might be an indication of the Org- ment Decade, and that clearly called for an expansion anization's dynamism and effectiveness. of WHO's activities. He associated himself with the comments made by Dr EVANG (Norway) said that his delegation sup- the United States delegate.With regard to medical ported the budget level proposed by the Director - research, he would like to suggest that the main centre General and endorsed by the Executive Board. Various of operations be gradually shifted to the under- speakers had stressed the rather rapid rise of the budget developed countries, since that would greatly stimulate level during the past years. There were two reasons for them to solve their own problems. the increase, apart from the inclusion in the regular He took the opportunity of expressing appreciation budget of provisions for the malaria eradication pro- of the assistance given to his country by WHO and also gramme. One of those reasons was that there had been of the bilateral assistance of the United States Govern- a general rise in wages and prices which would, with- ment. out any increase in the activities of WHO, have caused an increase of from four to five per cent. as compared Dr GHANI AFZAL (Afghanistan), after referring to with 1963, so that the actual increase of 7.59 per cent. the urgency of the need to eradicate malaria and small- was not unduly large.The other reason was that, in pox, expressed his delegation's full support of the the rapidly expanding membership of the Organiz- Director -General's proposed budget level. ation, many of the new Members were those in the greatest need of assistance for the development of their Dr CLAVERO DEL CAMPO (Spain) observed that the discussion of the budget level was always a difficult health services and consequently the increase in the moment in the work of the Health Assembly because, level of the budget would necessarily be greater than while everybody agreed about the effectiveness of the percentage increase in membership. WHO's work and the needs of the newly emerging Many of the points made by the delegate of the countries, the cost of the programme proposed always United States of America regarding possible future looked too high. The position of those governments priorities for WHO expenditures would meet with gen- entitled to designate members of the Executive Board eral approval, particularly the improvement of environ- was particularly difficult, because those Board mem- mental sanitation, including water supplies, and small- bers had examined and individually approved all the pox eradication, but he was surprised that no mention items of the programme and their costing, and could had been made of two essential activities : the educa- not therefore logically object to the overall figure. tion and training of medical and auxiliary personnel Such was his own position; and therefore, taking also and the strengthening of health services. The latter was into account other factors such as the general increase of particular importance in both advanced and develop- in costs, the increase in WHO's membership, and the ing countries for, if health services everywhere were fact that the newest Members were not richer but truly effective, many times the cost of operating WHO poorer than the older ones, he considered that the would be saved every year. On the other hand, the proposed budget level was reasonable. Organization should be wary of impinging on the acti- vities of FAO. He agreed with the delegates of Peru and the United Certainly kwashiorkor was a major States of America that in future a more functional cause of death, but it should not be the subject of a presentation of the budget would be helpful. He also separate WHO programme. agreed in general with the suggestions of the United When considering thefigureproposed by the States delegate regarding priorities. However, he point- Director -General it should be remembered that most ed out that proper environmental sanitation included countries spent considerably more than that on their not only adequate water supplies but effective waste national health services.The essential was that the disposal, which was beyond the present resources of money provided in the budget should be used effec- many countries. Again, provision of adequate protein - tively. rich foods was extremely expensive, and there was no Dr OMURA (Japan) said that his delegation ap- limit to the amount that could be spent on medical re- preciated that the rise in the budget was caused by the search without necessarily obtaining commensurate rapid increase in the membership of WHO and the 206 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II growing importance of the role of WHO in health his delegation was not satisfied that the whole of the throughout the world; however, it was of the opinion budget would be used for fulfilling the Organization's that the rate of increase of the budget should in some fundamental tasks.The estimates for administrative way be geared to the rate of the world's economic expenses had increased by8.83per cent. as compared growth. His delegation also stressed the importance of with1963,whereas the increase for the operating effective utilization of all funds available both inside programme was10.83per cent.That proportion and outside WHO through a system of priorities and, appeared unjustified; with a developed and efficient while supporting the proposed budget level, hoped that administrativemachinery,administrativeexpenses those considerations would be taken into account by should increase more slowly than those of the operat- the Director -General in preparing future budgets. ing programme. When the programme and budget were discussed in ProfessorAUJALEU(France) said that his delegation, detail, his delegation would make concrete suggestions conscious of the need for WHO to find its level as the for economies that could be effected without disrupt- number of Members rose and the number of demands ing the operating programmes. for its services increased, and of the increase resulting from the inclusion in the regular budget of provision MrZOHRAB(New Zealand) agreed with previous for the malaria eradication programme, was prepared speakers on the Organization's need for a steady rate to support the proposed budget level.It would not, of growth which would at the same time be acceptable however, favour similar increases in future budgets. A to its Members. He approved of the principle of estab- rise of six to seven per cent., provided it was not due to lishing a system of priorities for future activities and, inflation, was an acceptable rate of growth. In a coun- while expressing his support for the proposed budget try, as in the world, it was useless to expand the budget ceiling, agreed with the delegate of Peru that the budget for health very considerably unless additional provi- could with advantage be presented in what might be sions were made for housing, education and other called a "functional" or "programme" way. social factors. He did not suggest that the Director - MrPERERA(Ceylon) said that, while approving the General should seek to pare down the budget, as he budget ceiling, he was aware that more requests for thought that any economies which could be made would assistance were made to WHO than there were re- be negligible, but rather that emphasis should be laid sources to meet them; he would therefore like the on devoting funds to those projects which would be Director -General again to review the programme from most effective and most profitable.It was the task of the point of view of priorities.He agreed with the the Health Assembly and the Executive Board to delegate of India on the importance of the problem ensure that the Organization's help to countries request- of disease caused by faulty environmental sanitation ing it was accentuated without undue increase in the and, particularly, by the lack of a pure water supply. It budget. had been shown that40per cent. of the morbidity in Ceylon was due to those causes and it was certain that DrVYSOHLÍD(Czechoslovakia) said that the regular the rate could be reduced very considerably if the efforts budget had increased by139per cent. since1959and being made by his Government could be reinforced by the proposed figure for1964showed a rise of 12 per adequate financial and technical assistance.He was cent. over the level for1963.He referred to the point certain that the situation was similar in most tropical made by the head of his delegation in plenary session, and subtropical countries. when he had said that the Organization's activities had become too wide and that it had taken on more and Sir GeorgeGODBER(United Kingdom of Great more new tasks, some of which did not correspond to Britain and Northern Ireland) agreed with the Director - its basic objective, with the result that its budget had General's contention that WHO could not stand still. grown both vertically and horizontally -a develop- He also supported what had been said by the delegate ment to which the Czechoslovak delegation was enti- of France. A moderate rate of increase in the budget rely opposed.His delegation could not support the was desirable, but it should not put an intolerable budget level proposed.It was obviously of the first strain on the smaller Member States.It should be importance that the developing countries should be borne in mind also that the cost of each programme to assisted in speeding up the development of their health the recipient country was far greater than the cost to services, which, the Director -General had said, was the WHO. He agreed with the comments on priorities salient feature of the programme and budget for1964. made by the delegate of the United States of America : It was also necessary that the Organization should two of the three priority items he had mentioned, how- assume a co- ordinating function over investigations ever, were large local service undertakings -and it was into the safety and efficacy of new drugs. Nevertheless, the function of WHO to advise, plan and support but COMMITTEE ON PROGRAMME AND BUDGET : SIXTH MEETING 207 not to execute.Moreover, there should not be too plenary meeting to the steep rise in the budget. The rigid an adherence to priorities, or the total programme inclusion of provision for the malaria eradication pro- of the Organization would suffer. He agreed with the gramme was a contributing factor.Nonetheless, the delegate of Norway as regards the nutrition pro- increase was creating difficulties for many countries, gramme.His delegation would support the budget and some of them had not been able fully to meet their level proposed by the Director -General. obligations. He did not know whether any other inter- national agency had increased its budget as rapidly as DrLAMBIN(Upper Volta) said that, after the cong- WHO had done.His delegation shared the concern ratulatory speeches to the Director -General in plenary expressed by the delegate of the Union of Soviet Social- session, he was surprised that there should be an ex- ist Republics. Every year it became more difficult to pression of views that the budget level was too high, persuade governments to increase their contributions. especially if it were borne in mind that the needs of His delegation would not vote for the budget level many countries were still not met.Other countries, proposed. still to become independent, might soon be asking for the help of WHO so that a further increase in future ProfessorPESONEN(Finland) said that his delegation years might be necessary. would support the proposed budget level. A reason- The scourge of smallpox was widespread in Africa able increase from year to year was justified, since and supplies of vaccine woefully lacking; epidemics of further efforts should be made to improve the services meningitis were of yearly occurence, and much medi- already given by he Organization and to tackle the new cal research was needed before they could be combated problems that would face it in the future. successfully; fertile lands were deserted and the popula- tions of entire villages were blind as a result of oncho- MrBRADY(Ireland) said that his delegation was cerciasis; malaria eradication did not cover many parts happy to support a budget that had been so ably pre- of Africa; and nothing had been done to provide water sented. He felt that useful warnings had been voiced regarding future budgetary trends and hoped that, now supplies. In view of the great needs it was only logical to approve the proposed budget level, which his dele- that the full cost of the malaria eradication programme had been included in the regular budget, the rate of gation warmly supported. increase would be more modest. He was sure that the DrGOOSSENS(Belgium) congratulated the Chairman, Director -General would take note of the remarks by Vice- Chairman and Rapporteur on their election and the delegate of Chile concerning the difficulty exper- the Director -General on his reappointment. ienced by some Member Statesin meeting their In previous years, he had consistently recommended contributions.His delegation had been impressed by caution and sought for a reduction in the budget level; the remarks of the delegate of the United States of on the present occasion he had no fault to find, because America. While it was not practicable for the Health he believed that the proposed budget was the necessary Assembly to make detailed recommendations, general and realistic outcome of the decisions of past years. directives on programme development were most use- However, even if budgetary growth was an inescapable ful. concomitant of the life of the Organization, it still must His delegation welcomed the request that the ques- be kept within reasonable limits; particularly, it was tion of priorities be re- examined.It was realized that necessary that WHO should complete the tasks in the programme depended largely on requests from which it was at present engaged before venturing into Member States;nonetheless, undue dispersion of new fields, unless unforeseen circumstances should make WHO's resources should be avoided. such a venture necessary. He believed that the intro- KEITA(Guinea) thought it should have been ductory statement made by the Director -General showed Dr a clear realization of those requirements, but associa- clear, even at the very beginning of the Organization's ted himself with the points made by the delegate of work, that the budget would necessarily increase with Spain with regard to priorities. He also hoped that the the adherence of new Member States. Moreover, the Director -General would provide some clarification reg- objectives of the Organization had changed over the The late-corners to the Organization were in arding the items appearing under the heading "Malaria years. Eradication Special Account -Accelerated ". fact the countries most in need of help, and assistance In spite of those few words of caution, he believed to them became a matter of international solidarity. that acceptance of the proposed budget level would As had so often been mentioned, even a slight reduc- be the best possible tribute to the Director -General. tion in armaments would provide enough money to finance the whole WHO budget. DrARNAUDOV(Bulgaria) recalled that the chief It was very difficult to find where the budget could be delegate of Bulgaria had already drawn attention in the reduced.One could only ensure that there was no 208 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II wastage, and that the results were commensurate with vide more funds to meet new needs. He suggested that the money spent.If opinions were divided as to funds would easily become available if the great pow- whether the budget ceiling was too high or too low, ers would stop nuclear testing and devote the money that alone would seem to indicate that a satisfactory instead to health. compromise had been found.His delegation would support the budget level as at present proposed. Dr STRALAU (Federal Republic of Germany) expres- sed his support for the proposed budget. Dr JALLOUL (Lebanon) said that, not only did his delegation feel that the increase in the budget level was Professor SANGSINGKEO (Thailand) said his delega- justified, but it wondered whether the increase was suf- tion appreciated the careful preparation and presenta- tion of the budget and felt that the increase was reason- ficient in view of all the health problems facing WHO. He agreed with the delegate of Pakistan that every able in view of the social and economic development of the modern world . effort should be made to find new financial resources; he also agreed on the need for establishing priorities, He emphasized the importance of research in mental but pointed out that priorities would vary from one health, particularly from the point of view of promot- country to another. He entirely agreed with the need ing understanding among peoples of different creeds for devoting funds to medical research, since in that and cultures. field WHO should be internationally the ultimately Dr MONTALVÁN (Ecuador) congratulated the Direc- responsible medical body. tor- General on the excellent presentation and prepara- Dr ENGEL (Sweden) said that the increase in the tion of the budget estimates for 1964. The economy of his own country was not very highly developed. Al- budget seemed reasonable by comparison with that in national health budgets he was familiar with, each of though he had often been instructed to oppose in other which had shown a rise from seven or eight per cent. international meetings budget increases that would call for an additional contribution by his country, he had annually. It was necessary that the programmes of the Organization should develop so as to meet new chal- received no such instructions for the present meeting and was thus at liberty to support the proposals, and lenges in the field of health and the Director -General was to be congratulated on his achievements in that therefore the increase. He nevertheless agreed with the views expressed by the delegate of Chile concerning the direction. effects of the increases on the various countries. His delegation's views on priorities would be given He had studied the scale of assessments and had when the proposed programme was examined in detail. worked out the increased contribution that would be It would support the proposed budget level. required of his country.He had expected that the Dr ARAFEH (Syria) believed that any reduction in the increase would be smaller because of the the number of budget would be contrary to the aim of improving the new Member countries that had joined the Organiza- health of the world and expressed his delegation's tion.In fact, the proportionate increase for Ecuador support for the proposed budget level. was 12.3 per cent, while the average for all countries was 11.6 per cent. He would be grateful for an explana- Dr LAYTON (Canada) said that his delegation agreed with many of the suggestions that had been made tion of the slightly higher percentage for his country. Nevertheless, his delegation fully supported the 1964 during the discussion on the recommended budget for 1964, particularly in regard to future budgets of WHO budget proposals submitted by the Director -General, which reflected the general desire to serve the cause of in terms of careful consideration, prudent progress and clarity of presentation. His delegation would support world health. the proposed budget. Mr COLY (Senegal) said that, after hearing the expla- nations and comments on the budget proposals at that Professor GORNICKI (Poland) said that his delega- meeting, his delegation would vote in favour of the tion had already expressed its satisfaction regarding the Director- General's proposals, which had already been work of the Director -General in particular and of WHO approved by the Executive Board. in general, but the increase in the budget level seemed to be out of proportion to that of other years, even In the discussions on the work of WHO, many speak- ers had emphasized the importance of the vast tasks considering the increased aid required by the many new which lay ahead. He had himself said in that Commit- Members. Consequently, his delegation would reserve tee that the work of malaria eradication seemed to be its position regarding the proposed budget level. delayed in the African countries in comparison with Dr EL BITASH (United Arab Republic), although the programmes for other continents. His own country approving the proposed budget level, hoped that the was newly independent and had many health problems Director -General would look for other sources to pro- which it could not solve by itself. Mention had already COMMITTEE ON PROGRAMME AND BUDGET :SIXTH MEETING 209
been made of the ravages on the African continent Government of the Philippines had found that help caused by meningitis, smallpox, measles, leprosy and so from WHO was well worth the price. on. There was also malnutrition, the need to provide He therefore wholeheartedly supported the proposed drinking -water and many other problems.It was, he WHO budget for 1964, which had been so meticulously believed, generally agreed that it was necessary to deal prepared by the Organization's able Director -General with those problems without delay and he was there- and approved by the Executive Board.If it was not fore somewhat surprised at the reluctance with which presumptuous, he would commend the experience of some speakers approached the necessary budget in- the Philippines to the attention of new and developing crease that would help to make it possible to raise the countries. health standards of the population of countries such as his.He therefore appealed to all present, for the Dr SHAMI (Jordan) said that his delegation would sake of international solidarity, to support the Director - vote for the 1964 budget proposals submitted by the General's proposals. Director -General. Professor GERIC (Yugoslavia) recalled the statement Mr FERAA (Morocco) wished to be associated with by the chief of his delegation in plenary session that the the many speakers who had congratulated the Chair- increase in the budget of the Organization was a logical man and other officers of the Committee, the Director - consequence of the Organization's development. The General and the representative of the Executive Board. delegate of Guinea had rightly called attention to the His delegation had been much impressed by the re- great needs of developing countries, and it was gener- marks of previous speakers and favoured the suggestion ally agreed that to meet those needs would require that a budget presentation showing operational totals continuing budget increases. He sympathized with the would permit better understanding. He sympathized apprehensions of some countries as to the effect on with the countries that had referred to their difficulty in their own economies :everything possible should be keeping up with the budgetary increases, and agreed done to ensure that expenditure was reduced to a with the comments made by the delegate of Norway, minimum and properly applied, and that the priorities who had stressed the fundamental nature of certain were correctly assessed. His delegation was convinced objectives. While agreeing fully with the points men- that savings were possible in implementing the pro- tioned by the delegate of the United States of America, grammes, after such assessment. Meanwhile, however, he emphasized that the field programme was in fact the Organization must be given the means to continue being expanded, as could be seen from the various its work. charts. With regard to assistance with the strengthening of Dr EVANG (Norway), on a point of order, moved health services in the developing countries, he agreed that, in view of the full discussion that had taken place with the delegate of France that priorities should be and the general readiness to accept the proposals of the established in relation to actual needs, chief impor- Director -General, Rule 61 of the Rules of Procedure tance being given to the training of personnel at all should be applied and the debate closed. levels on whom the success of all health work depended. Professor AUJALEU (France) said that he opposed the His delegation was concerned at the increases in the motion. Since he had himself spoken he did not think budget and supported the suggestion that the present he could decently refuse others an opportunity of doing rate of increase should not be exceeded in coining likewise. years : although some annual increase was normal, it should not reach the point at which it jeopardized the Professor GARCÍA ORCOYEN (Spain) also opposed financing of programmes which were so badly needed. the motion, for the same reasons as the delegate of His delegation would vote for the budget proposals France. for 1964 submitted by the Director -General. The CHAIRMAN said that, since two delegates had spoken against the motion, a vote would be taken. Dr CAÑOS (Philippines) thought that the fears ex- pressed that an increase in WHO's budget would put a Decision:The motion for closure of debate was severe strain on the economy of developing countries carried by 41 votes to 27, with 16 abstentions. was more imaginary than real.An improvement in The CHAIRMAN called on Mr Siegel, Assistant Direc- health was the natural consequence of the improved tor- General, to answer some of the questions that had health programme that resulted from joining WHO, been raised. and could only lead to economic growth.Contribu- tions by such countries to the WHO budget were there- Mr SIEGEL, Assistant Director -General, said that a fore cancelled out by the advantages obtained.The number of comments had been made during the discus- 210 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II sion regarding budget presentation in future years. He working budget and the budget level for 1964, as it assured delegates that they would be fully taken into appeared in the working paper before the Committee, account; the attention of the Executive Board would inserting the proposed figure in paragraph (1) : also no doubt be drawn, by its representative at the Committee, to the different points raised. The form in The Sixteenth World Health Assembly which the budget had hitherto been presented was DECIDES that : based on the various requests and suggestions made (1)the effective working budget for 1964 shall be from time to time. US$ 34 065 100; The Executive Board's report on the proposed pro- gramme and budget estimates (Official Records No. 125) (2)the budget level for 1964 shall be established in incorporated some of the suggestions that had been an amount equal to the effective working budget as made. For example, Appendix 5 to that report was a provided in paragraph (1) above, plus the assess- table showing the functional breakdown of the budget ments represented by the Undistributed Reserve; and and Appendix 8 gave a summary of the information (3) the budget for 1964 shall be financed by assess- contained in the budget, on a percentage basis for the ments on Members after deducting three years concerned. (i)the amount of US$ 756 990 available by With regard to the question raised by the delegate of reimbursement from the Special Account of the Italy and to which the delegate of Belgium had also Expanded Programme of Technical Assistance; and referred, the Committee on Administration, Finance and Legal Matters was considering a draft resolution (ii)the amount of US$ 849 100 available as casual on the Malaria Eradication Special Account which income for 1964.' appeared in section 4 of its draft second report (see The CHAIRMAN reminded the Committee that, in page 410). The final paragraph of the preamble to that accordance with Rule 70 of the Rules of Procedure, a resolution noted that the "accelerated "programme of two -thirds majority vote was required for the approval malaria eradication would be financed through funds of the draft resolution. set aside by the Director -General not only for the cur- rent year's obligations, but also for continuing com- Decision:The draft resolution was approved by 76 mitments in the ensuing year, either up to the full votes to 8, with one abstention.2 completion of any individual activity approved for implementation within a period of two years, or to such appropriate phase of the activity as would be 2.First Report of the Committee decided in each instance. The application of that pru- Dr SENTICI (Morocco), Rapporteur, read out the dent financial policy would preclude the risk of re- draft first report of the Committee, containing the course to the regular budget for the financing of the resolution just approved. "accelerated" programme. Decision: The report was adopted (see page 408). The SECRETARY, at the request of the CHAIRMAN, read out the text of the draft resolution on the effective The meeting rose at 6.20 p.m.
SEVENTH MEETING Thursday, 16 May 1963, at 10.15 a.m. Chairman: Dr V. V. ®LGUNN (Argentina)
1.Report on Development of the Malaria Eradication The delegate of France had also asked for an inser- Programme (continued from fifth meeting) tion in operative paragraph 1 and the Secretary would Agenda, 2.3 read out the text as amended. The CHAIRMAN invited the Committee to resume 1 Amount recommended by the Committee on Administra- consideration of the draft resolution submitted by the tion, Finance and Legal Matters (see p. 343). Working Party (see page 196), to which a number of 2 Transmitted to the Health Assembly in the Committee's amendments had been accepted at the fifth meeting. first report and adopted as resolution WHA16.13. COMMITTEE ON PROGRAMME AND BUDGET : SEVENTH MEETING 211
Dr KAUL, Assistant Director -General, Secretary, changes in the behaviour of the vectors, as well as said that, if he had understood aright, the French dele- parasite resistance to drugs, may delay the effective gate was suggesting that the paragraph be amended to development of malaria eradication in certain areas. to read :"Invites governments to undertake prelimin- ary operations or to pursue with vigour the eradication 1. INVITES governments to take preliminary opera- tions or to pursue with vigour the eradication pro- programmes . . .". grammes to their planned conclusion and to collabo- Dr AUJOULAT (France) confirmed that that was the rate with neighbouring countries on a regional basis French proposal. to permit progress to be made on a broad geographi- cal area and for mutual protection against reintro- The CHAIRMAN, noting that there were no further duction of the disease; suggestions for amendment, proposed to proceed to the voting. He put to the vote first the French amend- 2.RECOMMENDS, in countries without the adminis- ment. trative and public health facilities for full implemen- tation of malaria eradication programmes, the paral- Decision :The amendment was approved by 75 lel development in a flexible way of a minimum votes to 4, with 5 abstentions. public health service on the basis of total coverage, Dr NAYAR (India) said she had voted against the to support effectively such programmes especially amendment because it was unnecessary and would during the consolidation and maintenance phases; seem to be more restrictive than the original wording, 3. REQUESTS the Director- General to provide ap- which would have left governments free to undertake propriate assistance for the study and solution of the whichever type of operations was suitable to the technical difficulties found in problem areas and to national conditions. pursue research into the development of methods to overcome the technical difficulties encountered in Dr HAQUE (Pakistan) agreed with that view. malaria eradication;
Dr FISEK (Turkey) explained that he had voted for 4.REQUESTS the Director -General to study the the amendment since the wording seemed to cover the present position in regard to the implementation of actual situation in regard to malaria work in that it the malaria eradication programme, itsachieve- recognized the two phases involved -preliminary oper- ments, shortcomings and prospects, including the ations, followed by an eradication programme. provision of adequate staff and finances for the Dr SUBANDRIO (Indonesia) said she too had voted global eradication programme, and to submit a for the amendment under the same impression. report on the matter to the World Health Assembly as early as possible; and At the request of the CHAIRMAN, the SECRETARY read out the draft resolution as amended by the decision 5. REQUESTS the Director -General to report further just taken and at the fifth meeting : progress in the malaria eradication programme to the Seventeenth World Health Assembly. The Sixteenth World Health Assembly, Having considered the report of the Director - Dr FISEK (Turkey) found the wording of operative General on the development of the malaria eradica- paragraph 2 unclear; the Committee might perhaps tion programme; prefer to revert to the wording for that paragraph Noting that the objectives of the co- ordinated plan proposed by the delegate of Nigeria at the fourth meet- for continental Europe had been successfully fulfil- ing. At any rate, the word "minimum" before "public led in that all the remaining malarious areas had health service" should be changed to either "optimum" reached the consolidation phase by the end of 1962; or "satisfactory ". Noting the outstanding progress towards eradica- The CHAIRMAN ruled that, the voting on the draft tion during the past year, in which areas inhabited resolution having been started, further proposals for by millions of people passed from the attack to the amendment were inadmissible unless the Committee consolidation phase, mainly in South -East Asia and agreed to reopen the discussion in accordance with Rule in the Americas; and 74 of the Rules of Procedure. Recognizing that administrative and technical pro- blems such as inadequate health services, particular Dr NAYAR (India) reminded the Turkish delegate epidemiological patterns, insecticide resistance or that the delegate of Nigeria had been a member of the 212 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
working party and had endorsed the draft resolution tion in particular and disease control in general, had agreed upon by that group. been brought to the attention of UNICEF. Decision: The amended draft resolution, as read out Resolution EB31.R32 also contained an expression by the Secretary, was unanimously approved.' of satisfaction with the continuing co- operation be- tween the two organizations in all aspects of the work jointly assisted by them. He was glad to be able to 2.Developments inActivities Assisted Jointly with confirm that the Secretariat had invariably found col- UNICEF laboration with the UNICEF Secretariat most satis- Agenda, 2.12 factory and looked forward to continued good work in assistance to children in the same spirit of mutual At the request of the CHAIRMAN, Dr DOROLLE, understanding and co- operation. Deputy Director -General, introduced the item. The report before the Committee covered develop- Sir Herbert BROADLEY (United Nations Children's ments at the two sessions of the UNICEF Executive Fund) said he was glad to be able to confirm the happy Board held in June and December 1962. A table was relationship that existed between UNICEF and WHO included showing the percentage distribution of alloca- in their mutual endeavours to better the lot of children. tions approved by the UNICEF Board for the years There had been a turning point in the history of 1961 and 1962, from which it would be seen that UNICEF in June 1961 when its Executive Board had UNICEF had continued to allocate the greater part decided to adopt the principle of UNICEF interest in of its funds to work on health services in general and all aspects of child welfare, including assistance in edu- disease control. The trend emerging from the discus- cation, social welfare, vocational training and so on, but sions at the two sessions was to favour increasing without prejudice toits traditional fields of work : UNICEF aid for establishing basic health services. maternal and child health, disease control and nutri- Fifteen allocations for continuing assistance to mala- tion.It had been further decided that UNICEF, in ria eradication campaigns had been approved at the association with the specialized agencies, would assist June session and thirteen at the December session. governments in the preparation of long -term plans for WHO had been requested to submit an analytical study economic and social development, in order to ensure of the malaria eradication situation to the UNICEF adequate coverage for child welfare. Executive Board at its session to be held in Bangkok in January 1964, as a basis for deciding policy on future The Deputy Director -General had mentioned the UNICEF action in that sphere. part UNICEF was ready to play in increased activities under the Development Decade ;again, those activ- The report included an account of the trends of ities would be undertaken in consultation with the opinion and decisions taken on planning for children technicalagencies,particularly WHO, FAO and in national development and of UNICEF action within UNESCO. Those decisions had been endorsed by the the framework of the United Nations Development Economic and Social Council and the United Nations Decade. The United Nations General Assembly had General Assembly. adopted a resolution at its last session endorsing the The Committee would be reassured to learn that decision taken by the UNICEF Executive Board and nearly 85 per cent. of UNICEF's total allocations in recommending that other United Nations agencies join 1962, which had amounted to $ 33 million, had been with UNICEF in supporting planning for children. In that connexion it would be noted that resolution devoted to the traditional fields of work he had men- tioned.During the year 273 new projects, at a total EB31.R32, adopted by the WHO Executive Board at total cost of $ 43.5 million, had been approved, bring- its thirty -first session, reiterated the importance of the ing UNICEF's total commitments, including opera- health needs of children forming part of general plans tional and administrative costs, up to $ 50 million. for health services and emphasized the importance of That gave some indication of the part UNICEF was malaria eradication activities as a prerequisite for trying to play in the very important tasks of bettering social and economic progress and particularly for the lot of children. It was hoped that activities could be agricultural development. That resolution, as well as maintained on much the same scale for the two years to the opinions expressed in the Executive Board on the come. importance of basic health services for malaria eradica- Another point of importance was that activities in 1 Transmitted to the Health Assembly in section 1 of the Com- Africa were rapidly increasing in extent and would mittee's second report and adopted as resolution WHA16.23. continue to do so. A new regional office had been COMMITTEE ON PROGRAMME AND BUDGET : SEVENTH MEETING 213 opened in 1962 in Lagos, as well as area and country self with the tribute to the role played by UNICEF, offices in different parts of the continent. Some 41 per side by side with WHO, in harmonious collaboration. cent. of the total allocations to African countries in However, the shift in UNICEF policy away from 1962 had been for training. programmes for a specified objective was causing some The most important subject to be considered by the anxiety.In many cases, the chances of initiating a Executive Board at its January 1964 session would be programme drawn up in collaboration with WHO were policy on malaria eradication work. The review would substantially increased if the country in question was be undertaken on the basis of the report to be supplied able to count on UNICEF aid by way of equipment by WHO. The increased importance being attached to and material. The lack of that additional help would training would also come up for discussion. The trend have repercussions on both the material and the moral in that direction was illustrated by the fact that the level; for instance, another source of financing for the proportion of total funds allotted to training work had requisite equipment and material would have to be risen from 10 per cent. in 1960 to 27 per cent. in 1962. found. Those considerations applied in particular to Substantial sums were being set aside for training acti- malaria eradication programmes, in regard to which vities in India. The training provided by the Interna- UNICEF was on the point of taking very important tional Children's Centre in Paris was being stimulated decisions. He trusted that the survey to be prepared by and two new training courses were being organized in the WHO Secretariat would help to swing the decision the United Kingdom, with part of the training to be in the direction of continued help by UNICEF to such given in the home conditions of trainees. He went on programmes.So far as pre- eradication programmes to give details of those new courses, one of which was were concerned, there would be no difficulty since they for paediatric professors and the other for nutrition would come under the heading of establishment of workers. basic health services. In regard to malaria eradication work, he was unable Professor 2DANOV (Union of Soviet Socialist Repub- to say more than that UNICEF policy would be re- lics) also thanked the Deputy Director -General and viewed in January 1964. In the meantime, work in that Sir Herbert Broadley; their remarks reflected the sphere would be continued, a ceiling amount of spirit of mutual understanding that had grown up $ 10 million having been set aside for the purpose. In between WHO and UNICEF over the ten years of general UNICEF took the view that more importance their close association. should be attached to the establishment of basic health He hoped that joint activities in the future would services as the foundation for mass campaigns, al- give more attention to the establishment of medical though recognizing that the work could not be delayed and health services, since the promotion of health was until perfect systems were available. Over $ 6 million the main factor in the well -being of children. Secondly, had been allocated for malaria eradication programmes he would stress the wisdom of UNICEF's policy of in 1962 and no doubt further allocations would be increasing its assistance to the newly independent coun- made at the June 1963 session of the Executive Board. tries, and especially those of Africa. It was hoped that The trend towards multi -purpose programmes would future efforts in that direction would not be too mean further close and continuous collaboration with broadly spread and would be directed principally to the the specialized agencies so that UNICEF might have African countries. He asked that future reports to the the benefit of their technical guidance. It was encour- Health Assembly should include information on the aging to note that there was growing recognition of the regional distribution of UNICEF assistance. human factor in schemes for economic and social development.It was human resources that, after all, Dr SYMAN (Israel) welcomed the opportunity to pay made material progress possible in the long run, and a tribute once again to the work of UNICEF in its emphasis on the needs of children would be of par- happy collaboration with WHO. He was glad to note amount importance in that sphere. that work on the establishment of health services and in disease control and nutrition was still receiving the The CHAIRMAN thanked the representative of UNICEF major part of the funds invested by UNICEF, and that for his interesting statement. He was sure he could not that policy was likely to be maintained in the future. overstress the extent to which WHO and its individual Many countries would join in welcoming the greater Members valued the efforts being made by UNICEF flexibility UNICEF was introducing in paying local and how much importance they attributed to its con- costs. That step would certainly enable many projects tinuedcollaborationin work to improve health to be implemented more easily.But apart from the throughout the world. financial aid provided, UNICEF deserved great thanks Dr FARAH (Tunisia) thanked the Deputy `Director - for formulating a comprehensive policy for meeting General and Sir Herbert Broadley, and associated him- children's needs as part of general economic and social 214 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II development, within the framework of the community. project or any government request before consulting He also welcomed the emphasis being laid on work to the specialized agency concerned. The trend towards promote general public health services, which was in multi- purpose projects was extremely important and line with the trend in WHO. That was a formula that might ultimately make it necessary to consider some might satisfy the UNICEF Executive Board on the reorganization of the headquarters structure, both in need for continuing help to malaria eradication pro- WHO and in UNICEF. grammes. He was also glad to see the emphasis that was being As an illustration of the broad potential scope of the placed on the training of national staff in local areas, help that could be obtained from UNICEF under its especially in the developing countries.It was impor- old and new policies, he described some of the tant, too, for WHO and UNICEF staff to be trained in UNICEF -assisted projects at present in operation in his the regions where they would have to work. country, ranging from emergency aid for the feeding of It would be very useful in planning and implement- children to BCG- vaccination campaigns, milk conser- ing multi -purpose projects if details could be collected vation and development of protein -rich foods. -in the form of a manual or handbook -of the health situation and problems in each country and giving the Dr Dow (Mali) said his delegation had read the names of organizations and personnel working in the field.Governments might beaskedtoprovide report with great interest.The effectiveness of the regular information so that a manual could be pro- joint programme, particularly for the young countries duced or each region or area. of Africa, had no need of proof, and his delegation particularly welcomed resolution EB31.R32, in which the need for organizing and strengthening basic health Professor GERIÓ (Yugoslavia) said that the report services as a means of combating the communicable now being discussed showed once again the importance diseases was stressed.It was also glad to know that of co- operation between the specialized agencies of the UNICEF intended to support that type of action. United Nations. The number of projects carried out jointly by WHO and UNICEF was increasing rapidly, The dynamic policy instituted by UNICEF was and the countries that were helped by those projects - warmly welcomed by the young African States, which including Yugoslavia- recognized their importance in had, at one and the same time, to tackle the whole stimulating local activity. gamut of public health and social problems, and gave Yugoslavia had already received help from UNICEF them hope of attaining their priority objectives more and WHO in the malaria eradication campaign, and speedily. His country had been a recipient of UNICEF other important projects were also being carried out, assistance since 1955, first in campaigns against leprosy including programmes for school health and maternal and subsequently in organizing maternal and child and child welfare. health services.Those services had greatly expanded Co- operation between WHO and UNICEF was since 1960 but were still part of the general public extremely important, particularly to the developing health services because of the lack of specialized staff. countries. By their joint action the two organizations The Mali people greatly appreciated the help given by had helped to improve the health of thousands of chil- the travelling maternal and child health teams, whose dren, and he hoped they would continue their policy of work had served to reduce infant mortality substan- close co- operation. tially in the villages. A project much broader in scope and covering the training of basic health and social Dr NAYAR (India) thanked the Deputy Director - service staff was under study, and his Government was General and the representative of UNICEF for their hopeful of UNICEF approval of and help in that work. excellent statements. She entirely supported the policy of co- operative action between the United Nations Dr ADENIYI -JONES (Nigeria) expressed great ap- agencies. Nutritionwas animportant example preciation of the work done under the joint WHO/ of a subject where such co- operation was needed, UNICEF projects, and congratulated the Deputy forit was no use teaching people what food to Director -General and the UNICEF representative on eat without also teaching them how to produce it. their excellent reports. The success of the activities was She welcomed the projects for training staff in the in a large measure due to the tact and enthusiasm of the United Kingdom, but hoped there would also be train- people involved, both at headquarters and in the field. ing in the regions, so that people would be able to learn In connexion with the multi- purpose programmes, he about conditions in the places where they would be was glad to note that UNICEF would not support any working. COMMITTEE ON PROGRAMME AND BUDGET :SEVENTH MEETING 215
UNICEF was to be particularly congratulated on its the Committee and further clarified by the Deputy wisdom and vision in designing its projects to deal with Director -General and the UNICEF representative. the total needs of children, which had led it to concern itself with the control of communicable disease and the Dr HAQUE (Pakistan) thanked the Deputy Director - production of vaccines.India greatly valued the help received in vaccine production, but it would be useful GeneralandUNICEF'srepresentativefor their if help could also be given in developing regional valuable statements.He also wished, through its laboratories for testing vaccines.It would be useful, representative, to thank UNICEF for all its help to too, if help in the control of communicable diseases his country. could be extended to include testing facilities for neces- As the delegate of Tunisia had stated, most of the sary drugs on a regional basis. One of the important developingcountries,and particularlythenewly problems in nutrition was adulteration, and India independentones,werelargelydependenton would welcome help and advice in dealing with the UNICEF's help in obtaining the materials needed for problem. She welcomed the continued emphasis on the carrying out their programmes, for they were unable traditional fields of basic health services, maternal and to produce them themselves.Those countries would child welfare, and primary health centres, but stressed therefore be faced with serious difficulties if UNICEF the need to improve them.Help and advice to that changed its policy on the lines indicated. end would be greatly appreciated. He wished to associate himself with the comments She was particularly glad to see that in the United of the delegates of the Soviet Union and India on the Nations Development Decade UNICEF was devoting geographical distribution of UNICEF's aid, which increasing attention to such important subjects as should, he considered, *be based on population and on water- supply, sanitation and housing development. regional requirements. She would like to see a concerted campaign for On the question of training, he agreed with the water -supply and sanitation, with emphasis on hygiene Indian delegate that staff should be trained in the in food establishments, because of its importance for region where they would be working. Most countries preventing epidemics.Another subject that required were unable to send large numbers of people to be study was urbanization, which was the cause of many trained abroad; there was also the language diffi- troubles. culty and the fact that governments wished their India was very grateful to UNICEF for its help, nationals to learn about the diseases they would be and looked forward to help and co- operation in the dealing with. future. Dr QUIRÓS (Peru)expressedconcernover Dr GONZÁLEZ GONZÁLEZ (Chile) congratulated the UNICEF's proposed change of policy.It was true Deputy Director-General and the UNICEF represent- that the United Nations agencies were all autonomous ative on their illuminating statements.The report and co- ordination between them depended to some before the Committee showed how UNICEF was extent on good will and understanding. But he developing in meeting the needs of social medicine and wondered if that state of affairs could continue for also how it was concentrating on training, health ever, for there were so many problems to deal with in services, hygiene to prevent communicable diseases, the developing countries that a more organized method maternal and child welfare and the family, as aspects of using the limited resources available was necessary. of the whole problem. In his opinion a general plan of action should be drawn He also took the opportunity of referring to the up for social and economic development, the details earthquake which had afflicted Chile four years earlier being left to the countries concerned.The World and had disrupted water -supplies and sewage disposal, Health Assembly might recommend that the Director - bringing with it the danger of epidemics. Countries all General should inform UNICEF that the developing over the world had rallied to Chile's assistance, and his countries were concerned over the possible effects of country was particularly indebted to UNICEF for a radical change of policy,particularly on such its help in repairing the damage. problems as malaria, training, nutrition and public health services.Planning and co- ordination of effort Dr MURRAY (South Africa) said his Government were essential. was deeply impressed by UNICEF's humanitarian work and was happy once again to be able to con- Professor GORNICKI (Poland), after commenting on tribute a sum of $30 000 for 1963, to enable it to the excellence of the report, stressed the importance continue the activities set out in the document before of co- operation between WHO and UNICEF. Poland 216 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II had for many years derived great benefit from the Turkey and the excellent co- operation between the two activitiesof the two organizations and was very organizations in carrying out joint projects inhis grateful to them.With UNICEF's help, training country. courses inpaediatrics, gynaecology and obstetrics had been organized over the past six years at the mother and child institutes in Warsaw and in other Dr ANASTASSIADES (Greece) referred to the experi- mental health unit which had been set up with the help parts of the country, and hundreds of people had . of UNICEF in Thessaly, and which was one of the most benefited from the training. A strong body of trained important examples of assistance from that organiza- people had thus been built up and great improvements tion. The unit was an experiment in health organiza- in maternal, child and family welfare had resulted. tion by the Ministry of Social Welfare designed to co- Training courses were now organized and financed by ordinate and complete the action of different medical the Polish Government with the exception of inter- and social bodies and to provide his country -and national courses on social paediatrics, such as the ones particularly the rural areas -with a permanent network organized in 1959 and 1962 in co- operation with the of preventive medical services. UNICEF was helping International Children's Centre at Paris. by providing transport and health equipment, and WHO by training medical and paramedical personnel Dr WATT (United States of America) joined previous and by granting fellowships and providing consultants. speakers in commending the reports by the Deputy The plan of operations, which had been drawn up in Director - General and the UNICEF representative. 1959, provided for the work to be carried out during UNICEF was an organization dedicated to the cause the period 1961 -1964. of children. It was sometimes difficult when discussing The unit would be organized on the basis of action by health programmes to see how directly and closely three main services : the national and rural health ser- they were related to the needs of children in the com- vice, health centres, and a group of new specialist munity. He was sure that the members of the UNICEF services.The hospital at the regional centre of the Executive Board were fully alive to the problem; and unit would include specialist services in paediatrics and WHO, too, should be sure that the relationship was other branches, to meet the needs of the whole region. brought out clearly in its own discussions on health He thanked UNICEF for its assistance. matters.The question of food might illustrate the Obviously children must be point he had in mind. Dr CLAVERO DEL CAMPO (Spain) expressed his coun- provided with enough of the right kind of food for try's appreciation of the help received from UNICEF proper physical and mental development, but it was over the past ten years. Spain was indebted to UNICEF their parents who produced and provided them with for a service for premature children, and for three food; thus well -fed parents meant well -fed children. programmes dealing respectively with rehabilitation; Inthatconnexion malariaeradication was health education with emphasis on food in schools - relevant, for attention had already been drawn during a pilot study which might be useful for other countries the discussions to the improvement in working capacity and in which FAO and WHO were co- operating; and resulting from the elimination of malaria. It was clear, the provision of safe milk -a programme that included therefore, that funds for the benefit of children should the establishment of milk centres and the preparation be used first and foremost for dealing with the basic of powdered milk. needs of people, to enable children to be properly In his opinion the new policy of UNICEF would not looked after. develop as fast as some speakers had suggested; he hoped that the change would be carried out progres- Dr FISEK (Turkey) thanked the Deputy Director - sively. in the interest of programmes at present in hand. General and the UNICEF representative for their reports. He understood the reasons and the need for Mr COLY (Senegal) welcomed the harmonious and the proposed new policy, and was sure that, far from effective co- operation between UNICEF and WHO. decreasing UNICEF's contribution to world health Maternal and childwelfare,which was one of programmes, it would make it more effective by dealing UNICEF's chief activities, was of vital interest to his with matters not covered by other agencies. He hoped own and most other developing countries. In Senegal that co- operation between UNICEF and WHO would the rate of infantile mortality was still high and in continue to develop for the benefit of the countries of recent years UNICEF's helps had given new impetus the world. He deeply appreciated UNICEF's help to to the maternal and child welfare centres. He wished to COMMITTEE ON PROGRAMME AND BUDGET : SEVENTH MEETING 217 express his gratitude to UNICEF, whose help was and education to change eating habits in both parents given so quickly to those people who needed it. and children; the problem was urgent since it needed at least a generation to change the habits of human Dr SUBANDRIO (Indonesia) expressed her apprecia- beings. tion of the reports on the activities of UNICEF and He fully endorsed what was said in the report about WHO.Her country had received great help from the importance of UNICEF's role in the field of urbani- UNICEF in promoting health progress.As several zation, since that was a serious problem in Thailand. earlier speakers had stressed, effective help to develop- Since Bangkok had become urbanized, the population ing countries needed more emphasis on how to provide had doubled in a matter of fifteen years.Lack of the material means to implement programmes : how, accommodation, lack of schools and lack of occupa- for example, to manufacture the necessary drugs in the tion were widespread, and family ties were being developing countries themselves.In nutrition the broken.It was essential to provide help at the outset emphasis was on training health workers in the field; with community services for families and children. there again, it was important to help countries to pro- vide enough food for their own population. Mr TouRÉ (Mauritania) joined in the expressions of Indonesia was very grateful for UNICEF's help in appreciation for UNICEF's help, which had enabled setting up maternal and child welfare clinics and train- his country during the past two years to start a mater- ing midwives and other personnel. UNICEF had also nal and child welfare service. The service was essential provided most of the milk needed and had given valu- since at the present time maternal and child welfare able help in transport. The maternal and child health was dealt with by medical centres dispersed all over clinics had become a nucleus for establishing village the country with only limited personnel and limited public health services; their number had risen from means. He thanked UNICEF for its help and hoped 300 in 1950 to about 4000. It was hoped that within a that the Fund's co- operation with WHO would be few years they would have become fully- fledged rural intensified. health services, for an excellent way of reaching the rural population was through the mothers who attend- ed the clinics. Indonesia had recently recognized the Dr AMORIN (Togo) wished to thank UNICEF for the value of milk, and it was now being widely consumed. help it had given in various health projects carried out Hitherto her country had depended on supplies from in his country. The problem of nutrition in the develop- ing countries was becoming more acute each year.It UNICEF, but it now wished to produce its own. could not be solved solely by teaching better utilization She appealed to UNICEF and WHO to consider the of available produce, for under -development was the possibility of helping developing countries to produce principal cause of malnutrition, and was the thing that milk, drugs and other necessities for themselves. developing countries must attack.In addition, the developing countries needed to sell their produce to the Dr TORRES BRACAMONTE (Bolivia) wished to record developed countries at reasonable prices so as to enable his Government's sincere gratitude to UNICEF for its them to finance their development plans. Thus a fair valuable help. distribution of national revenue was a corollary of Professor SANGSINGKEO (Thailand) wished to ex- economic and social development. presshiscountry'swholehearted appreciationof UNICEF's work, especially in his country. He agreed Dr MAGALHAES DA SILVEIRA (Brazil) paid a tribute with the UNICEF representative on the importance of to UNICEF for its excellent work in many countries. human resources in the present period of rapid social Its efforts had greatly contributed to Brazil's economic and economic change, and considered that training and and social development and he hoped they would long education should be of first priority. The problem of continue. nutrition, for example, could only be solved by training The meeting rose at 12.25 p.m. 218 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
EIGHTH MEETING
Thursday, 16 May 1963, at 3.30 p.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1.Developments in Activities Assisted Jointly with by UNICEF in leprosy control and the establishment UNICEF (continued) of maternal and child health programmes. The manner Agenda, 2.12 in which the aid had been provided should serve as a Dr SHAMI (Jordan) expressedhisgratitudeto model to other organizations. UNICEF for the assistance provided in malaria eradic- Dr LoFRUSCIO (Paraguay) said that UNICEF had ation, maternal and child health programmes and other fields, and his satisfaction at hearing that UNICEF provided, in 1961 and 1962, more than eight labora- tories for clinical analysis, and equipment for education planned to continue that type of assistance; the more so and training. It had assisted in the development of the since his Government would be requesting UNICEF help maternal and child health services, particularly in rural in the establishment of an adequate rural health service. areas, and the success obtained was demonstrated by Dr GHANI AFZAL (Afghanistan) said that his country the statistics showing that infant mortality had fallen was particularly grateful to UNICEF for help in mater- from 102 per thousand live births in 1958 to 30.3 per nal and child health, malaria eradication, and rural thousand in 1961. There had been an improvement in health programmes. environmental sanitation, and the campaign against Dr KEITA (Guinea) said that UNICEF had given endemic goitre had been intensified. UNICEF's assis- effective and timely aid to his country in the establish- tance to the malaria eradication campaign was well ment of a maternal and child health programme. A known, but he would make special mention of its help first group of social workers had been trained. A pilot in a plan for nutrition and nutritional education, in maternal and child health centre to be opened shortly which FAO, UNESCO and WHO were also collabor- at Conakry would also serve as a training school for ating. For all those benefits, his country was sincerely medical auxiliaries; and further help had been promised grateful. by both WHO and UNICEF in establishing training Dr ALDEA (Romania) said that it was a matter of programmes for midwives, social workers, nurses and great satisfaction to his delegation that the Executive other auxiliary personnel. UNICEF had also assisted Board of UNICEF had raised the percentage for educat- his country with transport and medical supplies, and ional and vocational training from 0.93 in 1961 to 7.32 WHO had provided a technical expert to set up a in 1962, since it was a field in which the developing public health programme.His country particularly countries had particularly severe problems to face. appreciated the speed with which UNICEF supplied He hoped that UNICEF would be guided by the substantial and regular assistance. principle of fair geographical distribution of the assis- Dr MONTALVÁN (Ecuador) expressed his appreci- tance it gave, bearing in mind the social and economic ation for the assistance given by UNICEF in various situation and the morbidity rates of the various coun- public health programmes, particularly malaria eradi- tries. cation and tuberculosis control. A mass vaccination Dr GANGBO (Dahomey) said that his own country campaign had been carried out and a tuberculosis was grateful for the rapid and effective aid provided by centre, equipped by UNICEF, gave various courses UNICEF in malaria eradication, the control of yaws and received fellows from other countries of Latin and leprosy, and the development of maternal and America. UNICEF was also assisting in an integrated child health services. It was a matter of grave concern programme of public health, in leprosy control, and in to his Government that the nursing school, which had a milk hygiene programme. He very much hoped that been built with the help of France and completed in UNICEF's contribution to WHO's work would con- 1962, could not be used for lack of equipment. Since, tinue at the present level. at the present rate of growth, the population of his Dr LAMBIN (Upper Volta) said that he had no words country could be expected to double within the next to express his country's appreciation for the help given twenty -five years, the need for increasing the number of COMMITTEE ON PROGRAMME AND BUDGET :EIGHTH MEETING 219 trained nurses was apparent. He hoped that UNICEF were an integral part of the more general public health would be able to provide assistance in that matter. services. The growing emphasis laid by UNICEF on education and training, and on nutrition -fields in which the developing countries required particular Mr BOLYA (Congo, Leopoldville) reiterated the assistance -was also welcome. thanks of his delegation to UNICEF already expressed Valuable assistance had been provided by UNICEF in plenary session. The difficulties his country had had in Morocco in connexion with communicable diseases, to face in providing for the destitute after its painful eye diseases and venereal diseases, and also in training accession to independence had been increased by an of medical and paramedical personnel.The help influx of refugees from Angola and Rwanda. Had it recently given to the Institute of Public Health had not been for the assistance of UNICEF, many people, made it possible to train doctors in social and preven- particularly small children, would not have survived. tive medicine and also to train the auxiliary teams so UNICEF had not only helped with the maintenance necessary for the country's programmes. and improvement of prenatal and child clinics, but had The report before the Committee was very encour- also equipped a pilot maternal and child health centre aging. He appreciated the importance for UNICEF of a in Leopoldville that would serve as a model for similar planned policy within a wider framework, but hoped centres to be set up in the towns and even in rural that that would not entail the discontinuance of exist- areas.It had also provided teaching material for ing forms of assistance, since the developing countries auxiliary personnel and had given support to the train- also had their plans and priorities. The malaria eradi- ing of social workers. He was happy to take the oppor- cation campaign in Morocco, for instance, was to enter tunity of conveying his country's appreciation for the attack phase in 1965 and would be largely depend- UNICEF aid.The assistance of the international ent on UNICEF supplies.He therefore hoped that organizations was precious for the developing countries the new trends would intensify the assistance in tradi- because it was disinterested and was extended through tional fields, while extending and diversifying them. the normal government channels. The CHAIRMAN called upon the Deputy Director - Mr MARADAS -NADO (Central African Republic) said General to reply to points raised during the debate. that UNICEF aid had been particularly valuable incampaigns againstleprosyand yaws;it was Dr DOROLLE, Deputy Director- General, assured the also being given forthe equipping of a nursing Committee that the Secretariat had taken note of all school and maternal and child health centres, so that the points raised; he would comment on a few of them. training could proceed in proper conditions. Further- The request from the delegate of the Union of Soviet more, the endemo- epidemic disease control services Socialist Republics for information regarding the geo- relied almost entirely on the transport provided by graphical distribution of aid given by UNICEF to WHO UNICEF. The importance of UNICEF help to speci- projects would be met in the following year; the basis fic projects, particularly in Africa, could not be over- would be the report on projects by area distribution emphasized. submitted by UNICEF to the Economic and Social He noted with satisfaction the excellent collabora- Council of the United Nations.With regard to the tion between WHO and UNICEF, but hoped that some issue raised by the delegate of Nigeria, he said that the Programme Co- ordination unit already established means might be found whereby requests could be dealt with without administrative delays.The need for in the Secretariat had precisely the function of co- ordina- UNICEF to obtain the technical advice of WHO be- ting the different aspects of the technical relationships fore granting such requests might sometimes involve a of WHO with UNICEF and other agencies. It was felt that the need for advice to individual countries on delay that would hold up, for example, a vaccination campaign by months or even by years. Judicious co- possible sources of assistance from agencies, founda- tions and other bodies for programmes in the health ordination, and quicker implementation of health pro- field would be met by the increase in the number of jects,would enable African countries to obtain the WHO country representatives, each of whom would be maximum benefit from UNICEF assistance. competent to supply the necessary information and suggest the best means of utilizing whatever sources Mr FERAA (Morocco) said that his delegation had were available. noted with satisfaction the close collaboration between He noted that concern had been expressed over the UNICEF and WHO, and UNICEF's policy of adapt- shifting of UNICEF policy from individual projects, ing itself to the evolution of public health services - such as malaria eradication, to a general programme in particular the recognition that child health services for the betterment of the condition of children, and 220 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
that that concern was reflected in an amendment pro- The Sixteenth World Health Assembly, posed by the delegations of Pakistan and Tunisia to Having considered the report of the Director -Gene- the draft resolution which had been circulated (see ral on developments in activities assisted jointly with below). He also noted the suggestions of delegates as to UNICEF, activities where UNICEF co- operation would be valu- I. able : smallpox control, improvement of water supply NOTES the report of the Director -General; and investigation into food handling, including the 2. ENDORSES the views expressed by the Executive adulteration of food.Most of those activities were Board at itsthirty -firstsession, with particular already undertaken by WHO or other specialized agen- emphasis on UNICEF's continued support of pro- cies, alone or jointly; in the latter case, close collabora- grammes forthe establishment of basic health tion was ensured at the highest level by a joint commit- services,and for mass control and eradication tee. He assured the delegate of the United States of campaigns against communicable diseases, and the America that his comments on the factors affecting the importance of assistance to malaria eradication condition of children would be borne in mind in the activities, particularly in Africa; and preparation of programmes. 3. EXPRESSES its satisfaction with the continuing close and efficient co- operation between the two The CHAIRMANinvitedtherepresentativeof organizations in jointly- assisted programmes. UNICEF to make a closing statement. Dr HAQUE (Pakistan) drew attention to a proposal Sir Herbert BROADLEY (United Nations Children's put forward by his delegation and that of Tunisia to Fund) thanked all those speakers who had expressed add to the draft resolution a new paragraph reading : their assistance appreciation of the provided by 4.REQUESTS the Director- General to transmit to UNICEF; their thanks and their comments would be UNICEF /the concern of WHO in that any change in transmitted to the Executive Directcr. He felt that the policy which might reduce material assistance to statement of the Executive Director, as quoted in the joint UNICEF /WHO activities would adversely report submitted by the Director -General, "that the affect the health and welfare of children. emphasis of the work of UNICEF was shifting gradu- ally from interest in the individual project to a wider Dr FARAH (Tunisia) said that the amendment was concern with the way in which UNICEF aid might con- proposed not because of any misunderstanding of the tribute to the overall improvement of the condition of statement made by the Executive Director of UNICEF children in a given country ", had given rise to some but because ithad already been decided by the misapprehensions. The shift of UNICEF policy did UNICEF Executive Board to discontinue assistance to not imply that assistance would henceforth be spread some malaria eradication programmes. thinly over a much wider field; aid would still be given to individual projects, but each would be considered Dr ALDEA (Romania) proposed the insertion of the against a wider background. The effect of urbani- words "education and training" after "basic health zation, industrialization, and other factors of modern services" in paragraph 2 of the draft resolution. life that produced increasing strains tending to disrupt the family, must all be taken into account. Therefore Sir Herbert BROADLEY (United Nations Children's the purpose of UNICEF would be to give, to the Fund) felt that the words "change in policy" in the maximum possible extent, co- ordinated aid to the amendment proposed by the delegations of Pakistans recipient countries. He sympathized entirely with the and Tunisia might be misleading and prejudicial to its view expressed by the delegate of the United States intention. Perhaps it would meet the point if the reso- that the condition of children and young people was lution were merely to refer to WHO's concern that any affected vitally by the condition of their parents and reduction in material assistance would adversely affect other members of the community.After lengthy the health and welfare of children. debates in the UNICEF Executive Board, that view was gaining the support of the majority and, conse- Dr FARAH (Tunisia) and Dr HAQUE (Pakistan) quently, the aim of UNICEF was gradually becoming accepted the suggestion made by the representative of the provision of aid from which children would benefit : UNICEF. the role of UNICEF was to contribute to ensuring for the rising generation a fuller life on that planet. Decision: The amendment proposed by the delegates of Pakistan and Tunisia,as modified, and the Dr SENTICI (Morocco), Rapporteur, read out the amendment proposed by the delegate of Romania, draft resolution which had been circulated : were approved. COMMITTEE ON PROGRAMME AND BUDGET : EIGHTH MEETING 221
The CHAIRMAN asked whether there was any objec- convened in Geneva in October 1962.To meet the tion to the adoption of the draft resolution as a whole, wishes of FAO, it had been given the amended title which now read : of "Joint FAO /WHO Conference on Food Standards ". The report of the Conference, which had been attended The Sixteenth World Health Assembly, by representatives of forty -four Member countries, of Having considered the report of the Director - either or both the two organizations, and of twenty - General on developments in activities assisted jointly four international organizations, was reproduced as with UNICEF, Appendix 1 to Annex 17 of Official Records No. 124, and it would be seen that it had made in effect five 1. NOTES the report of the Director -General; main recommendations. 2.ENDORSES the views expressed by the Executive First, the Conference had endorsed a proposal for Board at its thirty -first session, with particular em- a joint FAO /WHO programme on food standards phasis on UNICEF's continued support of pro- whose principal organ would be the Codex Alimentarius grammes for the establishment of basic health ser- Commission. vices, education and training, and for mass control Secondly,theDirector -General of WHO was and eradication campaigns against communicable requested to communicate that endorsement to the diseases, and the importance of assistance to malaria Executive Board and the Health Assembly. eradication activities, particularly in Africa; Thirdly, the Conference had adopted for the work 3.EXPRESSESS its satisfaction with the continuing of the proposed Codex Alimentarius Commission the close and efficient co- operation between the two guide -lines set out in the part of the report reproduced organizations in jointly- assisted programmes; and on pages 68 -72 of Official Records No. 124. 4. REQUESTS the Director- General to transmit to Fourthly, it was proposed, subject to endorsement UNICEF the concern of WHO in that any reduction by WHO, that the first session of the Commission in material assistance to joint UNICEF /WHO acti- should be held in Rome in June 1963. With regard to vities would adversely affect the health and welfare that recommendation, the present position was as of children. follows. A note had been sent out by the Director - General of FAO in late March and early April 1963 Decision: The draft resolution was approved.1 informing Member governments and interested organiz- ations of the proposed date of the meeting; copies of 2.Joint FAO /WHO Programme on Food Standards the note had also been sent to governments that were (Codex Alimentarius) :Report of the Joint FAO/ WHO Conference on Food Standards Members of WHO but not of FAO. As soon as the Health Assembly, on the recommendation of the Agenda, 2.11 present Committee, formally endorsed the joint pro- The CHAIRMAN invited the representative of the gramme, invitations would be dispatched inthe Director- General to introduce the item. names of the Directors- General of the two organi- zations. Dr GRUNDY, Assistant Director -General, said that Fifthly, the Conference had noted the financial the relevant documentation consisted of resolution provisions for the joint programme, namely, that a EB31.R34, which contained a draft resolution for the special trust fund administered by FAO had been set consideration of the Health Assembly (reproduced on up in accordance with Articles 8 and 9 of the Statutes page 20 of Official Records No. 124), and of Annex 17 of the Codex Alimentarius Commission. The operating to the same volume. expenses of the Commission and of the Secretariat Tracing briefly the course of procedural events that members of FAO and WHO directly serving it were to had led to the adoption of resolution EB31.R34, he be defrayed from the trust fund, contributions to said that the Executive Board had had before it at its which from participating countries would be accepted twenty -ninth session a report of the Director- General only through or with the approval of the governments relating to the creation of a joint FAO /WHO pro- concerned. Thus the proposals were for the time being gramme on food standards and the assumption by the without budgetary implications for WHO. However, two agencies of the activities of the European Council it should be noted that some governments had indicated of the Codex Alimentarius. that they would prefer to see the cost borne by the Pursuant to resolution EB29.R23 and to resolution regular budgets of FAO and WHO instead of by the 12/61 of the eleventh session of the FAO conference, trust fund; that matter was to be reviewed by the a joint FAO /WHO committee of experts had been FAO Conference at its twelfth session, in November 1 Transmitted to the Health Assembly in section 2 of the Com- 1963. If the FAO Conference should decide to modify mittee's second report and adopted as resolution WHA16.24. the method of financing, the Director -General of FAO 222 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II was to consult with the Director -General of WHO, WHO's membership included several interested coun- who would study the proposals and submit them to tries that were not at present Members of FAO. the appropriate bodies of WHO. That matter was referred to in paragraph 4 of the draft resolution The CHAIRMAN, after stressing the importance of the recommended to the Health Assembly in resolution proposed joint FAO /WHO programme on food EB31.R34 of the Executive Board. standards, which would unify and develop the work As to the Statutes of the Codex Alimentarius Com- being done in individual countries, invited the repre- mission and the guide -lines (pages 68 -72 of Official sentative of FAO to address the Committee. Records No. 124), the Committee would wish to note in the first place that both were in form and sub- Mr CRAPON DE CAPRONA (Food and Agriculture stance as approved by the Director -General of FAO Organization) said that after the very full introduction and WHO. The purpose of the Codex Alimentarius by Dr Grundy he could only emphasize the satisfaction as described in the guide -lines was to constitute a of the governing bodies of FAO at the launching of collection of internationally adopted food standards the joint programme with WHO and express on behalf presented in a unified form, with the two -fold aim of of his Director -General every hope for its full success. With regard to financing, he confirmed that any ensuring fair practices in the food trade and protecting proposal made by the FAO Conference for a change the consumer's health.It was intended to include in time all the principal foods and the whole range of in the present method would be communicated by food additives and contaminants, together with rules the Director -General of FAO to Dr Candau, for submission to the WHO Executive Board and the on food hygiene. Regarding methods of work,the Commission Seventeenth World Health Assembly. would depend upon draft 'standards prepared by ad Dr DAELEN (Federal Republic of Germany) said that hoc working groups and by outside bodies. Its her delegation endorsed the recommendations con- function was essentially one of distribution and co- tained in resolution EB31.R34. Her Government was ordination except inthestagesof producing in ready to co- operate in the proposed joint programme definitive form, and publishing, a standard. The and to contribute to the regular budget for the work needs both for world -wide standards and for those of the Codex Alimentarius Commission according to mainly of interest to a specific region were provided the approved scale of assessments.She hoped that for.The procedures for the consideration of draft final agreement would soon be reached so that the standards by governments, and for their acceptance work of the Commission could go ahead. of standards approved by the Commission, were She stressed the view of her delegation that pro- described in paragraphs 32 -37 of the guide- lines. grammes on food standards should be concerned only On approval by the Commission, standards were to be with protecting the consumer and should not be communicated to Member governments of FAO and influenced by economic or political considerations. WHO through those agencies, with an invitation to indicate whether they were acceptable, and when, in Dr SCHINDL (Austria) said that his delegation was the view of the Commission, enough government particularly interested in the item under discussion, acceptances had been received, the standards were to as his country had been concerned with the Codex be published in the Codex Alimentarius, together with Alimentarius since its inception.General provisions, a list of accepting countries. methods of sampling and analysis, and standards for A point of special interest to the Committee would some foodstuffs had been published by the European be the high priority recommended for food additives. Council of Codex Alimentarius a few weeks previously, In that connexion he drew attention to paragraph 41 and other standards were in preparation.He had of the report of the Joint FAO /WHO Conference represented his Government at the Joint FAO /WHO (Official Records No. 124, page 71) and also noted Conference on Food Standards in 1962 and favoured in that food additives headed the summary listof principle the establishment of a Codex Alimentarius priorities contained in paragraph 58 of the report. Commission, but had a few remarks to make. In conclusion, he stressed that the governing bodies First, traditions, past developments and present of FAO had on several occasions indicated the great situations with regard to food standards differed from importance they attached to WHO's participation in the one region to another and it would not be possible in work on food standards.They regarded such parti- the near future to obtain many relevant results for a cipation as highly desirable for three reasons :first, Codex Alimentarius on a world -wide basis. It would be becauseofitsobvioushealthaspects; secondly, preferable for the time being to concentrate on work because many countries dealt with food standards at the regional level, in which good results had already through their ministries of health; and thirdly, because been obtained. COMMITTEE ON PROGRAMME AND BUDGET :EIGHTH MEETING 223
Secondly, more attentionshouldbegivento food code and since the Second World War it had protecting the health of the consumer and to ensuring started the publication of handbooks on food quality that he could really know what he was buying.He standards and uniform methods of analysis, which inc- also agreed with the other main purpose of the pro- luded principles of food hygiene.Control of food posed Commission -the development of the food products was now highly developed, and the centraliz- trade.Experience in Austria, however, showed that ed direction under the socialist regime facilitated the care must be taken not to interfere with private com- solution of questions of principle, including those con- petition. In that connexion he referred to Article 8 of nected with prophylaxis. No special food code com- the proposed statutes of the Codex Alimentarius mission had as yet been established, but the authorities Commission, which provided that contributions to responsible for disease control measures had at their the trust fund from which the operating expenses disposal a committee of experts whose work was in were to be defrayed could be accepted only through effect a contribution to the preparation of a food code. or with the approval of the government concerned. He therefore considered that Czechoslovakia was in a In his view it would be preferable to lay down that only position to make a positive contribution to the pro- directcontributions from governments might be posed programme. accepted. Regarding the programme of work, he considered When arrangements for financing were reviewed by that the foodstuffs to be considered by the Codex the FAO Conference later in the year, careful consider- Alimentarius Commission should include beverages, ation should be given to whether all the expenses of particularly soft drinks and, as far as alcoholic drinks preparatory work on draft standards undertaken by were concerned, beer and other hop products; and that existing regional groups could not be defrayed by it should also consider the question of food additives. the Commission, as otherwise countries participating Dr KRUISINGA (Netherlands), commenting on the in such groups would have to meet those costs twice draft resolution recommended by the Executive Board over. Such a decision in favour of work on a regional in its resolution EB31.R34, said that his delegation basis would accelerate the pace of the programme as agreed in principle with paragraph 1, which provided a whole. In the light of the above observations he proposed for the establishment of a joint FAO /WHO programme on food standards and of the Codex Alimentarius the deletion of paragraph 4 of the draft resolution Commission.It was important, however, to consider recommended by the Executive Board in its resolution the extent to which the Commission could and would EB31.R34 and the insertion in its place of three para- serve the interests of the regional group. As the Com- graphs reading as follows : mittee was aware, the Codex Alimentarius had been an 4.EXPRESSES the hope that the Codex Alimenta- Austrian initiative and had originally been intended rius Commission will give priority to the health asapurely European undertaking to safeguard aspects in its work and will further preparatory work public health and protect consumers against frauds on a regional basis; in the food trade. The setting up of a European 5. REQUESTS the Director -General to take steps to Council of the Codex Alimentarius had given rise to ensure the fullest participation of WHO in the pro- difficulties, and it was accordingly most gratifying posed foods standards work; and that the work could now continue under the auspices 6. REQUESTS the Director -General to submit a fur- of FAO and WHO. It would be necessary to clarify ther report on the progress of the work of the Codex whether the purely European activities would also be Alimentarius Commission. promoted under the special trust fund referred to in Article 8 of the Statutes of the Codex Alimentarius Dr DOUBEK (Czechoslovakia) said that his Govern- Commission. ment would like to participate actively in the proposed He wondered, furthermore, whether it would be programme. Czechoslovakia both imported and expor- possible for WHO to expand its work on foods stand- ted food products and his Government was interested ards and to be remunerated for such additional activ- in the establishment of standards -particularly stand- ities by the trust fund. It must be clearly understood ards of hygiene -in order to facilitate international that work undertaken on the Codex Alimentarius was trade.It already had considerable experience in that primarily intended to serve as a measure for the pro- regard : as long ago as 1937 it had published a national tection of health. 224 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
He foresaw certain difficulties arising out of para- try. For some years past a central committee for food graph 2 of the Executive Board's proposed resolution. standards, dealing with all natural and processed food- While reference was made in that paragraph to the stuffs and beverages, had been functioning in India, and adoption of the Statutes of the Codex Alimentarius that work was still continuing. Although the occasion- Commission, which included Article 8 relating to the al difficulties that had arisen in the past owing to the special trust fund, paragraph 4 of the same draft resolu- discrepancies between standards in the various coun- tion requested the Director -General to report to the tries were to some extent to be expected, and were thirty -third session of the Executive Board on the dependent on differing conditions, generally acceptable outcome of the review of the method of financing the international standards were desirable, not only for the work of the Commission to be made by the FAO primary purpose of health, but also in the interest of Conference in November 1963.It therefore seemed the import and export trades. somewhat premature to approve the principle of the trust fund. Dr FLEURY (Switzerland) said that his delegation His delegation's view on that point was further supported the considerations raised by the Austrian delegate. strengthened by the general principle, to which his Government subscribed, that all WHO's activities It was his own experience that food standards showed great divergencies as between countries and regions. should be financed by the regular budget and not by Undoubtedly the establishment of accepted standards means of special accounts.Acceptance of Article 8 at the regional level afforded more immediate possi- of the Statutes might, moreover, give rise to possible bilities of success than did that of world -wide inter- difficulties as a result of contributions from non- nationalstandards; infact,tangibleresults were governmental sources that might not reflect govern- already apparent in that sphere.It was therefore mental policy in a particular matter. Any contribution essential not only to provide for regional consideration by his Government to the work of the Codex Alimen- of the problem at the request of he Codex Alimentarius tarius at the outset should not be taken as implying Commission but to preserve the right of regional bodies unqualified approval of the procedures envisaged. He to initiate such a study. would urge the Director -General to investigate further the points to which he had called attention, and par- The DEPUTY DIRECTOR- GENERAL, notedthat ticularly the possibility of WHO including activities general agreement existed on the need for achieving relating to the Codex Alimentarius under its regular standardization.Comments had been made on the budget. resolution adopted by the Executive Board and reser- Commenting on Article 6 of the Statutes of the vations had been expressed on certain provisions in Codex Alimentarius Commission, he requested clarifica- the Statutes of the Codex Alimentarius Commission, tion as to the type of subsidiary body it was envisaged which had been adopted by the FAO Conference. that the Commission might establish.He wondered It would not be appropriate for any reply to be given whether the European group would be included among to the various questions that had been raised in the such bodies, and whether there was any guarantee that Committee without previous consultation with FAO the necessary funds referred to would be available. and without taking legal opinion.He accordingly He supported the amendment proposed by the suggested that, in order to allow for that, further con- Austrian delegate. sideration of the item should be deferred until later in the session. Dr CHADHA (India) said that his delegation fully The CHAIRMAN considered the suggestion made by endorsed the recommendation in resolution EB31.R34 the Deputy Director -General to be sound. Following regarding the establishment of the Codex Alimentarius Commission. It was most important that international such consultation, the Committee would resume con- sideration of the item and decide what recommenda- standards should be drawn up for all foodstuffs and tion to formulate to the Health Assembly. beverages; in particular, questions of food additives, colouring matters used, and methods of processing (For continuation of discussion, see minutes of the seventeenth meeting, section 5). foodstuffs should be considered. The matter was of intense concern to his own coun- The meeting rose at 5.45 p.m. COMMITTEE ON PROGRAMME AND BUDGET : NINTH MEETING 225
NINTH MEETING Friday, 17 May 1963, at 10.35 a.m. Chairman: Dr V. V. OLGUÍN (Argentina)
1.Second Report of the Committee would cover most aspects of theoretical and clinica Dr SENTICI (Morocco), Rapporteur, read the draft medicine. The aim was to give the students a scientific second report of the Committee. training that would permit them to continue research Decision : The report was adopted (see page 408). work independently and initiate and direct research in their own countries.It was important, therefore, that 2.Review and Approval of the Programme and Budget students should have adequate financial resources to Estimates for 1964 (continued from the sixth continue scientific activities on their return home. meeting) The WHO medical research programme presented in Agenda, 2.2 1959 had laid down principles for research training and had recommended the provision of grants for senior Detailed Review of the Operating Programme research scholars and junior research students.The Agenda, 2.2.3 Organization could give invaluable help and encourage- The CHAIRMAN drew attention to the proposed pro- ment to the Swedish project by providing long -term gramme and budget estimates for 1964 (Official Re- junior fellowships for post -graduates from the develop- cords No. 121) and to the comments of the Executive ing countries.He hoped that the Secretariat would Board (Official Records No. 125). After reminding the consider the possibility. Committee that the budget ceiling had already been dealt with and that the Committee on Administration, The CHAIRMAN said that the suggestion would be Finance and Legal Matters had considered Part I of the noted. proposed programme and budget estimates (see page 366), he invited the Committee to consider Part II, Section 4.3Health Statistics section by section. There were no comments. Section 4.1Offices of the Assistant Directors -General There were no comments. Section 4.4Biology and Pharmocology Dr FISEK (Turkey), referring to section 4.4.3, Phar- Section 4.2Reaserch Planning and Co- ordination maceuticals, inquired whether any action had been Dr TOTTIE (Sweden) said that the Sixteenth World taken since the Fifteenth World Health Assembly to Health Assembly had brought out the importance of provide governments with information on new drugs, laying sound scientific foundations for public health and particularly on their harmful effects. activities. The general discussions had produced many instances of the need to develop medical research in Sir George GODBER (United Kingdom of Great countries which lacked the necessary facilities. His own Britain and Northern Ireland) was interested in the country, which attached the greatest importance to the same point : he had been unable to find any evidence in promotion of medical research as a means of improving the proposed programme and budget of an increase in medical care and raising public health standards, had work or staff for investigating the toxic effects of drugs, already embarked on a project for helping post- existing as well as new. graduate students from the developing countries to obtain education and training in medical research. The DIRECTOR -GENERAL suggested that discussion on the item should be deferred until item 2.8 of the As a first step, an international school of medical agenda (Clinical and pharmacological evaluation of research was to be set up, under the sponsorship of the drugs) came up for consideration, when a full expla- Karolinska Institutet in Stockholm, to provide scien- nation would be given of WHO's present and future tific training for graduate students from countries that activities. lacked the resources for training. The training, which would cover a period of between two and three years, It was so agreed. (See minutes of the fourteenth meet- would include practical research as well as theory and ing, section 3). 226 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Section 4.5Malaria Eradication Agreement relating to seafarers. The time had come There were no comments. for a world -wide review of techniques and practices for contact tracing so that national and international Section 4.6Communicable Diseases standards could be improved. It would also be useful Dr TOTTIE(InternationalUnionagainstthe if a study could be made of legislation in different Venereal Diseases and the Treponematoses), speaking countries to ascertain how far legal provision was made attheinvitationoftheChairman,referredto for action in case -finding. He also suggested that WHO section 4.6.2 and stressed the need for international might consider the possibility of establishing an inter- co- operation on a non -governmental basis to comple- national method of reporting contacts.The Union ment the work of WHO.The Union, which had would also devote attention to research on the labor- enjoyed official relationship with WHO since 1948, atory and epidemiological aspects of venereal diseases, was grateful to WHO for its support and would con- for many vital problems were still unsolved. tinue to co- operate fully in the future. The Union was ready to give WHO its full co- New developments in the sphere of venereal diseases operation in the field he had outlined. and their recrudescence in many countries called for a reorganization of the Union's activities to meet the The CHAIRMAN thanked the observer for the Inter- needs of different countries and different regions. national Union against Venereal Diseases and the Treponematoses for his statement and assured him The process, which was already under way, would that his remarks would be taken into account in include the establishment of regional offices in addition connexion with WHO's future work. to the two that already existed for the Americas and for Europe. Professor CRAMAROSSA (Italy), referring to section Apart from a number of technical and other 4.6.3, Veterinary Public Health, said that WHO had meetings, the Union had recently organized a con- conducted valuable and interesting research on the ference in Brussels to study the problems caused by leptospiral infections. Italy had co- operated in studies recrudescence of venereal disease, and a meeting in on the frequency of infections in Ceylon, the results Cracow on non -gonococcal infections.The Union's of which had been reported at the present Assembly. General Assembly in Washington in 1962, the " World There was also serological evidence of a wide diffusion Forum onSyphilis and Other Treponematoses " of leptospirosis in Laos.It would be useful if WHO and the XII International Dermatological Congress would promote and support similar surveys, parti- that followed it had provided a useful basis for future cularly in the Asian rice -growing countries, so that with work, which would be focused on medical education a knowledge of the frequency of infections it might be and research, methods of contact tracing, psychological possible to obtain a picture of the pattern of infectious aspects of human behaviour in relation to venereal diseases in those countries.It would thus be possible disease, and health education. to reduce the number of unknown fevers and avoid He then commented on some of the more important mistakes in diagnosis -for leptospiral infections were problems which the Union intended to tackle with a sometimes confused with other better -known infections view to bringing venereal diseases under control and such as malaria. eliminating them as a public health problem.An Dr TURBOTT (New Zealand) asked for information important subject on which studies should be continued on immunization against leptospirosis, which was a and extended was promiscuity in special groups of the matter of great interest to his own country. population, such as adolescents, immigrants, homo- sexuals and prostitutes.Since success in combating Dr KAPLAN,Chief,VeterinaryPublicHealth, venereal diseases depended largely on the medical replied that WHO had been studying the use of human profession and their ability to understand the epidemio- vaccine for a number of years, and experiments in the logical and clinical problems, it was important to Italian rice fields and in Spain had produced fairly ensure proper teaching of the subject at undergraduate encouraging results. The vaccine had now been and post -graduate levels.It would be useful if WHO recommended for use under control conditions. It was could undertake a study of medical education in that important to use strains of leptospirosis prevalent in field.The tracing and interviewing of contacts were the region concerned because of the specificity of the essential measures in epidemiological control, but in immunity produced.Careful study was needed, with many countries the percentage of contacts traced and theidentification of leptospirosis sero -typesina treated was very small; despite the effects of rapid particular region, which was made possible because modern travel, there appeared to be no effective inter- the leptospirosis reference centres had a standard national arrangements for tracing contacts and few procedure for identification and comparison. He countries had used the facilities of the 1924 Brussels would be happy to supply the delegate of New Zealand COMMITTEE ON PROGRAMME AND BUDGET : NINTH MEETING 227 with more detailed information on the present situation page 33 of Official Records No.121 would keep and on methods of preparing vaccine. the point well in mind. Dr CLAVERO DEL CAMPO (Spain),referring to Dr CHADHA (India) inquired if the smallpox pro- section 4.6.4, Virus Diseases, stressed the importance gramme would be discussed in detail at a later stage. of epidemic typhus; it was a subject of concern to He welcomed WHO's work on virus diseases, which many countriesand required more fundamental were a particularly important problem for India, study. Although theDirector -General'sReport where there were many undiagnosed fevers and indicated that a programme was being prepared on the infections of virus origin. subject, he could find no reference to it in the proposed Dr LISICYN (Union of Soviet Socialist Republics) programme and budget. associated himself with the questions asked by the Professor CRAMAROSSA (Italy), also speaking on United Kingdom delegate. He welcomed the studies section 4.6.4, stressed the need for action by other on respiratory virusinfections under Contractual agencies as well as WHO, and by the countries con- Technical Services (No. 87) and asked whether more cerned to combat trachoma, which was widespread detailed information could be given. He was surprised in many tropical and subtropical countries.Efforts to see no provision under Contractual Technical were meeting with mixed results, for a serious obstacle Services for a study on infectious hepatitis, which was the occurrence of reinfection owing to unsatis- was a serious disease and was spreading in many countries, and asked what were the plans for under- factory local environmental conditions.Small -scale taking a study on that important subject. experiments with anti -trachoma vaccines were being conducted to an increasing extent but it was difficult Professor GERIé (Yugoslavia) asked whether there to assess the results. It would be useful if WHO could were any plans for research on measles, particularly in conduct a wide -scale field trial to establish the efficacy the production and testing of vaccines against the disease. of vaccines.If the results were satisfactory, people Measles was one of the most serious of the infectious in the danger areas could be protected from the disease. diseases and caused many deaths in his country.It also had an adverse effect on the national economy, Dr SUBANDRIO (Indonesia) described how in Indo- particularly in countries which were rapidly developing. nesia as a first step towards integrating the public Widespread efforts were being made to find a satis- health services in rural areas with the malaria eradic- factory method of immunization, and in Yugoslavia ation service, a board for the control of communicable a live vaccine had been prepared which had produced diseases had been set up, with the director -general of immunity in 98 per cent. of cases. The only problem the malaria eradication campaign as its chairman. that remained to be solved was the reaction, which, In Java, which contained approximately two- thirds while relatively slight, was stronger than considered of Indonesia's population, the services had hitherto desirable. Some countries, including the United been developed independently, but a start was being States of America, advocated the simultaneous use made towards integration now that the malaria of vaccine and gamma -globulin, which to some eradication campaign in Java was reaching the con- extent lessened reaction, but gamma -globulin was very solidation phase.It was intended to begin by using costly and often difficult to obtain. the malaria eradication facilities for smallpox eradic- Although WHO was fully aware of the seriousness ation in Java and later in the other islands.It was of the measles problem and had organized a number hoped that the entire population would have been of field studies, the subject did not appear to be included vaccinated against smallpox by the end of 1964. in the proposed programme. Comparative tests had Sir George GODBER (United Kingdom of Great been made in Yugoslavia of the American and Yugo- Britain and Northern Ireland) said he had been unable slav vaccines, using each with and without gamma - to find any reference to the development of immuniza- globulin, and results showed that the Yugoslav vaccine, tion against measles, although it was clearly going even without gamma- globulin, produced less strong to be one of the important advances in the coming reactions than the American vaccine. Intensive studies two or three years. He also pointed out that although were being continued and it was hoped that vaccination the references to smallpox control mentioned gamma - would start before the end of the year in the areas globulin, there appeared to be no mention of the where measles was most prevalent, and that in 1964 development of a killed antigen against smallpox, it would be possible to vaccinate the whole population. which was likely to become important as the smallpox Dr KAUL, Assistant Director -General,Secretary, eradication programme using live vaccine progressed. replied to questions asked during the discussions. He hoped that the expert committee referred to on With regard to the question of typhus, raised by the 228 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
delegate of Spain, he said that provision had been Professor CORRADETTI (Italy), referring to section made for a meeting of scientific experts on rickettsioses 4.6.5, Parasitic Diseases, said that, while agreeing in 1963, which would review the situation and make that WHO must limit its activity on leishmaniasis at recommendationsforfutureresearchandother the present stage to the study of epidemiological activities, including the setting up of reference services. factors and to experimental research, he nevertheless In reply to the delegate of Italy, who had asked for considered that more needed to be done than was pro- large -scale field trials of trachoma vaccine, he explained vided for under the 1964 programme. For instance, that the problem was still in the preliminary experi- no provision was made for investigation of the disease mental stage.New vaccines were being studied in in the Mediterranean area.Since it showed a great several parts of the world and if limited trials gave variety of epidemiological patterns the disease needed satisfactory results it would be possible to embark on to be investigated in the majority of areas where it was larger -scale experiments or campaigns. endemic. Basic research, such as that being carried out in Jerusalem, in the form of comparative studies of With regard to the comments on a measles vaccine, Leishmania strains, should be encouraged and ex- WHO was at present supporting field studies in Chile, tended; present knowledge was not adequate for Brazil,Yugoslavia, India, Japan, the USSR and pointing the way to eradication of the disease. South and West Africa. Studies had produced valuable The same was true for filariasis and malaria.He information on the use of vaccines and on the use of could notagreethatfieldinvestigations should gamma -globulin in association with vaccines.The have priority over basic laboratoryresearch; the results would be published as soon as the reports had value of the former was limited to the area involved, been completed.Experiments were also being made whereas the latter might lead to results capable of with a killed virus vaccine and with a combination general application and therefore give a better return of killed and live vaccines. for the funds expended. Smallpox was the subject of item 2.4 of the agenda. Dr MONTALVAN (Ecuador) regrettedthatlittle Provision had been made for an expert committee on provision seemed to have been made under trypano- smallpox in 1964, which would review the smallpox somiasis studies for investigating the disease in the eradication programme and existing knowledge on vaccines, immunology, epidemiology and research. Americas. That was a gap that should be filled. Field investigations should be carried out as well as Several virus diseases, including those produced by general biological studies and investigation of the arthropod -borneviruses,werebeingstudiedby sensitivity of disease vectors to residual insecticides. scientific groups and WHO was gradually developing A study on chemotherapy was also indicated, as no a wider programme, but the number and extent of the effective remedy had as yet been found for Chagas' diseases was so great that it was necessary to obtain disease. information from field and laboratory research. The SECRETARY explained that limited resources and With regard to infectious hepatitis, experts were manpower accounted for the small amount of work visiting a number of countries to investigate the being done on such diseases as leishmaniasis. As the epidemiology of the disease, and an expert committee possibilities offered, the programme would be gra- would be meeting in December 1963 and would review dually expanded and developed. A research centre for the epidemiological information collected and also the Leishmania strains found in the Mediterranean area in evidence on " candidate " viruses.It was true that at particular was being established and some consultant the present WHO was not giving any help for research studies initiated to survey the position of leishmaniasis. on the disease, but the Organization was waiting for In regard to filariasis, long -term research was being the expert committee to review the situation before started with a programme centred in Rangoon, Burma. deciding where support was needed for study and It was hoped that the information obtained on ento- research. mological and epidemiological aspects would lead Epidemiological studies on respiratory virus infec- to the development of appropriate control methods. tions had been carried on since 1960 in co- operation In addition to the research activities on Chagas' with the British Medical Research Council under disease being undertaken by the Pan American Health ContractualTechnicalServices(No.87). They Organization, a number of physiological studies on included studies on human volunteers and field surveys trypanosomestrainswereproposedunderthe to find out which viruses affected the upper respiratory Voluntary Fund forHealth Promotion(Official tract.A number of viruses had been isolated and Records No. 121, Annex 4).Although efforts would identified and efforts were now being made to find be made gradually to extend such research to cover methods of controlling them. other aspects, including chemotherapy, the need at the COMMITTEE ON PROGRAMME AND BUDGET : NINTH MEETING 229
moment was for more fundamental studies to gain the for preparing a manual on that subject. In the discus- basic knowledge on which to build a control pro- sion of the proposed programme and budget estimates gramme. for 1963, he had expressed the hope that a doctor would There were no comments on section 4.6.6, Bacterial be included in the editorial staff for the manual to Diseases. ensure that the medical aspects of hospital planning were fully covered. In view of the importance and the Dr CHADHA (India),referring tosection4.6.7, complicated nature of hospital planning, including Leprosy, asked whether any work was being done to the need to take account of the social structure and evaluate the effectiveness of BCG vaccination as a other conditions of the community to be served, he protection against leprosy. would appreciate information on the progress being The SECRETARY said that a number of studies had made in the preparation of the manual. already been undertaken on the matter and more Dr FISEK (Turkey) said he too would like informa- were proposed, both under the research programme tion on the subject. and in the form of field investigations.The Secre- He thanked the Director -General for the recent tariat specialist on leprosy would give more details. publication on thecost and financing of health Dr BECHELLI, Chief, Leprosy, stated that there was services,' which was a work of great value. He hoped evidence that BCG vaccination might causethe that more information on that subject would eventually conversion of the lepromin test in persons who were be made available after further work. lepromin- negative. Sinceapositivereactionto Dr CHADHA (India) said the question of hospital lepromin was regarded as an expression of a certain planning was oneof great importanceforthe amount of resistance to Mycobacterium leprae, many developing countries. In view of their limited.resources, doctors, in view of those findings, recommended the it was important that buildings to be erected for use of BCG in the prevention of leprosy.However, hospitals, dispensaries, health centres and so on should certain facts must be cleared up; for instance,it be inexpensive and utilitarian in type. The designs for seemed that in a small part of the population (10 -15 buildings should also be suited to the climatic con- per cent.) lepromin reactivity remained unchanged ditions.Work on those lines should be undertaken after BCG vaccination. On the other hand, extensive by the Organization. testing of the population, before the studies with BCG Sir George GODBER (United Kingdom of Great were started in leprosy, had shown that after twenty Britain and Northern Ireland) said he shared the con- years of age some 80 per cent. of the population were cern of the previous speakers.Guidance in hospital lepromin reactors. Would, therefore, the anticipation planning to suit the wide range of conditions through- of lepromin conversion be useful to the individuals out the world was a big undertaking but one that exposed to M. leprae? Would BCG be useful to those might be well worth while; it would need much more who were persistently lepromin- negative ? Should provision than was proposed under the 1964 pro- BCG mass vaccination be used when only a small part gramme. of the population needed protection ? Field and other Dr TURBOTT (New Zealand) said he was most studies were necessary to determine the action of BCG doubtful about the value of the proposed manual. in leprosy prevention. In view of the great interest in Each country had to investigate for itself the type of solving that problem, WHO had planned and would structure that would best suit its own peculiar needs; carry out a BCG trial in Burma which, it was hoped, otherwise the result would be merely to copy what was would provide some of the answers toexisting being done elsewhere and that, as his own country's doubts. experience had shown, was highly unsatisfactory. There were no comments on section 4.6.8, Inter- national Quarantine. Dr CHADHA (India) said that the whole object of his request that WHO prepare designs for use in Section 4.7Public Health Services tropical regions was to avoid following unsuitable There were no comments on sections 4.7.0, Office examples.Any research needed to determine the of the Director, and 4.7.1, Public Health Administra- most appropriate kind of structure should be under- tion. taken by WHO. Professor PESONEN (Finland),referringtosec- Dr ADENIYI -JONES (Nigeria) said he was also con- tion 4.7.2, Organization of Medical Care, said he vinced of the value of collecting material and evaluating assumed that the proposal to add a technical assistant the usefulness of different types of hospitals.In that to help collect and classify information on hospital 1 Abel- Smith, B. (1963) Paying for health services,Geneva planning and organization was related to the project (Wld Hlth Org. Publ. Hlth Pap. 17). 230 SIXTEENTH WORLD HEALTH ASSEMBLY, PART H way, the developing countries would gain the benefit was ripe for full integration of medical and public of experience elsewhere and avoid making the same health services and a group of experts should be formed mistakes. An attempt should be made to ensure that to consider hospital planning in that context. hospital designers included facilities for the practice of preventive and social medicine. That would be Professor GORNICKI (Poland) pointed to the need one means of obtaining the integration of services forproviding teachingfacilitieswithinhospitals. so generally desired. That aspect should not be lost sight of.
Dr TORRES BRAMACAMONTE (Bolivia) also thought it Dr GUNARATNE (Ceylon) suggested that a hospital would be valuable to the developing countries if architect be provided for each region, since the climatic WHO were to study the planning of hospitals for conditions varied so widely.After hearing from the integrated curative and preventive services. individual countries the requirements to be met, each architect would be in a position to design a building Professor TRAN DINH DE (Republic of Viet -Nam) suitable to their needs. said that, given the great variety of climatic conditions and levels of development throughout the world, Dr GRUNDY, Assistant Director -General, remarked there could be no single standard hospital that would that it was plain from the discussion that there was be suitable everywhere. However, minimum standards some apprehension about the role WHO was playing could be laid down for such matters as air -space per or might assume in relation to hospital architecture. bed, number of doors and windows, and width of He could reassure the Committee that there was no corridors. He accordingly supported the provision to intention of trying to produce manuals on hospital developing countries of consultants in the matter.It planning giving detailed guidance on the type of would be important that experts appointed for that structure needed for different parts of the world. task should either have previous experience of the That was a matter largely for national architects. type of country they were assigned to or stay long Instead, WHO was trying to concentrate on the enough to learn about local conditions and needs principles underlying hospital functions as a guidance before attempting to give advice. to the planning of the hospital structure.In other words, it was concerned with the methodology Dr AMMUNDSEN (Denmark) said she was doubtful planning.The small group undertaking that work of the value of spending too much money on a study had been composed of three doctors, a medical of hospital planning. Even in a small country like administrator, a medical specialist in laboratory work, her own, the needs to be fulfilled varied so greatly a psychiatrist (to cover mental hospital aspects), a that no two hospitals were alike.The same applied nursing expert and an architect. The manual prepared to other countries. was again under consideration by a an expert group and before publication would be submitted to members Mr FERAA (Morocco) supported the work being of the Expert Panel on Organization of Medical Care done by WHO in the matter.Experience in his own for comment. country had shown that mistakes could be made in the The relatively small provision of $2000 included in absence of guidance.Priority had been given under the 1963 budget and not repeated was to provide for the five -year plan to improving dispensaries and the obtaining of hospital blueprints for inclusion in health centres for preventive work. Work was now the manual. going to begin on hospitals to cover the curative The Director- General appreciated the point made aspect, and the authorities were experiencing diffi- about the importance for the developing countries culties in deciding upon the type of functional unit to in particular of considering hospital planning in con- adopt, both for individual services and for the hospital junction with planning for the health servicesin It would therefore be of great value to as a whole. general. Increasing attention was being given in have information on designs adopted indifferent investigations to the functions of the general practi- countries. The study might be carried out by a com- mittee which would investigate all aspects, taking tioner and of health units in relation to health services account of the organizational structure of the countries as a whole and in particular to hospital requirements. concerned, morbidity rates, and different trends in the The additional post of technical assistant was not health structure. directlyassociated with the manual on hospital planning; the task of the person concerned would be Professor SANGSINKEO (Thailand) endorsed the views to help in collecting and classifying information on expressed by the delegate of Viet -Nam.The time hospital planning and organization in connexion with COMMITTEE ON PROGRAMME AND BUDGET : TENTH MEETING 231 study of the cost and financing of health services. A ultimate aim of getting comparable hospital and preliminary study on that matter had been undertaken cost statistics for publication, as had been done in in six countries and it was planned to extend the scope respect of vital statistics. of the inquiry. The main purpose was to get definition of and uniformity in systems of accounting, with the The meeting rose at 12.25 p.m.
TENTH MEETING
Friday, 17 May 1963, at 2.30 p.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1.Review and Approval of the Programme and Budget had beneficial repercussions on the home and socia Estimates for 1964 (continued) background.Particular attention should be given to Agenda, 2.2 school health work in the newly developing countries, where educational facilities were in the process of Detailed Review of the Operating Programme (con- being organized. Thus, the population of those tinued) developing countries could from the outset become Agenda, 2.2.3 health- conscious. Section 4.7Public Health Services (continued) With regard to maternal care, it should be borne in mind that more than half the deliveries that took place ProfessorGORNICKI(Poland),commenting on in the world every year lacked obstetrical attention, section 4.7.5, Health Education, referred to the im- resulting in the annual death in child -birth of about a mense distance that separated the latest discoveries in million mothers and ten million new -born infants. medicine and public health from the level of knowledge He accordingly suggested that high priority should in those subjects of the mass of the population. Health be given to conducting a survey of the existing state education was a work of instruction and information, of maternity work throughout the world. To eradicate the scientific basis of which had biological, pedagogical, suffering for millions of women in child -birth was as sociological and other aspects. He wondered whether important as to eradicate the major communicable there existed any central supervision for unifying that diseases. scientific basis, possibly by means of the expert panel and committees referred to under subparagraph (4) Professor TRAN DINH DE (Republic of Viet -Nam) of the functions and responsibilities of the unit. associated himself with the remarks made by the previous speaker, particularly on obstetricalcare. Dr GRUNDY, Assistant Director -General, confirmed From the specific point of view of the developing that one of the functions of the expert advisory panel countries, where it was clearly impossible at the and the committees referred to was indeed to provide a present time for all deliveries to be attended by doctors body of expert advice to the technical units as required. in view of the shortage of medical personnel, con- sideration should be given to the possibilities for Professor DE HAAS (Netherlands) said, in respect of training an adequate number of midwives, who, in section 4.7.6, Maternal and Child Health, that his accordance with the system followed in France and in delegation welcomed the broadening of the activities many countries with French influence, should be able undertaken under that heading to include health to cope with all normal deliveries, as well as being problems of adolescents.The subject was ofgreat able to recognize when expert attendance was required importance, since after all adolescents were the parents in cases of difficulty.There could be two main and workers of the future, and hitherto it had been categories of midwives trained :those who would be somewhat neglected by WHO. fully qualified after three or four years, and those He hoped that WHO's activities in school health who would receive an accelerated training lasting one work would be further intensified, since that type of year, which should enable them to serve in the rural programme could be organized relatively easily and areas. 232 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Obstetricsgenerally, and the careof pregnant developing countries. Dental health and health educa- women, as well as post -natal care and care of new -born tion in schools formed part of WHO's continuing infants, had hitherto been given insufficient emphasis by activities.The questions of medical inspection and WHO and it was desirable for such activities to be care, physical training, and the use of school records intensified.While obstetrics constituted one of the for research were at present under consideration. major branches of medical training, the number of Seminars on child health had been held at the regional doctors specializing in it afterwards was comparatively level, and an inter -country seminar on child health lower than in other branches, and that discrepancy was and the school would be held in the Netherlands in even more marked in the newly developing countries. August 1963. Midwifery training, along the lines he had suggested, With regard to obstetrical care, WHO's functions seemed the best solution at present, and would con- were essentially those of providing central intelligence stitute a real contribution towards a humanitarian and guidance and of seeking to assist projects in the purpose. regions according to local conditions and needs. An Dr NAYAR (India) supported the statements made by expert committee was to be proposed for 1965 on the the delegates of the Netherlands and the Republic of role of nurse midwifery in maternity care. An expert Viet Nam. committee would be held in June 1963 on the social aspects of the teaching of obstetrics. WHO was also School health was a vitally important question, not conducting a comparative review of home and hospital only as regards the detection of defects and their correc- confinements which included an assessment of the tion but also as regards the determining of methods social and other factors that determined the choice. that could be used in countries where there were insuf- WHO had collected a large number of statistics on ficient trained personnel. The subject was worthy of child -birth and on the organization of maternal and study by WHO with a view to a broader dissemination obstetric services and it was hoped to expand those of knowledge on possible methods. activities and make them as complete as possible. While much had been done in maternal and child health, there could be no doubt that a general review of Sir George GODBER (United Kingdom of Great the situation of obstetrical care in the world was long Britain and Northern Ireland), commenting on the overdue.More midwives were needed, as had been reference made by the Assistant Director -General to emphasized by the delegate of the Republic of Viet - the comparative study on home and hospital confine- Nam, and it was also essential to ensure that the best ments, stressed that such a comparison could only be use was being made of existing staff.Some useful done prospectively with accurate controls. That had expert studies had been carried out in a number of been attempted for many years in the United Kingdom countries and it was desirable that WHO should make without success. He was accordingly most interested such knowledge available to other countries, in par- in any such undertaking by WHO but hoped that it ticular to those in the process of development. would be made in that form. While physical needs in maternal and child health were important, increasing attention should also be Section 4.8Health Protection and Promotion given to the mental health aspects of the question. The Professor PESONEN (Finland), commenting on sec- role of the school- teacher in that respect could usefully tion 4.8.1, Social and Occupational Health, drew atten- be explored further. tion to the extremely wide range of subjects covered in sub -paragraph (1) of the paragraph listing the func- Dr GRUNDY said that while WHO was doing tions and responsibilities of the unit, and particularly considerable work in school health and obstetrical stressed the reference to the provision of technical care, there nevertheless remained a great deal to be guidance on rheumatic disease and other chronic non - done. He assured the Committee, however, that communicable diseases not otherwise covered, and to there had been much thinking and planning within problems of social medicine connected with aged per- the Organization in both fields over the past year. sons. Although a systematic review of WHO's work in It had been observed that the age structure of the school health had not been undertaken in recent years, population in many countries was changing rapidly and the Organization was contributing towards such work that old people were coming to play an increasing role in other parts of its programme : through programmes in the life of the community. Experience showed that on the nutrition of schoolchildren undertaken jointly the extent of medical services required by old people with FAO, and through programmes conducted joint- was four times greater than for other groups of the ly with UNESCO for teacher training in health educa- population. Consequently, the world -wide demand for tion, and to promote school health services in the health services was increasing ever more rapidly. COMMITTEE ON PROGRAMME AND BUDGET : TENTH MEETING 233
Because of what had been achieved in medical research, Dr AFRIDI, representative of the Executive Board, it was now known that many diseases were preventable. drew attention to the statement made by the Director- He drew attention to the immense scope of that prob- General and contained in the Executive Board's report lem, without entering into details such as rehabilita- on the proposed programme and budget estimates for tion, etc., and pointed out that it would appear vir- 1964 (Official Records No. 125, Chapter IV, paragraph tually impossible for the Social and Occupational 106), to the effect that a re- examination of the work of Health Unit, with the two medical officers proposed for the Social and Occupational Health unit appeared to it in the budget estimates for 1964, to deal with all the be warranted. problems listed as its responsibility.The Director - General should consider the possibility of establishing Dr DOROLLE, Deputy Director- General, confirmed a special unit relating to the medical and public health that the Director -General considered that the functions problems of the aged. While he welcomed the increas- and responsibilities of the Social and Occupational ing attention being paid in the European Region to Health unit were still too broad, and that he intended that problem, it was necessary for it to be given more to continue, when circumstances permitted, the trend, universal consideration. already begun, of narrowing its work.
Dr BRAVO (Chile) recalled that he had had occasion Dr GRUNDY, Assistant Director -General, replying at past Health Assemblies and in the Executive Board to the point made by the delegate of Chile, on the to refer to the International Occupational Safety and International Occupational Safety and Health Infor- Health Information Centre (listed under Contractual mation Centre, recalled that WHO had originally made Technical Services No. 141), to which WHO made an a contribution to that centre for the purpose of sub- annual contribution of $4 000, and that he had request- sidizing sets of cards with up -to -date information for ed that the Organization should maintain some super- countries unable to purchase them themselves. Starting vision of the activities of that centre. According to information he had received, the Centre in 1963, $ 1000 had been set aside for that purpose, was spending an annual amount of $ 160 000 and was the remaining $ 3000 being in the nature of a general providing only limited information; moreover, delays contribution. had been experienced by certain countries in receiving WHO's contribution, together with the good will the information and some had accordingly withdrawn existing between ILO and WHO, ensured that due their support from the Centre. He would appreciate weight was given to the health aspect of the Centre's the opinion of the Assistant Director -General on the work as well as to occupational safety. manner in which the activities of the Centre were pro- gressing, as well as on the benefit that WHO was draw- Dr NAYAR (India) said that it was essential to ensure ing from the expenditure it made.While the sum that WHO placed adequate emphasis on work in indus- involved of $ 4000 was not a large one, it might perhaps trial health, as distinct from what was being done by be possible to effect an economy in that respect. ILO. Industrial health was a most important part of the general health of the population, and occupational Professor ZDANOV (Union of Soviet Socialist Repub- hazards such as diseases arising from mining conditions, lics) expressed the view that the functions and respon- and those due to pollution of rivers by industrial sibilities of the Social and Occupational Health unit effluents, should not be overlooked. appeared to be dispersed over too wide a field and that some reorganization might be desirable. One solution, The DEPUTY DIRECTOR - GENERAL said that, by virtue however, might be to concentrate on two or three main of their constitutional instruments, WHO and ILO had problems rather than to try and cover all the different identical responsibilities regarding industrial health fields.The choice would not be difficult to make : problems. Any potential overlapping was avoided by foremost would come the problem of geriatrics to the institution of joint expert committees and by the which the delegate of Finland had referred; another excellent collaboration between the secretariats of both choice might be the diseases of urban populations, organizations. The specific points to which the Indian which were of growing importance in many countries. delegate had drawn attention were covered by WHO Moreover, it seemed to him that every effort should be elsewhere in its programme, for example under environ- made to utilize the work already being done by nation- mental health. al centres in a number of countries.The unit could then make a comparative study of solutions proposed With regard to section 4.8.2, Mental Health, the for a limited number of problems :to cover all the CHAIRMAN drew attention to a draft resolution on the ground would not be possible, even with a much larger study of the influence of television on youth, proposed staff. by the delegations of Belgium, France, the Netherlands, 234 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II the Union of SovietSocialist Republics and the tion had emphasized the need for establishing priori- United States of America. ties in the work and for seeking to effect economies in marginal activities. Certainly any inquiry into the It read : influence of television could only be termed a marginal The Sixteenth World Health Assembly, activity.Little evidence existed at the national level Aware of the great influence of television pro- that it had so far had any adverse effects on mental grammes and of the risk that those based on violence health.Consequently, the matter should be given an and crime may adversely affect mental health parti- extremely low priority.At all events, investigations cularly of the younger viewers; should first of all be carried out at the national level. His delegation was accordingly opposed to the draft Taking into account the need to obtain a scien- resolution. tific assessment of the effects of such programmes; and Dr CLAVERO DEL CAMPO (Spain) supported the pro- posal. There was no doubt that the cinema also had a Mindful of the different measures taken by govern- considerable influence on youth. Nevertheless,it ments to secure the avoidance of harmful influences, seemed to him appropriate to limit the proposal to 1. STRESSES the educational value of television, with television, in respect of which adequate control of special regard to programmes in the field of health viewing by children did not exist to the same degree. education and medical training; Possibly drunkenness should be added to the undesir- 2.RECOMMENDS that national health authorities able aspects in certain programmes listed by the propos- encourage the study of television influence on mental sing delegations in their introductory note to the draft health;and resolution as that undoubtedly had serious effects on 3.SUGGESTS that the Director -General consider the mental health. possibility of collating the information obtained Dr BOYE- JOHNSON (Sierra Leone) pointed out that from national studies of the influence of television the influence of television was confined to the highly - on the mental health of the viewers, with particular developed countries. The developing countries, on the regard to measures for safeguarding children and other hand, were principally concerned with the effect young adults. of the cinema, which had undoubted repercussions on juvenile delinquency.The cinema might also affect Professor DE HAAS (Netherlands), speaking as one of the sponsors of the draft resolution, said that he hoped adults adversely, since it impaired the national culture His delegation would accordingly that the Committee would not conclude that its inten- in some instances. support the draft resolution but would recommend the tion was to minimize the undoubted value of television. The purpose of the draft resolution was to draw atten- inclusion of a reference to the cinema also. tion to the possibility of the mental health repercus- While he agreed with the delegate of Australia that sions, particularly on children, of many of the pro- investigations could be carried out at the national level, that was applicable only to the highly -developed grammes. countries :the developing countries would welcome Dr ALDEA (Romania) commended the delegations action by WHO along the lines suggested by the that had taken the initiative of raising a problem of draft resolution. great importance for the future of mankind. He whole- heartedly supported the proposal.However, he sug- Dr SAUTER (Switzerland) was in agreement with the gested that it should also refer to the cinema, which draft resolution in principle.It was necessary not to exerted considerable influence on the public in his overlook another aspect of the influence of television own country. on children, namely, that viewing resulted in their assuming a purely receptive and passive role, thereby Professor ZDANOV (Union of Soviet Socialist Repub- limiting the development of their imaginations and lics) urged the Committee to support the draft resolu- creative faculties. He accordingly proposed an amend- tion before it. ment to operative paragraph 3 : to insert after the word "viewers" the words "and especially on their emotional Dr PHILLIPS (Australia) reminded the Committee and intellectual development ". that the resources of WHO were already being used to their maximum extent. It was essential, therefore, that Dr NAYAR (India) supported the point made by the they should be directed towards those problems that delegate of Sierra Leone that the influence of the cinema were of the greatest urgency. Several delegations, inc- was of considerable importance in developing coun- luding that of the Soviet Union, had expressed concern tries. It was accordingly desirable that the draft at the size of the budget; and the United States delega- resolution should take all audio -visual media into COMMITTEE ON PROGRAMME AND BUDGET : TENTH MEETING 235 account.The subject was of great importance and Since general agreement existed on the purpose of warranted WHO's attention. the proposal, it might be possible to amend it some- what in order to limit the expenditure involved still Dr TURBOTT (New Zealand) was opposed to the further.The important point was that the Health draft resolution.Studies of the problem were in fact Assembly should draw attention to the danger that did being carried out on a relatively large scale and their exist in respect of mental health as a result of the findings would shortly be made public.If the list of influence of television. undesirable activities given in the explanatory note were to be amplified, gambling might well be included. Dr BRAKHOTT (Israel) said that his country was on He found it hard to understand how the United the eve of introducing educational television. He States delegation could reconcile its views on the need agreed that it was important for WHO to encourage a for economy in the budget with the proposal. He re- study of the effects on mental health of television. He called that the United States delegation had maintained did not think that there were any very considerable that a constant evaluation of the programme of the administrative and financial implications, and would Organization was necessary in order not to stretch therefore support the draft resolution before the Com- unduly its administrative capacities. The collation of mittee. information requested under paragraph 3 of the draft resolution would tend to dissipate the energies of WHO Professor ZDANOV (Union of Soviet Socialist Repub- staff without real need. lics) did not consider that his delegation's position as co- sponsor of the draft resolution implied any con- Sir George GOOBER (United Kingdom of Great tradiction with the stand it had adopted in respect of Britain and Northern Ireland) fully appreciated the WHO's budget in future years. A study of the matter purpose behind the draft resolution.However, the was undoubtedly necessary and it did not seem to him question was not only vast in scope but was also in- that any great amount of administrative work would fluenced by personal reactions. Furthermore, television result. For WHO, with all the prestige and authority was like other forms of entertainment in that it was at its disposal, to express its concern in the matter influenced by national cultures. would by itself encourage the appropriate national It was essential that WHO should set itself limited authorities to think seriously about the problem. objectives which were attainable.It would be one matter to study national reports available on the in- Dr TURBOTT (New Zealand) pointed out that adop- fluence of television, but it was highly questionable tion of paragraph 3 of the draft resolution would whether WHO could go beyond that with the limited clearly result in administrative expenditure in the form resources available to it.There could, after all, be no of salaries for the staff required to collate the informa- end to the list of types of entertainment that might be tion obtained from national studies. considered undesirable by different people. Professor PESONEN (Finland) referred to the possible Dr GOOSSENS (Belgium), replying to the delegate of ill- effects of television on health as a whole and not Australia, said that his own delegation was in a position just on mental health. Intensive publicity for the use of similar to that of the Soviet Union and United States drugs might well result in their abuse. delegations in that it had also stressed the need for caution regarding increases in the budget in future Dr MoNTALvAN (Ecuador) was of the opinion that years.Indeed, it had expressed the view that WHO the proposal was of great importance for mental should not enter into new activities unless there was an health. There could be no doubt that the influence of urgent need for them.However, while of course the television and the cinema on both adults and the young influence of television could not be considered as an was of such magnitude as to colour their mental and urgent question, the proposal seemed to him valid social attitudes.Accordingly, it was a sphere where since practically no expense was involved in its accept- WHO should show its concern. ance.He was therefore unable to see why certain The expenditure involved was slight. However, the delegations were unable to accept it. moral authority of WHO was such that evidence of While he was in principle prepared to include the its interest in the problem would no doubt influence influence of the cinema in the proposal, he did not think national authorities to improve their television pro- it wise to broaden the draft resolution, as that might grammes and would strengthen any national studies lead to the inclusion of still further subjects.Televi- being carried out. sion, after all, presented the peculiar characteristic of He supported the inclusion in the draft resolution an entertainment which came into people's homes. of a reference to the influence of the cinema. 236 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Dr PHILLIPS (Australia) agreed with the New Zea- also be mentioned in the draft resolution.She hoped land delegate that the additional work, particularly if the proposal would be adopted. broader health aspects were also included, was bound Professor ZDANOV (Union of Soviet Socialist Repub- to have repercussions on expenditure. lics) said he accepted the New Zealand amendment, Dr BRAVO (Chile) thought there was general agree- but only because he was sure that the responsible unit ment that the effects of television on mental health of the Secretariat would in any case do what was required investigation, the only objections being on required in paragraph 3 of the draft resolution even financial grounds. Like many other forms of entertain- without specific instructions. ment which had started quite innocuously, television Professor de HAAS (Netherlands) and Dr CAYLA tended to exercise an increasingly harmful influence as (France), as co- sponsors of the draft resolution, also it developed and expanded.It was important to take accepted the amendment. measures to prevent that process in those countries where television did not yet play a big part in the Dr PHILLIPS (Australia) said that the amendment national life.In Chile there were as yet only two met the objections he had raised. television channels, under the control of the two main Dr GOOSSENS (Belgium) said that, as the last of the universities, so there was for the moment no danger five sponsors of the draft resolution, he readily accep- from commercial influences. ted the amendment, particularly as the declaration of Dr TuRBOTT (New Zealand) proposed as a com- principle, which was all he really wanted, would remain. promise to retain the first two operative paragraphs of He wondered whether the Secretariat could give any the draft resolution but to delete paragraph 3. WHO indication of the amount of expenditure in which the would then be involved in no action, but the desired Organization would be involved by the provisions of recommendation would be made to national health paragraph 3 of the draft resolution. authorities. Dr GRUNDY replied that, in considering the possi- Sir George GODBER (United Kingdom of Great bility of collating information from national studies Britain and Northern Ireland) supported the proposed of the influence of television on mental health, the amendment. For the time being studies would best be Director -General would as a first step have to collect conducted at the national level; when they were further and assess the available facts, and then, as a second developed the Assembly might reconsider whether it step, to collate, epitomize and draw conclusions. For was appropriate for WHO to collate the information the time being, therefore, with or without paragraph 3, the adoption of the draft resolution was unlikely to obtained. involve the Organization in any immediate substantial Dr AMMUNDSEN (Denmark) said she agreed that the expenditure. influence of television, and also of the cinema, on men- Dr WILLIAMS (United States of America), on a point tal health required investigation, but shared the doubts of order, noted that, as all five sponsors of the draft of the Australian and New Zealand delegates as to resolution had agreed to the New Zealand amendment, whether anything useful could be achieved in the mat- paragraph 3 of the draft resolution was no longer ter by WHO without incurring expenditure. She there- before the meeting. fore supported the amendment. Professor PESONEN (Finland) reiterated his opinion Dr WILLIAMS (United States of America) said that, that studies of the influence of television should relate subject to the agreement of the other four sponsors of to health in general. He therefore proposed the dele- the draft resolution, he accepted the proposed amend- tion of the word "mental" in paragraph 2. ment, on the understanding that action by a future Health Assembly on the lines of the deleted paragraph Dr NAYAR (India) again recalled that it had been 3 would not be precluded if it seemed warranted. proposed to insert a reference to the cinema as well as to television wherever applicable in the draft resolu- Dr 1BRAHIM (Somalia) also supported the New tion. Zealand amendment. He suggested that the recommen- dation in paragraph 2 of the draft resolution might be Sir George GODBER (United Kingdom of Great expanded by an invitation to the television producers Britain and Northern Ireland) understood the reasons to conduct an investigation into the evil effects of their which had prompted the proposal to include a refer- own industry. ence to the cinema but felt that the national studies proposed would be diffuse enough even if they covered Dr NAYAR (India) observed that several delegations only television. He also appreciated the reasons for the had proposed that the influence of the cinema should amendment proposed by the delegate of Finland, but COMMITTEE ON PROGRAMME AND BUDGET : TENTH MEETING 237 observed that a study of the influence of television on psychiatric aspects of prevention of crime and treat- health in general would extend to such matters as the ment of delinquents" and of "the effects on mental problem of obesity caused by sitting too long in front health of technological change and change of cultural of the set. He would therefore prefer the draft resolu- patterns ". tion to remain as it stood. Dr EL -BORAI (Kuwait) was against including a Dr CAYLA (France) was also opposed to mentioning reference to the cinema in the draft resolution and the cinema. As the delegate of Belgium had pointed against deleting the word "mental" in paragraph 2. out, television was unique in that it forced its way into the home, whereas a visit to the cinema called for a The CHAIRMAN, noting that there were no further deliberate decision. Moreover, the cinema had existed comments, put to the vote the proposal to include for much longer and its dangers were already well references to the cinema in the draft resolution where known. appropriate. He agreed with the delegate of Finland that, while Decision:The proposal was rejected by 31 votes to television might have an important influence on mental 21, with 9 abstentions. health, it could also do physical and biological harm, for example, by publicity for dangerous drugs. Perhaps The CHAIRMAN put to the vote the proposal to delete his co- sponsors of the draft resolution might agree to the word "mental" from paragraph 2. refer in paragraph 2 to the influence of television on Decision:The proposal was rejected by 41 votes to health in general, and mental health in particular. 15, with 11 abstentions. Dr NAYAR (India) pointed out that television sets were quite expensive, even in the highly developed The CHAIRMAN put to the vote the proposal of the delegate of Iceland to add the words "particularly of countries, whereas a visit to the cinema was within the children and young adults" at the end of paragraph 2. reach even of the poorest classes everywhere. Decision:The proposal was adopted by 57 votes to Dr MONTALVAN (Ecuador) agreed with the delegate 2, with 6 abstentions. of India. The sponsors of the draft resolution had con- sidered mainly the situation existing in their own coun- The CHAIRMAN put to the vote the draft resolution tries, where the influence of television was strong and as a whole, which now read : widespread.In the less developed countries, where standards of living were lower, the cinema was a far The Sixteenth World Health Assembly, more important influence. Aware of the great influence of television pro- grammes and of the risk that those based on violence Professor de HAAS (Netherlands) was opposed to and crime may adversely affect mental health, par- including a mention of the cinema, for the reasons ticularly of the younger viewers; given by the United Kingdom delegate. Taking into account the need to obtain a scien- Dr ALDEA (Romania) said that when he had origin- tific assessment of the effects of such programmes; ally proposed the inclusion of a reference to the cinema and he had been thinking specifically of the developing Mindful of the different measures taken by govern- countries, where television was still a luxury. ments to secure the avoidance of harmful influences,
Professor PESONEN (Finland) thanked the delegate 1. STRESSES the educational value of television, with of France for supporting his proposal, which he main- special regard to programmes in the field of health tained. If television had an influence on mental health, education and medical training; and it must also have an influence on psychosomatic 2.RECOMMENDS that national health authorities disease. encourage the study of television influence on mental Dr SIGURDSSON (Iceland) said that in his country health, particularly of children and young adults. there was as yet no television.Nevertheless, he ven- Decision:The draftresolution was approved tured to intervene in the discussion and propose the by 61 votes to none, with 5 abstentions.1 insertion at the end of paragraph 2 of the draft resolu- tion of the words "particularly of children and young Professor GORNICKI (Poland), referring to section adults ". 4.8.3, Nutrition, emphasized the need for stimulating and co- ordinating work at the international level with a Dr TOTTIE (Sweden) agreed with the remarks made by the United Kingdom delegate. The functions of the 1 Transmitted to the Health Assembly in the section 1 of Com- Mental Health unit already included the study of "the mittee's third report and adopted as resolution WHAI 6.25. 238 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II view to establishing nutritional standards for young picked wild and rich in vitamin C, etc. Soon they had children, particularly between the ages of 0 and 2 begun to buy sugar and flour, and over the next ten years. For example, the minimum protein -calorie and years they had adopted a European -type diet, but vitamin requirements had not yet been determined. without balancing it. The change he had described had He was convinced from what he had seen himself that occurred in the very short space of forty years, and he diets during the first four months of life were often believed that the same phenomenon might well occur deficient in vitamins A, perhaps B2. and B6. He won- in the near future in many of the developing countries. dered whether any expert committee was concerned with that problem. Dr JUNGALWALLA (India), referring to the problem of endemic goitre, said he hoped the Nutrition unit and Dr CLAVERO DEL CAMPO (Spain) apologized for the other units concerned would give attention to the raising a linguistic point that concerned only the problem of obtaining sufficient iodine for the manu- Spanish- speaking members of the Committee :in the facture of iodized salt in countries where there were no Spanish text of the paragraph referring to the proposed indigenous sources. expert committee on nutrition in pregnancy and lac- He realized that the problem of the utilization of tation, the word "pregnant" was rendered by "encin- available protein -rich foods inits relation to local tas", which was a colloquial rather than a scientific habits and prejudices was already under consideration, word, though he did not know how it was used in but he would like it to receive even closer attention, so Latin America. The correct word in the context was that the results of studies conducted in individual coun- "embarazadas ". tries could be made internationally available. With regard to the studies being carried out on the Dr MONTALVÁN (Ecuador) confirmed that the word interrelation of nutrition and infection, he hoped that "encinta" was widely used in Latin America, but not the importance of helminthic infection was being given normally in the plural. due weight.
The CHAIRMAN said that the comment would be Section 4.9Environmental Health noted. In his country, the word "encinta" was frequent- Professor ZDANOV (Union of Soviet Socialist Repub- ly used, but not in scientific or technical contexts. lics) suggested that it would be more rational to include Dr TURBOTT (New Zealand). referring to item 142 the activities described under sections 4.9.1, Water and under "Contractual Technical Services ", concerning Wastes, and 4.9.2, Air and Water Pollution, under one research on the etiology of iron deficiency anaemia in unit, since the two subjects appeared to be closely the tropics and sub -tropics, said it might interest the related. Committee to know that during the past two years in Dr JUNGALWALLA (India) referring to section 4.9.1, his country an exhaustive study had been conducted of said that the problem of water supplies to small rural health among Maori tribes, every man, woman and communities had been reviewed by a WHO group, child being systematically examined. A great deal of under the leadership of an eminent engineer, which had anaemia had been found amoug new -born babies and looked into all the types of environmental health work children of pre -school age, a gradual improvement set- of WHO. Community water supply was a question of ting in at school age. He knew that a similar situation great concern to his own and to many other countries; had been found in Fiji, which showed that the problem he hoped that it could be given special priority and not was not confined to tropical and sub -tropical areas. be dealt with merely as part of the general water supply Apart from the matter of anaemia, the study had question. produced some peculiar findings. Forty years ago the Maoris had been thin and lithe and had suffered very Dr KAUL, Assistant Director -General, Secretary, little from diabetes or from gall bladder or coronary replying to the delegate of the Soviet Union, said that disease. Nowadays they no longer suffered from the although there was a similarity between the titles of diseases formerly prevalent, but there was ten times as sections 4.9.1 and 4.9.2, the roles of the two units were much diabetes as among the European population, a quite distinct. The first dealt with the provision of water, great deal of rheumatic disease and gout, while coron- water quality standards, and engineering designs for ary and hypertensive diseases were on the increase, with water supplies; the second was not concerned with the peculiarity, found nowhere else in the world, that water supplies but only with water pollution.The women were more prone to coronary disease than men. functional difference between the two units would not, When he himself had first worked among Maoris in of course, prevent close collaboration between them or 1920, they had still lived on their traditional diet, which with other units of the same division when any common was excellent, consisting of fish, seaweed, vegetables problems arose. COMMITTEE ON PROGRAMME AND BUDGET : TENTH MEETING 239
In reply to the delegate of India, he said that the be done, travelling professors with secure, long -term development of community water supplies had long appointments should be provided.It was obviously had a high priority; rural water supplies were included more economical to train professors who could after- in that context but presented greater difficulties because wards impart their learning to others than simply to of the problem of finding adequate water resources. train doctors. However, the assistance given by WHO and UNICEF It was true that professors were sometimes available in that field would continue and might well increase. to teach in the developing countries, but their careers suffered if they were absent for too long from their Dr JUNGALWALLA (India) said that he hoped that, countries of origin; moreover, they were not always the in view of the importance of the problem, the unit most suitable people to teach the medical personnel of might be strengthened in order to provide additional a developing country, since many of them did not personnel to deal with that particular aspect of water appreciate the need for including preventive and social supply. medicine in their courses. The SECRETARY said that programmes were devel- Professor SANGSINGKEO (Thailand) said that the oped and assistance provided both at headquarters and emphasis laid during the technical discussions on the regional office level; the units at headquarters devel- need for a revision of the curriculum of medical schools oped policies and were responsible for developing ought to be given practical effect as soon as possible : methods and disseminating technical information, but students should study social and preventive medicine the regional offices were usually adequately provided from the beginning of their medical training. with personnel who could apply such policies and advise governments on their implementation. A Com- Professor PESONEN (Finland) said that, as public munity Water Supply unit at headquarters was pro- health and preventive medicine depended not only on vided for under the Voluntary. Fund for Health Pro- the number but also on the standard of the doctors motion :its functions and the related regional pro- involved, it was right and proper that education and grammes were set out in Official Records No. 121, training should receive a high priority in WHO pages 450 -461. programmes.It was obviously extremely important that the large numbers of new medical schools should Dr AI.DEA (Romania) said that staphylococcal and obtain advice on standards of professional qualification streptococcal infections in hospitals presented a major from the more advanced countries. He believed that problem which needed attention. the matter was the subject of an organizational study The SECRETARY said that the study of such infections by the Executive Board. was among the functions of the Bacterial Diseases unit, Dr ALDEA (Romania) observed that thebasic as shown in section 4.6.6; laboratory work in that field problem of every health service was the training of was undertaken at the international centre for staphy- medical personnel. A certain standard of professional lococcal phage- typing, to which reference was made in knowledge must be reached by every doctor, and his Official Records No. 121, page 35, under Contractual training should include a knowledge of the structure of Technical Services (item 115). the health authority of his country as well as an appreciation of the specific causes of morbidity.In Section 4.10Education and Training Romania, the aim of medical training was to ensure an Professor TRAN DINH DE (Republic of Viet Nam) adequate number of medical and publichealth said that WHO should become the principal organizing personnel, but the emphasis in training was constantly body for medical and educational training.It should being adapted to the present and future tasks of the collect data on each country's requirements in medical health services and the changing pattern of morbidity. and paramedical personnel and on its training facilities. Medical training must also be constantly revised in Should training facilities exist in a country, WHO the light of new scientific discoveries.The public should ascertain whether the curriculum was adequate health orientation of medical teaching in Romania was or whether certain necessary subjects could not be supplemented by theoretical and practical training in taught through lack of teaching staff.In that way, it various specialities and in epidemiology, and by train- would be possible to assess the requirements in teach- ing in the various clinical disciplines. The latter was of ing staff and the languages in which they would be great importance, since early case -finding and adequate expected to teach. treatment that would prevent complications and It would obviously be desirable, where possible, to sequelae were, in themselves, one of the main methods train competent personnel so that they might serve as of preventive medicine. Undergraduate medical train- teachers in their own countries; where that could not ing should produce qualified general practitioners; 240 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II specialization was not desirable during that period and tenor of the discussion appeared to indicate that that should be reserved for the post -graduate stage. section of the programme was being developed in The principal way of ensuring medical training was, accordance with the wishes of the Health Assembly and of course, the establishment and development of the Executive Board. Without wishing to anticipate the national schools of medicine. But whatever the form of presentation of the organizational study made by the training, it was essential to avoid having two categories Executive Board, he would like to recall to the delegate of doctors -those of the economically developed and of the Republic of Viet -Nam that reference was made those of the developing countries. A solution to the to itinerant professional teams in that study; it seemed problem of providing better health services in spite of that that method of rendering assistance in the streng- the shortage of doctors lay in the training of enough thening of existing schools and the establishment of adequately educated auxiliary health personnel. How- new schools might be an alternative to sponsorship by, ever, it was necessary for the developing countries, with or affiliation with, other medical schools.It might be the assistance of WHO, to introduce better training and particularly valuable in countries where only clinical education methods, for both professional and auxiliary training was required, medical undergraduates having personnel. taken their pre -clinical training elsewhere. It was clear from the discussion that the need for greatly increased Dr AFRIDI, representative of the Executive Board, numbers of executive medical personnel was deeply said that medical education and training was also the felt and that there was also a realization of a need for subject of the organizational study referred to in teachers, research workers and medical administrators. resolution EB31.R36, and he would raise the matter again at the appropriate time. Meanwhile, referring to In reply to the delegate of the United Kingdom, he the proposed expert committee (under section 4.10.2) said that the terms of reference of the proposed expert on undergraduate medical teaching of the natural committee on undergraduate medical teaching of the sciences, he informed the meeting that the terms of natural sciences would be amended in accordance with reference of that expert committee had been discussed the recommendation of the Executive Board. at length by the Executive Board, which had eventually recommended that they should be modified as shown in Professor PESONEN (Finland) asked whether the Official Records No. 125, Chapter IV, paragraph 137. expert committee to which reference had been made would be composed mainly of teachers of basic medical Dr FISEK (Turkey) said that, although the import- sciences or whether it would include clinicians as well. ance of medical education and training was recognized, the budgetary provision for it was usually reduced in favour of other more urgent programmes. He noted Dr GRUNDY said that it was the intention to include that there was only an increase of approximately specialists in the natural sciences, clinicians and general $ 5000 in the estimates for section 4.10 as compared medical educators, such as the deans of undergraduate with the appropriation for 1963. He felt that there was medical schools, in the composition of the expert great need for provision to strengthen the division committee. concerned, at least in the 1965 and later budgets. Special emphasis should be laid, in advice to govern- Professor PESONEN (Finland) said he felt that the ments, on the inclusion of social and preventive emphasis in the work of the expert committee should medicine in training programmes.In his own country be on the means of integrating basic medical studies there was one doctor for every 2300 people, but it was into clinical studies rather than on the length of time very difficult, to find suitably qualified personnel to needed to complete preclinical medical studies. do rural public health work, for the five -year plan; that also was a problem that should be studied by the Dr AFRIDI, representative of the Executive Board, units in question. said that that point had been raised during the dis- cussions in the Executive Board. The terms of reference Sir George GODBER (United Kingdom of Great of the expert committee had been framed to deal with Britain and Northern Ireland) asked whether the pre -medical studies as opposed to pre -clinical studies. terms of reference of the proposed expert committee on undergraduate medical teaching of the natural In some countries that differentiation did not exist, but sciences would be modified in accordance with the basically the purpose of the expert committee would be proposal of the Executive Board. to determine the necessary level of education for would - be entrants to the medical schools. The necessity for Dr GRUNDY, Assistant Director -General, said that that had arisen owing to the number of students from the points raised by speakers had been noted.The overseas who were unable to complete their first -year COMMITTEE ON PROGRAMME AND BUDGET : ELEVENTH MEETING 241 medical course through lack of basic pre -medical approved only on condition that a suitable tutor was training. available to train auxiliary medical staff, the developing countries would gradually obtain a well -trained cadre Professor PESONEN (Finland) thanked the Assistant of auxiliary personnel as a foundation for their basic Director -General for his explanation and expressed his health services. support for the terms of reference of the expert committee as recommended by the Executive Board. Dr RÍOS- VARGAS (Mexico) said that one of the most pressing problems in his country had been the diffi- The CHAIRMAN invited the representative of the culty of obtaining hospital administrators.Trainees Executive Board to comment on section 4.10.3, Public were sent by most Latin American countries to the Health Education and Training. United States of America but, unfortunately, only Dr AFRIDI, representative of the Executive Board, about one -third of those enrolled inthe courses said that the terms of reference of the proposed expert completed their training and were of use to their committee had again been the subject of a lengthy national health administrations. Public health adminis- discussion in the Executive Board, which was reflected tration courses were now available in Brazil, Chile, in Official Records No. 125, Chapter IV, paragraph Mexico and Venezuela; they included instruction in 139. The Executive Board had decided to recommend keeping records, personnel management, and other to the Health Assembly that the revised terms of subjects that were useful in hospital administration. reference it proposed in that paragraph would be more The courses were attended by trainees from many of appropriate to a study group than to an expert the central American countries. There was also a post- committee. graduate course for hospital administrators. He hoped that WHO would inspire widespread interest in that Dr JUNGALWALLA (India) said that he was grateful essential section of public health administration. for the clarification given by the representative of the Executive Board, since he felt that the orientation of Sir George GODBER (United Kingdom of Great senior medical administrators towards public health Britain and Northern Ireland) thought that there required a more subtle approach than could be might be some danger of the discussion's straying afforded by the requirement to take degree or diploma beyond the comments and recommendations of the courses. Executive Board.The substance of those comments was that training should be provided that would pro- Dr SYMAN (Israel) said that one of the principal duce administrators in a wider field than that of a difficulties in the training of medical personnel was the single hospital or local health service; it was agreed lack of tutors; those who were available were not that there was a great need for administrators of that necessarily suitable for the countries in which they were type.It was a different point from that raised by the sent to teach. It was therefore essential that a corps of delegate of Israel -with whom he agreed -that there tutors in all public health fields should be established was also a need for training instructors who could, and that each individual tutor should be given a special in turn, pass on their knowledge. orientation course for the country, or countries, in which he was to teach. If that were done, and projects The meeting rose at 6.05 p.m.
ELEVENTH MEETING
Saturday, 18 May 1963, at 10.15 a.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1.Review and Approvalof the Programme and Budget Section 4.11Editorial and Reference Services Estimates for 1964(continued) Agenda, 2.2 There were no comments.
Detailed ReviewoftheOperating Programme (con - Section 4.12Programme Co- ordination tinued) Agenda, 2.2.3 There were no comments. 242 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Section 4.13.Programme Evaluation be possible, inconsultation with the governments There were no comments. concerned, to implement a number of them by means of the savings made during the operational year. Section S.Regional Offices He drew attention to page 322 of Official Records No. 121, which gave a summary of field activities in The CHAIRMAN said that the estimates for the the Region under subject headings. It would be noticed regional offices would be examined in conjunction with that there was a large increase in the programmes for activities in the regions. education and training in 1964 as compared with Section 6.Expert Committees previous years; that also applied to cancer control, radiationprotection,mental health and nursing. There were no comments. Inter -country programmes also showed an appreciable increase. Section 7.Other Statutory Staff Costs With regard to education and training, considerable The CHAIRMAN said that the section had been dealt assistance had so far been given and would continue with by the Committee on Administration, Finance and to be given in the training of medical auxiliaries of all Legal Matters. categories.Fellowships were another very important aspect of the programme : during 1962, 321 fellowships Eastern Mediterranean Region had been awarded, twenty -three of which were for The CHAIRMAN requested the Regional Director for undergraduate education. As a policy, undergraduate the Eastern Mediterranean to introduce the proposed fellowships were only granted in countries where no programme and budget estimates forthe Region medical faculties existed. With regard to WHO assist- (Official Records No. 121, pages 159 -175 and 319 -343). ance in medical education, he outlined the emphasis being given to the subject in the work of the Regional Dr TABA, Regional Director for the Eastern Medi- Office. The trend was to increase the activity in that terranean, said that the programme proposed for the field. Eastern Mediterranean Region in 1964 was in line with A large proportion of the budget for 1964 -in fact the general programme of work laid down by the more than half of the funds available -was still Assembly in consultation with the Regional Committee being devoted to assistance in the control of communi- for the Eastern Mediterranean. It showed an increase cable diseases. The trend, however, was for that type of about 11 per cent compared with that for 1963 but of WHO assistance to decrease gradually as a number funds from United Nations Technical Assistance sour- of countries were conducting, with their nationals, ces were slightly reduced in comparison with previous their own control programmes. years. Requests received from governments had consi- With regard to malaria eradication, he referred to derably exceeded the projects that it had been possible border co- ordination units sponsored by WHO between to include in the proposed programme. Quite a number groups of countries as required throughout the Region. of projects had been carried out or were proposed for He also referred to the importance of training of implementation by arrangements with the country malariaworkers,throughassistancetotraining concerned through funds in trust.In such cases the projects or award of WHO fellowships. programme was carried out in the same way as any An important problem in the Region was smallpox, other WHO programme, but the government concerned and assistance was being given whenever required. reimbursed the expenditure entailed.Such arrange- A large element of research was being conducted in ments had been made with Israel, Libya and Saudi connexion with a project in the United Arab Republic Arabia and would also be made, in all probability, for on bilharziasis which, it was hoped, would assist with other countries in the future, in view of the large training of bilharziasis workers from other parts of the number of requests being received, largely consequent Region. The results obtained so far from the research on the very rapid development in all fields taking place on trachoma virus being carried out in the WHO - in the Region. A large number of countries had long- assisted project in Tunis were encouraging. He hoped term development plans with adequate components for to be able to report at a later date on the findings health and related fields. WHO was assisting other of that project. countries in preparing their long -term health develop- In conclusion he said that he would be glad to ment plans either through WHO representatives or by provide any additional information that might be ad hoc arrangements. Annex 6 to Official Records No. required by delegates. 121 contained a number of requests which had been made but could not be accommodated in the body of Dr EL BITASH (United Arab Republic) expressed his the programme.However, he hoped that it would appreciation of the Regional Director's efficiency and COMMITTEE ON PROGRAMME AND BUDGET : ELEVENTH MEETING 243 friendliness. He was glad to note the good progress every attempt was being made to cover the interests of being achieved. all Member countries in the eradication of malaria and smallpox and the control of bilharziasis and other Dr FARAH (Tunisia) also expressed appreciation of diseases.The launching of large -scale malaria eradi- the work carried out by the WHO Regional Office for cation campaigns in many countries of the Region had the Eastern Mediterranean under its able Director and resulted in the drawing -up of comprehensive and congratulated him on his excellent report.It was not effective operational plans and the co- ordination of necessary for him to mention the human and profes- programmes in neighbouring countries.With regard sional qualities of the Regional Director, since all were to tuberculosis control he referred to the project aware of them, as also of his conscientiousness, embarked upon by his country and said that the competence and probity.His delegation was most assistance of WHO had been invaluable. grateful for the valuable assistance provided by WHO. Dr ABDULHADI (Libya) and Dr BASSEGHI ([ran) also Dr VASSILOPOULOS (Cyprus) also expressedhis Government's sincere gratitude to the Regional Office expressed their gratitude for the assistance provided by and to its Director, whose keen interest in the welfare the Regional Office for the Eastern Mediterranean of the people of Cyprus was highly appreciated. under its able Director. Dr TABA,Regional fortheEastern Dr HAMZA (Sudan) and Dr JALLOUL (Lebanon) also Director thanked the Regional Office and its able Director for Mediterranean, thanked all those who had expressed the assistance they had provided. appreciation and said that he would convey their remarks to the staff of the Regional Office and to those Dr HAQUE (Pakistan) reiterated the thanks he had in the field. expressed in plenary session to the Director and staff of the Regional Office and also his gratitude for their Western Pacific Region efforts towards the implementation of the additional The CHAIRMAN requested the Regional Director for projects requested, the inclusion of which inthe the Western Pacific to introduce the estimates for the proposed programme and budget estimates had not Region (Official Records No. 121, pages 176 -188 and been possible. 344 -371). Dr EL -BORAI (Kuwait) expressed his delegation's Dr FANG, Regional Director for the Western Pacific, deep satisfaction with the work carried out by the said that the proposed programme and budget had Regional Office and the clear report the Director had been drawn up in consultation with Member govern- given.That satisfaction was no doubt shared by all ments in the Region and, in accordance with customary present. procedure, had been reviewed by a Sub- Committee on The Regional Director's report showed how the Programme and Budget during the session of the spheres of co- operation between the countries of the Regional Committee. From the regional summary on Region could be expanded for their common benefit. page 344 of Official Records No. 121 it would be seen H e had noted the assistance the Regional Office had that increases were proposed under the regular budget, been providing to governments, upon request,in the Malaria Eradication Special Account, and other strengthening health services, stimulating and advanc- extra -budgetary funds. The Technical Assistance ing work with a view to the eradication of endemo- programme was based on requests of Member govern- epidemic and other diseases, and promoting education ments to the Technical Assistance Board for the and training. That assistance was provided by means biennium 1963 -1964. of short- and long -term plans for bringing relief to the The proposals took into account continuing commit- countries that were badly in need of basic health ments, current requirements and long -range health
services. goals cf the Region. WHO representatives visited as His country would never forget the great assistance many countries as possible to discuss future pro- the Regional Office had provided in many health fields grammes withthehealthauthoritiesand those and the numerous visits received from different experts. conversations were extremely useful when determining His Government would be grateful for anything the which projects should be includedinthe regular Regional Office could do to assist in improving the programme and which should appear as "additional country's basic educational facilities.The Regional projects ". The summary on page 344 of Official Office had attached considerable importance to the Records No. 121 showed a net increase, in the regular granting of fellowships,with the result that the budget, of $ 192 039 over1963, consisting of an standards of medical institutions had improved con- increase of $ 188 176 under field activities and of siderably. He had also noted with much pleasure that $ 3863 for the Regional Office. Thus, over 98 per cent. 244 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II of the 1964 increase applied to activitiesdirectly tuberculosisadvisory team and theinter -country connected with assistance to Member governments, treponematoses team. An extremely useful provision whileprovisionforadministrativeand"house- was that proposed under public health administration keeping" expenditure had been maintained at the advisory services which permitted the Regional Office minimum required to operate an effective regional to meet urgent requests from governments for short - headquarters.The 1964 provision for the Regional term consultants, provision for which was not made Office totalled $ 320 688, approximately one per cent. in the individual country programmes. more than the 1963 provision. Eighty -seven additional projects, at a total estimated The proposals for regional advisers provided for an cost of $ 933 487, requested by governments but which increase of $ 22 058, mainly in respect of statutory could not be accommodated within theRegion's salary increases and two new adviser posts.The allocation, were shown on pages 524 and 525 of advisers were required to cope with the increasing Official Records No.121. Their implementation number of requests from governments in connexion depended upon savings from the regular budget. with communicable diseases and nursing. In his opinion the 1964 programme and budget There was no significant change in the proposals for reflected the successful growth of activities in the WHO representatives and the net increase of $ 3770 Western Pacific, and the proposals were well- balanced was mainly to cover increased officerentals and and made the most effective use of the resources statutory salary increments. available. Consideration had been given to the needs Ninety -eight projects were proposed, under eighteen of the Region as a whole, the requests of the individual major subject headings, compared to ninety -two in governments and the general priorities established at 1963; eighty -five were country and thirteen inter - past sessions of the Regional Committee. countryprojects. Included inthe1964 regular programme were ninety -four fellowships, of which Dr RAMSAY (Australia) expressedhiscountry's satisfaction with and appreciation of the work carried thirty were for study within the Region, against sixty - out by the Regional Office under the excellent guidance nine fellowships in 1963, of which thirty -two were for of its Director. study within the Region. Continued emphasis was laid on education and training, public health administra- Professor TRAN DINH DE (Republic of Viet -Nam) tion,developmentof campaigns against various alsocongratulated the Regional Director on his communicable diseases and projects for the streng- excellent work during the past year and for the whole thening of nursing, maternal and child health and of the period during which he had been in office. environmental health services in many of the develop- ing countries of the Region. As shown in the summary Dr Chung Kun PARK (Republic of Korea) also of field activities, the largest individual percentage of expressed appreciation of the work carried out by the funds under the regular budget for field activities Regional Office and thanked the Regional Director in continued to be provided for public health admini- particular for his great efforts and advice for the well- stration (30.8 per cent. of the total), followed by being of the people of Korea. nursing (10.05 per cent.).Communicable diseases, Dr JAYESURIA (Federation of Malaya) expressed the covering malaria, tuberculosis, venereal diseases and sincere thanks of his Government to the Regional treponematoses, bacterial diseases, virus diseases and Director and to WHO for the assistance and advice leprosy, accounted for 18 per cent. of the total. furnished to his country. Continued importance was placed on the projects with regional scope such as a tuberculosis refresher Dr OMURA (Japan), Dr SOUVANNAVONG (Laos) and course for assistant medical officers of the South Dr TURBOTT (New Zealand) also expressed apprecia- Pacific island territories, a seminar on national health tion of the assistance provided by the Regional Office planning, epidemiological surveys of dental diseases and its Director. and a seminar on methods of improving nutritional Dr FANG, Regional Director for the Western Pacific, standards at villagelevel. Fellowships were also thanked previous speakers for their expressions of included both to meet the need of health authorities in appreciation, which he would convey to the staff of the territories in the South Pacific for more health educa- Regional Office. tion workers, and to increase the number of assistant medical or dental officers in the health services of the African Region South Pacific island territories by enabling students The CHAIRMAN requested the Regional Director for from those territories to study at the Fiji School of Africa to introduce the proposed programme and Medicine. With a view to efficient utilization of staff budget estimates for the African Region (Official and resources, provision continued for the regional Records No. 121, pages 107 -121 and 200 -232). COMMITTEE ON PROGRAMME AND BUDGET : ELEVENTH MEETING 245
Dr CAMBOURNAC, Regional Director for Africa, setting up in the various countries an efficient organiza- greeted the countries of the African Region which had tion which could be responsible for preventive and gained their independence and become Members of curative services within the framework of a well - WHO since the Fifteenth World Health Assembly, balanced programme. namely Burundi, Rwanda and Uganda, and wished In view of the growing needs of the Region and of them a happy and prosperous future. He also extended the increased funds available, the proposed develop- his best wishes to Kenya and Mauritius, which had ment of the programmes would call for an increase in acceded to associate membership during the same staff. However, the number of posts proposed for the period. Regional Office itself would be only seventy -six for The Regional Committee for Africa was now 1964, as compared with seventy -four in 1963. The total composed of representatives of twenty -nine Member number of posts relating to projects, including the States and three Associate Members. In view of the accelerated malaria programme, would be increased conditions obtaining in the African States which had from 393 in 1963 to 456 in 1964.Thus, the Region achievedtheir independence recently, WHO was would have 532 posts in all for 1964 as compared with concentrating its action in the Region on a number of 467 for 1963.Those figures took into account staff fundamental needs : education and training, the control under the regular budget, the Expanded Programme of communicable diseases, nutrition, and strengthening of Technical Assistance and the Malaria Eradication health services. Special Account, but not the 233 posts relating to the The trainingof nationalhealth and auxiliary staff operating in the Congo (Leopoldville). personnel constituted by far the greatest need of the An increase of $ 37 726 as compared with 1963 was majority of the countries and WHO was doing its being proposed for the Regional Office itself, owing to utmost to render the maximum assistance in that field the establishment of two additional posts (a translator with the funds available, so that those countries would and a secretary), to statutory salary increases, and to be able to use their potential personnel as soon as increased requirements for public information supplies possible. The fellowships programme was being and materials and common services. There was, developed, and education as a whole called for parti- however, as shown on page 202 of Official Records cular attention since it afforded the most satisfactory No. 121, a decrease of $ 5285 in respect of space and method fordeveloping and strengtheninghealth equipment services relating to the Regional Office, and services, which would enable newly emerging countries a decrease of $ 2700 for space and equipment services to become technically independent.Communicable relating to the regional advisers, as shown on page 204. disease control remained a major activity in the Region, Those decreases were due to the efforts made to keep since considerable needs remained to be met in that expenditure for common services to the minimum. respect. The total amount proposed under the regular budget Efforts were being continued with a view to develop- was of the order of $ 2 332 812 for 1964, as compared ing public health services so that they could not only with $ 2 184 637 for 1963, i.e., an increase of $ 148 175. provide the essential basis for the structure of a The total budget, taking into account the regular national health organization, but also absorb and budget, the Malaria Eradication Special Account and administer special services set up to deal with specific the Expanded Programme of Technical Assistance, problems. Rural health centres were particularly was $6 720 799 for 1964, as compared with $ 6 575 168 valuable for training staff, and especially auxiliary for 1963.The total amount would be $ 9 509 858 if personnel. They would moreover be extremely useful - the accelerated malaria programme was included. sometimes even essential -in connexion with sur- The total number of projects, both country and veillance operations and with the consolidation and inter- country,includedinthebudgetestimates maintenance phases of campaigns for the eradication amounted to 216 in 1964, including the accelerated of communicable diseases, such as malaria and yaws. malaria programme, as compared with 201 in 1963. Such campaigns were furthermore so organized as to Nevertheless, if additional projects and projects under contribute to the greatest possible extenttothe Category II of the Expanded Programme of Technical strengthening of health services. Assistance were also included, the general total for As a first step in developing health services, WHO 1964 would be 379as compared with only 243 was placing at the disposal of governments public in 1963. health administrators to assist in establishing their The number of fellowships proposed for 1964 was needs and priorities, as well as to co- ordinate health 259; however, taking into account fellowships under planning on a scientifically and technically sound basis additional projects and under Category IIof the and in a form acceptable to the populations concerned. Expanded Programme of Technical Assistance, the The policy followed by the Regional Office aimed at total number for 1964 would be 419. None the less, 246 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II it should be noted that, since all efforts were made to expressions of gratitude to them were no mere form- use WHO personnel assigned to projects also for ality.Their efforts to meet the needs of a region in education and trainingof health personnel and rapidexpansion weretireless,and the Regional particularly auxiliary personnel,it was anticipated Director deserved the greatest credit and admiration that in 1964 more than a thousand persons would for the amount he had already accomplished. He would receive training related to programme activities over wish him equal success in carrying on his task in the and above those participating in seminars, symposia, future. etc.Already in 1962, about a thousand persons had received training and practice in the Region. Investi- Dr FENDALL (Kenya), joining in the thanks to the gations had been undertaken in the various countries Regional Director and his staff, unreservedly endorsed of the Region, and in particular in the newly independ- the policy in the Region of giving emphasis to the ent countries, so as to ascertain their resources in development of basic health services, training for candidates and their needs with a view to providing professional and auxiliary medical staff and control of assistance in training essential medical and paramedical communicable diseases. The distribution of the funds personnel. allocatedtothe Region among thoseobjectives In connexion with the other activities of the Regional reflected to some extent the difficulties of the Member Office, to avoid making too long a statement he would countries in tackling specific health problems and at refer only to the considerable developments which had the same time trying to build up their general health taken place in the control of communicable diseases, services on a small budget.As far as Kenya was particularly yaws.There was no doubt that greater concerned, for example, the rise in the cost of malaria efforts were required in respect of smallpox. As for eradication operations represented an increase of 60 cerebrospinal meningitis, the Regional Office was per cent. on its current budget for that purpose. The extremely grateful to the governments which had ability of countries in the Region to undertake such helped it to develop considerable activities in that projects would therefore depend to a large extent sphere. It had been possible, with the help of UNICEF on help from outside agencies to meet part of that and thanks to the generosity of the Government of the additional cost. And it should be borne in mind that Niger, for drugs to be stocked at Niamey for speedy despite the 12 per cent. increase in WHO's budget for delivery where needed. Several countries had already 1964 -that had been so warmly debated -there were benefited from that scheme in the current year. still many unfulfilled requests, mostly designed to Fortunately, the epidemic was much less severe than in institute basic health services, that would not be met in the previous year. 1964, as Annex 6 to the budget document testified. The more favourable conditions prevailing for health Dr DOLO (Mali) joined in the tribute to the work of work, including the possibilities of applying modern the Regional Office and to its Director, who had medical methods and public health administration in adapted the new programmes in a region in full social the Region, together with the aspirations of those development to the wishes of the governments con- countriestowardsspeediersocialand economic cerned.His country was particularly grateful for the development, pointed the way towards the achievement public health administrators and sanitary engineers of a higher standard of living and health in the future. put at its disposal, as well as for the vocational training Accordingly, WHO would receive a greater number provided, to help towards the development of its of requests in future and would be in a position to general health services. render important assistance to the respective countries, provided that sufficient funds were placedatits Dr DIBUE (Cameroon) expressedhiscountry's disposal. gratitudetotheRegional Director and Deputy Director for the painstaking efforts they were making Dr MURRAY (South Africa) said that, more than any other Regional Director, Dr Cambournac had had to better the lot of the African peoples. It was gratify- ing to know that such a large proportion of the total to deal with additional problems arising out of the WHO budget was being allotted in 1964 for work in recent attainment of independence by a large number the African Region. That reflected to some extent the of States.He offered sincere congratulations to him able way in which the Regional Director had been able and his staff on the able manner in which that challenge to put forward the strong claims of Africa for WHO had been met. help. Dr ALAKIJA (Nigeria) said that a glance at the As the bulk of the population of his country lived number of projects proposed for the African Region in rural areas, help was needed to develop and extend would show the magnitude of the task facing the rural health services. In the past year, the means had Regional Director and his staff. In the circumstances, been lacking to provide all the drugs needed in health COMMITTEE ON PROGRAMME AND BUDGET: ELEVENTH MEETING 247
work.Some other requirements included food and Dr DE ANDRADE SILVA (Portugal) thanked the milk for maternal and child health activities and supplies Regional Director for the help and technical advice the of the triple pertussis- tetanus -diphtheria vaccine.It Regional Office was providing to the Portuguese over- would be helpful if the Regional Director could find seas provinces. The Portuguese health authorities were time to visit his country in order to get first -hand doing their utmost to eradicate endemic communicable knowledge of some of its difficulties. diseases, including malaria, and the help being received in that task was indeed great. He offered the Regional Dr GOURTAY (Chad) also expressed his Govern- Director his best wishes for continued success in the ment's gratitude to the Regional Director for the work he was doing. effective assistance received in its health work.His courtesy and understanding were greatly appreciated Dr CAMBOURNAC, Regional Director for Africa, and it was to be hoped that he would direct the work of said he was grateful for the encouragement given by the Regional Office for a long time to come. the previous speakers; their expressions of gratitude Dr TCHIKOUNZI (Congo, Brazzaville) thanked the would be conveyed to the staff of the Regional Office, Regional Director for the understanding he had to whose efforts the success of the work was largely due. invariably shown towards his country's health prob- He would be very interested tovisit Cameroon lems and for the assistance given. in order to get better acquainted with the country's problems as a means of giving more help in developing Dr DIALLO (Senegal) joined in the expressions of appropriate health action. gratitude to the Regional Director. The effective The remarks of the representative of Kenya had been action undertaken in his own country was all the more particularly apposite. The requests set out in Annex 6 deserving of gratitude considering the additional calls to the programme and budget estimates reflected the on the Regional Office for help from countries that had great need for help in strengthening Africa's health recently gained independence.The volume of such services.In particular, the future success of the work requests would be increasing as more countries joined in malaria eradication, under the new concept of that the ranks of the free and independent. programme, would depend on greater efforts to develop Dr N'DIA KOFFI (Ivory Coast) expressed to the those services. Regional Director and his staff the deep gratitude of his Government for the assistance received and sincere Region of the Americas wishes for future success in the work of the Regional The CHAIRMAN requested the Regional Director for Office. the Americas to introduce the proposed programme and budget estimates for the Region (Official Records Dr LAMBIN (Upper Volta) expressed his country's No. 121, pages 122 -134 and 233 -273). high esteem for the Regional Director and appre- ciation of his dynamism and humanitarian attitude. Dr HORWITZ, Regional Director for the Americas, Despite the additiónal calls for help from the countries said that the proposed programme for 1964 reflected recentlyaccedingtoindependence,theRegional the two main trends in health work in the Americas, Director had shown himself capable of maintaining an namely, the concentration on drawing up long -term equitable distribution of assistance, in accordance with health plans to be integrated within the general develop- priority needs.His country was particularly grateful ment programme, and stress on work to deal with for the assistance given in disease control. specific priority problems in line with WHO's general Mr TouRÉ (Mauritania) said his country greatly programme of work. appreciated the intelligent approach of WHO to the In regard to the first, the lack of established method- ology and trained planners meant that the Organiza- health problems of the Region. His delegation was in agreement with the way the problems were being tion's work had to be concentrated on training activities, advisory services to governments to formu- tackled and with the priorities established, and thanked late preliminary health plans and assistance in the the Regional Director for the active part he had played organization of planning units at the ministries of in that connexion. health, related to the national development boards. In Dr KEITA (Guinea) added hiscountry'sgreat 1962 two courses had been held, one in collaboration appreciation to the Regional Director for what was with the Centre for Studies on Development of the being done in the Region. The staff of the Regional University of Caracas, Venezuela, and the other at the Office shared equally in the credit for success.The Latin American Institute for Economic and Social example they gave spurred on the countries themselves Planning; thirty -threepublic health administrators to even greater efforts. had been trained as a result, and it was proposed to 248 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II organize annual courses for some twenty to thirty verted intoa systematic country -wide eradication officials. campaign. A health planning guide was being prepared and was The Committee was already aware of the agreement expected to be ready at the end of 1963.It would concluded between PAHO and the Inter -American contain the basic methodology to be adapted to local Development Bank for joint activities to promote and situations. Health plans at present were statements of carry out urban and rural water projects. To date, the policy for each major health problem, with definite Bank had approved thirty projects for twelve countries, objectives to be accomplished in a certain period. which would benefit 16 million people living in 858 Even with incomplete health and vital statistics there communities. Taking Bank loans and domestic invest- was in Latin America a basic amount of information - ment together, the cost of water amounted to an average of $ 20 per person served. Current work was continuously improving -sufficient to establish those directed mostly to urban communities and attention policies.On the other hand there was no sound was now being given to expanding the programme to methodology to formulate a development plan for rural areas, for which purpose a special rural welfare a country or community to include economic growth fund was envisaged. The Organization would be and social welfare projects in an integrated way. continuing its help to governments in the matter in 1964 There, research was essential. through training and advisory services in all phases of While plans were being formulated, the Regional community water programmes, taking 11.2 per cent. of Office would continue in 1964 advising the govern- the total budget. ments with regard to major health problems and the A total investment of 28.2 per cent. of the budget basic instruments to solve them. To that end, three was proposed for health promotion work, to be types of approach were suggested : first, to strengthen devoted partly to general services and partly to specific health services, with special emphasis on facilities to programmes.Special attention would be paid to improve the environment; second, to concentrate on statistics and nutrition. Nutrition work would receive specificdiseases,particularlymalaria,smallpox, 6.6 per cent. and the major part of those funds would diarrhoea and enteritis, tuberculosis and malnutrition, be allotted to the Institute of Nutrition of Central which was the most prevalent; and third, to tackle America and Panama. The lack of satisfactory pro- major economic development problems in which gress in nutrition in the Region was due to the fact that health had a fundamental role to play. the work had not become a routine local function and that the responsibility of the ministries of health and Under the 1964 programme, it was planned to invest agriculture was not clearly specified.It was intended some $ 200 000 for planning work. Some 45 per cent. to concentrate efforts in that field in 1964. of the total budget would be allotted to health protec- Undereducation andtraining,provisionwas tion, including control of communicable diseases and included for direct assistance to institutions in the environmental sanitation. The eradication of malaria amount of some 7 per cent. of the budget. Taking all was still the largest programme in the Americas, with a training activities together, including those relating to total investment of 23.1 per cent., covering 37 projects, projects, fellowships, seminars and in- service courses, 20 of which would be inter -country projects.It was the total investment would be 30.7 per cent. Some 518 expected that Jamaca, British Honduras, Trinidad and fellowships were provided for the year. Tobago, and large areas of Mexico, Nicaragua, Costa A conference was being organized in October 1963, Rica, Honduras, Bolivia, Peru, Argentina and Surinam jointly with the Millbank Memorial Fund, for the would pass into the maintenance phase of malaria purpose of estimating Latin American needs for eradication during 1964, and that the whole of Brazil doctors over the coming twenty years, in line with the would go into the attack phase. population growth and economic expansion. Depend- Two seminars were to be held in 1963 and 1964 for ing on the report of the conference,it might be health administrators and malariologists. The purpose possible to get funds to develop the study in the coming was to determine how best to co- ordinate the activity two years. of localhealthservicesand malaria eradication Research work under the Pan American Health services. Brazil was still the chief focus of smallpox in Organization was continuing in close collaboration and the Americas, and it was hoped that the current isolated co- ordination with the WHO programme.In 1964, frontier -zone programmes would gradually be con- 314 projects were proposed : sixty -six in communicable COMMITTEE ON PROGRAMME AND BUDGET : ELEVENTH MEETING 249
diseases, 219 in health promotion, twenty in education Dr TERRY (United States of America) joined on and training, and nine in miscellaneous subjects. The behalf of his Government in thanking the Regional budget showed an increase of 7.6 per cent. compared Director for the sincere and effective leadership he had with that for 1963, which left a relatively small sum for given in the development of health programmes in the the expansion of field work when account was taken of Americas. the statutory costs increase.For that reason only Dr MONTALVAN (Ecuador) thought that particular twenty -two new projects were proposed for 1964. The thanks were due to the Regional Director, not only for total number of posts stood at 1043- slightly below the effective work carried out in 1962 but also for the the number for 1963. excellent leadership he had given to health work in the He wished once again to record the gratitude of the Region during his whole term in office. The fact that Region to the United States Government for the site he had been reappointedRegionalDirector by of the new headquarters building for the Pan American unanimous vote was the greatest testimony to his Officeforthe Sanitary Bureau (WHO Regional ability. His work was all the more deserving of praise its Americas) and to the Kellog Foundation for in that he had broad combined responsibilities covering generous contribution towards the building. activities under WHO, the Pan American Health In conclusion, he said that the 1964 programme still Organization, and other agencies concerned with the looked rather diversified.He expected that when development of American countries. His country was governments had prepared their national health plans satisfied that its requests had always been met to the and implemented them, they would be in a better greatest possible extent and he hoped the work would position to obtain advisory services and assistance continue and develop in the future. needed from WHO and, at the sanie time, the inter- national organizations would find it simpler to co- Dr RÍOS- VARGAS (Mexico) joined in the sincere ordinate their efforts towards attaining the national tribute paid to the Regional Director for the valuable health goals. assistance that was being provided to the countries of the Region in their efforts to better the health of their Dr MAGALHXES DA SILVEIRA (Brazil) expressed his populations. country's appreciation to the Regional Director and the Much credit was due to him and his Pan American Health Organization for the help and hard -working staff for the success of programmes assistance being received in different projects and undertaken. He particularly welcomed the emphasis campaigns in Brazil. He hoped that the co- operation that was being given to developing planning method- in health work that was so indispensable if the countries ology; the results would be of great value to the of the Region were to attain their goals would be main- countries of the Region. tained and strengthened in the future. Dr QUIRÓS (Peru), joining in the thanks to the Regional Director, remarked that he had been enabled Dr FIGUEROA (Venezuela) congratulated the Region- better to appreciate the value of the work being al Director on his excellent introductory statement, done in the Region as a result of his service on the which plainly showed the good work being done and Executive Board. his constant concern for tackling the health problems in the Region. He also wished to thank WHO and the Dr PEAT (Jamaica) particularly commended the Pan American Sanitary Bureau for theeffective Regional Director and his staff for their readiness to assistance provided. listen to requests for advice and their willingness to give help to the utmost possible extent. Dr TORRES- BRACAMONTE (Bolivia)said that the Regional Director was already well aware how much Dr BRAVO (Chile) joinedin congratulating the his country appreciated the assistance it was receiving Regional Director on behalf of his Government. Chile from the Regional Office.He thanked him for the was proud that one of its citizens was at the head of the excellent report he had given. Pan American Health Organization and was gratified at the direction given to the work of the Pan American Dr COMISSIONG (Trinidad and Tobago) also thanked Sanitary Bureau through the Regional Director's the Regional Director, and expressed particular appre- intelligent understanding of the special problems of ciation for the understanding he had shown of the each of the Member States. "teething" problems to be faced by a newly independ- ent country such as his. Events that could not possibly The CHAIRMAN, speaking as delegate of Argentina, have been foreseen had sometimes made it difficult for expressed his country's gratitude for the work carried his Government to meet commitments under WHO out by the Regional Director in the Americas. He had programmes. He also wished to thank the zone had occasion many times to say that Argentina fully representative. endorsed the policies governing the work in the 250 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Region,whichcontributedsubstantiallytothe Prospects in the work on nutrition were promising, economic and social development of the various but many obstacles to success also existed.It was countries. hoped that further experience might be gained through the activities now going on under the joint sponsorship Dr HORWITZ, Regional Director for the Americas, of FAO, UNICEF and WHO in programmes known said that he was gratified to hear the tributes to the as extension or applied nutrition programmes, and a work being done in the Region; he would convey the number were being developed in India, Thailand and expressions of appreciation to his stff. Indonesia. In sanitation, a sphere of extreme difficulty and South -East Asia Region involving vast initial expenditure, it was hoped to The CHAIRMAN requested the Regional Director for develop some experimental work on water supply to South -East Asia to introduce the proposed programme rural areas, in collaboration with UNICEF.That and budget estimates for the Region (Official Records programme would be additional to the two projects No. 121, pages 135 -146 and 274 -293). enjoying assistance from the United Nations Special Fund. Dr MANI, Regional Director for South -East Asia, He had given very briefly some of the salient points stated that in 1964 WHO's activities in the Region of the programme for 1964 and would be happy to would continue to be concentrated on three main answer any questions that might arise. spheres : the control of communicable diseases ; training of all categories of personnel; and promotion and Dr BAIDYA (Nepal) thanked the Regional Director development of ruralhealthcentres. The pro- and his staff for their co- operation and help in solving gramme in communicable disease control accounted for the many and complicated health problems of one approximately 55 per cent. of the budget allotted to of the most highly populated regions. The Regional field activities. It was largely concentrated on malaria, Director had spared no effort in helping Nepal in the tuberculosis, leprosy, yaws and trachoma. Projects for different fields of public health; and with his keen the year would total 124, including twenty -five in interest Nepal's project for setting up a medical college communicablediseases,fifteeninpublichealth would soon take shape. He was sure that every dele- administration, thirteen in nursing education, and gate from the Region would join in congratulating the sixteen in general education and training for both Regional Director on his excellent report. doctors and auxiliary staff.Field staff to the number Dr SUBANDRIO(Indonesia)congratulatedthe of 324 would be engaged on those projects, including Regional Director on his appointment for a third term 140 doctors, forty nurses and twenty -five sanitarians. of office and hoped the Region would enjoy many Commenting on the more important trends in the more years of hisconstructive work forhealth. programme, he said that help was being given to Indonesia deeply appreciated the help provided by the governments in the production of vaccines against the Regional Director and his staff and their understanding communicable diseases, including freeze -dried small- of the Region's problems.Despite divergent social pox vaccine, the triplediphtheria- tetanus -pertussis and political conditions, the countries of the Region vaccine and oral poliomyelitis vaccine. One proposed had, thanks to the Regional Office and its Director, project concerned participation in the work of the new developed the closest co- operation in working for institute for economic development and planning which health and solving the many problems that existed. was being sponsored by the United Nations Economic Her country was deeply conscious of the honour Commission for Asia and the Far East. Afghanistan conferred on it by being elected as a Member entitled to was receiving assistance in staffing a new public health designate a person to serve on the Executive Board of institute; six staff members from WHO would work WHO and would help the Regional Office to the best there in collaboration with their national counterparts. of its ability. She congratulated the Regional Office on Training for medical auxiliaries constituted a high its new headquarters in New Delhi and thanked WHO priority activity in the Region. In medical education, and the Regional Director for the assistance given to it had been felt that the supplying by WHO of an odd her country. teacher here and there had not been enough and an effort was being made to develop different techniques Dr HAN TUN (Burma) congratulated the Regional by bringing in more substantial assistance to individual Director on his achievements and expressed gratitude medical colleges. For the time being, as an experimen- for the help that his country had received from the tal measure, one contract had been entered into with a Regional Office. His Government was gratified at the foreign university to provide six teachers to serve for choice of Burma as the site for a research unit for six years in one medical college. filariasis and for studies on the prevention of leprosy by COMMITTEE ON PROGRAMME AND BUDGET : ELEVENTH MEETING 251
BCG vaccination, by which his country hoped to secretarial services; secondly, a substantial programme contribute to WHO's store of scientific knowledge. was planned for Algeria, both under the regular budget and under the Expanded Programme of Technical expressedthe Dr GHANI AFZAL (Afghanistan) Assistance;thirdly, the number of fellowships was appreciation of his delegation and of his Government constantly rising.In regard to the last item, it had to the Regional Office and its dynamic Director for been necessary to divide the unit responsible for their valuable help and advice in the development of fellowships into two parts, one to deal with fellowships health projects in Afghanistan. for the European Region and one with fellowship - Dr GUNARATNE (Ceylon) paid a warm tribute to the holders from all parts of the world who wished to Regional Director, whose outstanding ability and study in Europe. In 1962, the unit had taken care of understanding of the Region's problems had won him 555 fellowship- holders from the European Region and his well- deserved reappointment. Ceylon was deeply 340 fellowship -holders from other countries. The grateful for the help given by the Regional Director and influx of the latter caused a great deal of extra work in particularly for his prompt action in the recent polio- placement, maintenance of contact, payment of allow- myelitis epidemic. ances and various other administrative fields. With regard to the programme in the Region, certain Professor SANGSINGKEO (Thailand) said he had been of the activities would not be found in the section on much impressed by the Regional Director's report. Europe inthe proposed programme and budget His country greatly appreciated the help given by the estimates for 1964 (Official Records No. 121, pages Regional Office in improving standards of health. 147 -158), since they were included among the inter- Dr JUNGALWALLA (India) said he was proud to join regional projects financed by the special contribution his fellow delegates from South -East Asia in thanking from Denmark tothe Expanded Programme of the Regional Director and his able and dedicated staff Technical Assistance. Since those inter -regional health for their help, especially in his country's three five - activities were at present centred in Europe, the major year plans.The harmonious relations that existed part of their administration and technical control fell between the Member countries of the Region was upon the Regional Office. largely due to the Regional Director and his staff, and In the matter of staffing, apart from the engagement those countries were very glad to know that they would of Russian -speaking personnel in 1963, little change continue under his leadership for another term. He was proposed for 1964: one additional clerical post looked forward to further progress in dealing with two in budget and finance and the transfer to the regular of the most serious problems facing his country - budget of a sanitary engineer in community water tuberculosis and rural water supplies. supplies, for whom provision had hitherto been made from theSpecial Account for Community Water Dr MANI, Regional Director for South -East Asia, Supply.The rising cost -of- living index in Denmark said he had been very moved by the many tributes to would certainly entail an increase in the cost -of- living the Regional Office. He would pass them on to the allowances for international personnel and a rise in staff, who really did the work. salaries for those locally recruited.Since the budget- European Region ary allocation would probably not be sufficient to meet that increase, it would be necessary to find means of The CHAIRMAN requested the Regional Director for Europe to introduce the proposed programme and economizing in other ways, either by reducing expendi- budget estimates for the Region (Official Records No. ture or by increasing the workload of the staff. How- ever, the problem was still to find how expenditure 121, pages 147 -158 and 294 -318). could be reduced. Dr VAN DE CALSEYDE, Regional Director for Europe, From the summary of the proposed programme and welcomed the delegates of Algeria, who were taking budget estimates (Official Records No. 121, page 294) part in the Health Assembly for the first time as it would be seen that a slight increase of about three representatives of an independent State, and also the per cent., as compared with 1963, was envisaged for delegates of Hungary, which had resumed active the Regional Office, and four per cent.for field participation in the Organization. The European activities. The total budget estimates for the Regional Region now included thirty active Members. The work Office and field activities in 1964, compared with 1963, of the Regional Office continued to grow, both from showed an increase of approximately four per cent. an administrative and technical point of view. That was With regardtothe Expanded Programmeof due to three main factors :first, that the Russian Technical Assistance, it might seem that there was a language had become an official working language in notable reduction in the 1964 programme compared the Region, necessitating an increase in translating and with that of 1963, and a smaller one compared with 252 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II that of 1962. However, it was misleading to compare appreciation of theRegionalOffice'swork and percentages year by year as, with the new planning assured the Regional Director that his country would system, the Expanded Programme was now established do its best to help the office to carry out its programme. for a period of two years. The figures for 1963 and Professor ZDANOV (UnionofSovietSocialist 1964 shown in the Official Records were not exactly Republics) congratulated the Regional Director on his correct, as it had been impossible to include estimates excellent report and on his valuable work. He also for programmes planned in Albania or the revised warmly welcomed Algeria estimates for programmes in Algeria.The slight as a Member of the European Region. reduction in the estimate under the Malaria Eradi- cation Special Account was due to the fact that the In general, he was satisfied with the way in which the in Turkey was nearly programmes werebeingimplemented,and was programme of eradication particularly glad to see inter -regional programmes concluded. being given priority in Europe. It was gratifying, too, He wished to express his appreciation to the Member that Russian was now one of the Region's working States of the Region for their assistance and advice in languages. the preparation of the programme for 1964.The He hoped, however, that the Regional Office would Regional Committee had given particular attention to be able to increase its work on cardiovascular diseases, inter -country programmes and, while accepting the malignant tumours, and metabolism, and on smallpox, majority of proposals, had made certain modifications which was invading the Region too frequently. Also, and had specially requested the inclusion of two meet- more could be done to help the developing countries in ings listed among the additional projects. The inten- training their health personnel. In that connexion the tion of the Regional Committee was to reduce resources of the European countries were far from expenditure on certain traditional activities and to being fully exploited, in particular as regards the develop forward -looking programmes of immediate specialists that the Eastern European countries could value to present -day health activities which would provide. serve as a basis for tackling future health problems. As The European Region had a fine tradition, and had in previous years, a number of additional inter - found the forms of work appropriate to it, which he country projects were suggested by the Members of hoped would further the Region but could not be included in the proposed programme and budget because of lack of funds. The Dr KATSACOS (Greece) said that his Government inter -country programme for 1964, adopted by the was deeply grateful to the Regional Director and his Regional Committee, did, however, include seventeen assistants for their help in his country's health pro- inter -country meetings, seven training courses to be gramme. financed under the regular budget and four inter- ProfessorWIDY -WIRSKI(Poland)thankedthe regional training courses to be financed by the special Regional Director and his staff for their valuable and Danish contribution to the Expanded Programme of courteous assistance. Technical Assistance. Dr FISEK (Turkey) thanked the Regional Director Professor MUNTENDAM (Netherlands) expressed his and his staff for their excellent work both in organizing warm appreciation of the valuable work done by the inter -country projects and in helping countries with Regional Office in 1962 under its able Director. specific programmes. His country greatly appreciated the valuable assistance received in programmes on Dr SENTICI (Morocco) said that the qualities shown education, nursing, malaria and tuberculosis, maternal by the Regional Director in carrying out his task were known and appreciated by all the countries in the and child health and in other fields. Region.Morocco had had ample experience of the Dr AMMUNDSEN (Denmark) wished to be associated ability of the Director and his staff both in preparing with the tributes from other speakers to the Regional and implementing programmes and in times of disaster. Director and his staff.She thanked the Regional He warmly thanked the Director and his assistants. Director for his kind words about her country, despite the rise in the cost of living, which Denmark, too, Dr CLAVERO DEL CAMPO (Spain) warmly thanked regretted. She also thanked the members of the the Regional Director and his staff for their work. Regional Office for being such good guests in her country. Dr EL -KAMAL (Algeria) thanked theRegional Director for his welcome to the delegation of Algeria, Professor BABUDIERI (Italy) expressed his apprecia- representing a free and independent country at the tion of the Regional Director and staff and his best Assembly. He also expressed his Government's great wishes for the future work of the Regional Office. COMMITTEE ON PROGRAMME AND BUDGET : ELEVENTH MEETING 253
Dr ALDEA (Romania) expressed his entire satisfac- problems and in presenting and supporting their tion with the Regional Director's work and hoped he requests in the Regional Office.In his opinion the would continue to tackle his important task with the policy of appointing WHO representatives was a good same energy as in the past. one and should be extended where financially possible. He had been very moved by the expressions of Dr SZABO (Hungary) thanked the Regional Director appreciation from delegates, and would transmit them for his words of welcome. His country looked forward to his colleagues. to playing its part in the work of WHO. Dr CHATTY (Syria) said he greatly appreciated the Inter -regional and other Activities work of the Regional Director and of the Regional Office. There were no comments. The co- operation received from the whole Region, and particularly from the Government of Turkey, in the Malaria Operations Planned to be Financed from the closing stages of the malaria eradication programme Malaria Eradication Special Account and other Funds in Syria, was invaluable. He expressed doubts as There were no comments. to the benefits to be derived from the appointment of WHO representatives. Although they may have Voluntary Fund for Health Promotion proved useful in one Region he wondered whether they Medical Research might not hamper the excellent co- operation that Dr TERRY (United States of America) said that his existed in the European Region Government, believing that in high -priority medical research an international organization had certain Dr KLost (Albania) thanked the Director -General advantages over a national organization, had, in 1958, and the Regional Director for the help given to his pledged a voluntary contribution of $ 300 000 to enable country and congratulated the Regional Director on WHO to study and develop plans for an intensified his ability and impartiality in directing the Regional programme of medical research.From that small Office and attending to the needs of the European beginning, WHO had built up a substantial research countries. programme for which the proposed estimate for 1964 Dr KIVITS (Belgium) joined in the expressions of amounted to some $ 4 500 000; of that amount, only appreciation to the Regional Director. He was proud about $ 1 750 000 was provided for in the regular of the work of his compatriot and of its recognition by budget; the remainder would have to come from the countries of the Region. voluntary contributions. Since 1960 the United States Government had made Dr VAN DE CALSEYDE, Regional Director for Europe, annual voluntary contributions to the programme, replying to questions raised during the discussion, with the object of encouraging other nations to support informed the delegate of the Soviet Union that his it.The response of Member States and the achieve- comments and suggestions would be very carefully mentsoftheDirector -Generalweregratifying considered.As he had already stated, the Regional vindications of his Government's hope. Specific Office was carrying out intensive work during the researchinareasof great importance was well - current year on cardiovascular diseases and cancer, advanced, for instance in cardiovascular diseases, but and it would probably continue for some years to come. it was now necessary to decide on new fields of research. A special paper on smallpox was being prepared for The Director -General had suggested four immuno- discussion by the Regional Committee at its forth- logy, human reproduction,drugevaluationand coming session in Stockholm. microchemical contamination of the environment. He With regard to the question asked by the delegate believed that those were all excellent choices, but the of Syria, his own experience of WHO representatives rate of expansion of the regular budget for medical was rather limited. The work of the Regional Office research,although well judged, was certainly not for Europe tended to be inter -country, and it could not sufficient to permit simultaneous initiation of signifi- therefore be compared with other regions, where there cant research in all four fields at once. Under those were large numbers of field projects. In the European circumstances, his Government had pledged a further Region there were WHO representatives in Turkey, voluntary contribution of $ 500 000 to the WHO Morocco and Algeria and it was hoped in 1965 to research programme, to be used for the development provide a representative for Greece, where the number of a research unit in human reproduction. of projects was increasing. He was sure that the work There was a dearth of scientific knowledge on human of the Regional Office would have been less complete reproduction, and the techniques being used in an without those representatives, who performed valuable attempt tosolve thehealth problems of human work in helping governments to deal with their reproduction had little scientific validity. That situa- 254 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
tion had led to controversy, which would disappear if contribution of the United States of America was now more knowledge were available. Research was needed to be used within a limited field. on the way in which hereditary and environmental At an earlier meeting the United Kingdom delegate factors affected the menstrual cycle; on the varia- had asked about WHO's work on drug evaluation. bility of the cycle itself; on the influence, if any, of the Sums of $ 40 000 for 1963 and $ 23 000 for 1964 had seasons of the year on human fertility; on the effect of been set aside in the Special Account for research on increasing age on fertility.Knowledge about the drug evaluation, but effective work would depend on basic physiology of human reproduction would, in obtaining more voluntary contributions. time, benefit thousands of sterile couples and might The Netherlands delegate had raised an extremely prevent the malformation, crippling and retardation important point about which he himself was equally of hundreds of thousands of babies. The immediate concerned. Although efforts had been made for some importance of research in that field had led his timetofinda way of improving research on Government to the decision to which he had referred. public health practice, he was not satisfied with the Further reasonable increases in the regular budget situation and efforts were being intensified. for research would continue to receive support from his Government, which hoped that other countries Inconclusion,he thanked delegatesfortheir would also continue to make voluntary contributions comments and appealed to them to make every effort and thus enable research work in the other three fields to encourage their governments to provide means for to be initiated. developing the exchange and training of research workers. Professor DE HAAS (Netherlands) said he was glad to see from the research programme planned to be Dr AFRIDI, representative of the Executive Board, financed from the regular budget and theSpecial drew attention to resolution EB31.R27, in which a Account for Medical Research that provision had been 'draft resolution concerning the programme planned made in 1964 for some projects on public health under the Special Account for Medical Research was practice. He felt, however, that the subject was not recommended for adoption by the Assembly. being given enough attention, as compared with other The draft resolution read : types of research. WHO should promote more work The Sixteenth World Health Assembly, in a field which was neglected by most research institutions and foundations.Research inpublic Considering that the programme planned under health practice was necessary to the more developed the Special Account for Medical Research as set countries,tohelp them toevaluate their health forth inOfficial Records No. 121, Annex 4,is services, and was of paramount importance to the satisfactory; developing countries, which needed, from the begin- Noting that this programme is complementary to ning, to base the organization of their health services on the research programme included in the regular the results of research, analysis and evaluation. budget of the Organization; and The DIRECTOR -GENERAL thanked the delegates of Emphasizingtheworld -wideimportanceof the United States of America and the Netherlands for medical research, their suggestions. Medical research activities were of 1. EXPRESSES the hope that more countries will make great value to WHO and to its Member countries and voluntary contributions to the Special Account; he was concerned to learn that the United States of America wished to reduce the financial assistance it 2.REQUESTS the Director -General to implement the had been giving for some years. Although provision medical research programme, within the broad for medical research in the regular budget had been concept of the third general programme of work for gradually increased, there was still a need for voluntary a specific period, to the extent that funds become contributions, not only in money but in services.It available through voluntary contributions to the was not enough torecognize the importance of Special Account; and increasing research work in the developing countries; 3. INVITEStheDirector -Generaltotakesuch he hoped that governments would endeavour to make further action as would most effectively contribute practical contributions, not necessarily in money, but, to the development of the medical research pro- for instance, by providing fellowships for training gramme. research workers from the less developed areas. He had Decision:The draft resolution was approved.' visited many countries to encourage governments to contribute to the programme and he hoped that his ' Transmitted to the Health Assembly in section 2 of the Com- appeals would be met, particularly as the voluntary mittee's third report and adopted as resolution WHA16.26. COMMITTEE ON PROGRAMME AND BUDGET : ELEVENTH MEETING 255
Community Water Supply Programme advanced. The assistance covered a wide field, includ- The CHAIRMAN invited the Secretary to introduce ing the engineering aspects of water -supply improve- the subject. ment, training of national personnel, development of necessary organizational structures, and the planning, Dr KAUL, Assistant Director -General, Secretary, financing, construction and operation of water -supply said that a report on the progress made since the schemes. TwelfthWorldHealthAssembly,inresolution In some areas the construction stage of community WHAl2.48, had authorized a global programme of water supply was now being approached. WHO was assistance to Member States for providing community using its limited resources to assist Member States with water -supplies now seemed due. the difficult problem of arranging for the financing of The Division of Environmental Health had been such works and for developing the competence to strengthened by the establishment of a special unit operate, maintain and manage community water concerned with community water supplies. The systems. In response to requests from Member Organization had been developing principles and States, WHO had completed eight major project guide -lines to assist countries in initiating activities in reports(Ghana,Nigeria,Madagascar,Liberia, that field, and had also established a pool of consul- Pakistan, Calcutta, Morocco and Taiwan). Two tants to provide specialist services to governments. projects had received approval and allocations from the Another important function had been the stimulation United Nations Special Fund :Calcutta and Ghana. and promotion of technical training. In 1963 the WHO programme included the provision An agreement had been concluded with the United of the services of consulting engineering firms for six Nations Special Fund for executing projects with Member States : Dahomey, Liberia, Turkey, Republic allocations from the Fund, and contacts had been of Korea, Ghana and India. established with other international financing agencies The 1964 programme proposals were designed to for possible support in the construction of water - continue existing activities and meet further requests supply systems when plans had been approved. Firms now in sight.The extent to which they could be of engineers had been approached for help both in the carried out would depend, of course, on contributions development of plans and in the detailed drawing -up to the Special Account.The estimates for 1964, of blue- prints and cost estimates. Community water - amounting to about $ 1 350 000, which included the supply advisers had been appointed at all the Regional programme of the Pan American Health Organization, Offices. were obviously modest in relation to the vastness of A broad review of the present situation with regard the total problem. The rapid growth in population and to community water supplies throughout the world urbanization, particularly in newly independent count- had recently been completed. It had been found that of ries, would mean a huge growth in demand for urban the approximately 215 million urban people in the sanitation, and community water supply was an essen- under -developed countries of Africa and Asia -a tial basis on which that sanitation must be built. number which was increasing at about four per cent. per year -only one in five had piped water in the home Dr AFRIDI, representative of the Executive Board, and less than half had access to piped water within drew attention to resolution EB31.R28, in which the half a mile of their homes.Reports from field staff Executive Board recommended totheSixteenth indicated that less than half the public water supplies World Health Assembly a draft resolution similar to in operation were adequate in quantity and quality. the draft resolution on the medical research programme If it was considered that as a practical goal all urban contained in resolution EB31.R27, and stressing the peoples should, by 1980, have piped water reasonably need for voluntary contributions from governments to accessible to their homes, the necessary investments in the Special Account for Community Water Supply. Latin America, Africa and Asia should be at a rate of at least 400 million dollars a year.That was about The draft resolution read : a quarter of one per cent. of the gross national product The Sixteenth World Health Assembly, of the countries concerned.According to available figures the present construction rate was less than 50 Considering that the programme planned under million dollars a year. the Special Account for Community Water Supply At present WHO had active community water - as set forth in Official Records No. 121, Annex 4, is supplyprojectsintwenty -threeMemberStates, satisfactory; and excluding those in the Americas.In addition, there Believing that this programme is of considerable were twenty -one national projects in the Americas, importance in stimulating and assisting countries to where the water -supply programme was much further develop plans for community water supply systems, 256 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
1. EXPRESSES the hope that more countries will make and strengthen water supplyauthorities,thereby voluntary contributions to the Special Account; assisting them to qualify for the loans becoming 2.REQUESTS the Director -General to implement the increasingly available from international agencies to planned programme, within the broad concept of the cover the actual construction costs. Secondly, he third general programme of work for a specific stressed the importance of considering the needs of period, to the extent that funds become available small towns and villages as well as of the larger towns, through voluntary contributions totheSpecial which had received most of the attention so far. Account; and Finally,his delegation considered the community water supply programme so important that it would 3. INVITEStheDirector -General totakesuch like to see some appropriation made in the regular further action as would most effectively contribute budget as from 1965. to the development of the community water supply programme. The CHAIRMAN put to the meeting the draft resolu- tion recommended by the Executive Board inits Dr STRALAU (FederalRepublicof Germany), resolution EB31.R28. emphasizing the importance of ample supplies of Decision:Thedraftresolutionwasapproved safedrinking -waterinpreventing thespreadof communicable diseases and thereby promoting econo- unanimously.' mic and social development, expressed his delegation's Expanded Programme of Technical Assistance:Cate- support for the draft resolution recommended by the gory II Projects Executive Board. He agreed with the remarks made by There were no comments. the President of the Fifteenth World Health Assembly in his opening address to the Sixteenth regarding the Additional Projects Requested by Governments and Not complexity of the financial problems involved. How- Included inthe Proposed Programme and Budget ever,hisGovernment'sexperienceinproviding Estimates technical assistance in the health field showed that There were no comments. many Member States were increasingly in need of outsidehelpintheirwater -supply programmes, Appropriation Resolution for the Financial Year 1964 particularly in the earlier stages. Examples of fields in The SECRETARY noted that in its second report to which assistance was particularly required were the the Committee on Programme and Budget, (see page development of water -supplypolicies,studieson 411) the Committee on Administration, Finance and hydraulic resources, estimates of future water require- Legal Matters had transmitted a text for the Appro- ments, the setting -up of water authorities, preliminary priationResolution, complete except forPartII, technical planning and, last but not least, raising the Operating Programme, the figures for which, pursuant necessary funds for implementation of the project. to the decisions just taken by the present committee, There was no doubt about the importance of the were as follows : part WHO could play in providing such assistance. US$ He had pleasure in announcing that the Federal 4.Programme Activities 16439819 Republic of Germany intended to answer the appeal 5. Regional Offices 2663706 contained in paragraph 1 of the draft resolution 6. Expert Committees 226600 recommended by the Executive Board. A first con- 7.Other Statutory Staff Costs . 5521280 tribution of DM 100 000 would be made to the Special Account in 1963. Professor ZDANOV (UnionofSovietSocialist Republics) said he would vote against the draft Appro- Dr WILLIAMS (United States of America) said he priation Resolution, for the reasons he had stated was very glad to hear that the Federal Republic of during the discussion of the overall budget level. Germany intended tocontributetotheSpecial Decision: The draft Appropriation Resolution Account. The Committee was, of course, aware of the as completed, was approved,2 the dissent of the high priority given by the United States Government delegation of the Soviet Union being noted. to the community water supply programme He had a few comments to make on the statement by The meeting rose at 1.30 p.m. the Secretary.Firstly, his delegation considered that, to use the limited resources available to the best ' Transmitted to the Health Assembly in section 3 of the Committee's third report and adopted as resolution WHA16.27. possible effect and avoid dispersal of effort, WHO 2 Transmitted to the Health Assembly in section 4 of the should concentrate on assisting countries to establish Committee third report and adopted as resolution WHA16.28. COMMITTEE ON PROGRAMME AND BUDGET : TWELFTH MEETING 257
TWELFTH MEETING
Monday, 20 May 1963, at 9.30 a.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1.Third Report of the Committee ensure that the universities for which it was respon- sible would provide opportunities for medical educa- Dr SENTICI (Morocco), Rapporteur, introduced the tion to students from the developing countries and Committee's draft third report. thatitssystem of secondary education in those Decision:The report was adopted (see page 408). countries would be strengthened sufficiently to produce more students capable of profiting from such higher education. 2.Statement by the Observer for the Holy See Since circumstances beyond his control prevented Reverend Father DE RIEDMATTEN (Holy Sée), speak- him from speaking in plenary session, as he was ing at the invitation of the Chairman, said that he was accustomed to do, he congratulated the Director - grateful for the opportunity to address the Committee, General on his reappointment. since he had not wished to prolong the debate at the previous meeting. The Holy See had studied the proposed programme 3.Measures for Providing Effective Assistance in and budget of WHO for 1964 in the light of its belief Medical Education and Training to Meet Priority that the problem of development was one of the major Needs of the Newly Independent and Emerging Countries factors in the maintenance of world peace, a subject to which the Holy Father had recently devoted an Agenda, 2.6.1 important encyclical.A clear impression had been The CHAIRMAN requested the representative of the obtained that the programme of WHO, over the last Executive Board to introduce the item. fifteen years, had followed the necessary lines to ensure Dr AFRIDI, representative of the Executive Board, a well regulated development. At the recent United said that he would briefly summarize the Board's Nations Conference on the Application of Science and report 1 on its organizational study and point out the Technology for the Benefit of Less Developed Areas, salient features. The foreword gave an account of the the Secretary -General, Professor Chagas, had stressed origins of the study and of its conceptual basis that that the two fundamentals of all development were medical education and training should be widened health and food.Development depended for its to include that of paramedical and auxiliary medical success mainly on the human resources available, and personnel as well.The purpose of the study was to those resources could not be utilized unless they explore the needs for trained medical personnel and enjoyed the state of balanced well -being corresponding the ways of meeting them, with recommendations as to the definition of health contained in the Constitu- to possible priorities, and to explore problems of tion of WHO.Criticisms of other international policy and implementation.The need for trained organizations during recent years did not appear to be personnel had been defined to mean the gap between applicable to WHO, which had from the beginning the available number of such personnel and the number concerned itself with the essential structure of public that was immediately required or would be required health and with the provision of the necessary medical at certain target dates in the future.The assessment and health personnel, and had now engaged in the of needs had been based on the fact -finding surveys very fruitful field of co- ordination and intensification in seventeen African countries during 1961 -1962 and of research. Certainly, a satisfactory solution had not on published data regarding health personnel, hospitals been found for all the problems tackled by WHO but and training institutions. From those data, it was clear there had been no attempt to evade them or dodge the that a minimum of 1200 doctors would have to qualify issues. each year for the next twenty years if, by the end of The Holy See wished to assure WHO of its interest that period, the ratio of physicians to population was to in and sympathy with the Organization's activities, particularly since it was redoubling its own efforts to 1 Off. Rec. Wld Hlth Org. 127, Annex 15. 258 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II be increased from 1: 20 000 to 1: 10 000. However, it provided,ifnecessary,toensurethatqualified was also clear that not only were university teaching personnel would fill key roles throughout the country, facilities lacking but there was a shortage of secondary rather than congregating in the cities. school students of a sufficiently high standard to profit The report ended with a section containing recom- from university facilities, were they available.Con- mendationsregardingthefinancingofmedical sequently, the bulk of the medical and health services education and training programmes. The conclusion for most of the developing countries would have to be drawn by the Executive Board as a result of the study provided for many years to come by paramedical and was that a solution to the problem of medical and auxiliary personnel. allied education and training was essential for the The Executive Board had, therefore, concluded that maintenance and development of health services in all the first step towards meeting the needs for medical countries of the world. personnel in any given country was to assess the Dr DAELEN (Federal Republic of Germany) said that availability of such personnel, of teaching facilities and the problem of medical education and training had of training institutions; the second step would be to been studied by her Government in co- operation with plan the large -scale training of auxiliary personnel in newly independent countries, within the framework of the country itself, simultaneously with the training bilateral programmes of assistance. Clearly, the long- of medical and paramedical personnel either inside or term solution to the problem lay in the development of outside the country. A judicious distribution of func- adequatetrainingfacilitieswithinthecountries tions between medical and paramedical personnel on themselves, but for the present they would have to the one hand and their respective auxiliaries on the rely largely on the training of their own nationals other should permit economy both in staff and in the abroad and on the employment of trained foreign time required for training. personnel.Many nationals of such countries were As regardspatternsoftraining,inter -country receiving medical training in the Federal Republic, but programmes might be a suitable and economically that could never be of equal value with education of a satisfactory solution where types of personnel and similar standard in their own countries, where basic problems were comparable between the countries problems relevant to the area could be included in the concerned. The report recommended that the assist- curriculum.With that important consideration in ance of WHO should be designed to supplement and mind, her Government had, under the afore -mentioned not supplant the efforts of each country and that it bilateral assistance agreements, set up a dental faculty should mainly consist of the provision of short -term in Indonesia and a school of nursing in Guinea. consultants, visiting professors, fellowships, equipment However, since a shortage of teaching facilities in the and other services.It also recommended that, while developing countries would certainly continue for many the operating plans for training schools, including years, her Government also invited candidates from medicalschools,shouldnot betooambitious, those countries to take part in courses on tuberculosis there should be no lowering of the standards of and tropical health.To deal with the language professional qualification in the name of expediency. difficulty, there would be lectures in English at the The problem of developing new medical schools was beginning of public health courses,followed by great, in view both of the world -wide shortage of lectures in German when the students had acquired an teaching staff and of the capital cost, but, as the adequate proficiency in the language. Executive Board pointed out, a medical school was valuable to a country not only for its teaching facilities Professor PESONEN (Finland) said the Executive but because of its influence on the country and the Board had provided a very clear picture of the present situation of trained personnel and training facilities; community and because it acted as a channel through although the report referred only to Africa, it was which information on the latest advances in medical obvious that the problem throughout the world must science could pass. Therefore it was recommended that, be immense. He felt that the aim of one physician to in countries where there was no immediate prospect every 10 000 of population should be adopted rather of establishing a medical school, the facilities of one as an immediate target than as an objective for the suitable hospital should be developed to allow for future. With regard to the training of physicians, the clinical courses of study, with a well- designed curri- modern system of bedside teaching, while a great culum and a fixed number of admissions to such improvement on the old system ofex cathedrateach- courses.The report warned that the training of all ing, nevertheless demanded far more hospital space. types of levels of health personnel must be related to It would be of great interest if WHO could recommend overall public health plans and the consequent opportu- a ratio of hospital space to students for that type of nities for employment. Special inducements should be teaching. However, even if hospital space were avail- COMMITTEE ON PROGRAMME AND BUDGET : TWELFTH MEETING 259 able, an increase in the number of medical students cerned, and thatitstill had the responsibility of through the introduction of parallel courses was setting up training institutions of the type envisaged. normally impracticable because of the lack of teaching His delegation considered the report presented by the staff.He entirely agreed with the suggestion that Executive Board eminently satisfactory and com- countries having adequate facilities should use them mended the Executive Board and the Director -General for the clinical training of their medical students, and on its preparation. He also expressed appreciation for thought that WHO should be prepared to offer finan- the valuable documentation on the subject submitted cial assistance for the engagement of extra teaching by Dr Grundy, Assistant Director -General, to the staff in those medical schools that were willing to last session of the Regional Committee for Africa. absorb such medical undergraduates for pre -clinical The Executive Board's report stressed two main training. If twenty medical faculties were willing, with considerations with which there would be general that assistance, to teach an extra forty or fifty students agreement, namely, that the shortage of medical each year, the output of qualified personnel would personnel constituted one of the main obstacles to the reach some eight hundred a year after six or seven improvement of health in the newly emerging countries, years and thus be brought much nearer to the requis- and that it was necessary to set up as soon as possible ite figure of 1200 per year. He did not believe that the medical schools in the countries themselves where linguistic problem was very great, since students of a nationalstaff could be trained, although outside suitable educational standard could normally acquire assistance should of course continue to be provided as an adequate proficiency to follow the courses after a long as necessary. concentrated short -term course in either English or The report drew attention to the immense extent of French. The attainment by students of an adequate the needs to be met. Indeed, for the African Region, level of education, which would permit them to profit it would be desirable over the next seven years to train from higher education, was a matter in which the some 13 000 doctors, 49 000 nursing staff and 16 000 assistance of UNESCO would be required. He sanitarians. While it was apparent that, even with the wondered if some type of plan could be developed help of international organizations and the highly between WHO and UNESCO to solve that problem. developed countries,the goal was impossible to His delegation was in favour of the proposals achieve, it was nevertheless salutary to emphasize the embodied in the study, but he should make it clear shortage and thus call attention to the urgency of the that his Government was very clearly aware of the action required. necessity for medical personnel to be trained in their The report also indicated the problems that had to own countries, whenever and wherever facilities were be solved.In the first place, it should not be over- available.On the other hand, the idea of medical looked that in many countries possibilities of employ- practitioners with an inferior standard of qualifica- ment for doctors and nursing staff were severely tions seemed highly undesirable, and it was preferable restricted for financial reasons, and thus full use was for countries unable totraintheir own medical not being made of all potential personnel.Secondly, personnel to establish their health services on the basis the medical profession seemed in recent years to have of locally trained health auxiliaries. The need for teach- been proving somewhat lessattractiveincertain ing staff was paramount, and all Member States countries; in some African countries, for instance, should be asked to try strenuously to find teachers certainadministrativecareers were proving more willing to serve in the medical schools of the developing remunerative and required a shorter period of training. countries. With reference to the categories of medical Thirdly, there was a falling -off of candidates and personnel that were most needed, he suggested that the students, particularly among those who went abroad training of public health nurses who were also mid- to study.The percentage of failures was somewhat wives was a great advantage, particularly in rural high, probably owing to inadequate selection and communities. In conclusion, his delegation felt that the orientation at the outset, combined with difficulties of study might have included more direct technical adaptation. That trend constituted an additional reason advice on the essential elements of a curriculum for for preferring local training.It would be desirable in medical schools, since detailed advice in that matter future for national ministries of health and social would obviously be of the greatest service to countries affairs to collaborate more directly in the question of planning the establishment of medical faculties. selection of candidates with the ministries of education. Commenting on the establishment of medical schools Dr AUJOULAT (France) recalled that his country had in the newly independent and emerging countries, he considerable experience in the education and training stressed the difficulties -to which the report drew of medical and paramedical personnel in countries of attention -encountered in that process. The question the nature of those with which the report was con- of finding enough professors from abroad was most 260 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
difficult, and WHO's interest in the problem was already heard about theassistancerendered by therefore greatly to be welcomed.The training of Czechoslovakia in undergraduate medical training, localteachingstaff was anessentially long -term and he would restrict his comments to points directly undertaking. Accordingly, in order to arrive at a more connected with the Executive Board's report. immediate solution of the problem, WHO action in His delegation whole -heartedly supported the view favouring the development of agreements between that medical faculties should be established in the neighbouring States for inter -country medical schools developing countries themselves. None the less, it was in the interim was to be encouraged, since it was important to stress that the development of medical clearly preferable for students to receive training in services had to be linked with development in the their own continent.That suggestion was not made economic,social and culturalspheres,sincethe with a view to closing the doors of foreign universities number and categories of medical workers that could to them, but rather with a view to ensuring that basic be trained, and the priorities required, depended on training was given under local conditions and that the that development. best -qualified graduates should then go abroad for On the basis of experience, his delegation believed further training or specialization. that one of the most effective ways of rapidly increasing On the question of the actual education provided, the number of doctors in countries where there was at he recalled that the view had been expressed by several least one medical faculty was to concentrate on participants in the technical discussions held in the strengthening the departments teaching basic and course of the present Health Assembly that the newly pre -clinical subjects.Clinical training could be given independent countries were in a favourable condition in the hospital attached to the faculty.In countries to take advantage of the latest developments of pre- where no medical faculty existed, the most urgent task ventive and social medicine in the integration of their was to train teachers of basic and pre -clinical subjects general programmes of medical education. While abroad. In setting up a medical school, the establish- there could be no doubt that the newly emerging ment of departments for basic and pre -clinical subjects countries could indeed benefit from the most recent was one of the hardest tasks, because of the difficulty trends in medicine, it was important not to minimize of finding suitable teachers.In that connexion, his the difficulties that they would encounter in adapting country could give assistance if required. to their own needs the various elements of medical The establishment of new faculties of medicine, able education available, and the risks of loss of quality of to accommodate at least fifty students yearly, needed certain programmes of study. For that reason some careful consideration ; the economic situation had to countries might prefer at the outset to adopt in their be taken into account, as also the possibilities for entirety the programmes and methods of the older developing teaching and research work.For that universities and to adapt them to their needs at a later reason, in certain cases it would be suitable for doctors juncture. WHO could play a most valuable role in from neighbouring countries to be trained in one of helping those countries to achieve the necessary adap- them. tation of the curriculum to their existing needs at the The doctor was the essential element in the develop- earliest possible stage, without allowing the standard ment of contemporary medical services. Therefore, in of education to suffer to any degree. Moreover, it was view of the time required for medical education, it was important to ensure that diplomas granted in the newly necessary to start programmes of training of doctors independent and emerging countries should have their at the earliest possible time, so that they would be full equivalent value at an international level. available concurrently with the other health personnel With those considerations in mind, his delegation trained later. was whole -heartedly in favour of setting up inter - country committees on medical and allied education, Dr EL -BORAI (Kuwait) expressed appreciation to the as considered in the Executive Board's report.Such Executive Board for the comprehensive report it had committees could greatly assist in achieving the inter - submitted. State agreements to which he had referred earlier and The problem of providing medical education and could do valuable work in the essential task of co- training for the newly emerging countries was a most ordinating programmes and diplomas. delicate one, particularly as no single criterion could be set for their needs. Some of those countries had a Dr DOUBEK (Czechoslovakia) said that the investi- nucleus of medical personnel with adequate training, gations carried out as to the requirements of certain whereas others had practically no national trained countries in Africa with regard to medical and other physicians.The insufficiency of trained personnel health personnel clearly pointed to the need for constituted a formidable difficulty. It was essential that rendering speedy assistance. The Health Assembly had WHO should adopt a positive attitude, and in helping COMMITTEE ON PROGRAMME AND BUDGET: TWELFTH MEETING 261 to create a basis for medical education and training it Yugoslavia had at present a number of medical should take into account preventive and social as students from developing countries on fellowships well as curative medicine. provided either by the Yugoslav Government or by There could be no doubt that poverty and ignorance their own countries. Experience had shown that one or still remained the main barriers to any real break- two years were necessary before foreign students could through in the improvement of health conditions. satisfactorily follow the courses given in Serbo- Croat. Consequently,economic andsocialdevelopment, Accordingly the University of Belgrade was organizing which would also permit education and training, was teaching in the French language for the first two years of prime importance.It was the responsibility of the of medical training, the remainder of the course to be international community to assist the newly emerging in Serbo -Croat. countriesin such development and in providing His country was prepared also, in co-operation with adequate housing, community water -suppliesand WHO, to sponsor particular institutions with a view to waste disposal, etc.In the field of health proper, the setting up medical schools. He was convinced that that creation of a corps of adequately trained health type of assistance could greatly strengthen international personnel was the main problem. efforts to help in meeting the shortage of doctors. He was sure that WHO would be of immense help WHO had an important part to play in ensuring the in providing assistance in education and training. For co- ordination of all efforts. those countries with some medical personnel, the most useful form of assistance would be the provision of Dr HAQUE (Pakistan) considered that the Executive regional advisers to assist in planning.It was import- Board had made a most comprehensive review of the ant to build up a central hospital with adequate problem. Pakistan, as a developing country, had facilities and highly trained personnel. The prepara- experienced many of the difficulties referred to.He tion of academic staff should be met by the provision recalled that his country had had, at the time of of fellowships.In his view, it was preferable for gaining independence, a ratio of physicians to popula- medical training to be undertaken locally. There was tion of 1 to 30 000, and one medical school with 100 also a need for appropriate legislation to enforce doctors. Fifteen years later, Pakistan had a physician the rights and obligations of doctors. With regard to to population ratio of 1 to 7000 and twelve medical countries where adequately trained doctors were almost schools. Of course there was still a shortage of totally lacking, he stressed the desirability of developing doctors. education and training potentialitiesin theright In keeping with WHO policy, Pakistan was admitting direction from the outset.Doctors were the prime to its medical schools students from neighbouring need, to be followed by auxiliary personnel.Efforts regions. There were at the present time between 150 should also be made to further post- graduate courses and 200 foreign medical students. Difficulties had been in public health administration as a whole, including experienced in finding teachers for the basic medical its legal basis. sciences, and accordingly post -graduate training for He was convinced that WHO would, by concerted that purpose had been established; Pakistan would action, achieve valuable results for the future of the welcome the participation of foreign students in that newly independent and emerging countries. course. Some language difficulties had been encoun- tered in the past, all courses being given in English, and ProfessorGERIC(Yugoslavia) commended the language training had been necessary. Difficulties had Executive Board on the report it had presented. The also arisen in ensuring that foreign students had recommendations made were well conceived although adequate pre -medical training in the basic sciences, it should be realized that they would call for consider- and it would be helpful if WHO could make some able efforts by, all countries concerned and by WHO. recommendations regarding minimum standards in In considering how best to meet the problem, it that sphere. should first of all be borne in mind that the resources Pakistan had a medical council which was respon- of WHO were clearly inadequate tb meet existing sible for standardizing medical training in all schools. needs. The newly emerging countries were interested in The number of five clinical beds per student was main- receiving aid both on an international and on a tained.It had been found that training abroad often bilateral basis.One of the possible methods for placed emphasis on diseases not relevant to Pakistan, accelerating the training of medical personnel, parti- and therefore a post -graduate medical centre had been cularly doctors, was the application of the system of opened for teaching clinical sciences. A post -graduate theHadassahMedicalSchooloftheHebrew nursing school for sister tutors had also been estab- University, Jerusalem, which would be valued by many lished. Pakistan would be glad to receive foreign countries receiving students from developing countries. studentsat both those post -graduate institutions. 262 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
While the Executive Board's report mentioned as a methods which might assist in a solution of the problem tentative goal a ratio of physicians to population of were worthy of consideration. 1 to 10 000, that figure should be considered purely in Previous speakers had mentioned the utility of the nature of a guide -line, since the number of doctors sending to Africa teachers who would remain there would clearly in the last analysis be dependent upon until local personnel could replace them.Auxiliary the financial possibilities of the government concerned, personnel should in the main be trained locally. The as well as on the per capita income of the population. view expressed that medical students should receive Every plan would have to vary slightly as between one their theoretical training abroad and their clinical country and another; otherwise only frustration could practice locally was worthy of attention. The sugges- result. tion for linking medical institutes in economically With regard to the training of auxiliary personnel, he developed countries with a higher medical teaching considered that specialized training should only be institution set up in Africa was interesting.That given following an all -round basic training. He drew naturally implied exchange of teachers,students, attention to the need for guarding against a dangerous teaching material, etc. trend whereby auxiliary personnel might in some The Soviet Union, for its part, was ready to grant cases seek to practise as doctors.It was essential for all necessary facilities to the developing countries. He the newly emerging countries toprofit from the recalled that the Patrice Lumumba University in the experience of others and prevent that from the outset. USSR had a medical faculty.His country was A technicians' council was being set up in Pakistan, prepared to extend such training and also to send wheretheparticularspecializationsofauxiliary experienced teachers to African countries, as well as to personnel could be officially registered. train African teaching staff in its medical institutes and other teaching establishments. The Soviet Union was Dr NOVGORODCEV (UnionofSovietSocialist also prepared togive newly established medical Republics) said that, as was evident from the report, institutions information on teaching methods, pro- the newly developing countries were faced with an grammes, equipment, manuals, etc. used in the USSR. immense shortage of doctors.It was striking to think It would also be desirable to consider whether that the present ratio of physicians to population in additional funds for medical education and training Africa was less than 1 to 20 000, whereas in the Soviet could not be made available through such bodies as Union there were 20 doctors per 10 000 inhabitants. UNESCO, the United Nations Special Fund and the One of the causes of that situation was that the Expanded Programme of Technical Assistance, WHO European doctors, who had to some extent in previous beingresponsibleforcentralplanning andco- years filled the gap made by the lack of adequate ordination. national staff, had left those countries when independ- The decision taken at the European Symposium ence had been achieved. Consequently, the training on Training in Tropical Medicine to arrange meetings, of national medical staff was at present the basic in which the representatives of the developing coun- problem at issue. tries would take part, to consider what could be done by The question of how best to organize such training European institutions to meet their training needs, was called for thorough consideration.National medical worthy of support. institutions would clearly have to be established. The report under consideration constituted a first However, that presented two difficulties, namely, the and valuable step towards fulfilling the task of training shortage of students with sufficient secondary educa- medical and auxiliary personnel for the developing tion tobenefit from medical education, and the countries of Africa.The needs for such personnel inevitabletime -lagbeforequalifieddoctors were would increase in keeping with the economic develop- available. Accordingly, it appeared necessary to con- ment of the countries concerned.That was why the sider other methods which would enable medical present report should serve as the beginning of a services, albeit of an elementary nature, to be provided thorough investigation into the matter. in a shorter period. He recalled the experience of the Soviet Union in Professor GoRNICKI (Poland) said that while there training persons without full secondary education as were various forms which effective assistance in pro- feldshers. The tasks attributed to such personnel had viding training for medical and paramedical personnel of course to be strictly delimited, and they should could take, the task was undoubtedly of a long -term receive full secondary education to qualify them to nature. continue their medical studies in a medical institute. Aspects to be considered were the provision of In view of the limited resources available both to university education for nationals of the developing WHO and to the developing countries in Africa, all countries; the provision of teaching staff for medical COMMITTEE ON PROGRAMME AND BUDGET : TWELFTH MEETING 263 schools in those countries; and the organization, with and other categories of health worker in the social WHO help, of courses for paramedical personnel on framework. The field of action and the responsibility nursing and first aid. Courses of social medicine, help of medical auxiliaries must be expanded to reflect the to nursing schools, and specialized courses for post- modern tendency to integrate preventive and curative graduate training should also be taken into account. services.At present, many sanitarians were not fully His country was in a position to help the newly justifying their existence because their field of opera- emerging countries in several ways.It could continue tion was too limited, though their training was wide to provide teaching staff in a number of the main enough to allow them to do very valuable work in disciplines.Moreover, it was prepared to take each immunization, simple childcare,nutrition, minor year in Polish medical faculties between fifteen and treatment, and the registering of statistical data.If twenty new students who would receive a preliminary those possibilities were not taken into account and if year's language training in Polish before their studies. needs were assessed in terms of the existing function of At present there were ninety foreign students, mostly doctors in the developed countries, the amount of from African countries, at the medical faculty of the leeway to be made up would seem discouragingly University of Warsaw; their level was entirely satisfac- great.Obviously it was not realistic to suppose that tory. The Polish health administration could organize countries where there was one doctor to 100 000 courses lasting six months on the principles of nursing population could ever catch up with those where there and first aid for groups of ten to twenty persons in was one to only 475 people; by the time they had as French and English.Nurses could also be sent to many as one doctor to 20 000 population, the ratio in centres designated by WHO to undertake training. the developed countries would be lower still. Furthermore, six to eight nursing students could be In considering the nature and extent of the need, trained in Poland for work in their own countries. consideration should also be given to the role of the Financial assistance by WHO would be required in hospital. As had already been mentioned during the respect of the nursing training. discussion, hospitals provided a valuable ground for He also drew attention to the possibilities of prov- clinical training, but they could also be used for iding training in paediatrics and obstetrics in the preventive and social work in the community. If their maternal and child health institute in Warsaw and its specialized staff were made available for that purpose, four branches. A course, with thirty -four participants they could, by supervising the work of large numbers from thirty countries, most of which were developing of auxiliaries outside, produce a far bigger impact than countries, had taken place in 1962 with the assistance if they were confined within the walls of the hospital. of the International Children's Centre in Paris. A The delegate of Pakistan had said that, to assess the further international training course on maternal and need for training facilities, it was necessary to consider child health would be organized, with the help of such factors as the amount of money available to pay UNICEF and WHO, in Warsaw in 1964. The institute for medical care and the number of posts in the in Warsaw was prepared to arrange for such courses government health service.With all respect, he con- yearly. sidered that represented an approach which should be The report submitted by the Executive Board was an abandoned. First the number of personnel required for extremely important one and well prepared. All efforts a basic minimum service should be estimated, and the to revise medical education should take into account necessary measures taken to provide them, and only not only the needs of the particular country concerned then should it be left to people to make arrangements but also those of countries requiring effective help. for their individual needs. Attention should be given to the need to change the Dr ADENIYI -JONES (Nigeria) said that the remarks pattern of training not only in the under -developed he was about to make were based on several years' countries but also in the more advanced countries.It experience in his country of trying to develop training would be in their own interest, for at present huge of health personnel at various levels. sums were being spent on a pattern of medical care that Section 2 of the Board's report on its organizational was not very economic. Furthermore, a more rational study gave figures for the present ratio of doctors, use of available manpower, in particular the use of nurses, hospital beds etc. to population in the African auxiliaries to do some of the work now being done by Region, but those figures did not show the full serious- doctors, would make more staff available for assisting ness of the problem as they did not reveal the fact that the under -developed countries.The main change much of the most highly trained staff was concentrated required was to integrate the various disciplines and in a few selected areas. The need was thus even greater reduce the number of different teaching specialities than appeared, and in reviewing it it would be neces- which made the course unduly expensive and tended sary to reconsider the role of the physician, the nurse, to confuse the student. Meanwhile, in countries that 264 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II were still under colonial rule, immediate measures even where students had to go abroad for training, to should be taken to allow local staff to acquire qualifi- provide a degree or other qualification based on the cations and to practise, so as to avoid the recurrence local institution.It was also essential that, as soon as of situations such as had arisen in his own country and possible after a medical teaching institute was set up, in the Congo (Leopoldville) when foreign staff had been provision should be made for post -graduate studies, withdrawn. so that the training of future teachers could be based on As had been pointed out in the report and by many local conditions. speakers, the provision of facilities for training in the A major difficulty in implementing training policy candidate's home country was essential, but it must was the problem of financing, and he therefore be realized that for a long time to come much training suggested that the Committee consider raising the would have to be obtained in the developed countries. grant for assistance in that field. The advanced countries themselves, even when they He expressed appreciation of the assistance received already had excellent training facilities, had continued by Nigeria from Canada, the Federal Republic of to send medical students abroad and had thus fur- Germany, Israel, the United Kingdom and the United thered the development of medical science both at States of America, as well as from WHO itself, in the home and in the countries of study. He stressed that the training of medical and auxiliary personnel. point, because some speakers seemed to be suggesting that some form of restriction should be imposed on He supported the proposal that regional groups be training outside the candidate's country. established to assess needs in the field of medical He agreed to the maintenance of auxiliaries as a education and see how they could be met. separate category rather than the establishment of two different levels of doctor.Regarding the content of Professor DE HAAS (Netherlands) said that the their training, it was important that auxiliaries be impressive review contained in the Board's report on given a sense of their duty to the community and not its organizational study showed convincingly that the merely be taught technical skills as, particularly in the shortage of doctors and other medical staff in Africa under -developedcountries,theacquisitionof a was appalling.The average ratio of physicians to modicum of skill was often regarded simply as a means population might be about 1 to 20 000; but in many of raising oneself above the rest of the population. rural areas it was actually 1 to 100 000. From his own The training of hospital nurses and midwives should experience he knew that even such an unfavourable be integrated with that of public health nurses, so as to proportion allowed useful pioneer work to be done, produce a type of community nurse able to turn her but there was no doubt that the number of doctors hand to any of the three types of work. must be increased rapidly. He stressed the importance of including public In section 3.3.5.2, sub -paragraph (a), of the report, health aspects in the training of all engineers and it was stated that an annual intake of not less than architects, particularly in the tropical countries. fifty students should be foreseen for an undergraduate The importance of training health workers as a medical school serving a country or area with a popu- team and of providing for the doctor, the nurse, the lation of two and a half to three million if the number sanitarian, and the other members to do some of their of school -leavers with a complete secondary education practical training together had already been suffi- was reasonably large, on the assumption that not ciently stressed. more than one -tenth of them could be expected to take Regarding the suggestion that basic science could be up medicine. As the average birth -rate in Africa was learned abroad and clinical training obtained at home, about 40 per thousand, a population of the order he thought that, in view of the practical difficulties, it assumed would have between 100 000 and 120 000 would be better to shorten the basic science course and births a year. The percentage of highly gifted children in the meantime make every effort to provide facilities being the same throughout the world -two or three for it to be taken at home. per cent. -two or three thousand gifted children were With regard to the provision of specialized teaching born every year in such a country. Thus, if secondary staff, he felt that there was undue emphasis on ques- schools, universities and medical schools in developing tions of status and pay and that many of the persons countries would select their pupils from the gifted concerned were not really doing specialized work but group, the wastage of candidates mentioned in the merely working in special fields without learning about document would hardly be possible. Moreover, gifted the particular conditions of the country to which they students were by definition able to finish the medical were sent. curriculum quicker and better than average students It was important that local training should have a and to become teachers themselves within a relatively sufficiently high status and it was therefore desirable, short time.Thus the selection of gifted candidates COMMITTEE ON PROGRAMME AND BUDGET : TWELFTH MEETING 265 would greatly speed up the production of sufficient whose salaries would be paid partly by the country doctors in the developing countries. concerned and partly by WHO. The previous month, during the visit to his country of Dr SYMAN (Israel), referring to the problem of one of the Assistant Directors -General of WHO, Dr location of training, said that his Government had Grundy, discussions had been held at the Ministry of established in Jerusalem a medical school to provide Health and two medical faculties on the possibility of training in the English language for students from the giving assistance to an African country in establishing developing countries.It was realized that that was not a medical school.It had not yet been possible to give an ideal solution, but with the present shortage of a definite answer but his Government was contem- facilitiesand the problem of placing prospective plating making available a number of professors or students, especially from Africa, the best that could be assistant professors from the six or seven medical done until every country had its own medical schools schools of the Netherlands. was to establish institutes of that type. His delegation considered that pre -clinical teaching, He agreed with the delegate of Nigeria about the especially of social medicine, was of fundamental need for a reassessment of the function of the doctor importance in establishing a new medical school. The in society, particularly in relation to the shortage teachingofvitalsatistics,medicaldemography, which existedeverywhere, even inthe advanced nutrition, environmental health, epidemiology and countries, as was shown by the fact that students from public health demonstrations should begin as early as the developing countries often stayed thereafter possible in the medical curriculum. qualifying.The advanced countries could afford to wait for such a redefinition of the doctor's function, The education of doctors was justified only if, at the but in the developing countries it was a matter of same time, enough nurses and midwives were trained. urgency and could, he believed, be of historical Table IV in Appendix 1 to the report suggested a ratio importance for the development of medicine through - of 1 to 2 but his delegation considered a ratio of 1 to 5 out the world by showing how, with a different concep- or even 1 to 10 more realistic from the point of view of tion of the relationship between, the doctor and the efficiency. medical auxiliary, valuable work could be accomplis- Finally, his delegation considered that in helping a hed even with a very low ratio of physicians to newly created medical school an assisting country population. benefited as much as the recipient country from the He agreed with the delegate of the Netherlands that co- operation between them. the ratio of auxiliary workers to doctors could be much higher than indicatedinthereportbeforethe Dr LE CUU TRUONG (Republic of Viet Nam) Committee -ten to one or even more.During the stressed theimportanceof assistancetounder- Committee's discussions on the progress of WHO's developed countries in overcoming their shortage of work in various health fields, from the control' of doctors by establishing their own medical schools. malaria and smallpox to nutritional education, he had In the long run, such schools would no doubt be noted the extent to which every programme depended staffed by local teachers, but for a long time to come on the auxiliary health staff.In training that key foreignstaff would be required. Unfortunately, personnel three considerations should be paramount : recruitment was a problem because of language diffi- first, a clear definition of function; secondly, the culties and because suitably qualified persons were not establishment of an appropriate syllabus; and thirdly, often willing to sacrifice career opportunities in their the provision of suitable teaching staff, which for the own countries. He knew of countries which had for time being would have to be provided largely by the years been trying tofill teaching posts with inter- technically advanced countries.Unfortunately can- national staff recruited through WHO, but without didates did not come forward very readily and, even when available, they required some grounding in the success. conditions existing in the countries where they were To overcome that difficulty he suggested that the to teach. WHO could help to solve that problem Organization might first draw up an estimate of the by establishing a pool of teaching staff for auxiliary number of teaching staff likely to be required in the personnel with enough knowledge of local conditions various medical specialities over the next 10 or 20 in different parts of the world to be able to serve years, and then set out to build up, through the grant- anywhere on request. ing of fellowships or some other method, a cadre of Development in the training of paramedical per- international teaching staff who would be available to sonnel would not only help to solve the health problems be sent to developing countries at their request, and of the emerging countries, but would also serve the 266 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II sociological purpose of providing suitable employment Her country had done all it could to help other for the increasing numbers of persons benefiting from countries whose needs were greater, and would be primary and secondary education. happy to continue to render such assistance to the best of its ability so long as that was necessary. Dr VASSILOPOULOS (Cyprus) said that, as he had stated in plenary session, his Government was short Dr TUVAN (Mongolia) said that the detailed report of certain specialized medical and nursing staff and was by the Executive Board and the lively discussion that sending candidates for training abroad. He thanked had taken place showed the great importance of the WHO and the individual countries which had helped problem. The training of medical staff was indeed of by providing fellowships for that purpose and hoped the utmost importance and the health of the popula- that further such assistance would be received. tions of the world depended thereon to a large degree. The experience of his country showed that it was Dr HAMZA (Sudan) congratulated the Executive Board and its Chairman, Dr Afridi, for the excellent possible in a fairly short time to train enough doctors report, many of the features of which had been and health workers : the medical institute had been in applied in Sudan. The proposal that, when there was existence for some twenty years and there was now a no immediate prospect of establishing a medical doctor for every 970 inhabitants; within five years there would be one for every 720 inhabitants. school, the possibility should be explored of using any Such success was mainly due to the establishment of the available hospital for the clinical training of those who would have carried out their medical studies abroad medical institute providing training in Mongolia and sending students to study abroad, mainly in the USSR. was most practical.Such steps had been taken in his country when medical education had started with a In the beginning professors from the Soviet Union had school in which the teachers were exclusively hospital come to teach in Mongolia, but at present all the teaching posts were held by nationals of his country. specialists. Speaking from the experience gained in his country, he suggested that classes for such training Clearly the only way to satisfy the needs of a country should always be small to avoid overloading the teach- for doctors was to set up there a medical institute that ing staff and to make the most of personal tuition. would providetraininginthenative Also the recommended practice of training failures at However, WHO could be of great assistance in training some stage of medical education for health work had specialists. been followed in his country but was no longer With regard to the problem of tiding over the period necessary since the creation of a separate school of until doctors had been trained, he agreed with the hygiene. Opportunities for advancement in the various comments made by the delegate of the USSR regard- categories of auxiliary personnel mentioned in the ing feldshers, which were halfway between nurses and report were given attention in his country to ensure doctors. Before creating medical training institu- the attractiveness of such a career. He welcomed the tions Mongolia had set up schools where students stress laid upon training in those categories because, without full secondary education trained as feldshers, and also completed their secondary education. After in view of the limited basic education required, there working for a few years as feldshers, they were excel- was no difficulty in recruitment, and since training was lent candidates for training as doctors. carried out by local doctors there was also no problem It might be worth while for representatives of developing countries in that connexion. Furthermore, such staff were easily adaptable to conditions in rural areas. to give some thought to such a procedure until a sufficient number of doctors had been trained.He Dr NAYAR (India) said that her delegation had been would be glad to provide furtherdetails of the very happy to read the report by the Executive Board. experience obtained in his country and of the organiza- Although the problems referred to were more acute tion of such schools, should representatives of develop- in the countries covered by the survey, and their needs ing countries be interested. At the present time there should of course be granted priority, to some extent were sufficient doctors in Mongolia and the feldsher the situation was similar in all the developing countries. school would be transformed into a school for nurses She had noted the emphasis on the proper training of or a preparatory school for the faculty of medicine. teachers and on special arrangements between univer- His country was now in a position to provide aid to sities of different countries to enable the services of developing countries, and would be happy to do so in teachers from other countries to be obtained. co- operation with WHO. COMMITTEE ON PROGRAMME AND BUDGET : TWELFTH MEETING 267
Dr EL BITASH (United Arab Republic) said that his extending public education it would be seen that a country had given the subject of medical education and solution to the problem was far distant. The situation training first priority. In addition to the four existing in his country was such that, with a school attendance medical faculties, two new medical schools had been rate of an average of 20 per cent., some 70 thousand set up some two years before and, for post-'graduate million francs would be required to bring it up to 100 medical training, an institute of public health created per cent., enabling about twenty doctors to be trained at Alexandria which was partly supported by WHO and a year in African or other universities from 1970 on- for which further assistance was sought with regard to wards. At the moment it was possible to train only fellowships. A new nursing school had been set up a two or three new doctors a year so that, in 1963, there few years before. A technical public health institute had was an average of one doctor for 42 000 inhabitants. also been created, producing X -ray and environmental The vast size of his country should also be borne in sanitation technicians and laboratory assistants. In all mind, and the fact that the problem was further those training centres, the urgent needs of developing complicated by the nomadic population in many parts, countries were taken into account and ten places were so that in some regions there was only one doctor for reserved for the countries of Asia and Africa.Since 100 000 or 150 000 inhabitants.To alleviate the environmental conditions were similar in those coun- situation mobile medical units were planned. tries to those of the United Arab Republic, he was sure There was a similar shortage of auxiliary medical that the experience gained by the students would staff, but the opening in 1962 of a secondary health enable them to deal effectively with the problems school helped to meet that problem, together with the facing them later at home. school for auxiliary medical staff which had been in Another type of training given at the medical operation since 1958. It was therefore hoped to satisfy centres of his country for medical and paramedical the needs in paramedical staff, but that could only be staff was a short training programme dealing with the done in so far as there were sufficient doctors to main problems the students would have to face later supervise training.The main problem was therefore when taking up their new responsibilities.Doctors the training of doctors. assigned to work in the new rural health units were There was so far no school of medicine in his given a three -month training course in the special country, but some forty students were training in problems they were likely to encounter in such fields as European and American universities.Unfortunately there was a tendency towards specialization, whereas health education, maternal and child welfare, parasitic the need in his country was for general practitioners and communicable diseases and environmental sani- capable of handling paediatric and obstetric cases, and tation. of performing surgery.It was for that reason that his On behalf of his country he stated that candidates Government envisaged arrangements with the coun- from many of the developing friendly countries were tries where the students were training to enable them welcome to train in its medical centres. Moreover, the to return after the last year of basic training to United Arab Republic had already supplied a number acquaint themselves with local conditions ; after two or of highly trained staff who were now carrying out threeyears'practice they could decide on their their responsibilities in the developing countries of specialization. Asia and Africa. The delegation of Mali supported the views express- ed by the delegate of France regarding the co- ordina- Dr Dom) (Mali) felt that the report by the Executive tionof medicalstudyprogrammesby WHO, Board showed the scope and complexity of the problem of particularly in medical faculties where there were many providing developing countries with medical personnel. students from developing countries. The situation was dramatic because it was closely In conclusion, he expressed his gratitude to those linked with the question of education in general.In countries where students from Mali were being trained. many of the countries concerned the school attendance rate was less than 15 per cent.In view of the cost of The meeting rose at 12.40 p.m. 268 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
THIRTEENTH MEETING
Monday, 20 May 1963, at 2.30 p.m.
Chairman: Dr V. V. OLGUNN (Argentina)
1.Measures for Providing Effective Assistancein touched upon during the technical discussions, namely, Medical Education and Training to Meet Priority the need to train doctors in their own countries so Needs of the Newly Independent and Emerging that they would be acquainted with prevailing condi- Countries (continued) tions when they left the university and would know the Agenda, 2.6.1 pathology and medico - social problems of their future Dr BAIDYA (Nepal) congratulated the Executive patients. Board on the excellent report it had produced. He As far as Africa was concerned, organizations such would take the opportunity once again to stress his as UNESCO and WHO might grant scholarships only country's urgent need for a medical school which to those students who were studying locally.Those would enable national doctors to be trained in the who were going on to careers in universities could, of environment in which they would serve.Nepal was course, complete their studies abroad later. As, especially grateful to India for training some twenty however, it was not possible to make all countries train to twenty -five Nepalese medical students each year their students at home, WHO should also produce and to the United Kingdom for the post -graduate medical books standardizing the different methods of training provided for prospective teaching staff in the teaching in different countries.Moreover, certain various medical specialities.A number of other countries would do well to pool their resources in countries, including the United States, Soviet order to build universities and medical faculties in Union, Pakistan, Burma and Israel, -had also given common. much appreciated help in training medical students. It should be pointed out that in many African It was plain from the statement on bilateral aid made countries a medical career did not . attract students by the delegate of the Federal Republic of Germany because of the modest material conditions which that Nepal could also count on the support of the awaited them after their studies.There was also Federal Republic for assistance, possibly in the form of considerable wastage, not only with regard to African equipment for the proposed medical school. An students who studied abroad -as the delegate of appeal for help with the project to such member France had said -but also with regard to those who countries of the Colombo Plan as New Zealand, studied at the few existing African universities. That Australia and Canada, and to certain United States was because some professors insisted on applying foundations, might not be considered out of place, as European standards.Previously, for example, it had similar help had been given to other Colombo Plan been the custom to admit to first -year medical studies countries in the past. only 25 -30 per cent. of the students taking the pre- F or its part, WHO would no doubt give assistance medical year of training. While that was appropriate in providing the necessary teaching staff until such in a country where there were many doctors, it was not time as national personnel had gained sufficient ex- so in Africa.Unfortunately the practice continued. perience to take over the work. Last but not least were He fully agreed with the emphasis laid by the report the maintenance and running costs, for which Nepal on the need to share doctors equally between urban intended to ask for a loan from the United States and rural areas. But the young doctor was apprehen- Agency for International Development. The need for sive about practising in a rural area because there he such a medical school was well illustrated by the fact was not only general practitioner but also surgeon, that at the moment Nepal had only one doctor to paediatrician and expert in preventive medicine :the approximately fifty thousand of the population. magnitude and variety of the task frightened him. For that reason, doctors should be fully trained so Dr DIALLO (Senegal) said that he had read the that they could do the work of the general practitioner, report before the Committee with +great interest. One do simple surgical operations and introduce the pre- of the problems with which it dealt had already been ventive and social aspects of medicine. COMMITTEE ON PROGRAMME AND BUDGET : THIRTEENTH MEETING 269
Dr SZABO (Hungary) said that his country recog- developingcountries. An important point was nized the vital importance of training, since the basis language. In his own country teaching had been given for a sound health service was the requisite number of first in Italian, then in French and finally in Turkish, medical and auxiliary personnel. Hungary had several when the number of students in the medical schools had medical schools and Hungarian specialists had taught rapidly increased. It was essential, therefore, for in other countries.His country looked forward to teaching to be given in the language of the country playing its part in teaching at its own or in foreign concerned. Free education had also given very good universities. results in Turkey. But his country had also made mistakes, and one Dr FISEK (Turkey) congratulated the representative was in basing its curricula on the curricula of schools of the Executive Board on his excellent statement. in the economically developed countries, which were He had a number of comments to make which the not suited to Turkey's needs.The result was that Committee might consider for inclusion in the reso- doctors wished tospecialize instead of becoming lution. general practitioners. In the newly developing countries, before considering His delegation was ready to support a resolution medical education it was important to draw up a long- calling for a special fund for medical education, term health programme for a period of at least fifteen assistance to be provided in cash, in kind or by supply- years. On the basis of available manpower and money, ing teachers.He also supported the suggestion for the health and the educational authorities in consul- pairing schools in newly emerging countries with tation should then prepare job descriptions for the schools in the economically developed countries and staff necessary, so that the schools could plan their hoped WHO would promote co- operation directly training programmes with those in view.The point between schools and not necessarily through govern- was touched on in the last sentence of section 3.1.4 of ments. the report. In connexion with section 3.1.5, Patterns of Training, Dr AL -WAHBI (Iraq) said that both the Executive he did not agree with the second sentence (" It is not Board and the Secretariat were to be congratulated on advisable to introduce totally new concepts likely the excellent report. The subject was complicated, and to meet resistance and to provoke contradictory so important that he could have wished that the report advice ") if it referred to the administrative pattern of had been circulated to Member governments before health services.In medical education each country the Health Assembly, so that it could have been should give first priority to its own needs. He believed examined and discussed byallthedepartments that the developing countries required nationalized concerned : it was impossible for delegations to include health services. One reason was that the people could experts in every field. He hoped that in future impor- not afford to pay for the medical care that they .were tant documents would be circulated to Member entitled to.Another reason was the reluctance of governments well in advance, for proper study and con- doctors to go to the rural areas.Turkey had 12 000 sultation would undoubtedly lead to more fruitful doctors -a proportion of one doctor per 2300 of the discussions at meetings. population; but whereas in Istanbul the proportion The shortage of teaching staff, particularly in the was one doctor per 600 of the population, in certain basic medical sciences, had been emphasized by most areas it was one per 30 000. By nationalization he did of the speakers. Everyone was aware of the situation, not mean compulsory service for health personnel but and governments and WHO were doing their utmost that the government should pay a high enough salary to remedy it; but there was still not enough being done. to attract medical personnel to full -time work in the He urged that UNESCO should be approached for government service.If the words "new concepts" in help at least in preparing teachers in pre -clinical or the sentence he had quoted meant that there should be basic medical sciences. less emphasis on social aspects and a reduction of the He agreed with the ideas in section 3.3.3, Preparation time spent teaching medical sciences and the tradi- of Teaching Staff, but thought more emphasis should tional clinical courses, he would also disagree. be placed on the need for teaching fellowships, so that A mediaeval type of medical school had been young and energetic teachers from medical colleges, established in Constantinople asfar back as the chosen by WHO in consultation with the heads of twelfth century, and the first modern medical school colleges, could teach and be taught in colleges in other had been established in 1827; thus his country had the parts of the world.With regard to section 3.3.4, benefit of many years' experience to offer to the newly Importing Teaching Staff, he would like to see high 270 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II priority given to the idea of affiliation between new and, representatives of WHO who wished to participate in old medical schools. The practice had produced good the discussions on co- ordination. results in the past and WHO was the best medium for promoting it. Dr EASMON (Ghana) noted the general agreement that it was best to provide medical education and Sir George GODBER (United Kingdom of Great training in the countries concerned.Unfortunately, Britain and Northern Ireland) said that the report was however, that was both costly and impracticable at the a valuable one and a commendably brief review of a present time.Since training abroad would be necess- very complex subject. Its chief merit was that it showed ary for many years to come, a system of priorities in the extent of the task to be faced.The delegate of planning for the future would have to be devised, and Pakistan had shown how much could be achieved in a he would like to emphasize certain points for considera- short time. The United Kingdom was already provid- tion, some of which had already been mentioned by ing training for many post -graduate medical students, other delegates, including the delegate of Israel. midwives, nurses and other workers and an independ- The utmost priority should be given to the training ent committee had reported on measures for increasing of paramedical personnel and medical auxiliaries in training. A number of universities had pairing their own countries to alleviate the acute shortage of arrangements with new institutions in Africa and India. those categoriesof health workers. There were It should also be possible to arrange for training in the many disadvantages to the training abroad of nurses, principal teaching hospitals, and he hoped that some- midwives and medical auxiliaries, and little to recom- thing could be arranged through the National Health mend it.Local training was essential to help them to Service. He agreed with the delegate of the Netherlands adjust to working under conditions of shortage of that training schemes were beneficial to those who equipment and facilities; to develop a proper regard offered as well as those who received training. He also for local customs and practices and the right attitude endorsed the points made by the delegate of Israel. to their less fortunate fellow human beings; and to In his opinion the report was the most important learn the traditions of service and dedication that document before the Assembly, and he hoped that belonged to medicine and nursing. delegates would take it back to their countries and He also strongly urged the adoption of multi- think very seriously about what action could be taken. purpose or comprehensive training for paramedical There were no grounds for satisfaction with what had and auxiliary personnel, particularly nurses and mid- been achieved so far. wives. The existing system of single- purpose specialist training was expensive, irrational and wasteful, and Dr CHATTY (Syria) said that although there was a was unsuited to local conditions.Those who had shortage of medical personnel in his country it was not undergone multi -purpose training would be able to acute; there was approximately one doctor per 4000 of work in many capacities in different medical disciplines. No doctor could function effectively without adequate the population, and 900 undergraduates were studying support from paramedical and auxiliary personnel, medical or allied subjects in Europe. A medical school whose training should take priority over that of teaching in Arabic had for the past fifty years provided medical students. The provision of training facilities medical personnel inSyria and for neighbouring for nursing and midwifery tutors was also important : countries, and the possibility was being studied, with a school had already been established in Ghana and WHO's help, of setting up a new medical school in would start operations in October 1963. Aleppo to teach in English. There were also the two It was essentialalsotoprovide regular post- medical schools in Lebanon : the American university graduate or refresher courses for all medical and of Beirut, which followed the United States system; paramedical personnel; that was particularly import- and the French medical school, which followed the ant in the developing countries, which lacked libraries French system.The three schools had served the and post- graduate facilities. countries of the Region for over half a century. Lastly, there was the need to provide facilities for The Syrian Government and health authorities had internship in all developing countries, especially for been greatly stimulated by the Director -General's doctors trained abroad. It was vital for students from report to the Executive Board at its thirty -first session developing countries, who had to be trained in many and by the report under consideration. A proposal for different countries with different backgrounds and co- ordinating the activities of the three schools had different medical traditions, to do their internship in been favourably received, and it was hoped that there their own countries so as to become familiar with would be good results.Syria would welcome any their health problems, needs and medical practice. COMMITTEE ON PROGRAMME AND BUDGET :THIRTEENTH MEETING 271
The CHAIRMAN invited the representative of the train future teachers as well as practising doctors, Executive Board to comment on the discussion. especially in the basic medical sciences, where there would be great deficiencies for the next five or ten Dr AFRIDI, representative of the Executive Board, years or even more. One of the problems in training said that the members of the Board would be gratified studentsabroad was language,and theUnited at the way the Committee had received the report; the Nations and the specialized agencies had recently Board had taken great pains with the report and had decided to exchange information on the problem in a not been able to complete it at the thirty -first session, sub -committee on education and training of the which accounted for the delay in its circulation to Administrative Committee on Co- ordination. Member governments.He had been very interested Commenting on present activities,he said that in the proposals and suggestions made during the countries that applied to headquarters were being discussion. Some of them elaborated on the Board's helped to review facts, define their problems and suggestions and others gave new emphasis to some of formulate their requests. For countries wishing to set its statements, but they would all serve to crystallize the up new schoolsaprototype project had been prepared. Executive Board's ideas and guide its future action. A kind of clearing -house was being established to deal He had been particularly interested in the comments with requests as they came in so that, for example, on the need to redefine the functions of doctors and available consultants and schools offering training auxiliaries -a thought which had been uppermost in could be readily identified. Information was also being the Executive Board's study and discussion. gathered on medical schools or groups of schools that would provide teams, on the lines suggested by the Dr GRUNDY, Assistant Director -General, said that delegate of the Netherlands; and on schemes for after the long and informative debate on the report and sponsorship between new and old schools. The aim the summing up by the representative of the Executive was to be able to respond quickly to requests. There Board he would comment on one or two particular were no precedents in the work :it was a case of learn- points only. ing by experience.It was realized, for example, that The discussion had been very heartening, especially groups of schools jointly could more easily offer the many expressions of willingness and even eagerness facilities than single schools; that the same individuals to support the fellowships programme. The references -especiallyseniorprofessors -could notusually to bilateral programmes had also been encouraging, serve abroad for long periods, so that there would because one of the difficulties in formulating overall have to be rotation of personnel; that most schools plans was the lack of knowledge on bilateral activities would need sufficient notice to engage supernumerary which ought to be taken into account.The factual staff if they were to provide assistance; and that teams information and the new ideas that had emerged in the of teachers going toestablish new universities or debate were valuable and would be taken into account receiving students for pre -clinical training would have by the Director -General, for not only would the report to be assured of adequate standards of pre -medical and the discussion on it form the basis of a valuable education for the students admitted to medical studies. policy document, but it was of immediate practical On the planning of health services at the national importance to the Director - General to know the ideas level, WHO was committed to certain general prin- of Member countries; the problem was an urgent one ciples.Although no final plans could be made until and was being dealt with with a sense of urgency. there was some kind of country plan, it was under- Throughout the initial period, which had culminated stood that, because of the long period of years needed in the Executive Board's study, there had been no for establishing medical schools, and to a lesser thought in the Director -General's mind that long -term degree allied training institutions, action on requests plans at any level would curtail, restrict or postpone from developing countries would not be delayed immediate action. The delegate of Nigeria had until comprehensive plans for health services had observed that it would be a long time before the need been formulated and agreed.The idea was to meet for training abroad ceased; he assured the Committee requests, bearing in mind that changes might be that WHO was providing for training abroad until it necessary at a later stage as plans developed. was possible to establish and strengthen the schools on Turning to particular pointsin thediscussion, home ground. Very careful attention would be given WHO was already working in close co- operation to the point raised by certain delegates as to the need to with UNESCO and had participated in a conference 272 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II on the development of education in Africa, held in 2.REQUESTS the Director -General to develop the Addis Ababa in 1961, and in a conference on higher education and training programme further, taking education, held in Tananarive in 1962. WHO had into account the contents of the report and the provided estimates of teaching staff needed, and under comments of the Committee on Programme and the informal agreement on the allocation of duties Budget of the Sixteenth World Health Assembly. between the two organizations the responsibility for Decision: The draft resolution was approved.' higher educationinmedical andalliedsubjects remained with WHO. 2.Methods of Planning and Execution of Projects : To the delegate of Turkey, who had questioned the Report on Progress of Organizational Study reference to " totally new concepts ", he explained that the intention was to avoid introducing any Agenda, 2.6.2 concept or pattern that was unsuited to the country The CHAIRMAN invited the representative of the concerned and might therefore provoke resistance. Executive Board to introduce the item. He assured the delegate of Iraq, who had asked about increasing the number of teaching fellowships, Dr AFRIDI, representative of the Executive Board, that no limitations were imposed by the conditions informed the Committee that the study bythe governing the award of fellowships; the countries Executive Board was still proceeding; despite pro- themselves should ask for the fellowships they wanted. longed discússions, the Board had felt that the subject With regard to bedside teaching, referred to by the would need much further detailed consideration. delegate of Finland, it was true that no standards The outline of the study, together with the remarks had been laid down, but the general working figure made by members of the Board at itsthirty -first was an annual intake of about fifty students for 500 session, was to be brought before it for finalization beds in teaching hospitals -a ratio of about ten beds at its thirty- second session. to one student.The delegate of Finland had also referred to a curriculum for developing countries. The CHAIRMAN thanked the representative of the The problem had been mentioned in the study group's Executive Board for his introduction of the item, and report and the broad features of a curriculum had invited the Committee's comments. been suggested for guidance in developing schools. Dr DOUBEK (Czechoslovakia) said that it would be Finally, although the subject would be discussed useful from every point of view if the study dealt later in the agenda, he would mention the case more with theeffectiveutilization of the funds presented for consideration by the Special Fund as allocated than with working methods. In recent years a possible source of finance for the establishment of WHO had concentrated on a small number of selected medical schools, because it had been referred to problems. The questions dealt with were undoubtedly several times in the debate.In presenting the case, important and were gradually beginning to establish due regard had been given to the fact that a medical their own tradition. As time went on, however, and school should not only produce medical graduates and theactivitiesof the Organization expanded, the paramedical personnel, provide the necessary staff disproportion between the magnitude of the tasks it and courses, and maintain medical standards and was required to perform and the means at its disposal practice in the community; it should also be an was becoming increasingly obvious.That was due essential factor in the whole economic, educational not only to the disproportion between its economic and cultural structure of a nation. resources and the demands made on them- particu- larly when the priority requirement of raising as quickly The CHAIRMAN read out the following draft reso- as possible the level of medical aid to the population lution : of the developing countries was taken into account - but also to the fact that many of the measures being The Sixteenth World Health Assembly, carried out were a compromise in an attempt to Having considered the report of the Executive comply with proposals on different subjects, or to Board on its organizational study on " Measures satisfy regional needs and interests.The result in for providing effective assistance in medical educa- practice was the fragmentation of the main line of tion and training to meet priority needs of the newly activity into a number of inadequately co- ordinated
independent and emerging countries ",prepared . measures.That was particularly noticeable in the atthe request of theFifteenth World Health carrying out of individual measures in the regions. Assembly, ' Transmitted to the Health Assembly in section 1 of the Corn- 1 . THANKS the Board for the study made; and mittee's fourth report and adopted as resolution WHA16.29. COMMITTEE ON PROGRAMME AND BUDGET : THIRTEENTH MEETING 273
His delegation was convinced that, if those defects deployment of the different measures of the whole were corrected, WHO's work would develop in the community. Public health was an applied science and right direction and contribute to an appreciation of an integral part of economic and social evolution. the importance of medical aid to the population.It Planning was the concrete basis of any administra- could also help to raise the cultural and economic tive process, its purpose being to rationalize activi- level of developing countries and create favourable ties; it should be considered not only as a starting - conditions for peaceful co- existence between States point but as a dynamic operational process.The with different social systems. generalprinciplesmustreflecttheunavoidable WHO was participating in the projects of a large variations that existed -differences in administrative number of governments, and the details of such structure, in the stage of social development, in the technicalassistance should be theorganizational nature and extent of public health needs, and in the responsibility of the regional offices.And since the resources available to meet those needs. greater part of the organizational work on all projects One obvious common feature was the responsibility would be done by the regional offices, it would be of the government to provide personal and environ- advisable to decentralizeactivities further and to mental health services. It must always be remembered widen the powers of the regional offices, which ought that the fundamental step in planning was the deter- also to take part in approving projects carried out in mination of the government health policy.Govern- co- operation with other organizations --WHO/ ments must see that the health services of their UNICEF projects, for example. countries were meeting the needs of their people, and For maximum economy and efficiency of work, that their plans were based upon the latest scientific it would be advisable to select certain projects and to knowledge.It was useful to determine programme analyse them inaccordance withthefollowing requirements; the most commonly required items were principles :(a) the evaluation of a particular project those for hospital construction and for determining must remain the province of the government in whose services,staffing,equipping and financinghealth country the project was being carried out; and (b) the establishments. analysis should be carried out mainly by the regional In carrying out any health programme, all pro- office, in collaboration with headquarters. fessions and institutions concerned must co- operate His delegation recommended that special attention fully to achieve the maximum result.A periodical be paid to international co- operation in carrying out assessment of the programme should be carried out projects,thatthey should beco- ordinated with to evaluate progress and to ensure that targets were particular care, and that after the successful completion being met : the method chiefly used for that purpose of the project, the scientific and organizational know- was statistical accountancy, which allowed an analysis ledgeacquired must be communicated toother of the plan as a whole and in its individual parts; in countries as quickly as possible. that way any lack of proportion was detected and The Czechoslovak delegation was convinced that the untapped resources discovered. implementation of the Director -General's proposals in The broad objectives during formulation of the plan pursuance of resolution EB31.R45 would lead to the could be discussed with representative groups of the attainment of some of the aims put forward by the population in national committees and at public Soviet Union and other delegations at the Fifteenth meetings and discussions, by which their acceptance World Health Assembly. and interest could be gained.All medical and health workers could also participate and full use could be Dr EL -BORAI (Kuwait) said that the public attitude made of their experience and knowledge. to health problems in a given area was of prime import- In view of the increasing complexity of medical, ance and must always be taken into account in plan- hygienic, and socio- medical activities, and their cost, ning any health project. Projects should be planned on a scientific and not on a haphazard or empirical basis : there must be a planning body responsible for all modern planning demanded certain general principles levels -it could be a council, commission or special that depended entirely upon up -to -date medical and department in the ministry with wide terms of reference public health knowledge. Development in other parts to study the health problems, assess resources, create of the world should be taken into consideration. facilities and make recommendations.If that was Special attention should also be paid to advances in impossible, an expert might be invited to evaluate the medicine, the effects of social, economic and cultural situationand make recommendations forfuture conditions on public health, and improved control of policy. Close collaboration should be maintained the national economy. Those factors enabled planned between the health and planning authorities and with development to be considered as part of the efficient other government departments. 274 SIXTEENTH WORLD HEALTH ASSEMBLY, PART Ii
The government structure should include a compe- delegates at the present Assembly had spoken in the tent central health administration, which should be same sense. consideredastheresponsibleagency forhealth Secondly, the savings made would enable more development and be acquainted with government resources to be allocated for intensified assistance to policy with regard not only to health but to economic newly independent countries. A number of instances and social matters also. of the insufficiently economical and effective use of the A survey must be made to evaluate the health Organization's resources had been referred to by situation and to highlight health problems, on the delegations, including his own, during the discussion basis of which priorities and deadlines could be of the Organization's budget for1964. Official decided.It was advisable to have extensive consulta- Records No. 121 showed that an additional sum of tion with all medical and health workers concerned. $ 2 235 000 was envisaged to meet the most pressing Emphasis should be placed on preventive health needs of the less -developed countries; but over half measures, and those engaged in productive work that sum was earmarked for purposes only remotely should be provided with all the necessary health related to such activities.Another example was the services, including in particular maternal and child numericalratiobetweeninternationalstaffand health services; nutritional standards must be improv- locally recruited staff;it was proposed to increase ed, and hoursof work regulated. Programmes those two groups in 1964 by twenty -five and twenty should aim at providing health services free of charge posts respectively. The ratio was a matter for study, toallthe population,controllingoreradicating even if the increase were accepted. endemic and epidemic diseases, and making provision An analysis of Official Records No. 121 showed the for sanitary water -supplies and sewage disposal. need to study the advisability of planning allocations Care was needed to ensure that programmes did not for research training, for which $ 75 000 more had exceed possible resources, and the availability of been budgeted for in 1964 than in 1962. The allocation personnel and other resources must be carefully of five new posts for Administrative Services -clerical weighed. On the other hand, development should be and stenographic posts in a number of headquarters progressive and should anticipate new developments units, including the Liaison Office with the United in the medical and public health fields.It might Nations -was also pertinent to the subject under sometimes be essential to concentrate on specialized discussion. programmes of mass control of diseases -a measure There was also the question of the relation between that created public confidence and interest.Health the appropriations for field activities in the regions. education of the public was an effective weapon. Official Records No. 121 showed that it was planned to increase the allocation for those purposes in Africa by Dr NOVGORODCEV (Union ofSovietSocialist approximately $ 110 500, and for the Americas by Republics) said that the question before the Committee $ 222 800 -twice the sum. deserved the most serious attention, and should be Although not all the examples he had given were discussed again in spite of its having been dealt with directly related to the question under discussion, they during the discussion on the programme and budget. were undeniably connected with it.They showed in Analysis of the report by the Director - General showed particular the impossibility of studying methods of that it reflected the proposal put forward by the Soviet planning and execution of projects at the local level Union at the Fifteenth World Health Assembly for a only, and the need to study them at regional and review of the Organization's activities with a view to headquarters level also.An important basis for the the more effective use of resources. His delegation was review in question was provided by the speeches of well aware that it was impossible to do everything in a many delegates during the discussion of the proposed short time, but it would like its suggestions to be programme and budget estimates for 1964, when they reflected at least partly in the report presented, in had emphasized the need for establishing priorities for particular the question of the economical use of the most urgent forms of activity and for reducing the resources. number of secondary programmes and projects. The Director -General's report discussed only the It was necessary of course to start modestly, for field activities of the Organization- namely, country example, by setting up a small committee to make a and inter -country projects; the question of head- sample study of certain projects.That committee quarters activity was left completely aside. The Soviet could work at headquarters in the same way as an delegation had, however, pointed out that the economy expert committee or a scientific group, holding two in resources that would be obtained by a review of sessions each of five to ten days every year, the first to methods of work was closely connected with the ques- take place immediately after the Health Assembly.It tion of stabilizing the WHO budget. A number of should consist of about six or seven persons, including COMMITTEE ON PROGRAMME AND BUDGET :THIRTEENTH MEETING 275
representatives of the regions and of countries.Its Dr CHATTY (Syria) said that the moment was not main work would be the study, analysis and evaluation opportune to comment on the progress report before of material related to the execution of individual the Committee since, as had been indicated, the study projects and programmes and the trends of work at was still proceeding.He would, however, take the headquarters and in the regional offices.It would opportunity of asking the Director -General to consider itself determine the projects to be chosen for study and a more objective evaluation of projects in execution. evaluation, among which might be :the main causes Such an evaluation might improve the execution of holding up implementation of a project and how to projects and possibly save unnecessary expenditure. avoid them; the nature,size and advisability of His remarks were not made as a particular criticism, particular projects; the main causes of stagnation in but it was obvious that there was always room for some projects after WHO assistance had ceased and improvement in anything that was done. how to eliminate those causes; the re- distribution of Dr BRAVO (Chile) said that the question of methods resources with a view to greater decentralization, and of planning and execution of projects was a basic a more uniform study of country projects by special- necessity for systematic work in any field of economic ists representing different types of health services; and and social development, especially health work. finally the study of the duplication of work and ways Planning had to be made at various levels, from the of preventing such duplication. highest, where the general policy and priorities were His proposal was made solely with a view to making determined, down to the level where decisions were the activities of the Organization more productive. taken on needs and resources.It might be asked, The DIRECTOR -GENERAL, said that the delegates of however, how one could reconcile, at the international theSoviet Union and Czechoslovakia had made level, the autonomy of the national administrations several references to the report of the Director - with the work of an advisory body such as WHO. If General; but the point under discussion was simply a the various countries recognized that WHO had to do progress report that the Executive Board was sub- the planning, they would also have to forego some of mitting on an organizational studyit had been their autonomy in the implementation of the projects. requested to make by the Fifteenth World Health Any project requested by a government was imple- Assembly. He would have no objection to giving the mented sooner or later; and, in many cases, if the Board any information it might wish, but it was for execution of the project was not as foreseen or was too that body to request what it needed for its study, which difficult, the responsibility fell upon the governments was still going on. themselves, which had been unable to request projects At the Fifteenth World Health Assembly he had in accordance with their needs or actual resources. stated that the time had come to depart from vague However, it was probable that, if there were a "functional"presentation i.e. criticisms that created a very difficult situation for the of thebudget, by Secretariat to deal with. The delegate of Czechoslo- programmes (reference to which had already been made in previous meetings of the Committee), planning vakia had nevertheless repeated statements made at the Fifteenth World Health Assembly; he regretted that he could probably be done on a more scientific basis.It had nopossible way of answering such vague would be possible to compare the cost with the results, and perhaps to reorientate the work of the Organiza- statements. tion. The delegate of the USSR had also made a state- It should not be forgotten that a study of the cost of ment, in which he had mentioned details of the health work was very difficult, and that "planning" programme and budget, the Liaison Office with the was not synonymous with "economy ". Better results United Nations in New York, and headquarters might be achieved with the available resources, but activities -points that had already been dealt with new problems might be discovered that would give during the consideration of the proposed programme rise to further expenditure. and budget estimates for 1964 by the present Health The Board's organizational study on the methods Assembly.The examples given showed a complete of planning and execution of projects would be of the lack of understanding of the way in which the Organi- greatest interest, but it needed time to complete that zation worked. To suggest that an expert committee study. be set up to analyse the budget in all its details was tantamount to a suggestion for the replacement of the Dr DIBUE (Cameroon) said he was aware that no Executive Board, its Standing Committee on Admin- final report had yet been submitted but he had a few istration and Finance, and the regional committees. observations to make. The Secretariat could have no comments to make on Recipient countries were often requested to con- that. tribute their national quota for each project.The 276 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
African countries had many health problems, and according to needs, and would be glad to receive their financial resources were so slender that they were assistance on that basis. often unable to participate.If the Executive Board made a survey of the health problems in Cameroon it Dr NOVGORODCEV (Union ofSovietSocialist Republics) said that he had attempted in his statement would find that requirements included, for example, a medical school for doctors, a public health nursing to summarize what had been said concerning the desire school, the eradication of communicable diseases, etc. for an improvement in planning the use of resources. The report he had been referring to was the document He would make the plea that, whenever the Director - General was convinced of the urgent need for a health presented by the Director- General to the thirty -first programme in any country, and the government session of the Executive Board. There was no question concerned was unable to contribute its quota, WHO of revising a budget that had already been accepted, should undertake to meet the full cost of such items as but it was quite legitimate to comment on it. He had wished to draw attention to the fact that building and staff costs until the government could take over the burden. many proposals, despite the wishes of the Fifteenth World Health Assembly, had not been acted on at all. Dr SUBANDRIO (Indonesia) said that her attention No financial evaluation had been made of the malaria had been attracted by the third paragraph of the eradication or smallpox eradication programmes, or of preamble to resolution EB31.R45, which read : many others. There had been a two -day debate on the matter at the thirty -firstsession of the Executive Recallingitspreviousorganizationalstudies, Board, but little had been done during the past year by particularlythose on programme analysisand headquartersstaff,and he was surprisedat the evaluation, programme planning, and co- ordination vehemence with which theDirector- General had with the United Nations and specialized agencies; defended the present position. No planning organ At the meeting of the Regional Committee for was without its shortcomings and WHO was no South -East Asia in Bandung in 1960, projects that had exception. been started with other international agencies, such as His delegation considered that the budget, and the UNICEF and FAO, had been described, and the programme, should be studied in its details, in parti- desire had been expressed for better planning and for cular the basic problems. The Director- General had an evaluation of those projects that had already been referred to the Executive Board -but the Board, in .a started. two -week session, had before it almost as many matters Countries in the process of development had gone as the present Committee, and would not have the time through many phases. When Indonesia had begun its todiscuss individual projects. He reiterated his co- operation with WHO at the time of its accession to proposal for the setting up of a committee, on which independence in 1950, some good projects had been the various countries and regions would be represented, started, but others had proved not to be so satisfactory, to evaluate at least one project and determine whether since at that time the health authorities of the country, or not it achieved its purpose. That was his delega- through lack of experience, had been led into projects tion's only proposal, and its sole intention was to that were not among the foremost needs. A better carry out the wishes of the Executive Board. understanding of the problems had developed over the The DIRECTOR- GENERAL said that the statement years, and there was a desire for better planning. made by the delegate of the Union of Soviet Socialist Account must always be taken of the rising demands Republics was very useful.It should not seem so of the population as a whole, and in the face of limited surprising that it had not been possible to do more in means and limited assistance, the planning of projects one year :the Secretariat could only work with the and the drawing up of priorities were essential. Prob- Board, and the Board had felt unable to follow up the lems such as malaria and smallpox control, nutrition, study any more quickly. and maternal and child health should have top priority. He did not understand what was meant by the The few medical, technical and auxiliary personnel statement that the malaria programme had not been available should be used in those important fields and budgeted and programmed in accordance with the not for small projects that did not serve the needs of the wishes of the Assembly.It was impossible to comply population as a whole. Her delegation would there- with the individual wishes of all Members, and the fore support a re- evaluation either by headquarters, average opinion had to be followed. Varying opinions by regional offices, or by the various governments. were given during the Assembly, and the Secretariat Many countries were now really aware of their own tried to find the best way of dealing with the wishes requirements. Indonesia, for example, had embarked expressed. He had no doubt that there was room for upon its eight -year plan :it had done its best to plan improvement, as in all aspects of the work of the COMMITTEE ON PROGRAMME AND BUDGET :THIRTEENTH MEETING 277
Organization.But it was a little difficult to accept 3.Continued Assistance to Newly Independent States criticismsthatcould be misinterpreted by other Agenda, 2.5 Members and give the impression that the Secretariat was not doing as much as possible to meet the requests At the invitation of the CHAIRMAN, the DIRECTOR - of the Assembly. GENERAL introduced the item. Perhaps there was a misunderstanding due to His report on the subject to the thirty -first session of language difficulties. the Executive Board was to be found in Annex 18 of Official Records No. 124, and the document now before Dr TuRBOTT (New Zealand) had also been wonder- the Committee described developmentssincethe ing whether there was a problem of communication. meeting of the Board.Part I referred to WHO He had understood the delegate of Czechoslovakia representatives -an important subject in relation to to say that the Organization should select projects and some of the discussion that had taken place earlier in assesstheir usefulness beforehand, and that they the Assembly and during the present meeting of the should be analysed in the regions :all those things Committee. WHO representatives were assigned to were done in the Western Pacific Region.He had advise governments on day -to -day problems regarding called for international co- operation in execution : health services, to assist in connexion with health the Western Pacific Region worked in co- operation planning and the provision of international assistance. with FAO, UNICEF, the South Pacific Commission, One of the most important steps taken by the Organi- and the South Pacific Health Board. New knowledge, zation during the past few months had been the whenever it was received, was sent out to all Members increase in the number of WHO representatives, who of the Region. The Regional Office even went further were being provided, through more intensive briefing, than was asked by the delegate of Czechoslovakia :it with the necessary knowledge on general problems of evaluated the projects, and had a list of such evaluated co- ordination with other agencies. projects for use at regional meetings. Part II described the special assistance being given With regard to the remarks made by the delegate of by WHO to some of the newly independent Countries, theSovietUnion,theStanding Committee on such as Algeria, Burundi and Rwanda. Administration and Finance of the Executive Board Part III referred to the accelerated programme of had taken one project and analysed it in detail; had assistance, in particular, national health planning taken one Region and analysed that in detail.It had and related training.The Organization had already taken a lot of time, but the Standing Committee signed plans of operation with the Governments of finally knew that the project was well founded. That Gabon, Mali, Niger and Sierra Leone, and it was was the purpose of that committee. What would be expected that an agreement would soon be concluded the point of setting up another committee of the with the Government of Liberia, which, though not Executive Board ? newly independent, was a developing country, and The delegate of Syria had asked for a more objective had asked for such assistance. and better evaluation of projects.Surely it was the The subject of medical education and training of task of the Region concerned to evaluate the projects national staff had already been discussed in the Com- it approved ?The Western Pacific Region was cer- mittee and during the technical discussions.In that tainly trying to achieve that end. connexion, reference was made in the document The delegate of Indonesia had spoken of the need before the Committee to the fact that the Organization for better evaluation, and asked that priority be given had provided 429 fellowships to students from twenty - in accordance with the government's wishes. Surely it nine newly independent countries during 1962.: that was for the government to state its needs, andthe representedone- quatter . of thetotalnumber of Organization would act accordingly. fellowships awarded. With regard to operational The CHAIRMAN read out the following draft resolu- assistance and the criteria as approved by the Executive tion : Board(containedinOfficialRecords No.124, pages 79 -80), the Organization had been analysing The Sixteenth World Health Assembly requests for such assistance and hoped to be able, to NOTES the report on the progress of the organiza- meet as many as possible of those requests very soon. tional study on the methods of planning and During thediscussion on assistancetonewly execution of projects. independent States and on the Organization's pro- gramme and budget, reference had been made to Decision :The draft resolution was approved.' financial limitations on the action of WHO. In the 1 Transmitted to the Health Assembly in section 2 of the course of discussion on the Board's organizational Committee's fourth report and adopted as resolution WHA16.30. study regarding medical education and training, the 278 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II delegate of Turkey had mentioned the possibility The Belgian Government attached great importance of the creation of a special fund for medical education. to the training of national medical personnel, whether In fact, the Fifteenth World Health Assembly, in its trained in the countries themselves or in Belgium. resolution WHA15.22, had decided to establish a Priority was given to training locally, and extensive Special Account for Accelerated Assistance to Newly assistance was provided to medical faculties, both in Independent and Emerging States. Any country the form of financial subsidies and by the provision wishing to contribute to that special fund could do of teaching personnel :similar support was given to so, stating, if it so wished, that it was contributing schools training paramedical personnel at the pro- especially for education or for any other particular fessional or auxiliary level.That was in conformity service in newly independent States. Many countries with the conclusions of the excellent organizational had large programmes of bilateralassistanceto study made by the Executive Board.In addition, newly independent States, and they might feel that students and newly qualified doctors received fellow- some of the money set aside for bilateral assistance ships in order to study in Belgium, in medical faculties could be channelled through WHO, which would and in scientificinstitutions interested in overseas make it possible for the Organization to provide more medical work.In that connexion, he mentioned in assistance.There would be no question of hard particular the courses on tropical public health, to be currency, countries being able to contribute in their organized in the near future in Belgium and the own currency. Netherlands,throughcollaborationbetweenthe tropical institutes of the two countries.Fellowships Dr KIVITS (Belgium) said that since Belgium no would beavailableformedicalpersonnel from longer had responsibility for the administration of developing countries, and the courses would be given overseas territories it had been using its experience alternately in English and French. and resources, so far as development was concerned, With regard to the Republic of the Congo (Leopold- to co- operate with countries requesting such assistance. ville) where WHO was itself undertaking a vast pro- During 1962 the Government had set up the " Office gramme, a bilateral agreement had been made with de la Coopération au Développement ", which was the Government, takingintoaccountresolution responsible for implementing development projects, WHA15.18 of the Fifteenth World Health Assembly. in agreement with the authorities of countries request- That agreement (which had been mentioned with ing such collaboration. appreciation by the Minister of Health of the Congo At the moment, technical assistance provided by during plenary session, and which had been made Belgium was primarily for Africa, to which it was with the desire for the maximum amount of co- linked by long years of friendship and co- operation, ordination with the assistance being provided by and in that connexion he thanked the delegates of WHO) made available to the health services of the Burundi and Congo (Leopoldville) who, in plenary Congo a considerable number of doctors and tech- session, had expressed their gratitude for the assistance nicallyqualifiedhealthauxiliariestocollaborate that Belgium was giving them. with the national personnel, and aimed at furthering In addition, Belgium was participating in multi- the training of Congolese personnel.Belgium would lateral programmes, and had concluded bilateral also be providing drugs and equipment.The agree- agreements with countries seeking its collaboration. ment had been made, as had been stressed by the In providing international assistance, Belgium was Minister of Health of the Congo, in a spirit of friend- particularly interested in the promotion of health ship, and with full respect for the sovereignty of the and education, which it regarded as indispensable Republic. for economic and social development.In the field The collaboration and experience of Belgian experts of health, official agreements had been made on the were alsoavailable for the Organization or any basis of well- defined projects, and programmes were Member States that might request them. The Belgian implemented by Belgianspecialistsand national Government appreciated that, during the past year, personnel workingtogether. Belgium provided the Organization had used the services of several operational personnel, including doctors and tech- Belgian experts in the fields of leprosy, nutrition, nically qualified health auxiliaries, who assisted the tuberculosis, malaria and maternal and child health. national teams.It also partly financed them and obtained upon request medicaments, instruments and Dr DAELEN (Federal Republic of Germany) referred equipment. Belgian experts were also sent to countries to the comprehensive report submitted by the Director - that had signed agreements in order to study together General. with the local authorities certain particular health The question of healthservicesindeveloping problems. countries was undoubtedly one of the major problems COMMITTEE ON PROGRAMME AND BUDGET :THIRTEENTH MEETING 279 of WHO. The Government of the Federal Republic co- operation with the Federal Union of Physicians, of Germany also realized the need for assistance to importance being attached, in addition to scientific newly independent States. It had received many and linguistic qualifications, to the ability to adapt requests for assistance, and was intensifying its efforts to new surroundings and to establish personal contacts; on a bilateralbásis. The health services in the and (4) great importance was attached to educational developing countries had to be brought to a level that assistance, the aim being to enable the emerging would meet the basic needs of the people, and the countries to develop their national health programmes limited resources available for that purpose must be within their own resources. used to best advantage. The technically more developed countries had to adapt their experience and adjust Dr MURRAY (South Africa) reminded the Committee themselves to the conditions prevailing in the develop- that in operative paragraph 5 of resolution WHA15.22, ing countries. the Fifteenth World Health Assembly had requested The Federal Republic of Germany, in granting the Director- General " to study the question of WHO's bilateral assistance, usually sent experts to examine serving as a co- ordinator in the provision of assistance the resources of the country before draft plans were to newly independent States with a view primarily made.The Federal Republic had provided a con- to assisting them in the basic training and higher siderable number of medical personnel, as well as education of their national medical staff ".By that medical equipment and supplies. The personnel resolution,the Assembly had alsoestablisheda carried out their assigned duties under the administra- Special Account for Accelerated Assistance to Newly tive control of the government concerned.At the Independent and Emerging States.Paragraph 6 of moment, about sixty German physicians were working Part I of the Director-General's report to the thirty -first in Africa -in Togo, Ethiopia, Guinea and Algeria, session of the Executive Board (Official Records for example. Consultants were also provided to No. 124, Annex 18) stated :" Lack of sufficient funds assist in setting up efficient health services. has prevented rapid acceleration of the full programme Other examples of bilateral co- operation included of assistance to newly independent States, presented the establishment of the Bilharziasis Institute near by theDirector -General totheFifteenth World Cairo, for research (assistance would also shortly be Health Assembly." given for the control of bilharziasis in the Fayum He wished to draw attention to an offer made by area); the setting up of an institute of hygiene in Lomé, the Government of South Africa in connexion with Togo, where a section for rural sanitation was soon to the extension of the Regional Office for Africa, not on be opened; a trachoma control and research project account of the offer itself, but in connexion with the being carried out in Guinea by a German team; and method adopted -an interest -free loan, the annual epidemiological studies by a research team from the repayments of which could be ploughed back into the Hamburg Institute of Tropical Medicine on onchocer- Organization and utilized for providing operational ciasis in Guinea, especially on the biology and ecology assistance,in expanding and accelerating medical of Si/indium vectors. In addition, the Federal Govern- education and training of national staff or in any ment was granting financial aid on loan for certain other direction.It seemed to be a sound principle of health projects -for example, for the establishment financing assistance, embodying a reasonable amount of about fifteen health centres in Nigeria. of control while ensuring a good preview of the In all the more than one hundred projects so far income to be expected from the source of the loan for initiated by the Federal Government the far -reaching a known period.Such a method might be worthy experience of WHO had been used to advantage. of consideration by other governments. Moreover, the Federal Republic would continue to give its full support to the programmes planned by Dr WILLIAMS (United States of America) said his WHO. delegation was gratified to note that the programme of In conclusion, the main principles the Federal assistancetothe newly independentStateswas Government followed were :(1)consultants were developing so rapidly and on such sound lines. Great provided, in large -scale health programmes, in order emphasis should be placed on the regional aspects todefineclearlyand evaluatethegovernment's of the programme, particularly in regard to health request;(2)valuable apparatus, such ashospital planning.Attention to that matter, particularly in installations and medical units, was provided only Africa with its large number of emerging countries, when German technical personnel could be made would pay rich dividends in the years to come. WHO available to operate the equipment while local techni- was in a position to ensure better regional co- ordina- cians were being trained to take over as soon as tion than could be achieved in any single bilateral possible; (3) the selection of physicians was made in country programme and that was why the United 280 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
States made provision in its plans for bilateral assist- ten physicians to Algeria through WHO in response ance for the health aspects to receive WHO guidance. to the resolution on help to that country adopted by Secondly, he would urge the Director - General and the Regional Committee for Europe at its twelfth his staff to make the maximum possible use of United session. In addition,itwas providing material Nations agencies, such as OPEX, the Expanded Pro- assistance in the form of drugs, equipment, etc. gramme of Technical Assistance, and theSpecial In continuation of its help to the newly independent Fund, for operational work under the programme. countries, his Government was prepared to increase United States representatives on the governing bodies the number of fellowships offered to medical students of those agencies would endeavour toassist that by a further fifteen to twenty; to provide teachers and objective by . calling attention to the fundamental receive fellows for training as teachers in all branches importance of the WHO programme.In regard to of medicine; where needed, to send groups of medical operational assistance, he would ask the Director - workers and experts to carry on current work; to General whether he was proposing expenditure under organize courses and seminars for the training of the regular budget in 1964 for the programme and if various specialists, in co- operation with WHO; and so approximately how much was being allocated. to give the material help needed to accelerate the There was no implied criticism in that question, development of national medical services. since the United States felt strongly that expenditure of the kind was appropriate. Mr KOSENKO (Union of Soviet Socialist Republics) Finally, his delegation found the criteria for pro- stated that his delegation attached great importance vidingoperationalassistance good and soundly - to the programme of assistance to newly independent based; their application should result in a sound pro- countries. In accordance with its policy towards such gramme. countries, the Soviet Union was giving, and would continuetogive,economic,technical,scientific, Dr DOUBEK (Czechoslovakia) remarked that at a medical and other help.It well understood the needs time when doctors and biologists were solving the of those countries in their desire to overcome the problems of space travel, hundreds of millions of legacy of economic backwardness, so that the living people in the colonial and developing countries were standards and health of their populations might be still suffering from the scourge of widespread infectious bettered as quickly as possible. and parasitic diseases. That situation meant that WHO The help given by the Soviet Union was of two had two problems to face,: first, it had to take action, kinds :assistanceunderbilateralagreementsfor with broad international co- operation, to ensure that disastrous epidemics did not break out in those economic and technical co- operation; and assistance countries, and, secondly, it had in co- operation with under the United Nations technical assistance pro- other specialized agencies such as UNESCO to give grammes.Its action was motivated by a sincere desire assistance in the systematic training of national medical to help the peoples of the developing countries to staff needed to tackle the most urgent tasks. create a modern industrialstate and to develop His Government was well aware that the best way agriculture and other branches of the economy. to give effect to the principles of peaceful co- existence Considerable assistance was also being given to the and international co- operation was to help in the public health services through the supply of drugs, training of medical specialists for those countries. help in building hospitals, and training for national Accordingly it was receiving medical students for medical staff. undergraduateandpost -graduatestudiesinall The assistance given by the Soviet Union ran into branches of medicine.It provided, in particular, the billions of dollars.Examples of it were the metal- chance for those students to learn the sound principles lurgical plant set up in India; hundreds of industrial of public health.It was also sending out qualified and agricultural enterprises built in other countries; medical experts at the request of individual govern- and the vast construction of the Aswan Dam in the ments. United Arab Republic. Indeed, the help in aggregate To alleviate the critical situation that had arisen as far exceeded the budgets of WHO, the other specialized the result of the sudden withdrawal of foreign staff agenciesand theUnited Nationsputtogether. followingtheaccessiontoindependence,Czech The Soviet protest at the size of the WHO budget was medical workers were being sent out for various based on its opposition to an irrational expenditure periods, under bilateral agreements as well as under of funds on the maintenance of a large headquarters WHO auspices.At the moment 273 Czechoslovak machinery. The Soviet Union recognized that the task medical workers were serving. in eighteen countries. of raising health standards everywhere throughout Furthermore, Czechoslovakia was prepared to send the world would be beyond the strength and resources COMMITTEE ON PROGRAMME AND BUDGET :THIRTEENTH MEETING 281 of WHO alone. What was needed was large -scale help Dr SUBANDRIO (Indonesia) remarkedthather from every country. country might not qualify for aid under the special The basic principles on which the programme should programme, if " newly independent and emerging be established were set out in resolution WHA15.22. States " meant only those that had acquired indepen- The programme of medical education and training of dence in the recent past.She would, however, like to national staff aimed at a minimum provision of one make a claim for help on behalf of West Irian, which doctor to 10 000 population in the next twenty years. had recently become part of Indonesia. It was estimated that that would cost approximately The CHAIRMAN, noting that there were no further $1 888 000 a year.Operational assistance would be speakers, asked the Director - General to answer points provided according to the needs of the country.In raised in the discussion. most cases the action 'would be of a long -term nature, covering five to fifteen years.Stringent economy The DIRECTOR- GENERAL said he had found the in budget allocations was therefore required in order discussion extremely useful.The Indonesian request that the most effective possible use be made of the on behalf of West Irian raised an important point of resources at WHO's disposal. interpretation; however, he could say immediately The Soviet delegation considered that WHO would that Indonesia, as a developing country, had every be able to release more funds for work of the kind if right to assistance from the Organization. measures were adopted in accordance with the Soviet The Secretariat had taken the view that to help proposals on methods of work, made at the Fifteenth countries in health planning and in analysing the type Health Assembly. The Secretariat and the Executive of assistance they could obtain from the various Board had done little in the interim to implement the sources of funds available was one of its most resolution adopted by the Fifteenth World Health important tasks.Countries in the first stages of Assembly.His delegation trusted that the current independence often had difficultyindetermining Health Assembly would give the important question where to apply for help for specific objectives, and the of methods of work the requisite attention. WHO representatives could give them useful guidance Attention had rightly been drawn to United Nations in that matter.In that connexion, it would be most sources of funds for work to help the newly indepen- helpful for co- ordination purposes if countries offering dent and developing countries; he had in mind in bilateralassistance would keep theOrganization particular the United NationsSpecial Fund, the better informed of what was being planned and under- Expanded Programme of Technical Assistance, and taken. Information at the planning stage would be of UNICEF. So far not half enough use had been made particular value. of those sources : as the Director - General had reported As he had already mentioned, the Organization had to the Fifteenth Health Assembly, only $849 000 out for the first time signed agreements with four countries of total funds of $173 000 000 had been allocated by in. Africa providing for help in studying their health the Special Fund to health projects.The Special problems and in planning the action to be undertaken Fund and the Technical Assistance programme would in the years to come.With that work in view, two again have at their disposal very substantial funds for staff members from the African Region had been sent work in the current year and the Secretariat should to take special courses on health planning at the take the necessary steps to ensure that more was Johns Hopkins University in the United States.At allocated for assistance to the newly independent the same time, the Secretariat had been endeavour- and developing countries.It would be most useful ing to determine how best to utilize the funds set aside if the Director -General could study the question and for the programme by the Fifteenth World Health make an appeal to the United Nations Secretary - Assembly.Of the total of $714 000, $300 000 had General on behalf of the Sixteenth Health Assembly, been allotted for the provision of operational services; askingthatfundsbeallocated under Technical and the remainder for work in Algeria, Rwanda, Assistance, for example, for the building of a regional Burundi and some other countries. hospital in Africa.That would be a valuable con- The question of recourse to the United Nations tribution by the United Nations to the needs of public Special Fund, the Expanded Programme of Technical health in that region, where so much was lacking. Assistance, and OPEX had been raised at the Fifteenth World Health Assembly.The funds made available ProfessorGORNICKI(Poland)saidthat many to OPEX remained static at $850 000 a year, and that Polish physicians, nurses and professors were currently amount had to cover work in all fields of public serving in developing countries. He would not go into administration.It was therefore not to be expected furtherdetail;therecipientcountries themselves that the share of health would be great. He was in might do so if they so wished. full agreement on the need to make a bigger effort to 282 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II get help for the programme of assistance to the newly would be forthcoming in the future from those sources independent countries under the United Nations of funds. Special Fund. The suggestion that he should approach At the request of the CHAIRMAN, Dr SENTICI the Secretary -General of the United Nations for funds (Morocco),Rapporteur,submittedthefollowing would seem impractical in present circumstances : draft resolution for the Committee's consideration : the United Nations' needs at the moment appeared to be greater than those of WHO. In any case, the The Sixteenth World Health Assembly, decision on how the funds of the Special Fund should Having studied the report of the Director -General be utilized did not lie with the Secretary- General but on continuedassistancetonewly independent with the governments serving on the Fund's Governing States; Council. That was an important point that must be Noting resolution EB31.R39 adopted by the borne in mind. All the efforts he had made and might Executive Board at its thirty -first session; continue to make vis à vis the Fund's Managing Recognizing the urgent need to accelerate the Director would be fruitless unless the governments in assistancetonewly independent and emerging question followed the example given by the represent- States inaccordance with the programme laid ative of France on the governing body of the Fund in down by the Fifteenth World Health Assembly in viewinghealthprojectswithgreatersympathy; resolution WHA15.22; and otherwise there was nothing that either the Secretariat of the Fund or the Secretariat of WHO could do. Realizing that the implementation of such an accelerated programme requires larger resources Under the Technical Assistance programme, the than are currently available to the Organization, recipient countries themselves established priorities for help. No funds were made available directly to 1. NOTES the report of the Director -General; the participating agencies. Accordingly, if the countries 2. ENDORSES the actions taken by the. Director - desired greater help under Technical Assistance in General to implement an accelerated programme for health projects,they themselves must give those assisting newly independent and emerging States ; projects higher priority. He trusted he had made that and point absolutely plain, since it would be unfortunate 3. INVITES Members that are in a position to do so to if the delegations of the newly independent countries make voluntary contributions to the Special Account were to get the impression that the Secretariat of for Accelerated Assistance to Newly Independent WHO was doing nothing in the matter. The Secretariat and Emerging States, as established by the Fifteenth could not change the policy of the United Nations; World Health Assembly in its resolution WHA15.22. delegations alone could take action to introduce legislative changes. Some of the statements that had Decision: The draft resolution was approved.' been made during the discussion had given him renewed hope that greater support for health projects The meeting rose at 6.15 p.m.
FOURTEENTH MEETING
Tuesday, 21 May 1963, at 9.30 a.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1.Fourth Report of the Committee 2.Consideration of the Eleventh Report of the Com- mittee on International Quarantine At the request of the CHAIRMAN, Dr SENTICI Agenda, 2.7 (Morocco), Rapporteur, read out the draft fourth The CHAIRMAN invited the Secretary to introduce report of the Committee. the item.
reportwasadoptedwithout Decision :The ' Transmitted to the Health Assembly in section 3 of the comment (see page 409). Committee's fourth report and adopted as resolution WHA16.31. COMMITTEE ON PROGRAMME AND BUDGET :FOURTEENTH MEETING 283
Dr KAUL, Assistant Director -General, Secretary, (a)a local area where there is a non -imported or said that the document before the Committee 1 con- non -transferred case of plague, cholera, yellow fever tained the eleventh report of the Committee on or smallpox. International Quarantine and also, at the request of the Executive Board in its resolution EB31.R2, the Paragraphs (b), (c) and (d) of the definition of "infected minutes of the Board's discussion of that report at its local area" remained unchanged. thirty -first session. Under section 21 of the report, the Committee The Committee on International Quarantine had recommended that Article 3 of the Regulations be considered the annual report of the Director -General, amended by adding the following paragraph after the prepared in accordance with Article 13 of the Inter- first paragraph : national Sanitary Regulations, on the functioning of 2. In addition, each health administration shall the Regulations and theireffect on international notify the Organization by telegram within twenty- traffic.Its resultant opinions and recommendations four hours of its being informed : were given in the report. First, it recommended to the (a)that one or more cases of a quarantinable Health Assembly certain amendments whose primary disease have been imported or transferred into a purpose was to achieve clarification and epidemio- non -infected local area -the notificationshall logical realism regarding notification of quarantinable include information on the origin of infection; diseases and to put on a formal basis practices followed in the administration of the Regulations. One other (b)that a ship or aircraft has arrived with one or more cases of a quarantinable disease on board - amendment concerned facilitationof international the notification shall include the name of the ship traffic. or the flight number of the aircraft, its previous Sections 14 and 15 of the report concerned defini- and subsequent ports of call, and whether the tions in Article 1 of the Regulations.It was recom- ship or aircraft has been dealt with. mended that the definition of imported case should be amended to read : In section 95 of the report it was recommended that, "imported case" means an infected person arriving for purposes of facilitating international travel, Article on an international voyage. 97, paragraph 1, of the Regulations be amended by adding after the words "Appendix 6" the words "except It should be noted that the words "infected person" when a health administration does not require it ". and "international voyage" were already defined in With regardtosection 96 of the report the Article 1. The present definition of "infected person" Committee recommended the addition to Article 36 read : of the Regulations, concerning sanitary measures-on "infected person" means a person who is suffering arrival, of a third paragraph reading : from a quarantinable disease, or who is believed to 3. Where ahealthadministration hasspecial be infected with such a disease. problems constituting a grave danger to public Thus the purpose of the amendment was to include in health a person on an international voyage may, on the definition of an imported case a person in the arrival, be required to give a destination address in incubation period of a quarantinable disease but writing. clearly not yet recognized as a case.There had been some confusion in the past as to when an infected Information on cholera El Tor was given in sections 45 -61 of the report. The Committee on International person became a case. "International voyage" as now defined meant "in the case of a person, a voyage Quarantine had discussed the present situation in great involving entry into the territory of a State other than detail but, because of the gaps in fundamental knowl- the territory of the State in which that person com- edge about the spread of cholera, had felt it was not mences his voyage ". yet the time to recommend any amendment to the The Committee recommended the addition of a new Regulations with regard to cholera. Information had phrase, "transferred case ", and defined it as follows : been given to the Committee on the Organization's programme of cholera research. "transferred case" means an infected person whose Referring to sections 70 -93 of the report, he said infection originated in another local area under the that extensive information had been given to the jurisdiction of the same health administration. Committee on International Quarantine regarding It was recommended that paragraph (a) of the certain aspects of smallpox and its international spread. definition of "infected local area" be changed to read : The smallpox provisions of the Regulations had been considered in great detail, especially in relation to the 1 O,$. Rec. Wld Hlth Org. 127, Annex 1. importation of the disease.The Committee had not 284 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II been convinced that any amendment to the Regulations in Moscow in 1960 it had proved extremely difficult to in respect of smallpox should be made at the present trace the persons responsible for importing the infec- time and it had noted especially that the Director - tion. General was proposing a meeting of the Expert Committee on Smallpox in 1964, to review recent Dr TorrlE (Sweden) said that the governments of the Scandinavian countries had studied the eleventh report scientific developments and the progress of the eradica- of the Committee on International Quarantine with tion programme. As mentioned in the Committee's comments on sections 70 -90 one member of the great interest, for they were much concerned with the danger of the spread of communicable diseases through Committee had recordedhisdivergentopinion, which was reproduced in Appendix 2 to the report. international traffic to countries long free from them. The recent outbreak of smallpox in Sweden had been To enable delegations to see the amendments to the caused by a sailor coming from Indonesia by air and Regulations as recommended by the Committee on carrying a certificate indicating revaccination three International Quarantine, the Director -General had years previously. At a recent meeting of health officers circulated, in a document, a draft resolution setting of the Scandinavian countries, a thorough discussion out the proposed changes in the form of Additional had taken place of the question of recording the Regulations amending theInternationalSanitary results of revaccination.Considerable sympathy was Regulations. felt with the views of the United Kingdom delegate, as Professor 2DANOV (UnionofSovietSocialist set out in Appendix 2 to the report, but it was realized Republics) supported all the amendments proposed to that obligatory recording of results could lead to theInternationalSanitaryRegulationsbythe difficulties in some cases. He therefore considered that Committee on International Quarantine, which he a decision on that matter should be deferred until after considered one of the most useful bodies in WHO and the next meeting of the Expert Committee on Smallpox, whose annual meetings to review the Regulations in but that until then WHO should recommend health the light of experience were indispensable. authorities throughout the world toensure that He had a few remarks to make for the consideration physicians did not issue certificates until the results of of the Committee on International Quarantine in its revaccination were checked and the operation repeated future work.In the first place, he suggested that in if necessary.Such measures would promote greater the Regulations it was essential to include among the understanding among vaccinators of the desirability, infected areasports, airports and other transport where feasible, of checking results, and the protective terminalsifthesurrounding, territory had been value of vaccination of the individual traveller in declared infected.Experience in recent years had preventing the world -wide spread of smallpox would be shown that the risk of infection through personnel greatly enhanced. working in an airport and living in the surrounding Dr TEELOCK (Mauritius), referring to section 11 of area was very great. The list of such ports and airports the report of the Committee on International Quaran- could be published in the Weekly Epidemiological tine, on aircraft disinsection, said that his Government Record. had been requested by an air company to consider Regarding cholera, there was need for some pro- using the "blocks away" method instead of the present vision in the Regulations for the isolation and surveil- method of disinsection on arrival. He had read with lance of travellers who had been in contact with cases interest the paper entitled "Studies on aircraft disin- of cholera during the journey, irrespective of whether section at `blocks away' in tropical areas" and had they were in possession of a valid certificate of noted that, while the aerosol method was considered vaccination or not.There was no need for him to biologically effective, the authors recognized that only explain how dangerous a healthy carrier could be. the passenger cabin would be effectively disinsected, With regard to smallpox, he considered that pro- the flight deck, toilet area and luggage compartment vision should be made in the Regulations for compul- being left untouched. The human element of neglect sory vaccination for persons leaving areas where it was by the air crew had also to be considered and the prevalent :an amendment of Article36 of the authors recognized the need for a firm directive that the Regulations to include such a provision would be operation be carried out immediately the doors were desirable.Furthermore, he agreed with the United closed for departure.However, that might interfere Kingdom Government that health authorities should with the crew's duties regarding briefing for safety be empowered to require a destination address so as to regulations and he therefore wondered how farit facilitate the tracing of arrivals from infected areas. would actually be observed. Everybody was aware of the cases that had recently His Government was not prepared to endanger the occurred in Sweden, and during the similar outbreak health of its people nor the sugar -cane industry, on COMMITTEE ON PROGRAMME AND BUDGET : FOURTEENTH MEETING 285
which the island's economy depended.Both Ano- presented valid certificates, giving reason to believe pheles funestus, the main local malaria vector, and that they were effectively vaccinated against smallpox, Aedes aegypti had been eliminated a dozen years ago when in fact they were not. Since it was well established and the sugar canes were remarkably free from major that the cutaneous reaction to smallpox vaccination diseases such as Fiji disease and mosaic, but the vector provided in many cases a sufficient indication whether of Fiji disease was present, and the disease itself was the virus had really been inoculated and thus whether widespread in Madagascar, with which there were many the subject was likely to have acquired immunity, his contacts. For the moment, therefore, his Government delegation considered that the reaction observed should preferred to continue the present method of disin- be entered on the certificate. He realized that such a section on arrival. As Mauritius was a terminal flight provision could cause some delay for travellers and point, the inconvenience to passengers was negligible. might also involve difficulties in the interpretation of He suggested that the Expert Committee on Insecti- the cutaneous reaction, but considered that it would cidesconsiderthepossibilityof some form of make 'for greater safety than the measures at present automatic pre -flight release of aerosol throughout the applied.It was, of course, only one of many possible aircraft, including the luggage compartment. solutions to a problem which in the past had wrongly been considered simple. Other important lines requir- Dr OMURA (Japan) was in favour of the amendments proposed by the Committee on International Quaran- ing investigation, and which he knew were already receiving attention from WHO, related to the quality tine to the International Sanitary Regulations.He requested that studies be continued with a view to of vaccines and the choice of a reliable technique of providing the necessary amendments to the provisions vaccination. regardingcholera,takingintoconsiderationthe Dr MORSHED (Iran)referringtothe proposed proposals made by his Government. amendment to the definition of "imported case" in The spread of smallpox and cholera through air Article 1 of the Regulations, asked what was to be the travel had become a serious problem, and a solution was length of the incubation period during which a person urgently required. For example, only a week before, an could be considered as infected, there being as yet no imported case of Asian -type cholera had been found symptoms to show whether he would in fact develop in a hotel near the lake at the foot of Mount Fuji in the disease or not. Japan, the person concerned being an English tourist As stated in section 15 of the report, the hospitaliza- who had come to Japan after spending about a month tion of a single case in an area was not considered to in an infected area of South -East Asia and who was in make it an infected local area. However, before such possession of a valid cholera vaccination certificate a case was isolated several other persons might well issued in the United Kingdom.His Government have been infected. Moreover, effective isolation was trusted that WHO, and particularly the Committee on sometimes not feasible, as in the case, mentioned in International Quarantine, would accelerate its studies section 23 of the report, where a nurse hospitalized in withaview toestablishingeffectivequarantine an isolation ward had nevertheless communicated measures to prevent the importation of cholera by air. smallpox to a nurse in an adjoining ward. Cholera and smallpox were serious problems not He thought that all delegations would echo the only for the countries where they were endemic and request of the Committee on International Quarantine claimed many victims, but also for the countries where to the Director -General, in the last paragraph under their importation was a constant threat.In that section 61 of its report, to pursue vigorously and connexion he recalled the discussions on priorities that energetically research to close the gaps in fundamental had taken place during the debate on the proposed knowledge of cholera.Present vaccination methods programme and budget for 1964 and expressed the were only 50 per cent. effective at the most, and the view that smallpox and cholera eradication pro- other measures applied by certaincountries,for grammes should be given high priority in all areas example the taking of swabs, were not feasible every- where those diseases were endemic.Meanwhile, he where. suggested that the countries concerned should estab- lish bilateral agreements for effective measures to Dr DOUBEK (Czechoslovakia) said that the health prevent international spread, and that WHO should be service at Prague airport had often found that the ready to give them appropriate advice and guidance in measures taken, particularly in regard to vaccination the application of such measures. certificates in respect of persons travelling on Euro- pean air routes but coming originally from infected Professor SOHIER (France) observed that the report areas, were not always properly applied. Such persons oftheCommitteeonInternationalQuarantine had been known to arrive in Czechoslovakia, after contained several examples of travellers who had following a roundabout route, within the fourteen 286 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II critical days after leaving an infected area. His The report showed that some countries were still delegation considered that there should be a very failing to give the notifications and epidemiological strict control at the first airport of arrival in Europe of information required under the Regulations. His the vaccination certificates of such persons -both in delegation shared the views of the Committee on the case of travellers intending to stay in the country International Quarantine in that regard and appealed and of those going on to other countries. If they had no to the health administrations concerned to fulfil their vaccinationcertificatetheyshould begiventhe obligations for the sake of world health. appropriate vaccination on arrival. In conclusion, he stated that the drinking -water supplied to ships and aircraft in Kuwait was in con- Dr EL -BORAI (Kuwait) said that the information formity with the international standards established contained in the report regarding the importation of by WHO. smallpox cases into a number of countries showed the need for co- operation between governments to raise ProfessorMUNTENDAM (Netherlands)saidthe the level of protection and for the energetic continua- admirable report of the Committee on International tion of research on methods of vaccine production and Quarantine made it very clear that infectious diseases other epidemiological and immunological problems. were still a danger to the health of the world. Govern- Although imported cases did not constitute grounds ments and peoples must be regularly reminded that fordeclaringaterritory infected, experience any weakening of measures to increase resistance to showed that they were often a source of outbreaks. such diseases and combat their spread would be a Among the possible reasons for the cases that occurred threat both to the country concerned and to its neigh- were poor vaccine, ineffective vaccination techniques, bours. In that connexion, he considered that in and the improper issue of certificates. respect of smallpox the use of the word " eradication " Kuwait being considered as free from malaria, his could give the public a misleading impression that Government was awaiting with interest the recom- the final stage of the struggle against the disease had mendations of the Expert Committee on Malaria that been reached, whereas recent experience showed that was to meet in the present year and consider measures that was not the case.In agreement, therefore, with for international protection against the importation of the author of an article in the February 1963 issue of the disease. the American Journal of Public Health, he would His Government had noted the opinion that "blocks 'prefer at the present stage to use the word " control ". away" aircraft disinsection was considered an accept- As his delegation was in favour of all measures to able alternative to disinsection of the passenger cabin improve protection against importation of smallpox, with aerosols after arrival of the aircraft, and intended it supported in principle the proposal contained in to apply it as soon as practicable, with all due respect Appendix 2 to the report for the amendment of the to the Government of Mauritius, which, for reasons of International Certificate of Vaccination or Revaccin- its own, took the opposite view. ation against Smallpox. Collectionof mosquitosforidentification was regularly carried out in the ports and airports of his Dr MURRAY (United Kingdom of Great Britain country, and so far no malaria vector or Aedes aegypti and Northern Ireland) said that his delegation accepted had been found. all the recommendations in the report except those His delegation supported the proposals of the relating to the International Certificate of Vaccination Committee on International Quarantine for amending or Revaccination against Smallpox. On that matter the definitions of " imported case " and " infected it shared the view of the member of the Committee local area ", and for inserting a definition of a new on International Quarantine who had exercised his expression, " transferred case ". right to attach to the report a divergent opinion The previous year the Committee on International regardingarecommendation which he had not Quarantine had endorsed the opinion of the Scientific considered in the best interests of world health. Group on Cholera Research that cholera El Tor be Recent smallpox importations had shown that the considered essentially identical with classical cholera. certificate in its present form was not medically sound In that regard his delegation had no opinion to put and did not constitute evidence either of successful forward -until the gaps in fundamental knowledge re- vaccination or of immunity.It was not medically regarding the relationship between the two forms of sound, because it became valid immediately revaccin- cholera were filled.He hoped that WHO would ation was performed and however long a period had endeavour to make the necessary information available elapsed since previous vaccination;it provided no as soon as possible, so that a final decision could be evidence of immunity, because the result of the taken. vaccination was not entered.The divergent opinion COMMITTEE ON PROGRAMME AND BUDGET :FOURTEENTH MEETING 287 represented an attempt to put the certificate on a Committee that it was intended to convene in 1964, sounder medical basis. the same argument surely applied to the smallpox The underlying philosophy of the International eradication campaign.There were many gaps in the Sanitary Regulations aimed at providing maximum Regulations as regards smallpox, ranging from the security against the spread of disease compatible with conscientious objector to the inadequacy of the Inter- minimum interference with international traffic. Often national Certificate of Vaccination or Revaccination. in the past the best interests of health as advocated However, something could be done about the latter by the medical authorities had been set aside for traffic which, with good publicity, should prove acceptable considerations. His delegation's proposal was to take to the travelling public. back in some measure what had been granted to facilitate international traffic in 1951, when the speed Dr CLAVERO DEL CAMPO (Spain) said that the report and volume of air transport had not yet reached present of the Committee on International Quarantine was levels and the consequent threat to health had not extremely interesting, and he therefore regretted that been as great as today. the Committee would probably meet less frequently The divergent opinion put forward two main in the future. recommendations, one regarding primary vaccination Nearly half the report dealt with imported smallpox. and one regarding revaccination.The first recom- The fact was that, notwithstanding the decisions of the mendation, which was that the validity of the certificate Health Assembly and the will of countries to eradicate could not begin until fourteen days after primary smallpox, the disease was still endemic in many areas vaccination, perhaps went further than would at and was frequently exported.The only measures present be acceptable and might cause delays dis- provided for in the International Sanitary Regulations proportionate to the advantages it would give; his were that infected local areas should be notified and delegation would therefore not press it.With regard that, in some cases, travellers could be required to to revaccination, however, he asked the Committee to carry certificates of vaccination.His delegation did accept the recommendations in the divergent opinion not think that any additional measures would be and the proposed amendment to the certificate. justified, since the flow of international traffic, on which economic and social development depended, Dr HAMZA (Sudan), after expressing his apprecia- should not be hampered; but the existing provisions tion of the report of the Committee on International should be more strictly enforced. Quarantine, asked for clarification of the meaning of As regards the certificates of vaccination or revacci- the proposed amendment to Article 3 (see page 283). nation, in his experience not much reliance was placed Did it imply that notification should be made to the on them; and it was a fact that most of the imported Organization of each case of quarantinable disease cases of smallpox had been in possession of up -to- which had been transferred into a non -infected local date certificates.There were many reasons why the area, or should notification only be made after the certificates, even when their validity was not in ques- first case had been so transferred ? The former would tion, did not fulfil their purpose; but the main diffi- seem to be unnecessarily repetitious, since such cases culty, in his view, was that the certificates of most would already have been notified at the time they travellers concerned revaccination, and the result of were first discovered; if the latter were intended, it the revaccination was not shown. would surely be clearer to say that health administra- His delegation considered that all steps that would tions should notify the Organization of any local help to avoid exporting smallpox should be taken, area which became infected as a result of an imported but not blindly.It was difficult for the health author- or transferred case.That, however, would appear ities of countries of arrival to determine whether or not to conflict with the interpretation of the definition of travellers came from infected local areas.Therefore " infected local area ", referred to in section 15 of the the countries in which smallpox existed should take report of the Committee on International Quarantine. the necessary measures. If such countries would His delegation entirely agreed with the remarks of requireacertificateof vaccinationof departing the delegate of the United Kingdom concerning the travellers and if,in the case of revaccination, the importance of the divergent opinion given in Appen- result was indicated on the certificate, much would dix 2 to the report. If the main argument of the Com- be accomplished. He would suggest that the certificate mittee on International Quarantine against amending be amended to enable the result of vaccination to be theInternationalCertificateofVaccinationor indicated when circumstances justified. Countries Revaccination againstSmallpox was that further couldalwaysconcludebilateralormultilateral study of the epidemiological and other aspects of agreements to waive that requirement in the interest smallpox was required, preferably by the Expert of facilitating international traffic. 288 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Dr ALAN (Turkey) praised the report and said that travellers themselves.His Government, which was his delegation would support the proposed amend- desirousofimprovinginternationalquarantine ments to the International Sanitary Regulations. measures and of co- operating closely with WHO in the However, at the Fifteenth World Health Assembly matter, would welcome a conference on international his delegation had referred to the difficulty of deter- quarantine which would include representatives of all mining whether or not an international traveller the countries in the European and Eastern Medi- arriving from an area free from infection had been, a terranean Regions. few days or even hours previously, in an infected local area, and therefore whether or not a certificate Professor NAUCK (Federal Republic of Germany) of vaccination should be required. The report of the said that the importation of smallpox would continue Committee on InternationalQuarantine did not as long as the disease was endemic in several countries appear to offer any solution to that problem.It was, and that the only absolute solution to the problem however, gratifying to note that the Committee had would be eradication of the endemic foci by mass recommended health administrations, when designat- vaccination.The measures prescribed in the Inter- ing infected local areas in heavily populated sections of national Sanitary Regulations provided a degree of the country, to take into consideration the extent of protection against the importation of smallpox by movement of population between several adminis- internationaltraffic,particularlyairtraffic,but trative districts. He hoped that the Committee would additional measures were needed in view of the continue to keep the matter on its agenda. repeated importation of the disease into countries of Western Europe. He agreed that governments should Mr CALDERWOOD (United States of America) said ensure that potent vaccines and proper vaccination that his delegation supported the views, recommend- procedures were used.He also considered that the ations and amendments proposed in the report of the International Certificate of Vaccination or Revaccina- Committee on International Quarantine, but suggested tion against Smallpox should be amended to provide two modifications to the proposed amendments as for the results of revaccination to be recorded. follows,: Nevertheless, greater knowledge of smallpox and Under Article 1:the definition of an "infected vaccination was needed and the problem should be local area" in sub -paragraph (a) should be deleted referred to the Expert Committee on Smallpox to be and replaced by "(a) a local area where there is a held in 1964. case of plague, cholera, yellow fever, or smallpox that is neither an imported case nor a transferred Dr ALDEA (Romania) saidthat smallpox was case;or ". especiallyliabletobe transmitted bytravellers, Under Article 3:the words "the notification shall particularly those travelling by air.In view of that, include...." in sub -paragraphs (a) and (b) should special measures should be taken to ensure the vaccina- read "the notification to include....". tion of all aircraft crews and ships' crews who had Those modifications, he felt, would lead to greater contact with countries in which smallpox was endemic; clarity. also of all customs officers and staff in hotels who He agreed with the previous speakers who had might deal with passengers from such countries; and drawn attention to the problem of smallpox.The particularly of all medical staff in hospitals which matter needed further consideration by the Committee might receive suspected cases of smallpox. Such on International Quarantine, and it was regrettable measures were being taken in Romania, in addition to that that committee was not scheduled to meet the compulsory vaccination programme. An import- annually. He agreed that the convening of the Expert ant problem arose in connexion with the disinfection of Committee on Smallpox might also be desirable. aircraft, ships and cars; the existing methods were difficult to apply, were not readily accepted by owners, Dr ARNAUDOV (Bulgaria) said that his country had and were apt to cause material damage.It would be great difficulty in applying Article 83 of the Interna- very helpful if research_could be initiated with a view tional Sanitary Regulations when travellers arrived to finding an effective disinfectant which could be either by car or train, in transit or for a stay of only a rapidly applied and which would not damage the few days. Many such travellers, coming from count- article treated. ries where smallpox was still endemic, arrived within the incubation period of the disease; some of them Dr NAYAR (India) said that all the measures laid agreed to vaccination, but others refused and therefore down in the International Sanitary Regulations would had to be placed under surveillance, which created remain necessary until the quarantinable diseases had difficulties both for the health administration and the been everywhere eradicated.It was clear that the COMMITTEE ON PROGRAMME AND BUDGET : FOURTEENTH MEETING 289
International Certificate of Vaccination or Revaccina- remained viable for up to three months at normal tion was not fulfilling its function.She believed that temperatures; the medium had been supplied to that was mainly due to two causes. First, the mass of school- teachers and other persons in the villages so the public, and many responsible persons, did not that swabs from suspected cholera cases could be understand the need for quarantine measures and placed in it and sent to the laboratory for testing. pressure was constantly being put upon the health Investigations into the endemicity and epidemiology of authorities to relax them.That attitude led some- cholera seemed to indicate that not only faulty water times even to the use of false - vaccination certificates. supplies but also the nutrition of the people and Secondly, the vaccines used were not always reliable. the pH value of the water played a part. The apathy of the public could be combated by health education, and the use of false certificates could be kept Dr MURRAY (South Africa) referring to the report down by a rigorous limitation of the number of persons from the Government of the United States of America, authorized toissuetheinternationalcertificates; quoted in section 110 of the report of the Committee improvement in the reliability of the vaccine would be on International Quarantine, said that experience in achieved if WHO would set up regional centres for his country had indicated that in many cases the testing vaccine and also, where necessary, for supplying health part of the Aircraft General Declaration was the need. probably completed before the beginning of the She was interested in the recommendations of the voyage -since it was duplicated and not handwritten. Committee on International Quarantine concerning To be of any relevance, it should be completed just El Tor and classical cholera but believed that, although before arrival at the point of final destination and there were gaps in the fundamental knowledge about should reflect the events of the actual voyage. He those diseases, enough data had already been collected entirely supported the delegate of the United Kingdom to make possible their eradication. WHO could be of regarding the necessity for an amendment to the great help in stimulating the application of existing international certificate with respect to revaccination. knowledge in Member countries. Where cholera was Dr FENDALL (Kenya), referring to section 62 of the endemic, its foci were known and in each case the key report, said that the Government of Kenya was fully to the problem was the water supply for the area. If the aware of itsobligations under theInternational problem of protected water supplies could be given the Sanitary Regulations and adhered strictly to the terms same priority as malaria eradication and the same of Articles 34, 19 and 20. With reference to section 63 financial assistance, the eradication of cholera and of a of the report, strict regulations were enforced in Kenya number of other gastro- eiítericdiseases would be regarding the export of monkeys in order to prevent possible. the spread of yellow fever infection, but it would be Dr HAQUE (Pakistan) expressed the support of his helpful if guide -lines on procedures for the inter- delegation for the recommendations made by the national transport of monkeys could be laid down. Committee on International Quarantine. Since the provisions of the International Sanitary Regulations of 1951 on yellow fever were still in force As regards smallpox vaccination, the use of freeze - for certain countries, the adoption by Kenya of the dried vaccines in Pakistan was producing a far higher "blocks away" procedure for aircraft disinsection proportion of successfulrevaccinationsthan was would depend on the response of other countries obtained with liquid vaccine, and the freeze -dried which feared the importation of yellow fever.His vaccine gave a large measure of protection. He Government would like information on the attitude of believed that, no change in the International Certificate countries to "blocks away" disinsection to be issued of Vaccination or Revaccination should be con- by the Organization. He supported the proposals of templated before the Expert Committee on Smallpox the delegate of the United Kingdom for the amendment had reviewed the matter. of the International Certificate of Vaccination. He agreed with what the delegate of India had said about false vaccination certificates; his Government Dr EL BITASH (United Arab Republic) suggested took strong action when any such certificates were that those countries in favour of showing the results of detected.Moreover, in Pakistan, few persons were revaccination on vaccination certificates might begin authorized to issue smallpox vaccination certificates. to do so without waiting for international legislation. With regard to cholera, the notification of cases Sincehiscountry had been accused of over - from rural areas had been complicated by the difficulty strictnessinenforcingtheInternationalSanitary of diagnosis, since the symptoms were similar to those Regulations, he appealed to the delegates present to occurring in some types of diarrhoea.Latterly a ensure that travellers from their countries carried the medium had been developed in which cholera vibrios necessary vaccination certificates. 290 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Dr LAYTON (Canada) expressed appreciation of the certificates was evidence that some revaccinations were report of the Committee on International Quarantine. unsuccessful and that in some cases fraudulent certifi- In general, his delegation was in agreement with cates might have been given.It would be valuable measures, or modifications of existing procedures, that for WHO to issue an authoritative statement on could contribute to preventing the transmission of smallpox vaccination requirements for the guidance of disease from any country or area to another, and all authorities concerned with international travel. appreciated thedifficultsituationof countriesat Although his delegation supported the inclusion on special risk. the International Certificate of the result of revaccina- He agreed with previous speakers that amendment tion, it would like the matter to be first referred to the of the smallpox vaccination certificateas regards Expert Committee on Smallpox; it regretted, however, recording of the results of revaccination should be the that that committee would be meeting only in 1964, subject of further study by the Committee on Inter- and not in the current year. national Quarantine and by an expert committee. It was also difficult to accept, without further intensive Professor GERIé (Yugoslavia) asked whether strains study, the suggestion made in the report that a valid of cholera El Tor should be added to vaccine against certificate might be required only from travellers classical cholera, and whether any experiments had coming from infected areas. been done in that field. He expressed approval of the amendments submitted Dr GOOSSENS (Belgium) said that at the Fifteenth totheInternationalSanitaryRegulationsasan World Health Assembly he had mentioned difficulties improvement on the original text. He also supported experienced in the interpretation of the International the proposals made by various speakers with a view to Sanitary Regulations when an epidemic had broken out intensifyingresearchintotheepidemiology and in a neighbouring country. He was glad to see that the immunology of quarantinable diseases. eleventh report of the Committee on International Quarantine met most of the points he had raised.In Dr FIGUEROA (Venezuela) expressed appreciation only two cases did he disagree with the findings of the of the report of the Committee on International Committee ; in the matter of recording the results of Quarantine and of the valuable comments made revaccination ontheInternationalCertificateof thereon. Vaccination or Revaccination against smallpox, he Referring to Table IIin the Director- General's agreed with the divergent opinion of one member of report on smallpox eradication,1 he noted that eleven the Committee, and he would have liked a better cases of smallpox had been reported in Venezuela in definition of what constituted a revaccination, or in 1962. It should, however, be borne in mind that other words, a recommendation asto the period Venezuela had been free from smallpox since 1956 and after primary vaccination that could elapse before the that the cases reported had occurred in the part of the person should be considered as not having been country bordering on Brazil, which country had been vaccinated previously.He did not press the second responsible for 2759 cases out of a total number of point, but urged for serious consideration of the pro- 3029 reported in respect of 1962 for the Region of the posal made by the delegate of the United Kingdom. Americas. He had noted that, as stated in the report He realized that an amendment to the certificate would on smallpox eradication, Brazil was ready to begin an not eliminate the importation of smallpox, but any eradication programme. measures that might help should be taken. He approved all the amendments to the Regulations Dr ALAKIJA (Nigeria) expressed regret that he had proposed by theCommitteeonInternational been unable to attend the eleventh session of the Quarantine. Committee on International Quarantine, to which he had been invited.He associated himself with those Dr PHILLIPS (Australia) congratulatedthe Com- speakers who had commended its report. mittee on International Quarantine on its excellent In the course of the discussion relating to revaccina- report. tion against smallpox, the opinion had been expressed Owing to the increased risk of the international that restrictions should be introduced as to the officials spread of smallpox arising out of the growth of air authorized to issue international certificates.While travel, his delegation was in favour of the proposal agreeing in principle with that view, he drew attention whereby the result of revaccination would be recorded to the possible practical difficulties that might arise in on the International Certificate of Vaccination or a large country such as his own, where, if the results of Revaccination.The recent introduction of smallpox revaccination had to be recorded, travellers would be into the United Kingdom, Sweden and the Federal Republic of Germany by persons holding valid 1 Off Rec. Wld Hith Org. 127, Annex 16. COMMITTEE ON PROGRAMME AND BUDGET : FOURTEENTH MEETING 291 required to make stays of a few days in a particular defininitionrecommended by the Committee on town in order that that could be done. Furthermore, InternationalQuarantineof an"imported case" additional risks of fraudulent certificates might thus be presentedtheadvantageof takingintoaccount incurred. He suggested accordingly that it might be infected persons in the incubation period of the disease desirable to study the.question further and to consider and thus eliminated the vagueness hitherto existing in whether it might not be preferable to stipulate that the that respect in the International Sanitary Regulations. period of validity of the certificate be reduced from It would be of interest that the Director- General had in three years to two in the case of revaccination, the fact been using the new definition proposed in admin- traveller then being allowed to proceed immediately istering the Regulations. after revaccination without waiting for the result to be With regard to the definition of an "infected local recorded. area ", in section 15 of the report, he expressed the view that the amendment proposed by the delegate of the Mr BRADY (Ireland) said that his Government had United States was an improvement on the proposed been impressed by the careful and important report draft submitted by the Director -General in accordance submitted. He would have hoped, however, that the with the recommendations of the Committee on recommendationscontainedinthestatementof International Quarantine and that it did not introduce divergent opinion on the question of amendments to any change in the intention of the recommendation. the International Certificate of Vaccination or Re- He recalled that the unduly narrow definition of an vaccinationagainstSmallpoxwouldhavebeen infected local area had caused some problems, since accepted.He supported the views expressed by the some areas which had boundaries with infected areas delegate of the United Kingdom and by other delegates had not been satisfied with the position.He called regarding the desirability of recording the results of attention in that connexion to the recommendation revaccination on the certificate.If the Committee did made by the Committee on International Quarantine to not wish to amend the certificate in that respect at the healthadministrationsthatinheavily populated presenttime,hisdelegation would supportthe sections of a State, the designation of local areas suggestion to refer the matter to the Expert Committee should take into consideration the extent of movement on Smallpox at the earliest possible time. He agreed of population within several adjacent administrative with the delegate of Belgium that it was not possible to districts. He stressed the fact that a realistic attitude by prevent entirely the importation of smallpox, but all governments in that respect could go a long way possible measures should be taken. He was aware of towards solving the problem. the difficulties referred to by the delegates of Nigeria and In reply to a question raised in the course of the Pakistan. He also expressed appreciation of the efforts discussion as to whether an area would be declared of those countries attempting eradication. It seemed to infected after the first imported case, he explained that, him that the practical difficulties in the way of record- under the existing International Sanitary Regulations, ing the results of revaccination were not insuperable a local area would be infected only when the first local and that travellers could avoid delay by keeping their case appeared. No change in that respect was proposed certificates up to date. He endorsed the remarks made by the Committee on International Quarantine. by the delegate of Canada concerning circumstances in There had been considerable discussionat the which certificates of vaccination might be required. present meeting on both smallpox and cholera. With Dr BRAKHOTT (Israel) said that his delegation had regard to cholera, the Committee on International studied the report and listened to the debate with Quarantine had, inits tenth report,1 reviewed the interest.He considered that the basic need was to situation in respect of the epidemics of cholera El Tor induce the doctors and health authorities involved to which had occurred in the Western Pacific and in alter their attitudes to smallpox, since modern traffic South -East Asia and, on the basis of the findings of the was changing the pattern of the disease; WHO should Scientific Group onCholeraResearch, had convene an expert committee to consider how that recommended that the International Sanitary Regula- could be done, rather than a committee to provide tions should apply to cholera El Tor in the same way further expert knowledge on smallpox itself. as to classical cholera. That recommendation had been approved by the Fifteenth World Health Assembly. The SECRETARY said that he would attempt to reply The situation at present was that there still remained to the points made in the discussion in the order in scope for considerable research into the epidemiology which they related to the report of the Committee on of the spread of cholera and cholera El Tor; while International Quarantine. several hypotheses had been advanced, there were as Referring to the definitions in respect of Article 1, in section 14 of the report, he pointed out that the new 1 O, f Rec. Wld Hlth Org. 118, 61. 292 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II yet no conclusive proofs.The Committee on Inter- had taken an extremely positive attitude in the matter, national Quarantine had felt that, until more precise but it considered that at present no change in the information was available and until more specific International Sanitary Regulations should be made. scientific measures could be recommended, the Inter- Reference was also made to the divergent opinion of one national Sanitary Regulations should remain as they member, reproduced in Appendix 2 to the report. stood in that respect.However, the Committee on WHO was doing its utmost to stimulate further InternationalQuarantinerecommendedthatthe knowledge regarding smallpox under activities spon- Organization should undertake research in that field. sored by its medical research programme, and would Reference had been made at the present meeting to place the latest results of investigations before the research being undertaken in India and Pakistan, and Expert Committee on Smallpox and, following that proposals existed for other research projects to be meeting, the Committee on International Quarantine. stimulated by WHO in the near future regarding Reference had also been made in the course of the vaccines, epidemiology and carriers. discussion at the present meeting to the "blocks away" A number of delegations had stressed the need for method of aircraft disinsection. He called attention to giving priority to projects relating to community water thefindingsof the Committee on International supplies and waste disposal as specific anticholera Quarantine on that point, contained in section 11, in measures.It was hoped that such activities would be which it expressed the view that "blocks away" disin- expanded as part of the United Nations Development section was regarded asa technically acceptable Decade and in keeping with the intensification of the alternative method for disinsection of the passenger Organization's water supply programmes over the cabin with aerosols.Details of "blocks away" disin- years. section were contained in the Recommendations on There were a number of problems in connexion with theDisinsectionof Aircraft,formulated by the smallpox.The recent importation of smallpox into WHO Expert Committee on Insecticides and which Europe had highlighted the possibilities of smallpox werereproducedasAnnex VIItothesecond entering non -infected areas. The question of whether annotatededitionof theInternationalSanitary any change in the International Sanitary Regulations Regulations, and paragraph 2 of the description 2 could improve the situation called for consideration. related to the flight deck. A point had been raised Although vaccination against smallpox had a long regarding the effectiveness of disinsection of the crew history, and in spite of the existence of smallpox eradic- compartment. He pointed out that the Committee on ation programmes, knowledge of some aspects of the International Quarantine had, on the basis of the epidemiology and immunology of the disease remained findings of the Expert Committee on Insecticides, inadequate. He recalled that WHO had in 1951 considered the method effective and recommended its adopted the International Sanitary Regulations in their adoption to governments. present form, i.e. without a requirement for the reading As he had mentioned in connexion with the malaria of results of revaccination. The position was that there eradication programme, the Expert Committee on was no real certainty as to what were the minimum Malaria would be considering, at its meeting in 1963, results which could be considered successful.Several international protection against malaria as a major delegations had stressed the importance of the type of item. vaccines used. 'It was agreed that freeze -dried vaccines In connexion with the need for developing regional conserved their potency better than liquid vaccines. It reference centres to provide opportunities for testing was essential to ensure that governments were making standards and potency of vaccines, he said that WHO all efforts in that sphere and emphasis would be laid, had. already established an international reference at the time of the consideration of the item on smallpox centre for that purpose and would examine the possi- eradication, on the importance of the potency of bilitiesforsetting up regional referencecentres. vaccines used.In view of the state of knowledge on Meanwhile, the Organization was in a position to the subject, it had been considered that the question of assistcountriesinobtaining the examination of smallpox should be reviewed both by the Executive vaccines and an opinion thereon, if they so desired. Committee on Smallpox and by the Committee on Replying to the. point raised in connexion with the International Quarantine. In that connexion, he drew transit of monkeys from yellow -fever infected areas to particular attention to the findings of the Committee on non -infected areas, he said that that question was International Quarantine as set out in its comments on already covered to a great extent by bilateral agree- sections 70 -90 of the report.1 As could be seen from its ments. A request had been made for guide -lines on findings, the Committee on International Quarantine 2 World Health Organization (1961) International Sanitary 1 Off Rec. Wld filth Org. 127, 51. Regulations, second annotated edition, Geneva, 106. COMMITTEE ON PROGRAMME AND BUDGET :FOURTEENTH MEETING 293 the matter; that request had been noted and due Transferred case. Add the following definition : action would be taken at an early date. " ` transferred case 'means an infected person The delegateof Venezuela had referredtoa whose infection originated in another local area point in connexion with smallpox eradication.He under the jurisdiction of the same health admin- would revert to it under the specific item of the agenda istration; ". relating to smallpox eradication. (See minutes of the fifteenth meeting of the Committee, section 2.) Article 3 Insert as paragraph 2: The CHAIRMAN invited the Committee to consider the draft resolutions before it with regard to the " 2.In addition each health administration shall recommendations of the Committee on International notifytheOrganizationby telegramwithin Quarantine. twenty -four hours of its being informed : (a)that one or more cases of a quarantinable The SECRETARY drew attention to the draft additional disease have been imported or transferred regulationsamendingtheInternationalSanitary into a non -infected local area -the notification Regulations in particular with respect to notifications, to include information on the origin of infec- contained in the form of a draft resolution. tion ; He recalled that certain amendments proposed by the United States delegation to that draft resolution (b)that a ship or aircraft has arrived with one had been accepted. The amendment under Article 1 or more cases of a quarantinable disease on in respect of an infected local area should thus read board -the notification to include the name of as follows : " (a) a local area where there is a case of the ship or the flight number of the aircraft, plague, cholera, yellow fever or smallpox that is its previous and subsequent ports -of -call, and neither an imported case nor a transferred case; or ". whether the ship or aircraft has been dealt Under Article 3, paragraph 2 (a) and (b), the words with." " the notification shall include " should be amended Re- number paragraph 2 as paragraph 3. to read " the notification to include ". Article 36 The CHAIRMAN put to the vote the amended draft Insert as paragraph 3: resolution, which read as follows : " 3.Where a health administration has special The Sixteenth World Health Assembly, problems constituting a grave danger to public health a person on an international voyage may, Considering the need for the amendment of certain on arrival, be required to give a destination of the provisions of the International Sanitary address in writing." Regulations, as adopted by the Fourth World Health Assembly on 25 May 1951, in particular with respect Article 97 to notifications; In paragraph 1, after the words " Appendix 6 ", Having regard to Articles 2 (k), 21 (a) and 22 of insert the words : the Constitution of the World Health Organization, " except when a health administration does not ADOPTS, this...May1963,thefollowing require it ". Additional Regulations : ARTICLE H The period provided in execution of Article 22 ARTICLE I of the Constitution of the Organization for rejection In Articles 1,3, 36 and 97 of the International or reservation shall be three months from the date Sanitary Regulations,thereshallbe made the of the notification by the Director -General of the following amendments : adoption of these Additional Regulations by the Article 1 World Health Assembly. Imported case. Delete this definition and replace by : ARTICLE III " ` imported case' means an infected person These Additional Regulations shall come into arriving on an international voyage : ". force on the first day of October 1963. Infected localarea.Delete paragraph(a)and replace by : ARTICLE IV " (a)a local area where there is a case of plague, The followingfinalprovisionsof theInter- cholera, yellow fever, or smallpox that is neither national Sanitary Regulations shall apply to these an imported case nor a transferred case; or ". Additional Regulations : paragraph 3 of Article 106, 294 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
paragraphs 1 and 2 and the first sentence of para- Evaluation of the Safety and Efficacy of Drugs, which graph 5 of 107, 108 and paragraph 2 of 109, sub- had met in March 1963. He drew particular attention stituting the date mentioned in Article III of these to the view expressed by the Scientific Group that the Additional Regulations for that mentioned therein, problems in that new field of activity for WHO were 110 to 113 inclusive. urgent and important from the point of view of the IN FAITH WHEREOF we have set our hands at protection of public health, and that the programme Geneva this ... day of May 1963. as outlined by the Fifteenth World Health Assembly and specified by the Executive Board was within the M. A. MAJEKODUNMI Organization's technicalcapacity. The Director - President of the Sixteenth World Health Assembly General would study the technical and administrative aspects of the recommendations of theScientific M. G. CANDAU Director -General of the World Health Organization Group, as formulated in sections 2.2 to 2.5 of his report, and would, in so doing, take into consideration Decision: The draft resolution was approved by advice from the Advisory Committee on Medical 70 votes to none, with 2 abstentions.' Research. Dr SENTICI (Morocco), Rapporteur, then submitted The report of the Director- General was submitted the following draft resolution for the consideration to the Health Assembly for the recommendation of the Committee : of such future action as it might deem necessary. He would be glad to reply to any specific points The Sixteenth World Health Assembly, that delegations might wish to raise. Having considered the eleventh report of the Committee on International Quarantine, Dr AMMUNDSEN (Denmark) submitted, on behalf of the delegations of Finland, Iceland, the Nether- 1. THANKS the members of the Committee for lands, Norway, Sweden and Denmark, the following their work; and draft resolution for the consideration of the Com- 2.ADOPTS the eleventh report of the Committee mittee on International Quarantine. The Sixteenth World Health Assembly, Decision: The draft resolution was approved.' Having noted the resolution of the Executive Board on the clinical and pharmacological evalua- 3.Clinical and Pharmacological Evaluation of Drugs tion of drugs; Agenda, 2.8 Having examined the report by the Director - Dr BAROYAN, Assistant Director -General,intro- Generalontheclinicalandpharmacological ducing the item, said that the problem of the clinical evaluation -of drugs; and pharmacological evaluation of drugs was one Considering that international co- operationis to which the Director -General had devoted a great essential for the achievement of the best possible deal of attention over the past two years. He recalled protection against hazards for man arising out of the decision of the Fifteenth World Health Assembly the use of drugs; which had resulted from the great interest expressed Agreeing to the definition of a " drug " as any by delegations in action by WHO following the substance, or mixture of substances, destined for dramatic events that had occurred in respect of use in the diagnosis, treatment, mitigation or pre- certain drugs. matter 3 vention of disease in man as set out in the report The Director -General'sreport on the of the Study Group on the Use of Specifications related to the steps taken by the Director- General for Pharmaceutical Preparations; ' as a result of the resolutions adopted by the World Health Assembly and the Executive Board.Section 2 Realizing the technical and administrative diffi- ofthereportcontainedtheDirector -General's culties of securing regular exchange of information observations, formulated in the light of the recom- on all drugs, mendations made by the Scientific Group on the 1. REAFFIRMS the need for early action in regard 1 Transmitted to the Health Assembly in section 1 of the Com- to rapid dissemination of information on adverse mittee's fifth report and adopted as resolution WHA16.34. drug reactions; 2 Transmitted to the Health Assembly in section 2 of the Com- mittee's fifth report and adopted as resolution WHA16.35. 3 Of Rec. Wld Hlth Org. 127, Annex 12. 4 Wld filth Org. teche. Rep. Ser., 1957, 138, 14. COMMITTEE ON PROGRAMME AND BUDGET :FOURTEENTH MEETING 295
2.REQUESTS Member States that WHO assistance in the matter was requested, (a)to communicate immediately to WHO together with opportunities for contact with other countries.While the principal responsibility for new (i)any decision to prohibit or limit the drugsnaturallyrestedwiththenationalhealth availability of a drug already in use, authorities concerned, increased co- operation between (ii)any decision to refuse the approval of countries would supplement most valuably infor- a new drug, mation otherwise gleaned solely fi om scientific publi- (iii)any approval for general use of a new cations. drug when accompaniedbyrestrictive In her own country, the compulsory registration of provisions, malformationsin new -borninfantshad recently if these decisions are taken as a result of serious been introduced.That would be necessarily incom- adverse reactions; and plete in the sense that internal malformations became apparent only later;it was hoped to make some (b)to include in this communication as far as possible the reasons for the action taken and provision for recording that also. the non -proprietary and other names, and the She drew attention to the request contained in the chemical formula or the definition; second operative paragraph of the draft resolution to Member States to communicate with WHO on a 3. INVITES MemberStatestoarrangefora number of matters listed.The third operative para- systematic collection of information on serious graph was particularly important in the inteiests of adverse drug reactions observed during the develop- speedy action; furthermore, it was to be anticipated ment of a drug, in particular after its release for that information transmitted through WHO would be general use, and to transmit such information to reliable. WHO; It was fullyrealized that the proposal would 4. REQUESTS the Director - General involve additional expenditure which it was not (a)to transmit immediately to Member States possible to estimate at the present juncture. However, the information received under 2; she was sure that many delegations in addition to those sponsoring the draft resolution agreed that rapid (b)to study the feasibility of collecting from Member States the non -proprietary and other action was essential and that the matter should be names, chemical formulae, and definitions of given priority consideration. Some means would new drugs released or approved and of the have to be found to prevent and limit adverse effects dissemination to Member States of this infor- of drugs.If it were possible, in accordance with the mation ; request formulated in operative paragraph 4 (c), to arriveatbasicprinciplesandrequirements,the (c)to continue the study of the possibility of insecurity and frustration at present felt by many formulating,andofseekinginternational would be greatly lessened. acceptance of, basic principles and requirements applicable to the toxicological, pharmacological, Professor BABUDIERI (Italy) expressed his country's and clinical evaluation of drugs; great interest in the establishment of minimum basic (d)to pursue action in the matter and report requirements fordrugs. Naturally, that was an to the Executive Board and to the Seventeenth inherently long -term task which called for expert World Health Assembly. research. On the other hand, the function of collecting information could be undertaken and yield results She recalled the initiative taken by the Swedish rapidly. The factor of safety of drugs was even more delegation at the Fifteenth World Health Assembly important than that of efficacy, and if a satisfactory which had led to the adoption of resolution WHA15.41. procedure were evolved for collection and dissemi- The chief of the Swedish delegation had unfortunately been obliged to leave Geneva and was therefore nation of information, it should be possible to sound indubious cases where certain unable to introduce the present draft resolution. speedy warnings It would be superfluous to refer again to the tragic possible side -effects, for instance, had been noted. situation that had resulted in 1961 and 1962 from the It would be desirable, in evolving that procedure, if use of the drug thalidomide.It had been a grave each government could designate aspecific body, shock to all those responsible for the distribution of either a national department of public health or a drugs in their own countries -a shock from which ministry, to which any untoward developments could no -one had fully recovered.It was for that reason be reported.If the national authority responsible 296 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II considered those developments significant, they would the Director -General's report, as well as the draft report in their turn to WHO headquarters, which resolution just submitted. would then disseminate the information to its Member Following the suggestion made by the Scientific States. He realized that the appropriate services Group on the Evaluation of the Safety and Efficacy would have to be organized within WHO for that of Drugs that methodology should be improved, he activity, but he was confident that the Director - would propose an amendment to the draft resolution General would be able to overcome any possible to include a penultimate sub -paragraph in its fourth difficulties. WHO should not in that connexion operative paragraph reading as follows : undertake any critical analysis of the information "(d)to promote statistical research in suitable reported nor assume any liability for it, but should areas on the frequency of major and minor foetal merely transmit the information, leaving the respon- abnormalities which could be connected with the sibility for any future action to the governments consumption of certain drugs." concerned. His delegation supported the recommendations in The meeting rose at 12.35 p.
FIFTEENTH MEETING
Tuesday, 21 May 1963, at 2.30 p.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1. Clinical and Pharmacological Evaluation of Drugs WHO collecting from and disseminating to (continued) Member States Agenda, 2.8 (i)the non -proprietary and other names, The CHAIRMAN invited the Committee to continue chemical formulae and definitions of new consideration of the item. drugs released or approved; (ii)the information contained in 3 (b). Dr MURRAY (United Kingdom of Great Britain and Northern Ireland) introduced the amendments It was in the interest of all countries that new drugs proposed by the delegations of Australia, Belgium, should be taken into use only after careful testing of Canada, the Federal Republic of Germany, France, their safety and effectiveness, and that the adverse the United Kingdom, the United States of America effects of such drugs not hitherto known should be and the Union of Soviet Socialist Republics to the reported promptly, in order that any risks attached to draft resolution which had been presented at the pre- their use might be known to actual and potential vious meeting by the delegate of Denmark on behalf of users.Operative paragraphs 1, 2 and 4 (a) of the her own and five other delegations (see page 294). original draft resolution were designed to ensure that It was proposed to replace operative paragraph 3 by a decision reached in any country to the effect that the following : adverse reactions produced by a drug called for 3.(a)RECOGNIZES the importance of accurate restriction or prohibition of its use should be com- appraisal, at the national level, of the toxic effects municated at once to other countries; WHO was the of drugs; and appropriate agency to undertake the dissemination (b)INVITES Member States to arrange for a of such information. In those paragraphs, the timing systematic collection of information on serious and nature of the action required was defined and his adverse drug reactions observed during the delegation supported their provisions fully. development of a drug and, in particular, after Operative paragraph 3 of the draft resolution gave its release for general use; encouragement to Member States to set up national reporting systems, but at the same time implied that and operative paragraph 4 (b) by the following : every report of an adverse reaction, whether or not 4.(b)to study the value and feasibility, including substantiated, should be communicated to WHO. the administrative and financial implications, of That latter provision would have three effects that his COMMITTEE ON PROGRAMME AND BUDGET :FIFTEENTH MEETING 297 delegation considered would be seriously damaging to that action should be, especially in case of doubt.It the object in mind :first, individual reports needed was obviously neither practical nor scientific to act to be examined and related both to the circumstances on suspicion alone and for that reason the amendment of the case and to the authority and experience of the to operative paragraph 3 had been proposed.It observer, otherwise no true appraisal of the evidence contained two provisions, the first recognizing the could be made. Accordingly his delegation considered importance of accurate appraisal, at the national level, that the appraisal must always be made at the national of the toxic effects of drugs; and the second repeating level.Secondly, the variety and number of individual exactly operative paragraph 3 of the original draft reports would almost certainly be so great that an resolution save for the deletion of the final phrase on excessive burden would be placed on the Secretariat transmitting such information to WHO. The content and the panel of experts. Thirdly, the individual phy- of the additional paragraph proposed by the delegate sician might be deterred from communicating early of Italy would be covered by that wording, since suspicion of an adverse reaction by the fact that his statistical data on foetal abnormalities would auto- report would be immediately transmitted to WHO. matically be included. The United Kingdom delegation supported the The additional provision, relating to the value of invitation to Member States toset up reporting WHO's collecting and disseminating information on authorities but considered it premature to send in all drugs, introduced by the amendment to operative reports without proper national evaluation before- paragraph 4(b), was based on the need to ensure hand. Hence its sponsorship of the proposed amend- that countries lacking adequate drug control services ment to operative paragraph 3, which would provide would not automatically authorize the use of a drug a safeguard on that score. authorized by a country where such services were The proposed amendment tooperativepara- well developed, since past experience had shown that graph 4 (b) would give the Director -General the dangerous mistakes could not automatically be ruled opportunity of studying national reporting systems out. and of keeping under review the practicability of He appealed to the sponsors of the draft resolution using national systems in the future as a source of to accept the amendments and asked the delegate of information.It would seem reasonable, too, to ask Italy to withdraw the amendment he had proposed. that the value and feasibility, including the administra- The draft resolution as amended should meet all views tive and financial implications, of such a large new and hence command general support. undertaking should be studied before WHO decided to assume responsibility for it.His delegation there- Professor WIDY- WIRSKI (Poland), referring to the fore supported the proposed amendment as being need for uniform procedures for the evaluation of more practical and more likely to lead quickly to drugs, said that it was necessary to settle first the successful arrangements.It would also support the criteria for determining that a drug was effective and amendment proposed by the Italian delegation at not harmful, and therefore suitable for clinical trials, the end of the fourteenth meeting. (the requirements to be met and the test methods varying according to the different groups of drugs); Dr CAYLA (France) said he was sure all members and secondly the criteria for the clinical trials and of the Committee appreciated the importance of the for the results to be obtained before a drug could question under study. Having taken part in the work be put into general circulation. In Poland the pharma- of drafting the original draft resolution, he was bound cological evaluation of new drugs was carried out by to give it his general support. On the other hand, the the Warsaw Pharmaceutical Institute, with the help amendments which his delegation and others were of bodies working under its supervision.The scope submitting made provision for slight changes, whose of the investigation to be undertaken was laid down import had been admirably explained by the previous for different groups of drugs and it generally included speaker. experimental use in animals.If satisfactory results The initial stress in the draft resolution had been were obtained in the pharmacological evaluation, placed on the need for prompt action to disseminate the new drug was subjected to clinical testing, and the information on toxic effects of drugs -a matter on results obtained were subsequently analysed by a whichtherewas obviousgeneralagreement. special committee of the . Pharmaceutical Institute. Operative paragraph 2 was also unexceptionable in The Minister of Health's decision on its possible that it was designed to sound an immediate warning distribution was based on the recommendation of that wherever there was danger or risk of danger to public committee. health. The existence of such a danger or risk called In connexion with exchange of information, he was for immediate action.The point at issue was what of the opinion that the term " new drug " should be 298 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II discarded;informationshouldrelatepurelyto be taken on mere suspicion by individual physicians; chemical and biological preparations that had not yet appraisal at the national level was indispensable. been used for medical purposes,sinceotherwise Member Statestherefore had another important WHO would be submerged by a mass of data. Inform- task to perform, namely, to develop machinery for ation on drugs whose sale had been prohibited or such appraisal. Two methods had been tried out in limited should be supplied only where the decision Israel : first, hospitals of high standing had been asked was based on the observance of serious adverse to investigate the side -effects of drugs; and secondly reactions. a system had been instituted somewhat similar to that There were three kinds of adverse reactions to be described by the delegate of Italy.In its work on the considered :(1) acute toxicity, which normally would problem, WHO should also cover groups of drugs be observed at the pharmacological evaluation stage; that were known to produce side -effects, such as (2) toxic or harmful effects, after prolonged use, on barbiturates and tranquillizers. the different organs or in pregnancy, and (3) addiction He supported the draft resolution with the amend- arising from the use of,for instance, such inter- ments proposed. nationally controlled drugs as the barbiturates or certain tranquillizers. A further distinction must be Professor 2DANOV (UnionofSovietSocialist drawn between side -effects proper and those due to Republics) remarked that the great increase in recent impurities inthe drug; obviously, the latter case years in the production and wide use of new drugs would not require to be reported for purposes of made it increasingly urgent to adopt effective measures exchange of information. for evaluating their therapeutic qualities and possible A control system similar to that of Poland was in toxic side -effects.Effective control required a series force in the German Democratic Republic, and regular of measures, including the laying -down of requirements information was exchanged with that country on for experimental research on the strength and toxicity new drugs produced. of new preparations, requirements for clinical testing, His delegation supported the idea that WHO and lastly, an authoritative decision to release such should undertake the task of collecting and dissemin- preparations for general use, covering conditions of ating information on the lines laid down by the draft sale and so on. The system should cover the whole of resolution, as amended by the proposals which had a country and should be under the responsibility of been introduced at the beginning of the meeting. the State health authorities. In the Soviet Union, the On the other hand, it considered that the Italian Ministry of Health was responsible for those measures amendment went too far. and it had special expert committees, with wide powers, to help in the work. Dr SYMAN (Israel) said there could be no doubt The methods now in use for the purpose had not that there was urgent need for international action been sufficiently perfected :they could not guarantee in evaluation of drugs.There were two main objec- safety and absence of toxic side -effects.There was tives. The first should be to establish minimum therefore need for action to evolve better control requirements and standard evaluation methods, and methods. The problem was one of growing urgency that would be a long -term undertaking which should for many countries and was also acquiring urgency not be pushed on too hastily.The matter required at the international level because of the interchange careful study by experts, and a slow and sure start of drugs among countries.Accordingly, there was would eventually be more effective than pressure for need for organizing international exchange of infor- quick results.The second objective- collection and mation on new drugs. International co- operation on the dissemination of information on serious side- effects- matter might cover the working out of basic require- was a short -term matter that could be started soon. ments for evaluation; arrangements for the systematic The process was a two -way one :the provision of exchange of information on toxic side -effects; and the information to WHO by Member States, and the organizing of a system for the rapid dissemination of general dissemination by WHO of the data supplied. information on drugs having those side -effects. ObviouslytheDirector- Generalcould not com- Those and similar questions had been discussed by municate information that he had not received, and the Fifteenth World Health Assembly and by the particular efforts were calledfor on the part of Executive Board at its thirty -first session, and had also Member States to notify the Organization immediately been studied by the scientific group convened in March of adverse reactions observed and, inparticular, 1963 by the Director -General. The scientific group had of government decisions to prohibit the use of a drug. recognized the urgency of the matter and had taken the The collection of information within a country was view that there was a scientific basis for undertaking a complicated matter. He agreed that action could not international work to improve the present state of COMMITTEE ON PROGRAMME AND BUDGET :FIFTEENTH MEETING 299 affairs.It had further recommended to the Director - Dr FELKAI (Hungary) said that, since Hungary General a number of measures to put into effect the had a well -developed pharmaceutical industry, the decisions made by the Fifteenth Health Assembly and Hungarian Government gave great attention to the the Executive Board.He would not take up the control of drugs and serobacteriological preparation. Committee's time by going into those recommenda- The Ministry of Health was responsible for control of tions in detail, but would merely express the hope that, the manufacture, supply and sale of pharmaceutical after the present consideration of the matter, WHO products. Standardized methods fordescribing, would proceed to work out a specific programme along preparing and controlling medicines were laid down in the lines proposed by the scientific group. The draft the Fifth Hungarian Pharmacopoeia.The National resolutionand amendmentstheretobeforethe Public Health Institute was the central organ author- Committee represented the first attempt at drawing up ized to control manufacture and sale of medicines.It such a programme. Accordingly, his delegation would was responsible,interalia, for directing the work of the support them, while at the same time making it plain industrial quality -control laboratories and for control that it regarded the measures advocated as a first step of pharmaceutical production at all stages. It also laid only in tackling the problem. down the test requirements for quality control of drugs and insisted on preliminary approval before medicines Dr SAUTER (Switzerland)saidthattheSwiss were put on sale, with a view to safeguarding public delegation could endorse the principles underlying the health. draft resolution proposed by the six delegations and the He went on to describe the different steps whereby amendments proposed thereto.It could give un- control was exercised, including pharmacological and reservedsupporttotheprovisioninoperative toxicological testing, followed by clinical testing in paragraph 1.However, it would not be easy, in hospitals. The Scientific Health Council was in particular for those countries where legislation on charge of clinical testing and was responsible for drugs did not fall or only partlyfell within the evaluating the reports sent in by hospitals and for competence of the central authorities, to give effect to determining the utilization of individual preparations. the provision in operative paragraph 2.As the pro- The decision of the Ministry of Health whether or not vision in question took the form of an invitation to to authorize manufacture of a preparation was based Member States rather than a formal commitment, on the recommendation of that body. Member States could, however, accept it in principle He went on to give further details of the measures in even though aware that they might require to ins- force for ensuring that drugs placed on sale were up to titute arrangements to put it into effect. standard and free of risk to public health. The term " limit the availability" of a drug, as used Dr NAYAR (India) said that her delegation would in operative paragraph 2 (a)(i) might give rise to welcome any proposals designed to improve the difficultiesof interpretation;itmight mean, for quality of drugs.It would accordingly support the example, requiring a drug to be made available only by draft resolution as well as the amendments thereto. doctor's prescription, or placing a restriction on the She drew attention to a point not covered in the uses to which it might be put, and so on. With regard draft resolution, namely, the need for ensuring that to operative paragraph 2 (a) (ii), it should be noted drugs exported for sale abroad were of proper quality. that no manufacturer would be likely to ask that a new She had been reliably informed that in a number of drug be approved where serious toxic effects had countries no means existed for preventing the export already been observed. In so far as operative paragraph of drugs whose domestic sale was not permitted. She 3 was concerned, he stated that Switzerland saw no therefore proposed the following draft resolution, possibility at the moment of being able to arrange for covering that point, for the Committee's consideration : the systematic collection of information on serious The Sixteenth World Health Assembly adverse reactions observed during the development of a drug. The responsible authorities were not informed 1. INVITES Member States to take steps to arrange of all tests undertaken during the development of a that drugs which are produced in their countries are drug, and he thought that other countries were in the tested and certified by the drug -controlling author- ity before permission is granted to export or place same position. these drugs in international trade; and His remarks were designed purely to make plain the REQUESTS the Director - General to bring this practical position of his country in regard to putting 2. resolution to the attention of Member States. the draft resolution into effect if it were adopted. His delegation was in a position to support the draft Dr DOUBEK (Czechoslovakia) said it was essential resolution as it stood. in the interests of humanity that the Members of 300 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
WHO should help to ensure safer and more effective The CHAIRMAN said that the Indian proposal would medical use of drugs. WHO had a very important be circulated as a separate draft resolution and would part to play, in promoting and in ensuring scientific and be dealt with later in the meeting. organizational co- ordination. Procedures for drug control differed in different countries, and WHO must Dr DANNER (Federal Republic of Germany) express- be the intermediary to ensure that experience acquired ed great appreciation of WHO's work on drug in countries which had worked on the subject was evaluation. The problem was one that had to be faced transmitted to other countries. by most countries, and action by WHO was therefore In countries like Czechoslovakia, where medical aid, most important. Hiscountry was particularly including drugs, was provided free for all workers and interested in the exchange of information on the for children up to the age of fifteen, the State medical adverse effects of drugs and would co- operate fully in servicewasvitallyconcernedthatmedicalaid WHO's activities. should be of the highest quality; and in countries where He supported the draft resolution with the proposed medical aid was still a matter of private enterprise amendments. it was taken for granted that there should be a guaran- Dr APPEL (United States of America) supported the tee that the drugs prescribed to patients were of the draft resolution with the proposed amendments. He highest quality, effective, and safe to use.It was was glad to see that the draft resolution placed matters therefore essential that in each country the public in the right order of importance, by focusing attention health organs should ensure that those guarantees first on the urgent problem of the exchange of informa- existed. For ethical reasons, it was essential that tion (operative paragraph 2). With regard to operative experimental data collected before clinical testing paragraph 3, the transmittal of information should should always be carefully checked by competent be carefully studied in relation to its value and the authorities before the clinical tests were carried out. In administrative and financial implications, as suggested Czechoslovakia there was a Medical Research Council in paragraph 4 (b) (ii) of the amendment. With regard for which appropriate projects were prepared by a to the suggestion in section 2.4 of the Director - pharmacological commission;clinicaltesting was General's report 1 that WHO might organize a more therefore authorized by a body comprising the most comprehensive service of information on adverse drug highly qualified medical specialists in the country. For reactions, he agreed with the Danish and other a number of years in his country there had been a delegates who thought that the primary responsibility scientific approach to the testing of new drugs in for evaluating safety should rest with national health controlled therapeutic trials; thus it was possible not administrations, and therefore welcomed the reference only to ascertain speedily the therapeutic value of new to the subject in paragraph 3 (a) of the amendment to drugs as compared with existing drugs and methods of the draft resolution. He also agreed with paragraph 4 treatment, but also to discover the more important (b) (i) of the amendment, which provided that the side -effects of the drug tested. He looked forward to Director- General should study the value and feasi- the possibility of WHO becoming a centre for inform- bility of WHO collecting from and disseminating to ing Member countries of serious cases of adverse Member. States the information referred to, since it reactions produced by new drugs, which would might be very costly for the Organization. prevent the recurrence of the recent tragic events The delegate of Italy had made a useful proposal, associated with certaindrugs. International co- which he would support if it implied that WHO should operation would make for speedier study of the new promote, but not undertake or finance, the research drugs. In his opinion more attention should be paid to in question. pharmacotherapy both in medical faculties and in post -graduate training. Dr LE CUU TRUONG (Republic of Viet Nam) fully Finally, WHO could perform a very valuable service supported the proposals for WHO action on the if it could help to put an end to irresponsible advertising clinical and pharmacological evaluation of pharma- and to secure an agreement that all special drugs should ceutical preparations. be labelled with the non -propriety name or with their The point he wished to comment on had already chemical composition -a practice followed widely in been referred to by the delegates of France and India. the Czechoslovak pharmaceutical industry. It was difficult for countries which imported most of His Government would support any action by their pharmaceutical products to know whether they WHO to improve international co- operation. He had been approved by the producing country, because therefore supported both the draft resolution with the they were normally exported by the manufacturer; and amendments proposed and the proposal made by the Indian delegate. 1 Off Rec. Wld Hlth Org. 127, 167. COMMITTEE ON PROGRAMME AND BUDGET :FIFTEENTH MEETING 301 it was difficult to test them without adequate labora- Dr HAQUE (Pakistan)pointedoutthattoilet toryfacilities. Moreover,thefactthatthe preparations apparently did not come within the manufacturer mightstatethattheproduct was definition of the term "drug ", although many of them guaranteed was no assurance that it was guaranteed by were detrimental to health. Something should be done the government of the producing country.Another to remedy the situation, as had already been done under problem was that there might be conflicting informa- the Drugs Act in Pakistan. tion : WHO might transmit reports received from a With regard to the point raised by the delegate of country that a certain drug had adverse side -effects, India it was surely for the national authorities to stop whereas the manufacturer might have stated that the undesirable imports.In Pakistan products could not product was safe. He suggested therefore, that, when be imported without a certificate from the exporter that transmitting information, WHO should also give the they had been passed by the national authorities. opinion of a firm or body which could guarantee that There were, however, no means of testing indigenous the product was satisfactory.There could also be medical remedies -herbal ones for example -which confusion over the toxic effects of particular drugs, were imported and exported in considerable quantities. since opinions might vary in different countries.It would be useful, therefore, if WHO could draw up a Dr JONASSEN (Norway) said he could not accept any comprehensive list of drugs for the countries that did amendment that would weaken the safeguards in the not possess laboratories of research and testing centres. draft resolution of which he was one of the sponsors. Dr FIGUEROA (Venezuela) supportedthedraft He therefore opposed the amendments which had resolution on the clinical and pharmacological evalua- been proposed at the beginning of the meeting. tion of drugs.His country was greatly concerned with the supervision and control of pharmaceutical Dr AMMUNDSEN (Denmark) thanked the delegates products, and a department for the registration of for the interest they had shown in the draft resolution pharmaceutical products had been set up under the proposed by her own and other delegations, and Ministry of Health and Social Welfare, which was particularly those who had supported it.With regard responsible for the authorization of new products, to the amendments proposed by the eight delegations the review of those registered, the control of those and which had been introduced at the beginning of the already on the market, and all other matters concerning meeting, the differences of opinion in the discussion pharmaceutical products.For the authorization or had probably been due to the difference in size of rejection of a new product the procedure included countries. In Denmark, for example, there was no need legal, pharmacological and microbiological reports for special arrangements for notifying side -effects of and technical evaluation by a group of pharmaco- drugs for they were automatically notified and pub- lished in the scientific papers. logicalspecialists. Theauthorizationindicated That was why it was whether a product could be sold freely or only on proposed in the draft resolution that evaluation should medical prescription. be carried out in the countries and not left entirely to WHO. Seeing, however, that that would not be Dr BOYE- JOHNSON (Sierra Leone) strongly endorsed practicable in all countries, and that it would be the statement of the delegate of India. Many govern- better for the procedure to be carried out in two stages ments were probably unaware of what happened to instead of one, she would accept the proposed amend- drugs after they were exported, and it was essential ments to the draft resolution. She could not, however, for the developing countries to keep a careful watch accept the amendment proposed by the delegate of on imported drugs.Many drugs had inscriptions Italy for the reasons given by the delegate of the describing them as remedies for various diseases or United States. attributing certain qualities, but without any indication ShethankedtheDirector -Generalandthe of what they contained.In countries with many Secretariat for their excellent work and hoped that uneducated people it was often thought that the countries would be successfully helped in the very greater the quantity of drugs taken, the quicker the serious problem under consideration. cure : drugs with toxic ingredients such as strychnine had been known to cause death.The authorities of Dr TCHOUNGUI (Cameroon) supported the views Sierra Leone did their best, but were often at a loss of the delegate of India and stressed the importance of in dealing with exporters.It was difficult to under- investigating the therapeutic effects of drugs when stand how dubious and often worthless drugs could be evaluating their toxicity. Many drugs were exported sent to the under -developed countries by the developed to the developing countries and often, though not countries without proper supervision. The developing harmful, were not curative. In many cases, they made countries therefore welcomed the draft resolution. false claims to cure cancer and other diseases.He 302 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II hoped that WHO would consider how the export of major, and only by a complete and rational study drugs without therapeutic value could be prohibited. could the causes be established. Dr MONTALVÁN (Ecuador) said he was glad the Professor PESONEN (Finland) said that as one of the subject was being discussed, because it was important sponsors of the draft resolution he would accept the for all countries, and especially for those which were amendments proposed by the eight delegations but not in a position to exercise effective control. Until not that proposed by the delegate of Italy. recently it had been thought that only general control was necessary in certain kinds of clinical testing, but Professor MUNTENDAM (Netherlands) agreed with the experience with thalidomide had shown that the delegate of Denmark in supporting the amend- ments proposed by the eight delegations. He could not, something more than traditional control was necessary, particularly in the form of international co- operation however, support the amendment proposed by the and full exchange of information. delegate of Italy because it would interfere with There was a need to increase the exchange of research on foetal abnormalities, which could be information for the benefit of all countries, and he caused by many other things besides drugs. supported the proposal of the delegate of India. The draft resolution proposed by the delegate of India would need careful study. Dr IBRAHIM (Somalia) agreed with the comments of the delegates of Cameroon and Sierra Leone and Dr PHILLIPS (Australia) supported the draft resolu- pointedoutthatsomecountriesevensupplied tion and the amendments proposed by the eight dangerous drugs such as morphia without labelling delegations, but opposed the amendment proposed by them.His own country had experience of importing the delegate of Italy, which would place too great a such unlabelled drugs. burden on WHO and have the effect of restricting research on foetal abnormalities. DrTOTTIE(Sweden)stronglysupportedthe comments of the delegate of Denmark, and accepted DrSIGURDSSON(Iceland)alsosupportedthe the amendments proposed by the eight delegations. amendments proposed by the eight delegations and For the reasons stated by the delegates of France and opposed that proposed by the delegate of Italy. other countries he was unable, however, to accept the Dr DANNER (Federal Republic of Germany), while amendment proposed by the delegate of Italy. not supporting the amendment proposed by the dele- Professor BABUDIERI (Italy) explained the reasons gate of Italy, recognized the importance of statistical for his proposed amendment.It was not, as the research on foetal abnormalities. He hoped, therefore, delegate of. France had suggested, already provided for thatas much information aspossible would be in paragraph 3 of the amendments proposed by the obtained on the frequency of such abnormalities. eight delegations for there was a difference between The CHAIRMANinvitedtheDeputyDirector - selecting individual cases of foetal abnormality and General to comment on the discussion. making a systematic statistical study of the incidence of foetal abnormality in selected communities, such as Dr DOROLLE, Deputy Director -General, said that large maternity hospitals -especially for certain drugs the Committee still had before it the draft resolution such as hormone preparations and compounds which and the amendments proposed by the eight delegations, were difficult to test on laboratory animals. which had been accepted by the sponsors of the original It was not his intention that WHO should undertake draft resolution except for the delegate of Norway. the work, but rather that it should be done by countries The amendments had therefore not been accepted and themselves; but it would be useful if the work could be would have to be put to the vote. co- ordinated by an international agency like WHO. As he had been asked for the Secretariat's opinion, The term "promote" in his amendment was, perhaps, he would say that, with due respect to the delegate of not entirely satisfactory and he would be willing to Norway, from the Secretariat's point of view the replaceit by a more suitable word, for example amendments would promote a more rational and "support" or "co- ordinate ". logical approach to the problem, particularly because If his amendment were adopted, a group of experts they began by inviting Member States to arrange for a could prepare and co- ordinate research in the different systematic collection of information, without asking countries.The statistical information now available for it to be transmitted to WHO, and at the same time in various countries was not of much use, since it asked WHO to study the possibility of obtaining concerned major and not minor abnormalities. For a information from Member States and transmitting to proper evaluation of the effects of a drug at the foetal them the information provided for in paragraph 3(b). stage of life, minor abnormalities were as important as The order was thus much more logical than in the COMMITTEE ON PROGRAMME AND BUDGET :FIFTEENTH MEETING 303 original draft resolution and the method proposed Agreeing to the definition of a "drug" as any would be easier to apply. substance, or mixture of substances, destined for use With regard to the proposal of the delegate of Italy, in the diagnosis, treatment, mitigation or prevention while it would be asking rather a lot of the Organiza- of disease in man, as set out in the report of the tion to expect it to co- ordinate the research in question, Study Group on the Use of Specifications for if it were simply a matter of encouraging such research Pharmaceutical Preparations; as some delegates had suggested, it might be simpler Realizing the technical and administrative diffi- to incorporate the request in the invitation to Member culties of securing regular exchange of information States; he agreed, moreover, with the delegates who on all drugs, considered that the subject would fall under the category of information on the adverse effects of drugs 1. REAFFIRMS the need for early action in regard to that Member governments were being invited to collect. rapid dissemination of information on adverse drug He assured the Committee that, whatever it decided, reactions; the Director -General would do hisbestto carry 2. REQUESTS Member States out the instructions given him.He reminded the Committee that well before the tragic events resulting (a)to communicate immediately to WHO from the teratogenic effects of a certain drug, and well (i) any decision to prohibit or limit the before the Fifteenth World Health Assembly, the availability of a drug already in use, Secretariat had embarked on the subject and the (ii) any decision to refuse the approval of Advisory Committee on Medical Research had already a new drug, consideredit. The Director -General was deeply (iii)any approval for general use of a new concerned in the matter and anxious to carry out drug when accompanied by restrictive pro- whatever instructions he received. visions, The CHAIRMAN invited the Committee to vote on the if these decisions are taken as a result of serious amendment proposed by the delegate of Italy to the adverse reactions; and draftresolutionproposed bythedelegationof (b)to include in this communication as far as Denmark and five other delegations. possible the reasons for the action taken and Decision:The amendment was rejected by 48 the non -proprietary and other names, and the votes to 2, with 19 abstentions. chemical formula or the definition; The CHAIRMAN invited the Committee to vote on the 3.(a)RECOGNIZEStheimportanceof accurate amendments proposed by Australia, Belgium, Canada, appraisal,at the nationallevel,of the toxic the Federal Republic of Germany, France, the United effects of drugs ; and Kingdom, the United States of America and the (b)INVITES Member States to arrange for a Union of Soviet Socialist Republics. systematic collection of information on serious Decision: The amendments were adopted by 66 votes adversedrugreactionsobservedduringthe to 1, with 2 abstentions. development of a drug and, in particular, after its release for general use; The CHAIRMAN invited the Committee to vote on the 4. draftresolution proposed by Denmark, Finland, REQUESTS the Director -General Iceland,theNetherlands, Norway andSweden, (a)to transmit immediately to Member States as amended, which read as follows : the information received under paragraph 2; The Sixteenth World Health Assembly, (b)to study the value and feasibility, including theadministrative andfinancialimplications, Having noted the resolution of the Executive of WHO collecting from and disseminating to Board on the clinical and pharmacological evalua- Member States tion of drugs; Having examined the report by the Director - (i) the non -proprietary and other names, chemical formulae anddefinitionsof new General on the clinical and pharmacological evalua- tion of drugs; drugs released or approved, (ii)the information contained in 3(b) above; Considering that international co- operationis essential for the achievement of the best possible (c)to continue the study of the possibility of protection against hazards for man arising out of the formulating,and ofseekinginternational use of drugs; acceptance of, basic principles and requirements 304 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
applicable to the toxicological, pharmacological Dr MURRAY (United Kingdom of Great Britain and and clinical evaluation of drugs; and Northern Ireland) accepted the motivation behind the (d)to pursue action in the matter and report draft resolution, but thought that as now worded it to the Executive Board and to the Seventeenth might present serious difficulties for some countries. World Health Assembly. The reference to a drug -control authority would undoubtedly cause difficulty for those countries whose The draft resolution, as amended, was Decision: administrations did not have such an authority.In approved by 71 votes to none, with 1 abstention.' other countries, there was no formal procedure for the The CHAIRMAN invited the Committee to consider certification or approval of a drug before issue; control the draft resolution proposed by the delegate of India. was enforced by other methods. The DEPUTY DIRECTOR - GENERAL suggested that the The delegate of Pakistan had also pointed out some draft resolution might be made more acceptable of the inherentdifficultiesinvolved.There were to some countries by the insertion of the words many issues in the new question, and he supported "who have not yet done so" in operative paragraph 1, the proposal made by the delegate of Sweden that after "Member States ". the matter be referred to the Executive Board for preliminary study. Dr NAYAR (India) said that that suggestion was acceptable, if there were States which had a control of Professor MUNTENDAM (Netherlands) and exported drugs.But steps would have to be taken Dr DANNER (Federal Republic of Germany) supported with regard to States that did not control exported the proposal made by the delegate of Sweden and drugs in the same way as drugs intended for the home supported by the United Kingdom. market. Dr APPEL (United States of America) was in full Mr BRADY (Ireland) expressed great sympathy with agreement with the delegates of Sweden and the the purpose of the draft resolution submitted by the United Kingdom that the draft resolution be referred delegate of India.However, as it was drafted at to the Executive Board. present, it might present difficulties for some States. For instance, some States might not submit all drugs Dr EL -BORAI (Kuwait) supported the draft resolu- to tests by the drug -control authority, but might tion proposed by the delegate of India, with the exert some other form of control, including com- amendment suggested by the Deputy Director -General. prehensive testing by manufacturers, and perhaps the The CHAIRMAN suggested that further consideration examination of protocols of tests by the drug -control of the item be deferred until the delegates of India, authority (as distinct from the test actually carried out Ireland and Sweden had had an opportunity to by that authority). The draft resolution might receive a formulate the text of a new draft resolution for greater measure of support if operative paragraph 1 submission to the Committee. were amended to read as follows It was so agreed. (For continuation of discussion, 1. INVITES Member States who have not yet done see minutes of the seventeenth meeting, section 1). so to arrange that drugs which are produced in their country are not released for export unless they Professor ZDANOV (UnionofSovietSocialist comply fully with the drug control requirements of Republics) hoped that, when the new draft resolution the country in which the drugs are manufactured. was being drafted, it would be borne in mind that the proposal of the delegate of India aimed essentially at Dr TOTTIE (Sweden) also expressed great sympathy protecting the health of populations of countries that with the draft resolution. However, it did not concern didnotthemselvesmanufacturepharmaceutical the evaluation of drugs, but the standard of drugs, and products and could not exercise any control over the that was quite a new item. Delegates were well aware products imported from abroad. The draft resolution, of the accident that had occurred, but which had noth- therefore, was a very useful one.It was quite possible ing to do with the standard of the drug used.The that the interests of exporting countries might be machinery of international trade was complex; there involved, but the health of mankind must take priority. had not yet been time to study the problem seriously in Sweden, and he hesitated to take a position on the subject. He suggested that the problem in all its 2.Smallpox Eradication Programme aspects should first be considered by the Executive Agenda, 2.4 Board. At the invitation of the CHAIRMAN, Dr KAUL, Assistant Director -General, Secretary, introduced the 1 Transmitted to the Health Assembly in section 3 of the Com- mittee's fifth report and adopted as resolution WHA16.36. reportof theDirector -General on the smallpox COMMITTEE ON PROGRAMME AND BUDGET : FIFTEENTH MEETING 305
eradication pro gramme,1 in which an attempt had been persons constituted a reservoir of infection in over- made to analyse the world incidence of smallpox in crowded parts of the larger cities.Studies were also relation to the endemic areas. The report also referred being made on methods of measuring the level of to the epidemiological and research studies that were protection of populations against smallpox. being supported by WHO. Vaccinationandrevaccinationwithastandard It was hoped that the report would encourage a vaccine of high potency were being carried out on critical approach to the persistence of infection in random samples of population, to determine the endemic areas, reveal gaps in scientific knowledge, and percentage of susceptiblesaccording toage and make it possible to deal with technical problems more interval since last vaccination.Information would effectively. Slow progress in the eradication pro- thus be obtained on the optimum intervalsfor gramme, however, was due not so much to technical revaccination for persons of different ages. problems, which were relatively few, as to administra- Laboratory studies were being developed on the tive, organizational and financial difficulties. levels of antibodies in the blood of vaccinated persons Table I indicated that the number of reported cases affording protection against challenge with highly in 1962 had shown no appreciable decrease : the total potent vaccine.The importance of production of of 73 913 was lower than in 1959 and 1961, but higher stable and highly potent vaccines could not be over- than in 1960.The reduction as compared with the emphasized. Recent studies had shown that only 1961 incidence was 0.7 per cent. in Africa, and 11 per vaccines of the highest potency would give satisfactory cent. in Asia. In the Americas, the general decline in revaccination "take" rates.A vaccine producing a incidence since 1959 had been halted in 1962 by the high percentage of "takes" in primary vaccinations, occurrence of a large number of cases in Brazil, but failing partially or completely in revaccination, not which, as the delegate of Venezuela had mentioned in only doomed a campaign to failure but also gave a the previous meeting of the Committee, had had false sense of security. certain repercussions on the frontier area between the Comparative trials on results obtained by using jet two countries.Table II showed the countries and injectors and multi- pressure technique in vaccination territories in which cases had been reported during were now in progress, and in Liberia such trials were the past three years. In 1962, fifty -seven countries and being developed by a WHO medical officer.The territories had reported cases -thirty -five in Africa, seven in the Americas, eleven in Asia, and four in Organization was also supporting studies on the production andtestingof animal hyperimmune Europe. gamma -globulin with a view to itspossible use in Section 3 of the report referred to world incidence prevention and treatment. in relation to endemicity.Table III showed that eighteen countries and territories had reported more The Organization had supported studies in Madras than 500 cases in 1962, and the rates per 100 000 of the on the infectiousness of smallpox in the early stages of population for those countries indicated that parts of the disease, and on the dissemination of the virus by Africa were as highly endemic as parts of Asia. air.An expert committee on smallpox was to be Table IV, indicating the number of weeks in which convened in 1964, to advise on the epidemiology and cases of smallpox had been reported in 1960, 1961 and prevention of smallpox, to review the research that had 1962 showed that the infection was prevalent almost been carried out, and to evaluate the organization and throughout the year in most countries in Africa and progress of the eradication programme. Asia.Areas of high endemicity as indicated by the Section 5 of the report described the procedure frequency of such reports were shown in the maps 2 adopted by the Organization for testing donated following Table IV, the map for 1962 showing also the vaccines before they were accepted for distribution. countries and territories in which eradication pro- The amounts of vaccine received and distributed were grammes were either planned or in progress. shown in Table V : it would be noted that there would Section 4dealt mainly with technicalaspects. be a shortfall to meet 1963 requirements unless further Epidemiological studies were necessary in order to substantial donations were received in the near future. learn more about the behaviour of the disease in Part II described the progress in the eradication densely populated areas as compared with sparsely programme. Table VI summarized the present state of populated areas,indifferentage -groups, and in programmes in the endemic countries :of forty -four persons in whom immunity had declined.It was also countries and territories where smallpox was endemic, necessarytodiscoverwhetherpartially immune fourteen were now developing eradication programmes or eliminating residual foci, twenty -two had prepared 1 Of Rec. Wld Hlth Org. 127, Annex 16. programmes but had not yet begun to implement them, 2 Not reproduced in the printed version of the report. and eight had not as yet produced plans for eradication. 306 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Section B of Part II gave a summary of progress Inordertoacceleratethe global programme, country by country. concerted and sustained efforts were needed at both The Organization, aware of the danger of infection national and international levels. being reintroduced from endemic countries conducting eradication programmes, was urging neighbouring Professor MUNTENDAM (Netherlands) had been countries, particularly contiguous ones, to co- ordinate. very impressed by the report on the smallpox eradica- and whenever possible synchronize their control and tion programme, and recommended that it be printed eradication programmes.An example was the co- and distributed as widely as possible.It reviewed a ordination of eradication activities in a large area of problem that should be known to all doctors, both West Africa comprising Ghana, Guinea, Ivory Coast, public health doctors and clinicians, in developed as Liberia, Mali, and Upper Volta.At the Fifteenth well as in developing countries.Moreover, it should World Health Assembly it had been reported that help to make doctors more "world- health -minded " - progress in the smallpox eradication programme had an important task to which WHO should pay more been slow, owing mainly to difficulties encountered by attention. the endemic countries in finding sufficient funds for In the introduction to the report, it was deduced, on vehiclesandrefrigerationand otherequipment. the basis of the epidemics of 1951 and 1957 -1958, that Eradication programmes were still being hampered by 1963 and 1964 might be dangerous years.Had the lack of resources. The Fifteenth World Health epidemics of 1951 and 1957 taken place in Asia and Assembly, in its resolution WHA15.53, had invited Africa simultaneously ? voluntary contributionsincash or kind for the The report made recommendations concerning smallpox eradication programme, and in July 1962 the developing countries, but the implementation of those Director - General had accordingly issued a circular recommendations was dependent on assistance pro- letterinviting contributions from Member States. vided by the developed countries. The Organization The following Member States had offered supplies of should use the anxiety felt by the developed countries vaccine :Switzerland, 2 million doses ; Chile, 500 000 at the possible importation of smallpox in order to doses; Italy,100 000 doses; and the Netherlands, urge those governments to support the smallpox 1 million doses. eradication campaign. The Organization continued toassistnational In order to reduce the risk of secondary cases when eradication programmes asfarasitsbudgetary smallpox was imported to non -endemic areas, various resources permitted, but its limited assistance was measures were obviously required -for example, the insufficient to accelerate the eradication programme. vaccination or revaccination of all doctors and nurses The assistance provided by the Organization consisted in hospitals, and of non -medical hospital personnel. of short -term consultants to advise and help national WHO should, however, take advantage of recent administrationsin the production of freeze -dried happenings and analysetheexperienceof such vaccine, and toadvise on theorganization and countries as the United Kingdom, the Federal Republic planningof eradication campaigns and onpilot of Germany, and Sweden, in which outbreaks due to eradication schemes, medical officers to advise and imported cases of smallpox had recently occurred.It assistin the implementation of eradication pro- could then make practical, up -to -date recommenda- grammes,equipmentandsuppliesforvaccine tions for the control of imported smallpox. production, and a limited amount of transport. The use of gamma- globulin for direct contacts, the The situation, as described in the report, could be construction of modern quarantinestations,and summarized as follows : while a few countries in the isolationandsurveillanceproceduresshouldbe endemic areas had completed their programmes and considered, and the individual practitioner should be had not reported cases for three years, the majority made to realize his great responsibility when he saw a were still encountering difficulties, mainly of a financial case where smallpox might be the diagnosis, however nature -transport and other equipment, and supplies, remote the possibility. were the main requirements; substantial amounts of A mass vaccination programme covering at least 80 vaccine were needed in the near future in order to per cent. of a country's population (both children and complete eradication campaigns in progress; WHO adults), as mentioned in the introduction to the report, continued to provide within its budgetary limitations seemed an unattainable goal for countries where the advice and support for studies and investigations on disease was not endemic.The report contained no smallpox (in epidemiology and immunology), and, to a mention of the very important paediatric aspect of limited extent, supplies and equipment for the pro- mass vaccination in developing countries. In practice, duction of freeze -dried vaccine, and transport and it was impossible to apply in endemic areas the contra- refrigeration requirements. indications normally followed in non -endemic areas, COMMITTEE ON PROGRAMME AND BUDGET :FIFTEENTH MEETING 307 but the general health condition of the individual effective vaccine could produce valid results, and closer should be considered, and under -nourished infants consideration should therefore be given to the pro- and pre -schoolchildren should of course not be duction and standardization of smallpox vaccines. included in mass vaccination programmes.It was Those were secondary points, however, since means hoped that WHO would advise countries in endemic for eradicating smallpox existed.Attention must be areas to include, whenever possible, a paediatrician given to the organizational side, and in that respect with vaccination experience in national and local co- ordination between neighbouring countries could vaccination committees. do much to reduce the danger of the disease spreading. Regarding the potency of the vaccine, it was stated in The map included in the report 1 served as a further section 4 of the report that a vaccine might produce a reminder that smallpox was indeed an international high percentage of "takes" in primary vaccination, but health problem, and that its eradication could be might fail in revaccination.It was hoped that WHO achieved only by a combined effort on the part of all would bring that important observation to the atten- countries in the world. tion of all countries. In conclusion, he would make an urgent request He would like to know what kind of local and that priority be given to the global smallpox eradica- general reactions in primary vaccination were produced tion programme. It was, perhaps, the only programme in children and adults by highly potent vaccines that could really be completed, and in the foreseeable giving a high percentage of "takes" in revaccination. future. Mass vaccination programmes -which did not Did those vaccines cause more severe reactions, or requireexorbitantfinancialresources -should be was there a divergence between immunogenicity on started; a clear and detailed eradication programme the one hand and degree of reaction on the other ? should be drawn up by WHO; and unceasing efforts should be made to achieve eradication.The Soviet Professor ZDANOV (UnionofSovietSocialist Union would do all in its power to help towards a Republics) recalled that smallpox was a disease that solution of such an important international health the public health authorities were certainlyin a problem. position to eradicate. During the first half of the last decade certain progress had been made, but later the Dr DA SILVA TRAVASSOS (Portugal) wished to make a disease appeared to remain stationary or, what was few comments on the excellent report before the worse, showed a tendency to spread in countries meeting.The global programme of eradication had where it had previously been eradicated.The report been started soon after the decision of the Eleventh showed that during 1962, 136 imported cases had been World Health Assembly in1958, but the results notifiedin Europe(intheFederal Republic of obtained sofar could not be considered wholly Germany, Poland, the United Kingdom and Switzer- satisfactory. There remained foci in Asia, Africa and land, and others more recently in the Scandinavian South America that were real reservoirs of smallpox countries). As long as endemic areas still existed, the and constituted a danger not only to neighbouring possibility remained that outbreaks would occur in countries but to the whole world.The present swift countries where the disease had been eradicated :in means of transport made the spread of smallpox from 1960, for instance, smallpox cases had been imported those areas very easy. into the Soviet Union from India. The report pointed out the essentials for a sound The problem of imported cases varied according to plan of eradication and the factors that influenced it, the country. There was obviously a problem where the e.g. quality of vaccine, techniques used and assessment population was dense around ports and airports. of results. There were of course epidemiological Smallpox was highly endemic in certain countries factors.But the summary appeared to omit a very during 1960 and 1961, 60 per cent. of all cases of important point :the need in some countries for smallpox had been registred in fifty -nine endemic legislation to introduce compulsory vaccination, so countries); in other countries, the outbreaks were thatsuitable age -groupswould be systematically sporadic; in others the only cases were imported. In vaccinated. spite of the difficulties, where endemicity was high the Another important point that the Committee might authorities should be urged to adopt national eradi- consider was the criterion for deciding when a country cation programmes. was free from smallpox. He referred to the summary, It must be said, however, that WHO was far from given in the second paragraph in Part II of the report, having done everything possible.Research was still of the position in a number of countries since 1958, and needed into new eradication methods. The pro- asked whether a country in which outbreaks were phylaxis at present in use was many years old and could certainly be improved.Moreover only a fully 1 Not reproduced in the printed version. 308 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
solely due to imported cases should be considered free Timor and Macao, no cases of smallpox had been from smallpox. reported for many years. He would be glad to have In Table VI of the report Angola, Mozambique and that information recorded.Finally he thought that, Portuguese Guinea were included among the countries on the map showing the weekly frequency of smallpox that had not yet reported plans for eradication. Yet in in 1962 2, Angola, Mozambique and Portuguese Guinea section B it was said of Angola that "a systematic should be shown as having eradication campaigns in vaccination campaign is carried out annually ", and of progress; the map as it stood was not accurate and Mozambique that a yearly vaccination programme was might be confusing. carried on in which thousands of vaccinations were In conclusion, on behalf of the Portuguese delega- done with a locally produced vaccine.In fact since tion, he congratulated the Chairman on his election and 1955 the number of vaccinations had been between for the able manner in which he was presiding over the 1 200 000 and 1 500 000 every year.In Portuguese Committee's discussions. Guinea also an eradication campaign was in progress. He asked whether Table VI included only those Dr FIGUEROA (Venezuela) recalled that,at the countries that had asked WHO for help with their fourteenth meeting, in the discussion on the report of the Committee on International Quarantine, he had national eradication programmes. If so, he wished to declare that his Government considered its health given some figures relating to smallpox which showed that in his country no cases of smallpox had been servicesadequateand competenttodealwith reported since 1956, except for eleven cases in 1962 in a campaigns against smallpox, which they considered to forest district near the Brazilian frontier. In spite of be normal public health work. To return to Angola, there had not been a single the topographical difficulties of that area, a vigorous case of smallpox in that territory in the four years vaccination campaign had been started and had been extended to the whole country by the local health before 1962, in which year there had been two imported cases followed by a small outbreak in two northern services; since then no further cases had been reported. districts. Up to the end of April 1963, eighteen cases According to the report before the Committee, had been diagnosed. On those facts, he thought that some 90 per cent. of the cases notified in the Americas Angola should be in the same category as Bolivia, had occurred in Brazil : 2759 out of a total of 3029. It Paraguay and Ceylon, referred to in the introduction was encouraging to note that Brazil was now about to to Table VI.' In the four years mentioned, systematic begin a very intensive smallpox eradication campaign. vaccination had been continued.It should also be Inconclusion,hecongratulatedtheDirector - mentioned in Table VI that in Cape Verde, in the General on the excellent report before the Committee. islands of Sao Tomé and Principe, and in Portuguese The meeting rose at 5.55 p.m.
SIXTEENTH MEETING
Wednesday, 22 May 1963, at 10.30 a.m.
Chairman: Dr V. V. OLGUÍN (Argentina)
1. Smallpox Eradication Programme (continued) was endemic were hampered in implementing national campaigns by lack of funds, transport, equipment and Agenda, 2.4 personnel, but there was still a danger of epidemics Dr EL -BORAI (Kuwait) said that the eradication of even in some countries with well organized public smallpox was one of the biggest problems facing the health services.The cause of many local outbreaks world today, but with speedy and concerted action it was the entry into a country of a person incubating the could be solved. As was stated in the report before the disease who spread it to other persons before the Committee 3, most of the countries where the disease health authorities became aware of the situation. Thus, not only was smallpox a terrifying problem in 1 Off. Rec. Wld Hith Org., 127, 202. 9 Not reproduced in the printed version. 3Off Rec. Wld Hlth Org., 127, Annex 16. COMMITTEE ON PROGRAMME AND BUDGET : SIXTEENTH MEETING 309 the countries where it was endemic, but the whole said that since1959 only one case of smallpox, world was exposed to the threat of infection.He imported by ship, had occurred. therefore appealed to the countries most directly His delegation would support the draft resolution concerned to intensify their eradication campaigns, recommended by the Executive Board and inviting and to neighbouring countries to co- ordinate opera- Member States to make voluntary contributions in tions with them.His delegation had welcomed the cash or kind to enable WHO to help requesting resolution adopted the previous year in which the countries meet their deficiencies of transport, equip- Health Assembly had requested UNICEF to give ment and vaccine. assistance to such campaigns. His delegation was aware that WHO was giving Dr WILLIAMS (United States of America) observed close attention to smallpox research, both epidemio- that, as had been pointed out by Dr Kaul and by the Soviet Union delegate, the slow progress made in the logical and virological. The recommendations of the smallpox eradication campaign the previous year had expert committee that was to meet in1964 were eagerly awaited, because an understanding of the been due to financial and administrative, rather than epidemiology of smallpox was a prerequisite for sound technical, difficulties. The smallpox eradication campaign had existed as a planningof eradication programmes. Questions requiring clarification included the choice of a suitable recognized WHO programme since 1951, but it had vaccine for revaccination and the problem of partially differed from the malaria eradication programme in that activities were undertaken mainly at the coun- immune persons in the community. try level with minimal assistance from international Theintroductionofdriedvaccinehad been organizations.Thus, the appropriation proposed by enthusiasticallywelcomed,but experiencehad unfortunately shown thatitdid not always give the Director -General and now approved by the Health Assembly for1964 amounted toonly$ 227 100. satisfactoryresultsunderfieldconditions. His Government was therefore looking forward to the Among the communicable diseases known to man, results of WHO's work on the production of heat - smallpox was one of those whose eradication seemed resistant dried vaccines.Another problem requiring most feasible, despite technical difficulties relating to attention was post -vaccinal encephalitis, of which for effectiveness of vaccines, techniques of vaccination and unknown reasons cases still occurred in some countries. criteria for reading results.It was endemic in only Vaccination with stable vaccine was not merely the three parts of the world : South -East Asia, Africa and most effective, but was the only weapon for the control South America. Eradication campaigns were in of smallpox; his delegation was therefore in favour of operation in South -East Asia, South America and legislationprovidingforcompulsoryvaccination South Africa, leaving most of the African continent throughout the world. In his country, legislation had without any specific action aimed at eradication. The been adopted in 1960 making primary vaccination Pan AmericanSanitaryConference, meetingin compulsory during the first three months of life, with Minneapolis in 1962, had 'set 1967 as the target date for the elimination of smallpox from the western hemi- inspectionofresultsafter one week, vesiculation being considered the only proof of success. If sphere. unsuccessful, vaccination was repeated up to twice at His delegation wished to urge the Director -General monthly intervals,the third unsuccessful attempt to give more attention to the problem in future budgets, entitling the patient to exemption. Exemption could setting aside funds for a stated number of years to also be granted on medical grounds. finance eradication programmes, particularly in the Though immunity was generally supposed to last for three endemic areas of the world. An expenditure of seven to ten years, the International Sanitary Regula- $ 10 million over a few years seemed realistic for tions, to increase the margin of safety, fixed the achieving eradication, but it would not be attained by validity of the vaccination certificate at three years, and waiting for voluntary contributions; provision must be his Government accordingly planned to carry out made in the regular budget. general vaccination at three -year intervals. One such His delegation would support a draft resolution vaccination had been carried out at the end of 1956 calling for synchronized co- operative action by govern- and the beginning of 1957 on the occurrence of ments to achieve the objectives laid down by previous sporadic cases imported from Oman, and a second in HealthAssemblies,withappropriateassistance 1959 to 1960. Unfortunately, the results had not been from WHO. evaluated, but emphasis would be placed on that Dr CHADHA (India) said the Committee was aware aspect next time. of the high incidence of smallpox in his country and Aftergivingfurtherdetailsofthelegislative would understand the anxiety of his Government to provisions in his country regarding vaccination, he liquidate the problem as expeditiously as possible. 310 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Of the 73 913 cases registered throughout the world in His country's experience with regard tohealth 1962, 42 231 had occurred in India.The figure had education might be of interest. It had been found that had been higher in 1961, but the difference was not to inform the population by drum -beat or leaflet a few substantial and the cyclical incidence of the disease, days in advance of the arrival of the vaccinators was with peaks every five to seven years due to the building insufficient. To break the barrier of apathy and up of susceptibility in the population, was recognized. superstition it was essential to begin weeks ahead and In 1958 his Government had appointed an expert impress on the population the benefits they would committee on smallpox and cholera which had derive from vaccination. produced its report in 1959.On the basis of its Guidance in the development of the campaign was findings pilot projects, covering a total population of supplied by an advisory committee at the national twelve million, had been launched in 1960 and 1961 in level, under the chairmanship of the Director -General all states and the Union territory of Delhi.The of Health, which met every few months to examine the vaccine employed had been the liquid lymph type, situation and remedy any defects. except in Orissa, where freeze -dried vaccine donated by the Netherlands had been used. No complications had Dr HAQUE (Pakistan) thought that, as his country occurred except for a mild case of encephalitis in a was one of the endemic smallpox areas of the world, the Committee would wish to know the situation there. child in Orissa. Following the pilot projects, a full -scale eradication East Pakistan, with a population of 50 000 000, had campaign had been launched in October 1962. So far had, until recently, 80 000 deaths a year from smallpox. only 75 000 000 persons, or less than 20 per cent. of With WHO assistance, and the use of freeze -dried the population, had been covered, so no appreciable vaccine donated by the Union of Soviet Socialist impact on the incidence of the disease could yet be Republics, a pilot project had been carried out in 1961 expected, but tangible results were expected by the in two districts with a total population of about following year, when coverage would be greater. 10 000 000. Since then, there had not been a single case Evaluation work had begun in the New Delhi area and in the areas concerned -a very satisfactory result it was expected that conclusions would soon be achieved through thorough preliminary surveys to ensure that nobody was left out. A full -scale eradica- available. Experience in the campaign had drawn attention to tion programme had now been launched throughout certain essentials, the first being a really satisfactory East Pakistan. vaccine. The liquid lymph type used in the past gave To meet the needs of the campaign, a freeze -dried good results when obtained fresh and stored in proper vaccine plant had been established.It was now conditions, but in the field its potency tended to vary, producing 2 000 000 doses a week, which covered national requirements and made it possible to supply affecting the success of operations. Freeze -dried vaccine had proved more reliable, and when used for vaccine to neighbouring countries. revaccinations gave up to 70 or 80 per cent. of success In West Pakistan, where the incidence of the disease compared with only 40 or 50 per cent. with liquid was lower, it was also planned to undertake eradica- vaccine. Freeze -dried vaccine (250 000 000 doses) had tion, but in conjunction with the campaign of BCG vaccination. Pilot projects would first be conducted to been donated by the Union ofSovietSocialist see whether such a combined operation was feasible. Republics. In India they were resorting to three or four The great strictness now exercised by the health insertions for primary vaccination and two or three authorities of Pakistan in issuing vaccination certifi- cates had contributed greatly to an improvement in the for revaccination, instead of only one as recommended in certain countries, the report of the expert committee situation. The incidence of smallpox was now down to having indicated that immunity was proportionate to 1000 to 2000 for the whole country, as against the previous figure of 80 000 for East Pakistan alone. scar area. Staffing and supervision were other important Professor GERIC (Yugoslavia) observed that, in factors. A deputy director -general had been appointed spite of the successes achieved against smallpox by to direct the campaign at the national level, and for WHO and its Member States, outbreaks were still every 3 000 000 persons a provincial unit had been occurring both in countries where the disease was established with a staff of sixty vaccinators and twelve endemic and in countries that had been freed from it. supervisors under the overall direction of a senior While the latter group of countries were naturally, in medical officer. The technique of vaccination was well their own interest, anxious to see smallpox eradicated known and success depended mainly on ensuring that from the world, it was the first group that would all the population was covered; close attention was benefit most directly. Unfortunately, those same therefore paid to enumeration and registration. countries suffered from a great shortage of qualified COMMITTEE ON PROGRAMME AND BUDGET :SIXTEENTH MEETING 311 staff and of money, which was why international Nigeria produced potent and stable freeze -dried agencies, in particular WHO, should do much more to vaccine, which it would supply at nominal cost to any help than they had done hitherto.He fully agreed African country requiring it. with the Soviet Union delegate that, in view of its Afterstressingthe importance of international technical feasibility, smallpox eradication should be co- ordination of eradication campaigns, he said that, given priority.The disease represented at least as while some individuals objected to vaccination on great a problem as malaria, the only difference being religious or other grounds, in the interests of the that its eradication would be easier to achieve.He people as a whole legislation should everywhere be hoped that, in drawing up the proposed programme introduced to make it compulsory. and budget estimates for 1965, the Director -General Mr MARADAS -NADO (Central African Republic) said would take account of the suggestions made during the present discussion and givegreater emphasis to that his country was indicated in Table VI of the report before the Committee as among the countries smallpox programmes. that had an eradication programme ready, whereas in Dr CHANDAVIMOL (Thailand) said that his country factitshould be grouped with those which had had long been preoccupied with the problem of completed eradication campaigns but where residual smallpox control.As it had become a centre of isolated foci were still reported.For the past fifteen communications intheSouth -East Asia area,it yearsmassvaccinationhadbeencontinuously sometimes happened that cases were imported.His carried out in three -year cycles and over 80 per Government was therefore participating in the eradica- cent. of the population had been vaccinated.Since tion campaign, with assistance from international 1954 not a single case, apart from one very doubt- agencies. ful one, had occurred until in 1962 a woman and Cases were still recorded every year, though the her child, who had caught the disease on a visit to the number had declined from 1548 (with 27 deaths) in neighbouring Republic of Chad, started a minor 1959 to 33 in 1960 and 34 in 1961. Up to September epidemic in the north. About fifty secondary cases had 1962 there had been only one case, imported by air. occurredintheirvillageamong non -vaccinated A three -year mass vaccination campaign had been persons, but the outbreak had been rapidly brought started in 1961 with the aim of vaccinating one -third of under control by emergency vaccination.Since then the population each year, but so far only 60 per cent. there had been no further cases in the country. The had been covered; the campaign was therefore being campaign was continuing and over the past three prolonged for two more years. years more than1 300 000 vaccinations had been Thanks to assistance from UNICEF and WHO, performed, for a total population of 1 200 000. a freeze -dried vaccine production plant had been set In conclusion, he suggested that, to promote co- up in 1960. ordinationofcampaigns amongneighbouring countries, WHO should supply dried vaccine of tested Dr OxwU (Nigeria)saidthat the problem of smallpox was world -wide and its solution called for potency to be used according to a standard method. operations on a world scale.His delegation con- Smallpox eradication should receive high priority because, unlike some other programmes, it could be sidered that it had not been tackled vigorously enough, and that if half the effort being spent on malaria successfully achieved in a relatively short time. eradication were devoted to smallpox the disease Dr Dow (Mali) said that his delegation had studied would be wiped out in a very few years. He did not, of the important report submitted by the Director - course, wish to minimize the importance of malaria, General with great interest, since smallpox had con- which was also a deadly menace and must be attacked stituted a problem in his country for more than twenty - with all available weapons. five years. The distribution of smallpox in Nigeria was peculiar; The four -year vaccination programme set up had it was endemic in the Northern Region, part of the decreased morbidity but had not achieved eradication. Western Region, and the Federal territory of Lagos, Over the last five years or so Mali had had a yearly but for some years past it had been almost unknown, average of 1500 cases of smallpox, with epidemics apart from imported cases, in the Eastern Region. every three or four years and a mortality rate ranging That result had been attained by years of constant, from 2 per cent. to 10 per cent. Inview of that daily vaccination, which had covered an estimated 70 persistent endemicity his Government had drawn up, per cent. of the population. If the disease threatened with the help of WHO, a plan of eradication over four anywhere, mobile epidemic units were ready to go into years, a campaign having been started at the end of action, and all auxiliary health workers were qualified 1962 following a thorough country -wide campaign for to perform vaccinations in an emergency. health education of the public in that respect.An 312 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II independent health service had been set up for the resulting in a striking drop in the number of cases in purpose, with an independent budget. The programme 1962. Western Java had been the last area to achieve was progressing favourably. Ten vaccination teams, internal security, and that fact was perhaps related to each with a supervisor, were constantly travelling the outbreaks of smallpox that had taken place in round the country and were being very well received by 1962 in the mountainous areas of Western Java. The the population, 80 per cent. attending for vaccination. authorities were coping with the vaccination of the It was expected that 300 000 persons would have been total population by using teams of vaccinators which vaccinated by the end of June. included medical students and student sanitarians. He called attention to certain difficulties that had Some 2000 students were also being used in Djakarta. arisen due to the size of the country, communication The students had proved most satisfactory. difficulties, the rainy season, and nomadic populations With regard to future action, Indonesia had not as in certain regions. WHO had been requested to extend yet drawn up any eradication plan but was still at the its assistance in that programme by the supply of control stage. A board for the control of communi- transport and of equipment for storage of vaccines. cable diseases had been set up under the chairmanship WHO had also been requested to supply a doctor to of the executive director of the malaria eradication assist in the eradication programme and it was hoped service.It was proposed to integrate the projects for that that medical officer would be recruited very smallpoxeradicationwithmalariaeradication, shortly. particularlyinconnexion with theconsolidation He emphasized the problem facing Mali in connexion andmaintenancephases ofthelatter,with a with adequate control of persons crossing its frontiers, view to making full joint use of facilities such as trans- since the country was in the interior. There could be no port.Proposals in that connexion had not yet been doubt that the only effective way of eradicating discussedwith WHO orwiththe Agencyfor smallpox on the African continent would be to International Development (AID) of theUnited organize simultaneous and co- ordinated programmes States of America and she would invite them to study among neighbouring States. that plan. He expressed his delegation's gratitude to WHO and Provision had also been made for vaccination, to the Government of the USSR for the help they had particularly of new -born infants,to be provided given. through maternal and child health services. Indonesia was planning to use maternal and child health clinics, Dr SUBANDRIO (Indonesia)congratulatedthe of which there would be nearly 4000 assisted by Director -General on the excellent report submitted, UNICEF, as a nucleus for health services, based in the which should prove most valuable, particularly for the first instance on mothers and children. The smallpox countries directly concerned. eradication division was being included in the division Indonesia was a country where smallpox was of epidemiology in her national ministry under one endemic and she gave an account of measures being director.Furthermore, in order to facilitate compul- taken for the control of that disease. soryvaccination,specificlegislationrelatingto She called attention to the number of cases of epidemics had been adopted the previous year. smallpox in Indonesia over the past three years, as shown in Table II of the report. Cases of smallpox had Dr MURRAY (South Africa) said that his delegation dropped from 5196 in 1960 to 3777 in 1961 and to 586 associated itself with the statement made by the in 1962. The problem of smallpox in her country had delegate of the United States of America in connexion been closely linked with the problem of establishing with the financing of smallpox eradication, and would support any resolution recommending that the eradica- internal security.She recalled that there had been no outbreaks of smallpox before 1958, as an excellent tion campaign should be financed by means of the vaccination system had been in force.Since then, regular budget of WHO rather than by voluntary however, because of the armed rebellions that had contributions.That would not only ensure a more taken place in parts of the country, particularly in stable flow of funds but would also make it possible to mountain areas, it had become extremely difficult for achieveco- ordinated programmesforcontiguous vaccination teams to make all the necessary contacts territories, thus leading to the ultimate eradication of with the population. The incidence of smallpox had the disease. thus risen to a peak in 1960, the situation improving Dr.GUNARATNE (Ceylon) complimented the Director - after that as the result of the termination of armed General on his comprehensive report. conflict. A vaccination campaign, with the assistance SmallpoxwasnotendemicinCeylon,but of the army and of many branches of the civil admini- occasionally a few imported cases occurred.As the stration, had been undertaken at the end of 1961, report showed, there had been 34 cases in 1961 and 12 COMMITTEE ON PROGRAMME AND BUDGET: SIXTEENTH MEETING 313 cases in 1962, whereas the country had been free of the which had achieved 80 per cent. participation of the disease for several years previously. He drew attention population, had taken place in 1960 and another to difficulties in establishing a correct diagnosis of the would be undertaken in 1964. The majority of those first cases.Usually, some four to twelve secondary who had not received vaccination in 1960 had been cases were necessary before the first imported case vaccinated in the intervening years.Moreover, all was definitely recognized. infants were vaccinated at the age of two months. Ceylon had a satisfactory programme for primary vaccination but did not undertake revaccination as a Professor PESONEN (Finland) said that the question routine measure.The cases that had occurred were of smallpox eradication was of the utmost importance probably due to reduction of immunity. He therefore to the whole of mankind, as had been pointed out by a requested WHO to make a considered recommendation number of delegations including those of the United regardingdesirableage -groupsforsecondaryor States of America and the USSR. WHO should subsequent vaccination, since the introduction of that intensify its efforts in that sphere. There could be no would be theonly method toprevent sporadic doubt, from the purely financial viewpoint, that the outbreaks. eradication or effective control of smallpox would result in considerable economies on the national plane, Dr KEITA (Guinea) expressed appreciation of the since the need for vaccination would be obviated. Director -General's excellent report.The question of Accordingly, all countries should support the Director - smallpox was of great interest to all African countries, General's efforts in that field. particularly since some had not as yet initiated any Reference had been made to the need for more programme for its control and eradication, although vaccinatorsand vaccines. The valuablereport the disease was endemic on that continent. He providedbytheDirector -Generalshowedthat emphasized the urgency of establishing a co- ordinated generous contributions of vaccines had been received programme so as not to omit any areas which might from a number of countries. WHO should seek to become a source of danger in the future. obtain further contributions of that kind. It seemed to Hecontrastedtheprogressalready .achieved him that the training of vaccinators was a process towards smallpox eradication in Asia and that in which could take place fairly rapidly. Africa. There were fifteen cases of smallpox per 100 000 population in Africa whereas that ratio had Dr AFRIDI, representative of the Executive Board, dropped to seven in Asia. called attention to resolution EB31.R33, in which He drew attention to the number of cases of small- the Board had recommended a resolution for adoption pox which had occurred in Guinea over the past by the World Health Assembly. years, as shown in Table II of the report. The number Dr KAUL, Assistant Director- General, Secretary, had fluctuated from 176 in 1960 to 96 in 1961 and 2948 said that the discussion had been most valuable not in 1962. Those figures were indicative of the fact that only in suggesting means whereby programmes could his country was still not free of epidemics.The be improved, which would be noted and taken into Institut Pasteur in Kindia was being adapted for the account in planning future WHO assistance, but also in production of freeze -dried vaccine.In that respect, showing the progress that had been made in eradica- assistancehad beenrequested from WHO and tion. In reply to those delegations that had requested UNICEF in the form of laboratory and refrigeration that the report be published and circulated, he said equipment and transport. It was anticipated that that that the Director -General would investigate whether production centre would be able to supply twenty resources would permit its publication in the Official million doses, which would meet the needs of neigh- Record of the Sixteenth World Health Assembly or if bouring countries as well as those of his own.He an alternative means of publication could be found. stressed the desirability of further studies on the levels To those delegations that questioned whether WHO of antibodies which gave total immunity. Thus had made sufficienteffortsto stimulate smallpox campaigns could be restricted to those sections of the eradication, he said that the Organization was giving population susceptibletothedisease. He also as much encouragement as possible; the reasons for supported the UnitedStates view that smallpox slow progress were mainly to be found at the national eradication activities should be financed under the levelwhereadministrativedifficultiesand grave regular budget in the interests of more effective action. material shortages had to be overcome. He had noted Dr JALLOUL (Lebanon) said that there had not been a the remarks of the delegate of the Soviet Union and singlecase of smallpox in Lebanon since1957. other speakers on the need for assistance from the Legislation provided for compulsory mass vaccination Organization under the regular programmes; advisory every four years.A mass vaccination campaign, serviceswerealreadyavailabletoany Member 314 SIXTEENTH WORLD HEALTH ASSEMBLY, PART H government that requested them; material assistance, Assembly, he said that eradication was considered to the provision of transport, vaccine and other supplies, be completed if no cases of smallpox appeared in a was necessarily limited by the extent of the funds a country within three years after its last vaccination available. In view of this, the voluntary contributions, campaign. in cash or in kind, of Member States, in support of Replying to the delegate of Kuwait, he said that nationalsmallpoxeradicationprogrammeswere freeze -dried vaccine did not deteriorateifit was invaluable; further contributions had been received properly prepared and kept under suitable conditions; recently and it was hoped that it would be possible to there was deterioration in vacuum -dried vaccine; meet all the requirements for vaccine from that source. consequently, it was hoped that all vaccine would now The delegate of the Netherlands had raised the be prepared by the proper method. question of smallpox epidemics. A survey of incidence In answer to the question from the delegate of in recent years was included in the report but it was Pakistan as to whether smallpox and BCG vaccination clear that waves of epidemics occurred approximately programmes could be carried out simultaneously, he at five to seven -year intervals. There had been said that studies so far undertaken suggested no contra- epidemics in Africa in 1950 (41 000 cases) and in 1957 indications.Several delegations had emphasized the (33 000 cases), as compared with an annual average of need for inter -country co- ordination of eradication 20 000 to 25 000 cases;in Asia, there had been programmes; WHO would continue to encourage the epidemicsin1951(400 000 cases) and in1958 establishment of co- ordinated plans such as that in (227 000 cases), as compared with an annual average West Africa, to which reference was made in the last of about 140 000 cases; in the Americas, there had been paragraph of the introduction to the report.The an epidemic in 1950, but the advanced state of the question of the delegate of Ceylon regarding the value programme of eradication had prevented any further and timing of secondary vaccination would come epidemics except for a limited outbreak centred on within the field of work of the Expert Committee on Brazil in 1962. Smallpox, which would undoubtedly make recom- The delegate of the Netherlands had also asked mendations on those points; for the present, it was whether the use of high- potency vaccine entailed a recommended that revaccination should be carried greater risk of serious reactions and complications. out at intervals of five to seven years in countries where From the information available, it was clear that high - smallpox was not endemic, and at intervals of three to potency vaccines suitable for revaccination did not five years in countries where smallpox was endemic. causeseriousreactions when usedforprimary Decision: The draft resolution recommended by the vaccination; it appeared that potency and ability to Executive Boardinresolution EB31.R33 was cause reactions were separate characteristics in the approved.' strains of the virus. In reply to the comment of the delegate of the Soviet Union on the slow progress of eradication 2.Fifth Report of the Comittee programmes, he pointed out that, as could be seen from Dr SENTICI (Morocco), Rapporteur, read out the Table VI of the report, since 1958, five countries had draft fifth report of the Committee. completed eradication programmes and were now free from smallpox; four countries had completed eradica- Sir George GoDBER (United Kingdom of Great tion programmes but reported isolated residual foci; Britain and Northern Ireland), referring to the second ten countries were developing eradication programmes, resolution embodied in the draft fifth report, said that twenty -two countries had such programmes planned although the recommendations of the Committee on and ready and only eight countries in endemic areas International Quarantine had been approved, his had not yet set up plans for eradication. delegation felt very strongly that, should the Expert The delegate of Portugal had made reference to Committee on Smallpox recommend a revision of the certain figures; those had been received by the Secreta- International Certificate of Vaccination or Revac- riat.It should be noted that statistics used by WHO cination against Smallpox, the swift implementation were based on the figures supplied from Member of such a revision was of the greatest importance. States in regular and special reports; if there were He therefore urged the Director -General to time the inaccuracies, the correct figures should be sent to the meeting of the Expert Committee on Smallpox and the Secretariat, which would amend its statistics accord- meeting of the Committee on International Quarantine, ingly. The delegate of Portugal had also asked what which would have to review any recommendation criterion was used to assess whether smallpox had been eradicated in a country. Referring to the report of the 1 Transmitted to the Health Assembly in section 1 of the Com- Director - GeneraltotheFifteenth World Health mittee's sixth report and adopted as resolution WHA16.37. COMMITTEE ON PROGRAMME AND BUDGET : SEVENTEENTH MEETING 315 affecting quarantine regulations, so that any recom- two -thirds majority vote in favour of re- opening the mended amendments to the International Sanitary debate on the subject of the resolution. Regulations could be submitted for consideration by the Seventeenth World Health Assembly. Professor ZDANOV (UnionofSovietSocialist Republics) said that it was not necessary to take a vote; Dr WILBAR (United States of America) supported he would be satisfied if his intervention was recorded the remarks of the delegate of the United Kingdom in the minutes. and strongly endorsed his request. The CHAIRMAN thanked the delegate of the Soviet The DIRECTOR- GENERAL assured the delegates of Union and assured him that his proposal would be the United Kingdom and the United States of America duly recorded. that the concern which they had expressed would Decision: The fifth report of the Committee was be borne in mind in arranging the timing of meetings; adopted (see page 409). the meeting of the Expert Committee on Smallpox was scheduled for January 1964 but he would try to advance the date, if possible. 3.Announcement of the Death of Dr S. Syman The CHAIRMAN said that it was with great regret Professor ZDANOV (UnionofSovietSocialist Republics) suggested that a third operative paragraph that he had to inform the Committee of the death of might be added to the second resolution in the draft Dr S. Syman, delegate of Israel, which had occurred fifth report of the Committee, requesting the Director - earlier that morning. Dr Syman had represented his General to transmit the comments made in the course country at meetings of the Committee and had been of the discussions to the Committee on International a personal friend of many of the delegates; he therefore Quarantine, which should be convened as soon as proposed that the Committee should observe one minute's silence as a mark of respect for their colleague possible. and fellow delegate. The CHAIRMAN said that, under Rule 68 of the The Committee stood in silence for one minute. Rules of Procedure, the reconsideration of a resolution which had already been approved would require a The meeting rose at 12.30 p.m.
SEVENTEENTH MEETING
Wednesday, 22 May 1963, at 2.30 p.m.
Chairman: Dr S. P. TCHOUNGUI (Cameroon) Later: Dr V. V. OLGUiN (Argentina)
1. Clinical and Pharmacological Evaluation of Drugs producing country comply with the drug control (continued from fifteenth meeting, section 1) requirements which apply in that country; and Agenda, 2.8 2.REQUESTS the Executive Board to report thereon to the Seventeenth World Health Assembly. The CHAIRMAN said that the Committee had before it the text of a draft resolution proposed by the Dr CHADHA (India) said that the text before the delegations of India, Ireland and Sweden.It read as Committee - the result of joint consultation between follows : the delegates of India, Ireland and Sweden - was acceptable to the Indian delegation. The Sixteenth World Health Assembly, Recognizing the urgent need of securing a high Dr TOTTIE (Sweden) had great pleasure in sponsoring standard of drugs for human use in all countries, the proposed draft resolution. 1. REQUESTS the Executive Board to examine ways Dr SUBANDRIO (Indonesia) thought that the text was and means of ensuring that drugs exported from a not quite clear.If a new drug were produced in a 316 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II country where no drug control requirements existed, sometemporarycontrol ;subsequently,another should that country be allowed to export it ? country, satisfied with its own experience with that same drug, might be deprived of the opportunity of Dr DOROLLE, Deputy Director -General, said that using it.Whilst it was true that a country wishing to the delegate of Ireland, who unfortunately was unable import the drug should be fully aware of any restric- to attend the present meeting, had explained to him tion placed upon it in the exporting country (and that the intent of the draft resolution, which recalled the had been the intention of the resolution passed by the text suggested by the delegate of Ireland at the fifteenth Committee the previous day), it should not necessarily meeting (see page 304). be governed by those restrictions.In that way, the The intention was that when a country exported decision regarding the control of the use of any drugs it should treat them in exactly the same way particular drug might be placed entirely in the hands as it treated drugs for home consumption.If it was of another country.In other words, the draft reso- a question of drugs for which no control was demanded lution might prove to be unduly restrictive. He was for home consumption, they could be exported without not quite clear whether that had been the intention of any special control. On the other hand, if any control the proposers of the draft resolution, but he thought was applied to those drugs,the exported drugs that they were concerned only with quality control. should comply with requirements for home con- sumption, if any. Dr EL -BORAI (Kuwait) said that the delegate of Dr NAYAR (India) confirmed that the idea behind Indonesia had already made the remarks he had the draft resolution was that States should apply intended to make. the same yardstick for drugs for export as for drugs Dr NAYAR (India), with reference to the remarks intended for home consumption, and that they should made by the delegate of the United Kingdom, explained not export drugs deemed unfit for the home market. that the idea behind the draft resolution was that Normallyspeaking,acountryproducingdrugs there were countries producing drugs considered would have machinery for some kind of testing and unfit for hóme use, and yet those drugs were exported for establishing standards.But if a country did not to other countries.It was all very well to say that have such standards, it could not be expected to importing countries should exercise discretion, but apply special standards for drugs intended for export. there were a number of developing countries that Dr SUBANDRIO (Indonesia), in order to make the might not have allthe necessary machinery for resolution clearer, proposed that the words " for quality control.Whilst the importing country needed domestic use " should be inserted after " in that to protect its own people, the exporting country shouldalsoobservecertainbasicethicalrules, country " inoperative paragraph 1 of the draft resolution. exporting only those drugs that it considered safe. For example, there might be some stocks of thali- The CHAIRMANaskedwhethertheproposed domide which, though considered unfit for home amendment was acceptable to the delegates of Sweden consumption, might be exported. and India. The draft resolution seemed to reflect the general feeling of the Health Assembly, and she had hoped Dr NAYAR (India) had no objection to the insertion that the proposed text, referring the whole subject to of the phrase proposed by the delegate of Indonesia, although she considered the draft resolution to be the Executive Board, would shorten the discussion. sufficiently clear and not to require any amendment. Professor SoHIER (France) fully understood that coun- Dr TOTTIE (Sweden) also considered that the pro- tries importing drugs and not having the facilities for posed amendment did not make the draft resolution controlling them should seek guarantees. He supported any clearer, but had no objection to accepting it. the resolution insofar as it would further an examination of ways of raising the standard of drugs in general. Sir George GODBER (United Kingdom of Great However, he thought that to refer the subject to the Britain and Northern Ireland) supported the proposed Executive Board would not bring practicál results, amendment, which seemed to be a clarification. at least not in the near future. A resolution passed However, he wondered where things were leading. by the World Health Assembly was not enough to He realized that the draft resolution only requested make countries give an undertaking to export only the Executive Board to study the subject.But it drugs that had been properly controlled.For that seemed that a drug might possibly be made in one governments would have to sign a convention on the country which, owing to a general state of uncertainty subject, and other international organizations would concerning the use of new drugs, might introduce probably be involved. He wondered therefore whether COMMITTEE ON PROGRAMME AND BUDGET :SEVENTEENTH MEETING 317
it might not be better simply to invite States wishing had been presented and that he would not press his to import drugs and not having facilities for controlling amendment. them to make certain, before importing, that the drug was acceptable in the country where it had been Dr TOTTIE (Sweden) fully supported the delegate produced. of India.The draft resolution had been proposed as a compromise on a very difficult subject. He now Professor BABUDIERI (Italy) said that in Italy all felt that documentation was required if the discussion drugs intended for export were subject to the same was to be continued any further. tests as those produced for home consumption. He fully supported the draft resolution, together with the Dr HAQUE (Pakistan) explained that there were a amendment proposed by the delegate of Indonesia, lot of countries in which well -known firms were pro- if that seemed to make it clearer. ducing drugs according to international standards, rather than according to drug control requirements, Sir George GODBER (United Kingdom of Great and were exporting those drugs.It was really for Britain and Northern Ireland) wished to clarify his the importing country to request drugs according to previous remarks.It was quite proper that importing BSP standard, United States Pharmacopoeia standard, countries should have access to information on the etc. A quality control requirement would therefore quality of drugs, and on any restrictions placed upon seem more practical than a drug control requirement. them in the country of origin.But did importing countries really want to hand over to other countries Sir George GODBER (United Kingdom of Great the decision as to what drugs they might or might not Britain and Northern Ireland) supported the sugges- use ? That seemed to be the effect of the proposal. tion made by the delegate of Pakistan, which seemed A country having full testing facilities might wish to to be a solution to the difficulty previously mentioned. use a particular drug in a particular way, but be It left it to the importing country, if it saw fit, to try prevented from obtaining it because the manufacturing out a drug which perhaps could not be used, or which country had placed some restriction upon it.The was restrictedinuse,intheexporting country, essential was that countries without testing facilities provided that the machinery for the dissemination of should have access to information about such tests. information about any such restrictions was operating, in accordance with the resolution already approved Dr AL -WAHBI (Iraq) considered the draft resolution at the fifteenth meeting. a very modest one. Indeed, it could be worded more strongly.He did not want to enter upon a long Professor ZDANOV (Union ofSovietSocialist discussion at that late stage, and hoped that there Republics) had been in full sympathy with the original would be ample time at the next and subsequent proposal made by the delegate of India and the amend- Assemblies fora thorough discussion and more ment proposed by the delegate of Ireland.It seemed, constructive proposals.For the moment, he whole- however, that the real object of the draft resolution heartedly supported the draft resolution. was receding into the distance, and in fact he was not as enthusiastic about the latest version before the Com- Dr HAQUE (Pakistan) was in general agreement with mittee.It seemed that a compromise resolution was the draft resolution, but, in order to make the position called for, on what was a very difficult problem.It quite clear, proposed that operative paragraph 1 be involved bringing drug control up to date in a number amended to read as follows : of countries, where such control was not exercised 1. REQUESTS the Executive Board to examine ways over drugs for export. But it was a problem that must and means of ensuring that drugs from a producing be solved, before there was another catastrophe such country comply with the quality control require- as had occurred with thalidomide. With those ments which apply for the same drugs for domestic reservations, therefore, he would support the draft use. resolution proposed by the delegationsof India, Ireland and Sweden, as amended by the delegate of Dr NAYAR (India) considered the expression " drug Indonesia. That text, though far from perfect, was at control ",asusedinthedraftresolution,was least a beginning to an important task that would have preferabletotheexpression" qualitycontrol ". to be continued. " Drug control " might mean that it was impossible to have a certain drug, whilst " quality control " The CHAIRMAN put to the vote the amendment pro- would merely mean that drugs should have a certain posed by the delegate of Pakistan. standard.She hoped that the delegate of Pakistan Decision: The amendment was rejected by 42 votes would appreciate the spirit in which the draft resolution to 2, with 25 abstentions. 318 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The CHAIRMAN put to the vote the draft resolution, 3.United Nations Development Decade as amended by the delegate of Indonesia. Agenda, 2.10 Decision: The draft resolution, as amended, was Dr DOROLLE, Deputy Director -General, reminded approved by 56 votes to 1, with 13 abstentions.1 theCommitteeof GeneralAssemblyresolution 1710 (XVI), instituting the United Nations Develop- ment Decade, on which the Director -General had 2.DecisionsoftheUnitedNations,Specialized already reported totheFifteenth World Health Agencies and theInternational Atomic Energy Assembly.'The Executive Board, at its thirty -first Agency affecting WHO's Activities (Programme session, had examined the report by the Director Matters) General,4 which had not been followed by any major Agenda, 2.9 new developments. The Board had adopted resolution At the invitation of the CHAIRMAN, Dr DOROLLE, EB31.R50, which recalled the decisions of the Fifteenh Deputy Director -General, introduced the item.The World Health Assembly, reiterated that the improve- report before the Committee brought up to date the ment of health was fundamental to social and economic information given by the Director -General tothe development, and called the attention of governments, thirty -first session of the Executive Board and distri- and particularly the national health authorities, to buted to all Member States.As the Committee was the aims and purposes of the Decade. The Director - aware, the decisions of the United Nations, the General was also submitting 5 an excerpt, relating to specialized agencies and the International Atomic the Development Decade, from the twenty- eighth Energy Agency affecting WHO's activities in admin- report of the Administrative Committee on Co- istrative and financial matters had already been ordination. Member States would shortly be receiving discussed by the Committee on Administration, copies of that report.He drew the Committee's Finance and Legal Matters and two resolutions had attention to the fact that, since the present official been adopted on the subject. text was in English, the French translation given was an unofficial one that might not conform exactly to the Professor 2DANOV (Union ofSovietSocialist final text issued by the United Nations in that language. Republics) said that the subject had been discussed The Health Assembly would probably wish to draw at all past Assemblies, and there had been ample attention once again, within the framework of the opportunity to speak about the strengthening of Development Decade, to the fact that the improvement co- operation with other organizations and a better use of health -and thus of human capital -was a sine of Technical Assistance facilities.He would only qua non for economic and social development.The emphasize that the training of national personnel in Committee might also wish to recommend that the developing countries was one of the most important Health Assembly emphasize the advisability of an and urgent problems, and in that connexion it was extension of WHO's activities, bearing in mind that the highly desirable that WHO intensify co- operation Fifteenth World Health Assembly had defined certain with UNESCO to the maximum. particular goals to be aimed at during the Develop- ment Decade. He emphasized that no special funds At the invitation of the CHAIRMAN Dr SENTICI had been set aside for the Development Decade. (Morocco), Rapporteur, read out the following draft resolution : At the request of the CHAIRMAN, Dr SENTICI (Morocco), Rapporteur, read out the following draft The Sixteenth World Health Assembly, resolution : Having considered the report of the Director - The Sixteenth World Health Assembly, General on the decisions of the United Nations, specialized agencies and the International Atomic Having studiedthereportof theDirector - Energy Agency affecting WHO's activities on pro- General on theUnited NationsDevelopment gramme matters, Decade ; NOTES the report. Reaffirming the decisions on the Development Decade set forth in resolution WHA15.57 of the Decision:Thedraftresolutionwasapproved Fifteenth World Health Assembly; and unanimously.2 Mindful of the aims of the United Nations Development Decade and the contribution which 1 Transmitted to the Health Assembly in section 2 of the Com- mittee's sixth report and adopted as resolution WHA16.38. ' Off. Rec. Wld Hlth Org. 118, Annex 3. 2 Transmitted to the Health Assembly in section 3 of the Com- 4 Off. Rec. Wld Hlth Org. 127, Annex 13. mittee's sixth report and adopted as resolution WHA16.39. 5 Of Rec. Wld Hith Org. 127, Annex 13, Appendix 6. COMMITTEE ON PROGRAMME AND BUDGET :SEVENTEENTH MEETING 319
the World Health Organization can make to their Secondly, there were serious problems with which achievement,particularlythroughassistanceto UNRWA had been able to cope only to a limited governments, on their request, in national health degree :the lack of adequate water -supplies in most planning and the education and training of pro- of the refugee camps; unsatisfactory sewage disposal fessional and auxiliary health staff, in suburban camps; the high mortality rate among small children; the lack of organized pre- school clinics; 1. NOTES the report of the Director -General; the marginal state of nutrition among some young 2. EMPHASIZES the importance of investment in age -groups; and overcrowded clinics and sub -standard health as a vital component of economic and social health buildings.He felt impelled to ask why those development; and problems were still allowed to persist and when action 3.STRESSES the need for expanding WHO activities would be taken to eliminate them. in keeping with the health objectives of the United Although he had no desire to go into political Nations Development Decade, both through the considerations, he could not forbear from pointing out Organization's regular programme and the use of that a natural solution existed, well -known to all, other available resources. for eliminating the problem of the Palestine refugees Decision:The draft resolution wasapproved.1 as a whole. A glance at the photograph of bare -footed children included inthe UNRWA report would 4.Extension of the Agreement with UNRWA suffice to bring home to members of the Committee the bare subsistence standard of living of the refugees. Agenda, 2.13 His Government was well aware of the good work Dr DOROLLE, Deputy Director -General, said that, done by WHO as shown by its readiness to go to the as the Committee was aware, the Organization was help of countries where health standards were excep- co- operating with the United Nations Relief and tionally low, whether as a result of human, action or Works Agency for Palestine Refugees in the Near manifestations of nature.One incontestable merit East, under the terms of an agreement entered into accruing to the Organization was that it had spread on 29 September 1950.The agreement had first its efforts to the farthest corners of the world, to been extended by resolution WHA13.62 of 19 May rescue peasants and villagers from the scourge of 1960, which had specified that the extension would run communicable disease and thus enable them to convert to 30 June 1963 or until the dissolution of the Agency, barren fields into fertile meadows and famine into if it should take place before that date. The United plenty. Nations General Assembly had, at its seventeenth Iftheprincipleofequalityamong mankind session, decided to extend the mandate of UNRWA remained valid, could there be any more important until 30 June 1965. The time had therefore arrived for task for WHO to do than to devote its main efforts to deciding whether the Organization wished to keep assisting the Palestine refugees in tackling health the agreement in force. The two secretariats considered problems that were the result of human action ? that it was desirable to extend the agreement (the text The international community should give financial of which was given in Annex 3 toOfficial Records assistance to those refugees if it were unable to help them No. 35) until 30 June 1965. A draft resolution on the on the political plane. It was for the well -developed subject was before the Committee. He reminded the countries to pledge enough funds and workers to Committee thata two -thirdsmajority would be relieve the misery of those people. There could not required for its adoption since it involved an agreement be a peaceful world where the one half was sick and with another international organization. the other healthy, the one half poor and wretched and Dr EL -BORAI (Kuwait) thanked the Director of the other wealthy and with every need satisfied. Health of UNRWA for the report he had made Dr SHAMI (Jordan) stated that over half a million of available and the Deputy Director- General for his the Palestine Arab refugees were living in Jordan, comprehensive statement.Some striking facts had some in UNR WA official camps and others spread emerged from the introduction to the UNRWA report through various towns and villages -the latter arrange- that spoke for themselves.First, there had been no ment making UNRWA's task more difficult.Never- increase in the amount of funds allotted for health theless, the health services provided by UNRWA activities and consequently no expansion of the health covered more orlessthe whole of the refugee services for the Palestine refugees, despite the fact population. that their numbers were increasing every year. Close co- operation and co- ordination of work were maintained at all levels between his country's health 1Transmitted to the Health Assembly in section 4 of the Com- mittee's sixth report and adopted as resolution WHA16.40. services and those of UNRWA; the two had co- 320 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
operated, for example, in the general mass vaccination Considering that the Thirteenth World Health against smallpox carried out in1962, which had Assembly, in resolution WHA13.62, extended the covered nearly 80 per cent. of the population, and in a duration of this agreement until 30 June 1963; nutritional survey made recently. Consideringthat,subsequently,theGeneral Considering UNR WA'sfinancialposition,the Assembly of the United Nations, at its seventeenth quality of the health services it provided was satis- session, extended the mandate of UNRWA until factory, and he would like to express Jordan's gratitude 30 June 1965; and for the valuable work being done by its Health Considering that the World Health Organization Department. should continue the technical direction of the health His delegation endorsed the proposed draft resolu- programme administered by UNRWA, tion; it considered it vital that the assistance given by AUTHORIZES the Director- General to extend the WHO to health work for the Palestine refugees should duration of the agreement with UNRWA until 30 be continued. June 1965. Dr AL -WAHBI (Iraq) said that, at previous Health Decision:Thedraftresolutionwasapproved Assemblies, he had tried to avoid taking part in discus- unanimously.1 sions on the painful question of assistance to Palestine Dr FLACHE (United Nations Relief and Works refugees, although he had, during the Second World Agency for Palestine Refugees in the Near East) said Health Assembly, appealed to delegates to give their that he was pleased to present the brief statement that support to assistance for those destitute people. The it had become traditional for the representative of his Palestine refugees in his own country were well looked organization to make to the Committee. The decision after, and his Government had not requested assistance to extend the agreement between the two organizations on their behalf from UNRWA or any other inter- would enable UNRWA to continue to benefit from national body; it was therefore not on behalf of that WHO's assistance in the task entrusted to it by the group that he was making his appeal. United Nations General Assembly. The problem had been dragging on for many years His organization's health programme, which was an without a solution, and the least that WHO could do emergency one to furnish basic medical care and to was to agree unanimously to the extension of its combat epidemics, had, in the thirteen years of its assistance in agreement with UNRWA. existence, been transformed into a complete and balanc- ed health service, in which preventive medicine played a Dr EL BITASH (United Arab Republic) said that the leading part. An attempt was being made to extend time had come for the Organization to increase its the programme, takingintoaccountthehealth assistance to Palestine refugees, who were living in services provided by the governments of host countries such destitution, and it gave him some satisfaction to to the local population.Those governments had, know that it was proposed to extend the agreement throughout UNRWA's existence, co- operated in all with UNRWA until 1965.The delegate of Kuwait aspects of its work, and he was pleased to express his had mentioned the increase in the numbers of such organization's gratitude. refugees, and had described the miserable conditions He also wished to express appreciation to WHO and in which they were living. He would like the Organiza- tothe many voluntaryorganizationsthathad tion to consider, from a humanitarian point of view, collaborated, to thank all delegates who had taken part in the discussion, and to convey to the Health Assembly providing at least the basic level of health and sanitary the best wishes of the Commissioner General of conditions. UNRWA. The CHAIRMAN put to the Committee the following draft resolution : 5.Joint FAO /WHO Programme on Food Standards (CodexAlimentarius) :ReportoftheJoint The Sixteenth World Health Assembly, FAO /WHO Conference on Food Standards (con- Considering that, on 29 September 1950, an tinued from eighth meeting, section 2) agreement was concluded between the Director - Agenda, 2.11 General of the World Health Organization and the Dr SCHINDL (Austria) introduced the amendment to Director of the United Nations Relief and Works the resolution proposed by the Executive Board in Agency for Palestine Refugees in the Near East resolution EB31.R34, submitted by the delegations of (UNRWA) on the basis of principles established by 1 Transmitted to the Health Assembly in section 5 of the Com- the Third World Health. Assembly; mittee's sixth report and adopted as resolution WHA16.41. COMMITTEE ON PROGRAMME AND BUDGET :SEVENTEENTH MEETING 321
Austria andtheNetherlands.That amendment Dr DAELEN(FederalRepublic' ofGermany) proposed that operative paragraph 4 of the Board's supported the amendment proposed by the delegations resolution be deleted and replaced by the following : of Austria and the Netherlands. 4.EXPRESSES the hope that the Codex Alimentarius Dr EL -BORAI (Kuwait) recalled that the recognition Commission will give priority to the health aspects that food might cause sickness and death went back to of its work and will further preparatory work on a the earliest period of recorded history.Man had regional basis wherever this appears desirable in learned to eliminate from his diet plant and animal order to achieve the fundamental aims laid down for foods that produced ill effects; he had later discovered the Commission; that the primary cause of such effects was bacterial 5. REQUESTS the Director -General to ensure the contamination or adulteration, and had begun to seek fullest participation of WHO in the joint food means for the sanitary production and preservation standards programme; of food.The establishment of the Food and Agri- 6. FURTHER REQUESTStheDirector -Generalto culture Organization had been the first step towards report to the thirty -third session of the Executive putting information to work by joint planning, and Board on the progress made by the Codex Alimen- towards dealing with the problem of establishing food tarius Commission, and on the outcome of the standards. That organization had, at its eleventh review of the method of financing the work of the session, adopted a resolutioncallingfora joint Commission to be made by the FAO Conference FAO /WHO conference on food standards. in November1963. The Executive Board of WHO, at its twenty -ninth session, had had before it a report by the Director- Some countries, he said, where the national Codex General concerning the proposed joint programme, Alimentarius Commission was working under the and had approved the convening in1962of the joint supervision of the public health authorities, were not committee to review the proposed programme and fullysatisfiedwith theguidelinesof theCodex draw up recommendations for future action.The Alimentarius Commission and its statutes,' and he had agenda of that committee had included such questions drawn attention to that point at the eighth meeting (see as the functioning of the Codex Alimentarius Com- page222). mission, the elaboration of guidelines, the date of the His delegation and others considered that WHO did Commission's first session, and the financing of the not participate in the joint food standards programme joint programme. to the extent desirable in view of the importance of the His delegation supported the recommendation that health aspects. The programme should be furthered on the Director- General of WHO be requested to take a regional basis, and not merely "unhindered ", which the necessary steps to communicate to the appropriate was the word used in paragraph20of the guidelines. bodies of WHO the endorsement of the proposed joint The item had been considered by a small group programme on food standards, whose principal organ consisting of the representative of FAO, the delegate would be the Codex Alimentarius Commission. It also of the Netherlands and himself. The representative of supported the guidelines for the work of the Com- FAO had reported that a way had been found of mission, and was glad to know that the Commission avoiding a duplication of costs for countries co- was being convened for its first session at FAO head- operating on food standards on a regional basis quarters in June1963. The policy of urging all interested Member States to Dr KRUISINGA (Netherlands) supported the remarks contribute to a special Trust Fund for financing the made by the delegate of Austria.The amendment programme was a wise one. The programme should be showed the significance of the Codex Alimentarius implemented as soon as sufficient funds were available. Commission as a measure of health protection and the desirabilityof furthering preparatory work on a Professor DANOV (Union ofSovietSocialist regional basis.After the information given by the Republics) said that the need for unifying legislation on FAO representative, his delegation would accept the foodstuffs, among countries that had trade relations Statutes of the Commission, including paragraph 8, covering both the natural and synthetic products used which covered financing by a special Trust Fund in the food industry, had long been apparent. It was to administered by FAO.It accepted that paragraph be hoped thattheintroductionof international reluctantly, however, and continued to prefer that the standards for foodstuffs by means of the Codex Codex Alimentarius Commission be financed from the Alimentarius would not only be of economic signi- regular budget. ficance but would contribute to improving the quality of products and to preventing diseases caused by the ' Off: Rec. Wld Hlth Org. 124, 68-72; 74. presence of harmful substances in food. His delegation 322 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II accordingly supported the draft resolution contained principal organ will be the Codex Alimentarius in resolution EB31.R34, as amended by the delegations Commission; of Austria and the Netherlands. 2.ADOPTS the statutes of the Codex Alimentarius Dr ANDERSEN (Denmark) said that his delegation Commission; was deeply interested in the question under discussion 3. AGREES to the calling of the first session of the and considered it to be of the greatest importance that Codex Alimentarius Commission in June1963; simplified and integrated food standards be introdùced 4.EXPRESSES the hope that the Codex Alimentarius on as wide a scale as possible. Commission will give priority to the health aspects With regard tothe financing of the operating of its work and will further preparatory work on a expenses, his delegation agreed in principle with those regional basis wherever this appears desirable in governments that at the Joint Conference had indicated order to achieve the fundamental aims laid down that they would prefer the costs to be borne by the for the Commission; regular budgets of the two organizations. The point was, however, not of vital importance at present, and 5. REQUESTS the Director -General to ensure the his delegation would therefore support the Executive fullest participation of WHO in the joint food Board's recommendation. standards programme; and With regard to the amendment proposed by the 6.FURTHER REQUESTS theDirector- Generalto delegationsof Austriaandthe Netherlands, his report to the thirty -third session of the Executive delegation did not think itadvisable togive the Board ontheprogress made bytheCodex Commission more detailed directives, and that applied Alimentarius Commission, and on the outcome of particularly to the idea of furthering preparatory work the review of the method of financing the work of on a regionalbasis. Itwas obvious thatthe the Commission to be made by the FAO Conference Commission should try to benefit from all local work in November 1963. carried out in that field, whether regional, inter - Decision:The draft resolution was approved as country or national, but that should be left to its own amended by 68 votes to none, with 3 abstentions.' discretion. His delegation would therefore support the draft resolution contained in resolution EB31.R34 in The meeting was suspended at 4.10 p.m. and its original form. resumed at 5.00 p.m., with Dr Olguín in the Chair. Dr DOROLLE, Deputy Director -General, recalled that the Secretariat had, at the Committee's eighth 6.Sixth Report of the Committee meeting, suggested that discussion of the item be At the invitation of the CHAIRMAN, Dr SENTICI adjourned because it was not completely clear about the nature and scope of the reservations that had been (Morocco), Rapporteur, read out the draft sixth report of the Committee (see page 409). made concerning certain articles of the Statutes, and because at that time also the views and comments of Decision:The report was adopted. FAO were needed.Those problems had now been solved.Note had been taken of the remarks with 7.Closure of the Session regard to methods of financing, but since the question The CHAIRMAN thanked the Committee forits could not be studied until the thirty -third session of the tireless and constructive work. It had achieved remark- Executive Board, after the next conference of FAO, able success in dealing with the extensive programme the problem did not arise at present. entrusted to it, and its discussions on the basic aspects The CHAIRMAN put to the vote the amendment of the programme -such asmalariaeradication, submitted by the delegations of Austria and the smallpox, assistance to newly independent countries, Netherlands. clinical and pharmacological evaluation of drugs, Decision:The amendment was adopted by 54 internationalquarantine,co- operation withother votes to 1, with 17 abstentions. internationalorganizations,theUnitedNations Development Decade, and finally the budget for all The CHAIRMAN put to the vote the draft resolution those activities -had been on an extremely high level. contained in resolution EB31.R34, as amended, which A solid body of health doctrine had been drawn up on read as follows : the basis of experience acquired in an extensive pro- The Sixteenth World Health Assembly gramme for world health. 1. APPROVES the establishment of a joint FAO/ ' Transmitted to the Health Assembly in section 6 of the WHO programmeonfoodstandardswhose Committee's sixth report and adopted as resolution WHAI6.42. COMMITTEEONPROGRAMMEANDBUDGET :SEVENTEENTH MEETING 323
The meetings had been characterized by the high Professor CANAPERIA (Italy) joined with the delegate quality of the discussions and by the important of the Soviet Union in expressing his appreciation of decisions taken for the execution of programmes. the admirable way in which the Chairman had The work of WHO, and its activities jointly with other conducted the discussions.With the help of the international organizations, was of vital importance; Vice -Chairman and the Rapporteur he had led the close co- ordination with activities in Member countries Committee to the successful conclusion of its work was essential, for health was a fundamental part of in an atmosphere of harmonious co- operation and economic planning and development. The Committee understanding. had made an important contribution to the realization Dr HAQUE (Pakistan) wished to be associated with of the objective that everyone had at heart . to improve the remarks of the two previous speakers.He thank- the health and well -being of all people.It had been ed the Chairman and the other officers of the Com- helped by the work of earlier committees and by the mittee and also the Secretariat, who had worked so community of ideas and ideals among its members. hard for the success of the Assembly. He deeply appreciated the honour conferred on his Dr CLAVERO DEL CAMPO (Spain) also thanked the country and himself by his election as Chairman of the Chairman for his able and cordial guidance of the Committee; histask had been lightened by the discussions.It was thanks to him that the Committee atmosphere of co- operation and understanding.He had been able to complete its task successfully. thanked theofficers and members of the Health Assembly and of the Committee, the representatives of Dr CASTILLO (Venezuela) congratulated the Chair- the Executive Board and the Director -General and the man, the Vice -Chairman, the Rapporteur and the Secretariat for their invaluable help and co- operation. Secretariat, who had helped the Committee in the The Committee deeply regretted the sudden and successful completion of its task. tragic death of Dr Syman of Israel, who had so greatly DrEL-KAMAL (Algeria) joined with theother contributed to its work. speakers in thanking the Chairman and the other officers of the Committee for so ably guiding the Professor ZDANOV (UnionofSovietSocialist Committee in its important work.His country was Republics) said that, in complimenting the Chairman going throughaperiod ofre- organizationand, on his most able guidance of the Committee's work, although his delegation had not taken part in the he was sure that he was expressing the views of all the technical discussions, it would take full account of the members of the Committee as well as his own.With Health Assembly's proposals and decisions and would the charm, wisdom and ability of its Chairman, Vice - make every effort to honour its commitments. Chairman and Rapporteur, the Committee had worked The CHAIRMAN declared the session closed. in an atmosphere of friendship and co- operation and had dealt with an imposing series of problems. The meeting rose at 5.30 p.m. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS
FIRST MEETING
Thursday, 9 May 1963, at 2.30 p.m.
Chairman: Mr I. T. KITTANI (Iraq)
The CHAIRMAN thankedalldelegatesforthe 3.Consideration of Establishmentof Legal Sub- honour conferred upon his country and himself by his Committee election and paid tribute to his predecessor, Dr Layton, Agenda; 3.7 who had presided with such distinction over the The CHAIRMAN proposed that, since there appeared Committee's discussions. to be no items on the agenda that required to be He reminded the Committee of its terms of reference, referred to a legal sub -committee, and since the set forth in paragraphs (2), (3) and (4) of resolution establishment of such a committee was not mandatory, WHA15.1. TheCommittee'sdebateswouldbe itshould be dispensed with.Should theresub- conducted, as far as practicable, in accordance with sequently arise any matter requiring to be dealt with the Rules of Procedure of the Health Assembly. by such a body, an ad hoc legal working group Rules 49 to 79 (Conduct of business and voting at could be set up. plenary meetings) were particularly relevant. It was so agreed.
1.Election of Vice -Chairman and Rapporteur 4.Review of the Financial Position of the Organization Agenda, 3.1 Agenda, 3.8 The CHAIRMAN read out Rule 36 of the Rules of The CHAIRMAN said that item 3.8 had inadvertently Procedure of the Health Assembly, concerning the been omitted from the Committee's programme of election of a vice- chairman and a rapporteur, and work appearinginthatday'sJournal.Itwas, noted that the Committee on Nominations in its third however, in accordance with past practice for the report (see page 407) had proposed Dr. J. Vysohlíd introduction of the item to be given at the first meeting. (Czechoslovakia) as Vice -Chairman of the Committee on Administration, Finance and Legal Matters, and Dr WEBB (Australia) proposed that, since delega- Dr A. L. Bravo (Chile) as Rapporteur. tions had not had prior notice that the item was to be taken up, it should be deferred to a later meeting. Decision: Dr Vysohlid and Dr Bravo were elected by acclamation. The CHAIRMAN explained that the intention was only to have the introduction of the item by Mr Siegel at the current meeting, any discussion being deferred 2.Participation by Representative of the Executive to a later meeting.He asked if the Committee agreed Board to follow that procedure. The CHAIRMAN welcomed Dr A. Nabulsi, who had It was so agreed. been appointed by the Executive Board to participate as its representative in the Committee, in accordance Mr SIEGEL, Assistant Director- General, Secretary, with Rule 43 of the Rules of Procedure of the Health made a statement on behalf of the Director -General Assembly. on the financial position of the Organization. - 324 - COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FIRST MEETING 325
The CHAIRMAN thanked the Secretary for his most proposed, therefore, that the Committee first discuss interesting statement.It had been the practice in the those items, in the following order : 3.8.1, 3.8.2, 3.8.3, past for the Secretary's statement to be circulated as 3.8.4, 3.3, 3.6 and 3.7.The documentation for those a document and appended to the minutes of the items was already available, except for that on item Committee's meeting.He suggested that that should 3.8.2, which would be distributed the following day. again be done. The Committee might also need to deal with two items It was so agreed (see Appendix below). - 3.14 and 3.12 - that might possibly have impli- cations for items 2.2.1 and 2.2.2. 5.Programme of Work of the Committee For the remaining items he proposed the following order: 3.4.1, 3.4.2, 3.4.3, 3.4.4, 3.9, 3.10, 3.16, 3.18, The CHAIRMAN said that certain items on the 3.20.1, 3.20.2, 3.11, 3.19 and 3.5, it being understood Committee's agenda had to be dealt with before the that that order could be modified if desirable. Committee on Programme and Budget could begin its consideration of items 2.2.1 and 2.2.2 - Exam- It was so agreed. ination of the main features of the programme, and recommendationofthebudgetaryceiling.He The meeting rose at 3.25 p.m.
Appendix
STATEMENT BY MR M. P. SIEGEL, ASSISTANT DIRECTOR -GENERAL
Mr Chairman, among the important responsibilities this year, Hungary informed the Director -General of of this committee is its annual review of the financial its resumption of active participation in the work of position of the Organization asreflectedinthe the Organization; itis to be hoped that the two
Financial Report,1 which is a supplement to the remaining inactive Members will soon do so, as well. Annual Report of the Director -General.In carrying I am pleased once more to report to you, on behalf out that review, members of the Committee are able of the Director -General, on his management of the to examine the administrative and managerial, as financial affairs and resources of the Organization. well as the financial, affairs of the Organization, and It is somewhat difficult for me to report, as I have the way in which they have been conducted.This done in many past years, that the financial position is year - the fifteenth anniversary of the Organization good, at a time when the Organization requires - the Committee has an opportunity to examine the additional financing for its headquarters building, as experiences of the past years, and on the basis of that recommended by the Executive Board -a matter which examination to form a judgement for the future.The this committee will be considering under item 3.11 Secretariat of your organization looks forward each of its agenda.However, leaving aside for the present year to the comments on, and criticisms of, its work the problem of completing the financing of the head- which are made during the Health Assembly. We quartersbuilding,thefinancialpositionof the are still learning all the time, and those comments and Organization continues to be sound. criticisms help us immensely in our constant efforts The collection of contributions as at 31 December to improve.It will, I am sure, come as no surprise 1962 was 94.2 per cent. of the total assessments on to the Committee that the philosophy which continues active Members.The corresponding percentages for to pervade the whole of the work of the Organization 1960 and 1961 were 96.08 and 93.90 per cent. respect- is that of " ideal realism ", which I described to this ively.But for a delay in payment by one of the larger committee five years ago. contributors because of parliamentary procedures, the I am sure that all members of the Committee percentage would have been even larger than for 1960. welcome the factthat in the past year Algeria, Since 1 January of this year, further contributions have Burundi, Jamaica, Rwanda, Trinidad and Tobago, been received, and details will be reported to the Com- and Uganda have become Members of the Organi- mittee when it deals with agenda item 3.8.2 - Status zation, which now has 118 Members, including one of collection of annual contributions and of advances Associate Member.Five years ago there were 88 to the Working Capital Fund. Members and Associate Members.In February of Briefly, payments amounting to $718 695 relating to arrears for 1962 and prior years were received
1OffRec. Wld Hlth Org. 126. during the period 1 January to 30 April 1963.Pay- 326 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
ments of contributions relating to the 1963 budget, first in the autumn of 1962, primarily for a group received during the same period, were 27.15 per cent. newly appointed to the position, the second in January of the total contributions due.The corresponding 1963, primarily for a group who have been carrying percentage for 1962 was 23.92. out this function for some time. A third such course Despite the generally satisfactory situation with is foreseen for the autumn of this year.In addition, respect to the payment of contributions, as at 30 April the orientation of newly appointed senior staff at 1963, twenty -one Members had not paid all or part of headquarters is now being undertaken on a more their contributions for 1962 and prior years.Eight systematic basis through a group presentation and were in arrears for a part of their 1962 assessment; discussion. Special training courses continue for four, for all of 1962; two, for more than one but less particular groups of new appointees such as staff than two years; four, for two years; and three for for the malaria eradication programme. In this same more than two years. trend, furthermore, there has been an additional When the Committee deals with agenda item 3.8.1 important development inthe organization of a (Financial report on the accounts of WHO for 1962, Frenchlanguageuniversitycourseinsanitary reportof theExternal Auditor,and comments engineering for present and prospective staff members thereon of the Ad Hoc Committee of the Executive at the University of Naples. Board) itwill be interested in the information on Management surveys were started or continued in budget performance for 1962. In summary, $24 164 650 three regional offices, and several WHO representa- or 97.19 per cent. of the effective working budget, was tives' offices were visited by our management staff. utilized,leavingan unusedbudgetbalanceof At the same time increasing attention was given to the $699 150. As only 94.2 per cent. of the contributions improvement and developmentofadministrative for 1962 was collected, there was a cash deficit of procedures and other matters at headquarters. In this $582 939, which has been more than covered by connexion, you may be interested to know that a contributions received between January and April broad management programme aiming atfurther 1963. mechanization of some administrative and other Obligations in 1962 from other sources of funds procedures was prepared.It was started in co-opera- available were :from the Expanded Programme of tion with an outside consultancy firm, and so far the Technical Assistance, $7 334 842; from the Malaria results have been encouraging. It is expected that the Eradication Special Account, $2 538 656 (not including implementation of this programme will be reached $2 000 000 transferred from the regular budget) ; from by gradual and orderly stages over a period of some the sub -accounts of the Voluntary Fund for Health years. Promotion, $1 185 353.In addition, $497 792 was During the past year, the new headquarters building obligated forprojects financed from the United has progressed from the stage of design and planning Nations Special Fund, and $87 338 from the Revolving to the stage of execution. Work on the foundations Sales Fund.Furthermore, $2 586 419 was disbursed for the main building has been completed and, as for the health programme in the Congo (Leopoldville), members who care to visit the site will see, the building against reimbursement by the United Nations. is beginning to rise.There have been, and continue In total, therefore, the World Health Organization to be, problems of work organization and of financing, in 1962 financed from the various sources of funds, not which I have already mentioned and which are dealt including the Headquarters Building Fund, activities with in detail in the report which the Director -General amounting to $38 395 050.It may be of interest to is making to the Assembly about the building. mention that administrative services costs in that year The purchasing service rendered by the Organization were $2 150 763, or 5.6 per cent. of the total. to Member governments continues to be a form of Important as are the financial resources of the assistance appreciated by a number of them. For one Organization, conservation and improvement of its such government, the purchase of 3900 different items human resources are even more vital to the success of for a single public health laboratory will be completed the Organization.Special attention has been given this year. Prompt action in the purchase and dispatch during the past year to the expansion of opportunities of such supplies as vaccines and drugs when appeals for senior key personnel of the Organization to develop are made by governments for help in emergency health in the knowledge and understanding of their functions, situations is another service which is provided.The their place in the total structure of the Organization stimulation of manufacturers of X -ray equipment to and, most importantly, in the history, current policies develop safer and more efficient tuberculosis and and prospective developments in the Organization general diagnostic X -ray equipment continues to be an itself.Two training courses of several weeks each activity which hopefully may result in a lasting global have been conducted for WHO representatives, the contribution to the quality of radiological examinations COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FIRST MEETING 327 and an important contribution to the protection of involved in the United Nations Development Decade; medicalworkersandpatientsagainstradiation and it has recently become increasingly concerned to hazards. provide assistance to governments, on request, in The task of co- ordination of the work of WHO national health planning as a part of overall planning with that of other organizations, to which I referred for economic and social development. The needs for in some detail in last year's report to this committee, regional offices to maintain close contact with minis- continues to occupy a considerable amount of the tries of health and, together with regional committees, time and attentionof theDirector -General and to have detailed knowledge of local conditions and his staff. There continue to be advocates of the substi- practical problems have similarly increased. tution of direction for co- ordination in the relation- The increase in the number and complexity of health ship between the United Nations and the specialized activities undertaken by governments,often with agencies. However, the co- ordination and co- operation the assistance or advice of WHO, has occurred at a among the secretariats of the various organizations time when multilateral and bilateral aid programmes have continued to function well on administrative as directlyor indirectly connected with health pro- well as programme matters. Five years ago I was able grammes have been expanding. To provide the to report that, in the ten years of its existence, the assistance which health ministries requireinco- Organization had, with the other members of the ordinating their national health plans and national United Nations family, worked out in detail, with a health programmes as a part of the over -all economic good deal of mutual adjustment, common adminis- and social development plans and programmes of the trative practices through the Administrative Com- government, the WHO representative serves as an mittee on Co- ordination, its sub- committees and the out -posted part of the regionaloffice, representing Technical Assistance Board. Today I am pleased to the regional director, and works closely with the resident report that only last week the Administrative Com- representatives of the Technical Assistance Board and mittee on Co- ordination approved detailed plans to local representatives of other multilateral as well as be submittedtotheInternationalCivilService Advisory Board, which would enable it to serve as an bilateral agencies. This arrangement can greatly enhance independent inter -organization body to make judge- the leadership which health can provide ininter- ments -free of the pressures of the immediate political national action for economic and social development. problems and expediencies -when problemsarise Within the last few years, economists have become in the administration of the common system of con- increasingly aware of the fact that human resources ditions of service for staff. If the new terms of reference form one of the major sources of economic growth. and authorities are approved by all concerned, it will The inseparability of social, economic and health become one of the most important steps yet taken to factors has, of course, been recognized explicitly by improve co- ordination in administrative matters. This the Executive Board and the World Health Assembly committee will be able to review and comment on since 1952, and implicitly even earlier.One eminent this development under item 3.19 of its agenda - economist,Professor Simon Smith Kuznets, has Decisions of the United Nations, specialized agencies observed that for " the study of economic growth over and the International Atomic Energy Agency affecting long periods and among widely different societies WHO's activities on administrative, budgetary and -the concept of capital and capital formation should financial matters. be broadened to include investment in health, edu- The development of the structure of the World cation and training of the population itself, that is, Health Organization over the fifteen years of its investment in human beings ". Some economists existence has been continuous. It has progressed from now refer to" human capital "asdistinct from the establishment of a headquarters staff to the coming " physical capital ", which provides more emphasis into being of strong regional organizations, and now to the importance of the people of each country to its to the general provision of WHO representatives at economic development. the country level.During the past year, sustained A certain amount of basic research has been done efforts have been made to increase the number of on some aspects of investment in human beings, but WHO representatives, to extend their functions and, so far relatively little has been done on the health as I mentioned earlier, to ensure their adequate pre- aspects of that investment. However, Dr Selma paration to carry out the functions assigned to them. J. Mushkin, another economist, in a paper entitled WHO operations at the country level have become of " Health as an Investment " prepared for the Explo- ever -increasing importance, as the Organization is ratory Conference on Capital Investment in Human committed by the Constitution to furnish technical Beings, sponsored in the United States of America by assistance upon the request of governments; itis theUniversities- NationalBureau Committeefor 328 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Economic Research, stated : " The concept of human is no lack of agencies, multilateral or bilateral, willing capital formation through both education and health to provide assistance to the developing nations.As services rests on the twin notions that people as the framers of the WHO Constitution recognized, productive agents are improved by investment in these however, it is essential that governments be assisted services and that the outlays made yield a continuing in the evaluation and projection of their health needs return in the future.Health services, like education, and in the establishment of an orderly programme of become a part of the individual, a part of his effective- priorities for meeting those needs from the various ness in field and factory. The future increase in labor forms of assistance available.This is the role which product resulting from education or from health WHO is designed to play and it is in large measure programs can be quantified to an extent useful for through the WHO representative on the spot that the programming purposes. While there are apparent Organization can render this service.I think it is limitations to such measures, these limitations can be significant that the normal maturing of our own identified. ". Further along in her paper, Dr Mushkin organization brings us to an effective level of capa- states :" In a modern economy biological selection bility in this respect at that moment in time when it is no longer an acceptable method of investing in appears that the significance of health to the total health, not only because our humanitarianism instincts economy is beginning to be recognized even in those rebel against it, but because it costs too much. The quarters which had not previously done so.This is cost of foregoing the productive contribution of those both an encouraging reflection on past achievements who die early is now too great."She also states : and a hint of the challenging responsibilities which " Health programs use economic resources -men and lie ahead for WHO. materials;theyalsocreateeconomicresources. During this year, which marks the fifteenth anni- Viewing expenditures for health programmes as an versary of the Organization, it is clear that the Orga- investment helps to underscore the contribution of nization must continue to grow and develop along the health programs to expansion of income and economic lines so wisely laid down by the Health Assemblies growth." and the Executive Board over the years -the alternative I have quoted these few excerpts from studies by is stagnation and failure to fulfil the high hopes of a economists on thesubject of " human capital " better life held by so many millions of human beings because I think it relevant to the structure, as well as throughout the world. It is clear, too, that we must be the functions, of our organization that economists adaptable tochanging conditions inthisrapidly are beginning to be concerned about the importance evolving world. We .must, too, continue boldly with of health to economic development.If this incipient the great adventure which is the pursuit of the prin- concern of the economists is to have practical effect ciples and the objective so clearly set forth in the in the lives of people it must do so through planning Constitution. We must have the courage to progress at the national level. As I have indicated earlier, there from where we are now to our established goal.
SECOND MEETING
Monday, 13 May 1963, at 9.30 a.m.
Chairman:Mr I. T. KITTANI (Iraq)
1.Review of the Financial Position of the Organization Dr CAYLA (France) congratulated the Chairman, (continued from first meeting, section 4) Vice -Chairman and Rapporteur on their election. Agenda, 3.8 He also welcomed newly admitted Members, parti- cularly Algeria. The CHAIRMAN recalled that the item had been He thanked the Secretary for his excellent intro- introduced at the previous meeting, when the Assistant ductory statement to the Financial Report, in which Director -General,Administrationand Finance, he had touched upon all the important matters that Secretary of the Committee, had presented his state- the Committee would be considering.He reserved ment (see page 325). He opened the general discussion his comments until the various subjects came up for on the item. discussion. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SECOND MEETING 329
Dr KRUISINGA (Netherlands) welcomed the state- South -East Asia] prove that newer institutions are ment presented by the Secretary. The line of thought badly needed, it seems equally important to arrange underlying that statement was of vital importance for for the proper staffing of existing institutions and the completion of the Organization's task in a well - their maintenance and repair, and to use modern balanced manner.The improvement of health care therapeutic methods in order to make the best possible was an essential prerequisite for the development of use of the facilities and knowledge at our disposal." 1 people's welfare in general. Health care should Experience in Belgium had confirmed the truth of continue, as in the past, to contribute to social and that statement. economic progress, through the prolongation of life In order to help to meet the need for medical and expectancy and the control of communicable diseases. paramedical personnel, the fellowships programme However, in order that health care might contribute should be improved, particularly as regards fellowships to general development in that way, it was essential for university studies. In that connexion his delegation to have sufficient financial resources, and an increasing fully shared the Director -General's anxiety to avoid part of national incomes would have to be devoted what he had judiciously referred to in his Report as to the health programme. Progress in medical science wastage. brought with it an increasing complexity of problems Dr VANNUGLI (Italy) congratulated the Chairman, for scientific workers : increased financial and " human capital " investments were therefore essential, and Vice -Chairman and Rapporteur on their election. public health administrators would have to see that It was encouraging to note that the Secretary, as always, had included in his introductory statement those investments were used efficiently. reference to the importance of the human factor. In the Netherlands, the proportion of the national Hidden behind figures and charts were the people income set aside for health care had increased from working, often under difficult conditions, for the 3.8 per cent. in 1953 to 4.2 per cent. in 1958: an well -being of mankind. It was essential to help those increase of 0.1 per cent. per annum. That trend had people cope with their problems, to help them feel been continued, and it was expected that during the that they were a part of the organization for which next four years the proportion of the national income they were working. devoted to health care would increase by at least The Committee would have an opportunity later on 0.1 per cent. per annum. to discuss in detail such matters as co- ordination with Governments could obtain a clear idea of the the United Nations and specialized agencies, the effectiveness of their policies only by obtaining more financing of the WHO programme, the headquarters and precise data on the financial and personnel building, etc. At the moment, he would refer merely to resources available for health care, and it was only the question of training of WHO staff: it would be by assessing the effectiveness of health policies that interesting for the Committee to have some data on an effective socio- economic policy could be developed. the people receiving such training, and the type of Such assessment was all the more important since training courses given. the need for manpower for health care would increase It was the task of delegates, as public health admi- continuously during the coming years. nistrators, to see that, in providing assistance to The Secretary had emphasized that human resources developing countries, particular emphasis was placed were one of the major requirements for economic upon health aspects of development, and that an growth, and that socio- economic and health factors adequate proportion of the funds available was used were inseparable in the development of national for the control of diseases, for the training of personnel, economies.It could not be overstressed that an and for the establishment of health services. For only increasing share of available financial resources would by liberating the population of a country from the have to be devoted to health. diseases that diminished its productive potential and by improving its health conditions could full develop- Mr DE CONINCK (Belgium) congratulated the Chair- man, and also the Vice -Chairman and Rapporteur, ment be secured. on their election. Dr ALAN (Turkey), after congratulating the Chair- His delegation had noted with satisfactionthe man, Vice -Chairman and Rapporteur on their election statement appearingintheIntroductiontothe and welcoming the representative of the Executive Director -General's Annual Report, to the effect that Board, commended the Secretary on his interesting experience in some countries had shown that the and informative statement.His delegation was fully efficiency of out -patient departments or hospital wards satisfied with the financial situation of the Organiza- could be increased by as much as 25 per cent." Al- though statistics in both regions [the Americas and 1 Off Rec. Wld Hith Org. 123, vIII. 330 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II tion, as described in the statement, and was pleased mittee would be able to discuss the matter and decide to note the emphasis placed therein on " human on the best course to be followed. capital ". Reference had been made to the remarks in the Secretary's statement concerning " human capital " Dr DIBA (Iran) congratulated the officers of the in economics.It was heartening to see that a science Committee on their election. which had for so long been called" the dismal He likewise congratulated the Secretary on his very science " was giving more and more attention to the clear statement on the financial situation of the development of human resources and to the role that Organization.It was most encouraging to note that welfare, in particular health, could play in economic the Organization was developing steadily and methodi- development.It was up to delegates, as health admi- cally. He was interested to learn that plans were being nistrators, to educate ministries as to the important prepared for further mechanization of some adminis- role that health and welfare services could play in a trative and other procedures, but hoped that that well -balanced development. mechanization would not diminish thesenseof The delegate of Iran had already drawn attention initiative among the staff. to the sometimes unsatisfactory position in some An extremely interesting philosophy could be sensed organizations providing financial assistance to govern- in the statement on the financial situation, in which ments.The Secretary had provided the Committee a health consciousness was present.Experience in with some commentaries made by economists linking Iran had shown that it was impossible to establish health and economic development.The Director - a sound economy without improvement of health, General would, no doubt, follow up that argumenta- anditwas unfortunate that some international tion and press for greater recognition, in the Special organizations providing assistance to governments Fund, the Techncial Assistance bodies, etc., of the had not been giving the necessary priority to health role that health could play in economic development. problems. Dr AL -WAHBI (Iraq) said that, once again, the Mr BRADY (Ireland) said that the Committee was Secretary had provided the Committee with a most very fortunate in having Mr Kittani as its Chairman, lucid and interesting statement. and he had no doubt that he would bring to the work He associated himself with the remarks made by of the Committee the same distinction as had marked the delegates of Italy and Iran, and, in particular, his contributions to the work of previous Assemblies. would welcome more information about the training He also welcomed new Members. of staff. That training, which seemed highly desirable, The statement presented by the Secretary to the seemed to include special courses arranged by the Committee provided a very satisfactory picture of Organization,fellowships,and,a new item,the the general financial position of the Organization, appointment of trainees on the staff. and, despite one or two clouds on the horizon, such Mr MCKITTERICK (UnitedStatesof America) as the arrangements for headquarters accommodation, appreciated the excellent stewardship demonstrated very heartening conclusions could be drawn from in the Secretary's statement. He would make further that statement. comments, on the subject of co- operation with other All delegates with experience of the Organization organizations, under item 3.19 of the agenda. would appreciate how fortunate it was in having a good administrative structure and personnel who Dr MUDALIAR (India) congratulated the. Chairman devoted their efforts so assiduously to the work that on his election. WHO had been doing for the last fifteen years.It He had read the Secretary's statement with great was encouraging that the Secretary and the External interest. There were many problems raised, and action Auditor were in a position to assure the Assembly would have to be taken to find solutions.The col- that, generally speaking, the financial position of the lection of contributions had been very satisfactory, Organization was quite sound. taking into consideration some of thedifficulties It was regrettable that the list of Members in arrears experienced by national administrations regarding was longer than usual, and, while the rate of collection the time factor.It was unfortunate that there were of contributions was still very satisfactory, it was a pity some countries that had fallen into arrears for more that some Members had not paid their contributions than two years. He warned against allowing that trend more promptly, or had encountered difficulties pre- to grow, for it had caused difficulties in other organiza- venting them from doing so. It seemed rather doubtful tions. whether the action taken in previous years could be He was glad that administrative costs, despite the regarded as satisfactory, but members of the Com- large expenditure during the year, had been only COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SECOND MEETING 331
5.6 per cent.It was to the credit of the Organization the reasons for those arrears was that the general that the bulk of the amount collected was spent on budget of the Organization had increased out of pro- health programmes. portion to the increase in national incomes. He was pleased to learn that training courses for In conclusion, there were two main factors which the staff had been started, that two had been completed should form the basis for determining the Organiza- and a third was planned for the autumn of 1963. He tion's financial policy :firstly, the rate of growth of would welcome more details about those courses. He national income, since that in the main determined was also glad to note that a course in public health the material, cultural and scientific level of develop- engineering was being held in Naples.In many ment of society, and secondly, the essential need to countries there were very few public health engineering strengthen co- ordination, and to develop collaboration schools, and that aspect of health work was worthy and planification. of WHO's support. It was also pleasing to see that the structure of the Dr LE Cuu TRUONG (Republic of Viet -Nam) Organization was developing continuously, and that congratulatedtheChairman,Vice -Chairman and WHO representatives were being sent to various Rapporteur on their election. countries.When the idea of regional organizations He likewise congratulated the Secretary on his had first been introduced, there had been a feeling statement. He was pleased to note that the financial that they might be obstructive rather than constructive. position of the Organization was satisfactory and that On the contrary, experience had proved regional the budget, although it was increasing, was in keeping organizations to be one of the best ventures of the with the general development of the Organization's Organization, and it was to be regretted that some work.Newly independent countries, in particular, other organizations had not seen the importance of were in need of the Organization's assistance for the such a structure. development of their health services, and it was clear that effective health services were essential for general Dr LISICYN (Union of Soviet Socialist Republics) social and economic development. congratulated the officers of the Committee on their With regard to medical supplies, he said that some election. countries had difficulties in ascertaining which pharma- He expressed satisfaction with the financial position ceutical preparations had been internationally ac- of the Organization, as reflected in the statement cepted.He thought that WHO could greatly assist presented by the Secretary. From the point of view of by providing information on such products, if such " financial philosophy ", the conception of " human a service was not already in existence. capital " in the statement was of great interest. There was no doubt that, in all countries, health had an Mr FERAA (Morocco) congratulated the officers of influence on the development of culture, science and the Committee on their election.He also took the economy. However, the value of " human capital " opportunity, in view of the presence of the Director - was increased not only by the resources devoted to General,of congratulating him on hisexcellent health and education, but above all by those put into Annual Report. developing the economy and raising living standards. The statement presented by the Secretary was excel- He was concerned that the financial resources made lent, both as regards form and content, and he was available to WHO, such as Technical Assistance and pleased to note that the financial position of the other funds of the United Nations, had, during the Organization was very good, despite the continuous past few years, not only shown no signs of being increase in the budget, and that, in spite of arrears increased,but, in some cases, had actually been of contributions, rather more than 94 per cent. of total decreased. That was particularly important since the assessments had been collected at the end of 1962.It functionsoftheOrganizationthatparticularly was also encouraging to note that, although the work concerned the Committee in its present debate were of theOrganization was increasing,therelative those of co- ordination, planning and control, and the increase in administrative costs was low. widening of WHO's collaboration with other organiza- He particularly wished to stress the importance tions.Those functions had also a direct bearing on of the initiative taken by the Director -General with such fundamental activities of WHO as the training regard to staff training. It was well known how difficult of all classes and types of personnel. it was at times for administration to keep pace with It was some matter for concern that, every year, technological developments. He was likewise pleased there were arrears in payment of contributions. That to learn that management surveys had been carried fact should be taken into consideration in the elabo- out in three regional offices, and fully supported the ration of the Organization's financial policy. One of plans for increasing efficiency through mechanization. 332 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
In that connexion, however, he would stress the need delegates in the steps taken by the Organization in for á gradual development. developing training programmes for the staff.The His delegation would have an opportunity later to need for such training before staff members were sent refertotheimportantsubjectof co- ordination out on assignments had become evident over the years. between WHO and other specialized agencies.Such The arrangements made and envisaged for the future co- ordination of programmes was essential -both in applied to new staff members as well as those who planning and in execution -and some lack of it had had been in the service of the Organization for some been felt in the developing countries. years.There was also a provision each year for a His delegation was pleased tonote theplea, limited number of staff members to take " study contained in the Secretary's statement, that health leave " to enable them to obtain up -to -date informa- should be taken into account in plans for economic tion on the scientific and technical developments in development; in Morocco it had always been placed their particular fields. on an equal footing with other projects in all five -year Another aspect of the training programme was that development plans. for malaria eradication personnel. Staff members In conclusion, he stressed the remarkable achieve- going to the special training centre in Jamaica were ment of the Secretary in having provided the Com- given instructions and up -to -date information on the mittee with a succinct summary of the events of the variousaspectsof . malariology,entomology and past year. laboratory techniques. At headquarters, the training effort for the time being was concentrated on WHO Dr KHALIL (Sudan) congratulated the officers of the country representatives.In general, the course was Committee on their election. He thanked the Secretary under the direction of a senior medical officer at for his comprehensive report, and was pleased to headquarters and included lectures by members of the note that, despite the increase in commitments of the Organization; external consultants were also employed Organization, its financial position remained sound. to deal with special aspects of the course and the " curriculum " included such items as :(1) history, Dr CHATTY (Syria) congratulated the officers of the structure and functions of WHO; (2) WHO's relations Committee on their election, and extended a warm with the United Nations and with other specialized welcome to new Members, and in particular to agencies;(3)status and conduct of international staff members; (4) staff regulations and rules; (5) duties Algeria. to be performed; and (6) techniques applicable to the The Secretary had been receiving expressions of type of function which the staff members were expected praise for his work during the last fifteen years, and to carry out. Arrangements had also been made on a there was no need now to add to them. very modest basis for administrative training -there With referencetotrainingcoursesfor WHO were two administrative trainees at the present time - representatives, he hoped that those courses would be and it was hoped that that trend could also be con- extended so that other senior appointees might benefit tinued in the future. from them. There was no doubt as to the benefit that All such training arrangements would contribute could be derived from such courses, especially when considerably to the human resources of the Organiza- staff were changing over from one specialty to another. tion and the more effective functioning of its personnel, as well as assisting the Organization in the improve- Mr ABRAR (Somalia) congratulated the Chairman, ment of the geographical distribution of its staff. Vice - Chairman and Rapporteur on their election. The Secretary deserved special commendation on Two speakers had also referred to mechanization, the statement he had presented to the Committee. which was a subject he had mentioned in his statement at the first meeting.He assured delegates that the The delegate of the Republic of Viet -Nam had referred to the need felt by some countries for information Organization would make use of modern management concerning new drugs.Somalia would particularly techniques and mechanical facilities available in a welcome assistance in that field. modest manner to begin with.There were, however, tasks which could be performed most effectively by Mr. SIEGEL, Assistant Director -General, Secretary, machines, such as the work carried out in finance, expressed the staff's appreciation of the remarks made accounting, budgets and statistics and also, no doubt, and assured all present that they would be borne in the medical research co- ordination programme. How- mind for the future development of the Organization. ever, mechanization would be undertaken in a gradual Commenting on the points raised during the discussion, and orderly manner and it would be some years before he referred to the special interest shown by many machines were used on a large scale. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SECOND MEETING 333
2.Financial Report on the Accounts of WHO for Mr BRUNSKOG, External Auditor, said that he had 1962, Report of the External Auditor, and Com- no additional comments to make. ments thereon of the Ad Hoc Committee of the Executive Board Dr CAYLA (France) said that he had listened with Agenda, 3.8.1 great interest to Dr Nabulsi's statement on behalf of the Ad. Hoc Committee of the Executive Board. The Before opening the debate, the CHAIRMAN, on behalf French delegation fully supported the draft resolution of the.Committee, welcomed Mr Brunskog,the External Auditor, to the podium. He then called upon proposed. Dr Nabulsi, representative of the Executive Board, to With reference to section 6 of the report, he sug- add any comments he might have to the report of the gested that the Committee might associate itself with Ad Hoc Committee of the Executive Board.1 the appreciation and thanks expressed therein to the External Auditor. Dr NABULSI, representative of the Executive Board, Mr MCKITTERICK (UnitedStatesof America) congratulatedtheChairman,Vice -Chairman and associated his delegation with the remarks made by Rapporteur on their election. the delegate of France. Introducing the report of the Ad Hoc Committee of the Executive Board, he explained that, in order The CHAIRMAN put to the Committee. the draft to comply with the provisions of Financial Regulation resolution contained in the Ad Hoc Committee's 12.4, the Executive Board at its thirty -first session report. had, by resolution EB31.R52, established an Ad Hoc Decision: The draft resolution was approved.2 Committee consisting of Dr. M. K. Afridi, Professor E. J. Aujaleu and Dr A. Nabulsi, to meet on 6 May The CHAIRMAN thanked Mr Brunskog, External 1963 to consider the report of the External Auditor Auditor, for his help in the matter. on the accounts of the Organization for the year 1962, and to submit to the Sixteenth World Health As- 3. Status of Collection of Annual Contributions and of sembly, on behalf of the Board, such comments as it Advances to the Working Capital Fund deemed necessary. The Ad Hoc Committee had met on 6 May 1963 Agenda, 3.8.2 and had elected Dr Afridi Chairman. Mr Brunskog, The CHAIRMAN asked the Secretary to introduce the External Auditor, had been present to reply to any item. questions raised. The SECRETARY referred the Committee to a report The items to which the Ad Hoc Committee wished by the Director -General, to which was annexed a to draw attention were mentioned in section 5 of its statement showing the status of collection of annual report, and section 7 contained a draft resolution for contributions and of advances to the Working Capital the Committee's consideration. Fund as at 30 April 1963.Section 2 of the report The draft resolution read : referred to the status of collection of contributions in The Sixteenth World Health Assembly, respect of the 1963 assessments and indicated that at the end of April 1963 the contributions received from Having examined the Financial Report of the active Members were 27.15 per cent. of the total Director -Generalfortheperiod 1 January to contributions of those Members.Details of those 31 December 1962 and the Report of the External contributions were given in the statement.Similar Auditor for the same financial period, as contained statements were dispatched to all Members of the in Official Records No. 126; and Organization each month.Since the beginning of Having considered the report of the Ad Hoc May, additional payments applicable to 1963 had Committee of the Executive Board on its examina- been received from eight countries and totalled just tion of these reports, under one million dollars, which raised the percentage ACCEPTS the Director- General's Financial Report of contributions received as at 13 May to 30.57 per and the Report of the External Auditor for the cent. As would be seen from section 3 of the report, financial year 1962. eighty -five Members' advances to the Working Capital Fund were fully paid, those of thirty Members were The CHAIRMAN asked the External Auditor if he outstanding and there were six new Members, includ- had anything to add to the observations contained ing former Associate Members, whose assessments in the Ad Hoc Committee's report. 2 Transmitted to the Health Assembly in section 1 of the Corn- ' Off. Rec. Wld Hith Org. 127, Annex 2. mittee's first report and adopted as resolution WHA16.5. 334 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II were to be fixed by the Assembly. It could not be said gested that the Committee should recommend to the that there were arrears with regard to the Working Health Assembly a resolution along the lines of those Capital Fund since the amounts due had to be paid adopted by previous Assemblies, but that it should before the end of 1963.Section 4 referred to contri- include a recommendation that the Seventeenth World butions for which the World Health Assembly had Health Assembly take action under Article 7 of the authorizedspecial arrangementsinresolution Constitution against any Members whose contribu- WHA9.9. tions were outstanding for two years or more.It Section 5 referred to the arrears of contributions would, however, in his opinion be preferable to defer for 1962 and prior years. The Executive Board in its consideration of the subject for a few days to enable resolution EB31.R29 had urged the Members con- delegates to give careful thought to the action required. cerned to liquidate arrears before the opening of the Sixteenth World Health Assembly.If they did not Dr CAYLA (France)agreed with theprevious do so, there was a possibility that Article 7 of the speaker that the debate should be adjourned but Constitution might be applied in accordance with wished beforehand to state his views. The Members paragraph 2 of resolution WHA8.13. concerned must have a reason for not paying their As was explained in paragraph 5.1.2, the Fifteenth contributions.If it was that they had insufficient World Health Assembly inresolution WHA15.9 resources available, then they should request a reduc- had accepted a proposal made by Bolivia for the tionintheircontributions -through theUnited liquidation of its arrears.The Director -General had Nations, since the Organization's scale of assessment been informed by the delegate of Bolivia that action was based on that of the United Nations. If, however, was being taken in the matter, but no payment had the arrears were due to negligence of their commit- so far been received. ments, the Organization should draw their attention It was stated in paragraph 5.1.3 of the report that to those undertakings. As the delegate of Ireland had on 1 January 1963 the arrears for 1962 and prior said, it was preferable not to apply the provisions of years, excluding those for China, were $1 691 354. Article 7 forthwith, but the lack of response to reso- Since that date, however, payments applicable to those lution EB31.R29 of the Executive Board was to be arrears amounting to $718 695 had been received, deplored. The matter was of considerable importance and since the beginning of May further payments and warranted further reflection; he agreed that a against arrears had been received from Chile, Peru decision should be postponed for the time being and and Liberia.Paragraphs 5.2 and 5.3 referred to the supportedtheproposal for adjournment of the unpaid contributions of China and of inactive Mem- debate. bers for the years prior to 1963. Dr LAYTON (Canada) associated himself with the Mr BRADY (Ireland) said that the subject of arrears remarks made by the delegate of Ireland and, to a of contributions had come up for consideration rather large extent, with those of the delegate of France; he early in the proceedings and he wondered whether it had not however interpreted the delegate of Ireland's was wise to take a definite stand on the matter without proposal as a formal motion of adjournment, but further study. He noted with regret that the number rather as a suggestion.He agreed that the matter of Members to whom the provisions of resolution required further thought and that a paragraph might WHA8.13 would apply was somewhat larger than in be inserted in the resolution on the subject, on the previous years and therefore felt that the matter lines suggested. required careful thought, particularly in view of the In reply to a question by the CHAIRMAN, Mr BRADY expanding programmes of the Organization and the (Ireland) said he had not made a formal proposal to necessity that all possible resources, big and small, adjourn the debate.If the Committee could come to should be made available to it.The action taken at an appropriate decision at the present meeting, he previous Assemblies had mainly been in the sense of would prefer that.However, he would rather the exhortations, which on a number of occasions had Committee gave further thought to the matter than had effect.The suspension of voting privileges was merely recommend to the Health Assembly a resolu- an action which any Assembly should be slow to take, tion similar to those adopted in the past. He would but in the present instance certain undertakings had welcome the views of other delegates on the subject. been given that had not been fulfilled. To take action was not pleasant, but account had to be taken of the Dr MUDALIAR (India) recalled debates in the past importance of maintaining the Organization's financial on the same subject, which was an important aspect position satisfactorily, and it would be dangerous if a of the work of the Assembly.He formally moved trend not to pay contributions developed.He sug- that a small working party, including some repre- COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : THIRD MEETING 335 sentatives of the Member countries concerned, be set Mr FURLONGER (Australia) found the matter a up to consider all aspects of the matter. painful one to raise and agreed that it would be preferable if the suspension of voting rights were Mr FERAA (Morocco) said that there was wisdom automatic, as was the case in certain other organiza- in all the suggestions put forward.It might be advis- tions.His delegation fully supported the proposal able to study more closely the reasons why Members that a small working party be set up which, in addition fell into arrears, but it was above all important that to the tasks to which reference had already been made, such a tendency should be checked.In his opinion, should give consideration to the possibility of auto- to save the embarrassment of application of the matic procedure in that connexion.All the points provisions of Article 7 of the Constitution, it would raised during the debate should also be given attention be preferable for their application to be made auto- by the working party. matic in certain cases, after a certain lapse of time. In conclusion, he fully supported the views expressed The CHAIRMAN proposed the following composition by the delegate of Ireland and the proposal by the for the working party : India, Iran, Ireland, the Philip- delegate of India that a working party be set up to pines, Poland, Sierra Leone, Venezuela.If the Com- consider the matter. mittee agreed, it could meet directly after the Com- mittee's afternoon meeting. Dr AL -WAHBI (Iraq)fully supported the views expressed by the delegate of Ireland. The problem Dr CASTILLO (Venezuela) recalled that the delegate was of much importance and more study was required of India had proposed including some Members whose before a decision could be reached.In the past such contributions were in arrears. complex matters had been resolved with the help of a The CHAIRMAN said that no delegates of the Member working party to prepare the ground and he therefore States concerned were present at the meeting; he wholeheartedly supported the proposal by the delegate therefore proposed that the working party should have of India that a working party be set up to go into the the composition he had indicated, and that it should matter and report its conclusions to the Committee. be empowered to hear any delegate of the Members Dr ALAN (Turkey) also supported the views ex- in arrears who might wish to make a statement. The pressed by the previous speakers and favoured the debate on the item would be adjourned until the setting -up of a working party to hear statements by working party submitted its report. the representatives of the countries concerned, who It was so agreed. would thus have an opportunity of explaining why such a state of affairs had arisen. The meeting rose at 12.5 p.m.
THIRD MEETING
Monday, 13 May 1963, at 2.30 p.m.
Chairman: Mr I. T. KITTANI (Iraq)
1.Status of Collection of Annual Contributions and of The CHAIRMAN announced that he had addressed a Advances to the Working Capital Fund (continued) letter, as Chairman of the Committee on Administra- Agenda, 3.8.2 tion, Finance and Legal Matters, to the five Member Mr SIEGEL, Assistant Director -General, Secretary, States concerned informing them of the action taken informed the Committee that he had received, since the by the Committee at the previous meeting and inviting previous meeting, notice of a payment by the Govern- ment of Paraguay which would meet the balance of its them to state their position, if they so desired, at the assessment for 1960 and for part of 1961. Accordingly, meeting, to be held immediately following on the the number of Member States in respect of whose present Committee meeting, of the working party set up contributions difficulties still existed was five. by the Committee to consider the question. 336 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Mr DE CONINCK (Belgium) recalled the fact that the income into account when considering the establish- problem of arrears of contributions had appeared on ment of the budget level for 1964. the agenda of several sessions of the Health Assembly. Even though a resolution had been adopted in the past Mr PERERA (Ceylon) asked for further information formulating certain measures which might have to be on the items which it was proposed should be financed implemented as a lastresort, in fact the Health from casual income. Assembly had never had recourse to them.It was The CHAIRMAN saidthatthe question of the important for the working party to bear in mind the delegate of Ceylon would be answered when the consideration that the situation was of long standing. Committee discussed item 3.3, Supplementary budget The CHAIRMAN said that the Committee would defer estimates for 1963, which was closely linked with the further consideration of that item until it had received items under discussion and which would be taken the report of the working party thereon (see minutes of after them.He recalled that the Committee had a the fourth meeting, section 3). number of items, including the present ones, on which a decision had to be reached before the Committee on Programme and Budget could proceed withits 2.Report on Casual Income : Status of the Assembly consideration of the budget level. Suspense Account Agenda, 3.8.3, 3.8.4 Dr CAYLA (France) said that it would be more The SECRETARY, introducing the items, recalled that logical for the Committee to consider the related item the Committee was required to consider at each 3.3, Supplementary budget estimates for 1963, before session of the Health Assembly the report of the items 3.8.3 and 3.8.4.That change in order would Director -General regarding casual income; in the enable the Committee to be informed of the reasons present instance, the casual income related to the for the supplementary budget estimates before it took budget for 1964 and to the supplementary budget a decision that included provision for financing them. estimates for 1963. The CHAIRMAN said he saw no objection to pro- The Director -General's report gave, in its paragraph 2, details of the casual income available under the ceeding forthwith with the discussion of item 3.3, various headings as at 30 April 1963, as well as reverting afterwards to items 3.8.3 and 3.8.4. information on the status of the Assembly Suspense It was so agreed (for resumption of discussion on Account. It was therefore useful for both items to be items 3.8.3 and 3.8.4, see section 4). considered simultaneously by the Committee. Paragraphs 3.1 and 3.2 of that report contained the 3.Supplementary Budget Estimates for 1963 recommendation of the Director -General and of the Executive Board and its Ad Hoc Committee that the Agenda, 3.3 amount of $500 000 of casual income be used to help Dr NABULSI, representative of the Executive Board, finance the proposed programme and budget estimates recalled that the Director -General had submitted to the for 1964, and, further, that the amounts of $438 100 Executive Board at its thirty -first session supplemen- required for the supplementary estimates for 1963 and tary estimates for 1963 in the amount of $162 000, of $349 100 for adjustments to the programme and $120 000 of which was required to meet the costs of a budget estimates for 1964 be financed from casual changeinthepostadjustmentclassificationfor income. Those recommendations were based on the Geneva from class 1 to class 2 and $42 000 of which principle of limiting the use of casual income for was to meet additional costs expected because of financing the annual budget in order to avoid sharp changes in post adjustment classifications for some of fluctuations in the annual assessments of Members. the regional offices where cost -of- living surveys were in As shown in paragraph 3.2 of the report, the balance of progress or about to be undertaken.The Executive casual income remaining after those deductions would Board had considered the report of the Director - be $96 358. General on the subject, contained in Official Records Should the Committee endorse the recommendations No.124, Annex 11, and had adopted resolution before it, the usual procedure to be followed would be EB31.R13 recommending to theSixteenth World for a report on the availability of casual income to be Health Assembly that it approve the supplementary transmitted by the Committee on Administration, budget estimates for 1963 and their financing as Finance and Legal Matters to the Committee on proposed by the Director -General, subject to minor Programme and Budget, as a separate report, so that adjustments in cost estimates, to be reported by the the Committee on Programme and Budget would be Director -General through the Ad Hoc Committee of able to take the situation existing in respect of casual the Executive Board. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : THIRD MEETING 337
Appropriation Purpose of Amount The Ad Hoc Committee of the Executive Board, section appropriation US $ which had met on 6 May 1963, in accordance with resolution EB31.R52, had considered the Director - PART III: ADMINISTRATIVE SERVICES General's report on the minor adjustments in cost 8. Administrative Services 27350 9.Other Statutory Staff Costs 36 estimates 1 and had, as stated in its report 1, noted that 620 the adjustments reported by the Director -General Total - Part III 63970 were of two kinds, firstly those that were mandatory under the Staff Regulations and Staff Rules of the PART IV : OTHER PURPOSES Organization and, secondly, those of a discretionary 10.Headquarters Building Fund 113000 nature. Mandatory adjustments, details of which were Total - Part IV 113000 contained in paragraphs 2, 3 and 4 of the Director - General's report, amounted to a total adjustment of Total - Parts II, III and IV438100 $285 100.The Ad Hoc Committee considered those estimates to be satisfactory and recommended their 3.DECIDES further to amend paragraph III of resolution approval by the Sixteenth World Health Assembly. WHA15.42 by increasing the amounts under sub -paragraphs The Ad Hoc Committee also recommended the (i) and (iii) as follows : (i) the amount of $ 35 990 available by reimbursement approval of the discretionary adjustments, details of from the Special Account of which were set forth in paragraphs 5 and 6 of the the Expanded Programme of Director -General's report, amounting to $40 000 for Technical Assistance provision for services to new Members and Members (ii) the amount of $402 110 representingmiscellaneous resuming active participation, and $113 000 for pro- incomeavailableforthe vision towards increased costs of the headquarters purpose building. He drew particular attention to the fact that Total $438 100 the Ad Hoc Committee had considered that the steps proposed by the Director -General towards meeting some of the additional costs of the headquarters Mr BRADY (Ireland) said that he had no objection to the supplementary budget estimates proposed for building were prudent and desirable. 1963. He agreed that it would be prudent to take the Noting that sufficient income was available to meet action recommended in respect of the headquarters the financing of the total supplementary estimates of building in view of the increased costs which had $438 100 for 1963, the Ad Hoc Committee submitted become apparent. for the consideration of the Committee on Administra- He requested clarification on two specific transfers tion, Finance and Legal Matters the following draft of funds; firstly, the decrease of $195 362 shown under resolution, which would replace the resolution in Appropriation Section 7, Other Statutory Staff Costs, paragraph 2 of resolution EB31.R13 : in the Director -General's report on transfers between sections of the Appropriation Resolution for 1963 The Sixteenth World Health Assembly, (Official Records No. 124, Annex 8); secondly, the Having considered the proposals of the Director -General and the recommendations of the Executive Board concerning increase of $130 000 under Appropriation Section 7, supplementary budget estimates for 1963, Other Statutory Staff Costs, in the Director -General's 1.APPROVES the supplementary estimates for 1963; report on supplementary budget estimates for 1963 2.DECIDES to amend the Appropriation Resolution for 1963 (Official Records No. 124, Annex 11), which amount (resolution WHA15.42) by increasing the amounts voted under had now been revised to $142 180. paragraph I as follows : The SECRETARY replied that the decrease of $195 362 Appropriation Purpose of Amount referred to was the result of greater precision achieved section appropriation US $ inrespectof distribution between appropriation PART II : OPERATING PROGRAMME sections of the assistance to be rendered to newly 4.Programme Activities 95250 independent countries. The amount shown in Official 5. Regional Offices 23700 Records No. 124, Annex 11, was intended to cover 7. Other Statutory Staff Costs 142180 unforeseen requirements. Total - Part II261130 The CHAIRMAN invited comment on thedraft resolution submitted by the Ad Hoc Committee of the 1 Of Rec. Wld Hlth Org. 127, Annex 3. Executive Board. 338 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Dr CAYLA (France) commended the representative 4.Report on Casual Income : Status of the Assembly of the Executive Board on his clear statement.He Suspense Account (resumed from section 2) moved the approval of the draft resolution. Agenda, 3.8.3, 3.8.4 Dr LISICYN (Union of Soviet Socialist Republics) The SECRETARY read out to the Committee the questioned whether it was a proper procedure for the following draft report of the Committee on Administra- Committee to approve, by approving the draft resolu- tion, Finance and Legal Matters to the Committee on tion before it,the amount relating to the Head- Programme and Budget, relating to availability of quarters Building Fund, since the entire question casual income : of headquarters accommodation, which constituted a The Committee on Administration, Finance and separate item of the agenda, had not yet been discussed. Legal Matters, having studied the amount of casual The Executive Board had discussed the matter at income available as at 30 April 1963 from assess- great length, and the question of constructing under- ments on new Members from previousyears, ground garages, and some other points, had given rise miscellaneous income, the cash portion of the to a number of objections. Assembly Suspense Account and the reimbursement from the Special Account of the Expanded Pro- The SECRETARY drew attention to paragraph 6 of gramme of Technical Assistance, recommends to the Director -General's report, setting out the reasons the Committee on Programme and Budget that which had prompted the Director -General to submit casual income in the amount of US $500 000 be that particular request for funds, which was only one used to finance the 1964 budget as it appears in of the measures being taken to obtain the additional Official Records No.121. The Committee on funds that would clearly be required. Furthermore, the Administration, Finance and Legal Matters further Fifteenth World Health Assembly had, by its Appro- recommends that, if the Committee on Programme priation Resolution for the financial year 1963 (WHA and Budget accepts the recommendation of the Ad 15.42) provided an amount of $387000 for repayment of Hoc Committee of the Executive Board to increase loans for the construction of the headquarters building. the1964 budget estimatesby $349 100,these Since WHO had not hitherto, owing to delays in the increased costs be also financed by using an additional construction work, drawn on that loan, it had been the $349 100 from the same source -i.e., a total of Director -General's view that that provision might be $849 100. used as a credit to the Headquarters Building Fund. As building costs had considerably increased, the The CHAIRMAN stated that the report would be Director - General had also thought it wise to increase circulated in the form of a committee document the amount by $113 000, thus making a total of before the following meeting, when a vote could be $500 000.There could not be the slightest doubt taken on it.The Committee would therefore defer that that amount was necessary, quite apart from the further consideration on the items before it until then question of underground garages. A similar provision (see minutes of the fourth meeting, section 2). wasalsoincluded inthesupplementary budget estimates for 1964, as additional funds would also be 5.Assessments for 1962 and 1963 of New Members necessary then. Agenda, 3.6 Dr ALAN (Turkey) supportedthe motion for The SECRETARY, introducing the item, said that it approval of the draft resolution. was necessary for the present session of the Health Decision:The draft resolution submitted by the Assembly to establish the assessments for 1962 and Ad Hoc Committee of the Executive Board was 1963 of the six Member States that had joined the approved unanimously.1 OrganizationsincetheFifteenthWorldHealth Assembly.It was proposed that their assessments The CHAIRMAN said that the unanimous approval of should be fixed at 0.04 per cent., and the Director - the draft resolution had satisfied the requirement, in General's report on the subject contained, in paragraph Rule 70 of the Rules of Procedure of the World 3, a draft resolution to that effect. Health Assembly,foratwo- thirdsmajorityfor It would also be necessary for the Health Assembly decisions affecting the amount of the effective working to consider whether those new Members, which were budget. carrying out malaria programmes, should be eligible for credits in the same way as Members listed in Schedule A to the Appropriation Resolutions for 1962 1 Transmitted to the Health Assembly in section 2 of the Com- mittee's first report and adopted as resolution WHA16.6. and 1963. A draft resolution providing for such credits, COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : THIRD MEETING 339
and a second draft resolution, making similar provision Decision: for Kenya and Mauritius, which would also be eligible (1)The draft resolution on assessment of new for credits in 1963, were also given in the Director - Members for 1962 and 1963 was approved.' General's report. (2)The draft resolution on eligibility for credits ByresolutionWHA13.16,theassessmentof was approved.2 Associate Members had been fixed at 0.02 per cent., and there was accordingly no need for a separate draft resolution on the assessment of Kenya and 6.Scale of Assessment for 1964 Mauritius. Agenda, 3.7 The draft resolution on the assessment of new The SECRETARY, introducing the item, recalled that Members for 1962 and 1963 read as follows : the Director- General's report on the scale of assessment for 1964 was submitted on thebasisof earlier The Sixteenth World Health Assembly, decisions of the Health Assembly with regard to thei, Noting that several States became Members of arrangements adopted concerning the annual scale of the Organization during 1962 and 1963 by depositing assessment. He called particular attention to the with the Secretary - General of the United Nations a provision in resolution WHA8.5 that the Health formal instrument of acceptance of the WHO Assembly should adjust the WHO scale to take into Constitution, account the latest available United Nations scale of assessment. DECIDES that these Members shall be assessed as The scale of assessment proposed for 1964, the follows : revised form of which was contained in an addendum
Member State 1962 1963 to the Director -General's report, gave effect to the per cent per cent total current membership of WHO. Algeria 0.04 0.04 Burundi 0.04 0.04 Dr VYSOHLÍD (Czechoslovakia) expressed his appre- Rwanda 0.04 0.04 ciation of the honour done to his country and to Trinidad and Tobago - 0.04 himself by his election to the office of Vice -Chairman. Uganda 0.04 As had been pointed out, WHO was required to Jamaica 0.04 base its scale of assessment on the latest available United Nations scale. In fact, the United Nations had Dr ALAN (Turkey) extended a welcome to the new not yet adopted its scale of assessment for 1963 and Members and Associate Members of the Organization. 1964 in its definitive form. In resolution 1870 (XVII) He moved the approval of the draft resolutions, on the General Assembly had requested the Secretary - the assessment of new Members, and on eligibility for General to undertake an expert study of statistical credits, contained in the Director -General's report. systems of national accounting, and the Committee on Dr CAYLA (France) supported the motion, but Contributions to report, in the light of that study and suggested that it would be desirable to incorporate in of information provided by Members, to the General one resolution provision for eligibility for credits both Assembly at its eighteenth session on the possibility of for the new Members and for the Associate Members revising the scale. Kenya and Mauritius. His delegation was accordingly of the opinion that the Health Assembly should take into consideration It was so agreed. the possibility of revising its own scale of assessment in the light of any decision the United Nations might The CHAIRMAN accordingly read out the following take. He proposed, therefore, that the draft resolution draft resolution on eligibility for credits, pointing out contained in the Director -General's report should be that the final words might read "1962 and /or 1963" or completed as follows : "1962 and 1963 as appropriate ". Considering that the WHO scale of assessment for The Sixteenth World Health Assembly 1964 is based on the latest available scale adopted by DECIDES that, since Algeria, Burundi, Rwanda, the United Nations, in accordance with the provisions Trinidad and Tobago, Uganda, Jamaica, Kenya, of resolution WHA8.5, paragraph 2 (5), adopted by and Mauritius are carrying out malaria programmes, the Eighth World Health Assembly; they are eligible for credits in 1962 and /or 1963 in the same way as those Members listed in Schedule ' Transmitted to the Health Assembly in section 3 of the Com- mittee's first report and adopted as resolution WHA16.7. A attached to the Appropriation Resolutions for 2 Transmitted to the Health Assembly in section 4 of the Com- the financial years 1962 and /or 1963. mittee's first report and adopted as resolution WHAI6.8. 340 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Noting that the General Assembly of the United Board had also noted that the Director -General had Nations in its resolution 1691 (XVI), after fixing the provided in the proposed programme and budget United Nations scale of assessment for 1962, 1963 estimates for 1964 for reimbursement to the Working and 1964 in paragraph 1 of the resolution, provides Capital Fund of $200000 advanced from the Fund un- in paragraph 5 that "in the event that the [General] der resolution WHA15.14 to help finance the construc- Assembly should at its seventeenth session revise the tion of the Regional Office for Africa. In view of the scale set out in paragraph 1 above, the contributions budgetary implications of the item and of the possible for 1962 shall be adjusted accordingly "; effects thereon of new voluntary contributions or Noting also that the General Assembly of the variations in the cost of the work, the Ad Hoc United Nations in its resolution 1870 (XVII) in Committee of the Executive Board appointed to meet paragraph 7 provides for possible revisions in the immediatelybeforetheSixteenthWorld Health scale of assessment as may appear warranted; Assembly had been requested to consider the latest DECIDES that, if the General Assembly of the information presented by the Director- General and to United Nations retroactively adjusts the United report on it to the Assembly.The report of the Nations scale of assessment for 1963, the WHO Director -General and that of the Ad Hoc Committee 2 scale of assessment for 1964 should be similarly indicated that the total building cost was estimated at adjusted, provided, however, that such adjustments about $700 000. That meant that, with the $100 000 shall be taken into account in calculating the provided for the purpose in the 1963 budget and the contributions to be paid by Members in respect of contributionsof $301 846 made orpledged by the budget of the Organization for the year 1965. Members of the Region, the entire amount of the advance of $300 000 authorized from the Working He hoped that such an amendment would prove Capital Fund would be needed.Since, however, acceptable to the Committee, particulary as it was in construction work would not begin before 1964, the keeping with the position adopted by the Fifteenth Ad Hoc Committee recommended that the Director - World Health Assembly on the subject. General be authorized to advance a further $100 000 from the Working Capital Fund and, if necessary, to Professor WIDY -WIRSKI (Poland) supported the make provision for the reimbursement of that sum in amendment. the programme and budget estimates for 1965. The The CHAIRMAN said that the amendment proposed Ad Hoc Committee therefore recommended, on by the delegate of Czechoslovakia would be circulated behalf of the Executive Board, the adoption of the later in the meeting as a working paper. He therefore following draft resolution : proposed to defer further consideration of the item until delegations had had an opportunity to study it The Sixteenth World Health Assembly, (see section 8). Having considered the report of the Director - General on accommodationfortheRegional Office for Africa and the report of the Executive Accommodation for the Regional Office for Africa 7. Board thereon; 2 Agenda, 3.12 Having notedwithgratificationthefurther Dr NABULSI, representative of the Executive Board, generous contributions offered by Members in the said that at its thirty -first session the Executive Board African Region to help finance the cost of extending had noted from the report of the Director -General 1 the accommodation of the Regional Office; that the plans for extending the building of the Recalling theprovisionsof paragraph 4 of RegionalOfficeforAfricahadbeenvirtually resolution WHA15.14, authorizing the Director - completed by the architect and that the detailed General, notwithstanding the provisions of part II, drawings should be finished during the current year. paragraph 1(2) of resolution WHA13.41, to ad- The Executive Board had been mainly concerned with vance from the Working Capital Fund an amount the arrangements for financing the work. It had noted not exceeding $300 000 to becreditedtothe that contributions had been made by a number of African Regional Office Building Fund; and Members of the Region and that the Republic of Noting that the Director -General will exercise South Africa had offered an interest -free loan of this authority to the extent of $200 000, reimburse- $200 000; it had requested the Director -General to ment being provided for in the proposed programme explore the details of that offer and report to the and budget estimates for 1964, Sixteenth World Health Assembly.The Executive
1 Off Rec. Wld Hlth Org. 124, Annex 13. 2 Off. Rec. Wld Hlth Org. 127, Annex 4. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : THIRD MEETING 341
1. INVITES all the Members in the African Region stress that there would be no departure from the that have not yet done so to make contributions for provisions of resolution WHA8.5, paragraph 2 (5). the extension of the Regional Office accommodation; and Dr VY §OHLiD (Czechoslovakia) agreed to withdraw the second preambular paragraph of his proposed 2. AUTHORIZEStheDirector -General,notwith- draft amendment and to delete the word "also" in the standing the provisions of part II, paragraph 1 (2) of first line of the third preambular paragraph. resolution WHA13.41, to advance from the Working Capital Fund an amount not exceeding $100 000 to Dr LISICYN (Union of Soviet Socialist Republics) be credited to the African Regional Office Building expressed his support for the draft amendment in its Fundtohelpfinancethesaidconstruction, revised form. He believed that the amendment would reimbursement to the Working Capital Fund of the be invaluable in rendering the proposed resolution sum so advanced to be provided for, if necessary, in more flexible in case there should be modifications in the programme and budget estimates for 1965. the scale of assessment.
Mr ROFFEY (United Kingdom of Great Britain and Dr LAYTON (Canada) was concerned lest a change Northern Ireland) moved that the draft resolution be in the scale of assessment might be made considerably approved. after the session of the Health Assembly and con- sequently involve governments in readjusting budgetary Dr CAYLA (France) seconded the motion. provisions which had already been approved. Decision:The draft resolution proposed by the The CHAIRMAN said that he understood that any Ad Hoc Committee of the Executive Board was adjustments which might be caused by a change in the approved unanimously.1 scale of assessment for 1964 would be taken into account only in the calculation of the assessments for 1965 and would not therefore affect national budgetary 8.Scale of Assessment for 1964 (resumed from section 6) procedures. Agenda, 3.7 Dr CAYLA (France) said that having heard the The CHAIRMAN said that the amendment proposed purpose of precedent the draft amendment, he by the delegation of Czechoslovakia to the draft entirely supported it. resolution on the scale of assessment for 1964 (see page Dr TIIIEME (Western Samoa) said that resolution 339) had been circulated and was open for discussion. WHA8.5 provided that no country should be assessed Dr AL -WAHBI (Iraq) asked for a clarification of the atmorepercapitathanthehighestassessed implications of the draft amendment. contributor, but the assessment for Western Samoa did, in fact, amount to a higher per capita rate than The SECRETARY said that the first two preambular that of the highest contributor. paragraphs of the draft amendment corresponded exactly, apart from appropriate changes of date, with The CHAIRMAN agreed that the level of the lowest the first two paragraphs of partII of resolution assessment had been the subject of complaint from many small countries, but the assessments were made WHA15.13. The third preambular paragraph referred in accordance with the scale determined by the General to the action requested by the General Assembly of the Assembly of the United Nations. United Nations in paragraphs 5 and 7 of its resolution 1870 (XVII) (on the scale of assessments for the appor- The SECRETARY said that a maximum rate of tionment of the expenses of the United Nations) assessmenthadbeenestablishedbyresolution which was reproduced in the document before the WHA8.5, and that a minimum rate had also been Committee. Itshould, however, be noted that, established. It was true that the minimum rate whereas the second preambular paragraph of part II of sometimes conflicted with the principle of per capita resolution WHA15.13 was based on a provision in limitation but the General Assembly of the United paragraph 5 of United Nations resolution 1691 (XVI), Nations had not so far reduced the minimum rate and no such provision existed in United Nations resolution consequently neither had the World Health Organiza- 1870 (XVII); the second preambular paragraph of the tion. proposed draft amendment did not therefore seem to be applicable.It was, however, most important to The CHAIRMAN said that it was to be hoped that the minimum rate of assessment might be reduced when 1 Transmitted to the Health Assembly in section 5 of the Com- next the United Nations General Assembly reviewed mittee's first report and adopted as resolution WHA16.9. the scale of assessment. 342 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Scale Dr THIEME (Western Samoa) recalled that his country Member (Percentage) was not a Member of the United Nations and was Czechoslovakia 1.06 therefore not subject to assessment by the General Dahomey 0.04 Assembly. Denmark 0.53 Dominican Republic 0.05 Dr ALAN (Turkey) welcomed the assurances that a Ecuador 0.05 subsequent modification of the scale of assessment El Salvador 0.04 Ethiopia 0.05 would not affect arrangements made by national Federation of Rhodesia and Nyasaland 0.02 authorities for paying their 1964 contributions, but Finland 0.33 asked when governments would be informed of the France 5.39 amount of those contributions. Gabon 0.04 Germany, Federal Republic of 5.17 The SECRETARY said that the previous procedure Ghana 0.08 Greece would be followed and all Members would be informed Guatemala 0.05 immediately after the Health Assembly of the amount Guinea 0.04 of their contributions to the budget of 1964.If the Haiti 0.04 draft amendment were accepted and if it later became Honduras 0.04 necessary to revise the scale as a result of adjustments Hungary 0.51 Id 1.84 or decisions taken by the General Assembly that India 1.84 affectedthe WHO scalefor1964,theresulting Indonesia 0.41 modifications would be taken into account in deter- Iran 0.18 mining the contributions to be paid by Members in Iraq 0.08 respect of WHO's budget for 1965. Ireland 0.13 Israel 0.14 The CHAIRMAN read the text of the proposed draft Italy 2.03 Ivory Coast 0.04 resolution, including the proposed draft amendment : Jamaica 0.04 Japan 2.06 The Sixteenth World Health Assembly Jordan 0.04 I Kenya 0.02 Korea, Republic of 0.17 DECIDES that the scale of assessment for 1964 shall be as Kuwait 0.04 follows : 0.04 Scale Laos Member (Percentage) Lebanon 0.05 Afghanistan 0.05 Liberia 0.04 Albania 0.04 Libya 0.04 Algeria 0.04 Luxembourg 0.05 Argentina 0.92 Madagascar 0.04 Australia 1.50 Malaya, Federation of 0.12 Austria 0.41 Mali 0.04 Belgium 1.09 Mauritania 0.04 Bolivia 0.04 Mauritius 0.02 Brazil 0.93 Mexico 0.67 Bulgaria 0.18 Monaco 0.04 Burma 0.06 Mongolia 0.04 Burundi 0.04 Morocco 0.13 Byelorussian SSR 0.47 Nepal 0.04 Cambodia 0.04 Netherlands 0.92 Cameroon 0.04 New Zealand 0.37 Canada 2.83 Nicaragua 0.04 Central African Republic 0.04 Niger 0.04 Ceylon 0.08 Nigeria 0.19 Chad 0.04 Norway 0.41 Chile 0.24 Pakistan 0.38 China 4.14 Panama 0.04 Colombia 0.24 Paraguay 0.04 Congo (Brazzaville) 0.04 Peru 0.09 Congo (Leopoldville) 0.06 Philippines 0.36 Costa Rica 0.04 Poland 1.16 Cuba 0.20 Portugal 0.14 Cyprus 0.04 Romania 0.29 COMMITTEE ON ADMINISTRATION FINANCE AND LEGAL MATTERS : FOURTH MEETING 343
Scale Scale Member (Percentage) Member (Percentage) Rwanda 0.04 Viet -Nam, Republic of 0.14 Saudi Arabia 0.06 Western Samoa 0.04 Senegal 0.05 Yemen 0.04 Sierra Leone 0.04 Yugoslavia 0.34 Somalia 0.04 Total100.00 South Africa 0.48
Spain 0.78 II 0.06 Sudan Considering that the WHO scale of assessment for 1964 Sweden 1.18 is based on the latest available scale adopted by the United Switzerland 0.86 Nations, in accordance with the provisions of resolution Syria 0.05 WHA8.5, paragraph 2 (5), adopted by the Eighth World Tanganyika 0.04 Health Assembly; and Thailand 0.14 Noting that the General Assembly of the United Nations Togo 0.04 in its resolution 1870 (XVII), in paragraph 7, provides for Trinidad and Tobago 0.04 possible revisions in the scale of assessment as may appear Tunisia 0.05 warranted, Turkey 0.36 DECIDES that, if the General Assembly of the United Nations Uganda 0.04 retroactively adjusts the United Nations scale of assessment Ukrainian SSR 1.80 for 1963, the WHO scale of assessment for 1964 should be Union of Soviet Socialist Republics 13.58 similarly adjusted, provided, however, that such adjustments United Arab Republic 0.22 shall be taken into account in calculating the contributions United Kingdom of Great Britain and Northern to be paid by Members in respect of the budget of the Orga- Ireland 6.88 nization for the year 1965. United States of America 31.29 Decision:The draft resolution, as amended, was Upper Volta 0.04 approved unanimously.' Uruguay 0.10 Venezuela 0.47 The meeting rose at 5 p.m.
FOURTH MEETING
Tuesday, 14 May 1963, at 9.30 a.m.
Chairman: Mr I. T. KITTANI (Iraq)
1.First Report of the Committee 3.Status of Collection of Annual Contributions and of Advances to the Working Capital Fund (continued At the request of the CHAIRMAN, Dr BRAVO (Chile), from third meeting, section 1) Rapporteur, read the Committee's draft first report. Agenda, 3.8.2 Decision:The first report was adopted (see page Progress Report by the Chairman of theWorking 409). Party At therequest of the CHAIRMAN, Mr BRADY 2.First Report of the Committee to the Committee on Programme and Budget (Ireland), who had been elected Chairman of the Working Party, gave a report on the progress made at At the request of the CHAIRMAN, Dr BRAVO (Chile), the meeting held after the afternoon meeting of the Rapporteur, read out the Committee's draftfirst Committee on the previous day. report to the Committee on Programme and Budget. The Chairman of the Committee had written to the Decision:The first report of the Committee to the delegations attending the Assembly from the Member Committee on Programme and Budget was adopted 1 Transmitted to the Health Assembly in section 6 of the Com- (see page 410). mittee's first report and adopted as resolution WHA16.10. 344 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
countries which might be affected by the application of continue his efforts, as in the past, for increasing Article 7 of the Constitution in accordance with voluntary contributions to the Malaria Eradication resolution WHA8.13, inviting them to be present at Special Account and to report on the matter regularly the deliberations of the Working Party. The Working to the Health Assembly. Section 2 gave details of the Party had heard the Chief Delegate of Bolivia on the status of the Malaria Eradication Special Account as subject of his country's arrears but neither of the at 30 April 1963 and indicated that the financing of the other two delegations concerned represented at the "regular" malaria eradication operations for the year Assembly had responded to that invitation. In view of 1963 was assured and that for 1964 the full cost of the the short notice given them, however, the Working "regular" eradication operations was included in the Party, in an effort to ensure that as full a picture as proposed regular budget estimates in accordance with possible was obtained as to the reasons for the arrears, resolution WHA14.15.It would be noted that there had decided that its Chairman should write a further was a balance of just under $1 300 000 available for the letter to the delegations of Panama and Guatemala. purpose of financing the cost of the "accelerated" That had been done, and arrangements would be made programme, but the amounts needed were far in excess for the Working Party to hold a second meeting to of that sum. Paragraph 2.4 mentioned the pledges in consider any reply received to those letters.At that cash and kind outstanding, while paragraph 2.6 time recommendations would be formulated on the showed theestimated requirementsfor the subject for the consideration of the Committee. "accelerated" portion of the programme for 1963 and 1964.Section 3 stressed the importance of continued The CHAIRMAN suggested that the debate on the item voluntary contributions to permit the implementation be suspended until a further report was received from of the programme operations plan mentioned in the Working Party. paragraph 3.3.Section 4 concerned fund raising and It was so agreed (see minutes of the fifth meeting, the requests made to the Director - General by the section 2). Executive Board and the World Health Assembly in their resolutions that he pursue his efforts to obtain voluntary contributions. 4.Malaria Eradication Special Account Appended to the Director- General's report were Agenda, 3.9 statements showing the contributions received from the various Member countries to the Malaria Eradica- At the request of the CHAIRMAN, Dr NABULSI, tion Special Account since its inception and those. representative of the Executive Board, introduced the made to the Special Malaria Fund of the Pan American item. The Executive Board, at its thirty -first session, had noted that the voluntary contributions (received Health Organization. and pledged) to the Malaria Eradication Special The Assembly might wish to adopt a resolution Account, added to the funds available from the along the lines of those approved at Health Assemblies in the past, reiterating the concern and the interest of regular budget and from other sources, were sufficient the Assembly in the continuing efforts to obtain to finance the "regular" malaria programme in 1963 voluntary contributions to enable the carrying out of but not to carry out activities under the "accelerated" the "accelerated" portion of the malaria eradication programme, the value of which was generally recog- programme to the extent such funds became available. nized.The Board had therefore again appealed (in resolution EB31.R26) to those Member States that Delegates would recall that some years ago financial difficulties had been encountered in connexion with could do so to contribute to the Malaria Eradication Special Account and had requested the Director - the Expanded Programme of Technical Assistance General to continue his efforts to obtain voluntary when the amounts expected to be made available on a voluntary basis had not in fact been received.The contributions. regular budget of the Organization had had to be Mr SIEGEL, Assistant Director -General, Secretary, charged with the sums corresponding to the amounts summarized the contents of the report by the Director - required for projects on which work had already General.' Section 1 referred to resolution WHA15.34 started, to save losing the investments already made. of the Fifteenth World Health Assembly, which It was the Director -General's intention, to prevent reiterated the conviction of the Health Assembly that such a situation arising again, to obligate funds continued voluntary contributions in cash and kind against the voluntary account to cover not only the were essential for accelerating the malaria eradication current year's obligations but also the continuing programme and requested the Director -General to commitments for the ensuing year,either to the completion of the particular activity approved for ' Ox. Rec. Wld H1th Org. 127, Annex 5. implementation within a period of two years, or to COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FOURTH MEETING 345 such appropriate phase thereof as would be decided Among those who worked in malaria eradication upon in each instance. It was the view of the Director - there was an esprit de corps comparable to that of the General that, by following such a conservative financial astronauts and space scientists preparing for and policy in respect of the activities dependent upon carrying out their explorations. Such men and women voluntary contributions, it would be possible to avoid were engaged in what was certainly the most successful difficulties which had arisen in the past, in accordance world -wide disease eradication programme ever under- with the wish expressed by the Assembly at that time. taken by mankind. It had to be seen to that they had the resources to enable them to reach their objective, Mr McKITTERICK (United States of America) noted for that objective was quite as achievable and quite that, as pointed out in the Director -General's report, as important as landing a human being on the surface the transfer to the WHO regular budget of the bulk of of the moon. the malaria eradication programme would be com- pleted in 1964. He felt that that fact was a considerable At the request of the CHAIRMAN, Dr BRAVO (Chile), tribute both to the skill and energy of the managers of Rapporteur, read the following draftresolution : WHO and to the support which the programme had The Sixteenth World Health Assembly, received from the Member States. Having considered the report of the Director - The Organization was charged with giving force and GeneralontheMalariaEradicationSpecial leadershiptothe world -wide malaria eradication Account; programme. It had been observed in many quarters in Having noted that the financing of the "regular" the Assembly that the job had not yet been completed. malaria eradication programme for the year 1963 Indeed, it had not. To do an effective world -wide job isassuredandthat,accordingtoresolution of malaria eradication many millions more would be WHA14.15, the full cost of the "regular" malaria be needed. The need for that money had to compete eradication programme for the year 1964 is included with other priority needs in the developing countries, in the proposed regular budget estimates; even with other needs in the field of health.In the circumstances it was not therefore possible to prepare Realizing, however, that funds are available only a financial plan or time -table for the completion of forfinancingaportionof the"accelerated" that vital programme. malaria eradication programme planned for 1963 Recognizing those realities, the Government of the and 1964; United States of America wished to reaffirmits Noting further that the "accelerated" programme continued unwavering commitment to the objective of will be financed through funds set aside by the the world -wide eradication of malaria.Financially Director -General not only for the current year's speaking, only the first milestone had been passed - obligations but also for continuing commitments in the establishment within the regular budget of a the ensuing year either up to the full completion of thriving programme in keeping with WHO's admin- any individual activity approved for implementation istrative capacity and its other priority tasks.The within a period of two years, or to such appropriate contributions of the United States Government to the phase of the activity as would be decided in each Malaria Eradication Special Account had been made instance depending upon its nature, with the purpose of encouraging such a programme in 1. REQUESTS the Director -General to transmit this the regular budget.His Government intended to resolution together with the report of the Director - continue to support the malaria eradication pro- General to all Members of the Organization, calling gramme through the regular budget of WHO, through particular attention to the Assembly's expression of continued bilateral support within its means and appreciation; and within the priority needs of the countries, and through 2.. REITERATES its appeal to Members in a position otherinternationalorganizationslikeUNICEF, to do so, and especially to economically more whichhadresourceswhichcouldlogicallybe developed Members, to make voluntary contribu- channelled into malaria eradication.The United tions to the Malaria Eradication Special Account in Statesof America would alsoencourageother order to enable the Organization to carry out governments to lend their support through the United planned "accelerated" operations. Nations and other channels, and hoped that WHO wouldpursuetheMalariaEradicationSpecial In the absence of any comments, the CHAIRMAN Account, particularly as a means of attracting support suggested that the item be left in abeyance until the for "special" projects within the programme -projects text of the draft resolution had been circulated to the perhaps for demonstrating new techniques or for meeting. starting operations in new regions. It was so agreed (see section 9). 346 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
5.Malaria Eradication Postage Stamps As stated in paragraph 6.4,thefinalfinancial Agenda, 3.10 account of income and expenditure was expected to be submitted to the thirty -third session of the Executive At the request of the CHAIRMAN, Dr NABULSI, Board and to the Seventeenth World Health Assembly. representative of the Executive Board, introduced the Section 6 of the report also explained how the project item. The Executive Board had studied the situation would be terminated and the steps which would be with regard to the issue of malaria eradication postage stamps and had considered the results thereof ex- taken as regards unsold stamps and related philatelic material, which would be destroyed in accordance with tremely satisfactory from the point of view of publicity Article V (a) of the agreement between WHO and the and worth while from the financial point of view. The Inter -Governmental Philatelic Corporation, although Board had taken note of the arrangements made for the Organization would retain a few postage stamps the termination of the project and had expressed the for display purposes at headquarters and in the hope that the donations promised would be received in regional offices. time; it had also confirmed its previous decision that postage stamps and philatelic material issued after 31 Dr ALAN (Turkey) said that, although the sales of December 1962 would not be considered as officially postage stamps had not been high, the publicity given part of the campaign.1 tothe malaria eradication programme had been successful and his delegation was satisfied with the The SECRETARY saidthatsincetheDirector - results of the campaign.He thanked the countries General's report on the subject' had been in the hands that had participated therein and congratulated the of Committee members for some time, he would not Director -General on his activities in that connexion. go into detailed explanation of its contents. Section 1 gave the background and purpose of the The CHAIRMAN suggested that, in the absence of campaign, which was (1) to disseminate information further comments, the discussion be resumed when and stimulate interest in the campaign against malaria, the draft resolution on the item had been circulated to and (2) to provide an additional source of income for the meeting. the world -wide malaria eradication programme. The It was so agreed (see section 10). success of the campaign had shown that information had been disseminated and interest stimulated. There 6.Appointment of the External Auditor had been a total of 114 participants, as was explained Agenda, 3.16 in paragraph 2.1, and eighty -threecountries and At the request of the CHAIRMAN, the SECRETARY territories had made or promised donations either in introduced the item, and drew attention to the Director - stamps, philatelic material and /or in cash. A statement General's report on the subject.It was the Health showing the participation of Members of WHO in the Assembly which appointed the External Auditor and, campaign, and a list of participants, with the dates of since the term of office of Mr Uno Brunskog expired issue of their stamps and related philatelic material, with the submission of his report on the accounts for were appended to the report. the year 1963, it was necessary for an appointment to Members of the Committee would be pleased to be made to cover the audit of accounts from 1 January note the extensive publicity which had resulted from 1964. He was able to inform the Committee that the campaign; section 3 referred to the coverage in the Mr Brunskog was prepared to accept the extension of press and in radio and television programmes, and to his appointment should the Assembly so decide. The the part played not only by the postal administrations Director -General's report contained a draft resolution but also by the International Boy Scout Movement, along the lines of previous resolutions adopted by the and several chemical and pharmaceutical companies. Health Assembly in connexion with the appointment The value of the postage stamps and related philatelic of the External Auditor. items sold as at 31 March 1963 amounted to $203 271 The draft resolution read : which, after deduction of the sales agent's commission, The Sixteenth World Health Assembly left a total of $172 780.Cash donations amounting to $22 094 had been received and further donations RESOLVESthat beappointed since that date had been announced from Madagascar, External Auditor of the accounts of the World the Ivory Coast and Cameroon. No doubt additional Health Organization for the three financial years funds would be received before the close of the 1964 to1966 inclusive, to make his audits in campaign. accordance with the principles incorporated in Article XII of the Financial Regulations, with the 1 Resolution EB31.R41. provision that, should the necessity arise, he may 2 Off. Rec. Wld HIM Org. 127, Annex 6. designate a representative to act in his absence. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FOURTH MEETING 347
Dr CAYLA (France) formally proposed the approval making it impossible for the World Health Assembly of the draft resolution, with the insertion of the name of also to take place in that building. He suggested that Mr Uno Brunskog. delegates might take any steps possible with the various other ministries within their governments to Decision:The draft resolution 1 was approved, with the inserticn of the name of Mr Uno Brunskog. ensure that the trade conference concerned was not held at the time the World Health Assembly was due to take place. Should difficulties later be encountered, the 7.Report on Amendments to the Staff Rules, as Executive Board might have to take action to deal with confirmed by the Executive Board them, since clearly a change in the place of the meeting Agenda, 3.18 to a building other than the Palais des Nations, or to At the request of the CHAIRMAN, Dr NABULSI, another city or country, would entail considerable representative of the Executive Board, introduced the expenditure which was not foreseen in the budget. item.According to Staff Regulation 12.2, a certain number of amendments to the Staff Rules made by the The CHAIRMAN reminded the Committee that it was Director -General, which had been confirmed by the the task of the Assembly to decide in which country or Board, were reported to the Health Assembly. Many region the next Assembly should be held. of them were of an editorial nature, while others were At his request, Dr BRAVO (Chile), Rapporteur, read necessary to bring the rules into line with those the following draft resolution : applicable in other international organizations. The Sixteenth World Health Assembly, The SECRETARY said that the amendments made by Considering the provision of Article 14 of the the Director -General and confirmed by the Executive Board required only to be noted by the Assembly Constitution with regard to the selection of the country or region in which the next Health Assembly At the request of the CHAIRMAN, Dr BRAVO (Chile), will be held, Rapporteur, read the following draft resolution : DECIDES thattheSeventeenth World Health The Sixteenth World Health Assembly Assembly shall be held in Switzerland. NOTES the amendments to the Staff Rules made by (Turkey) it might to the Director- General and confirmed by the Execu- include in the resolution some phrase which would tive Board.2 strengthen the position of ministries of health vis à vis Decision:The draft resolution was approved.3 their governments and other ministries.Accordingly, he suggested that the resolution include mention of the difficultiesinvolved, and, inparticular,the extra 8.Selection of the Country or Region in which the expenses that would be incurred should it be necessary Seventeenth World Health Assembly will be held to hold the Assembly elsewhere than in the Palais des Agenda, 3.5 Nations. That was a suggestion, rather than a formal At the request of the CHAIRMAN, the SECRETARY proposal, and he would like to hear the opinion of introduced the item. He referred to Article 14 of the other delegates. Constitution, which specified that the Assembly would The CHAIRMAN quoted Article 14 of the Constitution, select the country or region in which the next annual as follows : "The Health Assembly . . . shall select session would be held, the Executive Board sub- the country or region in which the next annual session sequently fixing the place. Since the Director -General shall be held, the Board subsequently fixing the place." had received no invitation to hold the Seventeenth That did not, of course, prevent the Assembly from World Health Assembly elsewhere, it would normally including anything of a general nature in a resolution take place in Switzerland. on the subject. He felt it his duty, however, to draw attention to the difficulties which might arise in view of the possibility Mr FERAA (Morocco) said that it had already been that a trade conference might be held in the Palais des suggested that the Assembly might have to be held Nations, which might continue into May 1964, somewhere in Switzerland other than in Geneva. He wondered whether, if there were no administrative 1 Transmitted to the Health Assembly in section 1 of the Com- difficulties involved, it might be possible to change the mittee's second report and adopted as resolution WHAI6.14. date of the Assembly in order to solve the problem: 2 Off Rec. WU HIM Org. 124, resolution EB31.R37 and With regard to the Secretary's suggestion, it might be Annex 6. somewhat difficult for ministries of health to try to 3 Transmitted to the Health Assembly in section 2 of the Com- mittee's second report and adopted as resolution WHA16.15. intervene at government level: the various depart- 348 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II ments enjoyed a considerable degree of autonomy, and budget of the United Nations with considerable extra it would be difficult to take any effective action, even cost in order to hold conferences in different places on if some such provision were included in the draft account of insufficient co- ordination.The Economic resolution. and Social Council would decide on the dates of the Mr FURLONGER (Australia) supported the sugges- trade conference during the summer.He agreed tion made by the delegate of Turkey.To adopt a with the Secretary that the resolution should not seem resolution specifying Switzerland as the country where to weaken the Organization's position. the next Assembly should be held would considerably Mr FURLONGER (Australia), although impressed by limit freedom of action of the Executive Board and the the remarks made by the Secretary and the delegate of Secretariat. In view of the fact that it seemed possible the United States of America, felt that the Committee that the next Assembly might have to meet outside should be realistic and take into consideration all Switzerland, he would propose that the following possible contingencies.It was not very likely that the proviso be added to the draft resolution : position of ministries of health would be very strong Unless the Executive Board should consider that vis -a -vis the various ministries concerned with trade : it circumstances subsequent to the meeting of this seemed to be a case of "one against several ".If the Assembly make it essential to meet elsewhere. Assembly adopted the draft resolution now before the Committee, and it then became impossible for the next Mr ZOHRAB (New Zealand) agreed with the sugges- Assembly to be held in Switzerland, what would tion made by the delegate of Australia. happen ? The Executive Board had no authority to act The SECRETARY explained that the possibilities of in such a situation. It might even be impossible to hold adjusting the dates of the Assembly had been explored. any Assembly at all. The exact dates of the trade conference were not yet The CHAIRMAN reminded the Committee that the known, and it seemed possible that it might be held early enough in 1964 for the Assembly to start in task now before it was to make a decision concerning the country or region in which the next Assembly was mid -May. However, that would mean that ILO would to be held.It was not concerned with the particular also have to delay its conference by a week or so, which place to be selected, so that the argument put forward might cause some difficulties.If the Organization had been given two years' notice it could have made by the delegate of Australia did not seem relevant. arrangements for some adjustment, such as had been The SECRETARY suggested that the word "Switzer- made in 1961, when the Assembly had been held in land" in the resolution might be replaced by "Europe ". February, in New Delhi. But any such change would involve additional cost, and there was no budgetary Mr FURLONGER (Australia) shared the desire of the Secretariat not to weaken the position of the Organiza- provision for that. On the. other hand, a change of tion.In proposing his amendment, his intention had date involving only one or two weeks in either direc- been merely to ensure that the Assembly and the tion could be made without any difficulty, provided Executive Board would be carrying out their functions other organizations could make similar adjustments. The proposal made by the delegate of Australia correctly according to the Constitution. The suggestion to change the word "Switzerland" to "Europe" did not would keep the position flexible, and it was therefore of really seem to meet the situation :the number of considerable merit.However, it might weaken the position of the Organization if the possibility of countries in Europe was considerable. On the other hand, he doubted very much whether there were any having to make a change were recognized in advance. other place in Switzerland apart from Geneva where If the Organization were forced to hold the Assembly the Assembly could be held : in practice, "Switzerland" elsewhere, the additional cost involved might amount really meant Geneva. He had been concerned as to the to $500 000. constitutional position of the Executive Board if it had Mr McKITTERICK (United States of America) said found itself in the position of having to change the that the trenchant remarks made by the Secretary decision contained in an Assembly resolution. How- echoed the sentiments of his delegation. He hoped that ever, he now recalled section (i) of Article 28 of the labour and health ministries of Member States would Constitution which stated that the functions of the be able to influence trade ministries.It was his Board should be "to take emergency measures within understanding that, according to the regulations of the functions and financial resources of the Organiza- United Nations conference procedures, if the venue of tion to deal with events requiring immediate action ". a conference were changed the host government would He would therefore be prepared to withdraw his have to pay the difference in cost. He hoped that it suggested amendment, if it was agreed that, according would not become the fashion to burden the regular to that article, the Executive Board was authorized to COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FOURTH MEETING 349 take emergency measures, should itlater become priority to it rather than to occasional meetings which impossible to hold the next Assembly in Switzerland. could be held in any other town without any financial disadvantage. The Assembly should therefore have no Mr BRADY (Ireland) agreed thatitwould be hesitation in claiming its right to that priority.He undesirable for the Organization to concede in advance fully supported the suggestion of the delegate of its position regarding the holding of the next Assembly Ireland that the Secretariat prepare a draft resolution in May, in Geneva.It should be borne in mind that along the lines indicated. WHO had for many years, by agreement with the United Nations authorities, held its Assemblies in the Dr AL -WAHBI (Iraq) understood that the holding of Palais des Nations :it should therefore be given every an Assembly anywhere other than at headquarters opportunity to continue to do so.In fact, it was (whether elsewhere in Switzerland or in some other part essentially a problem of co- ordination that might still of Europe) would cost an additional $500 000, for be settled by compromise and rearrangement of dates, which no provision had been made. He was inclined to particularly since the date of the forthcoming trade support the adoption of a resolution similar to those conference had not yet been fixed. adopted in previous years, so as not to weaken the On the assumption, therefore, that the constitutional position of the Organization.The text would be position was as mentioned by the delegate of Australia weakened by thesubstitutionof "Europe"for (that, should the Executive Board be faced with an "Switzerland ". He whole -heartedly supported the emergency situation following the adoption of what suggestion made by the delegate of Ireland. might seem to be a rather restrictive resolution, it could take the necessary action to meet the situation) he The CHAIRMAN reminded the Committee that the would support the adoption of the resolution naming only formal proposal now before it was thedraft Switzerland as the country where the next Assembly resolution as read out by the Rapporteur. should be held. Dr VANNUGLI (Italy)fully supported the draft In addition, he suggested that the Rapporteur and resolution before the Committee. the Secretariat might together formulate a resolution He considered the suggestion of the delegate of to be considered under item 3.19 of the agenda - Ireland a very wise one, and thought that the Director - Decisions of the United Nations, specialized agencies General and the Executive Board should be allowed and the International Atomic Energy Agency affecting freedom of action to take any steps which might seem WHO's activities.That resolution should plead for necessary. He hoped that there would be no question improved and continued co- ordination between the of additional expenditure, and that it would not be agencies concerned regarding the holding of meetings, necessary to invoke Article 28 (i) of the Constitution, bearing in mind the necessity for facilitating the which was not intended to refer to a purely administra- holding of annual assemblies by organizations such as tive matter such as the holding of an Assembly away WHO at the normal time, in view of the difficulties from headquarters. otherwise incurred for the Organization's work. Decision:The draft resolution was approved.1 The CHAIRMAN thanked the delegate of Ireland for his excellent suggestion, which would be considered Mr ROFFEY (United Kingdom of Great Britain and under the appropriate item of the agenda. Northern Ireland) suggested that, when the Secretariat drafted the proposed resolution regarding co- ordina- Dr CAYLA (France) said that the delegate of Ireland tion, reference should be made to the cost that a had just expressed what he himself had in mind. The change of venue would incur for WHO. World Health Organization was a specialized agency The CHAIRMAN said that that suggestion would be of the United Nations, a permanent institution, and taken into account.(See minutes of the seventh financially one of the most important. Article 13 of the meeting, section 3, page 369). Constitution provided that the Health Assembly should meet in regular annual session.As a general rule, Assemblies should be held at headquarters, and it was 9.Malaria Eradication Special Account (resumed exceptional that they should be held abroad.It was from section 4) clear that meetings at headquarters were less expensive Agenda, 3.9 than those held elsewhere. It would seem quite logical The CHAIRMAN reminded the Committee that the that priority should be given to a permanent institution Rapporteur had already presented toitadraft which had to meet annually.It should have the possibility of meeting at its headquarters on premises 1 Transmitted to the Health Assembly in section 3 of the Com- belonging to the United Nations, which should give mittee's second report and adopted as resolution WHA16.16. 350 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II resolution on the Malaria Eradication Special Account donations either in stamps and other philatelic (see page 345). He called for any further discussion on material or in cash; the item. 4.NOTES that the sale of stamps and related philatelic material will close during the year 1963 Dr VANNUGLI (Italy) supported the draft resolution, and that any unsold philatelic material will be duly but thought that paragraph 1 was somewhat imprecise, destroyed by theOrganizationinthe manner and that it should be stated to whom the Assembly described in the report of the Director- General; and was expressing appreciation. 5.REQUESTS the Director -General to submit a final The CHAIRMAN suggested inserting in paragraph 1, financial report on this project to a subsequent following the words "expression of appreciation ", the session of the Executive Board or the World Health words "to the donors to the Malaria Eradication Assembly. Special Account ". Decision:The draft resolution was approved.2 Decision:The draft resolution, as amended, was approved.1 11.Annual Report of the United Nations Joint Staff Pension Board for 1961 Agenda, 3.20.1 10.Malaria Eradication Postage Stamps (resumed The SECRETARY, at the invitation of the CHAIRMAN, from section 5) introducedtheDirector -General'sreporton the Agenda, 3.10 United Nations Joint Staff Pension Fund.' He thought At the invitation of the CHAIRMAN, Dr BRAVO that no further elaboration was needed. The United (Chile), Rapporteur, read the following draft resolu- Nations Joint Staff Pension Board submitted such a tion : report on the operation of the United Nations Joint The Sixteenth World Health Assembly, Staff Pension Fund to the Assembly each year. The Director -General'sreport contained the following Having considered the Director -General's report draftresolutionfortheconsiderationofthe on the malaria eradication postage stamp campaign, Committee : "The World United against Malaria "; and The Sixteenth World Health Assembly Taking into account the final list of participants, with the dates of issue of their stamps and related NOTES the status of the operation of the Joint Staff Pension Fund as indicated by the annual report philatelic material, under the World Health Organi- for the year 1961 and as reported by the Director - zation's malaria eradication postage stamp plan, as General. shown in Appendix 2 of the report, Decision:The draft resolution was approved.4 1. NOTES with satisfaction the results obtained through this philatelic campaign in publicizing the The meeting rose at 11.55 a.m. world malaria eradication programme and in raising funds for the Malaria Eradication Special Account; 2 Transmitted to the Health Assembly in section 5 of the Com- mittee's second report after correction in accordance with Rule 68 of the Rules of Procedure (see fifth meeting, section 1), and 2.EXPRESSES its appreciation to the governments adopted as resolution WHA16.18. that have participated in the project; ' The report gave a summary of the annual report of the Joint Staff Pension Board (United Nations document A/5208), 3.THANKS those governments that have offered including the decisions taken by the Pension Board at its eleventh session in April -May 1962. 1 Transmitted to the Health Assembly in section 4 of the Com- 4 Transmitted to the Health Assembly in section 6 of the Com- mittee's second report and adopted as resolution WHA16.17. mittee's second report and adopted as resolution WHA16.19. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FIFTH MEETING 351
FIFTH MEETING
Thursday, 16 May 1963, at 10.20 a.m.
Chairman: Mr I. T. KITTANI (Iraq)
1. Second Report of the Committee 2.Status of Collection of Annual Contributions and of Advances to the Working Capital Fund (con - The CHAIRMAN said that, in accordance with Rule 52 tinued from fourth meeting, section 3) of the Rules of Procedure of the Health Assembly, it Agenda, 3.8.2 was not necessary for the Rapporteur to read out the Report of the Working Party Committee's draft second report, since it had been in in the hands of delegates for more than twenty -four The CHAIRMAN invited Mr Brady, as Chairman of hours. the Working Party set up to consider the item, to introduce its report. Dr CAYLA (France) wished, without reopening the discussion, to propose a slight amendment to the Mr BRADY (Ireland) said that it would be noted that resolution in section 5- Malaria eradication postage the Working Party had found it possible to arrive at an stamps (see text of draft resolution on page 350). He agreed conclusion on the rather difficult question under thought it could he considered as a correction in consideration. accordance with Rule 68 of the Rules of Procedure. The problem which the Working Party had been Paragraph 2 of that resolution expressed appreciation asked to investigate was a very important one in all the to the governments that had participated in the project, international organization, although it had fortunately while paragraph 3 merely thanked those governments not hitherto been a very pressing problem for WHO. that had offered donations either in stamps and other Article 7 of the Constitution stated : philatelic material or in cash. He considered it more If a Member fails to meet its financial obligations appropriate for the words "Thanks the governments" to the Organization or in other exceptional circum- to be used in the case of paragraph 2 and "Expresses stances, the Health Assembly may, on such condi- its appreciation to those governments" in paragraph 3. tionsasitthinks proper, suspend the voting privileges and servicesto which a Member is The CHAIRMAN agreed that the proposed amendment entitled . . . did not alter the substance of the resolution, and was therefore acceptable. In pursuance of that Article, the Eighth World Health Assembly had adopted resolution WHA8.13 Paragraphs 2 and 3 would thus read : which, in addition to urging the prompt payment of 2. THANKS the governments that have participated contributions, resolved that :
in the project; . . .if a Member is in arrears in the payment of its financial contributions to the Organization in an 3. EXPRESSES its appreciation to those governments amount which equals or exceeds the amount of the that have offered donations either in stamps and contributions due from it for the preceding two full other philatelic material or in cash; years at the time of the opening of the World Health Decision:The amendment proposed by the dele- Assembly in any future year, the Assembly shall gate of France was adopted. consider,in accordance with Article7of the Constitution, whether or not the right of vote of such The CHAIRMAN put the report to the Committee a Member shall be suspended; section by section. Since there were now a number of Members that Decision:Thereport wasadopted,withthe might come within the terms of resolution WHA8.13, amendment already approved to section 5 (see the Committee had asked the Working Party to en- page 410). deavour to clarify the position as to what action might 352 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II be taken during the current year or what future pro- had been made to the effect that some form of auto- cedures might be introduced. matic forfeiture of vote should take place if a Member The Working Party had met on 13 and 15 May and fell into arrears to the extent that would bring the had listened to interesting statements by the delegates terms of resolution WHA8.13 into operation.The of Bolivia and Guatemala on the position with regard Working Party had, however, considered that it would to arrears in their countries' contributions. Delegations be premature to take such action, since the action that from the other countries affected by the terms of another type of organization might take in similar resolution WHA8.13 were not present at the current circumstances did not necessarily commend itself to a Assembly. health organization. Any humanitarian organization The Working Party had had a very full discussion of must take into account the value of participation the matter, and he was happy to report that it had been in its assemblies by all its Members. It had therefore possible, with no dissentient voice, to put forward been decided to recommend that voting rights should itsreport, with the draft resolution itcontained. not be suspended at the present Health Assembly. The draft resolution was divided into two parts : No question of forfeiture of services had arisen in Part I dealt mainly with the exhortation to Members to either the Working Party or the Committee.It was continue to pay their contributions promptly.He important to emphasize that, in a health organization, considered it necessary to get the problem into correct the services must continue to be available for the perspective as far as WHO was concerned.It was a relief of suffering humanity. tribute to the Director - General and his staff that Paragraph 2 of part II of the draft resolution, if contributions had been so promptly collected; but approved, would request the Executive Board to make they, of course, could perform only one part of the specific recommendations, with the reasons for them, operation, and the real tribute must go to Member to the Health Assembly, with regard to any Members in States, which, by and large, had paid so, promptly, arrears in the payment of contributions to an extent enabling it to be reported each year that the rate of that would invoke the provisions of Article 7 of the payment of contributions to WHO was among the Constitution. highest of all the international organizations.That Paragraph 3 invited Members that might be affected fact suggested that the Organization had proved by the terms of resolution WHA8.13 to submit to the itself to the satisfaction of Members, which regarded Executive Board a statement of their intentions as to its work to be of such importance that very few had payment of their arrears. The intention of the Working failed to pay their contributions in reasonable time. Party had not been to have a merely automatic The draft resolution noted that position with satisfac- procedure whereby explanations would be forwarded tion, and part I continued in terms similar to those Of to the Board without its taking action.It was hoped resolutions adopted in previous years, urging Members that the Board would examine the matter and make an to pay their contributions regularly and promptly. appropriate recommendation to the Health Assembly. Turning to part II of the draft resolution, he said It was necessary to seek to be fair to those Members in that the Working Party had considered it necessary to financial difficulties, but also to those that had been improve the present procedure. Resolution WHA8.13 paying their contributions promptly and on which the provided an opportunity for each Health Assembly to working of the Organization had depended. consider the problem, but although it had come up The report had been arrived at in a spirit of com- each year, the Health Assembly had not so far seen fit promise in the Working Party, and he expressed the to take action of a penal nature.Such action must hope thatitwould be similarly received in the naturally be approached with reluctance, but it must be Committee. borne in mind that any tendency on the part of Members to fall further into arrears would have dire Dr WEBB (Australia) considered that the report of effects on the Organization's finances.The health the Working Party was not sufficiently strong.His services of many Members depended to a considerable country had always supported the principle that voting extent on the Organization's help, and it was therefore rights should be suspended in cases where contribu- vital that contributions should be promptly obtained. tions were two years or more in arrears, unless the While the position did not at present give any great reasons for non- payment were beyond the control of cause for alarm, any possibility of an increased trend the Members concerned. When the matter had been towards arrears in payment must be discouraged, and discussed earlier in the Committee, his delegation had it was in the light of that objective that the proposed referred to the automatic suspension in force in other procedure had been put forward. organizations, and he had been glad to note from the During the Committee's discussions prior to the remarks of the Chairman of the Working Party that setting -up of the Working Party, some observations the procedure had been considered. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FIFTH MEETING 353
The report did not go far enough, in that the draft "INVITES Members that may, in future, be in arrears ", resolution did not even name the countries that were in of the words "to an extent which would invoke the arrears. He mentioned the analogy of a club, where, if provisions of Article 7 of the Constitution ". the fee of a member was not paid, the facilities were no longer available to him. It was not the responsibility of Dr LAYTON (Canada) said that the problem was a the club to undertake prolonged negotiations; the delicate and somewhat embarrassing one forall defaulter merely ceased to be a member. Considerable concerned.His delegation shared the views of the time had elapsed since the Eighth World Health delegates of Australia and Belgium in feeling that the Assembly, and he wondered how long the question draft resolution was not as strong as was desirable. could go on being raised continually without any The draft resolution contained little that was new, the action being taken.He feared that a dangerous one change being that the problem would be referred precedent might be set.He would like to hear the back to the Executive Board. views of other delegates on the matter. Ideas similar to that put forward in paragraph 3 of part II had been advanced on previous occasions with Mr DE CONINCK (Belgium) paid a tribute to the little effect. He confessed that he was a little puzzled eloquent and complete introduction by the Chairman by the expression "that may, in future, be in arrears ", of the Working Party, and commended the Working and asked whether those Members which were in Party on itsefforts.He was, however, somewhat arrears at present were not included. disappointed with the results obtained, and parti- Members of the Committee had listened with great cularly with the draft resolution submitted. He interest to the debate on the budget ceiling at the feared that the Committee might be eludingits sixth meeting of the Committee on Programme and responsibilities by passing on the burden tothe Budget, at which reference had been made to enjoying Executive Board, which already had a number of a repast and being unable to pay for it. The Director - problems to deal with. He realized, however, that a General was almost being put in that embarrassing firmer decision might possibly be forthcoming from position by not being given the necessary financial that quarter, enabling the provisions of Article 7 of the support. Consideration need not necessarily be given Constitution and of resolution WHA8.13 tobe to applying the provisions of Article 7 of the Con- applied. He supported the remarks of the delegate of stitution at the present session, but rather to providing Australia. for some future action which would ensure that full DrVANNUGLI(Italy) said that he had listened with support, financial as well as moral, was given to the great interest to the introduction of the report by the Director -General in carrying out the work of the Chairman of the Working Party. The Committee was Organization. faced with a rather difficult problem, and he considered Dr CHATTY (Syria) was in sympathy with those the conclusions arrived at by the Working Party to be delegates who considered that the draft resolution was in accordance with the spirit and the letter of the not strong enough, but thought it would be unfortunate Constitution. Article 7 of the Constitution stated that if the Organization were not to have the benefit of all " the Health Assembly may . . . suspend the voting its Members voting. The psychology of the Organiza- privileges ", and the Article thus left complete freedom tion was based on the principle of Members assisting to the Assembly in making its decisions. each other, and it was necessary therefore to help With regard to the possibility of taking a firmer countries in arrears to meet their duties and respon- attitude than that proposed in the draft resolution, he sibilities.Before taking any strong measures against considered that it was necessary to proceed by stages. the countries in arrears, an attempt should be made to Paragraph 3 of part II of the draft resolution invited discover what their problems were. He suggested that Members in arrears to submit to the Executive Board the Director -General be asked to study their diffi- a statement of their intentions as to payment of their culties with them and report to the following sessions arrears.That would represent a small step forward, of the Executive Board and the Health Assembly, at and would offer the possibility, at the Seventeenth which a resolution might be adopted that would World Health Assembly, of examining the question on enable those Members to remain in the Organization the basis of the results obtained.His delegation was and to be helped to meet their own responsibilities. completely satisfied with the draft resolution except A new paragraph to that effect might be inserted in that, in its opinion, it would be preferable for para- the draft resolution, after paragraph 3. graph 3 to refer to the Members that were in arrears for more than two years and thus came within the Mr GARCÍA PIÑEIRO (Argentina)saidthathis terms of Article 7 of the Constitution.He would delegation fully appreciated that it was essential to the therefore propose theaddition,afterthe words work of the Organization for Members to pay their 354 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
contributions at the appropriate time. Many opinions tion and a club. WHO had to offer services and had had been expressed during the discussion and he done so in many instances to non -Member States and congratulated the delegate of India on proposing the territories.He had therefore been gratified to hear Working Party, which had produced an excellent from the Chairman of the Working Party that any report. However, the problem was a complicated one decision that might be taken would have no effect on and his delegation rejected the idea that lateness of any services offered.He was, however, convinced that country in paying itscontribution could starta even the type of penal action that had been considered viciouscircle. The countries in arrears were all namely, suspension of voting, would be injurious and a developing States that were earnestly trying to solve dangerous precedent. The wording of the draft their many economic and social problems -including resolution could perhaps be improved,as some that of the payment of their contributions to inter- delegates had suggested, but he was in full agreement national organizations.Since most of the countries with the spirit in which the Working Party had made under consideration were in the Americas, his delega- its report, and with the contents of the draft resolution tion wished to emphasize the efforts they were making presented. to settle their arrears. However, the development and other plans of such countries were liable to be disrupted The CHAIRMAN said that he would attempt to by the adverse effect on their weak economies of sharp suggest an appropriate wording forthevarious fluctuations in international economic conditions. amendments that had been proposed. The decision of the United Nations to set up a The first concrete proposal was that of the delegate Development Decade and its recent Conference on the of Australia, who had pointed out that the names of Application of Science and Technology for the benefit countries in arrears for two or more years were not of less developed areas indicated that the United included in the draft resolution. He suggested that the Nations fully realized that some countries were in the point might be dealt with by deleting the words "a unfortunate position of needing both technical and few Members" in the second preambular paragraph of financialassistance. Theirpositiondeserved part II of the draft resolution, and inserting the names sympathetic consideration and they should be given of the countries that were in arrears for two or more every support in their efforts to put their economies on years, i.e.,Bolivia, Guatemala, Haiti, Panama and a sound footing and to comply with their international Uruguay. obligations. The next proposal was that of the delegate of Italy He supported the draft resolution proposed by the concerning paragraph 3 of part II. The addition of the Working Party. words "to an extent which would invoke the pro- visions of Article 7 of the Constitution" was merely a Professor ABBASY (United Arab Republic) con- question of clarification and semantics, and there gratulatedtheChairman, Vice - Chairman and should be no objection to it. Rapporteur on their election.He associated his That amendment should also cover the point raised delegation with the proposals made by the dele- by the delegate of Canada concerning the use of the gates of Syria and Italy, and informed the Committee word "may" in the same paragraph. That word had that the contribution of his Government for 1962 had been used because it was not known which countries been transfeired through the Central Bank of Egypt. would be involved in the future. Mr ZEUTHEN (Denmark) said that, while not being With regard to the proposal of the delegate of Syria, in disagreement with the views expressed by the he would suggest that it might be dealt with by adding delegateof Australia and others,hisdelegation at the end of paragraph 4, the words "and to report to considered that the Committee should find it possible the Executive Board on the matter ".In other words, to vote in favour of the draft resolution proposed by the Director -General would be asked to communicate the Working Party, thus giving the Executive Board the resolution to any Member concerned and to the opportunity of carefully scrutinizing the complex submit any relevant material to the Executive Board. question and making a full and detailed report on which the Seventeenth World Health Assembly could Dr CHATTY (Syria) said that his suggestion was not act. only to report to the Executive Board, but to study the difficulties with the authorities of the countries Dr AL -WAHBI (Iraq) said that the subject was a concerned and then to report. By studying the very complicated and thorny one, and thanked the difficulties it might be possible to find a solution and Working Group for its report. With all due respect come to an understanding, and it might also make it to the remarks made by the delegate of Australia, he easier for the countries involved to meet their responsi- could see no good comparison between the Organiza- bilities. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FIFTH MEETING 355
The CHAIRMAN said that the point could be met by warning to countries which had not paid their con- adding a new paragraph 4, on the following lines : tributions. He fully supported the draft resolution and the 4.REQUESTS the Director -General to study with the Member State concerned thedifficulties of the proposed amendments. countries in arrears, and report to the Executive Board or the Seventeenth World Health Assembly; Dr LAYTON (Canada) considered that in paragraph 3 of part II of the resolution the phrase "INVITES The existing paragraph 4 would accordingly become Members that may, in future, be in arrears" was not paragraph 5. clear. He suggested that, in order to make it clear that reference was being made to any year, as the problem Dr BRAVO (Chile) stressed that one of the aims of arose,the wording should be changed toread the Organization was universality.However, some "INVITES Members that are in arrears ". of the arguments that had been put forward during the discussion, in particular those of the delegates of Mr PERERA (Ceylon) did not wish to give a silent Australia, Belgium and Canada, had given him the vote on such an important subject.Everyone was impression that the Assembly was in danger of taking a agreed that it was a most delicate matter, which had to step backwards, denying the principle of universality be handled very carefully. Some points had been made by imposing sanctions against certain Member States - to the effect that the report of the Working Party did countries which, for understandable reasons, had been not go far enough.In fact, the Chairman of the unable to fulfil their financial obligations. Working Party had been the first to stress the serious- No country liked to be in arrears :if some found ness of the subject when it had been discussed earlier. themselves in that situation, it was because of circum- Itwas,therefore,reasonabletosupposethat stances beyond their control.It was the duty of discussionsintheWorkingParty,inparticular delegates, as physicians and public health administra- statements made by two of the Member States tors, to study the problem with good will, and to try concerned, had helped him and other delegates to to find the reasons for those arrears of payment.It realizethe inexpediency of maintaining a tough would be both unreasonable and dangerous to try to attitude. apply of 7 of the Constitution. The delegation of Ceylon could not subscribe to the At the moment, there were five Member States view that, unless the tendency to fall into arrears with involved : in coming years, the number might well be contributions were halted, a vicious circle might be considerably higher, and if the Assembly now estab- created and the finances of the Organization might lished a precedent of withdrawing rights from Member reach a "point of no return ".In fact, the number of States which had not paid their contributions, it might Member States in question was only five -less than well be that it would soon find that it had started to 5 per cent. of the total membership of the Organization. tread a path of self -destruction, and that it had reached To continue the metaphor regarding the club, a point where only wealthy nations were Members. mentioned previously during the discussion, if the Accordingly, he fully supported the draft resolution Assembly tried to be too strict it might eventually lose now before the Committee and the suggested amend - its ideal of universality (a danger which the delegate of ments-in particular, the amendment proposed by the Chile had so rightly stressed), and the Assembly might delegate of Syria. well be reduced to the status of an exclusive club.
Dr HAPPI (Cameroon) congratulated the Chairman Dr KRAUS (Yugoslavia) congratulated the officers of on his election. the Committee on their election. The problem under discussion was, of course, a very He fully supported the draft resolution and the difficult one. He wondered whether the speakers who proposed amendments. He agreed that the resolution had objected to the lack of forcefulness in the draft was not strong enough, but the aim had not been to resolution prepared by the Working Party would have adopt a strong resolution, but rather to present the expressed the same feeling if they had heard the points question clearly both for the governments concerned of view of the Member States that were in arrears with and for the Organization, in the hope that the question their contributions. would be solved to the satisfaction of all concerned. Doubtless,widelydifferingopinions had been represented in the Working Party, and the draft The CHAIRMAN thought the discussion had clarified resolution was the result of thorough discussion. the general feeling of the Committee.He read the Indeed, the very fact that the subject had given rise to draft resolution incorporating the amendments that such extensive discussions seemed in itself to be a had been proposed, so that the text was as follows. 356 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The Sixteenth World Health Assembly, 4.REQUESTS the Director -General to study with the Member States concerned the difficulties of I these countries and to report to the appropriate Having considered the report of the Director - sessions of the Executive Board and the World General on the status of collection of contributions Health Assembly; and of advances to the Working Capital Fund as at S. REQUESTS furthertheDirector -Generalto 30 April 1963; communicatethisresolutiontotheMembers Noting with satisfaction that a large number of which may be concerned. Members have paid their annual contributions and Mr ROFFEY (United Kingdom of Great Britain and advances to the Working Capital Fund, Northern Ireland) said that it was difficult to know just 1. CALLS THE ATTENTION of Members tothe how strong a stand should be taken at the present importance of paying their contributions as early as stage. He supported the draft resolution and the possible in the Organization's financial year; proposed amendments, and congratulated the Working 2.REQUESTS Members which have not done so to Party on its achievement. provide in their national budgets for regular payment to the World Health Organization of their annual Dr LISICYN (Union of Soviet Socialist Republics) contributions; and thought that the lengthy discussion had shown the problem to be more complicated than might have been 3.URGES Members to make specialeffortsto imagined.It was a difficult as well as a delicate liquidate their arrears in the shortest possible time; problem. It was within the power of the Assembly to take action, to break the so- called "vicious circle ". II In fact, the rapid increase of the budget, which had Considering that the continued non -payment of been discussed during the Assembly, was closely arrears could make it necessary to abandon or connected with the subject now under discussion, and curtail approved programmes of the Organization, was the basic cause of the trouble. Noting further with great regret that the Arrears of His delegation agreed that a closer study should be Bolivia, Guatemala, Haiti, Panama and Uruguay made to discover the reasons for arrears in payment of make it necessary for the Assembly to consider, in contributions, and the Assembly should not immedi- accordance with Article 7 of the Constitution ately apply sanctions against the Member States and the provisions of paragraph 2 of resolution concerned -in particular, the provisions contained in WHA8.13, whether or not their right to vote should Article 7 of the Constitution. The problem was very be suspendedattheSixteenth World Health complex, and its several aspects should be studied far Assembly; more thoroughly both by sessions of the Executive 1. DECIDES not to suspend the voting rights of the Board and the Assembly, and indiscussion with delegationsconcernedattheSixteenth World Member States and other competent organizations. Health Assembly; That was all the more necessary since,as other 2. REQUESTS the Executive Board, at its sessions speakers had said, the matter was fundamental to the when the agenda of the World Health Assembly is Organization's work and to universality. prepared, to make specific recommendations, with Accordingly, he supported the draft resolution and the reasons therefor, to the Health Assembly with the proposed amendments. regard to any Members in arrears in the payment of Dr MUDALIAR (India) stressed the importance of contributions to the Organization to an extent which realizing what would be the commitment for the would invoke the provisions of Article 7 of the Assembly if the draft resolution, as amended, were Constitution ; adopted.Certainly no one was very happy that it 3.INVITES Members that are in arrears to an extent should be necessary to adopt such a resolution, and which would invoke the provisions of Article 7 of the sympathies of all delegates were with the countries the Constitution, to submit to the Executive Board a that had been unable to pay their contributions. statement of their intentions as to payment of their The Working Party had invited the Member States arrears,so that the Health Assembly, when it concerned tosend representativesto discussthe considers the matter in accordance with the pro- subject, and it had been greatly appreciated that two of visions of resolution WHA8.13, will be able to make the countries had been represented at the meetings of its decision on the basis of the statements of such the Working Party. Members and the recommendations of the Executive Although Article 7 of the Constitution referred to Board; the possible suspension of both voting privileges and COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : FIFTH MEETING 357 services, no suggestion had been made for the suspen- suspending voting rights, which might well be a step sion of services, and the di aft resolution now before backwards and detract from the universal character of the Committee referred only to voting rights.The the Organization. Organization was interested in health on a global The United Nations had a similar problem, but there scale, and whole populations might well be harmed by was a tendency to confusion, since, in the case of that the suspension of the Organization's services. organization, there were political reasons for the It might be that, in some cases, a prompter method arrears of payment. The fact that Member States had was needed in order to make the governments of the not paid contributions to WHO, on the other hand, countries concerned realize how unfortunate it was was due to lack of funds. that their representatives to the Assembly should have At the moment, there were five countries involved. to hear criticism year after year. It was possible that in the coming years there would be He was rather perplexed about the arrears of pay- as many as fifty.Did that mean that it would be ment, especially in view of some of the figures included necessary to suspend voting rights of fifty countries ? in Appendix 2 of Official Records No. 125, giving the Suspension of voting rights was not a suitable punish- estimated contributions of governments to WHO - ment to use to correct delinquents.It was the task of assisted projects in their countries.In general, the the Assembly not to suspend those rights, but to find figures seemed to show that the governments con- means of making the countries concerned pay their cerned were paying very large sums as contributions to contributions. WHO- assisted projects in their countries. With regard to assessments, three of the Member States concerned Mr TAKIZAWA (Japan) thought that the report of the were assessed at 0.04 per cent. (the minimum assess- Working Party was not strong enough, but supported ment), one at 0.05 per cent., and one at 0.10 per cent. the resolution with the inclusion of the proposed It seemed, therefore, that perhaps it was not so much a amendments, which seemed to serve as a warning to question of availability of funds as a possible lack of the Member States concerned. co- ordination in national finances. Mr DE CONINCK (Belgium) had been impressed by The resolution had been proposed not in view of the the brilliant stateníent made by the delegate of India, small amounts of money involved, but in the hope of and fully supported the resolution with the amend- preventing thecontinuationof the tendency of ments proposed. Members to fall in arrears with contributions.The situation of another organization was already becom- Dr WEBB (Australia) did not want to leave the ing precarious. impression that his delegation was not sufficiently The Assembly, whilst concerned with health and sympathetic towards the countries in difficulties.He anxious to provide health facilities on a global scale, had been impressed by the remarks made by the was also anxious that the Constitution should be delegate of India. However, according to his calcula- respected by all Members.No country was being tion, there were thirty -seven States that were assessed penalizedas regardsservices,or prevented from at the minimum rate of contribution, and three of attending the Assembly for not paying its dues. them were amongst those in arrears. The Working Party had had to find a happy medium He suggested that paragraph 3 of part I of the between two extremes :a strong negative regarding text should read " URGES those Members concerned ", voting rights would not have been in the best interests instead of " URGES Members ". of the Organization, but, on the other hand, some He also proposed that paragraph 3 of part II action had to be taken. The first step had already been should be amended to include some mention of a made at the Eighth World Health Assembly, and eight specific time factor. years had passed without further action being taken. Otherwise, he was prepared to accept the report It would seem logical to adopt the resolution with with the proposed amendments. the proposed amendments, to provide an incentive to all Member States, not only to those in arrears with The CHAIRMAN thought that there would be no their contributions, to play their part. objection to the amendment to paragraph 3 of part I of the resolution as proposed by the delegate of Australia. Mr NGUYEN VAN THINH (Republic of Viet -Nam) Regarding the proposed amendment to paragraph 3 of noted that the Member States in arrears with con- part II, however, he said that it had been the intention tributions were developing countries. If the Assembly of the Working Party that the operation should be decided to suspend voting rights it would not be continuous, the Director -General having the task of taking into account the humanitarian side of the ascertaining the situation prior to each session of the problem. Serious thought should be given before Executive Board and of reporting to the Board. 358 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Dr ALAN (Turkey) proposed the closure of the The CHAIRMAN put to the vote the amendment debate. proposed by the delegate of Syria (paragraph 4 in part II of the draft resolution). The CHAIRMAN said that he had no more speakers on Decision:The amendment was approved. his list, so that the debate was in fact at an end and the Committee could vote on the proposals before it. The CHAIRMAN then put to the vote the draft resolution as amended. Dr CAYLA (France) suggested that the meeting be adjourned until copies of the amended draft resolution Decision:The draft resolution, as amended, was had been distributed. approved. Mr MCKITTERICK (UnitedStatesof America), The CHAIRMAN reminded the Committee that a explaining his vote, said that for other organizations motion for closure of the debate had been made, and (such as the United Nations and ILO) whose Con- that he would have to give it preference. However, he stitutions clearly provided for mandatory action in the considered that the proposed amendments were not so case of arrears of contributions for two or more years, substantial as to necessitate the circulation of another his Government believed that such constitutional document and the delegate of France might therefore provisions should not be diluted. He had acquiesced in agree to their being voted on forthwith. the resolution only because WHO's Constitution was different, allowing the Assembly discretion. Dr CAYLA (France) said he had no more to add to his previous remarks. The meeting rose at 11.50 a.m.
SIXTH MEETING
Thursday, 16 May 1963, at 3.30 p.m.
Chairman: Dr J. VYSOHLíD (Czechoslovakia)
1. WHO Staff Pension Committee : Appointment of In the customary form of resolution for this pur- Representatives to replace Members whose Period pose, in paragraph 5 of the Director- General's report, of Membership expires spaces had been left for the insertion of the names of Agenda, 3.20.2 the governments designating the members now to be Mr. SIEGEL, Assistant Director -General, Secretary, nominated by the Committee. at the request of the CHAIRMAN, explained that each year it was necessary for the Health Assembly to Dr CAYLA (France) formally moved the adoption appoint members to the WHO Staff Pension Com- of the draft resolution to which the Secretary had just mittee to replace those whose period of appointment referred, with the insertion of the names of Mali and had expired. The list of the present members of the New Zealand. Staff Pension Committee 1 was set out in the Director - General's report on the subject. The retiring members Dr BRAVO (Chile), Rapporteur, at the request of the were those designated by the Governments of the CHAIRMAN, read out the draft resolution so completed, United Kingdom of Great Britain and Northern as follows : Ireland and of Thailand, and they had to be replaced The Sixteenth World Health Assembly by a member and an alternate member from the membership of the Executive Board as it stood after RESOLVES that the member of the Executive Board designated by the Government of Mali be appointed the recent elections by the current Assembly. as member of the WHO Staff Pension Committee, 1 These were the members of the Executive Board designated and that the member of the Board designated by by the Governments of the United Kingdom of Great Britain and Northern Ireland, the United States of America, and Canada (members) and by the Governments of Thailand, Poland and the 3 Transmitted to the Health Assembly in section 1 of the Com- Union of Soviet Socialist Republics (alternates). mittee's third report and adopted as resolution WHA16.20. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SIXTH MEETING 359
the Government of New Zealand be appointed as The amounts already approved in the supplementary alternate member, the appointments being for a budget estimates for 1963 and in the programme and period of three years. budget estimates for 1964 covered a part of the Decision: The draft resolution was approved.' increased cost but about fifteen -and -a -half million Swiss francs remained to be found.
The SECRETARY, at the request of the CI- AIRMAN, 2.Headquarters Accommodation :Progress Report introduced the subject and referred the Committee Agenda, 3.11 to a working paper which contained the following Dr NABULSI, representative of the Executive Board, draft resolution for its consideration : speaking at the request of the CHAIRMAN, said that The Sixteenth World Health Assembly, the Executive Board had followed very closely the Noting the reports and recommendations of the development of the arrangements in regard to the new headquarters building and had carefully con- ExecutiveBoard,itsStanding Committeeon sidered the reports regularly presented to it by the Headquarters Accommodation, and its Ad Hoc Committee, as well as the report of the Director - Director -General, and itsStanding Committee on General on headquarters accommodation; Headquarters Accommodation. The latest report of the Standing Committee had been made to the Executive Noting the substantial increase in construction Board at its thirty -first session in January 1963 and costs since the Thirteenth World Health Assembly would be found inOfficialRecords No. 124, Annex 15, authorizedtheconstructionofaheadquarters on pages 56 -60.It stressed the need for a considerable building; increase in the financial provision, because of increases Recognizing the importance of adhering to good which had occurred in building costs, and probable quality standards of construction in the interest increases in the future. The Committee had noted the of staff efficiency and of long -term economy in efforts of the Director -General to keep the cost of the maintenance; building within the limits authorized by the Health Taking into account that making a reasonable Assembly and had studied the possibility of making provision for underground parking at this stage in further economies, but had reached the conclusion the construction programme willresultinan that further savings would seriously compromise the economy for the Organization over a period of utility of the construction. years; and The Standing Committee had also recommended that the provision for an underground garage, con - Considering therefore thatitisnecessary to tained in the original project and eliminated for re- establish such provision as was included in the reasons of economy, should be restored, the capacity original arrangement for the building, of the garage depending on whether further ground 1. EXPRESSESitsappreciationtothe Executive for surface parking could be obtained, and had sug- Board, and to its Standing Committee on Head- gested negotiations with the local authorities on that quarters Accommodation, for the continuing sur- possibility. veillance of this undertaking; The report of the Standing Committee and that of 2.ACKNOWLEDGES with appreciation the action (Official Records No.124, theDirector -General of those Member governments which have con- Annex 15, part 2) had been carefully considered by tributed to the building project and invites other the Board, which had adopted resolution EB31.R25. Member governments to do likewise; In accordance with paragraph 6 of that resolution, the Ad Hoc Committee of the Executive Board had 3. DECIDES to revise operative paragraph 1 of further examined the question in the light of the report resolution WHA13.46 by authorizing the construc- submitted by the Director -General to the present tionof the buildingatacostnot exceeding Assembly.' The Ad Hoc Committee's report' dealt Sw.fr. 60 000 000; with three main subjects :parking (paragraphs 4 4.DECIDES furthermore that, subject to the total to 7), expected cost increases (paragraphs 8 to 11), authorization of funds for the building project, and financing (paragraphs 12 and 13). provision for underground parking for about 300 vehicles should be made; ' Transmitted to the Health Assembly in section2 ofthe Com- mittee's third report and adopted as resolution WHA16.21. 5. REAFFIRMS itsexpressions of appreciation to the Government of the Swiss Confederation and ' Of.Rec. Wld Hlth Org. 127,Annex7,part 2.
3Off.Rec. Wld Hlth Org. 127,Annex 7, part 1. of the Republic and Canton of Geneva for the 360 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
generous assistance already provided toward the been laid at the Fifteenth World Health Assembly realization of the headquarters building; in 1962. It was therefore five years since the Organiza- 6.EXPRESSES its hope that the host government tion had entered on the scheme and, although they will find it possible to provide on an interest -free had moved as expeditiously as possible, in view of the basis the remaining credits required; and time required for the various negotiations and tender- ing, considerable delays had taken place, during which 7.REQUESTS the Executive Board and the Director - building costs had risenconsiderably throughout General to report further to the Seventeenth World Európe. The Organization had therefore been faced Health Assembly, including a report on the definitive with problems of additional financing. arrangements for the financing of the additional It was not practicable at the present stage to retrieve costs. the floor which had been deleted from the original The main difficulties in regard to the new head- plan, but it was possible to maintain the good quality quarters building were of a financial nature.The of construction and perhaps to retrieve the under- Committee might find it useful to review the history ground garage.The representative of the Executive of the submissions on the subject by the Director - Board had commented on that point and the Executive General to the Executive Board and World Health Board and its Ad Hoc Committee had dealt with it in Assemblies during the past five years; the relevant their reports to the Assembly. resolutions would be found on pages 353 to 356 of the Inconclusion,itnow appeared necessary,in Handbook of Resolutions and Decisions, sixth edition. accordance with the Director -General's recommenda- The first step towards the provision of a separate tions, (i) to increase the maximum limit for construc- headquarters building had been taken in 1958 at the tion costs from Sw.fr. 40 000 000 to Sw.fr. 60 000 000; Eleventh World Health Assembly.In 1959 the first (ii) to provide an underground garage for some 300 estimates had been submitted by the Director -General cars; and (iii) to provide for negotiations with the tothe Twelfth World Health Assembly through Swiss authorities for additional interest -free loans, as the Executive Board, and the Health Assembly had mentioned in paragraph 12 of the report of the (in resolution WHAl2.12) decided that plans and Ad Hoc Committee of the Executive Board.' specifications and more precise cost estimates within The CHAIRMAN declared the discussion open. a maximum limit 40 000 000 should be prepared.The Executive Board had subsequently Professor PESONEN (Finland) expressed thanks for approved the building site and the rules for an archi- the clear presentation of the problem in the reports tectural competition, which had opened in November before the Committee and in the statements that had 1959. In 1960 the Executive Board had been informed been made. He recalled that the Organization's by the Director -General of the loan offered by the original estimate of the cost of the building had been Swiss Confederation and had set up a building Sw.fr. 56 000 000, but the architect had calculated committee -the Standing Committee on Headquarters that its cost could be held within Sw.fr. 40 000 000. Accommodation.The Thirteenth Health Assembly Before the proposals had been submitted to the Health in 1960 had, in resolution WHA13.46, authorized Assembly, they had been revised to keep within the the construction of the building at a cost not exceeding ceiling of Sw.fr. 40 000 000, by reducing the height Sw.fr. 40 000 000, also delegating certain powers to of the building, and cutting out one storey and the the Executive Board and itsStanding Committee. proposed underground garage.In spite of those Immediately after that the architect had been requested reductions, when estimates on the contracts were to proceed with drawing up the final plans of the received there was an increase of 10 per cent. on the building.In October 1960 the Standing Committee cost of the first part of the work, and subsequent had approved the procedure for letting contracts and continuing increases estimated at about 5 per cent. the text of the agreement with the Swiss Confederation per annum were expected. and the Canton of Geneva regarding the loan and the The Executive Board had considered a suggestion building site.In December of that year the agree- not to provide a special meeting room for the Board ments had been signed, and in 1961 the plans for the but, since the saving thus incurred would be only building had beenfinallyaccepted. Numerous Sw.fr. 2 000 000, it had wisely decided that such a amendments had had to be made in order to keep the reduction was not worth while.He himself saw cost within the Sw.fr. 40 000 000 ceiling, including no possibility of reduction on the plan and only the elimination of one entire floor and of the under- regretted that there would be insufficient space in the ground car park.The first section of the work had new building for all meetings and Assemblies to be been put out for bid in early autumn 1961 and, as many present would recall, the foundation stone had 1 Off. Rec. WU Hlth Org. 127, Annex 7, part 1. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SIXTH MEETING 361
held there.In particular, the area of the site made the size of the underground garage would of course available seemed far too small; he wondered why the depend on whether more land could be found.He original area had been reduced, since, if it had not, noted also that at the end of the Director -General's an underground garage at an additional cost of about report (Official Records No. 124, Annex 15, part 2) Sw.fr. 5 000 000 might not have been necessary. it was stated that an additional Sw.fr. 20 000 000 In the circumstances, he thought that the'conclu- would be necessary to complete the building, including sions of the Executive Board could only be supported; the underground garage.Referring to the voluntary on the other hand he was doubtful whether the revised cash contributions received from governments (as estimate of Sw.fr. 60 000 000 would be sufficient to listed in section 6 of the Standing Committee's report meet the final cost. He referred to the letter received in Official Records No. 124, Annex 15), he expressed from the Department of Public Works of the Canton the hope that delegations would encourage their of Geneva, reproduced on page 61 of Official Records governments to make more voluntary contributions No. 124, showing a total increase in building costs of towards the cost of the building. As suggested in the about 20 per cent.during the period 1958 -1962, Standing Committee's report, perhaps the Director - including a 10 per pent. increase during the last year General might make such a request to Member of that period (1961 -1962).If the cost continued to States. rise by 5 per cent. each year, the total increase before He hoped that it would be possible to obtain a the building was completed in 1965 would be 14 per further interest -free loan to cover the probable future cent. increaseinconstructioncosts, mentioned inthe With regard to the additional funds to be found, he appendix to the Standing Committee's report. pointed out that the budget estimates for 1963 and the revised budget estimates for 1964 provided about Dr CASTILLO (Venezuela) stressed the importance of the matter and felt some concern about the difficult one quarter of the amount needed. He wished to take the opportunity of expressing problem of the underground garage. Space should be thanks to the authorities of Geneva and the Swiss provided for some 400 vehicles, but it had been Federal Government for their generous assistance so considered reasonable to take a figure of 300 cars as a far, and for the beautiful site they had made available. basis.In all countries urban planning showed an increasing trend to make provision for underground The Federal and Cantonal authorities, he under- garages, possibly on account of the increasing cost stood, were studying the question of further help, of land. for which the Organization was most grateful.He The Director -General inparagraph4.1of the understood that WHO might soon be hearing from report before the Committee had referred to increasing them about the possibility of further interest -free building costs in Geneva between 1959 and 1962. loans. Similarly inOfficial Records No. 124, Annex 15, Finally, some Members of the Organization had there was a reference to building costs in Zurich which promised gifts towards the cost of the equipment of showed an increase considered toapply alsoto the building and he noted that the Director General Geneva. In his opinion an underground garage, was in his report referred to further interesting possibilities necessary; if it were not provided now the cost would of furnishing offices and meeting rooms.He hoped no doubt be much greater when the work had to be that other Members would follow the example that undertaken later.It had been suggested that it might had been given. be possible to obtain more land from the Geneva In view of the fact that many of the points he had authorities but he thought it would be unwise to be too raised were covered in the draft resolution before the optimistic on that score. Committee, he supported its adoption. For all those reasons he supported the draft resolu- Mr. HIJJI (Kuwait) thanked the Standing Com- tion before the Committee, including the authorization mittee of the Executive Board for the report included of additional funds and the provision for underground parking facilities. in Official Records No. 124, Annex 15, which explained that delays had arisen as a result of which the work Dr LISICYN (Union of Soviet Socialist Republics) had fallen about three months behind schedule, but said that, before making a general statement, he wished that new proposals had been submitted which would to ask the Secretary three questions. In the first place, enable it to be finished by the proposed date.With had it not been possible to foresee in 1961 that the regard to the underground garage, he noted that the amount of Sw.fr. 40 000 000, decided upon at that area of thesiteoriginally proposed would have time, might be inadequate ? Secondly, were there any permitted surface parking, at a considerable saving in estimates, even approximate, of the total amount cost. The site available for surface parking and hence which would be required to complete the building by 362 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
1966 -since he was doubtful whether Sw.fr. 60 000 000 20 000 square metres.If that figure were applied in was the final figure ? And, thirdly, if no underground the case of the Palais des Nations, it would represent garage were constructed, what would be the maximum approximately 6 -7 per cent. of the total ground area number of cars which could be accommodated in the and, if applied to the WHO land, it would require surface car park ? about 33 per cent. of the ground area.From those figuresit was evident that, should WHO at some The SECRETARY replied that, when the sum of future date need to extend its building, it would be Sw.fr. 40 000 000 had originally been authorized by unable to do so unless provision were made at that the World Health Assembly, a sharp rise in costs had time for underground parking.Although, at a later not been expected since, in the three preceding years, date, additional underground parking would doubtless increase in costs in Switzerland had been only small, be required, provision should be made forthwith for and that fact had been taken into account in determin- at least some underground parking. ing the figure of Sw.fr. 40 000 000. Regarding estimates of the total amount which Dr LISICYN (Union of Soviet Socialist Republics) would be required for the completion of the building thanked the Secretary for the full answers he had by 1966, the report of the Ad Hoc Committee of the given and said that, although hisdelegation ap- Executive Board 1 contained the latest available cost preciated that it was not always possible to foresee all estimates as at 30 April 1963.It would be seen, from contingencies when planning a building, he was not a comparison between those figures and the cost entirely satisfied by the Secretary's explanation. The estimates submitted by the Director -General to the Secretary had stated that, in 1961, it was not possible Standing Committee on Headquarters Accommoda- to foresee that the sum needed to complete the building tion in November 1962, that there had been, even in would exceed Sw.fr. 40 000 000 as at that time there that period, variations which more than confirmed had been no marked increasein buildingcosts. the predictions for which provision had been made Nevertheless, some increase in the cost of living when the estimates were drawn up in November 1962. generally might perhaps have been envisaged, par- Those November figures had been brought up to date, ticularly as the World Health Assembly itself had and presented to the Ad Hoc Committee, and were often referred to that question in the past, when now before the World Health Assembly in the Ad Hoc discussing the increase in the budget. Delegates would Committee's report. recall that, in 1961, many of them had expressed some Concerning the number of cars for which provision disquiet about the large sums, greatly needed for field had to be made, cost estimates had been based on a work, which would be required for the building and figure of 600 vehicles, to be accommodated either in had stated that its construction would call for ever - an underground or a surface car park, or in a combina- increasing funds.Those fears had proved to be well tion of both.It was not possible to state categorically founded inasmuch as, in the space of only three years, at that point that there would be exactly 600 cars, the estimated cost of construction had risen consider- for the amount of traffic was always increasing and ably - from Sw.fr. 40 000 000 to Sw.fr. 60 000 000. every, day more people were using cars.Six hundred Consequently,althoughtheauthorizationof was perhaps a conservative estimate. However, taking Sw.fr.60 000 000 wasacceptabletothe USSR the figure of 500 vehicles as a basis, an analysis of the delegation, it was not convinced that that figure would ground area available to WHO and of that on which in fact ultimately suffice in the light of events over the the Palais des Nations stood had been made, giving preceding three years.In that connexion, he would comparative figures for those two areas, which had like to make certain proposals, some of which had been chosen because of delegates' familiarity with the already been touched upon during the discussions of latter.The Organization had available to it -and the Executive Board.First, it would be appreciated the information would also answer the question if the Secretariat, together with the Standing Com- raised by the delegate of Finland -approximately mittee on Headquarters Accommodation and the 60 700 square metres of land, compared with 249 000 other appropriate bodies, could draw up a more square metres for the Palais des Nations.The area economical plan for the construction of the WHO of the building of the Palais des Nations covered headquartersbuilding. Secondly, despitethe 18 600 square metres, which represented 7.46 per cent Secretary's full explanation concerning the number of the total ground area. Correspondingly, the WHO of cars and the desirability of constructing an under- building would require 15.48 per cent.The space ground garage, he would like the proposal for such required for approximately 600 cars would be about a garage to be abandoned in view of the cost involved. The estimated figure of vehicles given, namely 600, 1 Off. Rec. Wld Hlth Org. 127, Annex 7, part 1. was somewhat surprising. Presumably, the Secretariat COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SIXTH MEETING 363 had based that estimate on the growing number of originallyenvisaged. The questiontherefore was personnel who, it would seem, were expected, by 1965 whether a building, destined to be the symbol of or 1966, each to possess a car. That it was considered health throughout the world, should be erected along that the staff would increase to that extent was in strictly functional lines, as if it were a factory, or itself a disturbingfact. Thirdly,theSecretariat whether the aesthetic aspects should also be con- should,asthe delegateof Venezuela and other sidered.It was his opinion that the site should not be speakers had also suggested, continue their negotia- spoiled by converting it into a parking lot.If too tions with the Canton of Geneva with a view to many cars were to be parked outside the building, it acquiring more land so that surface parking could be would look very like a factory surrounded by vehicles. provided for cars.Finally, the Committee should It was difficult to believe that a country which had entrust the Standing Committee on Headquarters conceived the splendid perspectivesof Leningrad Accommodation and the Secretariat with the task of could be insensible to the aesthetic aspect of a building, furnishing more detailed and exact provisions regard- especially when that building was to be a symbol of ing the construction of the headquarters building. health throughout the world.The sum concerned In that way, the World Health Assembly would be was Sw.fr. 5 000 000. Should the Committee lay itself able to take into full account the exact sum needed to open to the criticisms of its successors by not providing complete the building. for an underground garage? With the exception of paragraph 4, calling for the Although in the past the French delegation had not provision of an underground garage, with which it always expressed itself in favour of budgetary increases, could not agree, the draft resolution was acceptable in the particular instance before the Committee it to his delegation. was of the opinion that it would be a serious mistake to take too narrow a view and not provide for cars Professor AUJALEU (France) said that he would to be parked out of sight, especially since the number address the Committee not as Chairman of the of cars would inevitably increase. Standing Committee on Headquarters Accommoda- In view of inflation throughout Europe and par- tion, in which capacity he could speak only before the ticularly in Switzerland, it was not possible to reply to Executive Board, but as chief of hisdelegation, those who asked if the sum of Sw.fr. 60 000 000 which would enable him to discuss frankly all the could be considered as a final figure. In any event, no problems concerned. building could be erected in the certainty that it would be completed for the sum originally foreseen. When the plans for the WHO building were being Those who had built hospitals would agree that the final cost chosen, the local authorities had indicated that a long was generally much higher. low building was desirable to harmonize with the He would support the draft resolution, with the Genevese countryside.Nevertheless, delegates would exception however of paragraph1,to which he have noticed that, not far away, there was under naturally could not subscribe as, in it, was expressed construction an hotel which was in fact a very tall the appreciation of the World Health Assembly to the building.It was, however, now no longer possible to Standing Committee, of which he was Chairman. alter the shape of the building.The present dis- cussion appeared to be centred around the sum of Dr ALAN (Turkey), after congratulating the Exe- Sw.fr. 60 000 000.From no matter what angle the cutive Board and its Standing Committee on the study situation was viewed, the building, the design of they had made and thanking the Director -General and which had been approved, was going to cost at least his colleagues for the careful attention which they had Sw.fr. 55 000 000. The increase in the cost of manual given to the matter, said that most of his opinions labour and building materials in Switzerland rendered had been voiced by the previous speaker. A building any further discussion on the subject useless. had been started and had to be finished.From a There remained the question -the only valid one recent experience, when it had not been possible for for discussion at the present stage in his opinion -of the Assembly to meet in plenary session in a suitable car parks. Originally it had been thought that the site room, it would seem that it was necessary to provide to be provided to WHO would be large enough for the adequate accommodation for people as well as for parking of from 500 to 600 vehicles.However, the cars. The Turkish delegation therefore supported the area finally allotted to WHO was considerably smaller draft resolution before the Committee. than had been expected; despite the fact that the Canton of Geneva had recently made some additional Mr TAKIZAWA (Japan) asked how the proposed landavailabletotheOrganization,thetotal additional loan by the Swiss Government would be area wasstillconsiderablylessthan had been reflected in future budgets. 364 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Mr ROFFEY (United Kingdom of Great Britain and mittee to take at the present stage.Although it was Northern Ireland) said that, in the light of the reports to be hoped that it would not in future be necessary to before the Committee and of the statements made by consider an increase in the budget of Sw.fr. 60 000 000, the delegate of France and the Secretary, his delega- nobody could provide such an assurance. tion was of the opinion that underground parking He joined the delegate of Finland in reaffirming his should be provided and was prepared to support the appreciation to the Swiss authorities and in expressing draft resolution. the hope that they would see their way to providing, on an interest -free basis, the remaining credit required. Mr ZOHRAB (New Zealand) stated that his delega- tion would also give its support to the draft resolution, Mr DE CONINCK (Belgium) said that at the time the and in particular to paragraph 4 contained therein. various points with regard to the building were being discussed he had, as the Director -General would Dr VANNUGLI (Italy) said that he had listened with recall, pointed out that the cost of the building great interest to the statements made by the Secretary including underground parking space would not and by other speakers in the Committee.It was greatly exceed its cost excluding such garage space. necessary to be realistic, to face the facts that costs Dr AL -WmHBI (Iraq) said that, although he fully had increased and to accept the detailed explanations agreed that there was an urgent need for a new head- that had been given regarding that increase. quarters building and that its design should be in With regard to the draft resolution, reference was keeping with the name and prestige of WHO, he was made in the fourth paragraph of the preamble to the nevertheless a little worried about the considerable economy which would arise over a period of years as increases expected in the costs.It was of course a result of the provision of underground parking. necessary to be realistic and practical and, with that That was not fully clear in its intent, in his opinion, in mind, it would appear that the only substantial and he would therefore suggest a minor amendment saving which could be made was in relation to the which would delete the reference to economy but underground garage.Perhaps construction of such a would retain the recommendation for provision of garage could be deferred and further consultations underground garage space.Otherwise, the letter and could be held with the architect with a view to making the spirit of the resolution were entirely acceptable to his delegation.In particular, paragraph 1 of the itself. draft resolution, expressing the World Health Assem- He referred briefly to his experience of such matters bly's appreciation to the Executive Board and to the inhis own country when, inco- operation with Standing Committee, should remain, for Professor consultant architects drawn from many countries, Aujaleu had confirmed how competently the Standing including the United States, the United Kingdom and Committee had studied the whole matter. Australia, it had been possible to make economies Mr. BRADY (Ireland) said that the Committee had without significantly affecting the building. In a had the benefit both of a comprehensive presentation similar manner, it might be possible for the Director - of the facts from the rostrum and of a statement by General, the Executive Board, the Standing Committee ProfessorAujaleuwhicheffectivelycoveredthe on Headquarters Accommodation and the architect various aspects of the study.In any 'building project to consult together for the purpose of securing econo- it was not possible to obtain a reliable estimate at the mies. Professor Pesonen of Finland had spoken outset but only after tenders had been obtained and in more detail on the same subject. it was in the light of the tenders obtained and the Dr MUDALIAR (India) supported the draft resolu- statistical information at hand that the present pro- tion.It should be realized that the building was to posals were before the Committee.As Professor meet the needs of the Organization for a long time Aujaleu had himself stated, they were only an informed to come and provision should therefore, in his opinion, guess " but the Standing Committee and the Exe- be made for underground parking space at the present cutive Board had been anxious to keep the Assembly stage.It would be a false economy to postpone pro- abreast of the trends. vision of underground parking space until a later Speaking as a member of the Standing Committee; date.For that reason, his delegation would give its he would follow the attitude of his chairman; speaking full support to the draft resolution.The Standing in his capacity as a member of the Irish delegation, he Committee, the Director -General and the Executive wished principally to clarify his vote.The Irish Board would, he was sure, co- operate to ensure that delegationconsideredthatthedraftresolution the building was constructed in the most economic provided the best solution to the problem and that it way, consistent with the dignity and efficiency of the constituted an appropriate decision for the Corn- World Health Organization. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SIXTH MEETING 365
Mr WHALEY (United States of America) said that Director- General, the architect, the Standing Com- his delegation would support the draft resolution Committee and a number of consulting engineers in its entirety. had all made considerable efforts to find ways of economizing throughout. Although only one or two The SECRETARY, replying to questions raised during had been mentioned a large number had in fact been earlier statements, said that a suggestion had been made from time to time. It was a matter which would made regarding the desirability of providing accom- in any event be kept uppermost in mind, but it was modation in the new building for all WHO's con- unlikely that further economies,could be made without ference requirements. In that connexion, it should be jeopardizing the standard and quality of construction. pointed out that it would not be possible to hold Rash economies at the present stage would only sessions of future Health Assemblies in the new result in heavy financial repercussions later when it building, since facilities of that magnitude could not came to maintenance and repair of the building. be provided in the building as now planned. The delegate of the USSR had referred to cost The CHAIRMAN asked if there were any objections estimates a number of times during the discussion to ending the discussion at that point. and had mentioned the figures provided in1961. Dr ALAN (Turkey) wished the Committee to con- The initial estimates made were set out in Official tinue its discussion in order to finish the item at that Records No. 95, containing the proceedings of the meeting. Twelfth World Health Assembly; in that volume it was reported that the Director -General had stated that, Dr AL -WAHBI (Iraq) shared the view of the delegate whilst the original estimate submitted to the Executive of Turkey regarding the continuation of the discussion. Board was Sw. fr.35 000 000, certain increases in In the light of the Secretary's statement, he withdrew costs had taken place and there was a clear indication his original objection to the provision of an under- that the figure to be authorized by the Health Assembly ground garage and said that he would agree to the should be Sw. fr. 40 000 000.The Twelfth World draft resolution as it stood. Health Assembly had in fact given its authorization The CHAIRMAN said that the Committee had a to that figure in May 1959. The cost estimates as at draft resolution before it.An amendment to the 30 April 1963, to be found in the report of the Ad Hoc fourth paragraph of the preamble had been proposed Committee of the Executive Board 1, not only made by the delegate of Italy on which, in accordance with provision for increased costs up to 30 April 1963 but Rule 65 of the Rules of Procedure, the Committee also, at the foot of the table, set out the provision for should proceed to vote. increased costs at a rate of 5 per cent. per annum for the periods between 30 April 1963 and 31 December Dr VANNUGLI (Italy) explained that, as his amend- 1963;1 January 1964 and 31 December 1964; and ment was of a minor drafting nature, if nobody 1 January 1965 and 30 November 1965.That was wished to second it he would withdraw it to save the probably the closest forecast which could be made time of the Committee. regarding additional costs. In reply to a question by the CHAIRMAN, Dr LISICYN The understood the delegate of the USSR also to (Union of Soviet Socialist Republics) explained that, have stated that he did not recall having seen the as paragraph 4 of the draft resolution called for the figure of 600 vehicles earlier.In paragraph 10 of the provision of underground parking, he could not agree Director- General's report to the Executive Board in with it. He also asked that the resolution, which had January 1963 (Official Records No. 124, Annex 15, only just been circulated to members of the Com- part 2), it was stated that " in the original project mittee, should be read aloud before a vote was taken. submitted by Mr Tschumi provision was included for underground parking for 439 of the total 600 vehicles Professor PESONEN (Finland) said that, on reflection, foreseen ".From that it was clear that the figure of he was of the opinion that the Committee should 600 had been used from the beginning. not decide at that stage on the number of vehicles for which the underground garage should provide. The delegate of Japan had asked what arrangements He would therefore suggest that, in paragraph 4 would be made to repay the loan of the Swiss Govern- of the draft resolution, the words " about 300 " ment. It could be assumed that arrangements for any should be deleted and that the appropriate figure additional loan would follow the lines of those for should be inserted by the Standing Committee at a existing loans, namely, repayment by instalment. later date. The delegate of Iraq should rest assured that the Dr BRAVO (Chile), Rapporteur, then read out the 1 Off Rec. Wid Hith Org. 127, Annex 7, part 1. draft resolution. 366 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Dr LISIcYN (Union of Soviet Socialist Republics) any serious effect and it might be advisable to leave explained that his remarks with regard to paragraph 4 the paragraph as originally drafted. did not constitute a formal amendment. Professor PESONEN (Finland) withdrew his proposal, Dr WEBB (Australia) opposed the proposal of the in the light of the Secretary's explanation. delegate of Finland to delete the words " about 300 " from paragraph 4 of the draft resolution. The CHAIRMAN asked if the Committee were prepared to approve the draft resolution as a whole, as originally The SECRETARY said that paragraph 4 provided that drafted. the amount of underground parking would be subject Decision: There being no objections, the draft to the total authorization of funds for the building resolution was approved.' project.It would therefore seem that the deletion proposed by the delegate of Finland would not have The meeting rose at 5.45 p.m.
SEVENTH MEETING
Friday, 17 May 1963, at 9.45 a.m.
Chairman: Dr J. VYSOHLÍD (Czechoslovakia)
Later: Mr I. T. KITTANI (Iraq)
1.Third Report of the Committee the Board had commended the decision taken by the At the invitation of the CHAIRMAN, Dr BRAVO Regional Committee for the Western Pacific to the (Chile), Rapporteur, read the draft third report of effect that the additional expense entailed by holding the Committee (see page 410). meetings away from the Regional Office should be met by the host government -a decision in line with the Decision: The report was adopted. wishes of the Health Assembly in resolution WHA9.20. The recommendationof theExecutiveBoard regarding the text of the Appropriation Resolution for the financial year 1964 was on pages 88 to 90. 2.Review of Programme and Budget Estimates for 1964 Regarding credits to be paid to eligible Members Agenda, 3.4 towards the payment of their contributions in respect The CHAIRMAN asked the representative of the of the portion of their assessments corresponding to Executive Board to comment on the item. the amount of the regular budget transferred to the Malaria Eradication Special Account, the Executive Dr NABULSI, representative of the Executive Board, Board, in accordance with the request made at the said that the remarks of the Standing Committee on Fifteenth World Health Assembly, had studied the Administration and Finance and the conclusions of question of maintaining such credits for 1964 at 50 per the Executive Board concerning Part I (Organizational cent. instead of reducing them to 25 per cent. as Meetings), Part III (Administrative Services), and recommended bytheFourteenth World Health Part IV (Other Purposes) of the proposed programme Assembly initsresolution WHA14.15. During and budget estimatesfor1964(Official Records the discussion, some members of the Board had No. 121) would be found in Official Records No. 125, expressed the opinion that the credits for 1964 should pages 28 -30, and 51 -58. With regard to the increase in cost estimates for 1 Transmitted to the Health Assembly in section 3 of the 1964 in respect of certain regional committee meetings, Committee's third report and adopted as resolution WHA16.22. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SEVENTH MEETING 367
be maintained at 50 per cent., on the grounds that the In conclusion, the provisions for Sections 1to 3 largest government expenditures on WHO- assisted and 8 to 12 of the Appropriation Resolution proposed malaria eradication programmes were met by under- by the Director -General and recommended by the developed countries with low per capita income. Executive Board for the Assembly's approval were Other members had felt that to keep the credits at shown in the last column of Appendix 1 to the 50 per cent. might reduce the amount available for Director -General's report.' financing eradication programmes to such an extent as Mr Kittani (Iraq) took the Chair. to hinder the development of those programmes, to the detriment of under -developed countries. The Mr SIEGEL, Assistant Director- General, Secretary, Board had finally decided, with fourteen members drew the attention of the Committee to the fact that the in favour, three against and six abstentions, to recom- estimates for the World Health Assembly (Appropria- mend to the Sixteenth World Health Assembly that tion Section 1) made provision for the Assembly to be the credits to be provided in 1964 should be at the rate held in the Palais des Nations, Geneva. He mentioned of 25 per cent. thatinview of the previous discussion regarding Regarding the proposed provisions under Appro- possible difficulties concerning time and place for the priationSections8 (AdministrativeServices),9 Seventeenth World Health Assembly (see minutes of (Other Statutory Staff Costs) and 10 (Headquarters the fourth meeting, section 8).So far as the time was Building : Repayment of Loans), the Committee would concerned, adjustments could be made of one to two no doubt wish to note the report 1 of the Ad Hoc weeks in either direction, but the estimates now before Committee of the Executive Board, which had met on the Committee might not be adequate to cover any 6 May 1963, in accordance with resolution EB31.R52. more extensive change. The Ad Hoc Committee, having examined the adjust- ments proposed by the Director -General 2 to the cost Organizational Meetings estimates of the proposed programme and budget Dr ALAN (Turkey) asked whether any decision had estimates for 1964, had recommended, on behalf of been taken, since the publication of the Executive the Executive Board, that the Assembly approve the Board's report on the proposed programme and budget adjustments relating to increases in the salary scales estimates for 1964 (Official Records No. 125), regarding for general service staff at certain offices, and in the place for the 1964 meeting of the Regional Com- payments to OIHP pensioners; it had also recom- mittee for the Americas. He wondered whether there mended that, under Appropriation Section 10 (Head- might be any possibility of some reduction in the quarters Building : Repayment of Loans) the amount indicated increase of $18 330 in cost estimates.' of $383 000 be increased by $117 000, the total of $500 000 to be credited to the Headquarters Building The SECRETARY said that no decision had as yet been Fund. taken.The estimate had been based on the average Having considered thereport of the Director - cost, and it was unlikely that any reduction would be General on accommodation for the Regional Office possible. for Africa 3, the Ad Hoc Committee in its report 1 Decision: The estimates for Part I (Organizational had endorsed the Director -General's proposal that no Meetings) were approved. adjustment need be made with regard to Section 12 of the Appropriation Resolution (Reimbursement of Administrative Services the Working Capital Fund). Decision: The estimates for Part III (Administrative The Ad Hoc Committee had called the attention of Services) were approved. the Sixteenth World Health Assembly to the fact that, by using $849 100 of casual income to help finance the Other Purposes total effective working budget of $34 065 100 for 1964, no increase in the total assessments of members Decision: The estimates for Part IV (Other Purposes) would be necessary as compared to the total assess- were approved. ments fortheeffective working budget levelof Mr FURLONGER (Australia) commended the Secre- $33 716 000 proposed by the Executive Board at its tariat on the extremely clear and comprehensive - thirty -first session. documentation, particularly as concerned the budget. The document references were well arranged and most 1 Off Rec. Wld Huth Org. 127, Annex 9, part 1. 2 I his report on the subject, reproduced as Off. Rec. Wld valuable. Hlth Org. 127, Annex 9, part 2. 3 Off. Rec. Wld Hlth Org. 127, Annex 4, part 2. 5 Off. Rec. Wld Hlth Org. 127, Annex 9, part 2. - 4 Off Rec. Wld Hlth Org. 127, Annex 4, part 1. 6 Off. Rec. Wld filth Org. 125, 29. - - 368 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Text of the Draft Appropriation Resolution for the The Sixteenth World Health Assembly Financial Year 1964 RESOLVES to appropriate for the financial year 1964 an amount of US$36 288 230 as follows : At the invitation of the CHAIRMAN, the SECRETARY introduced the item and recalled that the Assembly I. Appropriation Purpose of Appropriation Amount had, in its resolution WHA16.13, fixed the amount Section US $ of the effective working budget and the budget level PART I : ORGANIZATIONAL MEETINGS for 1964 at US $34 065 100.The following figures 1. World Health Assembly 317 210 could now be inserted in the draft Appropriation 2. Executive Board and its Committees . . 189 090 3. Regional Committees 100 530 Resolution, the text of which was before the Com- mittee : Total - Part I 606 830
Appropriaton Purpose of Appropriation Amount PART II : OPERATING PROGRAMME Section US $ 4. Programme Activities PART I: ORGANIZATIONAL MEETINGS 5. Regional Offices 1. World Health Assembly 317 210 6. Expert Committees 7. Other Statutory Staff Costs 2. Executive Board and its Committees 189 090 3. Regional Committees 100 530 Total - Part II 24 851 405 606830 Total - Part I PART III: ADMINISTRATICE SERVICES 8. Administrative Services 1 925 182 PART III: ADMINISTRATIVE SERVICES 9. Other Statutory Staff Costs 618 683
8. Administrative Services 1925182 Total - Part III 2 543 865 9. Other Statutory Staff Costs 618683 PART IV : OTHER PURPOSES Total - Part III2543865 10. Headquarters Building Fund 500 000 11. Transfer to the Malaria Eradication Special PART IV :OTHER PURPOSES Account 5 363 000 12. Reimbursement of the Working Capital 10. Headquarters Building Fund 500000 Fund 200 000 11. Transfer to the Malaria Eradication Special Account. 5363000 Total - Part IV 6 063 000 12. Reimbursement of the Working Capital Fund 200000 Sub -total - Parts. I, II,. III and IV 34 065 100 Total - Part IV6063000 PART V :RESERVE 13. Undistributed Reserve 2 223 130 The total for Part II (Operating Programme) was $24 851 405, but the details for the various Appro- Total - Part V 2 223 130 priation Sections under Part II would be completed by the Committee on Programme and Budget. TOTAL - ALL PARTS 36 288 230 In paragraph IV of the draft resolution, if the Com- mittee accepted the recommendation of the Fourteenth II.Amounts not exceeding the appropriations voted under paragraph I shall be available for the payment of obligations World Health Assembly and the Executive Board incurred during the period 1 January to 31 December 1964 in regarding credits of 25 per cent. to be given to the accordance with the provisions of the Financial Regulations. Members listed in Schedule A to the resolution, the Notwithstanding the provisions of this paragraph, the Director - figure $190 060 should be inserted. General shall limit the obligations to be incurred during the financial year 1964 to the effective working budget established by the World Health Assembly, i.e. Parts I, II, III and IV. The CHAIRMAN suggestedthattheCommittee consider first the insertion of the figure quoted in III.The appropriations voted under paragraph Ishall be paragraph IV of the resolution. financed by contributions from Members after deduction of : (i)the amount of $756 990available by reimbursement Decision: It was agreed to insert the figure $190 060 from the Special Account of in paragraph IV of the resolution. the Expanded Programme of Technical Assistance At the invitation of the CHAIRMAN, Dr BRAVO (ii)the amount of $98 860representing assessments on (Chile), Rapporteur, read the following draft Appro- new Members from previous priation Resolution : years COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SEVENTH MEETING 369
(iii)the amount. of $454 733representingmiscellaneous * Spain Turkey incomeavailableforthe Sudan Uganda purpose Syrian Arab Republic United Arab Republic (iv)the amount of $ 295 507available by transfer from Tanganyika Upper Volta thecashportionofthe Thailand Venezuela Assembly Suspense Account Togo Viet -Nam, Republic of Trinidad and Tobago Yemen Total $1 606 090 Tunisia Yugoslavia Decision: The draft Appropriation Resolution was thus resulting in assessments against Members of $34 682 140. approved.2 IV.The Director -General is authorized to transfer an amount not exceeding US$190 060 from the cash balance available in the Malaria EradicationSpecial Account to cover the credits 3.DecisionsoftheUnitedNations,Specialized towards the payment of contributions of Members in accordance Agencies and the International Atomic Energy with Schedule A attached. Agency affecting WHO's Activities (Administrative, Budgetary and Financial Matters) TABLE A Agenda, 3.19 At the invitation of the CHAIRMAN, the SECRETARY SCHEDULE A TO THE APPROPRIATION RESOLUTION FOR THE FINANCIAL YEAR 1964 introduced the item. The Director- General had submitted a report on the subject to the thirty -first Members eligible for credits of 25 per cent.1 towards the pay- session of the Executive Board (Official Records ment of their contributions in respect of that portion of their assessments corresponding to the total amount voted for No. 124, Annex 20) and the Board had subsequently Appropriation Section11 under Part IV (Other Purposes) adopted resolution EB31.R43. The Director- General's of paragraph I of the Appropriation Resolution : report a now before the Committee gave details of developments since the thirty -first session of the Board. Afghanistan Iran Albania Iraq In particular,itreferred to the meeting of the Algeria Israel Administrative Committee on Co- ordination (ACC), * Argentina Ivory Coast held in Geneva during May. It had not been possible Bolivia Jamaica to attach to the Director -General's report the final * Brazil Jordan Bulgaria Kenya text of the ACC report, which had not been available Burma Korea, Republic of when the Director -General's report had been prepared, Burundi Laos but it was understood that the information contained Cambodia Lebanon in that report was in accordance with what would Cameroon Liberia ultimately appear in the ACC report. The Committee Central African Republic Libya Ceylon Madagascar would no doubt wish to note, in particular, the ACC's Chad Malaya, Federation of conclusions concerning the new terms of reference of * China Mali theInternationalCivilServiceAdvisory Board Colombia Mauritania (ICSAB). In subsequent paragraphs of the Director - Congo (Brazzaville) Mauritius Congo (Leopoldville) * Mexico General's report, mention was made of the following Costa Rica Morocco facts :that the ACC had revised and amplified the Cuba Nepal inter -organization agreement on the transfer, second- Dahomey Nicaragua ment or loan of staff from one organization to another; Dominican Republic Niger that it agreed to continue for a further year the present Ecuador Nigeria El Salvador Pakistan cost -sharingarrangements by whichthevarious Ethiopia Panama organizations met the expenditure on certain joint Federation of Rhodesia and Paraguay administrative activities; and that it had agreed upon Nyasaland Peru arrangements to facilitate the exchange of information Gabon Philippines Ghana Portugal regarding the scheduling of conferences by the various Greece Romania organizations.Regarding the last item, the Com- Guatemala Rwanda mittee was already aware of the difficulties that would Guinea Saudi Arabia Haiti Senegal 2 The draft resolution, as completed by the Committee on Honduras Sierra Leone Programme and Budget at its eleventh meeting (see p. 256) by * India Somalia the insertion of the figures in sections 4 -7 of Part II, was trans- Indonesia South Africa mitted to the Health Assembly in section 4 of the third report of the Committee on Programme and Budget and adopted as 1 I accordance with resolution WHA14.15. resolution WHA16.28. * Eligible under resolution WHA15.35. a Off Rec. Wld Hlth Org. 127, Annex 11. 370 SIXTEENTH WORLD HEALTH ASSEMBLY,PART II possibly be faced in connexion with the meeting of the The United Nations Development Decade looked to Seventeenth World Health Assembly. the day when the United Nations family of agencies and commissions would become the true servant of The CHAIRMAN recalled that during the discussion national development plans,freely conceived and of item 3.5- Selection of the country or region in efficiently executed by the peoples of the developing which the Seventeenth World Health Assembly will countries which were Members of the United Nations. be held, the delegate of Ireland had suggested that the Co- ordination should be a practical instrument. Committee should consider, in connexion with the It was commonly said that development began at item at present before it, adopting a resolution con- home.It was less frequently observed, but no less cerning the co- ordination of meetings held in the true, that development involved choices that were often Palais des Nations.Later on he would invite the very difficult : choices among the many priority needs delegate of Ireland to enlarge on that proposal. of developmentimprovement of health, agriculture, Mr MCKITTERICK (UnitedStatesof America) education, etc. No United Nations agency or group wished to make a few comments on the subject of of agencies could make those choices, which could only co- ordination, to which the Secretary had referred at be made by the people of the less developed countries the first meeting during his statement introducing the themselves. On the other hand, the United Nations review on the financial position of the Organization. family of agencies could (as it was already doing, His Government was increasingly concerned over through its manifold technical assistance programmes) the relationships between United Nations agencies and help to clarify the choices which the governments of commissions -a subjectusuallydisposedof by the less developed countries should make : that could waving the magic wand called" co- ordination ". be done through providing specialists to help fashion The subject would probably figure more prominently projects, through helping to improve administration, on the agenda of the Committee during the coming and through bringing new knowledge to bear. year. The most responsible job of the United Nations Each year the family of United Nations agencies family was that of helping the leaders of the less and commissions grew a little larger, reflecting the developed countries to resolve the terrible dilemmas needs of the growing membership of the United of their development programmes : the United Nations, Nations itself.The United Nations Commission on while it could not determine priorities, could help Housing, Building and Planning had recently met for if invited. It seemed that the United Nations would be the first time, and next year the United Nations would invited to help with ever greater frequency, and the be holding its first trade conference, perhaps one of more difficult the choices, the more heavy would the largest conferences of its kind.Three of the be the responsibility of the United Nations system. regional commissions and three specialized agencies It was the prospect of increasing responsibilities that were sponsoring, or had already sponsored, develop- made the problems of co- operation within the United ment or planning institutes to train future leaders and Nations system so urgent.Whilst the development administrators. The United Nationsitself was activities of the United Nations agencies should fully considering establishing a " staff college " to train its reflect the needs of Member governments, the work own administrators, and, thanks to a generous gift of the United Nations system should not be devalued from the Government of the Netherlands, would by the creation of competing sovereignties within the shortly be establishing an Institute for Social Develop- system itself.The United Nations, like the less ment. developed countries, must economize in the use of The senior specialized agencies were continuously scarce resources by perfecting the existing administra- developing (WHO itself was a good example), and tions and building on success rather than increasing there were now at least thirty -four United Nations potential competition. agencies and commissions assisting the economic The UnitedStatesGovernment was therefore and social development of the less developed countries. opposed to the creation of new United Nations A great deal of activity was being promoted under agencies in such broad fields as industry, trade and therubricof theUnited Nations Development science; it was urging, through the Economic and Decade. Much of it was extremely important activity, Social Council, that steps be taken to streamline the for the economic and social problems of the developing legislative and administrative procedures of the Special countries were both urgent and important. However, Fund and the Expanded Programme of Technical the objective of the United Nations Development Assistance, and was continuing to urge Member Decade was not to proliferate agencies and pro- governments to match its offers of financial support grammes, to add new administrative burdens, or to to those agencies. The Special Fund and the Expanded discard old services simply because they were old. Programme of TechnicalAssistanceprovideda COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SEVENTH MEETING 371
considerable source of development energy through The United States Government was opposed to the the specialized agencies, which were the executing proliferationofUnitedNationsagencies,but agencies.The United States Government believed supported expansion of existing agencies where sound that they would grow in importance -not in authority administrative capacity had been demonstrated. WHO over the specialized agencies, but intheir role as was one of the successful United Nations organizations promoters of sound country development plans. on which to build in the United Nations Development It had been said that there were advocates for the Decade. substitution of direction for co- ordination : the United The question of co- ordination should not be left States Government was not among those advocates. to the Secretariat or the exhortations of the donor Many United Nations agencies, including WHO, nations.It was the task of the Ministers of the were engaged in technical assistance. He knew of no developing countries themselves to see that the United plans to try to curtail those activities, and could not Nations family functioned as the efficient servant of conceive of a situation in which the technical assistance their national development plans.It was to be hoped portions of the regular budgets of the specialized that some of the Ministers of Health represented at agencies would not continue to grow. In view of the the Assembly would call on WHO for assistance in very difficult choices which development planning preparing projectsfor financing by thefinancial involved, it was both logical and necessary for the agencies within the United Nations system. Without United Nations to have a central source of technical that initiative on their part, the co- ordination on assistance funds invested not according to some which the success of the United Nations Development arbitrarypatternof" fairshares "among the Decade depended seemed impossible.Perhaps some specialized agencies, but according to priority needs country or countries would approach the Special as determined by the developing countries themselves. Fund or the World Bank with a proposal worked out In WHO activities,the community water supply by several United Nations specializedagencies - programme served as an example.Reliable water a proposal designed to make a dramatic impact on supplies were essential not only for health, but for some community or region.As an example, instead industry, commerce, and agriculture.Here was an of tackling separately some endemic disease in a given instance where a health programme could be married area, perhaps a country would call on WHO, FAO, the with an economic programme, where there should be World Bank, and UNESCO to fashion a co- ordinated close co- ordination between WHO and the financial programme of development.Such a multi -purpose agencies of the United Nations,particularlythe project had been tried successfully in the case of large Special Fund, the Expanded Programme of Technical power dams connected with irrigation schemes. Assistance, and the World Bank. WHO seemed to be The implementation of such a programme would, of in the best position to provide leadership in giving course, strain the capacity of the United Nations technical assistance for the planning and administra- agencies to co- operate with one another. But that was tion of water authorities in the developing countries, the kind of strain which the developing countries and it was reasonable to expect the Organization to should demand in the United Nations Development finance that kind of assistance out of its regular budget, Decade, the kind of strain from which would spring and to help in the establishment of small administra- the type of service that the United Nations system tive units. But there was no realistic prospect of the should be rendering to the developing countries. WHO budget providing the necessary resources for the development of water resources and water systems The CHAIRMAN drew the Committee's attention to requiring capital financing and perhaps a considerable draftresolutions proposed by the delegations of amount of training : in such cases, WHO's role should Ireland and Australia respectively. He would call upon be that of a consultant for the developing countries, the delegates of those countries to introduce them to before the financial agencies of the United Nations. the Committee. There was room for closer co- ordination and co- operation inthe development of national health Mr FURLONGER (Australia) speaking first on the plans. WHO was currently implementing only four general subject of co- ordination, said that the question Special Fund projects, accounting for hardly more had been the concern of the United Nations family for than $2 000 000 of the more than $280 000 000 total a considerable time, and was one of the most complex which the Special Fund had invested. That small sum and intractable problems with which it had had to did not seem to do justice either to the priority of deal. A multiplicity of bodies had, over the period, WHO's work as it affected the total development been built up to deal with co- ordination, but it would effort of the less developed countries, or to the proved be fair to say that the progress made on the general administrative capacity of WHO. question did not bear much relation to the number of 372 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II bodies concerned with it.It almost seemed that the Having taken into account the views expressed in point had been reached where a co- ordinating body resolution EB31.R43, adopted by the Executive was needed to co- ordinate the co- ordinating bodies. Board at its thirty -first session, It was necessary, however, not to give up and regard 1. NOTES with satisfaction that progress continues the problem as insoluble :that would be to take the to be made in the co- ordination of administrative, easy way out. budgetary and financial matters; He wished only to comment on three aspects of what was a vast subject : programme co- ordination, 2.EXPRESSES its satisfaction that the Administrative jurisdictional co- ordination and administrative co- Committee on Co- ordination hasagreedthat, ordination. subject to the views of the Board itself, the Inter- Programme co- ordination was ultimately the most national Civil Service Advisory Board might serve important aspect of the problem.Unless the right as an independent inter -organization body to make programmes were chosen, the aid given would not go recommendations on problemsarisinginthe to those areas where it was most needed. In spite of administration of the common system of salaries and its importance, it was unfortunately true to say that allowances; progress in co- ordination of programmes had been 3.CONSIDERS that, if new terms of reference and slower than in other areas.Other bodies in Geneva authorities extending the competence of the Inter- would be considering the question at greater length national Civil Service Advisory Board are approved in the course of the next few months. The fundamental by all concerned, this will become, one of the most problem that had not yet been solved was that of important actions thus far taken to improve co- getting priorities right.Various attempts had been ordination on administrative matters; and made to tackle the problem, but it was doubtful 4.REQUESTS the Director -General, in the further whether they had been right in all cases. His concern consideration of this matter in the Administrative in that regard was shared to some extent by the Committee on Co- ordination, to take into account delegate of the United States of America. The the views expressed in the discussion in the World problem of priorities was very important, because the Health Assembly. costs of programmes were increasing year by year, and if money was not spent to best advantage there was The question had received a great deal of attention a danger that donor countries might sometimes find over the past ten to fifteen years.It was one to which it difficult to agree to the increases proposed.By the Administrative Committee on Co- ordination had donor countries was meant not only the traditional devoted a great deal of time, and evidence of the donor countries. The concept of technical assistance progress made was shown, for example, by the com- had changed over the years and reference was now mon system of salaries and allowances.Differences made to technical co- operation; some of the original had nevertheless . arisen from time to time in the recipientcountrieswere now themselvesdonor application of administrative co- ordination.A case countries, and he cited the case of India, which had in point was the difference in 1962 on the question of become a donor country offering large -scale technical salaries of general service staff, and the rather un- assistance and co- operation. satisfactory outcome of that problem. At the Fifteenth With regard to jurisdictional co- ordination, namely, World Health Assembly his delegation had had occa- the working -out of the areas of activity of each of the sion to raise the question of minus post adjustments- agencies of the United Nations family, a great deal a point that was still not satisfactorily settled.There had been done. The areas of activity had been worked was also the still- unresolved problem of standards of out reasonably well, and the problem was largely one air travel, on which WHO was " on the side of the of implementation. He would be interested to hear angels ". any comments from developing countries in that His Government had felt for some time that better respect. machinery was needed to formalize administrative The third aspect -administrative co- ordination- co- ordination and attempt to work out more uniform was the one that had given rise to his delegation's conditions of service, salaries and allowances.It draft resolution, which read : had therefore very warmly welcomed the decision of the Administrative Committee on Co- ordination, at The Sixteenth World Health Assembly, its meeting in May 1963, to review the terms of Having considered the report of the Director - reference of the International Civil Service Advisory General on decisions of the United Nations, special- Board (ICSAB). That could represent a very important ized agencies and the International Atomic Energy step forward in the whole field of . administrative Agency affecting WHO's activities; co- ordination.If it were possible gradually to work COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SEVENTH MEETING 373 towards a situation where an independent civil service Administrative Committee on Co- ordination. He body existed to look into the whole question of doubted whether the Board could normally discharge conditions of service, a big step forward would have its duty in the course of only one session a year, and been made. hoped that, when the Board was established and began Referring to the proposed new terms of reference of to operate, there would be provision in practice for as ICSAB, he said that if that newly revised body was to many sessions as might be considered necessary, and achieve anything that would bring about more uniform that funds would be found to finance them. conditions of service in the various agencies, the first He would be grateful if the representative of the fundamental requirement was that it should be a body Director -General could clarify some of those points of great authority and competence.He noted from later in the discussion.They were put forward in a paragraph 4 of the revised terms of reference that constructive sense, because his delegation would like members of high qualifications were to be chosen for the the Board to be an effective body, independent and Board, and that they would have no connexion with the with the right staff, facilities and funds. Secretariat of the United Nations or any specialized The purpose of the draft resolution proposed by his agency. That requirement was an important and delegation was to express the satisfaction of the Health valuable one that would go a long way towards Assembly with the decision of the Administrative making the Board an independent and authoritative Committee on Co- ordination to review the terms of tribunal. reference of ICSAB so that it might become an Paragraph 6 of the revised terms of reference stated independent body in the field of the common system that the Board would have a secretary. He expressed of salaries and allowances.It expressed the opinion the hope that he too would be a person of considerable that if the Board could become really effective it would standing, an experienced administrator, and one who be one of the most important developments in had no connexion with the Secretariat of the United administrative co- ordination.It was thought that it Nations or of any specialized agency. If the secretary might be helpful to the Director -General, in his was to do his job properly he must also have an further consultations with the other members of the independent staff, and he was somewhat concerned Administrative Committee on Co- ordination, to take about the terms of paragraph 9 of the revised terms of account of any consensus emerging in the course of the reference, which stated : Committee's discussion. He hoped that it might The executive heads shall make available such strengthen the Director -General's attempts, in ACC auxiliary staff and facilities as may be needed to and elsewhere, to assist in bringing about as uniforma enable the Board to discharge its responsibilities. system of conditions of service as possible. He hoped that the secretary might be given a small, The CHAIRMAN thanked the delegate of Australia for highly -qualified staff, in a position of real independence his illuminating statement. for the exercise of their work. He was also a little concerned about the reference to Mr BAUER (Canada) agreed, as stated in paragraph the frequency of meetings.Paragraph 10 of the 3 of the draft resolution proposed by the delegate of revised terms of reference stated that the Board should Australia, that the proposed action would becomeone normally have one regular session each year, and went of the most important thus far taken to improveco- on to say : ordination on administrative matters. His delegation was pleased to note that anotherstep Subject to budgetary limitations, the Chairman had been taken towards improving the recruitment may convene supplementary sessions of the full policy within the United Nations family and towards Board, or of a panel of the Board, if he deems that a further co- ordination of conditions of service. He matter before the Board must be dealt with before agreed with everything that the delegate of the United the next regular session. States of America had said about programmeco- ordination. A great deal of attention The fuctions of the Board, as set out in paragraph 7, was paid to the subject because it was part of the were to review and make recommendations, through raison d'êtreof the various agencies to have programmes that would ACC,on the system of classification of posts and its produce results.On the other hand, administrative application; salaries and allowances of staff in the co- operation was quite as important - perhaps more professional and higher categories, and of staff in the so- because without a good recruitment system, or generalservicecategoryatheadquartersareas; good co- ordination of administrative arrangements divergencies in the application of the common system; among the various agencies, the programmes were and other matters that might be referred to it by the bound to suffer. 374 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
The secretariats of the various agencies tended to the Fifth Committee and General Assembly of the become rather bored with the subject of administrative United Nations for comment. co- ordination as it came up year after year, but the He hoped that the discussion on the revised terms of remarks he was making were primarily in the interest reference would be of some assistance to the Director- of the health of the agencies themselves. Improvements General or his representative when the question was in co- ordination would enable them better to carry out again discussed in the Administrative Committee on their functions.The delegate of Australia had men- Co- ordination. The terms of reference were,in tioned the problem that had arisen during 1962 and general, good as far as they went. The goal of achieving been resolved in a rather ad hoc manner which an independent andauthoritativeBoard wasa probably had not in the long run contributed to the commendable one, but there were a few points in the health of the agencies.Official RecordsNo. 124, Annex revised terms of reference which did not, perhaps, fit 20, Appendix 1, contained a table on a similar sub- in as well as they might with that aim. The question ject- Comparison of organizations' current might be merely one of wording, but he hoped that the (November 1962) standards for air travel.It could be Director -General would take the comments of the seen that, while there were a few organizations in step Committee into account in his discussions with other with each other (the delegate of Australia had men- agency heads and in ACC before the final suggestions tioned that WHO was "on the side of the angels "), for terms of reference were submitted in New York. that could not be said of all of them. Where agencies Paragraph 1 of the revised terms of reference, for were competing for staff -and a large proportion of instance, stated that : the staff was available in a sense to all of them - The International Civil Service Advisory Board discrepancies in conditions of service gave some of shall be composed of a Chairman and ten other them an advantage over others.In the long run, a members appointed by the Secretary -General of the standard approach to conditions of service, salaries United Nations, with the advice and consent of the and post classifications could lead to a better position Administrative Committee on Co- ordination. for all the agencies concerned, and an improvement of the machinery for recruiting and maintaining the kind That paragraph was somewhat ambiguous, and he of personnel needed toenable them to function questioned the use of the term "advice and consent ". properly. If ICSAB was to be an independent body he would His delegation's satisfaction in seeing that further have thought that the words "in consultation with the step taken was modified to some extent by the realiza- Administrative Committee on Co- ordination" would tion that proposals on the same lines had been made be preferable.Knowing the relations that existed as long as seven years ago by a United Nations between the Secretary -General of the United Nations Salary Review Committee.A group of extremely and agency heads, he was confident that the lack of competent experts from all over the world had pro- consent by, for instance, one member of the Adminis- duced a magnificent report on the whole question, trative Committee on Co- ordination need not prevent which had been submitted in the autumn of 1956. the appointment of a member to the Board which all Many of the proposals had been implemented, but one the other members approved. He presumed that the of them had taken a considerable time : namely, the Secretary -General of the United Nations would also establishment of a strongly -constituted, independent, consultinformallymembersoftheAdvisory international civil service advisory board which would Committee on Administrative and Budgetary Ques- deal with the problems set out in the report under tions.That ICSAB should be an independent body discussion. ICSAB was a body that did not meet very was important not only to agencies but also to the often, and there was not much continuity. The contributing Governments, and he felt that ACABQ proposals made by the Administrative Committee on would appreciate being consulted regarding payment Co- ordination were therefore all to the good.His of the Board. delegation would be very happy if the proposals He agreed with the remarks of the delegate of originally made by the Salary Review Committee of the Australia concerning paragraph 4 of the revised terms United Nations were implemented. Governments of reference.It was important to ensure that the were being given their first opportunity to look at the members appointed to ICSAB were independent and suggestions that the Administrative Committee on competent persons.In that paragraph the words Co- ordination had worked out at its meeting on 2 and "whose high qualifications will ensure respect for the 3 May 1963. He presumed that the proposals would Board's advice" implied high qualifications in the be passed to ICSAB, from that body back to ACC, fieldstobedealtwith by ICSAB :personnel, then to the Advisory Committee on Administrative administration, etc.He also agreed wholeheartedly and Budgetary Questions (ACABQ) and ultimately to with the delegate of Australia concerning paragraph 6 COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SEVENTH MEETING 375 on the subject of a secretary for the Board.That through ACC, with ACC's comments accompanying paragraph represented a major innovation, since the them.In other words, the Board's reports would be Board had not hitherto had a secretary.If the Board to the legislative or executive bodies.They would was to be a continuing body, as envisaged in para- be integral reports prepared by ICSAB and would graph 2, a secretary was essential in order to provide have a commentary prepared by ACC or the relevant the necessary continuity of research and consultation. agency concerned. TheSalary Review Committee of the United In the draft resolution proposed by the delegation of Nations in 1956 had recommendçd that the secretary Australia, he did not understand the use of the term should be of senior rank and should be entitled to "inter- organization body" in paragraph 2. The Board attend meetings of the Consultative Committee on was to serve not as an inter -organization body but as Administrative Questions when matters concerning an independent body with no direct relationship or tie ICSAB were under discussion; and further that the with the agencies. Its members were private individuals Secretary -General would provide such other staff as serving in private capacities and could not be staff might prove necessary. He considered that the members of the United Nations or its specialized secretary must be of Director level.There was no agencies.The use of the term "inter- organization point in setting up an independent and authoritative body" might create confusion, and since it appeared body withasecretary who was not in a position to merely in the Director -General's report and not in the be independent, and he must therefore have the revised terms of reference, he hoped that the delegate of necessary qualifications, salary and position. Australia would agree to delete the term from his Another point made by the delegate of Australia draft resolution.In relation to the same operative that could not be emphasized too strongly was that paragraph, he asked the delegate of Australia whether concerning paragraph 9.It was difficult to envisage he would be willing, after the word "recommenda- how a body, depending for itseffectiveness on a tions", to insert the words "through the ACC to the secretary who obviously needed a staff, could remain appropriate legislative and executive bodies ".With independent if it had to go to the various agencies or to those reservations, he wholeheartedly supported the ACC for staff each time it had a job to do. He hoped draft resolution. therefore that a secretary of senior rank would be He would be grateful to hear any further comments provided with staff responsible to him and paid from that the Secretary could make on the subject. the United Nations budget. It was bad practice for an The CHAIRMAN asked the delegate of Canada what administrative board to be dependent for its funds on was intended by the term "executive bodies ", since in the agencies to which it would be giving advice; it his own interpretation it meant "secretariats ". would mean in effect that every agency's budget would have to contain an item every year for payment of the Mr BAUER (Canada) said that perhaps it would be secretary and his staff, making it necessary for ICSAB preferable to use the term "governing bodies ".He to run the hurdle of about twelve administrative bodies was thinking in terms of the Executive Board of WHO, each year. The only practical method was for payment the Governing Body of ILO, etc. to be made from the United Nations budget, through Mr FURLONGER (Australia) thanked the delegate of the Fifth Committee, the only exception being in the Canada for pointing out two weaknesses inhis case of a request from an agency for ICSAB to under- delegation's draft resolution, and agreed that the term take a study of particular interest to that one agency, "inter- organization" in paragraph 2 could be deleted. which might then be charged for the work. He would also be happy to accept the suggestion that Paragraph 7 (a) (iv) of the revised terms of reference was somewhat restrictive, and he considered that to the words "through the ACC to the appropriate the functions of the Board might be added, for legislative and governing bodies" be inserted after the instance, matters that the Advisory Committee on word "recommendations" in the same paragraph. Administrative and Budgetary Questions might wish to The SECRETARY said that he would limit his remarks refer toit,or matters that might be considered to clearing some possible misunderstandings that desirable by ICSAB itself, in co- operation with the might emerge from the record of the discussion, and to Administrative Committee on. Co- ordination. making a few points more clear with regard to the With regard to paragraph11, which read "The intention behind the development in the course of the reports of the Board shall be transmitted to the past year, following what had occurred in relation appropriate authorities of each organization through to general service salaries in Geneva, referred to by the ACC ", it would be desirable to be a little more specific, delegates of Australia and Canada. That occurrence and say that the reports should be transmitted to had, perhaps, contributed a great deal to the current theappropriategoverningorlegislativebodies, attempt to establish an independent body, identified as 376 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
ICSAB, and had had a stimulating effect. As a health concerned.The problem also arose of establishing organization, WHO liked to consider such develop- effective dates for putting certain recommendations ments, and the actions that stemmed from them, as into effect.If agencies continued to require that preventive administration. The intention, at least of recommendations be referred for acceptance to their WHO representatives participating in the various legislative or governing bodies, certain delays might inter -agencymeetings,wasthat the independent occur, and he would therefore strongly urge that the body to be created should be constituted in such a amendment proposed be revised to read " appropriate manner that there would be as little connexion as authorities ", or withdrawn entirely. possible with political organs, which all too often made He could see no difficulty in the deletion of the administrative decisions in a political arena without term " inter -organization " in paragraph 2. taking account of the administrative problems that really required to be solved. The CHAIRMAN emphasized the differences that It was intended that ICSAB should be as independ- existed between the practices of the various agencies ent as possible in its composition, selection of its staff regarding the need or otherwise to submit certain and budgetary arrangements; but it would not be questions, such as general service salaries, to their analtogetherhappy arrangementifitsbudget governing or executive bodies, as had been mentioned depended solely on action by the United Nations by the Secretary.In WHO the Director -General General Assembly and the Fifth Committee. It would had full authority to deal with such matters; in ILO be preferable for ICSAB to establish its own budget, the Governing Body had to decide; and in the United with all the agencies that participated in the common Nations the Secretary -General had the authority to system paying their appropriate share.If at any time deal with them, but in practice always waited for the legislative organs of the agencies that agreed to action by the General Assembly. He agreed that the participate in the plan felt that the budget of ICSAB wording proposed for insertion in paragraph 2 of the was becoming too large, they could indicate their draft resolution should be amended to read " to the feelings. For any one agency to have the responsibility appropriate authorities ", and he asked whether the of determining the budget might give rise to the delegate of Canada agreed to that wording. question whether that agency had too much control. Mr BAUER (Canada) thanked the Secretary for his With regard to some of the remarks that had been elaboration on the proposed revised terms of reference made about the arrangements for meetings of ICSAB, of ICSAB. He was now more than ever convinced and the selection of staff, he said that paragraphs 3 and that fundamental agreement existed on the desirability 10 of the revised terms of reference would make it of having a body such as ICSAB, and he sympathized possible for ICSAB to meet as often as it wished, entirely with the desire of the Secretary and of the either as a full body or in sub -committees, the ACC to keep it out of the political arena.If ICSAB decision being left to the Board itself. The question of was to be effective it must have the confidence not only staff was referred to in paragraph 9, and of the full - of the agencies but of governments, and it was necessary time secretary in paragraph 6.He interpreted para- to ensure that it was in a position to produce inde- graph 9 to mean that the staff of ICSAB would be pendent decisions. selected by that body itself, which would determine the He would agree that the insertion he had proposed number of staff needed, within its own budget, to in paragraph 2 of the draft resolution be amended which all agencies would contribute on a pro rata to read " to the appropriate authorities ", as suggested basis. by the Secretary. With reference to the proposal by the delegate of Canada for the insertion of some appropriate words The CHAIRMAN asked the delegate of. Australia after the word "recommendations" in paragraph 2 whetherthat amendment was acceptabletohis of the draft resolution proposed by the delegation of delegation. Australia, the terminology "appropriate authorities" Mr FURLONGER (Australia) said that he had under- had been very carefully worked out on an inter- stood the Secretary to say that in practice ICSAB agency basis, in preference to referring to the legis- would have its own budget and staff.The terms of lative,executiveorgoverning bodies concerned. reference as drafted appeared to go to great lengths Many recommendations were likely to emerge from to conceal that fact, and he was somewhat puzzled ICSAB which, so far as some agencies -WHO among by them. them -were concerned need not go beforetheir executive or governing bodies.Such matters as the The SECRETARY agreed that the point was not as establishment of general service salary scales,for clearly stated as it might have been, but said that the instance, came in that category as far as WHO was terms of reference of ICSAB would probably go COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : SEVENTH MEETING 377 through several processes before reaching their final Mr BRADY (Ireland) said he would like first to make form.There was to be a meeting of ICSAB in some general comments on the matters before the New York during the following week at which the Committee. terms of reference would probably be tidied up some- He was in full agreement with the proposals made what. Paragraph 12 of the terms of reference, which in the resolution put forward by the delegation of stated : " The costs of the Board shall be borne by the Australia, provided that the position as recorded in organizations in a manner to be agreed among them ", paragraph 2 of the Director -General's report continued was intended to cover the point under discussion. He to apply.He fully agreed that the revised terms of assured the Committee that WHO would maintain its reference and the procedures to be adopted in con- position on that point in any further discussion of the nexion with ICSAB should make it as independent terms of reference. and authoritative a body as possible.However, he With reference to the suggestion by the delegate considered that there was considerable importance in of Canada that in the appointment of the members the statement made in the fourth sentence of pat a- of ICSAB the Secretary -General of the United Nations graph 2 of the Director- General's report :" Final might wish to consult not only the Administrative authority would, for constitutional reasons, remain Committee on Co- ordination but also the Advisory with the appropriate authorities of each organization." Committee on Administrative and Budgetary Ques- He hoped that the independent authority and the tions, he assumed that any of the agency heads would calibre of the members of the reorganized ICSAB have the possibility of consulting any of the agency would be such thatitsrecommendations would organs : the Director - General of WHO, for example, commend themselves almost uniformly to the govern- might wish to consult the Executive Board on occasion. ment bodies and the legislative authorities of the That was fully the intention behind the provision different organizations.For constitutional reasons, that the Secretary- General of the United Nations the final decision must remain with the appropriate would consulttheAdministrative Committee on authorities of each organization. Co- ordination. Some very constructive contributions had been The CHAIRMAN suggestedthattheCommittee made by the delegates of the United States of America, should vote on the draft resolution proposed Australia and Canada. The interesting remarks by the delegation of Australia before going on to discuss the delegate of the United States of America had met one proposed by the delegate of Ireland. He read out with the approval of his delegation on many points, paragraph 2, with the amendments proposed by the and particularly on that concerning his desire for delegate of Canada and amended during the discus- every effort to be made to restrict the proliferation sion, as follows : of international agencies.From the narrower point of view of the interests of WHO he also supported EXPRESSES its satisfaction that the Administra- 2. the reference to the possible streamlining of available tive Committee on Co- ordination has agreed that, funds, and in particular of funds which might be subject to the views of the Board itself, the Inter- available to the United Nations Special Fund and the national Civil Service Advisory Board might serve Expanded Programme of Technical Assistance.A as an independent body to make recommendations very considerable amount of documentation had been to the appropriate authorities on problems arising in the administration of the common system of presented on the question of co- ordination, and there was one particular reference to which he would draw salaries and allowances; the special attention of the Committee. In the thirtieth Decision: The amendments contained in that para- report of the Advisory Committee on Administrative graph were adopted. and Budgetary Questions to the United Nations General Assembly at its seventeenth session (repro- The CHAIRMAN put to the Board the draft resolution ducedinOfficialRecords No.124, Annex 20, as amended. Appendix1)under the heading," Administrative Decision: The draft resolution, as amended, was and financial implications for agency budgets of approved.' assisting United Nations organs ",it was stated, in paragraph 56: The CHAIRMAN asked the delegate of Ireland to introduce the draft resolution proposed by his delega- This year the Advisory Committee has made a special inquiry into the matter of the impact upon tion. the specialized agencies of the adoption by United Nations bodies of resolutions on matters falling ' Transmitted to the Health Assembly in section 1 of the Com- mittee's fourth report and adopted as resolution WHA16.32. very largely in the province of an agency. 378 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Paragraph 57 went on to say : presentdifficulties. The conferencefacilitiesat Most of the specialized agencies have emphasized United Nations Headquartersin1964 would be their disappointment that the General Assembly limited owing to constructional work, and there was has not up to now acted to provide in its rules of the continued tendency for international conferences procedures for prior consultation in respect of to become more numerous and frequent.There was proposals for new activitiesinfieldsof direct also the difficulty that Geneva was attracting more concern to the agencies. conferences from other areas, giving rise to consider- able pressure on the accommodation available. WHO Paragraph 58 suggested a procedure to deal with the and its Assembly could be regarded as being in the possiblility of financial implications that might arise status of a regular customer of the Palais des Nations, and for which no budgetary provision had been made. and where ad hoc or new conferences were concerned a That procedure might be applied in cases where the certain priority ought to be given to the regular United Nations was venturing upon activities that customer. He therefore felt it desirable for the Organi- fell to a considerable extent within the ambit of the zation, by means of a further resolution, to seek to specialized agencies. The matter was a very important maintain its position, as had been done in the case of one, and he was glad to note that it had been referred to the resolution already adopted in regard to the in the Advisory Committee's report. location of the Seventeenth World Health Assembly. A great deal was heard about the word "co- ordina- The draft resolution proposed by his delegation tion", and there was of course a certain amount of referred to the fact that the question of co- ordination of misunderstanding about it. He urged the Committee to internationalmeetingshadalreadybeenunder adopt the view that co- ordination, to achieve its consideration by the Administrative Committee on purposeof avoidingunnecessaryduplication by Co- ordination, and mentioned the financial difficulties agencies, must be reciprocal. That was an aspect of the that would occur should any disruption at short notice matter in which the Organization had not been take place in the convening of the Seventeenth World entirely blameless. Health Assembly.In its operative portion it empha- It was up to delegates to ensure that they furthered sized the necessity for facilitating annual assemblies of co- ordination intheir own countries.With the organizations such as WHO at the normal time in growing complexities and heavy documentation it was order to avoid disruption of the established cycle of becoming difficult to co- ordinate not only at inter- operations of the Organization; expressed the hope national, but also at national level.There had been that there would be continuing and improved co- cases where co- ordination had been far from perfect, ordination and co- operation in the scheduling of and the issue of reciprocal co- ordination between meetings among the agencies concerned; requested agencies was one to which he would draw particular the Director -General to transmit the resolution to the attention. Secretary- General of the United Nations with the Introducing the draft resolution put forward by his request that he transmit itto the Economic and delegation, he recalled that when the question of the Social Council; and ended by expressing the hope holding of the Seventeenth World Health Assembly had that the Economic and Social Council would, in the been under consideration the Secretary had given the exercise of its responsibility under Article 63, para- Committee some information that had caused concern graph 2, of the Charter of the United Nations, take into among a number of delegates, including himself. The account the requirements of the specialized agencies suggestion had been made during the discussion of when it considered conference schedules. He read out that subject that an attempt be made to ensure that the the paragraph of the Charter of the United Nations matter would be considered further by the Ecomonic referred to, as follows : and Social Council sothat, by means of inter - 2. It [the Council] may co- ordinate the activities organizational co- ordination, the Health Assembly, of the specialized agencies through consultation held so often in Geneva, should continue to be held with and recommendations to such agencies and without undue disturbance.He was quite sure that, through recommendations to the General Assembly withoutanyindicationbytheCommittee,the and to the Members of the United Nations. Secretariat would endeavour, by every possible means, to arrange to fit in the Organization's meetings with He commended to the Committee the draft resolution the needs of other agencies.It would be wrong to proposed by his delegation, which read as follows : suggest that the difficulty had been created without full consideration on the part of the people responsible The Sixteenth World Health Assembly, for the organization of conferences.It would be Having considered the report of the Director- realized that several matters had contributed to the General ondecisionsof theUnitedNations, COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : EIGHTH MEETING 379
specialized agencies and the International Atomic Nations with the request that he transmit it to the Energy Agency affecting WHO's activities; Economic and Social Council; and Noting that the Administrative Committee on 4.EXPRESSES the hope that the Economic and Co- ordinationhasestablishedarrangementsto Social Council will, in the exercise of its responsi- facilitate the exchange of information regarding the bility under Article 63, paragraph 2, of the Charter of scheduling of conferences by the various organiza- the United Nations, take into account the require- tions ; ments of the specialized agencies when it considers Considering that such inter -secretariat co- ordina- conference schedules. tion, while useful, can only be effective if those concerned take full account of established recurring Dr CAYLA (France) strongly supported the draft requirements for scheduled conferences; resolution proposed by the delegate of Ireland.One Considering further that disruption of established reason for his support was that the Committee had just conference schedules results in unnecessary expense adopted its appropriation resolution, from which it to governments ; appeared thatthe provision fortheSeventeenth Recalling that the World Health Assembly has World Health Assembly would be insufficient to cover always met in the Palais des Nations in the month of it should it be held away from headquarters.He May when it has been convened in Geneva, expressed the hope that the Economic and Social
1. EMPHASIZES the necessity for facilitating annual Council would do everything necessary to ensure that assemblies of organizations such as the World WHO was given the priority due to it. Health Organization at the normal time in order to avoid disruption of the established cycle of opera- Dr ALAN (Turkey) associated himself with the tions of the Organization; delegate of France in supporting the draft resolution. 2. EXPRESSES the hope that there will be continuing and improved co- ordination and co- operation in the The CHAIRMAN put to the Committee the draft schedulingofmeetingsamongtheagencies resolution proposed by the delegate of Ireland. concerned; was approved.' 3. REQUESTS the Director -General to transmit this resolution to the Secretary -General of the United The meeting rose at 12.15 p.m.
EIGHTH MEETING
Friday, 17 May 1963, at 2.45 p.m.
Chairman: Mr I. T. KITTANI (Iraq)
1.Second Report of the Committee to the Committee Dr NABULSI, representative of the Executive Board, on Programme and Budget said that at its twelfth session the Regional Committee At the request of the CHAIRMAN, Dr BRAVO (Chile), for Africa had considered the reasons why the Rapporteur, read the Committee's draft second report Regional Committee had met in Geneva and the to the Committee on Programme and Budget, which measures to be taken to avoid a recurrence of a similarsituation,andhadadoptedresolution contained the draft Appropriation Resolution for 1964. AFR /RC12 /R17.2 The matter had been raised at the Decision:The report was adopted (see page 411). thirty -firstsession of the Board in January 1963, during discussion of the Regional Committee's report 2.Meetings of theRegional Committee for Africa on its twelfth session.The Director -General had at Agenda, 3.14 1 Transmitted to the Assembly in section 2 of the Committee's The CHAIRMANasked the representative of the fourth report and adopted as resolution WHA16.33. Executive Board tointroduce the item. 2 Reproduced in Off. Rec. Wld Hlth Org. 127, Annex 14. 380 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II that session informed the Board of his intention to to co- operate with other Members of that region.It transmit the resolution to the World Health Assembly, had placed its resources and technical knowledge at the and the Executve Board had decided therefore to disposal of the Region. South Africans were members place the matter on the agenda of the Sixteenth World of eleven WHO expert advisory panels.The South Health Assembly. African Institute for Medical Research was a WHO reference laboratory for influenza and other respiratory The CHAIRMAN, opening the general discussion on diseases; the South African Poliomyelitis Institute was the item, requested members of the Committee to a reference laboratory for poliomyelitis and entero- confine their remarks tothe subject under con - virus diseases. sideration. As regards finance, South Africa was considering Mr TALJAARD (South Africa) regretted that the item making an interest -free loan of $200 000 towards the had been placed on the agenda. As that had been done, cost of the regional office building, on the basis that the however,he would refer to a few factors concerning South repayment would be put back into the health develop- Africa's attitude towards health promotion in general ment of the Region. That offer was being made in a and its achievements in health. He recalled that he was spirit of co- operation, for the benefit of the health of representing six per cent. of the total population of the Region. South Africa subscribed to the Constitu- Africa, and that he was speaking on behalf of all tion and the objectives of the Organization and had South Africans, who belonged to ten different ethnic made many contributions in cash and kind to its communities with different languages and cultures. efforts.South Africa had always paid its relatively In plenary session the chief delegate of South large contribution regularly and had made practically Africa had briefly stated the attitude of South Africa no demands on the Organization's resources, believing to health matters, both as concerned its own people and that they could be used to better advantage in other the African continent in general, and the reasons why countries, where the need was greater.It had, more- health should be regarded as of primary importance over, contributed from its own resources to the control in the development of any country, and particularly of of human, animal and plant diseases in Africa. countries in Africa, had been fully expressed a number Under the WHO Constitution South Africa had of times in the course of the Assembly's debates. It had obligations, which it was fulfilling entirely. But it also been mentioned that South Africa had built up health had rights, and those rights should not be denigrated. services to a comparatively high degree. One or two South Africa was a State within the African Region details would servetoillustrate what had been and a member of the Regional Organization for Africa, achieved and South Africa's earnest will to tackle its which was an integral part of the Organization, in health problems. The largest hospital in the whole of accordance with the Constitution.It was the view of Africa was in South Africa, near Johannesburg. It had the South African delegation that every Member 2500 beds, and employed 200 full -time doctors and State of the Organization had the duty to ensure that 1200 nurses. Another hospital, in Natal, had 200 beds the rights of the other Member States were. respected. and 146 full -time doctors. The annual expenditure on If Members allowed matters outside the Constitution health amounted to some $170 million.There were to be introduced and considered, they would be 700 hospitals, clinics and district nursing services in the embarking on dangerousground. The Health country.$85 million was devoted annually to sub- Assembly had already taken the decision not to deal sidizing staple foods. There was one doctor for every with matters outside its competence when it adopted 1800 people, and a total of 114 200 hospital beds. The resolution WHA6.47, in which it called attention to benefits of those services were available to the whole the technical nature of the Organization and stated that population, including a million foreigners temporarily it should not be called upon to judge or determine earning their living in South Africa. questions of a political character, to resolve which The Organization was fully aware of South Africa's other, better qualified, bodies existed.That wise internal health picture. South Africa was anxious and decision should be maintained.Within the African able toco- operate with other AfricanStatesin Region all Member States should concentrate on co- improving conditions throughout the continent. It had operation.The differences existing should not be been combating malaria, trypanosomiasis, and other exaggerated; instead, attention should be focused on diseases with success for many years.Malaria had the Region's health problems and on finding a solution been practically eradicated and the tsetse -fly was under for the factors retarding its development. control. South Africa was always ready, within the Organiza- South Africa was one of the oldest Members of the tion, to meet with other Member States of the Region, Organization ;it was an integral part of the African to endeavour to find a solution to the grave problems Region and had consistently given evidence of its will facing it.To that task South Africa woud make a COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : EIGHTH MEETING 381 valuable contribution, which, one day, would receive The problem should, indeed, be of concern to all the recognition it deserved. countries of the world that believed in liberty and peace, for no peace was possible while in one part of Dr BA (Senegal) congratulated the Chairman on his the world there were people deprived of their most election. elementaryrights. Economic,socialandhealth The problem before the Committee was extremely development were incompatible with the conditions important and required a rapid solution, which would under which certain peoples were living, and the not be found unless the discussions were carried on in Organization, whose fundamental objective was to an atmosphere of calm. In that connexion his delega- promote the health of all peoples, should take that tion would respond to the Chairman's opening appeal. into account.In the United Nations, nearly all the First of all, he would request members not to see any African States had requested that sanctions be taken racial opposition in the problem before it.It was a against South Africa; some had gone as far as to problem posed by the situation of 94 per cent. of the request its expulsion from that organization, because population of South Africa. On various occasions, at they considered, rightly, that South Africa was not the General Assembly of the United Nations, resolu- respecting the United Nations Charter.Certainly, tions had been passed, inviting the Government of WHO was atechnicalorganization,but certain South Africa to take steps to abolish apartheid, to conditions had to be fulfilled before it could achieve its liberate the population of South Africa and enable it to technical aims. work for the betterment of its social and economic Senegal maintained its view that it was impossible to conditions. receive the Regional Committee for Africa as long as Once they became independent, African countries the delegation of South Africa remained on the had never refused to co- operate loyally and sincerely Regional Committee. His delegation could not speak with all countries of the world, for their common good, for other countries, but knew that, if a solution was on the basis of equality of rights and obligations. not soon found to the problem, it would gravely The reasons for which the Regional Committee for hamper the working of the Regional Committee. Africa had passed the resolution brought to the Compromise solutions might be sought, but none of Committee's attention were explained in the preamble them could effect a permanent remedy. of that resolution.It was only necessary to add that, because of the social and technical level of six per cent. Dr Dow (Mali) considered apartheid as a real of the population, much had been done for health in cause of morbidity and mortality in the African South Africa, but the achievements were not benefiting population, and the statement made by the delegate 94 per cent. of the people, most of whom were relegated of South Africa had not changed his opinion.His to the reservations.The preamble to the Regional delegation, speaking in the name of the people of Committee'sresolutioncontainedthefollowing Mali, protested strongly against the way the greater phrase : "Being conscious however of the needs of the part of the population was treated -because it was South African population and of the necessity for the black.In the United Nations many delegations had World Health Organization to be able to assist this many times appealed to the Government of South population ".The countries which had voted that Africa to abandon its policy of racial segregation. resolution were conscious of the needs of the popula- Apartheid was inhuman; it was deadly, because it tion of South Africa; they desired, however,the humiliated and wounded men. A humiliated man was assistance given to benefit the whole population, a sick man, and the humiliation of a whole population which, under present circumstances, was impossible. was a catastrophe that the world should not tolerate. They had not passed the resolution in order to Mental pain killed men slowly, but more surely eliminate the real South Africa, which one day would than any tubercle bacillus. No one could put up with be governed by the true nationals of the country; but being treated as an untouchable, and if the white they denounced the Government that was denying its minority of South Africa persisted in making men population the necessary minimum, in accordance untouchable, in segregating them in reservations, it with the principles of the Organization, to enable them had no place in a body consecrated to the ideals of to raise their level of health, a prerequisite for raising concord, solidarity, and physical and mental well- the standard of living, and take their place among the being. free peoples of the world. The countries of the African Region were determined The problem of apartheid was causing concern to to obtain the eradication of that new endemic in many. governments. The subject was on the agenda of Africa, and would do so. There could be no collabo- the conference of ministers of foreignaffairsof ration with the white minority in Africa while it main- African States, at present meeting in Addis Ababa. tained its present attitude; if it did, then the only 382 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II solution would be the disappearance of one com- a whole, then it would have to do everything in its munity or the other -and it was not difficult to see power to remove the barrier constituted by apartheid, which would prevail. which was the tragedy and the shame of the present The Health Assembly could not remain neutral in era. The problem had to be viewed objectively; the matter if it wished to respect the fundamental indeed,therewasaninadmissiblecontradiction principles on which the Organization was founded. between the role of the Organization to foster a health policy for the benefit of all humanity and passive Mr FERAA (Morocco) said that it was impossible acceptance of a system that was impeding the realiza- to remain indifferent to the problem which the pre- tion of that health policy.The Organization should ceding speakers had explained so clearly.Neither not elude its responsibilities.Certainly, progress in was it possible to dismiss it as belonging to another the health field had been made in South Africa, but it region.What would happen if every regional com- benefited only the whiteminority. TheSouth mittee had to meet at headquarters in Geneva, for African Government should, as a founding Member, It would cause all kinds of one reason or another ? apply faithfully the Constitution and recommendations difficulties, and would weaken the spirit of co- operation of the Organization. His delegation was not requesting which the Organization was seeking to develop. He that South Africa should be denied its rights in the had noted with great interest the considerable efforts African Region; that country would enjoy them fully made in South Africa. However, every Member of the if it respected the fundamental principles of WHO. Organization had not only rights, but obligations, However it did not appear possible to continue to when it subscribed to the Constitution. It was difficult collaborate with South Africa if it persisted in its to see how the Organization could allow a situation to persist that had political, economic and social policy of apartheid. The African delegations to the Health Assembly had implications.He was anxious to avoid touching on the political issue, but in the present case the technical prepared a resolution (see page 388), which he urged the Committee to approve.It was objective and implicationsweredifficulttoseparate from the contained only one requestthat the Government political ones.If certain Members in certain regions did not co- operate, if they did not take part in regional of South Africa should abandon its obsolete and meetings, the technical work of the Organization inhuman policy, so that the non -white population of South Africa could profit fully from the benefits of would suffer.Therefore, he requested the Committee to try to find a way of relieving the tension, so that modern medicine and the health programmes planned the Organization could reach its fundamental objective and put into effect by WHO. of improving the health of all peoples. Mr TALJAARD (South Africa) said he had listened Dr. KEITA (Guinea) said that, in maintaining racial with astonishment to the delegates of Senegal, Mali discrimination, the Government of South Africa was and Guinea, in whose speeches he had not found any violating the WHO Constitution and flouting the element of truth.He could not in the Committee humanitarian principles of the Organization. As enter into a discussion about the internal policy of from 5 May 1963, it was forbidden for black workers his country. Neither could he give all the facts relating to enter the towns, unless they had special permits to what had been said by the previous speakers. because their services were required. Their statements were based on prejudice. They had It was no use accusing the African countries of said that the non -white population of his country did introducing political issues in a technical forum; not reap any benefit from what had been accomplished their answer would be that they were speaking of there.But, to give one example, the hospital near health politics which had essentially technical reper- Johannesburg that he had mentioned earlier was not cussions. And the accusation would not prevent them for the white population; it was located in an area from speaking about the conditions under which the inhabited by his Bantu compatriots. Bantus were living, cynically kept away from the He had not said that the population of South Africa centres where health services and medical techniques wàs composed of six per cent. whites and 94 per cent. were modern and developed.Of a population of non -whites, but that the whole population of South sixteen million, 94 per cent. were relegated to the Africa, including all ethnic groups, was six per cent. rural areas, or to reservations.If the Organization of that of the African continent. really wished to attain its humanitarian objectives, if After having heard previous speakers, he was more it wished to ensure respect of its principles, of its than ever convinced that the subject could not be Constitution, and of the United Nations Charter, if it discussed at the Assembly. The course to take was for wanted the Regional Organization for Africato the Members of the African Region to meet in the function properly, and itself to function properly as Region, to discuss their difficulties, find out on what COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : EIGHTH MEETING 383
points they could reach agreement, and settle at least of health promotion, based on total coverage of the some of the outstanding problems.In that way, population.Unless the Committee, and the Health perhaps, they would settletheirdifferences. To Assembly, went on record as requesting that the quarrel over the problem was of no avail, and profited situation existing in South Africa should be changed, neither the affairs of the Region nor those of the they would not be fulfilling their moral obligations. Organization as a whole. Merely todiscuss the matter withinthe Health Assembly would be tantamount to preaching to the Mr BOLYA (Congo, Leopoldville) said that the converted. attitude of his Government to South Africa had been His delegation would have been happy had the clearly defined during the ceremonies that had marked delegate of South Africa described steps being taken its accession to independence on 30 June 1960.The to remove the obstacle to the full development of the Parliament of the Congo, as soon as it had met, even different racial groups in his country.However, he before the formation of the Government, had refused had attempted to justify the existing situation and to to allow the representatives of South Africa into the suggest that no change was necessary in order to country, because of the treatment of the black popula- improve the health of those groups; in his second tion by the whites. statement he had confirmed that the large hospital At every session of the United Nations held since near Johannesburg to which he had referred was a the Congo had become independent its representatives racial hospital. had condemned the policy of South Africa. Recently, His delegation's views might change if the delegate the Government had invited the Regional Committee of South Africa stated that his country was willing for Africa to meet in Leopoldville, but it had made to invite the representatives of the African countries it clear that the invitation did not extend to South to South Africa to meet there and to study the situa- Africa.His delegation joined with those of all the tion; in the absence of such a statement it was felt African countries in requesting that the representatives that the attitude of South Africa was not in keeping of South Africa be barred from visiting those countries with the public health principles that the Health until South Africa changed its policy of repression Assembly was trying to foster. and humiliation of the black population. It would appear that a praiseworthy effort to improve Dr GANGBO (Dahomey) said that his delegation had been made in South Africa; that made it all the admired the progress made in the health field in more necessary thatothercountries,faced with South Africa.The accomplishments in Dahomey in difficult health problems, be able to benefit from that respect were more modest.However, millions South Africa's experience. On the other hand, many of Africans were suffering; they were debarred from African countries could aid South Africa with their participating in international meetings, and prevented experience, if they were allowed to do so. But it was from receiving assistance from WHO. The wish of not possible to work within the Region with those who Dahomey was that the non -white people of South placed limitations on the extent to which they were Africa should be granted the indispensable minimum willing to go in putting into effect modern public to allow them to live in dignity.It was useless to try health principles. to avoid taking a decision on a problem of capital importance.Therefore his delegation requested the Dr SCHANDORF (Ghana)firstcongratulated the Committee to recommend to the Health Assembly Chairman on his election. the adoption of the resolution placed before it by the As regards the subject under discussion, he had African countries. The request was made hesitated to intervene, first because in the Health not merely for the sake of the non -white population Assembly it was difficult to dissociate the views of the of South Africa; the re- establishment of justice would individual speaker from those of his government, and bring with it the re- establishment of peace in Africa, secondly, because he was fearful of the consequences and help to preserve peace in the world -a task to tothe non -white populationof South Africaif which WHO should contribute. matters reached such a pass that South Africa had to withdraw from the Organization; there would then Dr ADENIYI -JONES (Nigeria) said that the time was be no way of finding out what the health situation in past when doctors could stand aloof from the com- the country was. munity in which they lived and worked.Therefore He regretted the misunderstanding over the per- all Members represented at the Health Assembly centages quoted by the delegate of South Africa. should state their views on the matter clearly;if However, would the delegate of South Africa inform they did so the delegate of South Africa would realize the Committee how many of the doctors working that his attitude was contrary to all modern principles at the hospital near Johannesburg were true Africans ? 384 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Would he say how much of the annual expenditure particularly in South Africa.The delegate of South on health was for the benefit of the native population ? Africa had said that the facts did not support the The delegate of South Africa had said that there was statements made by the speakers from the African one doctor to every J 800 people; how many of them countries.But, even from the official documentation were Africans ? And how many of the 114 200 hospital of WHO, which was compiled with the assistance of beds in the country were available to Africans ? MemberStates,sufficientinformationcouldbe He did not doubt that there were competent African gathered to refute his contention.From the annual doctors in South Africa, or that facilities for their reports of the Organization, and from its statistical training existed.But if Africans received the same publications, it could be seen that there were differences treatment as the white population in many respects, between the morbidity and mortality rates for the then why was there never an African representative white and non -white populations of South Africa. on theSouth African delegation tothe Health It was only necessary to examine the rates for tuber- Assembly, or to the Regional Committee ? culosis, for other communicable diseases, and the infant mortality figures, to see that those differences Dr LAMBIN (Upper Volta) stressed thecapital existed -although theywereconsiderablygreater importance of the subject under discussion to an thanappearedfromtheOrganization'sofficial organization whose Constitution stated that : " Health publications. is a state of complete physical, mental and social well -being and not merely the absence of disease In addition to the principle quoted by a previous or infirmity." No matter how good the health services speaker, the Preamble to the WHO Constitution of a country, all the efforts made were wasted if the stated :" The enjoyment of the highest attainable morale of the population was undermined.It was standard of health is one of the fundamental rights useless to spend millions of dollars for people who, at of every human being without distinction of race, certain times, were considered as animals.He was religion,politicalbelief, economic or social con- sure that all delegations, excluding that of South dition."The whole racial policy of South Africa Africa, were in a agreement with that view, even if, was in contradiction with that principle.Moreover, for various reasons, they did not say so. the Health Assembly had passed a number of resolu- Was South Africa afraid to collaborate with its tions declaring that WHO would not remain aloof from African population,togrant them their human questions concerned with conditions indispensable dignity ? He warned that, however powerful the for the preservation and improvement of health. present Government was, however many precautions One such resolution was that on the role of the it took, if the present situation continued the time physician in the preservation and promotion of peace; would come when the majority would rise against another, passed unanimously in 1961, dealt with the the minority in power, and would prevail. tasks of the World Health Organization in connexion The delegates of South Africa were sitting at the with the Declaration concerning the Granting of same table with the delegates of the African countries Independence to Colonial Countries and Peoples; because, by their international obligations, they were still another, also passed in 1961, concerned the univer- bound to do so; but, in their own country, they would sality of WHO membership. Finally, since WHO was apply to them the same treatment as to their coloured a specialized agency of the United Nations, he would population. refer the Committee to the resolution passed by the Already once the Regional Committee had had to General Assembly on apartheid and racial discrim- meet in Geneva; the invitation extended by the ination.Those, and other documents, showed that Congo (Leopoldville) had been withdrawn. As time WHO could not remain indifferent to the voice of the went on, many delegations would refuse to attend the States Members of the African Region. Therefore, his delega- Regional Committee sessions. Dr ANDRIAMASY (Madagascar) said that, having tion appealed to the Committee, and to the Assembly, already taken part in the Executive Board's delibera- to find a solution to the problem, otherwise the work tion and wishing to save the Committee's time, he had of the Regional Committee would be paralysed. desisted until that stage from intervening in the various Dr LISICYN (Union of Soviet Socialist Republics) debates.However, the item before the Committee said that the policy of racial discrimination applied -which was of a particularly delicate and painful by the Government of South Africa was of direct nature -was one on which he wished to express his concern to the Organization, and should be considered views, as it concerned the African Region. Some by the Committee. Racial discrimination was a source might feel that a technical gathering such as the World of pathological conditions, of morbidity, in African Health Assembly should not deal with problems of a and other countries where it was practised, and politicalnature.Nevertheless, inhisopinion,its COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : EIGHTH MEETING 385 members should, as skilled technicians and as human Mr BAUER (Canada) said that he did not wish to beings, face up to the situation. discuss the political issue of apartheid, because the A realistic attitude was needed.It was essential views of his Government on the subject had been that nothing should be allowed to hamper the smooth adequately expressed in the United Nations General running of the Organization and, for that reason, he Assembly and other international gatherings. appealed to the Committee and its members to seek The delegate of Ghana had stated that members calmly an appropriate solution to the problem before it. of the Committee were all representatives of govern- ments. Specifically, they were concerned with the Dr BIYOGHE (Gabon) noted that previous speakers best means of achieving the goals of WHO. Bearing had already outlined the views of all African countries that in mind, there were two issues involved in the on the question of apartheid.The Committee could subject under consideration, the first of which was not ignore what was essentially a human problem apartheid.In that connexion, the United Nations and he urged it to find a solution in keeping with the General Assembly had, in its resolution 1761 (XVII) humanitarian aims of WHO. passedin November1962, condemned apartheid Mr BRADY (Ireland) regretted thatit had been and had called upon Members of the United Nations necessary for the Committee to consider an item of the to take certain specific actions to bring about a solution nature of that before it, particularly as the proceedings of the problem.Furthermore, individual countries had so far been carried out in a remarkable spirit of were also studying various actions designed to bring international co- operation.Nevertheless, the matter about an effective and rapid solution to the problem. was a serious one and it was not always possible to The second point concerned the situation which the dissociate the health from the political factor. Regional Committee for Africa had referred to the The Irish Government had, both in the United Assembly for its consideration and it was the subject Nations General Assembly and elsewhere, made its of the resolution AFR /RC12 /R17 adopted by the attitude towards the policy of apartheid abundantly Regional Committee. In that resolution, it was pointed clear.It had been stated, on his country's behalf, out thatMembers of the African Region were that the policies of the South African Government increasingly refusing to admit representatives of the constituted a violation of the Charter of the United South African Government on their territories, or to Nations, of the natural law and of the tenets of the sit side by side with them in regional meetings, and the Christian faith.The racial policies of the South World Health Assembly was requestedtostudy African Government were, in the opinion of the Irish measures to put an end to that situation, which was Government, wrong and morally unjustifiable. liable to paralyse the functioning of the Regional However, whilst holding that view, the Irish Govern- Organization for Africa. ment had, whenever the matter had been raised, Regarding the first point, namely apartheid, anything opposed the imposition of any form of sanction upon that WHO might be able to do would be insignificant in the South African Government. There should, above comparison with the strong resolution already pássed all, be no question of excluding the South African by the United Nations General Assembly. The World Government either from the Organization or from Health Assembly did, however, have a real respon- the work of the Regional Committee for Africa. sibility to tackle the problem specifically referred to Earlier in the meeting, the delegate of South Africa it by the Regional Committee for Africa and it was a had spoken of the useful work being carried out in his very difficult question to which, so far, no delegation country in the field of health; that was doubtless so. had actually proposed a solution. All were agreed on The greatest care should be exercised not to counter certain basic principles : for instance, that a solution one evil, apartheid, by another evil. had to be found for the work of the Regional Com- For that reason, despite the provocation to other mittee to continue so that the health of the whole African countries caused by such policies, the Irish population of Africa might be efficiently protected. delegation appealed to Members of the Regional The fundamental problem was how to ensure that the Committee for Africa to keep the Committee together, population of Africa did not suffer as a result of a to meet and co- operate in so far as possible.That breakdown in the WHO system. would be in the best interests of both the African While sympathizing with the countries that saw countries themselves and also of the African popula- fit to refuse admittance to their territories to represent- tion in South Africa -a fact referred to in the draft atives of a certain government, he wished to ask, in resolution submitted to the Committee by the African all humility, whether such protests could not be made delegations. By ensuring the continuation of a unified moreeffectivelythroughthenormaldiplomatic Regional Committee for Africa, all Members would be channels within the United Nations.Even in the helping to further the cause of world health. recent past there had been instances of countries 386 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II which, although not officially recognizing each other, also to the noble ideals to which the Organization had nevertheless negotiated together. A certain amount was committed and which were expressed inits of understanding was required and an acceptance of Constitution. the fact that other more effective channels were open From the discussions that had taken place at the to solving the problem.Although it was perhaps Regional Committee for Africa and in the present unrealistic to place WHO right outside the political meeting, it was evident that the situation threatened sphere, nevertheless the overriding problem was the to paralyse the work of the Regional Committee. advancement of the health conditions of the popula- If that happened, the Organization, and many African tions of Africa. countries, would suffer. In the opinion of the Czecho- In other words, what could be accomplished as a slovak delegation, therefore, the Regional Committee result of the action recommended in the Regional had been right to pass a resolution calling attention Committee's resolution would be relatively small when to the matter. compared with the results if the problem were dealt The Czechoslovak delegation would support any with through other channels, and would certainly effective step taken by the Health Assembly to secure not justify the loss to the population of South Africa, a rapid solution to the problem and to ensure that the and in fact of Africa as a whole. South African people would finally acquire full rights He therefore suggested that a small working party, and liberty, and the possibility to take part in the composed of Members chosen on a broad geogra- efforts to improve their health conditions and to phical basis, be set up to study the matter further and eradicate the serious diseases affecting mankind. find a solution that would protect WHO's work in Africa. Dr BARCLAY (Liberia) said that, from the remarks Mr TouRÉ (Mauritania) said that his Government made by previous speakers, it would seem that South Africa was in the grip of a serious illness which had had already condemned the policy of racial discrimina- assumed both endemic and epidemic proportions. ation, in its political aspects, at the appropriate time and in the appropriate forum. The effects of apartheid The Liberian delegation therefore suggested that, as a first step, a committee should be appointed to study were not, however, solely political; it also reacted, as other speakers had already pointed out, on the health apartheid in South Africa, with particular reference to and other factors of life in South Africa.As far as its health implications.Liberia would be happy to doctors were concerned, health was not merely a serve on such a committee provided that the safety and freedom of movement of its representatives were state of physical fitness, but also included mental and guaranteed by the South African Government. social well- being.If the delegate of South Africa could convince the Committee that a citizen of his Mr FINDLAY (Sierra Leone) stated that his delegation country could rise to any rank, secure any employment, joined those speakers who had denounced the policy according to his intellectual and physical capacities, of apartheid; he appealed to the conscience and wisdom and if he could prove that apartheid had no repercus- of delegates to accord their sympathy to the resolution sions in the field of health and hygiene, then perhaps before them. The time had come when some positive apartheid could be viewed differently. Apartheid, action was needed by the Organization to ensure the however, resembled gangrene, the poisons of which progress of its work in the African Region. spread from South Africa to the rest of the continent and finally throughout the whole world. Dr EL BITASH (United Arab Republic) wished to It was not possible to continue to hold meetings and correct a statement made by the South African delegate discussions with delegates who, on their return to their who had claimed that, in South Africa, there existed own country, did not apply the recommendations that the largest hospital, containing 2500 beds, in the had been made. It was therefore essential that, during continent.In point of fact, there was in the United the current session of the Assembly, a solution should Arab Republic a hospital with 3500 beds, an extension be found that would enable WHO's work to be to which, providing for 500 more beds, had recently carried out in all countries, including those in the been approved.It served people regardless of their African Region, thereby bringing greater physical, colour. mental and social well -being to the South Africans The Government of the United Arab Republic who were victims of apartheid. totally rejected the policy of apartheid.It was to be Dr VYSOHLID (Czechoslovakia) said that the practice hoped thatdelegates would not view resolution of apartheid constituted a most serious violation of AFR /RC12/R17 of the Regional Committee for Africa fundamental human rights; it was contrary, not only in a political light but would realize that WHO had to the principles of the United Nations Charter, but to fulfil its obligations under the Constitution.His COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : EIGHTH MEETING 387 delegation considered that a vote should be taken the Organization.To exclude the representatives of on the item. South Africa from the deliberations of the Organiza- tion could only have a negative effect.The Organi- The CHAIRMAN said that some delegates appeared zation, as a body of doctors, should remain aware of to be under the impression that a draft resolution was its true purpose and should apply to the difficult before the Committee. That was not in fact so; the situation qualities of patience and forbearance. resolution 1 which the Director -General had referred The Organization had been established for the to the Assembly had already been adopted by the promotion of health and, in Africa, that meant the Regional Committee for Africa, which, in paragraph 2 of the resolution, requested the Assembly to study control of communicable diseases, which was a most Lines on a map could not prevent appropriate measures to put an end to the situation urgent problem. defined in its preamble. the spread of infection and any obstacle to wide co- operation would lessen efficiency. A resolution (see page 388) submitted by a number In view of the fact that there were difficulties of African countries had been handed in :it would be regarding meetings in certain countries of the African translated and circulated to the Committee as soon as Region,theUnited Kingdom delegationwould practicable. tentatively suggest that the right course might be to Dr PREZA (Albania) expressed agreement with the hold the meeting of the Regional Committee for statements which had been made by the delegates of Africa, if only as a temporary measure, either at the the African countries, and of the USSR and Czecho- headquarters of the Regional Office in Brazzaville slovakia. or, failing that, in Geneva. Dr KRAUS (Yugoslavia) said that his Government Dr AMORIN (Togo) urged that every effort should had voted for the United Nations resolution to which be made to secure a fair solution to the problem under reference had already been made by several previous consideration by the Committee. speakers. The South African Government was responsible for the existing state of affairs in that Dr ALAN (Turkey) said that, having listened carefully country and the only solution was to abandon the to previous speakers, he trusted that it would be policy of apartheid, which subjected South African possibletofindasolution without jeopardizing citizens to racial discrimination to the detriment of either the rights to health of the South African people their physical, mental and social well- being. His or the activities of WHO. In view of the difficulties delegation werethereforeinsympathy withthe which the subject presented, he would support the statements which had been made during the meeting suggestion of the delegate of Canada that a working by the members of the African Region, to whose views party be set up to study the question further. it wholeheartedly subscribed. Dr HAPPI (Cameroon) said that, in common with Mr ROFFEY (United Kingdom of Great Britain and other delegates, he regretted that it had been necessary Northern Ireland) said that the position of his Govern- for the subject of apartheid to be raised at the World ment was similar to that of the Government of Ireland. Health Assembly. Nevertheless, he did not think that The representative of the United Kingdom had voted the fault lay with the Regional Committee for Africa, for the resolution submitted by the Regional Com- which had drawn the attention of the Assembly to mittee for Africa, currently under examination, and at that question in the same way as it would do to any that time had said that the United Kingdom Govern- other illness occurring in Africa.Although certain ment could not support any proposal to exclude any delegates had seen fit to view the problem of apartheid Member State from WHO, as such an action would be in its political light, nevertheless the Regional Com- unconstitutional and would prejudice the right to mittee had above all been concerned with the medical health of those populations which it was the duty of aspect of the problem. the Organization to protect. The delegate of Ireland had suggested that a solution The racial policy of the South African Government, should be found so that the African continent could to which the United Kingdom was opposed, was co -exist with South Africa; but, in Africa, it was primarily a political matter and it would surely be known that a lamb and a panther could not co -exist wrong to take any action in the World Health Assembly and, for the rest of Africa, South Africa was a panther. which would detract from the efficient working of the For such co- existence to become a reality, South Organization and perhaps lessen the benefit which the Africa would have to undergo a metamorphosis. people of South Africa would otherwise receive from Finally, those delegates who refrained from con- demning the situation in South Africa should realize 1 Reproduced in Off Rec. Wld Hlth Org. 127, Annex14. that they were thereby also condemning those eminent 388 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
people who had drawn up the WHO Constitution, apartheid, and was in favour of the appointment of a for apartheid was an illness in the same way as tuber- working party to study the problem with a view to culosis and leprosy were illnesses and it was the task finding a solution. of WHO to fight them all. The CHAIRMAN said that the Committee had before Mr MARADAS -NADO (Central African Republic) it two resolutions, which he then read out as follows : wished to be associated with the views of those speakers who had condemned apartheid. 1.Draft resolution presented by the delegations of Dr KHALIL (Sudan) stated that his delegation Burundi,Cameroon,Central AfricanRepublic, opposedracialdiscriminationand favouredthe Congo (Brazzaville),Congo (Leopoldville), Da- proposal to set up a small working party to seek a homey,Gabon,Ghana,Guinea,IvoryCoast, solution to the problem. Liberia, Madagascar, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo and Upper Dr REFSHAUGE (Australia) said that his Government Volta had on many occasions, both in the United Nations and in other international gatherings, condemned the The Sixteenth World Health Assembly, policy of South Africa, and a statement to that effect Having takencognizanceoftheresolution had been made by the Australian Prime Minister. AFR /RC12 /R17 adopted by the Regional Com- From the long -term point of view, apartheid was not mittee for Africa at its twelfth session; in the best interests of any section of the South African Noting that the Government of South Africa, community.However, to deplore a certain policy in spite of the resolutions adopted in 1952, 1955 and was one thing; to take action which would harm the 1961 by the General Assemblies of the United very people it was desired to protect was another - Nations, persists in its policy of racial discrimina- which would be the main effect of any resolution tion; preventingSouth Africa from partakinginthe Considering that the conditions imposed upon deliberations of the Regional Committee for Africa. the non -white populations of South Africa seriously It should not be forgotten that communicable diseases prejudice their physical, mental and social health, knew no boundaries and, in considering the problem and are contrary to the principles of' our organi- before the Committee, priority should be given to zation.; the needs of the South African people, who would Considering that such a policy threatensto be the first to suffer from any far -reaching action paralyse the operation of the Regional Office for taken in the Committee. Africa, In order to ensure further that the peoples of South 1. INVITES the Government of South Africa to Africa were not deprived of the benefits of WHO, the renounce the practice of apartheid in the interests of delegations of Canada, New Zealand and Australia the non -white populations of that country; and wished to submit a draft resolution to the Committee. If it were accepted, the Australian delegation would 2.UNDERTAKES to support any action for the like to support the proposal of the delegate of Canada solution of this serious problem. that a small working party be set up to seek a mutually acceptable solution to the question. 2.Draft resolution proposed by the delegations of Australia, Canada and New Zealand Mr ABRAR (Somalia) expressed agreement with the views of members of the other African delegations The Sixteenth World Health Assembly, who had spoken on the subject. Having considered the report of the Director - Mr TALEB (Algeria) said that his delegation supported General on meetings of the Regional Committee the draft resolution submitted by the delegations of for Africa; the African countries.The African in South Africa Having noted that the World Health Assembly was not even granted the basic rights of health, such has beenrequestedtostudy theappropriate as hygiene and admission to certain hospitals, and that measures to put an end to the situation arising from situation was unacceptable to members of an organi- the refusal on the part of some Member States of zation whose task it was to fight illness and cure the the African Region to admit on their own territory afflicted. the representatives of the government of another Member State; Mr SEBSIBE (Ethiopia) wished to be associated with Taking into account the non -political and humani- those speakers who had condemned the policy of tarian principles and the objectives enunciated in the COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : EIGHTH MEETING 389
Constitution of the World Health Organization resolution before the Committee.Since that sugges- and especially with reference to the control of tion had been made, however, two draft resolutions communicable diseases which do not recognize had been submitted to the Committee and there was national boundaries; perhaps no longer any point in setting up a working Taking into account, in addition, that the resolu- party, which would only prolong the work of the tion of the Regional Committee for Africa calls Committee. attention to the necessity of safeguarding the health Dr BA (Senegal) wished to warn the Committee rights of all African populations concerned; Noting that the Director of the African Regional against an apparent tendency to adopt a formula Office, after consultation with the Director -General, which would allow the South African delegation to continue to sit in the meetings of the Regional Com- has notified the Member States in the Region that the thirteenth session of the Regional Committee mittee whilst at the same time ignoring the point contained in the second paragraph of the preamble for Africa will be held in September /October 1963 at the regional headquarters in Brazzaville because of the resolution approved by the Regional Committee for Africa. The problem could not thus be resolved of the circumstances which have not made it possible and would leave the African States with the impression to convene it at the place previously selected by the Regional Committee at its eleventh session, that the World Health Organization had only par- tially heeded their appeal. As the delegate of Cameroon APPROVES theaction taken by theRegional had pointed out, the proposal for a working party Director and by the Director -General to ensure had been motivated by a situation which no longer the functioning of the African Regional Organi- existed and the discussion should therefore continue zation and the fulfilment of theconstitutional in the full meeting of the Committee. functions of the African Regional Committee for the protection of the health rights of all populations Dr ADENIYI -JONES (Nigeria) supported the proposal of the Region; for the establishment of a working party to study the CALLS UPON the Member States of the Region two draft resolutions, and to report to the Committee to avoid any action which is not requested by the following day either with a composite resolution General Assemblyresolution1761(XVII)of or with its recommendations concerning the two draft 6 November 1962, and which would hinder the resolutions.It should also inform the Committee on effectivefunctioningof theRegionalAfrican the advisability of setting up a substantive working Organization and thus jeopardize the humanitarian party to study the question of finding a solution, goals of the World Health Organization and pre- unless the draft resolutions were themselves con- judice the health rights of certain populations of sidered to be adequate to express the feelings of the the area. Committee. With regard to the suggestion put forward by the Dr KEITA (Guinea) said that fundamentally the delegate of Canada and subsequently supported by problem was the elimination of apartheid and the aim other delegates, namely, that a small working party of both draft resolutions was to find a lasting and should be set up to attempt to reach a solution to the efficient solution to that problem. The African problem, the Chairman asked the Committee whether countries were not against the white South African there were any objections to the establishment of such population, quite the contrary, but it was imperative a working party. If the consensus of opinion were in that a solution be found which would enable them to favour of that proposal, he would be prepared to work side by side for the future of health in Africa. make a suggestion regarding the composition of the Consequently, he supported the proposal to establish a working party. working party to study the problem thoroughly and In reply to a remark by Dr BARCLAY (Liberia), who come forward with a resolution which, by its concrete observed that the two draft resolutions did not nature, would obviate the need for further discussion. appear to be mutually exclusive and therefore might be combined, the CHAIRMAN said that, if it were agreed Dr AL -WAHEI (Iraq) said that, in the past, the to establish a working party, it could be empowered establishment of working parties had generally led to to consider those resolutions and the possibility of good results. He therefore supported the proposal to combining them. set up a working party to study the two draft resolu- tions. Dr HAPPI (Cameroun) said that it was his under- standing that the two delegates who had spoken in Mr FERAA (Morocco) said that it was evident that the favour of the establishment of a working party had establishment of a working party would be helpful in done so because at that time there was no draft reaching asolutiontothe problem beforethe 390 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Committee. It would appear, however, that considera- In reply to Dr BA (Senegal) who suggested that, as tion of the two draft resolutions -the tenor of which the matter was of particular interest to the African was complementary rather than contradictory -could countries, a further four names from that Region, one lead only to a formula prohibiting any South African of which would be South Africa, should be added to delegate from attending meetingsinthe African the list already proposed, the CHAIRMAN said that, in a Region. That was further borne out by the terms of desire to keep the working party as small in number as the second paragraph of the preamble of the resolution possible, he had proposed only one representative adopted by the Regional Committee for Africa, to from the African Region. He was also of the opinion which the delegate of Senegal had earlier referred. that, as in all discussions on the problem before the For that reason, the working party should be given a Committee African delegates spoke with one voice, it certain latitude in its terms of reference, so that it was not necessary to have more than one representative would be free to draft another resolution, if necessary, on their behalf.However, he would welcome any taking into account the majority opinion voiced in the comments on the proposals just made by the delegates Committee itself, which would lead to a workable of France and Senegal. solution and allow the Organization to continue its activities whilst at the same time condemning the Dr BARCLAY (Liberia) considered that the addition policy of apartheid. of two other members, namely, Senegal and South He therefore formally supported the constitution of a Africa, would suffice. working party, on the condition that it was allowed sufficient latitude to enable itto bring about an Dr SCHANDORF (Ghana) was of the opinion that appropriate solution. only one member from the African Region should attend the working party, in view of the unanimity of The CHAIRMAN said that the consensusin the opinion which existed between African countries. Committee was in favour of the establishment of a Regarding the participation of the South African working party. He therefore suggested that it should be delegate, he would agree to his presence at the working convened the following morning, Saturday 18 May party on condition that he was prepared to speak on 1963, immediately after the plenary meeting of the behalf of his Government. If that was not the case, as Assembly, and that it should submit its report to the the South African delegate had just stated, then one Committee on Monday morning, 20 May 1963. member from the African Region would suffice. The Chair would suggest that the working party be composed of one representative from each Region, as Dr BA (Senegal) said the fact that African countries follows :Canada,FederationofMalaya,India, were admittedly united on the matter was no reason Liberia, Sudan and Turkey. for restricting African representation on the working Dr KEITA (Guinea) said that, without the presence party to one member. The working party had not been of the South African delegate in the working party, set up as a purely mechanical body but to study a that country would be unable to accept the solution grave problem from a humanitarian standpoint. For proposed to the problem. He therefore suggested that that reason, not only South Africa but also one or two the name of the South African delegate should be other members, irrespective of language or geographi- added to the list of those forming the working party. cal representation, should be invited to attend the working party. Mr TALJAARD (South Africa) stated that, although he was willing to attend the working party, he could In reply to Dr DoLo (Mali) who suggested that, in not of course participate in any political examination the absence of the delegate of the Federation of of his Government's policies,asit was not the Malaya from the Committee's deliberations,the appropriate forum for such a discussion. delegate of Indonesia should be appointed to the working party, the CHAIRMAN said that when he had Professor AUJALEU (France) was of the opinion that, drawn up the list the delegate of the Federation of although it was understandable that the Chairman Malaya had in fact been in the room. should wish to keep the working party small, the matter was of principal concern to Africa.There Mr TALJAARD (South Africa) reiterated that he was would perhaps therefore be no harm in adding a not prepared to discuss his Government's internal further name from the African Region, possibly that policies. of the French -speaking member of the Committee who had intervened in the debate on numerous occasions The CHAIRMAN then proposed that the working and whose absence from the working party was to be party should be composed of the representatives of regretted. Canada, Federation of Malaya, India, Liberia, Senegal, COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : NINTH MEETING 391
Sudan, Turkey, and South Africa, subject to the belong to the same region, and therefore proposed reservations which thelast -named had expressed. Japan.
Dr BARCLAY (Liberia) suggested that in the absence Mr TAKIZAWA (Japan) regretted that his delegation of the delegate of the Federation of Malaya, the name was not prepared to participate in the working party. of another country should be substituted in that list. At the invitation of the CHAIRMAN, Dr GATMAITAN (Philippines) agreed to serve on the working party. Dr MUDALIAR (India) pointed out that the Member selected to replace the Federation of Malaya should The meeting rose at 6 p.m.
NINTH MEETING
Tuesday, 21 May 1963, at 2.30 p.m.
Chairman: Mr 1. T. KITTANI (Iraq)
1.Fourth Report of the Committee The resolution contained in the Working Party's report read : The CHAIRMAN invited delegates to comment upon the draft fourth report of the Committee. The Sixteenth World Health Assembly, Decision :There being no comments, the report Having considered the report of the Director- was adopted (see page 410). General on meetings of the Regional Committee for Africa and the request of of the Regional Committee for Africa to the World Health Assembly; 2.Meetings of the Regional Committee for Africa Noting that the Government of the Republic of (continued) Agenda, 3.14 South Africa, in spite of a number of resolutions adoptedoverseveral yearsandinparticular At the invitation of the CHAIRMAN, Dr MUDALIAR resolution 1761 (XVII) of 6 November 1962 by the (India), Chairman of the Working Party set up to General Assembly of the United Nations on the study agenda item 3.14, introduced its report to the policies of apartheid of the Government of the Committee. Republic of South Africa, has not complied with He recalled that at the previous meeting of the those resolutions; Committee a working party had been established to Taking into account the humanitarian principles consider the question of the meetings of the Regional and the objectives enunciated in the Constitution of Committee for Africa. The Working Party, consisting the World Health Organization and especially with ofthedelegationsofCanada,India,Liberia, reference to the control of communicable diseases, Philippines, Senegal, South Africa, Sudan and Turkey, which do not recognize national boundaries; had met on 18 May and continued to work until about 5 o'clock in the evening. After a thorough discussion Taking into account, in addition, that the resolu- of the item the majority of the Working Party had tion of the Regional Committee for Africa calls agreed to transmit the draft resolution in the report to attention to the necessity of safeguarding the health the Committee on Administration, Finance and Legal rights of all African populations concerned; Matters. The delegate of South Africa had declared Considering that the conditions imposed upon the his reasons for objecting to the draft resolution and had non -white populations of South Africa seriously reserved the position of his delegation. The delegate prejudice their physical, mental and social health, of Turkey had said that he was not able to approve and are contrary to the principles of the Organiza- paragraph 2 of the draft resolution because he con- tion; sidered that that paragraph was purely political in Considering the necessity to avoid any action that nature and was not in accord with the position taken by may hamper the proper functioning of the Regional his delegation in previous Assemblies. Organization for Africa; and 392 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Noting that the Director of the African Regional resolution did not satisfactorily resolve the problem. Office, after consultation with the Director -General, For that reason the Turkish delegation reserved its has notified the Member States in the Region that position, particularly with regard to paragraph 2, which the thirteenth session of the Regional Committee for was of a purely political nature, urging Members to Africa will be held in September- October 1963 at give serious consideration to the implementation of the the African Regional Office because of the circum- proposalsof General Assemblyresolution1761 stances which have not made it possible to convene (XVII) of 6 November 1962. That resolution, the text it at the place previoulsy selected by the Regional of which was annexed to the report of the Working Committee at its eleventh session, Party, listed a number of political and economic measures (including the breaking off of diplomatic 1. APPROVES the actions taken by the Regional relations) which the Health Assembly could not ask its Director and by the Director -General to ensure the Members to apply. WHO, as the specialized agency functioning of the African Regional Organization responsible for promoting the health of all peoples, and the fulfilment of the constitutional functions could not concern itself with political matters. of the African Regional Committee for the pro- At previous Assemblies, the Turkish delegation had tection of the health rights of all populations of the always opposed the introduction of political questions Region; at WHO meetings. Although there were in the world 2. URGES all Members to give serious consideration many political problems to be solved, there were also to the implementation of the proposals of General many problems arising from sickness and disease, and Assembly resolution 1761 (XVII) of 6 November it was with those that the World Health Organization 1962, in order to impel the Government of the was qualified to deal.Paragraph 2 of the draft Republic of South Africa to abandon itsracial resolution could not be considered tooffer any policy of apartheid; solution to the health problems of the prople of 3.UNDERTAKES, within the provisions of the Con - South Africa, or indeed of any other part of Africa. stitution of the World Health Organization, to In keeping with WHO's long tradition of dealing support all measures that may be taken to contribute wisely with the problems facing it,every attempt towards the solution of the problem of apartheid; should be made to find a constructive solution to the problem now arising in the African Region. While no 4.INVITES the Government of the Republic of South Africa to take appropriate measures so that delegation was in favour of apartheid, WHO was primarily concerned with health :it should therefore all the populations of South Africa shall benefit by adopt measures for health protection and promotion the public health services of that country; and do nothing that might jeopardize its prestige. 5.EXPRESSES the hope that Members of the Region He therefore appealed to all delegations, and in will do whatever is possible to further the effective particular to those of the African Region, not to functioning of the African Regional Organization, insist upon the political aspects of the problem before promote the humanitarian goals of the World the Committee and to agree to the deletion of para- Health Organization, and protect the health rights graph 2 from the resolution. of the South African population; Mr HIM (Kuwait) said that his delegation would 6. REQUESTS the Director -General to transmit this support the report of the Working Party. The resolution to the Secretary -General of the United Committee should recommend that the World Health Nations with the request that it be made available to Assembly should call upon the Government of South the Special Committee appointed under the terms Africa to renounce the practice of apartheid and should of General Assembly resolution 1761 (XVII) of 6 urge the countries of the African Region to co- operate November 1962; with the Regional Office with a view to controlling 7. REQUESTS furtherthattheDirector -General communicable diseases and, at the same time, solving report to each session of the World Health Assembly the problem of apartheid. on this matter until such time as it is resolved to the Mr MCKITTERICK (United States of America) said satisfaction of the Regional Committee for Africa that he had not intervened in the debate as it seemed to and the World Health Assembly. him, as a newcomer, that the item should be discussed Dr ALAN (Turkey)explainedhisdelegation's by those whose long experience with WHO equipped reservations regarding paragraph 2of thedraft them to protect and determine the welfare of the resolution contained in the report of the Working Organization.All points of interest to the United Party. Despite the lengthy and exhaustive examination States Government had been mentioned by those who of the question by the Working Party, the draft had spoken at the Committee's eighth meeting on COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : NINTH MEETING 393
17 May 1963 and there was no need to defend or explain opinionoftheUnitedKingdomGovernment, the attitude of the United States Government towards unacceptable. the institution of apartheid: it held particularly strong His delegation, therefore, hoped that after further views about the rights of man in society whatever the consideration some acceptable reformulation of para- colour of his skin, and it endeavoured to act upon graph 2 would be found. If that were not the case, the those views in a manner for all the world to see. United Kingdom delegation might be forced to request However, although he had no objection to the two a vote on the draft resolution paragraph by paragraph draft resolutions (see page 388) which had been sub- so that it could reserve its position. mitted to the Working Party, or to a marriage of both, Dr KEITA (Guinea) said that some delegations had unfortunatelythedraftresolutionbeforethe expressed misgivings regarding paragraph 2, which Committee introduced entirely new factors into the nevertheless was very important.Those who were equation- factors which were most embarrassing to doctors would agree that, once the cause of an illness the United States Government and would involve had been discovered, it should be removed.Certain WHO directly in matters under consideration by a delegates, and in particular the delegate of Turkey, had special committee in New York.His Government stressed the political nature of the paragraph.The could not vote for the draft resolution so long as para- delegate of South Africa had also observed that the graph 2 was retained. Committee should not deal with the problem in view Whilst sympathizing with the frustrations of the of its political tone.Nevertheless, everybody was African countries over the fact that so many resolu- aware of therelationbetweenpoliticsand the tions on the subject were high in principle but low in technical matters with which WHO was concerned. calories, it was nevertheless a fact that, when there were As a specialized agency, WHO could not escape too many calories in a resolution of that kind, the dealing with a situation on which the United Nations principle was weakened rather than strengthened; and had adopted certain resolutions. that was clearly the case with paragraph 2 of the draft The delegates of the United States of America and of resolution. Turkey should realize that paragraph 2 was one of The delegate of Turkey had explained the stake of vital importance to his and other African delegations. the World Health Organization in the matter.He, Far from weakening the force of the resolution it gave therefore, echoed that delegate's appeal that, rather precision to an essential aspect of it. than involve WHO in the mechanics of a resolution He appealed to delegates to examine the paragraph against which the United States Government had objectively and thoroughly. The delegate of the United voted and the mechanics of negotiations which lay well Kingdom had expressed the opinion that an element of outside the terms of reference of the Committee, para- confusion had been introduced into the draft resolu- graph 2 should be deleted from the draft resolution. tion. In fact the Working Party had taken as the basis In that way, the tradition of a unanimous attitude foritsdiscussions the very precise terms of the which WHO had always taken to the hideous institu- General Assembly resolution.He therefore called tion of apartheid might be preserved and not weakened upon all delegates to support the draft resolution before by matters quite outside the principle at issue. them. Mr ROFFEY (United Kingdom of Great Britain and Mr FURLONGER (Australia), speaking as a member of Northern Ireland) expressed his delegation's gratitude one of the three delegations which had submitted one to Dr Mudaliar and the Working Party for the of the draft resolutions considered by the Working synthesis which they had achieved of the two draft Party, explained that his delegation had supported the resolutions referred to them. However, his delegation establishment of the Working Party as it considered had one proviso; it regretted that the draft resolution that there was a good deal of common ground in the put forward by the Working Party contained so many two draft resolutions then before the Committee and references to General Assembly resolution 1761 (XVII) was of the opinion that, if the Working Party were to of 6 November 1962, thus introducing an element of study them, there was a reasonable chance that a confusion not present in either of the two original unanimous solution would be found which all dele- draft resolutions, which his delegation could have gations could support. That was still the hope of the supported. That criticism applied particularly to Australian delegation. A unanimous -or virtually paragraph 2. The United Kingdom Government had unanimous- resolution passed by the Assembly would votedagainstGeneral Assembly 'resolution1761 carry a great deal more moral force than a resolution (XVII), not because it in any way accepted or con- which went through with a number of obstacles or doned the policy of apartheid, but because the sanctions votes against it.Accordingly, it was still the hope of which that resolution sought to impose were, in the his delegationthatitwould be possible for the 394 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Committee to reach agreement ona unanimous of meetings of the Regional Committee was the resolution,evenifthatmeantprolongingthe continued pursuance of the policy of apartheid in discussions. South Africa.That policy had repeatedly been con- The draft resolution proposed by the Working Party demned by the United Nations General Assembly, had much to commend it.It met the considerations which was the proper body to deal with such matters stressed by his delegation at the Committee's previous and where his Government had clearly statedits meeting and placedina prominent position the opposition to it. interests of WHO and of the people who benefited from Nevertheless, nothing would be gained by WHO's its work. He, however, differed from some delegates adopting a resolution similar to those that had been with regard to the political aspects of the draft passed by the United Nations General Assembly.In resolution. While his delegation had always held that fact, to do so would be to create a dangerous precedent; the Assembly should confine itself to non -political many other political issues might be introduced on the matters, it recognized that certain political policies grounds of their influence on mental and social well- might have consequences in the health field which were being. He felt that the Organization should not take of interest to WHO and to the Assembly. The any action beyond that outlined in the draft resolution Australian delegation would therefore not regard proposed by the delegations of Australia, Canada and it as improper for a resolution coming from the New Zealand (see page 388). Committee to address itself to what it considered to be He drew attention to the fact that paragraph 2 of the the effects on the health field of policies of a more draft resolution in the Working Party's report called political nature. for the implementation of General Assembly resolu- The draft resolution before the Committee had gone tion 1761 (XVII). If the provisions of paragraph 4 (d) a long way to meeting the hope of his delegation that of the General Assembly resolution were strictly unanimous acceptance was possible. The only problem applied, it would mean that drugs and other medical as far as his delegation was concerned, and for certain goods would not be exported to South Africa. Such a other countries, was paragraph 2.The Australian measure would undoubtedly affect health conditions of Government hadvotedagainstresolution1761 the people in that country and would be contrary to the (XVII) of the General Assembly, as other governments objectives of the Organization. represented upon Committee had also done, and, While sympathizing with the views expressed by the if paragraph 2 were retained in its existing form, it African delegates, his delegation considered that the would have to vote against it, and also against the draft resolution, and in particular paragraphs 2 and draftresolution. However, inthe view of the 3, could not lead to a solution of the problem. He Australian delegation, a slight reformulation would therefore appealed to African delegates to consider satisfy delegates of African countries and would at the withdrawing paragraphs 2 and 3 from thedraft same time meet the difficulties of certain other delega- resolution,which couldthen,with some minor tions, such as his own. drafting changes, be adopted with the unanimity that His delegation did not, at the present stage, have any was so desirable. specific drafting changes to put forward. But, if it were the desire on all sides in the Committee to accept the Dr DE ALMEIDA COELHO -LOPES (Portugal) said that concept that some drafting changes might be made, his Government had often expressed in the United then a formula could no doubt be found. Nations its views condemning racial discrimination. In putting forward his proposal and in supporting The Health Assembly was not, however, the right the earlier suggestion of the United Kingdom delega- forum in which to dicuss the political implications of tion, he did so in all sincerity. He was sure that the the question, except as they reflected upon human Committee would be able to reach a unanimous -or health.It would be advisable to seek a way of investi- virtually unanimous -decision. gating the effects of such a policy on health in various parts of the world, but until such time as fresh Dr SIGURaóNSSON (Iceland) expressed his agreement practical conclusions could be arrived at, political with the statements made by the delegate of Turkey and discussions should be avoided in the Health Assembly certain other delegates that WHO, being a strictly and in the Committee, both of which bodies existed for technical body, should avoid as far as possible taking the discussion of technical matters. issue on political matters. The Portuguesedelegationhadvotedagainst It was clear from the statements that had been made General Assembly resolution1761(XVII) inthe by speakers from the African Region at the previous United Nations, and therefore could not vote in favour meeting of the Committee that the underlying cause of of paragraphs 2 and 3 of the draft resolution or of any the difficulties that were preventing the normal holding other text which contained political implications, but it COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : NINTH MEETING 395 was prepared to approve a compromise resolution that intervention in national political affairs was totally took account of matters related to human health.It excluded in both the letter and the spirit of the was to be hoped that the spirit of co- operation which Constitution. had been manifest so far would continue to prevail and There could be no doubt at all that certain parts thus enable the Committee to find and unanimously of the draft resolution transmitted by the Working approve a resolution acceptable to all. Party were political in fact and in intent.In that connexion he referred in particular to the following Mr Azouz (Tunisia) explained that he had not been three paragraphs of the draft resolution proposed by able to follow the debate, owing to his absence on an the Working Party : official mission toAlbania. He stated that the (1) Second preambular paragraph : The mere fact Tunisian Government considered racial discrimination that the paragraph referred to the United Nations to be one of the most serious obstacles to the advance- General Assembly resolution1761(XVII) had ment of Africa. In denouncing such discrimination the inescapable political implications and consequences, African people were opening the way for the promo- because the subject matter of that resolution was tion of the social, health and economic development of politically highly controversial. their continent. The attitude of the African people to the policy followed by the South African Governemnt (2)Fifth preambular paragraph : What compara- was at the same time an act of faith and an expression tive facts regarding the health conditions of all oftheirdesireforprogress;itreaffirmedtheir the territories of the Member States of the African determination to work together in the interests of Region had been placed before the Assembly on humanity and of an era of peace and prosperity. which it could arrive at a conclusion so far removed from reality ?He had not seen a balanced and Mr TALJAARD (South Africa) stated that the South objective presentation of such facts. African delegation appreciated and understood the (3)Operative paragraphs 2, 3, 4 and 6 : By adopting sincerity with which delegates had approached the paragraph 2 especially, the Assembly would be question before the Committee, and fully respected committing a direct political act in violation of the their views. He assured them that his delegation was Organization's Constitution. equally sincere in the views it had expressed. As he had stated at the Committee's previous He did not for a moment imagine that delegates meeting,theSouth African Government whole- present did not fully appreciate the political character heartedly subscribed to the basic principles laid down of paragraph 3.Had they considered the effects in the WHO Constitution and particularly to the of such a decision and of the danger in establishing principle that governments had a responsibility which a precedent with respect to future conflicts between could only be fulfilled by the provision of adequate Member States ?Should not the Committee consider health and social services for all their peoples. In that the embarrassments and repercussions which decisions task, the South African Government had succeeded to of a political character were bound to have on relations a degree unparalled in the African Region and which between Member States and on the Director- General compared favourably with the best to be found under and his staff who, at that time, were co- operating similar circumstances anywhere in the world.If the andoperatingadmirably,objectivelyandnon- Assembly took the unwarranted liberty of inviting politically ?How would governments that were the the Republic of South Africa to "take appropriate victims of any future political decisions of the Health measures ", as suggested in paragraph 4 of the Work- Assembly regard their work and themselves ?The ing Party's draft resolution, it would not only commit South African delegation happened to be concerned an error of fact, since what was being asked had already in the case before the Committee but, in any event, been done, but it would also in effect be interfering in quite apart from that, as a matter of principle his the internal affairs of a Member State.It had been delegation would not be a party to such a decision. laid down in the Constitution as a cardinal principle It was for those reasons of principle that his delegation that WHO could assist governments at their request in asked permission to introduce a draft resolution of its strengthening their health services. But the Organiza- own, which read : tion had no constitutional power at all to address The Sixteenth World Health Assembly, demands togovernments. Considering that the founders of the Organization had felt it unwise to Having considered the report of the Director - accord to WHO any right of unrequested inter- General on meetings of the Regional Committee vention in the health affairs of Member States,it for Africa and the request of the Regional Com- becameclearwhyanythingresemblingpolitical mittee for Africa to the World Health Assembly; 396 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Considering that the World Health Organization Health Organization, and protect the health rights is by its nature a technical organization whose of the African populations. objective is the attainment by all peoples of the Mr Taljaard explained that the resolution proposed highest possible level of health; by his delegation repeated the considerata previously Considering that a technical organization such as adoptedbytheHealth Assemblyinresolution WHO should not be called upon to judge or to WHA6.47 (page 247 of the sixth edition of the Hand- determine questions of a political character, the book of Resolutions and Decisions of the World Health settlement of which will not be obtained by a Assembly and the Executive Board) as well as those of decision of the World Health Assembly; the draft resolution submitted by the Working Party Considering that there exist other political or which the South Africandelegation regardedas judicial bodies having such competence and which relevant and constitutional. are better qualified to deal with such differences; The South African delegation also believed that the two operative paragraphs contained in its submission Considering that it is highly desirable that the task were the proper ones to be adopted by the Assembly conferred upon the World Health Organization at the present juncture.It was the firm conviction of may be accomplished fully and without obstacles; his delegation that, should the Assembly adopt any Considering that the World Health Organization of the political considerations included in the Working isneither able nor wishes tointerferein the Party's draft resolution, it would be acting in con- differences existing between Member States of the tradiction to the Constitution of the Organization African Region of the Organization; and to its own previous decisions he had indicated. Considering the humanitarian principles and the Moreover, if the Assembly, fully aware of its actions, objectives enunciated in the Constitution of the took that course, it would have failed completely World Health Organization and especially with in its conciliatory task of ensuring that the African reference to the control of communicable diseases, Regional Organization functioned effectively for the which do not recognize national boundaries; protection of the health rights of all populations of the Region.The Assembly was faced with a grave Considering that the resolution of the Regional responsibilityof principle and of reconciliation; Committee for Africa calls attention to the necessity it should not shirk its responsibility for the sake of of safeguarding the health rights of all African political expediency, for which there should be no populations concerned; room in the Committee. Considering the necessity to avoid any action that may hamper the proper functioning of the Dr MAGALHAES DA SILVEIRA (Brazil) expressed his Regional Organization for Africa; and delegation's support for the draft resolution sub- mitted by the Working Party.In Brazil, no form of Noting that the Director of the African Regional segregationwasallowed.Politicalconsiderations Office, after consultation with the Director -General, should be laid aside where human suffering was has notified the Member States in the Region that involved.The health of the people depended upon the thirteenth session of the Regional Committee economic, social and moral conditions, all of which for Africa will be held in September /October 1963 segregation could only affect adversely. at the African Regional Office because of the cir- cumstances which have not made it possible to Mr BAUER (Canada) said that, during discussion convene it at the place previously selected by the in the Working Party, he had made it clear that Regional Committee at its eleventh session, paragraph 2 of the draft resolution was a matter of considerable concern for his delegation.It had found I.APPROVES the actions taken by the Regional itdifficult to adopt a positive attitude concerning Director and by the Director -General to ensure General Assembly resolution 1761 (XVII), since the the functioning of the African Regional Organi- Canadian delegation at the United Nations General zation and thefulfilment of the constitutional Assembly had voted against it. The only difference in functions of the African Regional Committee for approach to the problem of apartheid between those the protection of the health rights of all populations governments, includinghisown, that had voted in the Region; against the resolution, and those that had voted for 2.EXPRESSES the hope that Members of the Region it, was their position as to the adequacy of the cure. will do whatever is possible to further the effective The analogy had been used in the Working Party functioning of the African Regional Organization, that, of two physicians considering the use ofa drug promote the humanitarian goals of the World for treating a particular disease, one might be satisfied COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : NINTH MEETING 397 as to its efficacy while the other might consider that Furthermore, to delete paragraph 2 from the draft its side -effects outweighed its good effects.That was resolution proposed by the Working Party would be the root difficulty in approaching the resolution. a step backwards from the position taken by the He did not entirely agree with some of the previous United Nations General Assembly. He was sure that speakers, who had saidthatthe World Health that was not the Committee's wish. Assembly must avoid political discussion.If a group Referring to the draft resolution submitted by the of delegations had a sincere and legitimate political South African delegation, he failed to see how the problem that rebounded on health conditions, then objectives of the Organization could be achieved the basic premise that WHO was a non -political when health policies did not even exist for the coloured organization must be relaxed to some extent. When peoples of South Africa, who were kept in poverty a difference existed solely on the proper approach to a and ignorance.The distribution of power in South question, as in the present case, WHO had an obliga- Africa had permitted the introduction and continued tion in terms of the Constitution to try and come to application of apartheid, but that situation was not unanimous agreement on the final decision. irreversible. Reverting to paragraph 2 of the draft resolution On the other hand, the problem of apartheid could proposed by the Working Party,the Committee not be solved by a decision of the Health Assembly, should consider whether or not it was as important since that body was not in a position to change the as had been thought.In the original draft resolution relative weight of existing power, which would be the introduced by the twenty African countries, General decisive factor in eliminating apartheid. Assembly resolution1761(XVII) had not been The problem had, however, been brought before mentioned. A reference had, however, been made to it the Health Assembly in order to draw attention once in the draft resolution proposed by the delegations again to the conditions of life of the coloured popu- of 'Australia, New Zealand and Canada, to indicate lation of South Africa -conditions which deprived the tremendous scope of action open to all Members the world of the economic, social and cultural contri- of the United Nations with regard to the question of bution it could make, and which constituted a danger apartheid. Consequent upon the United Nations to world peace. resolution,asub -committee was examining and Dr BA (Senegal) paid tribute to the Chairman of the negotiating the problem.Nothing that the present Working Party, who had guided its discussions with Committee could say could have any influence upon authority and impartiality. He was intervening in the it, and little could be accomplished by urging Members debate because problems that had not been submitted to give serious consideration to it again.The draft to the Working Party had been raised in the Committee resolution proposed by the Working Party was much by members of the Working Party.Delegates of stronger and more direct than theoriginal draft African countries who had been represented in the produced by thetwenty Africancountries, and Working Party had accepted the draft resolution contained more than originally asked for even without contained in the report with a view to achieving a paragraph 2.It should not be difficult to find a way result that would be acceptable to all without entailing of meeting the difficulties expressed by delegations, the sacrifice of certain fundamental principles. and of producing an effective resolution with real The substance of paragraph 2 of the draft resolution, moral force, on an almost unanimous basis. which was the most contentious point, did not appear in Dr AMORIN (Togo) said that it was difficult to the draft resolution presented by the twenty African intervene on politicalquestions without speaking countries (see page 388), and he thanked the delegate of of politics. Apartheid wasa complexpolitico - Canada for having reminded the Committee that it was economic and social institution, and health, although the draft resolution proposed by the delegates of primarily a social matter, was also intimately linked Australia, Canada and New Zealand (see page 388)" with the other two aspects.In asking the Committee that had referred to General Assembly resolution not to intervene in the interior affairs of his country, 1761 (XVII). The purpose of paragraph 2 was to limit the delegate of the Republic of South Africa was action within the framework of that resolution, and himself introducing politics, by defending its policies. that was why the delegate of Canada and himself had A comparison between the state of public health in agreed to keep paragraph 2 in its present form. It was African countries and that in South Africa had not only after long discussion that the text before the been made, since that subject was not under discussion. Committee had been arrived at. He was not surprised 398 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II that paragraph 2 had evoked cross -fire and he referred tion, was proposing to do.The General Assembly to United Nations General Assembly resolution 1761 resolution had given shape to certain opinions held (XVII), which contained the words : by the politicalrepresentatives of the countries Regretting that the actions of some Member represented in the Committee.It therefore seemed Statesindirectly provide encouragement tothe unnecessary to reinforce that resolution atevery Government of South Africa toperpetuateits stage of the discussion. It had already been brought policy of racial segregation, which has been rejected tothe Health Assembly'sattention,and certain by the majority of that country's population, steps had been suggested in the light of it. There could be no doubt that WHO was interested Once again there was obvious proof of a situation that in the health of all people of all countries, whether was not such as to encourage South Africa to give way Members of the Organization or not.During his on the point, particularly since the same resolution sixteen years' attendance at World Health Assemblies went on to deplore "the failure of the Government of many such difficult problems hadarisen,but in the Republic of South Africa to comply with the approaching them ashealthpeople and notas repeated requests and demands of the General Assembly politicians, delegates had finally come to unanimous and of the Security Council and its flouting of world recommendations. public opinion by refusing to abandon itsracial The chief difficulty in the present case was in regard policies ". But even though the African countries to paragraph' 2 of the draft resolution proposed by the could not impose a solution on other Members of the Working Party. After hearing the difficulties stated by Organization, they had at least the right to remain the delegates of Turkey, Ireland, the United States of inflexible against certain pressures that were unaccept- America and the United Kingdom, it had occurred to able to them. him that the substance of paragraph2had already been The delegate of South Africa had introduced a brought to the attention of governments, and that the question that was unconnected with the point under paragraph was, after all, not the most vital of the discussion. He would reserve his position on it until it Working Party's recommendations. It was much more was dealt with under the appropriate item of the important to come to a conclusion that was as nearly agenda. unanimous as possible, and to that end he suggested Dr MUDALIAR (India) explained that he had not that paragraph 2 be amended to read : spoken during the Committee's discussion of the item 2. CALLS ATTENTION to General Assembly resolu- at the previous meeting because he had wanted to hear tion1761 (XVII)of6November1962,and invites African delegates speak for themselves on the problem, the Government of the Republic of South Africa to with which India itself had been so familiar.It was renounce the policy of apartheid in the interests of Mahatma Gandhi who had first taken up the question the physical, mental and social well -being of the now crystallized into the word apartheid; who had, in population. dealingwithit,always adoptedthehumanistic The last words of that substitute paragraph were, of approach, and while not agreeing with the policy of the governments concerned, had never been of the opinion course, taken from the Constitution, and might serve that individual citizens were in any way responsible for the necessary purpose while making it possible to it. In dealing with the question, the Committee should achieve unanimity.India had had experience of the problem, and understood it so well that his delegation keep separate its opinions of the policy of the Govern- considered that the interests of South Africa and other ment from its views or attitudes towards the people of South Africa, and he expressed his continued friend- coloured populations would be best served by a ship towards his two fellow delegates from that unanimous resolution.If delegations could see fit to country. approve the slight modification he had suggested, he There had been a certain stiffening of attitude by the could confidently appeal to them to adopt unanimously South African Government that had resulted in the the resolution as a whole. discussions that had taken place in the United Nations Paragraph3did not offend any of the principles of General Assembly in its resolution 1761 (XVII) of 6 WHO, since it stated that whatever was done would be within the provisions of the Constitution. November1962. He paid tribute to the delegate of Canada for having brought that resolution to the Dr AL -WAHBI (Iraq) said that the Republic of Iraq notice of delegates from Africa who had perhaps not had been one of the sponsors of United Nations been aware of it.He was also pleased that the dele- General Assembly resolution1761(XVII).It was gations of Australia, Canada and New Zealand had convinced that all peoples were born free and equal, introduced it in their draft resolution, to give an idea without regard to race, colour or caste.All had the of what the United Nations, as the political organiza- same responsibility and right to play their part in the COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : NINTH MEETING 399 promotion of health. His delegation condemned draft resolution without paragraph 2 the resolution racial discrimination of any kind, and it was the duty would be incomplete, and, as the delegate of Senegal and responsibility of the Committee to find a way of and others had indicated, would be going back on ensuring the proper functioning of the Organization for United Nations General Assembly resolution 1761 the benefit of all peoples. He was anxious to see the (XVII), and the Committee would be acting contrary problem resolved if possible unanimously, and would to its professional and moral duty.His delegation therefore support the proposed amendment by the thereforesupportedinfullthedraftresolution delegate of India to paragraph 2 of the draft resolution. proposed by the Working Party. Unanimous approval of the resolution was desirable and would certainly add Dr MARTÍNEZ REYES (Cuba) said that his delegation to its force, but in view of the political implications and had given careful study to the report of the Working of the arguments that had been advanced by delega- Party. The people of Cuba had in the past had cause to tions of African countries, he thought the Committee know the meaning of racial discrimination and its could not count on reaching unanimity. effects on social development.His Government had come to power at a time when the negro population Mr ROFFEY (United Kingdom of Great Britain and was living in miserable conditions, and the elimination Northern Ireland) expressed his delegation's thanks to of segregation had been one of its initial measures for the delegate of India for his very carefully thought -out ensuring social equality and better living conditions. proposal.The two previous speakers had perhaps The negro population had originally come from the overlooked the fact that the proposal now under western coast of Africa, and his Government therefore discussion was not the deletion of paragraph 2 but a deeply appreciated the problems of Africa. revised wording that might make its passage a little less His delegation supported the report of the Working difficult.The United Kingdom delegation, although Party in its existing form, because it understood the it would have preferred to omit the various references to deep underlying human and social reasons that had United Nations General Assembly resolution 1761 led to its preparation. To oppose or amend paragraph (XVII), would be ready to accept the redrafting now 2 of the draft resolution would be to go against proposed by the delegate of India :it did not consider resolution 1761 (XVII) of the United Nations General that that acceptance was necessarily inconsistent with Assembly, which the Committee had no authority to the fact that the United Kingdom had reservations do. concerning General Assembly resolution 1761. Mr TAVOR (Israel) said that, as representative of a Dr LISICYN (Union of Soviet Socialist Republics) people who had suffered throughout the centuries said that during the Committee's discussions it had from racial discrimination, there could be no doubt been proved that apartheid was the fundamental cause where the sympathies of his delegation lay.Racial of disease and of the poor conditions of hygiene in discrimination opposed the Charter of the United which the majority of the population of South Africa Nations and the Declaration of Human Rights, which lived. The reasoning that the policy of apartheid should contained certain provisions concerning the health of not,as a political question, be examined by the mankind. No world forumshouldmissany Committee was not well founded, sinceit was a opportunity of discussing the distortion of human policy that brought about social, material, and cultural rights caused by apartheid, and WHO should be conditions that were the cause of physical and mental allowed to continue its important work in Africa disease. A number of delegates who had spoken unhindered.He would be happy if the Committee against paragraph 2 of the draft resolution contained could reachagreement -even ifitrepresented a in the Working Party's report had in fact contradicted certain compromise -and would therefore support the themselves when they said that WHO was a purely amendment proposed by the delegate of India. technical organization which must not concern itself with political problems. Some of them were delegates Mr ZOHRAB (New Zealand) said that his delegation of the very countries that had opposed United would find it difficult to accept as it stood paragraph 2 Nations General Assembly resolution 1761 (XVII); of the draft resolution proposed by the Working Party, they had opposed that resolution for purely political since his country had voted against United Nations reasons, but were now speaking against paragraph 2 of General Assembly resolution 1761 (XVII) for reasons the draft resolution proposed by the Working Party that had not reflected any weakening of its attitude because they said that political arguments must not be against apartheid.It earnestly hoped, however, that a used in WHO. He could find no logic in such reason- unanimous decision might be reached, and would ing. The very statements on the subject were inspired therefore support the amendment proposed by the by political motives.If the Committee adopted the delegate of India. 400 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Mr FURLONGER (Australia) thanked the delegate of Mr PERERA (Ceylon) said that his country's views India for his helpful proposal and said that, even on the question of apartheid had been expressed in the though hisdelegation had voted against United General Assembly of the United Nations and other Nations General Assembly resolution 1761 (XVII), it forums. The unanimity reached by the Health would accept the proposed amendment in the interests Assembly in its resolutions was almost a byword of unanimity. among the international organizations, and he there- fore sincerely hoped that an attempt would be made to Dr ROWHANI (Iran) said that the characteristic maintain that proud record. His delegation accordingly feature of the current Health Assembly had been supported the amendment proposed by the delegate of unanimity and concord. There was no doubt that most India, and he appealed to his African friends also to of the Committee condemned the policy of apartheid, accept it.In doing so they need have no fear that the but it appeared that the unanimity so far obtained was stand they had consistently taken on the matter would in danger of breaking down. With a view to preventing be weakened -rather would the joint stand taken by thatunfortunatedevelopmenthewouldwhole- African and other countries on the vexed question of heartedly support the draft resolution prepared by the apartheid be weakened if the resolution, as amended, Working Party, with the amendment proposed by the failed to be carried unanimously, or nearly so, delegate of India. Mr ZEUTHEN (Denmark) said that his delegation had Mr BAUER (Canada) said that his delegation too been in the same predicament as others with regard to would, in the interests of compromise, but against its paragraph 2 of the draft resolution drawn up by the better judgment, accept the amendment propose d by Working Party, and was therefore happy to support the delegate of India. the amendment to that paragraph proposed by the The CHAIRMAN summarized the position. There were delegate of India. five documents before the Committee. The Director - Dr ALAN (Turkey) said that he did not wish his General's report on the subject 1 contained the text of position to. be misunderstood.He was against the the resolution adopted by the Regional Committee for discussion of political matters in the Health Assembly. Africa and called for no action from the procedural He fully supported the amendment proposed by the point of view. The draft resolutions proposed by the delegate of India but suggested that the word "invite" delegations of twenty African countries and by the be replaced by a less imperative word. delegations of Australia, Canada and New Zealand (seepage388) weretechnicallystillbeforethe Dr BA (Senegal) said that throughout the debate the Committee. In view of the fact that they had, however, Members of the African Region had sought to obtain a been incorporatedinthetextof theresolution majority in condemning racial discrimination in its proposed by the Working Party, he suggested that the most violent form- apartheid.They realized that authors might wish to withdraw them. unanimity in the matter was impossible but his There being no objection, it was so agreed. delegation was very grateful for the general atmosphere Thereremainedthreeproposalsbeforethe that had reigned during the discussion and sincerely Committee :first, the draft resolution recommended thanked all those who had unreservedly supported by the Working Party; second, the amendment thereto that condemnation. He expressed much gratitude to proposed by the delegate of India; and third, the draft the delegate of India for his efforts to obtain unanimity resolution from the South African delegation. When and accepted his amendment in the hope that no the time came for a vote to be taken, unless an appeal further difficulty would arise. was made to the contrary, the Chairman announced Dr SCHANDORF (Ghana) fully associated himself that, in accordance with Rule 66 of the Rules of with the views expressed by the previous speaker. Procedure, he would rule that the Indian ; amendment would be voted upon first, then the draft resolution of Dr SIGURJÓNSSON (Iceland) stated that, as he had the Working Party, and finally the draft resolution already explained, he had some doubts with regard to submitted by the South African delegation. possible interpretation of paragraph 2 of the draft resolution.He therefore supported the amendment Mr MCKITTERICK (United States of America) said proposed by the delegate of India and very much that the tact and wisdom of the amendment proposed appreciated that delegate's intervention. by the delegate of India would remove the objection he had expressed to paragraph 2, and he would therefore In reply to a question from Mr BAUER (Canada), support the amendment. Dr ALAN (Turkey) explained thathissuggestion concerned the French text only of the amendment put 1 Of Rec. Wld Hlth Org. 127, Annex 14. forward by the delegate of India. COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : NINTH MEETING 401
Dr AUJOULAT (France) paid tribute to the delegate French to correspond to the English; he also hoped of India for his contribution, as Chairman of the that the discussion could be concluded and no further Working Party and at the present meeting, to the difficulty would arise. progress that had been made in a most difficult debate. The efforts of the Working Party had been to a large Dr ALAN (Turkey) withdrew the amendment he had measuresuccessful,sincethereappearedtobe suggested. unanimity on most of the draft resolution.He also thanked the delegates of the African countries for Dr GATMA1TAN (Philippines) said that, as a member their understanding and for the concessions they had of the Working Party, his delegation had already made. With regard to the amendment proposed by the announceditsunqualifiedsupportof thedraft delegate of Turkey, he agreed that in French the word resolution, which represented not the thinking of "invite" had an imperative tone..Consequently it individual members but the crystallized opinion of the might be held that the amendment as now worded went members of the Working Party as a whole and which beyond what was permitted under Article 2, paragraph as a member thereof it was his duty to defend. The 7, of the Charter of the United Nations (concerning text which had finally been produced was the result of intervention in the domestic affairs of Member States), many hours' labour and concessions on the part of which also applied to WHO. He therefore asked for a many members of the group.In the interests of clear explanation of what was intended in the present unanimity therefore,he proposed thatthedraft instance, and said he would be prepared to accept a resolutionas amended by the Chairman of the rewording on the Iines suggested by the delegate of Working Party should be adopted and appealed to all Turkey. With that proviso, his delegation would join delegates to support that proposal. others in supporting the draft resolution now before Dr AUJOULAT (France) explained that his suggestion the Committee. had been motivated only by his wish that a unanimous Mr FERAA (Morocco) recalled that at the previous solution should be reached about which there would be meeting his delegation had proposed the setting -up of a no misunderstanding. The position of his country with Working Party, with a view to solving a difficult regard to the rights of man and the policy of discrimina- problem.The outcome was the text of the draft tion practiced by certain States was sufficiently well resolution under discussion and his delegation fully known. He had asked for an explanation in order to supported the amendment toit proposed by the ensure that the decision adopted by the Committee delegate of India, provided that there was no conflict was in conformity with the provisions of the Charter of with the provisions of the Charter of the United the United Nations. In view, however, of the explana- Nations. tionsgiven by the Chairman and confirmed by English- speaking delegates, he realized that "invites" Mr FURLONGER (Australia) said that there was no in English was fully in conformity with the provisions difficulty in so far as his delegation was concerned with of the articles to which he had referred; he could the interpretation of the word "invites" in English; the, therefore support the amendment on that under- original text had been in that language. standing. After a long and difficult discussion, they had very nearly reached unanimity and in the circumstances he Dr DE ALMEIDA COELHO -LOPES (Portugal) referred appealed to the delegates of Turkey and France to to the spirit of understanding which had prevailed withdraw their objections and allow the amendment throughout the discussion. His delegation was against proposed by the delegate of India to be adopted on the racialdiscriminationasallpresent were aware. understanding that the interpretation of the word However, the text of the resolution before the meeting "invites" would be based on the English meaning. was rather wide in scope and gave him cause for some doubt, particularly since the matter had already been Mr BAUER (Canada) joined in that appeal. discussed at length at the United Nations and was not, Dr HAPPI (Cameroon) expressed some surprise at a strictly speaking, a subject for discussion by the further amendment having been put forward by the Health Assembly. delegate of Turkey in spite of the statement by the delegate of Senegal that he would accept the amend- Mr ABRAR (Somalia) supported the draft resolution ment by the delegate of India in the hope that it was proposed by the Working Party, as amended by the the last. delegate of India. Dr KEITA (Guinea) said that he was sure a suitable The CHAIRMAN announced that, in accordance with meaning for the word "invites" could be found in Rule 66 of the Rules of Procedure of the Health 402 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Assembly, a vote would be taken first on the amend- tion.The Health Assembly was not the competent ment proposed by the delegate of India. body to deal with political matters or the internal Decision:The amendment was approved by69 affairs of a Member State. It could study the technical votes to none, with6abstentions. aspects of discrimination, but those aspects could only be examined after a thorough study had been made of The CHAIRMAN announced that a vote would be the effects of racial discrimination on health.The taken on the draft resolution drawn up by the Working Portuguese Government was opposed to any policy of Party,with the amendment that had justbeen discrimination, but it could not support a resolution approved. affecting a country's internal politics and referring to Decision:The draft resolution was approved by70 political subjects that had already been dealt with by a votes to 1, with4abstentions.1 competent international organization.
In accordance with Rule66of the Rules of Pro- Mr TAKIZAWA (Japan) explained that his delegation cedure of the Health Assembly, the CHAIRMAN ruled had abstained from voting because it was of the that the votes taken made it unnecessary for the other opinion that WHO was not competent to discuss resolution that had been before the Committee to be political issues. put to the vote. Mr ARROYO AZNAR (Spain) reiterated the state- ments made on the subject by representatives of his Mr ROFFEY (United Kingdom of Great Britain and country at all international meetings that his Govern- Northern Ireland) explaining his delegation's absten- ment opposed racial discrimination. That attitude was tion, said his Government had voted against General reflected in the history of his country as well as by Assembly resolution1761 (XVII)because it considered current policy.It was the opinion of his delegation that the sanctions proposed were unacceptable. That that it was not for the Health Assembly to interfere in reservationalso applied,therefore, wherever that the internal politics of the South African Government resolution was mentioned, for example in paragraphs and he referred in that connexion to Article 2, paragraph 2and6of the resolution the Committee had just 7,of the United Nations Charter.It was the task of approved.His delegation was also bound to make the World Health Organization to strive towards the some reservation on paragraph 3 of the resolution, attainment by all peoples of the highest possible level because it believed that the WHO Constitution in any of health.His delegation had therefore abstained case debarred the Health Assembly from attempting from voting. totake directlypoliticalaction to influence the Government of South Africa in its internal policies. Miss LUNSINGH MEIJER (Netherlands) said that her Those reservations should not, however, be taken to delegation had voted in favour of the resolution, suggest that his Government had in any way tempered althoughit would have preferreditnot to have its condemnation of the policy of apartheid. Members contained a reference to resolution1761 (XVII)of the of the Committee would recallthatthe United General Assembly of theUnited Nations. The KingdomrepresentativeonthespecialPolitical Netherlands delegation at the General Assembly of the Committee of the United Nations had in October1962 United Nations had voted against that resolution stated that the policy of apartheid was as repugnant to because it had not felt that sanctions were the right way his Government as it was to other Members of the of approachingtheproblem. Throughoutthe United Nations and to all right- minded people. The discussions on the subject in the United Nations, policy of his Government with regard to apartheid however, the attitude of the Netherlands delegation was unambiguous and its objection had been made had been to condemn racial discrimination.Her known directly and forcefully to the South African delegation had also hesitated in taking part in the vote Government at Pretoria.His Government could not which had just been taken, because it was of the opinion and would not give up its continued appeal to the that the World Health Assembly was not the right South African Government to modify its policy to forum for the discussion of a purely political issue. come into line with the views of all right- minded Mr. TouRÉ (Mauritania) said that the African dele- peoples in all countries. gations had brought before the Committee a difficult Dr DE ALMEIDA COELHO -LOPES (Portugal) also African problem in the hope that a solution would be explained his abstention. As he had previously stated, found. After much effort a solution had been found his Government did not approve of racial discrimina- which, if not unanimous, had been reached by a great majority and the African delegations were most 1 Transmitted to the Health Assembly in the Committee's grateful, particularly to the members of the Indian fifth report and adopted as resolution WHA16.43. delegation, who with their talent and intelligence had COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : TENTH MEETING 403 succeeded in reconciling the differing points of view. demned apartheid and agreed with the views expressed It had been said that the subject was political, but the by the majority of delegates at the present meeting, African delegations were not of that opinion and it although it did not agree as to the most appropriate was clear that no delegation represented on the and effective way of solving the problem.In conclu- Committee approved of apartheid, with the possible sion, his delegation wished to be associated with the exception of one. The delegation to which he referred views expressed by the delegate of India and his howeverrefutedtheconsequencesofapartheid, requestthatattitudestowardsgovernmentsand although they were clearly visible from the point of policies should be separated from attitudes towards view of health in general, including social and mental individuals. health.The African countries were happy that a solution had been found acceptable tothe vast The CHAIRMAN expressed the Committee's deep majority of delegations and thanked those who had thanks to the members of the Working Party and finally supported the resolution although their point of particularly toits Chairman, Dr Mudaliar of the view at the outset had been different. Indiandelegation,fortheirlabours,whichhad enabled a successful conclusion to be reached. He also Mr BAUER (Canada) explained that his delegation thanked the members of the Committee for the high had voted in favour of the resolution, but that did not level of the debate which had taken place on such a mean that there had been any change in its attitude to difficult subject. certain parts of resolution 1761 (XVII) of the United Nations General Assembly.His Government con- The meeting rose at 5.55 p.m.
TENTH MEETING
Wednesday, 22 May 1963, at 10.30 a.m.
Chairman: Mr I. T. KITTANI (Iraq)
1.Fifth Report of the Committee 2.Closure of Session At the request of the CHAIRMAN, Dr BRAVO (Chile), The CHAIRMAN said that the Committee had now Rapporteur, read the resolution contained in the completeditsbusiness. He expressedhisdeep Committee's draft fifth report, which had already been appreciation to all members of the Committee, first approved by a majority vote at the preceding meeting for the honour of his election to be Chairman and, of the Committee. second, for the excellent degree of co- operation and understanding which had prevailed throughout the Mr TALJAARD (South Africa) said that his delegation Committee's deliberations.His task had been easy, had at the previous meeting voted against the resolu- thanks to the members of the Committee and the tion recommended in the fifth report of the Committee Secretariat, who had once again demonstrated their on Administration, Finance and Legal Matters. Con- great efficiency and understanding of the problems sidering that that resolution (1) was based on political involved. He expressed his thanks in particular to the considerations (2) fell outside the competence of the World Health Assembly (3) was a violation of the Director -General, and to the Vice -Chairman, the Rapporteur, and the Secretary of the Committee for Constitution of the World Health Organization and their help in bringing the Committee's work to a (4) constituted intolerable interference in the internal successful conclusion.His parting hope was for the affairs of a Member State, the South African delega- tion recorded its unqualified opposition to the said continuous success and prosperity of the Organization. resolution. Dr CAYLA (France) congratulated the Chairman on Decision:The report was adopted (see page 410). his brilliant conduct of the Committee's work.His 404 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II legal knowledge and lucidity of mind had contributed which, in their turn, were ready to contribute to the in a large measure to the speed and efficiency with best of their ability to universal civilization. which the Committee had carried out its work. He was to be thanked and congratulated, not in a purely Mr Azouz (Tunisia) congratulated the Chairman on formal way, but as a friend with whom they had long the brilliant manner in which he had conducted the worked together. work of the Committee and thanked the Director - The French delegation also wished to be associated General and his staff for their help. with the expression of thanks paid by the Chairman to the Secretariat, which had done much to assist the Mr FERAA (Morocco) expressed his delegation's Committee in its work. thanks to the Chairman for the way in which he had presided over the work of the Committee and to the Dr MUDALIAR (India) wholeheartedly associated his Secretariat forallit had done to enable fruitful delegation with the remarks made by the delegation of conclusions to be reached. France. The Chairman had proved his worth in conducting difficult debates and all had appreciated DrCASTILLo (Venezuela)alsoexpressedhis his understanding of the position of the various congratulations to the Chairman, Vice Chairman and delegates and his efforts to ensure that justice and fair Rapporteur of the Committee, and his thanks to the play should prevail.Dr Mudaliar also echoed the staff for its assistance. sentiments expressed by the delegate of France with regard to the assistance provided by the Secretariat, Dr HAPPI (Cameroon) said that all had admired the and thanked in particular the Director -General and the tact with which the Chairman and his assistants had Assistant Director -General. He would leave the directed the debates; it would not be forgotten that Assembly with the hope and prayer that WHO would it was under Mr Kittani's chairmanship that the fifth continue to be one of the most unifying factors among report of the Committee on Administration, Finance all the international organizations for the promotion and Legal Matters had been adopted. The approval of of the health and welfare of the peoples of the world. that report was most encouraging and showed that the Health Assembly did not hesitate to tackle problems Mr ROFFEY (United Kingdom of Great Britain and that might endanger health, wherever they arose.It Northern Ireland) associated his delegation with the was the hope of his delegation that the report sub- sentiments expressed by the delegates of France and mitted by the Director -General to the following World India. Health Assembly would give hope for a solution of the problem. Dr LISICYN (Union of Soviet Socialist Republics) also expressed his delegation's appreciation of the Mr Hun (Kuwait) warmly congratulated the Chair- Chairman, Vice -Chairman, Rapporteur and man on the successful outcome of the work of the Secretariat. Committee and also thanked the Vice -Chairman, Rapporteur,Director -General,AssistantDirector - Mr DE CONINCK (Belgium) echoed the appreciation General and Secretariat for their assistance. which had been expressed by previous speakers and thanked the Chairman for all he had done. Dr GATMAITAN (Philippines) praised the Chairman for the great ability he had shown and congratulated Dr BA (Senegal), speakingonbehalf of the countries the Secretariat, headed by the Director -General, on of the African Region, thanked the Chairman, Vice - the effective assistance it had rendered. Even when the Chairman and Rapporteur of the Committee and the views had not appeared to be reconcilable at the Director -General and staff of the Organization,. as outset of certain discussions, a solution had been well as members of the Committee for their spirit of found, thanks to the spirit of international solidarity understanding when discussing delicate problems such i.hat had guided them. as the one -in which the African countries were parti- cularly interested.The way in which a solution had Dr KRAUS (Yugoslavia) joined previous speakers in been found showed that international solidarity was a thanking the Chairman, Vice -Chairman, Rapporteur reality.He was happy to note the atmosphere of and Secretariat for their excellent work. international co- operation which had prevailed. It was a very favourable omen for the future, as well as a Dr ROWHANI (Iran) also congratulated the Chair- guarantee of success for the African countries, to man on the efficient manner in which he had conducted which the assistance of WHO was so important and the work of the Committee and on the degree of COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : TENTHMEETING 405 unanimity that had been achieved, even in the recent Dr LAYTON (Canada) thanked the Chairman for the difficult debate. kind remarks he had made at the opening meeting of the session and expressed his appreciation of the Dr ALAN (Turkey) echoed the thanks that had also been expressed to the Chairman and others. He had manner in which the Chairman had conducted the been greatly moved by the spirit of international co- work of the Committee. If that task had beeneasy, as operation that had prevailed throughout the work of he had said, that was because of his great ability. the Committee, and hoped that it would continue in the future. The meeting rose at 11.5 a.m. COMMITTEE REPORTS
The texts of recommended resolutions subsequently adopted without change by the Health Assembly have here been omitted from the committee reports, as they appear in Part I (Official Records No. 127 ,pages I to 22) and are also incorporated in the record of the relevant meeting contained in the present volume. To facilitate reference to Part I, the serial numbers of the omitted resolutions are inserted in square brackets after the relevant headings in the reports.
COMMITTEE ON CREDENTIALS
FIRST REPORT ' Norway, Pakistan, Paraguay, Peru, Poland, Portugal, Republic of Korea, Republic of Viet -Nam, Romania, [A16/7 -7 May 1963] Saudi Arabia, Sierra Leone, Somalia, South Africa, The Committee on Credentials met on 7 May 1963. Spain, Sudan, Sweden, Switzerland, Syria, Thailand, Delegates of the following Members were present : Turkey, Uganda, Union of Soviet Socialist Republics, Australia, Bulgaria, Canada, Cyprus, Federation of United Arab Republic, United Kingdom of Great Malaya, Ghana, Madagascar, Nepal, Peru, Spain, Britain and NorthernIreland,UnitedStatesof Sweden, Syria. America, Upper Volta, Venezuela, Western Samoa, Dr B. D. B. Layton (Canada) was elected Chairman, Yemen, Yugoslavia. Dr A. G. W. Engel (Sweden) Vice -Chairman, and 2.Notifications from Cambodia, Ecuador, Dr A. C. Andriamasy (Madagascar) Rapporteur. Guatemala,Kuwait,Laos,Panama,Philippines, The Committee examined the credentials deposited Senegal, Tanganyika, Togo, Trinidad and Tobago, and by the delegations taking part in the Health Assembly, Tunisia, giving the composition of their delegations, state that credentials are being forwarded, and the 1. The credentials presented by the delegations and representatives listed below were found to be in order, Committee therefore recommends totheHealth thus entitling these delegations and representatives to Assembly that these delegations be recognized with take part in the work of the Health Assembly, as full rights in the Health Assembly pending the arrival defined by the Constitution of the World Health of their formal credentials. Organization. The Committee therefore proposes 3. The delegationof Bulgariaobjectedtothe thatthe Health Assembly should recognize the credentials submitted on behalf of China by the validity of the credentials presented by the following representatives of Chiang Kai -shek.It declared that delegations and representatives : only credentials issued by the Government of the Afghanistan, Albania, Algeria, Argentina, Australia, People's Republic of China gave the right to represent Austria, Belgium, Bolivia, Bulgaria, Burma, Burundi, China during thesessionofthe World Health Cameroon, Canada, Central African Republic, Ceylon, Assembly. Chad, Chile, China, Columbia, Congo (Brazzaville), Congo (Leopoldville), Cuba, Cyprus, Czechoslovakia, SECOND REPORT 2 Dahomey, Denmark, Ethiopia, Federal Republic of Germany, Federation of Malaya, Finland, France, [A16/9 -8 May 1963] Gabon, Ghana, Guinea, Hungary, Iceland, India, The Committee on Credentials met on 8 May 1963, Indonesia, Iran, Iraq, Ireland, Israel,Italy, Ivory under the chairmanship ` of Dr B. D. B. Layton Coast, Jamaica, Japan, Jordan, Lebanon, Liberia, (Canada). Libya, Luxembourg, Madagascar, Mali, Mauritania, The Committee accepted the formal credentials of Mexico,Monaco,Mongolia,Morocco,Nepal, the delegations of Brazil, Greece, Philippines and Netherlands, New Zealand,Nicaragua,Nigeria, 2 Approved by the Health Assembly at its third plenary I Approved by the Health Assembly at its first plenary meeting meeting. - 406 - COMMITTEE REPORTS 407
Tunisia, entitling their members to take part in the tives to take part in the work of the Health Assembly work of the Health Assembly as defined by the as defined by the Constitution of the World Health Constitution of the World Health Organization. Organization.
THIRD REPORT 1 FOURTH REPORT 2 [A16/11-14 May 1963] [A16/22 -22 May 1963] The Committee on Credentials met on 14 May 1963, The Committee on Credentials met on 22 May 1963, under the chairmanship of Dr B. D. B. Layton under the chairmanship of Dr B.D. B. Layton (Canada). (Canada). The Committee accepted the formal credentials of On the basis of documents presented by the delega- the delegates and representatives of the following tion of Rwanda, the Committee decided to recommend countries :Cambodia, Ecuador, Guatemala, Kenya, tothe Health Assembly thatthisdelegation be Laos, Mauritius, Niger, Panama, Senegal and Trinidad recognized with full rights in the Health Assembly and Tobago, entitling their delegates and representa- pending the arrival of its formal credentials.
COMMITTEE ON NOMINATIONS
FIRST REPORT 3 Vice -Presidents of the Assembly :Professor R. Geric (Yugoslavia), Mr Abdul Rahman bin Haji Talib [A16/5 -7 May 1963] (Federation of Malaya), Dr Sushila Nayar (India); The Committee on Nominations, consisting of delegates of the following Member States : Committee on Programme and Budget :Chairman Argentina, Cambodia, Congo (Leopoldville), France, Dr V. V. Olguín (Argentina); Gabon, India, Iran, Israel,Jamaica, Lebanon, Mexico, Morocco,Netherlands, New Zealand,Nigeria, Committee onAdministration,Finance and Legal Norway, Romania, Thailand, Tunisia, Union of Matters : Chairman, Mr I. T. Kittani (Iraq). Soviet Socialist Republics, United Arab Republic, Concerning the members of the General Committee United Kingdom of Great Britain and Northern to be elected under Rule 31 of the Rules of Procedure Ireland, United States of America, and Venezuela of the Health Assembly, the Committee decided to met on 7 May 1963. nominate the delegates of the following fourteen Dr A. L. Mudaliar (India) was elected Chairman, and countries : Cambodia, Canada, Congo (Leopoldville), Mr M. Feraa (Morocco) Rapporteur. Dahomey, France, Indonesia, Iran, Israel, Mexico, In accordance with Rule 25 of the Rules of Pro- Sweden,Tanganyika,UnionofSovietSocialist cedure of theHealth Assembly,the Committee Republics, United Kingdom of Great Britain and decided to propose to the Assembly the nomination of Northern Ireland and United States of America. Dr M. A. Majekodunmi (Nigeria) for the office of President of the Sixteenth World Health Assembly. THIRD REPORT 4 SECOND REPORT 3 [A16/8 -7 May 1963] [A16/6 -7 May 1963] At itsfirst meeting, held on 7 May 1963, the Committee on Nominations decided to propose to At itsfirst meeting, held on 7 May 1963, the each of the Main Committees, in accordance with Committee on Nominations decided to propose to the Rule 25 of the Rules of Procedure of the Health Assembly, in accordance with Rule 25 of the Rules of Assembly, the following nominations for the offices of Procedure of the Assembly, the following nominations : Vice -Chairman and Rapporteur : x Approved by the Health Assembly at its seventh plenary meeting. 3 Approved by the Health Assembly at its second plenary 2 Approved by the Health Assembly at its thirteenth plenary meeting. meeting. 4 See p. 169 and p. 324. 408 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Committee on Programme and Budget: Vice -Chairman, Committee on Administration,Finance and Legal DrS.P.Tchoungui (Cameroon);Rapporteur, Matters: Vice -Chairman, Dr J. Vysohlíd (Czechoslo- Dr M. Sentici (Morocco); vakia); Rapporteur, Dr A. L. Bravo (Chile).
GENERAL COMMITTEE
REPORT 1 election of eight Members to be entitled to designate a person to serve on the Executive Board : [A16/10 -13 May 1963] Brazil,Indonesia, New Zealand,Sierra Leone, Australia,Mali,Netherlands,Norway,Iran, Election of Members entitled to designate a Person Morocco, Turkey, Libya, to serve on the Executive Board The General Committee then recommended the At its meeting held on 13 May 1963, the General following eight Members which, in the Committee's Committee, in accordance with Rule 98 of the Rules of opinion, would provide, if elected, a balanced distribu- Procedure of the Health Assembly, drew up the tion on the Board as a whole : following list of twelve Members, to be transmitted to Brazil, New Zealand, Indonesia, Mali, Sierra Leone, the Health Assembly for the purpose of the annual Norway, Iran, Netherlands.
COMMITTEE ON PROGRAMME AND BUDGET
FIRST REPORT 2 decided to recommend the following resolutions for adoption by the Sixteenth World Health Assembly : [A16/12 -16 May 1963] 1. Report on Development of the Malaria Eradica- The Committee on Programme and Budget held its tion Programme [WHA16.23] first, second, third, fourth, fifth and sixth meetings on 2. Developments in Activities assisted jointly with 9, 13, 14 and 15 May 1963, under the chairmanship of UNICEF [WHA16.24] Dr V. V. Olguín (Argentina). On the proposal of the Committee on Nominations Dr S.P. Tchoungui (Cameroon) was elected Vice -Chairman and Dr M. Sentici (Morocco) Rapporteur. THIRD REPORT 4 At its sixth meeting, the Committee decided to [A16/17 -20 May 1963] recommend the following resolution for adoption by theSixteenth World Health Assembly :Effective At its ninth, tenth and eleventh meetings, held on 17 WorkingBudgetandBudgetLevelfor 1964 and 18 May 1963, the Committee on Programme and [WHA16.13] Budget decided to recommend the following resolu- tions for adoption by the Sixteenth World Health Assembly : SECOND REPORT s 1. Television Influence on Youth [WHA16.25] 2. Voluntary Fund for Health Promotion :Medical [A16/16 -17 May 1963] Research [WHA16.26] At its seventh and eighth meetings, held on 16 May 3.Voluntary Fund for Health Promotion : 1963, the Committee on Programme and Budget Community Water Supply [WHA16.27]
See verbatim record of the ninth plenary meeting, section 1. 4. Appropriation Resolution for the Financial Year 2 Approved by the Health Assembly atits tenth plenary 1964 [WHA16.28] meeting. 3 Approved by the Health Assembly at its eleventh plenary 4 Approved by the Health Assembly at its twelfth plenary meeting. meeting. COMMITTEE REPORTS 409
FOURTH REPORT 1 inparticularwithrespecttoNotifications [A16/19-21 May 1963] [WHA16.34] 2. Committee on International Quarantine : At its twelfth and thirteenth meetings, held on 20 Eleventh Report [WHA16.35] May 1963, the Committee on Programme and Budget decided to recommend the following resolutions for 3. ClinicalandPharmacologicalEvaluationof adoption by the Sixteenth World Health Assembly : Drugs [WHA16.36] 1. Organizational Study :Measures for providing Effective Assistance in Medical Education and SIXTH REPORT 2 Training to meet Priority Needs of the Newly [A16/23-23 May 1963] Independent and Emerging Countries [WHA16.29] At its sixteenth and seventeenth meetings, held on 2. Organizational Study :Methods of Planning and 22 May 1963, the Committee on Programme and Execution of Projects [WHA16.30] Budget decided to recommend the following resolu- 3. ContinuedAssistancetoNewly Independent tions for adoption by the Sixteenth World Health States [WHAI6.31] Assembly : 1. Smallpox Eradication Programme [WHA16.37] 2. ClinicalandPharmacologicalEvaluationof FIFTH REPORT 2 Drugs :Standards of Drugs [WHA16.38] [A16/21 -22 May 1963] 3. Decisions of the United Nations,Specialized At its fourteenth and fifteenth meetings, held on Agencies and IAEA affecting WHO's Activities : 21 May 1963, the Committee on Programme and - Programme Matters [WHA16.39] Budget decided to recommend the following resolu- 4. United Nations Development Decade [WHA16.40] tions for adoption by the Sixteenth World Health 5. ExtensionoftheAgreement with UNRWA Assembly : [WHA16.41 ]
1. Additional Regulations of . . . May 1963 6. Joint FAO /WHO Programme on Food Standards amending the International Sanitary Regulations, (Codex [WHA16.42]
COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS
FIRST REPORT 3 by a smaller group than the committee itself, a special ad hoc working group could be set up to deal with [A16/13 -14 May 1963] them. The Committee on Administration, Finance and The Committee decided to recommend tothe Legal Matters held its first, second and third meetings Sixteenth World Health Assembly the adoption of the on 9 and 13 May 1963 under the Chairmanship of following resolutions : Mr I.T. Kittani (Iraq).On the proposal of the Financial Report on the Accounts of WHO for CommitteeonNominations,Dr J. Vysohlíd 1962,Reportof theExternalAuditor,and (Czechoslovakia) waselectedVice -Chairman, and comments thereon of the Ad Hoc Committee of Dr A. L. Bravo (Chile), Rapporteur. the Executive Board [WHA16.5] As there did not appear to be items of the agenda that needed to be referred to a legal sub -committee, it 2. SupplementaryBudgetEstimates for 1963 was decided, at the suggestion of the Chairman, to [WHA16.6] dispense with theestablishment of such asub- 3. Assessments of New Members for 1962 and 1963 committee.If any legal or constitutional questions [WHA16.7] arose during the session which required consideration 4.Addition toSchedule A to the Appropriation Resolution for the Financial Years 1962 and 1963 1 Approved by the Health Assembly at its twelfth plenary meeting. [WHA16.8] 2 Approved by the Health Assembly at its thirteenth plenary 5. Accommodation fortheRegionalOfficefor meeting. Africa [WHA16.9] 3 Approved by the Health Assembly at its seventh plenary meeting. 6. Scale of Assessment for 1964 [WHA16.10] 410 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
SECOND REPORT 3. Headquarters Accommodation :Progress Report [WHA16.22] [A16/14 -16 May 1963] The Committee on Administration, Finance and Legal Matters held its fourth meeting on 14 May 1963. FOURTH REPORT The Committee adopted the following resolutions [A16/18-21 May 1963] for recommendation to the Sixteenth World Health Assembly : The Committee on Administration, Finance and Legal Matters held its seventh and eighth meetings on 1. Appointment of the External Auditor [WHA16.14] 17 May 1963. 2. Amendments to the Staff Rules [WHA16.15] The Committee adopted the following resolutions 3. Selection of the Country in which the Seventeenth for recommendation to the Sixteenth World Health World Health Assembly, will be held [WHA16.16] Assembly : 4.Malaria Eradication Special Account [WHA16.17] 1. Decisions of the United Nations,Specialized 5. Malaria Eradication Postage Stamps [WHA16.18] Agencies and IAEA affecting WHO's Activities : 6.Annual Report of the United Nations Joint Staff Administrative, Budgetary and Financial Matters Pension Board for 1961 [WHA16.19] -Inter -organization Machinery for Matters of Pay and Allowances [WHA16.32] 2. Decisions of the United Nations, THIRD REPORT Specialized Agencies and IAEA affecting WHO's activities : [A16/15 -17 May 1963] Conference Arrangements [WHA16.33] The Committee on Administration, Finance and Legal Matters held its fifth and sixth meetings on 16 FIFTH REPORT 4 May 1963. The Committee decided to recommend tothe [A16/20 -22 May 1963] Sixteenth World Health Assembly the adoption of the following resolutions : The Committee on Administration, Finance and Legal Matters held its ninth meeting on 21 May 1963. 1. Status of Collection of Annual Contributions and The Committee decided to recommend tothe of Advancestothe WorkingCapital Fund Sixteenth World Health Assembly the adoption of the [WHA16.20] following resolution : 2.Appointment of Representatives to the WHO Meetings of the Regional Committee for Africa Staff Pension Committee [WHA16.21] [WHA16.43]
REPORTS OF THE COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS TO THE COMMITTEE ON PROGRAMME AND BUDGET
FIRST REPORT Assistance, recommends to the Committee on Pro- gramme and Budget that casual income in the amount [A16 /P &B/15 -14 May 1963] of US $500 000 be used to finance the 1964 budget as Availability of Casual Income it appears in Official Records No. 121. The Committee The Committee on Administration, Finance and on Administration, Finance and Legal Matters further Legal Matters, having studied the amount of casual recommends that, if the Committee on Programme and income available as at 30 April 1963 from assessments Budget accepts the recommendation of the Ad Hoc on new Members from previous years, miscellaneous Committee of the Executive Board to increase the income, the cash portion of the Assembly Suspense 1964 budget estimates by $349 100, these increased Account and the reimbursement from the Special costs be also financed by using an additional $349 100 Account of the Expanded Programme of Technical from the same source -i.e., a total of $849 100.
1 Approved by the Health Assembly at its eleventh plenary 3 Approved by the Health Assembly at its twelfth plenary meeting. meeting. a See minutes of the sixth meeting of the Committeeon 4 Approved by the Health Assembly at its thirteenth plenary Programme and Budget, sction 1. meeting. COMMITTEE REPORTS 411
Appropriation Purpose of Appropriation Amount SECOND REPORT 1 Section US $ 9.Other Statutory Staff Costs 618 683 [A16 /P &B/18 -17 May 1963] In accordance with its terms of reference under Total - Part 1112543865 resolution WHA15.1 of the Health Assembly, the PART IV : OTHER PURPOSES Committee on Administration, Finance and Legal 10.Headquarters Building Fund 500000 Matters reports to the Committee on Programme and 11. Transfer to the Malaria Eradication Special Budget that the following amounts should be inserted Account 5363000 in Parts I, IIl and IV of the Appropriation Resolution. 12. Reimbursement of the Working Capital Fund 200000
1. Total - Part IV 6063000 Appropriation Purpose of Appropriation Amount Section US $ PART I : ORGANIZATIONAL MEETINGS The Committee on Administration, Finance and 1.World Health Assembly 317210 Legal Matters further recommends to the Committee
2.Executive Board and its Committees . . 189090 on Programme and Budget the following text of the 3. Regional Committees 100530 Appropriation Resolution, with the figures accepted by the Committee on Administration, Finance and Legal Total - Part I 606830 Matters insertedasindicatedintheappropriate places : PART III: ADMINISTRATIVE SERVICES [Thetextwhich followed was approved bythe 8. Administrative Services 1925 182 Committee on Programme and Budget at its eleventh 1 See minutes of the eleventh meeting of the Committeeon meeting (see page 256) and subsequently adopted by the Programme and Budget. Health Assembly as resolution WHA16.28.]
INDEX
INDEX
ABBASY, M, A. (United Arab Republic), 12, 354 Assessments, 203, 204, 207, 209, 334, 341 ABDEL BARR, M. F. (United Arab Republic), 12 new Members, 94, 338 ABDIRAHMAN HAJr MOOMIN (Somalia), 10,I 1 1 scale for 1964, 94, 200, 208, 339, 341 -343 ABDULHADI, A. (Libya), 7, 243 see alsoContributions ABDUL RAHMAN BIN HAJI TALIB (Federation of Malaya), Assistant Directors- General, Offices of, 225 Vice -President of the Health Assembly,4, 18, 32 Associate Members, new, admission, 78 -81 ABRAR, A. F. (Somalia), 11, 332, 388, 401 Atomic tests,seeNuclear tests ADENIYI-JONES, O. (Nigeria), 9, 180, 193, 214, 229, 263, 383, 389 ATZENWILER, L. (Permanent Central Opium Board and Drug Administrative Committee on Co- ordination, 131, 271, 318, 327, Supervisory Body), 15 369, 372, 373, 374, 376, 377, 378 AUDÉOUD- NAVILLE, Anne (Medical Women's International Administrative services, 367 Association;alsoWorld Federation for Mental Health), Advisory Committee on Administrative and Budgetary Questions, 16, 17 203, 374, 377, 378 Auditor,seeExternal Auditor Advisory Committee on Medical Research, 39, 90, 294, 303 AUJALEU, E. J. (France), 4, 164, 206, 209, 363, 390 Afghanistan, 60 -62 AUJOULAT, L. P. (France;alsoInternational Union for Health African Region, approval of programme and budget estimates, Education), 5,16, 211, 259, 401 244 -247 Austria, 109 see alsoRegional Committee for Africa; Regional Office for Auxiliary personnel, training, 38, 81, 105, 205, 240, 241, 246, 265 Africa AvJLÉs, O. (Nicaragua), 8 AFRIDI, M. K. (Representative of the Executive Board), 14, 36, Azouz, R. (Tunisia), 12, 395, 404 172, 188, 195, 198 -200, 233, 240, 241, 254, 255, 257, 271, 313 BA, H. (Senegal), 10, 381, 389, 390, 397, 400, 404 Agenda, 19 -21 BABUDIERI, B. (Italy), 6, 252, 295, 302, 317 adoption, 35 Bacterial diseases, 229 allocation of items, 35, 163 BADI, A. (Libya), 7 Aging, problems of, 232 BAHRI, M. (Tunisia), 12 Aircraft and airport disinsection, 284, 286, 289, 292 BAIDYA, D. (Nepal), 8,127, 186, 250, 268 Air travel and spread of infection, 284, 285, 289, 290 BALENCIE, J. (France), 5 AKOUCH TAYEB, K. (Algeria), 1 BALY BALY, M. (Cuba), 3 ALAKIJA, O. B. (Nigeria), 9, 148, 196, 246, 290 BARCLAY, E. M. (Liberia), 7, 386, 390, 391 ALAN, T. (Turkey), 12, 201, 288, 329, 335, 338, 339, 342, 346, BAREDETSE, A. M. (Burundi), 2, 118 347, 363, 367, 379, 387, 392, 400, 401, 405 BAROYAN, O. V. (Assistant Director -General), 294 Albania, 86 BARRIENTOS PÉREZ, R. (Universal Postal Union), 15 ALCAMBAR PEREIRA, F. DE (Portugal), 10 BASSEGHI, H. (Iran), 6, 243 ALDEA, M. (Romania), 10, 174, 195, 218, 220, 234, 237, 239, BASSET, P. (International Committee of the Red Cross), 16 253, 288 BAUDRY, E. (France), 5 ALESIN, A. D. (Union of Soviet Socialist Republics), 12 BAUER, W. E. (Canada), 2, 373 -375, 376, 385, 396, 400, 401, 403 Algeria, 50 BAUME, L. J. (International Dental Federation), .16 assessment, 339 BECHELLI, L. M. (Chief, Leprosy), 229 Alliance for Progress, 93, 115 BEER, H. (League of Red Cross Societies), 16 ALMEIDA COELHO- LOPES, A. H. DE (Portugal), 10, 394, 401 BELCHIOR, M. (Brazil), 2 ALSAYED ALY, R. (Saudi Arabia), 10, 126 BERNARD, E. (International Union against Tuberculosis), 16 AMMAN, F. (International Association for the Prevention of BERNARD, P. M. (France), 5, 197 Blindness), 15 BERNHEIM, J. (International Society for Criminology), 16 AMMLNDSEN, Esther (Denmark), 4, 230, 236, 252, 294, 301 BESSLING, 1. (Luxembourg), 7 AMOR, M. (Morocco), 8 Bilharziasis, 73, 242 AMORIN, J. (Togo), 12, 217, 387, 397 Biology and pharmacology, approval of programme and budget ANASTASSIADES, J. (Greece), 5, 216 estimates, 125 ANDERSEN, O. (Denmark), 4, 322 see alsoDrugs, clinical and pharmacological evaluation and ANDRADE SILVA, M. R. DE (Portugal), 10, 247 safety control ANDRIAMALALA, J. (Madagascar), 7 BIóRCK, G. (Sweden), 11 ANDRIAMASY, A.(Madagascar),Rapporteur,Commitee on BISCHTI, A. (Libya), 7, 117 Credentials,7, 18, 27, 36, 93, 153, 384 BrTASCH, M. H. EL (United Arab Republic), 12, 96 -98, 151, 186, ANIEL -QUIROGA, J. M. (Spain), 11 208, 242, 267, 289, 320, 386 Annual Report of the Director -General for 1962, 37 -46, 48 -57, BIYOGHE, J. B. (Gabon), 5, 385 57 -77, 81 -93, 94 -135, 138 -145, 146 BJORNSSON, J. (Norway), 9 procedure for examination, 166, 168 BOCAR ALPHA, B. (Mauritania), 8 APONTE, H. (Venezuela), 13 BOÉRI, E. (Monaco), 8 APPEL, J. Z. (United States of America), 13, 300, 304 Bolivia, 334, 344 Appropriation Resolutions, for 1962, Schedule A, 94, 339 BOI.YA, P. (Congo, Leopoldville), 3, 65, 165, 219, 383 for 1963, amendments, 337 BONHOFF, R. W. (International Air Transport Association), 15 Schedule A, 94, 339 BONNER, R. J. M. (World Federation of United Nations Asso- for 1964, 152, 256, 366, 367, 368, 379 ciations), 17 ARAFEH, A. (Syria), 11, 52, 208 BORAI, A. K. EL- (Kuwait), 7, 53 -55, 173, 193, 201, 237, 243, ARBOLI DES VALLS, J. J. (Spain), 11 260, 273, 286, 304, 308, 316, 319, 321 ARNAUDOV, D. (Bulgaria), 2, 207, 288 BORTH, R. (International Federation of Gynecology and Obste- ARROYO AZNAR, L. (Spain), 11, 402 trics), 16 Arthropod -borne virus diseases, 228 BOUDERBA, A. (Algeria),1 ASSCHER, J. (Office of the High Commissioner for Refugees), 15 BOUVIER, C. L. (International Dental Federation), 16 Assembly Suspense Account, status, 336, 338 BOYE- JOHNSON, D. E. (Sierra Leone), 10, 234, 301 - 415 - 416 SIXTEENTH WORLD HEALTH ASSEMBLY, PART Il
BRABANT, M. I. (United Kingdom of Great Britain and Northern Committee on Administration, Finance and Legal Matters, Ireland), 13 agenda, 20 BRADY, T. J. (Ireland), 6,137, 207, 291, 304, 330, 334, 337, officers, 18, 32, 324 343, 349, 351, 364, 377 -379, 385 participation by representative of the Executive Board, 324 BRAKHOTT, D. (Israel), 6, 181, 235, 291 reports to Committee on Programme and Budget, 338, 343, BRAVO, A. L. (Chile), Rapporteur, Committee on Administration, 379, 410 -411 Finance and Legal Matters,3,18, 57 -59, 94, 148,149, reports to Health Assembly, 93, 148, 152, 155, 201, 343, 351, 153, 155, 203, 233, 236, 249, 275, 345, 347, 350, 355, 358, 366, 391, 403, 409 -410 365, 366, .379, 403 Committee on Credentials, appointment, 27 BROADLEY, Sir Herbert (United Nations Children's Fund), 14, officers, 18 212, 220 reports, 27 -31, 36, 93, 153 BRUNSKOG, U. (External Auditor), 333 text, 406 -407 reappointment, 346 Committee on International Quarantine, 114, 315 Budget, 25, 72, 95, 103, 139 eleventh report, 154, 282 -294, 314 for 1963, supplementary estimates, 94, 336 -338 Committee on Nominations, election, 31 for 1964, 37, 52, 147, 199 -210, 344, 368 officers, 18 adjustments, 199, 200, 201, 367 reports, 32 extra -budgetary funds, 203, 208 text, 407 -408 for 1965, 342 Committee on Programme and Budget, agenda, 19 form of presentation, 131 officers, 18, 32, 169 see also Appropriation Resolutions; Programme and budget reports, 147, 149, 152, 154, 210, 225, 257, 282, 314, 322, estimates 408 -409 Bulgaria, 96, 188 terms of reference, 169 Burundi, 118, 339 Communicable diseases, 24, 25, 38, 60, 73, 82, 84, 101, 104, assessment, 339 139, 176, 187, 246 BUSSAT, P. (International Society of Cardiology), 16 programme for 1964, 226 -229, 242, 244, 245, 248, 250 see also under Medical research; United Nations Children's CALDERWOOD, H. B. (United States of America), 13, 288 Fund CALSEYDE, P. J. J. VAN DE (Regional Director for Europe), 251, Community water supplies, 25, 82, 84, 89, 203, 205, 206, 207, 253 209, 238, 248, 255, 289, 292, 371 CAMBOURNAC, F. J. C. (Regional Director for Africa), 245, 247 Voluntary Fund for Health Promotion, 152 CAMEJO- ARGUDIN, E. (Cuba), 3 Conference of Ministers of Foreign Affairs of African States, Cameroon, 105, 177, 246 Addis Ababa (1963), 381 CANAPERIA, G. A. (Italy; also International Union against the Congo (Leopoldville), 65, 219 Venereal Diseases and the Treponematoses), 6,16, 172, assistance to, 245 204, 323 CONINCK, J. DE (Belgium), 2, 329, 336, 353, 357, 364, 404 CANDAU, M. G., see Director- General Consultative Committee on Administrative Questions, 375 CAÑOS, R. T. (Philippines), 9, 209 Contractual technical services, 238, 239 CARIGUEL, C. (France), 5 Contributions, 35, 117. 209 CARVALHO SAMPAIO, A. R. DE (Portugal), 10 currency, 37 CASTILLO, D. (Venezuela), 13, 137, 323, 335, 361, 404 status of collection, 149, 199, 203, 204, 208, 325, 330, 333 -336, Casual income, 200, 201 343, 351 -358 report on, 336, 338 see also Assessments CAYLA, J. S. E. (France), 5, 236, 237, 297, 328, 333, 334, 336, Co- ordination with the United Nations, specialized agencies, 338, 339, 341, 349, 351, 358, 379, 403 etc., 37, 82, 123, 327 Central African Republic, 125, 219, 311 on staff matters, 369, 372 Ceylon, 143, 312 CORRADETTI, A. (Italy), 6, 174, 228 CHADHA, M. S. (India), 5, 177, 194, 203, 224, 227, 229, 310, 315 COTTIER, F. (International Union of Local Authorities), 16 Chagas' disease, 132, 228 COWAN, Sir Kenneth (United Kingdom of Great Britain and CHANDAVIMOL, P. (Thailand), 12, 311 Northern Ireland), 13 CHANG, C. K. (China), 3, 128 CRAMAROSSA, S. (Italy), 6, 226, 227 CHARLES -ROQUES (International Committee of Catholic Nurses), CRAPON DE CAPRONA, N. (Food and Agriculture Organization), 15 15, 222 CHATTY, Dia E. (Syria), 11, 253, 270, 275, 332, 353, 354 CROATTO, L. (International Association of Logopedics and CHELLI, Z. (Tunisia), 12, 108 Phoniatrics), 15 CHENG, P. N. (China), 3, 28 CRUICKSHANK, R. (Council for International Organizations of CHIKARAISHI, K. (Japan), 7 Medical Sciences), 15 Chile; 58 Cuba, 119 -123, 186 China, 129 CUCALÓN ICAZA, R. E. (Panama), 9 representation, 27 -31, 85 Cyprus, 64, 171, 179 Cholera, 284, 285, 289, 291 Czechoslovakia, 72, 223 Cholera Research Institute (SEATO), Pakistan, 184 Cholera Research, Scientific Group, 286, 291 DAELEN, Maria (Federal Republic of Germany), 4, 222, 258, El Tor, 283, 286 278, 321 Chronic diseases, 24, 84, 232 Dahomey, 218 CHUNG, Soon Kun (Republic of Korea), 10 DALZELL -WARD, A. J. (Central Council for Health Education), 15 CLAMAGERAN, A. G. S. (International Council of Nurses), 16 DANNER, H. (Federal Republic of Germany), 4, 300, 302, 304 CLAVERO DEL CAMPO, G. (Spain), 11, 113, 175, 188, 195, 205, Darling Foundation Medal and Prize, 36, 77 216, 227, 234, 238, 252, 287, 323 DDT, 171 CLOUTIER, F. (World Federation for Mental Health), 17 DE LEONI, U. (Italy), 6 Codex Alimentarius, see Food Standards, Joint FAO /WHO DECAZES, E. (Order of Malta), 14 Programme DELAFRESNAYE, J. F. (International Union against Cancer), 16 Colombo Plan, 268 DELBARRE, F. (International League against Rheumatism), 16 COLY, D. (Senegal), 10, 124, 177, 208, 216 DELÉTRA, J. (World Federation of United Nations Associations), COMIssIONG, L. M. (Trinidad and Tobago), 12, 115, 249 17 INDEX 417
DELORMAS, P. (Ivory Coast), 7 Executive Board (continued) Dental health, 232, 244 elections to, 57, 135 -138, 164 DIALLO, L. (Senegal), 10, 247, 268 examination of programme and budget estimates, 37, 198, DIBA, A. T. (Iran), 6, 330 203, 205, 240, 241 DIBUE, G. G. (Cameroon), 2, 246, 275 geographical distribution of members, 135, 164 Dieldrin, 171 organizational studies, methods of planning and execution of DIN BIN AHMAD (Federation of Malaya), 4, 110 projects, 25, 272 -277 Director -General, 18, 19, 23, 37 -40, 47, 146, 168, 200, 254, 275, newly independent States, assistance to, 36, 257 -272 276, 277, 281, 315 reports on thirtieth and thirty -first sessions, 36, 40 -46, 48 -57, contract of, 47, 163 57 -77, 81 -93, 94 -135, 138 -145, 146, 156, 172, 188, 191, appointment of, 47, 163 195, 203, 204, 210, 212, 214, 221, 233, 240, 318, 366 see also Annual Report of the Director- General Standing Committee on Administration and Finance, 277, 366 Disarmament, 71, 76, 91, 104 Standing Committee on Headquarters Accommodation, 360, United Nations resolutions on, 25, 140 361, 362, 363, 364, 365 see also Nuclear tests Expanded Programme of Technical Assistance, 140, 198, 199, DJEGHRI, M. (Algeria), 1 202, 203, 242, 245, 251, 252, 262, 280, 281, 282, 344, 370, DOLGOR, Peljegin (Mongolia), 8 371, 377 Dow, S. (Mali), 8, 183, 197, 214, 246, 267, 311, 381 category II projects, 256 DOROLLE, P. M. (Deputy Director -General), 47, 76, 136, 148, Expert Advisory Panel on Health Education, 232 172, 212, 219, 224, 233, 302, 304, 316, 318, 319, 322 Expert Advisory Panel on Organization of Medical Care, 230 DOUBEK, B. (Czechoslovakia), 3, 223, 260, 272, 280, 285, 299 Expert Advisory Panel on Public Health Services, 231 Drugs,clinical and pharmacological evaluation and safety Expert Committee on Infectious Hepatitis, 228 control, 40, 44, 49, 83, 117, 123, 139, 154, 206, 225, 254, Expert Committee on Insecticides, 285, 292 294 -304, 315 -318 Expert Committee on Malaria, 74, 77, 171, 190, 191, 192, 194, cost of, 117, 128 195, 286, 292 Evaluation of the Safety and Efficacy of Drugs, Scientific Expert Committee on Public Health Administration, 190 Group on, 294, 296 Expert Committee on the Role of Nurse Midwifery in Mater- see also under Malaria nity Care, 232 DUCHEMIN, C. (President of the Conseil d'Etat of the Republic Expert Committee on Smallpox, 227, 228, 284, 287, 288, 289, and Canton 6f Geneva), 26 290, 291, 292, 305, 314, 315 DUCHOSAL, P. W. (International Society of Cardiology), 16 Expert Committee on the Social Aspects of the Teaching of DuHR, E. (Luxembourg), 7 Obstetrics, 232 DUMONT -WILLEMIN, A. (Guatemala), 5 Expert Committee on Undergraduate Medical Teaching of the DURING, A. -M. (Switzerland), 11 Natural Sciences, 240 Expert committees, 242 EASMON, C. O. (Ghana), 5, 123, 270 External Auditor, report, 94, 330, 333 Eastern Mediterranean Region, 242 appointment, 148, 346 see also Regional Office for the Eastern Mediterranean Eye diseases, 42 Economic and Social Council, 101, 212, 219, 370, 378, 379 see also Trachoma Ecuador, 132, 218 Editorial and Reference Services, programme for 1964, 241 FANCONI, G. (International Paediatric Association), 16 Education and training, 34, 37, 59, 68, 70, 85, 92, 110, 123, 209, FANG, I. C. (Regional Director for the Western Pacific), 243, 244 239 -241, 277 -282 FAO, see Food and Agriculture Organization African Region, 245, 246, 257, 259, 263, 264, 267 FARAH, A. R. (Tunisia), 12, 213, 220, 243 Development of Education inAfrica, ECA /UNESCO FELKAI, D. (Hungary), 5, 299 Conference of African States, Addis Ababa (1961), 272 Fellowships, 38,81, 110, 138, 261, 262, 263, 266, 267, 268, Development of Higher Education in Africa, UNESCO 270, 329 Conference Tananarive, (1962), 272 African Region, 118, 119, 245 Americas, 248 Americas, 248 Eastern Mediterranean Region, 242 Eastern Mediterranean Region, 242 organizational study, newly independent States, 36, 257 -272 European Region, 175, 251 see also Auxiliary personnel; Fellowships; Medical education; Western Pacific Region, 244 Medical schools; Midwife training; Nurse training; and FENDALL, N. R. E. (Kenya), 14, 79, 80, 246, 289 under Malaria; Medical research; Public health admin- FENZI, B. (Italy), 6 istration FERAA, M. (Morocco), Rapporteur, Committee on Nominations, ELDEMIRE, H. (Jamaica), 7, 84 8, 18, 32, 209, 219, 230, 331, 335, 347, 382, 389, 401, 404 El Tor, see Cholera FIGUEROA, G. (Venezuela), 13, 249, 290, 301, 308 ENGEL. A. (Sweden), Vice -Chairman, Committee on Credentials, Filariasis, 82, 183, 228 11, 18, 165, 208 FILIPINETTI, G. (San Marino), 14 ENNES, H. (International Union for Health Education), 16 Financial position of WHO, review, 324, 325 -332 Environmental health (sanitation), 39, 56, 82, 124, 134, 202, Financial Report for 1962, 94, 333 203, 205, 206, 215, 220, 233, 238, 253 FINDLAY, M. A. O. (Sierra Leone), 10, 158, 386 air and water pollution, 39, 82, 289, 292 FISCHER, R. (International Society of Blood Transfusion), 16 Americas, 248 FISEK, N. H. (Turkey), 12, 135, 182, 211, 216, 225, 229, 240, South -East Asia Region, 250 252, 269 see also Community water supplies FLACHE, S. (United Nations Relief and Works Agency for ESCOBAR -BALLESTAS, A. (Colombia), 3 Palestine Refugees in the Near East), 15, 320 ETCHATS, R. (United Nations Special Fund; also Technical FLEURY, C. (Switzerland), 11, 224 Assistance Board), 15 FOGARTY, J. E. (United States of America), 13 Ethiopia, 68 -70, 187 Food additives, 39, 83, 155, 222, 223, 224, 321 European Region, approval of programme for 1964, 251 -253 Food and Agriculture Organization (FAO), 44, 82, 115, 127, see also Regional Office for Europe 131, 205, 212, 216, 218, 221, 222, 232, 250, 276, 277, 371 EVANG, K. (Norway), 9, 31, 176, 193, 194, 197, 205, 209 Conference (1963), 321 Executive Board, ad hoc committee, 94, 199, 333, 336, 340, statements by representatives, 155, 222 359, 362, 366 see also Food Standards, Joint FAO/WHO Programme 418 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
Food hygiene, 155, 223, 224 Health protection and promotion, programme for 1964, 90' Food standards, Joint FAO /WHO Conference, 221 223, 232 -238, 248 Joint FAO /WHO Programme, 154, 221 -224, 320 -322 Health services, development, 56, 64, 74, 82, 103, 170, 172, 175, Codex AlimentariosCommission, date and place of first 181, 182, 188, 189, 190, 193, 201, 205, 209, 211, 245, 246, session, 322 247, 312 priority for health aspects, 222, 223, 321, 332 see alsoNational health planning; Rural health services regional basis of work, 222, 223, 224, 321, 322 Health statistics, 225, 232 statutes, method of financing, 221, 222, 223, 224, 321, 322 HEINRICxs, E. (Finland), 4 see alsoFood additives HENTSCH, Y. (League of Red Cross Societies), 16 FORGET, J. G. (Mauritius), 14, 79 Hepatitis, infectious, 73, 227 FURLONGER, R. W. (Australia), 1, 135, 335, 348, 367, 371 -373, epidemiological investigation, 228 375, 376, 393, 400, 401 HEYMANS, Jules -Marie (International Committee of Catholic Nurses), 15 Gamma -globulin, 171, 183, 192, 227, 228, 305, 306 Hia.a, Y. J. (Kuwait), 7, 361, 392, 404 GANGBO, Z. S. (Dahomey), 4, 164, 165, 194, 218, 383 HLA MYINT (Burma), 2 GARCÍA ORCOYEN, J. (Spain), I1, 209 HOFMAN, F. A. (Universal Postal Union), 15 GARCÍA PIÑEIRO, O. (Argentina), 1, 353 HOLM, J. (International Union against Tuberculosis), 16 GASHAKAMBA, M. (Rwanda), 10, 157 Holy See, statement by observer, 257 GATMAITAN, C. S. (Philippines), 9, 28, 73, 391, 401, 404 HON, Y. M. C. (Federation of Malaya), 4 GAUTHIER, L. (Canada), 3 Hookworm, 184 GAVRILOV, G. (Bulgaria), 2 HORWITZ, A. (Regional Director for the Americas), 37, 247 -249, GEISENDORF, W. (International Federation of Gynecology and 250 Obstetrics), 16 Hospitals, cost statistics, 231 General Committee, election, 33 planning manual, 229 report, 135, 408 teaching facilities, 230, 258, 272 Geneva, Canton and City of, 23 HoULLEz, M. J. P. (Belgium), 2 address by the representative of theConseil d'Etat,26 HOURIHANE, J. D. (Ireland), 6, 72 GERié, R. (Yugoslavia),Vice -President of the Health Assembly, Housing, 206 14, 18, 32, 148, 173, 194, 209, 214, 227, 261, 290, 310 Hungary, 107 Germany, Federal Republic, 49 GHALI, F. H. (Iraq), 6 I BRAHIM, A. S. (Somalia), 1 I, 236, 302 Ghana, 123, 173 IGNATOV, K. (Bulgaria), 2, 94 -96, 188 GHANI AFZAL, A. (Afghanistan), 1, 205, 218, 251 ILO,seeInternational Labour Organisation GLEISSNER, H. (Austria),1 Immunology, 253 GODBER, Sir George (United Kingdom of Great Britain and India, 81, 82, 177, 215, 224, 310 Northern Ireland), 12, 31, 79, 84, 159, 164, 165, 168, 206, Indonesia, 100, 175, 217, 227, 312 225, 227, 229, 232, 235, 236, 240, 241, 270, 314, 316, 317 Industrial health,seeSocial and occupational health Goitre, endemic, 238 Infant mortality, 202, 231 GOLESTANEH, S. (Iran), 6 Infected local areas, 284, 287, 288, 291 Gonorrhoea, 73, 95 Influenza, 72 GONZÁLEZ GONZÁLEZ, J. A. (Chile) -,3, 215 Insecticides, 54, 83, 171, 172, 181, 186 GONZALEZ Ruiz, B. (Panama), 9 resistance to,see underMalaria GoossENS, J. F. (Belgium), 1, 207, 235, 236, 290 Institute of Nutrition of Central America and Panama, 89, GORNICKI, B. (Poland), 9, 194, 208, 215, 230, 231, 237, 262, 281 184, 248 GOURTAY, J. (Chad), 3, 247 Inter- American Development Bank, 248 GRANT, A. H. S. (Ghana), 5 International Atomic Energy Agency, 203 Greece, 70, 185, 216 decisions affecting WHO, conference arrangements, 153 Grenada, 171 administrative, budgetary and financial matters, 153, 369- GRUNDY, F. (Assistant Director -General), 221, 230, 231, 232, 379 233, 236, 240, 271 programme matters, 154, 318 Guinea, 128, 185, 218, 313 International certificates of vaccination, 82, 284, 285, 286, 287, GUNARATNE, V. T. Herat (Ceylon), 3, 230, 251, 312 288, 289, 290, 291, 309, 310, 314 GUTTERIDGE, F. (Chief, Legal Office),Secretary, Committee on International Children's Centre, 213, 263 Credentials,18 International Civil Service Advisory Board, 327, 369, 372, 373, 374, 375, 376 HAAS, J. H. DE (Netherlands), 8, 231, 234, 236, 237, 254, 264 International Labour Organisation (ILO), 233, 358, 376 Haiti, 180 International OccupationalSafety and Health Information HAKIMI, A. R. (Afghanistan), 1, 60 -62 Centre, 233 HAN, Sang Tae (Republic of Korea), 10, 30 International Quarantine, 229 HANDL, L. (Czechoslovakia), 3 see alsoCommittee on International Quarantine; International HANTCHEF, Z. S. (League of Red Cross Societies), 16 Sanitary Regulations HAN TUN (Burma), 2, 250 International Sanitary Regulations, 82, 98, 195, 309, 315 HAPPI, J. C. (Cameroon), 2, 355, 387, 389, 401, 404 additional regulations, 154, 283 -294 HAQUE, M. S. (Pakistan), 9, 98, 183, 204, 211, 215, 220, 243, International Union against the Venereal Diseases and the 261, 289, 301, 310, 317, 323 Treponematoses, statement by representative, 226 HARDENBERG, H. C. VON (Federal Republic of Germany), 4 Inter -regional activities, 253 HARINGTON HAWES, D. G. (International Hospital Federation), Institute for Social Development, 370 16 loAN, S. (Romania), 10, 30, 74 -76 Iran, 70, 187 HAVLASEK, R. (Austria),1 Headquarters building, 337 Iraq, 56 Fund, 200, 367 ISOGT, N. (Mongolia), 8 progress report, 149, 326, 359 -366 Israel, 181, 214 repayment of loans, 199, 201, 338 Health education, 56, 82, 175, 231, 310 JACOBSEN, C. (Denmark), 4 training of staff, 232 JACOT, C. (International Union for Child Welfare), 16 INDEX 419
JALLOUL, H. H. (Lebanon), 7, 112, 186, 208, 243, 313 Leprosy, 82, 229, 250 Jamaica, 84, 339 Leptospirosis, 226 assessment, 339 LEUENBERGER, M. (World Veterinary Association), 17 JANUgKEVICUS, Z. I. (Union of Soviet Socialist Republics), 12 Libya, 117 JAYESURIA, L. W. (Federation of Malaya), 4, 244 LIDBOM, C. (Sweden), 11 JEANNERET, O. (Switzerland), 11 LISICYN, Ju. P. (Union of Soviet Socialist Republics), 12, 227, Joint FAO /WHO Expert Committee on Food Additives, 49 331, 338, 341, 356, 361, 362, 365, 366, 384, 399, 404 Joint FAO /WHO Conference on Food Standards, see Food LISTON, J. M. (United Kingdom of Great Britain and Northern Standards Ireland; also International Leprosy Federation), 13, 16 Joint FAO /WHO Programme on Food Standards, see Food LOFFLER, H. (Federal Republic of Germany), 4 Standards, Codex Alimentarios Commission LOFRUSCIO, D. F. (Paraguay), 9, 114, 218 JONASSEN, 6. (Norway), 9, 301 LÓPEZ SÁNCHEZ, A. (Mexico), 8 Jordan 110 Lorz, E. (Belgium), 2 JUNGALWALLA, N. (India), 6, 238, 239, 241, 251 LUKER, N. G. (United Nations), 14 LUNSINGH MEIJER, A. F. W. (Netherlands), 8, 402 KABA, J. (Niger), 9, 187 KACPRZAK, M. (Poland), 9 Madagascar, 60, 180, 192 KADAMA, I.S. (Uganda), 12, 51 MAGALHÁES DA SILVEIRA, M. (Brazil), 2, 217, 249, 396 KADEVA HAN (Cambodia), 2 MAGAROTTO, C. (World Federation of the Deaf), 16 KADI, H. M. EL- (United Arab Republic), 12 MAGEREGERE, I. (Burundi), 2 Kala -azar, 183 MAGHUR, M. (Libya), 7 KAMAL, M. E. EL- (Algeria), 1, 252, 323 MAHGOUB HAMZA (Sudan), 11, 243, 266, 287 KAPLAN, M. (Chief, Veterinary Public Health), 226 MAILLOV x, G. (Canada), 2 KAPLUN -LE MEITOUR, A. M. (International Union for Health MAJEKODUNMI, M. A. (Nigeria), President of the Health Assem- Education), 16 bly; Chairman, General Committee, 9, 18, 32, 33 -35, 47, 77, KATSACOS, T. (Greece), 5, 71, 185, 252 151, 153, 156, 161, 168 KATZKI, K. (International Conference of Social Work), 16 Malaria, 25, 37, 73, 95, 169 -198, 202, 210 -212 KAUL, P. M. (Assistant Director- General), Secretary, Committee blood transfusion, transmission by, 173, 174, 192 on Programme Budget, 18, 169 -172, 189 -192, 195, 210, 211, certification of eradication, 171, 179 227, 228, 229, 238, 239, 255, 256, 283, 291 -293, 304 -306, 313 chemoprophylaxis and chemotherapy (drugs), 170, 171, 173, KEITA, O. (Guinea), 5, 128, 185, 194, 196, 197, 207, 218, 247, 179, 180, 186, 187, 192 313, 382, 389, 393, 401 Conference on Malaria Eradication Kellog Foundation, 249 African, Yaoundé (1962), 177, 183 KELLY, A. D. (Canada), 2 European, Palermo (1960), 170 Kenya, 35, 78, 79, 80, 246, 339 Tangier (1962), 173 KERMIA, M. (Algeria), 1 detailed evaluation report, 179, 184, 191, 193, 195, 211 KHALIL, A. (Sudan), 11, 141, 332, 388 importation, 171, 173, 174, 175, 176, 177,186. 190, 192, KHATIB, A. (Morocco), 8 195, 211, 292 KIANG, H. C. (China), 3 operational assistance, 170, 173,175, 180,181,182,186, KINZOUNZA, R. D. (Congo, Brazzaville), 3 187, 190 KITTANI, I. T. (Iraq), Chairman, Committee on Administration, postage stamps, 149, 346, 350, 351 Finance and Legal Matters, 6, 18, 32, 165, 168, 324, 333, pre- eradication programmes, 170, 172, 173, 176, 177, 178, 335, 336, 341, 347, 350, 354, 355, 357, 370, 375, 376, 377, 184, 185, 187, 191 387, 389, 390, 400, 403 programme co- ordination with neighbouring countries, 172, KNITS, M. (Belgium), 1, 178, 253, 278 179, 181, 183, 185, 186, 187, 191, 211 KLEIN, D. (International Association for the Prevention of programme financing and costs, 173, 176, 178, 183, 191, 194, Blindness), 15 199, 200, 204, 207, 226 KLOPMANN, M. (World Union OSE), 17 Regions, Africa, 173, 194, 195, 246 KLosI, S. (Albania), 1, 27, 85, 253 Americas, 170, 171, 189, 211, 248 KocH, A. (Order of Malta), 14 Eastern Mediterranean, 170, 171, 172, 192, 195, 242 KoLL, W. (Federal Republic of Germany), 4 Europe, 169, 171, 172, 176, 195, 211, 214 Korea Republic of, 66 South -East Asia, 170, 171, 189, 211 KOSENKO, P. S. (Union of Soviet Socialist Republics), 12, 280 Western Pacific, 170, 171, 179, 192 KOUHEN, A. EL (Morocco), 8 report on development of eradication programme, adoption, KOUKA, H. (Niger), 9 149 KRAUS, H. (Yugoslavia), 14, 355, 387, 404 research, 171, 173, 174, 175, 178, 182, 183, 185, 192. 211, 228 KRIMLY, H. (Saudi Arabia), 10 resistance, drug, 171, 173, 176, 178, 179, 211 KRUISINGA, R. H. J. (Netherlands), 8, 223, 321, 329 insecticide, 171, 176, 178, 179, 186, 187, 211 KURASOV, S. V. (Union of Soviet Socialist Republics), 12, 23 -26, services, relationship with public health services, 56, 74, 170, 33, 151, 161 171, 172, 173, 174, 175, 176, 177, 178, 179, 183, 184, KORSTEINER, P. (Switzerland), 11 185, 186, 189, 190, 193, 211, 248 Kuwait, 54, 243 terminology, 176, 181, 183, 185, 188, 189 Kwashiorkor, 205 training, 170, 172, 173, 174, 177, 178, 181, 187 see also Darling Foundation Medal and Prize; Expert Com- LAIRD, M. R. (United States of America), 13 mittee on Malaria; and under United Nations Children's LAMBIN, P. (Upper Volta), 13,129, 197, 207, 218, 247, 384 Fund LANDRAIN, F. (Burundi), 2 Malaria Eradication Special Account, 149, 198, 204, 207, 210, LANGENHAGEN, G. DE (International Council of Nurses), 16 245, 344, 349, 366 LAWSON. C. O. (Nigeria), 9 operations planned to be financed from, 253 LAYTON, B. D. B. (Canada), Chairman, Committee on Credentials Malaya, 111 2, 18, 164, 208, 290, 334, 341, 353, 355, 405 Mali, 214, 267, 311 LE Cuy TRUONG (Republic of Viet -Nam), 10, 265, 300, 331 Management surveys, 326 Lebanon, 186, 313 MANI, C. (Regional Director for South East Asia), 37, 250, 251 Leishmaniasis, 228 Manual on Epidemiological Evaluation and Surveillance in Malaria LEMOINE, J. (International Labour Organisation), 15 Eradication, 170 420 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
MARADAS -NADO, P. (Central African Republic), 3, 125, 219, 311, MONTALVÁN, C., J. A. (Ecuador), 4, 131 -133, 179, 193, 197, 208, 388 218, 228, 235, 237, 238, 244, 302 MARAIS, I. J. (South Africa), 11 MORE, R. (International Union of Pure and Applied Chemistry), MARKOVIC, M. (Yugoslavia), 14, 102 -104 16 MARQUET, J. C. (Monaco), 8 Morocco, 219 MARTI, T. (Permanent Committee and International Association MORSHED, H. (Iran), 6, 187, 285 on Occupational Health), 17 MOSER, A. E. (International Society for Rehabilitation of the MARTINAZZO, J. -P. (Gabon). 5 Disabled; also International Union for Child Welfare), 16 MARTÍNEZ REYES, C. M. (Cuba), 3, 31, 119 -123, 399 MTAWALI, C. V. (Tanganyika), 11 MASSENHOVE, G. VAN (International Committee of Catholic MUDALIAR, A. L. (India), Chairman, Committee on Nominations, Nurses), 15 5, 18, 168, 330, 334, 356, 364, 391, 398 -404 MASWANYA, S. A. (Tanganyika), 11, 40 -43 MUNGER, J. (San Marino), 14 Maternal and child health, 231, 312 MUNTENDAM, P. (Netherlands), 8, 45, 252, 286, 302, 304, 306 statistics, 232 MURPHY, W. G. (United States of America), 13 see also Infant mortality; United Nations Children's Fund MURRAY, C. A. M. (South Africa), 11, 133, 215, 246, 279, 289, Mauritius, 78, 79, 339 312 MAYSTRE, J. (World Medical Association), 17 MURRAY, L. H. (United Kingdom of Great Britain and Northern MBONYIMANA, J. (Rwanda), 10 Ireland), 13, 286, 296, 304 MCKITTERICx, N. M. (United States of America), 13, 29, 330, 333, 345, 348, 358, 370, 392, 400 NABULSI, A. (Representative of the Executive Board), 14, 333, Measles, 202, 209 336, 340, 344, 346, 347, 359, 366, 379 see also Vaccination and vaccines NAGAPPA ALVA, K. (India), 5 Mecca pilgrimage, 127 National health planning, 38, 46, 82, 83, 85, 105, 108, 110, 134, Medical care, 229 191, 193, 212, 230, 244, 247, 271, 281, 327, 371 see also Expert Advisory Panel guide, 248 Medical education, 34, 44, 59, 83, 85, 86, 105, 106, 300 NAUCK, E. G. (Federal Republic of Germany), 4, 288 curricula, 239, 259, 260, 267, 268, 272 NAYAR, Sushila (India), Vice -President of the Health Assembly, financing, 269 5,18, 32, 81 -84, 158, 194, 196, 197, 211, 214, 232, 233, organizational study, newly independent States, 36, 257 -272 234, 236, 237, 266, 288, 299, 304, 316, 317 post -graduate, 81, 266 N'DIA KoFE', B. (Ivory Coast), 7, 247 regions, Americas, Conference on, 248 N'DIAYE, A. (Senegal), 10 Eastern Mediterranean, 242 N'DIAYE, B. (Senegal), 10 Conference on, Teheran (1962), 70 NEAGU, R. (Romania), 10 regional advisers, 261 NEKKACHE, M. S. (Algeria),1, 50 standards, 24, 239, 261 Nepal, 128, 186 teaching staff, 239, 240, 259, 260, 262, 263, 265, 269, 271, Netherlands, 45 272 New Zealand, 87 technical discussions on, 34, 44, 59, 81, 89, 150 -152 Newly independent States and developing countries, assistance undergraduate, 239, 258 to, 37, 44, 53, 72, 86, 90, 98, 213, 214, 217, 277 -282, 329 see also Medical schools Cairo Conference (1957), 102 Medical research, 39, 44, 88, 202, 205, 248 financing, 279 centre for disseminating results, 40, 139, 300 general budgetary implications, 199, 200, 201, 203, 205, 206, communicable diseases, 54, 89, 129, 207, 248 207, 208 financing, 139, 200 organizational study, 36. 257 -272 immunology, 253 NGANDU, E. (Congo, Leopoldville), 3 mental health, 208 NGUYEN VAN THINH (Republic of Viet -Nam), 10, 29, 357 michrochemical contamination of the environment,' 253 NIAZ, T. M. (Pakistan), 9 planning and co- ordination, 103, 139, 225 NIELSEN, F. (Denmark), 4 programme for, 39, 103, 292 Niger, 187 reproduction, human, 253 Nigeria, 34, 116, 311 training for, 225, 254 NOGUEIRA RIVERO, P. (Cuba), 3, 186 Voluntary Fund for Health Promotion, 152 NOVGORODCEV, G. A. (Union of Soviet Socialist Republics), 12, see also Advisory Committee on Medical Research; and under 262, 274, 276 Malaria; Public health administration Nuclear (atomic) tests, 55, 57, 96, 97, 104, 208 Medical schools, 240, 250, 259, 260, 261, 269, 270, 271, 272 Nurse training, 59, 218, 244, 263, 265 Medical supplies, see Supplies and equipment Nutrition; 44, 82, 202, 203, 205, 207, 237 Member States, new, 23 regions, Africa, 209, 245 admission, 35, 40, 78 -81, 325 Americas, 248 see also Assessments Eastern Mediterranean, 320 MENDONÇA E SILVA, A. DE (Brazil), 2 South -East Asia, 250 Meningitis, 129, 207, 209, 246 Western Pacific, 244 Mental health, 83, 232, 233 -237 see also under Medical research Occupational health, see Social and occupational health MERTENS, A. T. L. M. (Netherlands), 8 Office International d'Hygiène Publique, 114, 199, 367 MESSERLI, P. -A. (Council for International Organizations of OJALA, A. P. (Finland), 4 Medical Sciences), 15 OKwu, B. C. (Nigeria), 9, 116, 311 MÉTALL, R. A. (International Labour Organisation), 15 OLGUIN, V. V.(Argentina),Chairman,Committee onPro- Methods of work of WHO, 42, 56, 91, 95, 103, 152 gramme and Budget, 1, 18, 32, 92, 157, 169, 213, 224, 226, Midwife training, 231, 265 238, 249, 315, 322 MILLER, J. D. (United Kingdom of Great Britain and Northern OMURA, T. (Japan), 7, 205, 244, 285 Ireland), 13 Onchocerciasis, 207 MILLIS, L. (International Water Supply Association), 16 ONWU, S. E. (Nigeria), 9 MOHANNY, A. A. (Yemen), 13, 134 Operational assistance, 34, 91, 244, 250, 280, 281 MOLITOR, L. (Luxembourg), 7 see also under Malaria Mongolia, 99, 266 Organization of America States, 122 INDEX 421
Organizational meetings, estimates for 1964, 367 Public health administration, 244 Organophosporus insecticides. 171 approval of programme and budget estimates, 229 OWENS, A. C. Glyn (WorldFederationof Occupational exchange of experience, 95 Therapists), 17 research, 83, 254 training for, 85, 241, 247 Public Health Papers, 59, 229 PAILLARD, H. (International Confederation of Midwives), 16 Public health services, 85, 95 Pakistan, 98, 183, 261, 310 approval of programme and budget estimates, 229 -232 Palestine refugees, 319 see also Health services, development PALTHEY, G. (United Nations), 14, 26 Pan American Health Organization, 89, 122, 132, 172, 186, 228, Punta del Este Charter, 93, 132 248, 249, 255 Special Malaria Fund, 344 Quarantinable diseases Pan American Sanitary Bureau, 59, 93, 115, 121, 186 imported cases, 283, 285, 291 accommodation, 249 see also Cholera; Smallpox; Yellow Fever Pan American Sanitary Conference (1962), 309 QUENUM, A. (Dahomey), 4 PANEQUE, Coralia (Cuba), 3 QUIRÓS SALINAS, C. (Peru), 9, 130, 185, 193, 201, 215, 249 Paraguay, 115, 218 PARANHOS DA SILVA, M. (International Labour Organisation), 15 Radiation health, 83 Parasitic diseases, 228 RAE, S. F. (Canada), 2 PARK, Chung Kun (Republic of Korea), 10, 66, 244 RAFAEL, I. (Israel), 6, 43 -45 PAVLOV, M. (International Labour Organisation), 15 RAMSAY, C. W. (Australia), 1, 244 Peace, role of the physician in the preservation and promotion RASCHIED, A. AL- (Kuwait), 7 of, 23 RAVOAHANGY -ANDRIANAVALONA, J. (Madagascar), 7, 59, 180 PEAT, A. A. (Jamaica), 7, 249 Red Cross, Centenary, 40, 56 Reference centres and laboratories, 380 PECKU, J. E. T. (Nigeria), 9 . PE KYIN (Burma), 2 vaccine testing, 285, 286, 288, 289, 292 Pension Committee, see Staff Pension Committee REFSHAUGE, W. D. (Australia), 1, 388 Pension Fund, see United Nations Joint Staff Pension Fund REGAMEY, R. H. (International Association of Microbiological PERERA, B. F. (Ceylon), 3, 143 -145, 206, 336, 355, 400 Societies), 15 PERRET, J. -P. (Switzerland), 11 Region of the Americas, programme for, 89, 247 -250 PESONEN, N. (Finland), 4, 207, 229, 232, 235, 236, 237, 239, Regional Committee for Africa, 155, 194 240, 241, 258, 302, 313, 360, 365, 366 composition, 245 PETERSON, Vera J. (Medical Women's International Association), meetings of, 155, 379 -391, 391 -403 16 Regional directors, procedure for appointment, 37 PETRILLI, F. (Italy), 6 reappointment, 37 PFEFFERMANN, M. (Council of Europe), 15 Regional Office for Africa, 181, 245, 392 Philippines, 74 accommodation, 94, 279, 340, 367, 380 PHILLIPS, C. W. (Australia), 1, 234, 236, 290, 302 Regional Office for the Americas, see Pan American Sanitary PIANCA, F. (Switzerland), 11 Bureau PINHEIRO CHAGAS, P. (Brazil), 2, 47 Regional Office for the Eastern Mediterranean, 186 PINTO DE BALSEMAO, F. J. P. (Portugal), 10 Regional Office for Europe, 250, 253 PINTUS, L. (Italy), 6 Regional Office for the Western Pacific, 244, 277 Planning, see National health planning; Programme planning REGOS, J. (Hungary), 5 PLATEN, C. H. VON (Sweden), 11 RENJIFO, S. (Colombia), 3 PLOJHAR, J. (Czechoslovakia), 3, 30, 71 Reproduction, human, 253 Poland, 91, 216 Research, see Medical research Poliomyelitis, 87, 114 RETTA, A. (Ethiopia), 41, 67 -70 Pollution, air and water, see under Environmental Health REYNOLD, F. DE (International Committee of the Red Cross), 16 Population problems, 82, 84, 92, 101, 182, 183 Rheumatism, 232 Portugal, 142 RIAHY, E. (Iran), 6, 70 overseas provinces, 141 Rickettsial diseases, 54 statement by delegate, 145 expert meeting on, 228 POZARSKIJ, V. S. (Union of Soviet Socialist Republics), 12 RIEDERER, Viola DE (International Committee of Catholic President of the Sixteenth World Health Assembly, 18 Nurses), 15 election, 32 RIEDMATTEN, H. M. DE (Holy See), 14, 257 presidential address, 33 -35 RIKLI, A. E. (United States of America), 13 Preventive medicine, 34, 85, 89, 124, 177, 320 Rios- VARGAS, A. (Mexico), 8, 241, 249 PREZA, B. (Albania), 1, 387 ROBECCHI, A. (International League against Rheumatism), 16 Programme and budget estimates, 60, 130 ROBERTSON, J. N. (Ghana), 5, 172, 194 for 1964, review and approval, 198 -210, 225 -256, 340, 366 -369 Rockefeller Foundation, 42, 184, 186 for 1965, 311, 340 ROFFEY, H. N. (United Kingdom of Great Britain and Northern form of presentation, 198, 201, 203, 204, 205, 206, 208, 209, 210 Ireland), 13, 341, 349, 356, 364, 387, 393, 399, 402, 404 procedure for examination, 172 ROGE, L. M. (International Committee of Catholic Nurses), 15 submission, 200 ROGGO, J. (Holy See), 14 Programme co- ordination, 241, 372, 373 R6KEN, W. (Federal Republic of Germany), 4 Programme evaluation, 90, 103, 203, 204, 206, 209, 242 ROLLIER, A. -M. (World Federation of Occupational Therapists), Programme, general, covering a specific period, 169 17 Programme planning, 24, 38, 85, 89, 95, 201, 202, 206, 207, Romania, 74 -76, 174 216 ROWHANI, M. (Iran), 6, 400, 404 organizational study, 36, 272 -277, 140 ROWINSKI, K. (Poland), 9 Programme priorities, 25, 52, 60, 64, 84, 86, 89, 91, 134, 202, Rural health services, 41, 101, 190, 240, 245 204, 205, 206, 207, 208, 209, 285, 328, 370, 371 Rwanda, 157, 339 Protein deficiency, 202 assessment, 339 422 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
SAIGNAVONGS, C. S. (Laos), 7 SPASOVA, I. (Bulgaria), 2 SAITO, Y. (Japan), 7 Special Account for Accelerated Assistance to Newly Indepen- Salaries, common system, 53, 372, 373 dent and Emerging States, 278, 282 general service staff, 199, 367, 372, 375 Special Account for Community Water Supply Programme, 251, see also International Civil Service Advisory Board 255, 256 SANGARÉ, A. (Mali), 8 Special Account for Medical Research, 139, 253 SANGSINGKEO, P. (Thailand), 12, 91, 208, 217, 230, 239, 251 Specialized agencies, 203, 373, 378 SANTERO, N. (Italy), 6 decisions affecting WHO, 318 SARRAUTTE, J. -P. (Commission for Technical Co- operation in seealso Co- ordination with United Nations,specialized Africa), 15 agencies, etc. Saudi Arabia, 126 St. Lucia, 171 SAUGRAIN, J. A. L. (Central African Republic), 3 Staff, composition, 83 SAUTER, A. (Switzerland), 11, 234, 299 recruitment, 43, 140, 146, 274, 374 SAYEGH, Y. (Syria), 11 training, 326, 329, 332 SCHALEJ, J. (Netherlands), 8 see also Budget for 1964, adjustments SCHANDORF, J. Adjei (Ghana), 5, 383, 390, 400 Staff Pension Committee, appointment of representatives, 149, SCHAR, M. (Switzerland), 11 358 Schedule of conferences, 349, 369, 370, 378 Staff Rules, amendments, 148, 347 SCHINDL, K. (Austria),1,109, 222, 320 Staphylococcal and streptococcal infections, 239 SCHMITZ, T. (Federal Republic of Germany), 4 STARKOV, R. M. (Union of Soviet Socialist Republics), 12 ScHNYDER, F. (High Commissioner for Refugees), 15 STRALAU, J. (Federal Republic of Germany), 4, 208, 256 SCHOU, C. (Intergovernmental Committee for European Migra- STRi:5M, A. (Norway), 9 tion), 15 SUBANDRIO Hurustiati (Indonesia), 6, 100 -102, 175, 194, 211 SCHWARZHAUPT, Elisabeth (Federal Republic of Germany), 4, 216, 227, 250, 276, 281, 312, 315, 316 48 -50 SUMNER, D. L. (Sierra Leone), 10, 62 SCOTT, C. P. (United Kingdom of Great Britain and Northern SUNARIO, R. (Indonesia), 6 Ireland), 13 Supplies and equipment, procurement by WHO, 326 SCROCCA, P. (Italy), 7 Sweden, 225 SEBSIBE, H. (Ethiopia), 4, 388 SYMAN, S. (Israel), 6, 213, 241, 265, 298 Senegal, 124 expression of condolences on death, 153, 315 SENTICI, M. (Morocco), Rapporteur, Committee on Programme tribute to, 156 and Budget, 8, 18, 147, 149, 152, 154, 169, 192, 210, 220, Syphilis, 73, 95 225, 252, 257, 282, 294, 314, 318, 322 SZABLEWSKI, K. (Poland), 9 Seventeenth World Health Assembly, place, see World Health SZABO, Z. (Hungary), 5, 253, 269 Assembly SGINDAR, P. (Romania), 10 SHAMI, K. A. (Jordan), 7, 110, 195, 209, 218, 319 TABA, A. H. (Regional Director for the Eastern Mediterranean), SHANKER NIGAM, K. (League of Red Cross Societies), 16 242, 243 SHER, A. C. (International Council of Nurses), 16 TAKIZAWA. N. (Japan), 7, 357, 363, 391, 402 SHOUSHA, A. T. (League of Arab States), 15, 150 -152 TALEB, C. (Algeria), 1, 145, 388 SIEGEL, M. P. (Assistant Director -General), Secretary, Com- TALJAARD, C. H. (South Africa), 11, 155, 380, 382, 390, 395, 403 mittee on Administration, Finance and Legal Matters, 18, Tanganyika, 40 -43 201, 209, 324, 325 -328, 332, 333, 335, 336, 337, 338, 339, TAVOR, E. (Israel), 6, 399 341, 342, 344, 346, 347, 348, 350, 358, 359, 362, 365, 366, TCHIKOUNZI, B. (Congo, Brazzaville), 3, 197, 247 367, 368, 369, 375, 376 TCHOUNGUI, S. P. (Cameroon), Vice -Chairman, Committee on Sierra Leone, 62 Programme and Budget, 2, 18, 104 -106, 169, 177, 301 SIGURDJÓNSSON, J. (Iceland), 5, 394, 400 Technical Assistance Committee, allocation of funds, 1963, 131 SIGURDSSON, S. (Iceland), 5, 237, 302 Technical Assistance Board, 327 SILVA TRAVASSOS, A. DA (Portugal), 9, 307 Technical Assistance Programme, see Expanded Programme of SIMONOVITS, I. (Hungary), 5, 107 Technical Assistance Smallpox, 25, 42, 82, 89, 114, 177, 185, 202 Technical discussions, Sixteenth World Health Assembly, 34, importation, 283, 284, 285, 286, 292, 306 44, 59, 81, 89 regions, Africa, 209, 246 report by General Chairman, 150 -152 Eastern Mediterranean, 242 TEELOCK, B. (Mauritius), 14, 79, 284 Europe, 252, 253 Television, influence on youth, 152, 233 -237 review of eradication programme, 154, 202, 304 -314 TERRY, L. L. (United States of America), 13, 88 -90, 249, 253 see also Expert Committee on Smallpox; Vaccination and TESORO, G. A. (United States of America), 13 vaccines Thailand, 91, 217, 311 SMITH, S. (International Association of Logopedics and Pho- Thalidomide, 40, 44, 49, 123, 139, 295, 302, 316, 317 niatrics), 15 THEISS, E. (International Union of Pure and Applied Chemistry), 16 SOARES MARTINEZ, P. M. (Portugal), 9, 141, 145 THIEME, J. C. (Western Samoa), 13, 160, 341, 342 Sod, S. (Yugoslavia), 14 THIOUNN -THOEUN (Cambodia), 2, 31 Social and occupational (industrial) health, 232 THUNAIN, A. M. (Kuwait), 7 Social medicine, 240 TITUS, J. -B. (Liberia), 7 SODDY, K. (World Federation for Mental Health), 17 TOFFOLI, F. (Italy), 7 SOHIER, R. (France), 5, 285, 316 TOLEDO, R. (Order of Malta), 14 Somalia, 112 TORRES- BRACAMONTE, F. (Bolivia), 2, 51, 217, 230, 247 SouM, H. (Monaco), 8 ToTTIa, M. (Sweden; also International Union against the South Africa, 134, 215, 380 Venereal Diseases and the Treponematoses), 11, 16, 225, composition of delegation, 384 226, 237, 284, 302, 304, 315, 316, 317 South -East Asia Region, 250 TOURÉ, M. (Mauritania), 8, 217, 247, 386, 402 South Pacific Commission, 277 TOWNSHEND, F. H. (Food and Agriculture Organization), 15, 155 South Pacific Health Board, 277 Trachoma, 53, 227, 242 SOUVANNAVONG, O. (Laos), 7 TRAN DINH DE (Republic of Viet -Nam), 10,106, 230, 231, Spain, 114, 216 239, 244 INDEX 423
TRANNOY, N. (France), 5 Vaccination and vaccines, BCG, 229, 250, 310, 314 Treponematosis, 185 cholera, 285, 290 Trinidad and Tobago, 115, 339 leptospirosis, 226 assessment, 339 measles, 88, 227, 228 Trypanosomiasis (sleeping sickness), 228 poliomyelitis, 144 see also Chagas' disease smallpox, 207, 227, 228, 286, 288, 289, 290, 292, 305, 306, 307, Tuberculosis, 82, 177, 185 308, 309, 310, 311, 313, 314, 320 Western Pacific Region, 244 trachoma, 227, 228 Tunisia, 108 see also International certificates of vaccination; Reference TURBOTT, H. B. (New Zealand), 8, 87, 226, 229, 235, 236, 238, centres and laboratories 277 VANDERICK, F. X. (Rwanda), 10 TURGUMAN, A. H. (Libya), 7 VANNI D'ARCHIRAFI, F. P. (Italy), 6 Turkey, 182 VANNUGLI, R. (Italy), 6, 329, 349, 350, 353, 364 TUVAN, G. (Mongolia), 8, 99, 266 VARLET, H. (Ivory Coast), 7 Typhus, 114, 227 VASSILOPOULOS, V. P. (Cyprus), 3, 63 -65, 179, 243, 266 see also Rickettsial diseases VEHLINGER, E. A. (International Council of Societies of Patho- logy), 16 UEHLINGER, E. A. (International Council of Societies of Patho- VEJJAJIVA, S. (Thailand), 12 logy), 16 VELASCO -SUÁREZ, M. (Mexico). 8 Uganda, 51, 339 VENEDIKTOV, D. D. (Union of Soviet Socialist Republics), 12 assessment, 339 Venezuela, 290, 301, 308 UNICEF, see United Nations Children's Fund Veterinary public health, 226 Union of Soviet Socialist Republics, 140, 262 VETTER, W. F. (International Union of Architects), 16 United Arab Republic, 97, 267 Vice -Presidents of the Sixteenth World Health Assembly, 18 United Nations, 345, 348, 357, 358, 373, 375, 376, 377, 378, 381 election, 32 Contributions, Committee on, 339 Viet -Nam, 106 decisionsaffecting WHO, administrative,budgetary and VILLEGAS Y URZÁIZ, M. DE (Spain), I1 financial matters, 153, 339, 341, 369 -379 Virus diseases, 227 programme matters, 154, 212, 318 VLAHOVI6, V. (Yugoslavia), 14 declaration on independence of colonial countries, 23, 384 Voluntary Fund for Health Promotion, 129, 152, 228, 253 Housing, Building and Planning, Commission on, 370 VONCKEN, J. (International Committee of Military Medicine and OPEX programme, 280, 281 Pharmacy), 15 representative, address by, 26 VOSSHENRICH, H. (Federal Republic of Germany), 4 Resolution 1761 (XVII) on apartheid and racial discrimination, VovoR (Togo), 12, 182 384, 385, 387, 392, 393, 394, 395, 396, 397, 398, 399, 402, 403 VYSOHLID, J. (Czechoslovakia), Vice - Chairman, Committee on scale of assessment, 339 Administration, Finance and Legal Matters,3,18, 206, see also Co- ordination with the United Nations, specialized 339, 341,386. agencies, etc. United Nations Children's Fund, 41, 53, 59, 61, 62, 65, 66, WACHOB, J. (United States of America), 13 91, 97, 99, 110, 111, 115, 117, 118, 126, 130, 132, 140, WAHBI, S. AL- (Iraq), 6, 55 -57, 160, 269, 317, 320, 330, 335, 198, 202, 239, 246, 281, 309 341, 349, 354, 364, 365, 389, 398 joint activities, 149, 212 -221, 273, 276, 277 WAKIL, E. (Lebanon), 7 communicable diseases, 62, 64, 69, 71, 74, 126, 212, 213, 214, WATT, J. (United States of America). 13, 216 215, 220, 221, 311, 313 WATTERSON, G. G. (Food and Agriculture Organization), 15 education and training, 41, 59, 68, 213, 214, 215, 217, 218, 220 WATTEVILLE, H. DE (International Federation of Gynecology malaria, 101, 112, 172, 175, 187, 212, 213, 214, 216, 221, 345 and Obstetrics), 16 maternal and child health, 118, 212, 214, 216, 217, 220, 263, 312 WEBB, R. C. (Australia),1, 324, 352, 357, 366 nutrition, 82, 109, 213, 214, 217, 218, 220, 250 Weekly Epidemiological Record, 171 operational assistance, 215 WEI, H. (China), 3 United Nations Conference on the Application of Science and Western Pacific Region, 366 Technology for the Benefit of the Less Developed Areas, approval of programme for, 243 38, 109, 354 WHALEY, S. H. (United States of America), 13, 365 United Nations Conference on Trade and Development, 102, WHO representatives, 253, 327, 332 347, 348, 349, 370 WIDY- WIRSKY, F. (Poland), 9,90, 252, 297, 340 United Nations Development Decade, 24, 37, 44, 49, 53, 56, WIKNJOSASTRO, H. (Indonesia), 6 82, 88, 93, 98, 102, 109, 154, 182, 191, 205, 212, 215, 292, WILBAR, C. L. (United States of America), 13, 315 318, 327, 354, 370, 371 WILLIAMS, C. L. (United States of America), 13, 184, 194, 202, United Nations Economic Commission for Asia and the Far 236, 256, 279, 309 East, 250 WOLDESEMAIT, A. (Ethiopia), 4, 187 United Nations Educational, Scientific and Cultural Organiza- WooD, A. V. A. (Ghana), 5 tion, 139, 212, 218, 232, 259, 262, 268, 269, 271, 280, 318, 371 WOODLEY, R. (United International Bureaux for the Protection United Nations Joint Staff Pension Board, annual report for of Industrial Property, Literary and Artistic Works), 15 1961, 149, 350 Working Capital Fund, 340 United Nations Relief and Works Agency for Palestine Refugees status of advances, 149, 199, 333 -336, 343, 351 -358 in the Near East, 110 World Bank, 371 extension of agreement, 154, 319 World Federation for Mental Health, 92 United Nations Salary Review Committee, 374, 375 World Health Assembly, Seventeenth, place, 148, 347 -349, 378, United Nations Special Fund, 131, 140, 199, 250, 255, 262, 379 272, 280, 281, 282, 370, 371, 377 World Health Day, 44, 46, 108 United States Agency for International Development, 67, 68, 69, 115, 132, 172, 175, 186, 187, 268, 312 YANSENNE, J. (Burundi), 2 United States of America, 88, 205 Yaws, 177, 180, 185, 246 Universal Declaration of Human Rights, 399 Yellow fever, 82, 289, 292 Upper Volta, 129 Yemen, 134 Urbanization, 215, 217, 220, 233 YESHURUN- BERMAN Tova (Israel), 6 424 SIXTEENTH WORLD HEALTH ASSEMBLY, PART II
YOUNG, M. D., 36, 77 2nANOV V. M. (continued) Yugoslavia, 103, 173, 214 235, 236, 238, 252, 256, 284, 298, 304, 307, 315, 317, 318, 321, 323 ZEUTHEN, J. H. (Denmark), 4, 354, 400 ZDANOV, V. M. (Union of Soviet Socialist Republics), 12, 28, ZIROUT, A. (Algeria), 1 138 -141, 152, 159, 178, 193, 195, 197, 203, 213, 233, 234, ZoHRAB, B. D. (New Zealand), 8, 206, 348, 364, 399